In the northern hemisphere, children born in October are most likely to be vaccinated for the flu in October – and are least likely to be diagnosed with influenza, according to results of the first large-scale study of optimal timing for the flu shot.
The study, by researchers from the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School, amplifies public health guidance that encourages getting flu vaccinations in October for those in the northern hemisphere. The findings appear in the BMJ.
“There are a lot of variables when it comes to the timing and severity of flu season or a person’s risk of getting sick, and many of those are out of our control,” said Anupam Jena, the Joseph P. Newhouse Professor of Health Care Policy at HMS, physician at Massachusetts General Hospital, and senior author of the study. Christopher Worsham, HMS assistant professor of medicine and critical care physician at Mass General, led the study.
“One thing we have some control over is the timing of the shot,” Jena said, “and it looks like October is indeed the best month for kids to get vaccinated against the flu.”
In January the U.S. Centers for Disease Control and Prevention reported at least 150,000 hospitalizations and 9,400 deaths due to flu as of the time of the report and noted that high demand for hospital care for influenza has contributed to strained hospital capacity in some parts of the country. Over the past decade in the U.S., between one and 199 children have died of influenza each flu season. Across the years, most children who die are not fully vaccinated against the flu.
Part of the reason the timing of the shot is tricky is the way the immune system responds to a vaccine. If a person gets the shot too early, their immunity may fade by the time flu season peaks. If they wait too long, their body may not have time to build immunity strong enough to protect against the peak level of infections.
How soon is too soon, and how late is too late?
While public health recommendations in the U.S. have long promoted September and October flu shots, there has never been a randomised clinical trial to test the best timing, nor a large-scale effort to see how likely people who get vaccinated in other months are to get sick, Jena said.
When Jena was at a late summer meeting in 2022, he mentioned that his arm was sore from getting his flu shot. A colleague asked whether he was concerned about his immunity waning before flu season.
“It hadn’t occurred to me to check if one month or the other might make a big difference,” Jena said. “When we looked at the science, we were surprised that no one had ever looked at the question in a big population.”
Organising a clinical trial would require a lot of time and resources to coordinate the random distribution of flu jabs across hundreds or thousands of people.
But Jena, Worsham, and study co-author Charles Bray, HMS research assistant in health care policy, had a good idea where they could find an already randomized study population.
The surprising link between birth dates and childhood flu vaccination
In prior research reported in the New England Journal of Medicine in 2020, Jena and Worsham documented the way birth month determines how likely it is that children get the flu shot at all.
Young children in the U.S. tend to get their yearly checkup around their birthday, and it’s also when they get most of their vaccines. Children with spring and summer birthdays often don’t get the flu shot because it’s not available when they go for their annual visit, and many parents don’t make an extra trip for it.
The NEJM research was meant to highlight the importance of promoting the flu vaccine in the fall for children with birthday months that make it less likely that they will get the vaccine. Jena and Worsham realized they could also leverage this quirk of health care to study a ready-made distribution of children who get checkups – and flu shots – across all the months when the vaccine is commonly available.
Randomised by birthday
Studying children who got a flu shot in their birth month minimised certain factors related to the risk of infection that would have made it harder to measure the true impact of the timing of the shot.
For instance, families who proactively sought out shots in a non-birthday month might have done so because the child had a higher risk of catching the flu or because family members were more cautious and more likely to take actions that would protect them from the flu, such as handwashing and disinfecting.
For the BMJ study, Jena, Worsham, and Bray analysed the anonymised commercial health insurance records of more than 800 000 children in the U.S. from 2 to 5 years old who received influenza vaccines from 2011 to 2018.
The analysis showed that children born in October had the lowest rate of influenza diagnosis. For example, 2.7% of children born and vaccinated in October were diagnosed with the flu that season, compared to 3% of those born and vaccinated in August or January, 2.9% of those born and vaccinated in September or December, and 2.8% of those born and vaccinated in November.
The findings suggest that U.S. public health interventions focused on vaccination of young children in October may yield the best protection in typical flu seasons, the authors said.
“This study can help people pinpoint the best time to get flu vaccines for their children – especially the ones who weren’t born in October,” Worsham said.
“We’ve had several rough winters in a row for respiratory viruses, between COVID-19, RSV, and the flu,” Worsham said. “We need all the help we can get to keep people safe from these diseases.”
Finance Minister Enoch Godongwana tables his 2024 Budget during a joint seating of the National Assembly in the Cape Town City Hall. (Photo: National Treasury)
By Wanga Zembe, Donela Besada, Funeka Bango, Tanya Doherty, Catherine Egbe, Charles Parry, Darshini Govindasamy, Renee Street, Caradee Wright and Tamara Kredo
The 2024 national budget offers some glimmers but allocations for direct health benefits fall short of making a difference to people’s health and wellbeing. These include a ring-fenced allocation to crack down on corruption in health to inspire trust for theNational Health Insurance, taxing accessories for e-cigarettes, a jacked up child-support grant, clarity on plans dealing with climate change and its impacts on human health, and finally greater investment to enhance women’s capabilities alongside the Covid-19 grant, researchers from the South African Medical Research Council write exclusively for Spotlight.
The 2024 national budget presented last week by Finance Minister Enoch Godongwana contained several key elements that have an impact on systems, services and wellbeing from a health perspective.
Importantly, not only direct health spend, but budget allocated to social protection and climate infrastructure has implications for health outcomes such as nutrition, growth and food security. Health taxes, to address illness caused by alcohol, cigarettes and e-cigarettes amongst others, are also key revenue streams with taxation intended to deter use.
As researchers at the South African Medical Research Council we are dedicated to improving the health of people in South Africa through research and innovation. We wish to share some insights into positive areas in the budget and to point out areas where there are gaps with potentially dire consequences for the health of our nation.
In real terms, the health budget is shrinking.
Health has been allocated a total of R848-billion over the medium-term expenditure framework. This includes R11.6-billion to address the 2023 wage agreement, R27.3-billion for infrastructure and R1.4-billion for the National Health Insurance (NHI) grant. Compared to the medium-term budget policy statement in October last year, government is now adding R57.6-billion to pay salaries of teachers, nurses and doctors, among other critical services.
In real terms, the health budget is shrinking. The allocation to cover last year’s higher-than-anticipated wage settlement is a positive step to try to fill posts for essential health workers. But this allocation falls short of fully funding the centrally agreed wage deal, meaning that provincial health departments will be unable to fill all essential posts.
Treasury’s Chief Director for Health and Social Development, Mark Blecher, was quoted as saying that the “extra money would not be sufficient to hire all the recently qualified doctors who have been unable to secure jobs with the state, and provincial Health Departments will need to determine which posts should be prioritised”. He added: “There will be less downsizing, and more posts will be filled, but it is unlikely they all will be.”
South Africa has a ratio of only 7.9 physicians per 100 000 people in the public health system, while it has been estimated that there are more than 800 unemployed newly qualified doctors. Considering the health-workforce shortfalls, the amount of money allocated appears optimistic for service coverage for the increasing population.
The World Health Organization (WHO) considers building a health workforce a highly cost-effective strategy. Salaries continue to consume the largest share of provincial health budgets, estimated at 64% since 2018. The Human Resources for Health strategy lacks clarity on the implementation of workforce-planning approaches with significant implications for how provinces prioritise workforce cadres to keep up with the increasing needs – particularly in light of NHI.
Nutrition support on the decline
The Minister described protecting the budgets of critical programmes such as school-nutrition programmes, which includes almost 20 000 schools. He noted that the early childhood development (ECD) grant will be allocated R1.6-billion rising to R2-billion over the medium term.
Ensuring nutrition support to children under-five for optimal physical and cognitive growth is vital. The 2023 National Food and Nutrition Security Survey by the Human Sciences Research Council found that 29% of children under five in South Africa are stunted (short for their age). The proportion of children experiencing both acute and chronic under-nutrition has increased over the past decade. Stunted children are more likely to earn less and have a higher risk of obesity and non-communicable diseases such as diabetes and heart disease as adults.
Currently, only registered or conditionally registered Early Learning Programmes (ELPs) serving poor children (determined by income-means testing) are eligible to receive the ECD subsidy. This is not aligned with inflation and the real value of the R17 per child per day subsidy and the contribution to nutrition costs have decreased over time. The subsidy is not enough to cover the costs of running quality programmes, let alone the costs of providing nutritious meals. The World Bank suggests a minimum of R31 per child per day.
There is also concern about the children missed who attend informal or unregistered programmes. According to the 2021 Early Childhood Development Census, only 41% of ELPs are registered and only 33%, registered or not, receive the subsidy. Unregistered ELPs are more likely to be based in vulnerable communities and attended by children from vulnerable households. Further, although about 1.7 million children are enrolled in ELPs, enrolment rates vary across provinces from 40% in Gauteng to 26% in the Eastern Cape. This means many young children are not enrolled, and, of those enrolled, most do not benefit from the subsidy.
Child grants increase not keeping up with inflation
Child grants appear in the budget every year, but the increases do not keep up with inflation, and particularly not with the basket of goods needed for a growing child. In real terms grant amounts are decreasing – visible in the way hunger is increasing throughout the country, particularly in the Eastern Cape where uptake of social grants is very high.
The Social Relief of Distress Grant and women’s economic empowerment
As part of pandemic recovery efforts, we commend government for the roll-out of the Social Relief of Distress (SRD) grant and its plans to extend this beyond March 2025. While SRD continues to suffer implementation challenges related to the amount and roll-out; it presents an opportunity for renewed attention to a comprehensive and inclusive approach to women’s economic empowerment.
The recent Stats SA labour survey reported a higher unemployment rate among women (35.7%) versus men (30.7%). Our research also finds that women caregivers of children and adolescents living with HIV are particularly vulnerable to poor health and economic outcomes. Greater investment in programmes that enhance women’s opportunities alongside the SRD could promote the sustainability of pandemic-recovery efforts.
The NHI, health-system reforms and dealing with corruption in health
The Minister indicated that the allocation for NHI – government’s policy for implementing universal health coverage – demonstrates commitment to this policy. He also noted that there are a range of system-strengthening activities, that are key enablers of an improved public healthcare system, including strengthening the health-information system; upgrading facilities; enhancing management at district and facility level; and developing reference pricing and provider payment mechanisms for hospitals. He recognised that these require further development before NHI can be rolled out at scale.
The NHI allocation must show a tangible commitment to health-system reforms. Funding needs to be allocated for the creation of organisational infrastructure that ensures transparent, trustworthy decisions will be made about the benefits package and programmes to be funded. Specifically, funding for conducting Health Technology Assessments with credible processes that manage interests and ensure coverage decisions are informed by independent appraisal of the best-available evidence, measures of affordability, and with public input. Some areas of government already undertake such work, for example the National Essential Medicine Committee, but how these processes will expand beyond medicine to include decisions about health-systems arrangements and public-health interventions remain unclear, and apparently unfunded.
Undoubtedly, facilities need to be upgraded. It’s positive to see this as a named activity. It is however unclear how the upgrade of health facilities and quality of care will be ensured, given that tertiary infrastructure grants have been reduced due to underspending of conditional grants. Currently, health facilities’ quality is assessed by the Office of Health Standards Compliance whose role is to inspect and certify facilities. This is a prerequisite for accreditation under NHI. This means the watchdog agency will need adequate budget. Implementation research is also required to test out the different NHI public-private contracting models. Furthermore, a ring-fenced allocation to deal with corruption in health, would be welcomed and inspire trust for NHI.
‘Sin’ taxes vs ’health taxes’
The Minister proposed excise duties and above-inflation increases of between 6.7 and 7.2% for 2024/25 for alcohol products and indicated that tobacco-excise duties will be increased by 4.7% for cigarettes and cigarette tobacco and by 8.2% for pipe tobacco and cigars. And, based on inputs from citizens, the Minister also tabled an increase in excise duties on electronic nicotine and non-nicotine delivery systems (vapes).
While there may be a concern that increasing taxes on products consumed by the poor is regressive, there are ways to direct revenue gained back to those sub-populations and it’s not fair to deny them the benefits of consuming less alcohol products.
It is notable that excise taxes on wine have been increased to a greater percentage than spirits, but the health effects of alcohol come from the ethanol not the type of liquor product so it would make more sense to make the excise tax rate per litre of absolute alcohol equal across all products. The budget has not moved this forward in any meaningful way.
The proposed tax on tobacco products is not in line with WHO recommendations and is below inflation. This should be at least 70% of the retail price to have a positive impact on public health by reducing tobacco use, especially in a country with one of the highest tobacco-use rates in the region. In South Africa, the tax is currently between 50 – 60%. Although the tax on electronic cigarettes has increased, it is still below inflation. We hope that this increase will deter more young people from starting to use e-cigarettes and encourage current users to quit. We also hope that this increase is not just once-off and that future increases are made with the goal of reducing e-cigarette use.
Overall, the taxes on tobacco products and electronic nicotine and non-nicotine delivery systems are below inflation. This means that manufacturers can absorb the increases, and consumers may not be deterred from using them. This is a missed opportunity, as there is a clear link between these products and the development of non-communicable diseases, like hypertension, and the worsening of communicable diseases, like tuberculosis.
The impact of climate change on lives and livelihoods
Climate and health are closely related, with more attention being paid by the global research community to potential impacts of climate change and natural disasters on lives and livelihoods. The Minister noted a multi-layered risk-based approach to manage some of the fiscal risks associated with climate change. These include a Climate Change Response Fund; disaster-response grants; support and funding from multilateral development banks and international funders to support climate adaptation, mitigation, energy transition and sustainability initiatives; and, municipal-level adaptation and mitigation initiatives.
There are numerous health co-benefits to these strategies. For example, investing in renewable energy sources can improve air quality, leading to reduced respiratory illness. There is a need to highlight these co-benefits and to foster intersectoral collaboration.
Overall, from the perspective of health researchers, we note the mention of NHI plans, social protection, nutrition, health workforce, health taxes and climate. However, we all agree that the allocations for direct health benefits and to address social determinants of health, such as education and poverty-alleviation, fall short of what is recommended, from global and national research evidence, to make a difference to people’s health and wellbeing.
People living in ancient Eastern Arabia appear to have developed resistance to malaria following the appearance of agriculture in the region around five thousand years ago, a new study published its in Cell Genomics reveals.
DNA analysis of the remains of four individuals from Tylos-period Bahrain (300 BCE to 600 CE) – the first ancient genomes from Eastern Arabia – revealed the malaria-protective G6PD Mediterranean mutation in three samples.
The discovery of the G6PD Mediterranean mutation in ancient Bahrainis suggests that many people in the region’s ancient populations may have enjoyed protection from malaria.
In the present day, among the populations examined, the G6PD mutation is detected at its peak frequency in the Emirates, the study indicates.
Researchers discovered that the ancestry of Tylos-period inhabitants of Bahrain comprises sources related to ancient groups from Anatolia, the Levant and Caucasus/Iran.
The four Bahrain individuals were genetically more like present-day populations from the Levant and Iraq than to Arabians.
Experts from Liverpool John Moores University, the University of Birmingham Dubai, and the University of Cambridge worked with the Bahrain Authority for Culture and Antiquities and other Arabian institutes such as the Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, as well as research centres in Europe.
Lead researcher Rui Martiniano, from Liverpool John Moores University, commented: “According to our estimates, the G6PD Mediterranean mutation rose in frequency around five-to-six thousand years ago — coinciding with the onset of agriculture in the region, which would have created ideal conditions for the proliferation of malaria.”
Due to poor ancient DNA preservation in hot and humid climates, no ancient DNA from Arabia has been sequenced until now — preventing the direct examination of the genetic ancestry of its past populations.
Marc Haber, from the University of Birmingham Dubai, commented: “By obtaining the first ancient genomes from Eastern Arabia, we provide unprecedented insights into human history and disease progression in this region. This knowledge goes beyond historical understanding, providing predictive capabilities for disease susceptibility, spread, and treatment, thus promoting better health outcomes.”
“The rich population history of Bahrain, and more generally of Arabia, has been severely understudied from a genetic perspective. We provide the first genetic snapshot of past Arabian populations – obtaining important insights about malaria adaptation, which was historically endemic in the region,” commented Fatima Aloraifi, from the Mersey and West Lancashire NHS Trust.
Salman Almahari, Director of Antiquities and Museums at the Bahrain Authority for Culture and Antiquities, states, “Our study also paves the way for future research that will shed light on human population movements in Arabia and other regions with harsh climates where it is difficult to find well-preserved sources of DNA.”
Data gathered from the analysis of the four individuals’ remains allowed researchers to characterise the genetic composition of the region’s pre-Islamic inhabitants – insights that could only have been obtained by directly examining ancient DNA sequences.
Researchers collected ancient human remains from archaeological collections stored at the Bahrain National Museum, gathering DNA from 25 of them. Only four samples were sequenced to higher coverage due to poor preservation.
The finding of malaria adaptation agrees with archaeological and textual evidence that suggested malaria was historically endemic in Eastern Arabia, whilst the DNA ancestry of Tylos-period inhabitants of Bahrain corroborates archaeological evidence of interactions between Bahrain and neighbouring regions.
A report from the world’s leading scientific and medical experts on hormone-related health conditions raises new concerns about the profound threats to human health from endocrine disrupting chemicals (EDCs) that are ubiquitous in our surroundings and everyday lives.
The report, “Endocrine Disrupting Chemicals: Threats to Human Health” provides a comprehensive update on the state of the science around EDCs, with increasing evidence that this large group of toxic substances may be implicated in rising global health concerns.
The report from the Endocrine Society, co-produced with the International Pollutants Elimination Network (IPEN), includes detailed analyses on exposure to EDCs from four sources: plastics, pesticides, consumer products (including children’s products), and per-and polyfluoroalkyl substances (PFAS), a class of thousands of chemicals known or suspected to be EDCs.
The Endocrine Society-IPEN report is being released during the U.N. Environment Assembly (UNEA-6) meeting in Nairobi.
At UNEA key agenda items include welcoming the newly adopted Global Framework on Chemicals, advancing global action on highly hazardous pesticides, and threats to the circular economy from plastics and toxic chemicals.
The groups’ report anticipates an update from UNEP and the WHO expected later this year on their 2012 Report on State of the Science of Endocrine Disrupting Chemicals.
“A well-established body of scientific research indicates that endocrine-disrupting chemicals that are part of our daily lives are making us more susceptible to reproductive disorders, cancer, diabetes, obesity, heart disease, and other serious health conditions,” said the report’s lead author, Andrea C. Gore, PhD, of the University of Texas at Austin, and a member of the Endocrine Society’s Board of Directors.
“These chemicals pose particularly serious risks to pregnant women and children. Now is the time for the UN Environment Assembly and other global policymakers to take action to address this threat to public health.”
By interfering with hormones and their actions, EDC exposure can impact many health-related functions, with consequences for increased risks of many serious conditions.
Evidence suggests that EDCs in the environment contribute to disorders such as diabetes, neurological disorders, reproductive disorders, inflammation, and compromised immune functioning.
Two of the four analyses in the report look at EDCs used in plastics and as pesticides.
Global production of plastics and pesticides is increasing even as scientists warn that chemical and plastic pollution is an escalating crisis. Glyphosate is the world’s most widely used herbicide, and a recent study found that glyphosate has eight of ten key characteristics of an EDC. Other studies have found links between glyphosate and adverse reproductive health outcomes.
Plastics are made with thousands of known toxic substances, some of which are known or suspected EDCs. The report examines bisphenols and phthalates, two toxic chemical groups found in many plastics. Exposures to EDCs from plastics occur at all phases of plastics production, use, disposal, and even from recycled plastics.
The Endocrine Society-IPEN report notes that, while evidence of health threats from EDCs is mounting, current regulations have not kept pace.
“EDCs are different than other toxic chemicals, but most regulations fail to address these differences,” said IPEN Science Advisor Sara Brosché, PhD. “For example, we know that even very low doses of endocrine disrupting chemicals can cause health problems and there may be no safe dose for exposure to EDCs. However, regulations typically do not protect against low-dose effects. We need a global approach to controlling EDCs based on the latest science with a goal of protecting the human right to a healthy environment.”
At the UNEA-6 meeting, IPEN is also releasing a new report on “The Global Threat from Highly Hazardous Pesticides,” highlighting ongoing health and environmental risks from HHPs, especially in low- and middle-income countries.
DDT, glyphosate, and chorpyrifos, three HHPs reviewed in the Endocrine Society report, are also highlighted in the new IPEN report as they continue to pose health threats especially in the Global South.
In addition to plastics and pesticides, the report looks at EDC exposures from arsenic and lead, and from widely used per- and polyfluoroalkyl substances (PFAS), humanmade “forever chemicals” used as oil and water repellents and coatings. Lead remains in use in paint in many countries, as documented in recent IPEN reports. Endocrine-related conditions from lead exposure may include delayed onset of puberty and early menopause. Arsenic is a common metal that has long been linked to cancer and other health conditions, and more recent evidence shows that arsenic can disrupt multiple endocrine systems. PFAS are used in hundreds of products including clothing and food packaging, but recent studies show that some PFAS can disrupt hormones such as oestrogen and testosterone and impair thyroid hormone functions.
Cedars-Sinai investigators have discovered why some injured kidneys heal while others develop scarring that can lead to kidney failure. Their findings, detailed in a paper published in the peer-reviewed journal Science, could lead to the development of noninvasive tests to detect kidney scarring and, eventually, new therapies to reverse the condition.
“The key to this discovery was our ability to directly compare injured kidney cells that successfully regenerated with those that did not,” said Sanjeev Kumar, MD, PhD, a nephrologist-scientist in the Board of Governors Regenerative Medicine Institute and the Department of Medicine at Cedars-Sinai and senior author of the study.
“Injured cells activate a protein called SOX9 to regenerate themselves. When they have healed, the cells silence this protein. Cells that aren’t able to regenerate leave SOX9 active, and this leads to a type of scarring called fibrosis. But when we deactivate SOX9 in a timely fashion, the scarring literally goes away.”
The kidneys can be injured by diabetes and high blood pressure, serious infections such as COVID-19, and overuse of antibiotics and non-steroidal anti-inflammatory pain medications, said Kumar, who is also part of the Department of Biomedical Sciences at Cedars-Sinai.
The SOX9 protein plays a major role in organ development but is not active in healthy adult kidneys.
In previous work at another institution, Kumar and team found that when kidneys are injured, the surviving cells reactivate SOX9 as part of the healing process.
In this study, Kumar and fellow investigators studied kidney damage in laboratory mice.
They labeled individual cells at the point of injury, then followed how the cells’ progeny evolved over time.
“At Day 10, some cells’ descendants were fully healed while others were not,” Kumar said.
“The cell lineage that healed had switched off SOX9 expression, while the unhealed lineage, in a continuing attempt to fully regenerate, maintained SOX9 activity. It’s like a sensor that switches on when cells want to regenerate, and off when they are restored, and we are the first to identify this.”
Further, investigators discovered that cells that were unable to regenerate began recruiting proteins called Wnts, another key player in organ development. Over time, this accumulation of Wnts triggered scarring. And they found that deactivating SOX9 a week after injury promoted kidney recovery.
Investigators observed the same process in patient databases from collaborating institutions in Switzerland and Belgium.
“We could see that by Day 7, human patients with transplanted kidneys that were slow to begin working also activated SOX9,” Kumar said.
“And in our collaborators’ database, we were able to distinguish that patients who had sustained SOX9 activation had lower kidney function and more scarring than those who did not. Human kidneys with cells that maintained SOX9 were also enriched with Wnts and showed increased fibrosis.”
These discoveries provide targets for drug development, as well as for noninvasive biomarker discovery permitting diagnosis of kidney fibrosis through the urine, Kumar said.
Currently, the only available test for kidney fibrosis is a biopsy, which carries many risks.
“Elucidating the mechanisms of scarless healing versus fibrosis has eluded investigators for decades and has implications beyond the kidney, including for certain cancers,” said Paul Noble, MD, chair of the Department of Medicine and director of the Women’s Guild Lung Institute at Cedars-Sinai and a co-author of the study.
Type 2 diabetes alters the behaviour of discs in the vertebral column, making them stiffer, and also causes the discs to change shape earlier than normal. As a result, the disc’s ability to withstand pressure is compromised. This is one of the findings of a new rodent-based study published in PNAS Nexus.
Low back pain is a major cause of disability, often associated with intervertebral disc degeneration. People with type 2 diabetes face a higher risk of low back pain and disc-related issues. Yet the precise mechanisms of disc degeneration remain unclear.
Investigating the biomechanical properties of the intervertebral disc is crucial for understanding the disease and developing effective strategies for managing low back pain.
“These findings provide novel insight into the potential mechanisms underlying diabetes-related disc tissue damage and may inform the development of preventative and therapeutic strategies for this debilitating condition,” the research team wrote. The team consisted of engineers and physicians from the University of California San Diego, UC Davis, UCSF and the University of Utah.
The study emphasises that nanoscale deformation mechanisms of collagen fibrils accommodate compressive loading of the intervertebral disc.
In the context of type 2 diabetes, these mechanisms are compromised, resulting in collagen embrittlement.
These findings provide novel insight into the potential mechanisms underlying diabetes-related disc tissue damage and may inform the development of preventative and therapeutic strategies for this debilitating condition.
Researchers employed synchrotron small-angle x-ray scattering (SAXS), an experimental technique that looks at collagen fibril deformation and orientation at the nanoscale.
They wanted to explore how alterations in collagen behaviour contribute to changes in the disc’s ability to withstand compression.
They compared discs from healthy rats to those from rats with type 2 diabetes (UC Davis rat model). The healthy rats showed that collagen fibrils rotate and stretch when discs are compressed, allowing the disc to dissipate energy effectively.
“In diabetic rats, the way vertebral discs dissipate energy under compression is significantly impaired: diabetes reduces the rotation and stretching of collagen fibrils, indicating a compromised ability to handle pressure,” the researchers write.
Further analysis showed that the discs from diabetic rats exhibited a stiffening of collagen fibrils, with a higher concentration of non-enzymatic cross-links.
This increase in collagen cross-linking, induced by hyperglycaemia, limited plastic deformations via fibrillar sliding.
These findings highlight that fibril reorientation, straightening, stretching, and sliding are crucial mechanisms facilitating whole-disc compression.
Type 2 diabetes disrupts these efficient deformation mechanisms, leading to altered whole-disc biomechanics and a more brittle (low-energy) behaviour.
Scores of unemployed doctors, nurses and other health workers marched to the Union Buildings in Pretoria on Monday, calling for the Presidency to intervene in the ongoing financial problems facing the health sector.
One of their main demands is for the health budget to be increased to absorb about 800 medical professionals.
Joining the march, Mandla Matshabe, said he never imagined being unemployed when he completed his community service at Sefako Makgatho University in December last year after studying in Cuba.
“Now I’m sitting at home with a medical qualification when there is a dire need. It’s appalling to think there are medical professionals at home,” he said.
Matshabe, who lives in Hazyview in Mpumalanga, said many unemployed health workers were becoming depressed at home. He said hiring qualified doctors could help alleviate some of the burnout among doctors in the public sector.
“Doctors in communities are overburdened because we don’t have enough medical professionals, including physiotherapists and dieticians or everyone in the hospital,” he said.
University of Cape Town graduate Lerato Jaca said it was discouraging to be an unemployed doctor. “I come from KwaNzimakwe in Port Shepstone where there were literally no doctors when I was growing up.”
Jaca was raised by an unemployed single mother who relied on the money she made during Jaca’s three-year community service employment at Ermelo Hospital.
She said they now rely on her brother’s disability grant and his children’s child support grants to buy food.
Deputy President of the South African Medical Association, Dr Nkateko Minisi, said: “Other health professionals in the allied sectors, including pharmacy, are here with us to hand over a memorandum to build up the health system. But to do so, we feel that human capital must be optimised by hiring all these unemployed professionals. Not tomorrow, not next week but now!” she said.
Mnisi said more than 80% of the population depends on public health services. “Healthcare is not a privilege that should be enjoyed by some; it is a basic human right that every single person deserves.”
Communications Manager at The Presidency, Phil Mahlangu accepted the group’s memorandum.
He said that the presidency was “immensely worried as the presidency about the negative issues affecting the medical industry”. He promised the protestors a response within a week.
A discovery by researchers in Switzerland reveals that the sleeping body also reacts to the external world during sleep, explaining how some information from the sensory environment can affect sleep quality.
A collaboration between University of Liège and University of Fribourg has investigated whether the body is truly disconnected from the external world during sleep.
To do so, they focused on how heartbeat changes when we hear different words during sleep.
They found that relaxing words slowed down cardiac activity as a reflection of deeper sleep and in comparison to neutral words that did not have such a slowing effect.
This discovery, published in the Journal of Sleep Research, sheds new light on brain-heart interactions during sleep.
Matthieu Koroma (postdoctoral researcher), Christina Schmidt and Athena Demertzi (rsesearch) from the GIGA Cyclotron Research Center at ULiège teamed up with colleagues from University of Fribourg led a previous study analysing brain data (electroencephalogram) showing that relaxing words increased deep sleep duration and sleep quality, showing that we can positively influence sleep using meaningful words.
By that time, the authors hypothesised that the brain also remains able to interpret sensory information in a way that makes our body more relaxed after hearing relaxing words during sleep.
In this new study, the authors had the opportunity to analyse cardiac activity to test this hypothesis and found that the heart slows down its activity only after the presentation of relaxing, but not control words.
Markers of both cardiac and brain activity were then compared to disentangle how much they contributed to the modulation of sleep by auditory information.
Cardiac activity has been indeed proposed to directly contribute to the way we perceive the world, but such evidence was so far obtained in wakefulness.
With these results, the ULiège researchers showed that it was also true in sleep, offering a new perspective on the essential role of bodily reactions beyond brain data for our understanding of sleep.
“Most of sleep research focuses on the brain and rarely investigates bodily activity,” says Dr Schmidt.
“We nevertheless hypothesise that the brain and the body are connected even when we cannot fully communicate, including sleep. Both brain and body information need then to be taken into account for a full understanding of how we think and react to our environment,” explains Dr Demertzi.
“We shared freely our methodology following the principles of Open Science hoping that the tools that helped to make this discovery will inspire other researchers to study the role played by the heart in other sleep functions,” Dr Koroma advocates.
This work offers a more comprehensive approach about the modulation of sleep functions by sensory information. By looking into the cardiac responses to sounds, we may, for example, study in the future the role of the body in the way sounds influence emotional processing of memories during sleep.
Can technological advances enable a new era of patient-centric healthcare that goes beyond the boundaries of healthcare providers and extends to patients’ homes?
This dynamic is already unfolding in the global healthcare sector, says Nazia Pillay, Partner Head at SAP Africa – and Africa isn’t far behind.
“The emergence of patient-centric healthcare holds immense promise for better patient experiences, greater accessibility, and improved healthcare outcomes,” says Pillay. “Supported by rapid advances in a range of complementary technologies and driven by a growing need to expand healthcare access, the adoption of patient-centric healthcare models represents the next step in the evolution of healthcare provision.”
Flipping the healthcare model
Until now, healthcare service models have required that patients navigate through often-complex systems to receive diagnoses, treatment and medical advice. Patient-centric healthcare reimagines this dynamic, building systems around the needs and preferences of the patient and prioritising the quality of their experience.
A 2021 report by KPMG found that 79% of healthcare CEOs believed the sector needed to take a more patient-centric approach in order to better respond to patient needs and preferences. However, only 31% rated their organisation’s ability to do so as ‘excellent’.
“A patient-centric healthcare approach prioritises elements such as patient experience and multi-dimensional team engagement, leading to a more holistic patient engagement, explains Johann Joubert, CEO at Converge Solutions. “This approach also makes healthcare more accessible and affordable as the patient can receive expert services in the comfort of their homes. Home-based patient-centric healthcare also benefits the whole ecosystem as the hospital bed becomes available to patients who require more intensive care, while the overall cost of healthcare delivery can be driven downward.”
He adds that, to achieve this, healthcare providers must consider what might be viewed as non-conventional investments in technology to drive innovation across patient-centric operations. “The healthcare system, for valid reasons, is slow to innovate, but we cannot stagnate. The future of healthcare must be different, if we want better patient outcomes and more affordable and accessible healthcare services.”
Healthcare access reaches patients’ homes
Global healthcare providers are increasingly shifting to home-based care models that provide primary, acute and palliative care at the patient’s home. “Home-based care represents a golden opportunity to improve the quality of care while also lowering healthcare costs,” says Joubert. “The world is not as it was twelve months ago. Rapid advances in a range of enabling technologies such as AI, connectivity and device mobility have already set new thresholds of digital possibilities. What was science fiction two years ago, will be mainstream in the next twenty-four months.”
Joubert adds that, in his view, connected intelligence and microservices is the way of the future. “To try and do everything yourself would put you at a disadvantage. Instead, we hand-pick our partners and then combine the expertise of each partner to ensure rapid, relevant, affordable healthcare solutions with tangible value.”
Pillay adds: “Healthcare providers are increasingly adopting powerful new technologies ranging from advanced analytics to cloud capabilities, as well as a range of tools to improve planning, human capital management, financial processes and CRM-based technologies to enable the delivery of personalised healthcare. Over the next few years, the focus is likely to shift slightly to include emerging technologies that enable home-based care and diagnosis, such as AI and machine vision.”
Technology building blocks for improved healthcare
A McKinsey study noted the growing impact of several technologies on healthcare systems and services, including Generative AI to boost productivity and content development
However, to achieve this, healthcare providers will need to lay the technological foundation that will enable the integration of new healthcare innovations.
“The digital transformation of the healthcare industry at a global level is being enabled across a range of patient-centric technologies, spanning from improved healthcare data and analytics to smart healthcare operations and greater empowerment of healthcare workers,” says Pillay. “The outcomes of this transformation can be felt across patient engagement, patient diagnosis and the broader patient experience, as well as providers’ ability to convert health data into health insights to drive improved patient outcomes. And considering the acute skills shortage throughout the continent’s health sector, the use of technology to drive better employee experiences and improve talent retention is immensely valuable.”
Growing evidence for patient-centric model
According to Joubert, the evidence for a more patient-centric healthcare model is clear. “We survey more than fifty thousand patients every month and their feedback confirms that patients want more curated information, more medical worker engagement and rapid responses to questions. It is not only about the patient though. Healthcare is a collective effort and as much as our focus is on patient outcomes, this means we need to take the nursing community on the journey with us. Informed and knowledgeable collaboration is critical.”
Joubert points to the rapid recent advances in AI as an opportunity for the healthcare sector, with Generative AI becoming ‘mainstream’ just more than a year ago. “At the moment there are multiple schools of thought. Some argue that we are entering a ‘trough of disillusionment’, where we will realise AI is not the answer to every problem. Others argue that we are only now at very advent of the exponential AI explosion that will erupt over the next twelve to twenty-four months. I believe both views hold merit. AI is certainly not the answer to every problem. As in the case of IoT over the last couple of years, we will get smarter in how we apply the technology and, most importantly, how we do so in an ethical manner.”
He adds that the healthcare sector must embrace digital capabilities or risk becoming irrelevant in the next five years. “The healthcare industry, by virtue of erring on the side of caution and being highly regulated, typically steers away from disruption or transformation. But unless the healthcare providers embrace digital capabilities and explore the best applications of technology to improve healthcare outcomes, they won’t survive the years ahead.”
An existing biologic drug, omalizumab, can make life safer for children with food allergies by preventing dangerous allergic responses to small quantities of allergy-triggering foods, according to a new study led by scientists at the Stanford School of Medicine.
The findings, published in the New England Journal of Medicine, suggest that regular use of omalizumab could protect people from severe allergic responses, such as difficulty breathing, if they accidentally eat a small amount of a food they are allergic to.
“I’m excited that we have a promising new treatment for multifood allergic patients. This new approach showed really great responses for many of the foods that trigger their allergies,” said the study’s senior author, Sharon Chinthrajah, MD, associate professor of medicine and of pediatrics, and the acting director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford Medicine.
“Patients impacted by food allergies face a daily threat of life-threatening reactions due to accidental exposures,” said the study’s lead author, Robert Wood, MD, professor of pediatrics at Johns Hopkins University School of Medicine. “The study showed that omalizumab can be a layer of protection against small, accidental exposures.”
Omalizumab, which the Food and Drug Administration originally approved to treat diseases such as allergic asthma and chronic hives, binds to and inactivates the antibodies that cause many kinds of allergic disease. Based on the data collected in the new study, the FDA approved omalizumab for reducing risk of allergic reactions to foods on Feb. 16.
All study participants were severely allergic to peanuts and at least two other foods. After four months of monthly or bimonthly omalizumab injections, two-thirds of the 118 participants receiving the drug safely ate small amounts of their allergy-triggering foods. Notably, 38.4% of the study participants were younger than 6 years, an age group at high risk from accidental ingestions of allergy-triggering foods.
Allergies are common
Food allergies affect about 8% of children and 10% of adults in the United States. People with severe allergies are advised to fully avoid foods containing their allergy triggers, but common allergens such as peanuts, milk, eggs and wheat can be hidden in so many places that everyday activities such as attending parties and eating in restaurants can be challenging.
“Food allergies have significant social and psychological impacts, including the threat of allergic reactions upon accidental exposures, some of which can be life-threatening,” Chinthrajah said. Families also face economic impacts from purchasing more expensive foods to avoid allergens, she added.
In the best available treatment for food allergies, called oral immunotherapy, patients ingest tiny, gradually increasing doses of allergy-triggering foods under a doctor’s supervision to build tolerance. But oral immunotherapy itself can trigger allergic responses, desensitization to allergens can take months or years, and the process is especially lengthy for people with several food allergies, as they are usually treated for one allergy at a time. Once they are desensitised to an allergen, patients also must continue to eat the food regularly to maintain their tolerance to it – but people often dislike foods they were long required to avoid.
“There is a real need for treatment that goes beyond vigilance and offers choices for our food allergic patients,” Chinthrajah said.
Omalizumab is an injected antibody that binds and deactivates all types of immunoglobin E, or IgE, the allergy-causing molecule in the blood and on the body’s immune cells. So far, omalizumab appears able to provide relief from multiple food allergens at once.
“We think it should have the same impact regardless of what food it is,” Chinthrajah said.
Injections stave off severe reactions
The study included 177 children with at least three food allergies each, of whom 38% were 1 to 5 years old, 37% were 6 to 11 years old, and 24% were 12 or older. Participants’ severe food allergies were verified by skin-prick testing and food challenges; they reacted to less than 100 milligrams of peanut protein and less than 300 milligrams of each other food.
Two-thirds of the participants were randomly assigned to receive omalizumab injections, and one-third received an injected placebo; the injections took place over 16 weeks. Medication doses were set based on each participant’s body weight and IgE levels, with injections given once every two or four weeks, depending on the dose needed. The participants were re-tested between weeks 16 and 20 to see how much of each allergy-triggering food they could safely tolerate.
Upon re-testing, 79 patients (66.9%) who had taken omalizumab could tolerate at least 600 mg of peanut protein, the amount in two or three peanuts, compared with only four patients (6.8%) who had the placebo. Similar proportions of patients showed improvement in their reactions to the other foods in the study.
About 80% of patients taking omalizumab were able to consume small amounts of at least one allergy-triggering food without inducing an allergenic reaction, 69% of patients could consume small amounts of two allergenic foods and 47% could eat small amounts of all three allergenic foods.
Omalizumab was safe and did not cause side effects, other than some instances of minor reactions at the site of injection. This study marks the first time its safety has been assessed in children as young as 1.
More questions
More research is needed to further understand how omalizumab could help people with food allergies, the researchers said.
“We have a lot of unanswered questions: How long do patients need to take this drug? Have we permanently changed the immune system? What factors predict which people will have the strongest response?” Chinthrajah said. “We don’t know yet.”
The team is planning studies to answer these questions and others, such as finding what type of monitoring would be needed to determine when a patient gains meaningful tolerance to an allergy-triggering food.
Many patients who have food allergies also experience other allergic conditions treated by omalizumab, Chinthrajah noted, such as asthma, allergic rhinitis (hay fever and allergies to environmental triggers such as mold, dogs or cats, or dust mites) or eczema. “One drug that could improve all of their allergic conditions is exactly what we’re hoping for,” she said.
The drug could be especially helpful for young children with severe food allergies, she added, because they tend to put things in their mouths and may not understand the dangers their allergies pose, she added.
The drug could also make it safer for community physicians to treat food allergy patients, since it cannot trigger dangerous allergic reactions, as oral immunotherapy sometimes does. “This is something that our food allergy community has been waiting a long time for,” Chinthrajah said. “It’s an easy drug regimen to implement in a medical practice, and many allergists are already using this for other allergic conditions.”
