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Study Reveals Unseen Changes in Motor Control After Spinal Cord Injury

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One of the study participants exerts force with their calf muscles while sensors measure electrical activity. (Photo: Ruoli Wang)

Even when people with incomplete spinal cord injuries can walk, everyday functions like standing, balancing or producing steady force may remain difficult. A new study shows why.

Using surface skin electrical sensors, a research team in Sweden identified previously unseen changes in motor coordination that result from incomplete spinal cord injuries (SCI). The study is the first to examine how individual motor units (nerve to muscle connections that create movement) work together in people with SCI.  

“Our study reveals, at the cellular level, how the central nervous system adapts to the injury to control movement,” says Ruoli Wang, associate professor in biomechanics at Promobilia MoveAbility Lab, KTH Royal Institute of Technology. She says the researchers’ approach was completely non-invasive.

The results were published in the Journal of NeuroEngineering and Rehabilitation.  

The study’s lead author, PhD student Zhihao Duan, says the researchers found the nervous system struggles to spread signals smoothly across muscles at low levels of exertion after the injury. And it appears to overcompensate at higher levels of exertion, sending “louder”, less refined signals.  

Effect on motor units

Muscles move through hundreds or thousands of motor units, each turning on and off precisely to create smooth force. Composed of a single motor neuron and its connecting muscle fibres, these motor units respond to shared signals from the nervous system, much like different sections of musicians led by an orchestra conductor. That shared input is what allows them to act in coordinated patterns. 

To explore how well these units coordinate under the control of the central nervous system, the team examined 25 people (including 10 control participants). They used high-density electromyography (HD-EMG) to measure electrical activity in the functionally similar calf muscles – soleus and gastrocnemius – while volunteers pushed lightly or moderately against a device.  

Duan says that at 20% effort, fewer of the motor units in the two calf muscles were working in a shared, coordinated way compared with people without injury. As a result, their movements were shaky and unstable. “They were much less being driven by the same coordinated signal from the nervous system.” he says. 

At a higher level of effort (50%) the SCI group showed stronger lowfrequency synchronization between the two muscles. The body loses flexibility and precision in control of the movement. “This could be a sign of the nervous system compensating by sending louder, less refined signals,” Duan says. 

Unique insights

“One interesting finding is that after spinal cord injury the nervous system becomes more rigid and less able to change its approach as the muscles work harder. A healthy nervous system on the other hand is able to adapt its strategy as force demands, to adjust the shared neural drive level,” Wang says. 

Although the study was limited by a small sample size and challenges in identifying enough motor units per muscle from the skin surface, Wang says the results offer unique insight into how SCI reshapes motor control.  

“This finding may open the door to a new rehabilitation biomarker, helping clinicians and researchers design new neurorehabilitation strategies to re-tune the spinal cord control and to restore coordinated neural input,” she says.  

David Callahan

Source: KTH Royal Institute of Technology

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Half of Social Science Research Results Cannot Be Replicated

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Photo by Pexels on Pixabay

A major international collaboration on scientific reliability has been completed and is now presented in three articles in Nature by researchers from institutions including Karolinska Institutet. Around half of previously published research results in the social and behavioural sciences could not be replicated in new experiments.

The research programme, known as SCORE, involved 865 researchers who analysed nearly 3900 scientific articles published between 2009 and 2018 in 62 journals in the fields of criminology, economics, educational science, health sciences, leadership, marketing, organisational behaviour, psychology, political science, public administration and sociology.

In three studies published in Nature, different methods were used to investigate whether the research results are reliable. The questions addressed were whether the results can be reproduced, whether they are robust, and whether they can be replicated.

Replication involves testing the same research question, but with new data. In the replication study, the researchers analysed 164 previously published results in the social and behavioural sciences. Of these, just under half, 49%, could be replicated with a similar result to that of the original study.

Open data is key

In the reproducibility study, the same analysis was carried out on the same data. Reproducibility was hampered by the fact that data was often unavailable; only just under a quarter of the articles studied had shared their data openly. Of the 143 articles analysed, 74% could be reproduced to an approximate degree, and 54% to an exact degree. When the original data and code were shared, these figures increased to 91 and 77%, respectively.

“This shows that transparency is key to achieving credible research results,” says Gustav Nilsonne, associate professor of neuroscience at Karolinska Institutet, who co-led the robustness study and is a co-author of all three papers. “Sharing research data enables outsiders to assess which results are reliable.”

In the robustness study, alternative analyses were tested on the same data in 100 different articles. For each article, at least five researchers analysed the same hypothesis using the same data, but with the analysis method they deemed to be the best.

Same conclusion in most cases

Only a third of the new analyses yielded results very close to those reported in the original study. However, three out of four analyses reached the same overall conclusion as the original article. But in about a quarter of the cases, no clear effects were found at all, and in a few cases (around two per cent), the results pointed in the opposite direction.

“This is the world’s largest research project to date investigating the reliability of reported scientific results, and an example of how large-scale collaborations can address questions that no single research group could answer alone,” concludes Gustav Nilsonne. “I hope we will see systematic replication attempts in more fields of research in the future.”

The collaboration was led by the Center for Open Science and researchers at Pennsylvania State University, TwoSix Technologies, the University of Southern California and Eötvös Loránd University. The programme was funded by the US research council DARPA.

Publications

“Investigating the reproducibility of the social and behavioural sciences”, Olivia Miske et al., Nature, online 1 April 2026, doi: 10.1038/s41586-026-10203-5.

“Investigating the analytical robustness of the social and behavioural sciences”, Balazs Aczel et al., Nature, online 1 April 2026, doi: 10.1038/s41586-025-09844-9.

“Investigating the replicability of the social and behavioural sciences”, Andrew Tyner et al., Nature, online 1 April 2026, doi: 10.1038/s41586-025-10078-y.

Source: Karolinska Institutet

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Is it Safe to Have an MRI After Hip or Knee Replacement Surgery?

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A patient with a knee replacement undergoing an MRI where modern technology reduces the distortions in the images.

It is a common concern for patients that metal implants, such as hip or knee replacements, may prevent them from having an MRI scan. In most cases, this is not true. Patients with modern joint replacements can safely undergo MRI, depending on the materials used in the implant. It is important to inform the radiology team about the implant before your scan.

Dr Jean de Villiers, a radiologist and director of SCP Radiology, answers some of the questions most frequently asked by patients, specifically around the process from referral to reporting in radiology imaging.

What is Magnetic Resonance Imaging (MRI)?

MRI is a non‑invasive imaging technique that uses powerful magnets and radio waves to create detailed images of the body’s internal structures. Unlike X‑rays or CT scans, MRI does not involve ionising radiation and is used extensively to diagnose a wide range of conditions.

Because MRI uses strong magnetic fields, many patients ask whether it is safe to have an MRI after a hip or knee replacement.

Can you have an MRI after a hip or knee replacement?

Yes, you can have an MRI scan on other parts of the body, as well as on the knee or hip where the implant is. Although some older MRI scanners may not be compatible with certain prostheses, the vast majority of MRI equipment in use today is safe and compatible with modern hip and knee implants.

How safe is MRI if the implant is made of metal?

Most implants are made from titanium or cobalt‑chromium alloys. Although these materials are metallic, they are not significantly affected by the magnetic field of an MRI scanner, nor do they heat up during the scan. Many implants also contain hard plastic components, all of which are designed to be compatible with MRI scanners. They are not attracted to the powerful magnet in the same way as older or highly magnetic materials.

Dr de Villiers explains, “The vast majority of joint replacements used today are MRI‑safe. The key is that we know about them in advance, so we can adjust the scan if needed.”

What is the main challenge with MRI and an implant?

The main challenge is image quality. Metal can sometimes cause image distortion, known as artefact, on MRI images. This may make it more difficult to assess structures close to the implant. However, modern MRI techniques have improved significantly and can often minimise these effects, allowing radiologists to assess surrounding tissues such as muscles and ligaments, and to detect complications such as infection or loosening. MRI is often the best imaging method for evaluating pain or complications after joint replacement surgery.

What happens if MRI does not produce clear diagnostic images?

In some cases, alternative imaging techniques such as CT or ultrasound may be recommended, depending on the clinical question. However, MRI remains safe and highly valuable for many patients with joint prostheses.

Are there implants that prevent you from having an MRI?

Certain implants and devices may be unsafe or require special precautions during MRI, including:

  • Implanted pacemakers
  • Intracranial aneurysm clips
  • Cochlear implants
  • Certain prosthetic devices
  • Implanted drug‑infusion pumps
  • Neurostimulators
  • Bone‑growth stimulators
  • Any other iron‑based metal implants

MRI is also contraindicated in the presence of some internal metallic objects such as bullets or shrapnel, as well as certain surgical clips, pins, plates, screws, metal sutures or wire mesh.

Having a hip or knee replacement does not automatically exclude you from having an MRI scan. With modern implants and appropriate planning, MRI is both a safe and important diagnostic tool. As technology continues to evolve, future developments are expected to further enhance MRI compatibility with hip and knee implants, making it an even more reliable tool for ongoing patient care.

It is crucial for patients to inform their healthcare providers about their joint replacement before undergoing an MRI. This allows the medical team to adjust the MRI settings and take appropriate precautions to ensure both safety and diagnostic accuracy.

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Plastic Additives Tied to Millions of Preterm Births Worldwide

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Photo by FLY:D on Unsplash

Exposure to a chemical commonly used to make plastic more flexible may have contributed to about 1.97 million preterm births in 2018 alone, or more than 8 percent of the world’s total, a new analysis of population surveys shows. The chemical was also linked to the deaths of 74 000 newborns, the researchers further estimate.

The toxin, di-2-ethylhexylphthalate (DEHP), is part of a group of chemicals called phthalates, which appear in cosmetics, detergents, bug repellents, and other household products. Experts have found that these substances can break down into microscopic particles and enter the body through food, air, and dust.

Led by NYU Langone Health researchers, the new study focused on preterm birth, which is a major risk factor for lasting learning and developmental issues and is a leading cause of infant death, according to the World Health Organization.

The new analysis provides the first global estimate of preterm births connected to exposure to DEHP and explores which parts of the world are most affected, according to the authors. A report on the findings published online March 31 in the journal eClinicalMedicine.

“By estimating how much phthalate exposure may contribute to preterm birth worldwide, our findings highlight that reducing exposure, especially in vulnerable regions, could help prevent early births and the health problems that often follow,” said study lead author Sara Hyman, MS.

Past studies have linked DEHP exposure to cancer, heart disease, and infertility, among many other health concerns, added Hyman, an associate research scientist at NYU Grossman School of Medicine. There is also a large body of research connecting the chemical to preterm birth.

According to the new work, DEHP exposure may have contributed to 1.2 million years lived with disability, a measure of all the years that people have lived or will live with illnesses, injuries, and other health issues caused by being born prematurely.

Hyman said that while the phthalate is in widespread use, certain regions are estimated to bear a much larger share of the health impacts than others, with the Middle East and South Asia representing 54 percent of estimated illness from preterm birth. These areas have rapidly growing plastics industries and high levels of global plastic waste.

Africa, which accounted for 26 percent of health problems from DEHP-linked preterm birth, has a disproportionate share of deaths compared with its share of overall premature cases. The researchers said this reflects the region’s higher underlying death toll from preterm birth.

For the study, the research team estimated DEHP exposure in 2018 across 200 countries and territories by pulling data from large national surveys in the United States, Europe, and Canada. They also used estimates from earlier investigations to fill in regions that did not have their own data.

The team then drew on earlier research that assessed how phthalate exposure may affect preterm birth and combined those findings with their global exposure estimates. Finally, they combined this information with worldwide figures on preterm births and deaths to gauge what share of these outcomes might be linked to DEHP.

The scientists repeated these steps for another phthalate called diisononyl phthalate (DiNP), a common replacement for DEHP. According to the results, DiNP may pose a similar risk as DEHP, having contributed to about 1.88 million preterm births around the world. The financial costs associated with newborn deaths ranged from millions to hundreds of billions of dollars for both phthalates.

“Our analysis makes clear that regulating phthalates one at a time and swapping in poorly understood replacements is unlikely to solve the larger problem,” said study senior author Leonardo Trasande, MD, MPP, Professor of Pediatrics at NYU Grossman School of Medicine. “We are playing a dangerous game of Whac-A-Mole with hazardous chemicals, and these findings highlight the urgent need for stronger, class-wide oversight of plastic additives to avoid repeating the same mistakes.”

Dr Trasande, who is also a professor in the Department of Population Health and director of the Division of Environmental Pediatrics and the Center for the Investigation of Environmental Hazards, cautions that the investigation was not designed to establish that DEHP and DiNP directly or alone cause preterm birth, nor did it take into account other types of phthalates.

In addition, because there is some uncertainty in the data, the researchers looked at a range of possible values rather than just one estimate. This uncertainty range showed that the true impact of DEHP could be up to four times smaller than the main estimate or slightly higher. Even under the most conservative estimates, the results point to a substantial health burden, said Hyman.

Despite the limits of this kind of global modelling, added Hyman, the work lays important groundwork for future studies to confirm and refine these results and begins to fill a major gap in understanding the extent to which plastic chemicals affect preterm birth worldwide.

Source: NYU Langone Health

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Thesis on Impact of Treatment Choice in Anterior Cruciate Ligament Injury

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Photo by Natanael Melchor on Unsplash

An anterior cruciate ligament injury is a serious knee injury that often affects young, physically active people. On April 30, Dzan Rizvanovic will defend his thesis “Anterior cruciate ligament reconstruction: rationale for graft choice and treatment of associated injuries” in which he has investigated how treatment choice affects outcomes after ACL reconstruction.

“An anterior cruciate ligament injury (ACL injury) is a serious knee injury that primarily affects young and physically active individuals and can have long-term consequences for knee function, work capacity, and quality of life. Each year, a large number of patients in Sweden undergo surgical reconstruction of the injured ligament (ACL reconstruction), and this is the focus of my thesis”, says Dzan Rizvanovic, doctoral student at the Sports Medicine research group at the Department of Molecular Medicine and Surgery, Karolinska Institutet and specialist in orthopaedic surgery at Capio Artro Clinic.

“Using data from the Swedish Knee Ligament Registry, we studied tens of thousands of patients to investigate which factors are associated with different treatment strategies, and how these in turn relate to patients’ perceived knee function and the need for further surgery (revision). The thesis also has a particular focus on how the surgical volume of both the surgeon and the clinic is associated with treatment choices and outcomes”.

Which are the most important results?

“The main findings show that treatment strategies in ACL reconstruction are not solely related to the patient’s injury, but also to organizational factors. Surgeons and clinics with higher surgical volume are more likely to use different types of grafts (tendons used to replace the injured ligament), which may increase the opportunity for individualized treatment. They also repair meniscal injuries more frequently, a strategy that has been shown to be beneficial for long-term knee health. The management of cartilage injuries is also partly influenced by surgical volume”.

“Patients operated on by high-volume surgeons report better knee function two years after surgery and experience shorter waiting times from injury to surgery as well as shorter operative times. In contrast, the need for additional ACL reconstruction in the same knee is more related to patient- and injury-factors than to surgical volume”.

“The thesis also shows that graft choice influences subjective knee function at two years after surgery, particularly among females, which is an important finding”. 

How can this new knowledge contribute to the improvement of people’s health?

“This knowledge can contribute to more equitable and individualised care. By clarifying how surgical experience and surgical volume are associated with treatment decisions and outcomes, healthcare systems can better organise resources and create conditions for strengthened competence and improved decision-making in ACL reconstruction”.

“The results can also be used in the dialogue between patient and surgeon to select the treatment that best matches the individual’s needs and circumstances, which in the long term may improve knee function and increase quality of life in this young and working-age population”.

“Furthermore, the results from this thesis highlight the need for discussion regarding clearer national guidelines for referral pathways, minimum surgical volume requirements, and follow-up of treatment outcomes. It is also important that reporting to national quality registers is complete and made mandatory in order to enable transparency and continuous quality improvement”.

What are your future ambitions? 

“I hope to continue combining research with my clinical work to drive development forward and contribute to ensuring that patients with knee and sports-related injuries receive the best possible treatment. I also aim to contribute to a more equitable organization of healthcare, in which access to the right expertise at the right time does not depend on where in the country a patient lives”, says Dzan Rizvanovic.

Dissertation

The dissertation seminar will be held on Thursday, April 30th 2026 at 09:00, CIFU, Capio Artro Clinic, Valhallavägen 91, lecture hall house R. The doctoral thesis has been supervised by Anders Stålman. 

Thesis

Rizvanovic, Dzan (2026). Anterior cruciate ligament reconstruction : rationale for graft choice and treatment of associated injuries. Karolinska Institutet. Thesis. https://doi.org/10.69622/31333828.v1

Source: Karolinska Institutet

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Anaemia Linked to Increased Cancer Risk

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Anaemia detected in healthcare is associated with an increased risk of both cancer and higher mortality. This is shown in a new population-based study from Karolinska Institutet, published in BMJ Oncology. The findings may help guide clinical follow-up of patients with anaemia in routine care.

Anaemia is common among patients in healthcare and is defined by haemoglobin levels below the normal range. In this study, the researchers analysed the association between newly detected anaemia and the risk of cancer and mortality, and examined whether different types of anaemia, classified by the size of red blood cells, play a role. 

The study is based on register data from the Stockholm Early Detection of Cancer Study (STEADY‑CAN) and includes almost the entire adult population of Stockholm County between 2011 and 2021. In total, just over 190 000 adults with newly detected anaemia were included, along with an equal number of age- and sex-matched individuals without anaemia. All participants were over 18 years of age and cancer-free at study entry. 

The participants were followed for up to 18 months after anaemia was detected. During this period, 6.2 per cent of men and 2.8 per cent of women with anaemia developed cancer. The corresponding figures among individuals without anaemia were 2.4 per cent and 1.1 per cent, respectively. Mortality was also higher in the group with anaemia. 

“We found that both the risk of cancer and the risk of death are highest during the first months after anaemia is detected, but that the increased risk persists later during follow-up as well,” says Elinor Nemlander, researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and first author of the study. 

Type of anaemia matters 

The study also shows that the type of anaemia is important. Individuals with small red blood cells, known as microcytosis, had a particularly high risk of cancer, especially cancers of the gastrointestinal tract and the haematopoietic system. By contrast, individuals with large red blood cells, macrocytosis, showed a stronger association with increased mortality, but not with cancer to the same extent. Red blood cell size is measured using the laboratory value MCV, which is included in routine blood tests. 

“Our findings suggest that anaemia may be a sign of underlying disease rather than a condition in its own right. Blood tests that are already part of routine care can provide important information about which patients need closer follow-up,” says Elinor Nemlander. 

Source: Karolinska Institutet

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Long COVID Associated with Increased Risk of Cardiovascular Disease

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Photo by Joice Kelly on Unsplash

People with long COVID are at increased risk of developing cardiovascular disease, according to a new study from Karolinska Institutet published in eClinicalMedicine. The results show that the risk of conditions such as cardiac arrhythmias and coronary artery disease is higher even among those who were not hospitalised during the acute infection.

Long COVID has become an increasingly significant health problem worldwide, and a growing number of studies suggest that the condition can lead to secondary cardiovascular diseases. To date, research has mainly focused on people who were hospitalised, whilst the risks for those who stayed at home or were treated at a GP are less well known. In the current study, the researchers investigated how often major cardiovascular events occur in these individuals compared with those without the diagnosis.

Of the just over 1.2 million people aged between 18 and 65 included in the study, around 9,000 had been diagnosed with long COVID, corresponding to 0.7 per cent. Two-thirds of them were women. People who had previously had cardiovascular disease or been hospitalised for COVID-19 were excluded from this group.

During the follow-up period of around four years, people with long COVID were more likely to suffer from cardiovascular disease: 18.2 per cent of women and 20.6 per cent of men experienced some form of cardiovascular event, compared with 8.4 per cent of women and 11.1 per cent of men in the group without long COVID.

When the researchers then adjusted the results for factors such as age, socio-economic status and other known risk factors, the differences remained. Women with long COVID had just over twice the risk of receiving a cardiovascular diagnosis compared with women without long COVID. Men had approximately a third higher risk.

“We found that cardiac arrhythmias and coronary artery disease were more common among both women and men with long COVID. In women, there was also an increased risk of heart failure and peripheral vascular disease. However, no clear association was found between long COVID and stroke,” says lead author Pia Lindberg, a nurse and PhD student at the Department of Medicine, Solna, Karolinska Institutet.

Need to be monitored more systematically

As many people with long COVID never required hospitalisation during their acute infection, there is a risk that secondary conditions may be missed, says Pia Lindberg, pointing out that the results suggest these patients may need to be monitored more systematically.

”Our results show that long COVID can be a risk factor for cardiovascular disease, even in younger people who were previously healthy. This underlines the need for structured follow-up that takes gender differences into account, particularly as cardiovascular disease in women often presents with more diffuse symptoms that can make diagnosis more difficult”, concludes Pia Lindberg.

Source: Karolinska Institutet

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Opinion Piece: Medical Aid Out-of-pocket Healthcare Expenses are the Highest Ever

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14 April 2026

Photo by Towfiqu barbhuiya on Unsplash

By James White, Director: Sales and Marketing at Turnberry Management Risk Solutions

Many South Africans assume that belonging to a medical scheme means their hospital treatment will be fully covered. In practice, this is often not the case. Patients are increasingly encountering co-payments, specialist shortfalls and benefit sub-limits that leave them responsible for part of the bill. This happens because medical schemes pay according to their own tariff structures, while specialists often charge significantly more than those tariffs, sometimes as much as 500% of the scheme rate.

The difference between the scheme tariff and the provider’s invoice is then billed to the patient, and it can amount to tens of thousands of Rands. Gap cover exists specifically to address these shortfalls by covering the gap between what medical schemes pay and what healthcare providers charge, offering peace of mind and greater financial certainty.

Healthcare costs are rising faster than household incomes

Medical inflation in South Africa has consistently outpaced general inflation. While many employees receive annual increases of around four or five percent, healthcare costs often rise by nine or ten percent. Hospital tariffs, specialist fees and the cost of advanced medical technology continue to increase each year.

Medical schemes therefore face a difficult balancing act: keeping contributions affordable while managing rising provider costs. To do this, schemes increasingly rely on co-payments, tighter benefit limits and reimbursement based on scheme tariffs. For members, this means that belonging to a medical scheme does not always guarantee that every medical expense will be fully covered.

The shortfall between tariffs and specialist fees

One of the most common out-of-pocket expenses occurs when a healthcare provider charges more than the scheme rate. Medical schemes reimburse treatment according to their own tariffs, while specialists may charge several times that amount. This can create confusion for members, because policies often state that they pay “100% of the scheme rate”. In practice, this means the scheme pays up to its tariff limit, not the full amount charged by the provider.

From a gap cover perspective, this tariff shortfall accounts for the majority of claims. In many cases it represents roughly 78% to 80% of claims, making it one of the most common funding gaps patients experience.

Co-payments and sub-limits add further pressure

Shortfalls are not the only challenge patients face – medical schemes increasingly rely on co-payments and sub-limits to manage rising healthcare costs.

A co-payment is a fixed amount that the member must pay before treatment takes place. Depending on the procedure and scheme rules, these amounts can range from around R5,000 up to R30,000, and in some cases even higher. For many households, being asked to produce this amount upfront can create significant financial strain.

Sub-limits can create a similar problem. Even when a procedure is covered, schemes may limit how much they will pay for certain treatments, scans or specialist services. Once the limit is reached, the remaining cost falls to the patient.

Why adviser education matters

Because the system is complex, many clients only discover these gaps when they receive a bill after treatment. They assume their medical aid will cover the full cost of care, only to find that co-payments, benefit limits or specialist shortfalls still apply.

This is why it is important for advisers to explain clearly how medical schemes pay claims, particularly the difference between scheme tariffs and provider fees. When clients understand how these shortfalls arise, the role of gap cover becomes easier to understand. Rather than being seen as an optional extra, gap cover becomes part of the overall structure of healthcare cover alongside medical aid.

Understanding your healthcare cover before you need it

Healthcare funding in South Africa is unlikely to become less complex in the near future. As costs continue to rise, it is essential to understand how your medical scheme operates and where potential shortfalls may arise.

Many people only learn how their cover works when a claim is processed and an unexpected bill appears. Understanding the difference between scheme tariffs, provider fees, co-payments and benefit limits can help prevent these surprises.

Gap cover plays an important role in addressing these shortfalls by covering the difference between what medical schemes pay and what healthcare providers charge. Speak to a broker about what your medical aid covers, where shortfalls may occur, and how gap cover can help protect you from unexpected medical bills.

Turnberry Management Risk Solutions (Pty) Ltd is an authorised Financial Services Provider (FSP no. 36571). Underwritten by Lombard Insurance Company, an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.

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World Voice Day: UP Researchers Develop Low-cost Voice Screening Device for SA

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Dr Maria du Toit takes a close-up look at vocal cords, capturing high-resolution images and video using widely available mobile technology. Traditionally, this type of examination requires expensive equipment and specialist doctors, making it difficult to access in many parts of South Africa

Ahead of World Voice Day on 16 April, researchers at the University of Pretoria (UP) are inviting the public to take part in free voice checks using a new, locally developed device that could significantly expand access to vocal health services across South Africa.

The groundbreaking, low-cost, smartphone-compatible device, which is currently being tested as part of ongoing research, enables clinicians and trained users to take a close-up look at the voice user’s vocal cords by capturing high-resolution images and video using widely available mobile technology. Traditionally, this type of examination – known as laryngoscopy – requires expensive equipment and specialist doctors, making it difficult to access in many parts of South Africa.

“Your voice is something you use every day – whether for work, social interactions, or simply being heard. Yet many people ignore early warning signs of vocal problems,” says Professor Jeannie van der Linde, who is leading the research team and is Head of UP’s Department of Speech-Language Pathology and Audiology in the Faculty of Humanities.

Voice disorders are more common than many people realise. Prof Van der Linde adds: “International estimates suggest that up to one in five people will experience a voice problem at some point in their lives, with higher risk for those who rely heavily on their voices for work, such as teachers, healthcare workers and call centre agents. Despite this, access to specialised diagnostic services remains limited, particularly outside major urban centres.”

The research and device are part of a broader effort to rethink how vocal health services are delivered in South Africa. “Our aim was to develop a solution that is more portable, more affordable and easier to integrate into different healthcare contexts,” says Dr Maria du Toit, a Lecturer in Speech-Language Pathology and member of the research team.

“Many people ignore early signs like hoarseness or vocal fatigue, often because they don’t have easy access to assessment services,” Dr Du Toit says. “If we can identify these issues earlier, we can intervene sooner and potentially prevent more significant problems from developing.

The development of the device forms part of ongoing efforts within the department to explore how mobile anddigital technologies can be used to increase the availability of vocal health assessment and care.

Dr Roxanne Malan, a postdoctoral fellow, speech therapist and research team member, highlights the importance of designing technology that balances functionality with affordability and ease of use. “We wanted to ensure that the device is not only clinically useful but also practical in a range of settings, including those withlimited resources,” she says. “The goal is to make vocal health screening more widely available without compromising on quality.”

The technology, which has not been named yet, is being developed at UP and is currently undergoing testing to compare its performance with gold-standard laryngoscopy. “We started feasibility testing in June 2025 and preliminary tests have been very positive, demonstrating that the device is usable and produces high-quality images of the relevant structures,” Dr Malan says. “It consists of a low-cost, off-the-shelf borescope – typically used industrially – adapted with a 3D-printed handle to ensure optimal placement of the scope in the patient’s mouth, as well as the correct angle for visualisation. We have also assessed its safety for human use and its ability to be properly disinfected.”

In addition to testing the device, the World Voice Day initiative seeks to increase general awareness about theimportance of vocal health. “Your voice is central to how you communicate, work and engage with others,” Dr DuToit says. “Taking care of it should be seen as an essential part of overall health, not something to think aboutonly when there is a problem.”

Dr Malan says the team’s vision is for the scope to be readily available as a screening device in public hospitalsand clinics all over South Africa and other low- and middle-income countries. “But we still foresee numerousphases of testing to ensure that it can be used by a range of healthcare professionals, and that it makes asignificant difference in the target healthcare sectors. We will name and launch it at a stage when this has beendone.”

Dr Du Toit says members of the public can support the research by booking their free voice health check. “Byattending, you’re not only taking care of your own vocal health – you’re helping researchers develop solutionsthat could make voice care more easily available to thousands of people who currently don’t have access tothese services.”

Event details: Members of the public are invited to take part in free voice checks on World Voice Day, 16 April 2026, at the Department of Speech-Language Pathology and Audiology at the University of Pretoria’s Hatfield Campus.

Participants will have the opportunity to learn more about their vocal health and contribute to research that aims to make voice care more accessible across South Africa.

Who should consider a voice check?

This free check is especially recommended for:

● Teachers and lecturers

● Singers and performers

● Healthcare workers

● Clergy and public speakers

● Call centre workers

● Anyone who uses their voice extensively

You should also consider attending if you:

● frequently experience hoarseness or voice changes;

● feel your voice tires easily;

● have ongoing throat discomfort when speaking; and/or

● simply want reassurance that your voice is healthy.

To register, visit: https://forms.gle/imqeHnpGveQaEuDD6


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Stopping Beta-Blockers After Heart Attack is Safe for Low-Risk Patients

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Findings suggest lifelong beta-blockers may be unnecessary in some patients

Human heart. Credit: Scientific Animations CC4.0

Among stable, relatively low-risk patients who had previously suffered a heart attack, discontinuing beta-blockers after at least one year was found to be non-inferior, or comparable, to continuing beta-blockers in terms of death, another heart attack or hospitalisation for heart failure, according to a study presented at the American College of Cardiology’s Annual Scientific Session (ACC.26).

Beta-blockers, which lower heart rate and blood pressure by inhibiting adrenaline and other hormones, have long been a mainstay of treatment to reduce the likelihood of subsequent cardiac events following a heart attack. However, many studies confirming their benefits were conducted decades ago, when procedures and medications for secondary prevention were more limited than they are today. More recent studies suggest the benefits of beta-blockers may vary depending on the overall health of a patient’s heart.

“In appropriately selected patients who survived a heart attack and do not have heart failure or left ventricular systolic dysfunction, routine continuation of beta-blockers indefinitely may not be necessary,” said Joo-Yong Hahn, MD, a cardiologist at Samsung Medical Center in Seoul, South Korea, and the study’s senior author. “In practice, for stable patients who are several years out from a heart attack, discontinuation can be considered through shared decision-making and with monitoring of blood pressure and heart rate. For patients with beta-blocker-related side effects – fatigue, dizziness, bradycardia, hypotension – the case for discontinuation is even stronger.”

The study evaluated 2,540 patients at 26 sites in South Korea between 2021 and 2024 who had no subsequent cardiac events after taking beta-blockers for at least one year following a heart attack. Participants’ average age was 63 years and 87% were men. At a median of 3.5 years following randomisation, the primary endpoint – a composite of all-cause death, recurrent heart attack or heart failure hospitalisation – occurred in 7.2% of those who discontinued beta-blockers and 9% of those who continued taking the medication. The results met the threshold for non-inferiority because of a lower rate of this composite endpoint in the group that stopped taking beta-blockers.

Discontinuation of beta-blockers was also found to be similar for secondary endpoints, including each of the components of the primary composite endpoint, new-onset atrial fibrillation, unfavourable changes in left ventricular function, changes in quality of life and serious adverse events.

“In current practice – where revascularisation rates are high and secondary prevention is strong – we expected that the incremental benefit of continuing beta-blockers indefinitely in stable patients might be small,” Hahn said. “We found that discontinuation did not worsen major outcomes, cardiac function or quality of life in this selected stable population.”

Since most study participants had been taking beta-blockers for several years before discontinuing, Hahn said that the results may not apply to patients who have been taking beta-blockers for a shorter amount of time. The study also does not definitively establish the earliest timepoint at which it is safe to stop taking beta-blockers.

The results were generally consistent across prespecified subgroups. However, women and patients with mildly reduced left ventricular ejection fraction made up a small proportion of the trial population, limiting the interpretation of results for these subgroups. In addition, the study was conducted only in South Korea, potentially limiting its generalisability to other areas of the world.

Hahn said future studies could help to clarify whether and when it is safe to discontinue beta-blockers among higher-risk groups, women and those with mildly reduced left ventricular ejection fraction and to better define the optimal timing of discontinuation. Pooled analyses across contemporary randomised trials could provide additional insights and help guide practice decisions. The researchers also plan to conduct further analyses to assess potential differences in health care costs.

The study was funded by the Patient-Centered Clinical Research Coordinating Center in the Ministry of Health and Welfare of the Republic of Korea.

This study was simultaneously published online in the New England Journal of Medicine at the time of presentation.

Source: American College of Cardiology