NHS doctors are going on strike just as the UK is facing a surge in cases of “superflu”, which would have by itself placed an even greater burden than the public health service usually faces this time of year as services are stretched thin.
According to The Guardian, this is the 14th such action since disputes over junior doctors’ pay and jobs began in March 2023. Since then, they have won the right to be called “resident doctors” in line with the US because the British Medical Association (BMA) felt that the previous term was demeaning and misleading.
Resentment between government and doctors grows
After the government’s last offer was rejected, BMA members voted in an online ballot 84% in favour of industrial action. UK Prime Minister Keir Starmer called the walkouts “irresponsible” amid a surge in super-flu cases. Meanwhile, the UK’s Secretary of State for Health and Social Care, Wes Streeting, asked junior doctors to ignore the BMA and show up for work. He dismissed the resident doctors’ 26% pay claim as a “fantasy demand”, and has also said that the strike could be “the Jenga piece” that finally brings about the collapse of the NHS just when it is needed the most.
The strike will begin on Wednesday 17th December at 7am and will continue until the following Monday at 7am.
The magnitude of the problem has echoes of South Africa’s own struggles to find training placements – but at a far larger scale. Some 30 000 newly graduated doctors are having to compete for around 10 000 training posts. Even the government’s best offer could only add 2000 extra jobs.
Dr Jack Fletcher, the chair of the BMA’s resident doctors committee, said: “There are no new jobs in this offer. He has simply cannibalised those jobs which already existed for the sake of ‘new’ jobs on paper. Neither was there anything on what Mr Streeting has said is a journey to restoring our pay – that has clearly hit the buffers.”
Is ‘superflu’ even real?
Experts have however cast doubt on the UK government’s narrative of a dangerous new influenza mutation a “superflu”. Mathematician Christina Pagel, University College London professor, said that the “superflu” term was based on “highly misleading statistics” and that the flu season had merely arrived a few weeks early.
Government spin or not, the strikes have sounded alarm in the NHS, which is struggling to deal cope with a record flu hospitalisations for this time of year, filling 1700 beds. More and more hospitals are unable to contend with these numbers and having to declare a “critical incident”.
Children have higher energy levels than adults – but what is ‘typical’ behaviour?
Photo by Annie Spratt on Unsplash
Parents of children who fidget, daydream, and enjoy running and jumping should not automatically be concerned about ADHD.
This is the argument of a team of experts, comprised of a paediatrician, social worker and occupational therapist. They say it is important to attempt to alleviate confusion among parents around what is ‘typical’, and when children need professional help for developmental or behavioural differences.
Based on extensive evidence, their new book Developmental and Behavioral Complexities in Children highlights how the prevalence of ADHD, autism spectrum disorder, and some other developmental and behavioural diagnoses has increased – although they suggest it is not clear if this is because more people are aware of the conditions, screening has improved, changes in the diagnostic criteria have occurred, and/or if there is a genuine increase in the population. The increase in public awareness can sometimes lead to parents and caregivers questioning whether their child’s behaviour is different from others.
Jo-Ann Blaymore Bier, a retired developmental-behavioural paediatrician from Boston Children’s Hospital, occupational therapist Theresa A. Johnson, and Ellen Mullane who is a social worker, also say that opinions can differ among professionals which adds to the uncertainty for people who have children.
“The field of child development is not always a ‘black and white’ science,” they add.
“The way that children behave varies under different conditions and settings. Professionals may have varying thresholds for recommending intervention.
For example, they say: “Being energetic does not necessarily mean that a child has ADHD. Most children enjoy movement, and young children have limited attention spans.
Based on latest research and clinical experience, the experts offer strategies to manage problematic behaviours and examine the evidence behind available treatments.
The book is intended for advanced level students and professionals working in the field of child development, but may also be beneficial for parents and other caregivers who may have concerns. The book also answers questions that caregivers often ask such as is it my child’s personality or something more serious?
The authors, who have helped thousands of children, document a range of ‘typical’ behaviours as well as those likely to be symptoms of specific diagnoses, including autism, ADHD, and oppositional defiant disorder.
In the book, they emphasise that no one demonstrates what others consider acceptable behaviour all the time, and that all children are ‘wired’ differently.
ADHD is the most common childhood neuro-behavioural disorder, with some data sources indicating that about a million more children and adolescents in the US were diagnosed with ADHD in 2022 compared to 2016.
Increased awareness, changes in diagnostic criteria and in social norms are among many factors which the authors of Developmental and Behavioral Complexities in Children suggest may have contributed to the rise in cases.
However, no single specific medical test exists for ADHD. Clinicians make an assessment based on the child’s clinical presentation and on information from people who have observed the child’s behaviour.
For instance, children who are more energetic than their peers but also ‘function in group activities’ may not necessarily have ADHD, according to the authors.
Autism spectrum disorder (ASD) is also on the rise and is examined in detail in the book. The authors say the ASD diagnosis may have become even more complex – instead of easier – to understand.
The term ‘neurodiversity’ has also become increasingly used. In the book, the authors say: “Accepting and encouraging individuality can be positive goals. But if an individual’s differences are having a negative impact on their functioning, providing supports to improve their quality of life can be beneficial.”
A commonly prescribed antibiotic could help reduce the risk of some young people developing schizophrenia, new research suggests. Experts found that patients of adolescent mental health services who were treated with the antibiotic doxycycline were significantly less likely to go on to develop schizophrenia in adulthood compared with patients treated with other antibiotics.
The researchers say that the findings highlight the potential to repurpose an existing, widely used medication as a preventive intervention for severe mental illness.
Lower risk
Schizophrenia is a severe mental disorder that typically emerges in early adulthood and is often associated with hallucinations and delusional beliefs.
To better understand potential ways of preventing the condition, researchers from the University of Edinburgh, in collaboration with the University of Oulu and University College Dublin, applied advanced statistical modelling to large-scale healthcare register data from Finland.
The team analysed data from more than 56 000 adolescents attending mental health services who had been prescribed antibiotics. They found that those treated with doxycycline had a 30–35% lower risk of developing schizophrenia than peers who received other antibiotics.
The researchers hypothesised that the protective effect could be linked to doxycycline’s impact on inflammation and brain development.
Reduce inflammation
Doxycycline is a broad-spectrum antibiotic commonly used to treat infections and acne. Previous studies suggest it can reduce inflammation in brain cells and influence synaptic pruning – a natural process where the brain refines its neural connections. Excessive pruning has been associated with the development of schizophrenia.
Further analyses showed that the lower risk wasn’t simply because the young people may have been treated for acne rather than having infections, and was unlikely to be explained by other hidden differences between the groups.
The study is published in the American Journal of Psychiatry. It involved researchers from the University of Edinburgh, the University of Oulu, University College Dublin, and St John of God Hospitaller Services Group, and was funded by the Health Research Board.
As many as half of the people who develop schizophrenia had previously attended child and adolescent mental health services for other mental health problems. At present, though, we don’t have any interventions that are known to reduce the risk of going on to develop schizophrenia in these young people. That makes these findings exciting.
Because the study was observational in nature and not a randomised controlled trial, it means we can’t draw firm conclusions on causality, but this is an important signal to further investigate the protective effect of doxycycline and other anti-inflammatory treatments in adolescent psychiatry patients as a way to potentially reduce the risk of developing severe mental illness in adulthood.
Professor Ian Kelleher, Professor of Child and Adolescent Psychiatry at the University of Edinburgh
It is not a stretch to say that the NHI Act has been one of the most controversial pieces of legislation in post-apartheid South Africa.
Since President Cyril Ramaphosa signed it into law in May 2024, just two weeks ahead of the national and provincial elections, at least nine different court cases have been launched against the Act, or specific provisions in the Act. None of those cases have made it through the courts and it seems likely some might be combined.
In one preliminary to the bigger court battles, the North Gauteng High Court in Pretoria ordered Ramaphosa to provide the record of his decision to sign the act, but the President is challenging that order.
A subtext to the torrent of court cases is the sense that it is only through litigation that the NHI Act might be scrapped, or that some of the most controversial provisions in it might be repealed. The alternative to litigation, political compromise, for now seems dead in the water. There was some hope for such compromise around a year ago when Business Unity South Africa and several healthcare worker groups pushed government for a change in course – but while the Presidency seemed open to considering changes, the health minister did not, and eventually the ANC, and government with it, decided to buckle down behind their current NHI plans.
The door to political compromise could of course reopen should the balance of political power in the country change – as it will surely do after the 2029 elections, if not earlier.
To the courts then
There has been much media coverage of the various court cases challenging the NHI Act. Understandably, a lot of the public statements were aimed at drumming up public support for the various points of view. In the end, the courts will hopefully look past the rhetoric and politicking and judge the cases on their merits.
This is why in recent months Spotlight put substantial resources into combing through seemingly endless court papers and chatting to a variety of lawyers in an attempt to sift the wheat from the chaff. As with many other court cases we’ve reported on, we suspect the various NHI-related cases will in the end turn on just a few key legal questions. In a special two-part series, we tried to pin down what these key legal questions are likely to be – you can see part 1 here and part 2 here. (Thank you to the three lawyers we quote in the article, as well as those who shared their views, but opted not to be named and quoted.)
In our view, this crystallisation of the legal case against the NHI Act, and/or specific provisions in the Act, is the most notable NHI-related development this year. After all, a major ruling against the Act could make much else moot.
Other NHI developments
Meanwhile, the Department of Health is moving ahead on the assumption that NHI will be implemented as envisaged in the Act. The first formal step towards setting out the proposed governance structure and processes of the NHI Fund is underway with draft regulations that were published in the Government Gazette in March. Amongst others, the regulations provide for the appointment of the board of the NHI Fund, the fund’s chief executive officer, and for a benefits advisory committee and a healthcare benefits pricing committee. In the background here is the fact that, until the NHI Fund has been established as a public entity, it cannot be awarded a budget by parliament.
One source of funding for NHI could be the phasing out of medical scheme tax credits. This is according to a presentation by the National Health Department’s NHI lead, Dr Nicholas Crisp, who was addressing the Standing Committee on Appropriations in the National Assembly. The presentation notes that medical scheme tax credits could raise as much as R34bn for the NHI Fund by 2027/28. At the moment, eligible beneficiaries receive medical scheme tax credits to the value of R364 per month for the primary member, R364 for the first dependant, and R246 for each additional dependant. The rough idea is that tax credits would first be phased out for high-income earners. This would eventually be followed by the state scrapping medical scheme subsidies to civil servants.
But Finance Minister Enoch Godongwana seems unconvinced. He told BusinessDay: “It’s actually an attack on the middle class”.
And indeed, the proposed scrapping of medical aid subsidies has added fuel to suggestions that government is intentionally undermining the viability of private healthcare in South Africa. A set of recommendations on how to better regulate the country’s private healthcare sector remains largely unimplemented six years after being published. Government did publish draft regulations for tariff determination in the private sector in February, but, as we recently reported, those draft regulations have now been withdrawn. In fact, those draft regulations were so poorly thought out that one wonders whether they were a serious attempt at addressing the issue in the first place.
According to Crisp’s presentation, NHI could take “10, 15 or more” years to implement. There is some welcome realism in this. Rather absurdly, Section 57 of the NHI Act still states that it will be introduced in two phases, between 2023 and 2026, and between 2026 and 2028.
Several experts have suggested to Spotlight that, mainly for financial reasons, NHI is essentially dead in the water and that the more serious people in the government and the ANC know this. Few are however willing to say this publicly. Others, like Crisp and Health Minister Dr Aaron Motsoaledi, would of course beg to differ, and mean it.
Not the only solution
One thing that should not get lost in all this is that things really do need to change. Apart from being extremely unequal, much of the healthcare system in South Africa is deeply dysfunctional. But Motsoaledi is wrong when he suggests that the specific system set out in the NHI Act is the only possible solution. As we’ve previously argued, there are other viable paths to universal health coverage, even if the current set of leaders in the ANC refuses to seriously consider them.
One of the great tragedies of NHI is that for all the noise, we have never really had an informed public debate about the policy options and the reasons for going with one set of health reforms rather than another. There were few things as depressing as watching members of parliament’s portfolio committee for health reducing someone’s nuanced and constructive feedback on the Bill to a simple question of whether someone is for or against NHI. The ANC of course had a majority in parliament prior to the 2024 elections, so maybe there was a sense that they did not need to listen and do the hard work of engaging and bringing people along with them.
Either way, it now seems likely that in 2026, the courts will have to make one or more landmark rulings that will determine the future of NHI. We have some idea of what the key issues will be on which those cases will turn, but as to how the courts will decide, your guess is as good as ours.
Over the last 20 years, substance use-related deaths have more than doubled for women of reproductive age. Overdose deaths are now a leading cause of maternal mortality in the US, and in some states, the leading cause.
Still, substantial gaps remain in understanding how different treatment approaches influence the short- and long-term health of mothers and infants, as well as their broader economic impacts over time.
New research published this month in the journal JAMA Pediatrics found that while established medications for opioid use disorder in mothers – buprenorphine and methadone – are both superior and cost saving compared to alternative treatment pathways (naltrexone, medication-assisted withdrawal or no treatment), buprenorphine produced the greatest health gains and cost savings for mothers and infants.
Using a mathematical simulation model, the study projected the health and cost outcomes for pregnant individuals with opioid use disorder and their infants over their lifetime. The economic model captured how treatment decisions during pregnancy can have lasting health and economic consequences, such as risks of preterm birth, that extend from infancy through adulthood and drive substantial downstream health effects and costs. Outpatient buprenorphine emerged as the optimal treatment in most scenarios tested (58%-100%) and in nearly every lifetime scenario that incorporated both mother and infant trajectories (99%). In other words, across thousands of simulations, buprenorphine consistently produced the best health outcomes and lower costs compared to alternative strategies.
The study, led by Ashley Leech, PhD, assistant professor of Health Policy at Vanderbilt University Medical Center, and Stephen Patrick, MD, MPH, O. Wayne Rollins Distinguished Professor of Health Policy and chair of the Department of Health Policy and Management at Emory University, is among the first to compare the short- and long-term health benefits and costs of opioid use disorder treatment for mothers and infants, examining outcomes during pregnancy, postpartum and beyond the infant’s first year of life using simulation modeling.
Existing studies have not examined outcomes beyond the infant’s first year of life. The study used a hypothetical treatment group modeled on known demographic and other social factors to estimate differences in outcomes and cost savings over time for each treatment and population group. The paper found that, although neonatal opioid withdrawal syndrome (NOWS) has received much of the clinical attention as a marker of poor infant health after opioid exposure during pregnancy, preterm birth and low birth weight carry greater morbidity and mortality and played a more significant role in shaping long-term infant outcomes. Notably, buprenorphine, despite its direct association with NOWS, was protective against these critical outcomes.
“Nationwide, we have seen a significant growth of pregnant women with opioid use disorder, but there have not been comprehensive models that evaluate trade-offs of different medications and strategies,” said Patrick. “This study evaluated the trade-offs we face as clinicians – How will medications affect moms and babies? With the evidence we have available, what can we expect years from now? Bottom line, we found that buprenorphine treatment in pregnancy was cost saving and improved outcomes for mothers with opioid use disorder and their babies.”
The researchers emphasised, however, that patient-centred care and patient choice remain essential to sustaining treatment. “While we found that buprenorphine yielded the greatest health gains and was cost saving across all model variations, methadone could still be a viable option for mothers, and at the individual level, it might work better for some,” said Leech, the lead author of the study. “Buprenorphine shows clear benefits for long-term infant outcomes, but it can be more difficult for patients to start and stay on this treatment because, as a partial agonist, it may not feel as strong to those dependent on drugs like heroin or fentanyl. Methadone, by contrast, is often easier for patients to initiate and sustain.
“This is an opportunity to make sure buprenorphine works as well as possible – by ensuring pregnant individuals receive effective doses across trimesters (since they often need higher and increasing amounts for effectiveness compared to nonpregnant patients) and by removing unnecessary Medicaid restrictions.”
The study estimated substantial cost savings to public insurance programmes like Medicaid, finding that treating pregnant individuals this year could save roughly $4 billion in infant-related lifetime costs alone.
“Medicaid is the largest payer for pregnant individuals and those with substance use disorders. Our research shows that treatment is not only effective but also has the potential to generate significant savings for Medicaid, benefiting both mothers and their children’s long-term health,” Leech said.
Inspiring South Africa to Support Mobility, Inclusion and the Power of Possibility
Össur South Africa‘s Team 1: Rentia Retief & Travis Warwick-Oliver
Össur South Africa is proud to announce the launch of the 2026 ‘What’s Your Epic?’ campaign, an initiative that champions one simple truth: everyone deserves the freedom to move. As the world turns its attention to the Cape Epic from 15 – 22 March 2026, Össur is once again harnessing this global stage to drive awareness, spark action, and rally support for mobility access across South Africa.
Following the success of last year’s inaugural campaign, Össur South Africa has entered three amputee teams into the 2026 Cape Epic, one of the world’s most iconic and demanding mountain biking events. These six remarkable riders embody grit, courage, and the unbreakable belief that mobility transforms lives. Their mission is bigger than the race: to unlock meaningful support and funding for three exceptional non-profit organisations: Jumping Kids, Zimele and Rejuvenate SA.
“Movement is a fundamental right, not a privilege reserved for the few,” says Blignaut Knoetze, Managing Director of Össur South Africa. “Whether you’re an elite athlete, a child receiving their first prosthetic or an adult rebuilding independence; mobility unlocks dignity, participation, and potential. ‘What’s Your Epic?’ is our call to South Africa to stand with us in supporting organisations who make this freedom possible.”
The 2026 campaign aims to raise funds and awareness for four organisations driving mobility access and inclusion:
Jumping Kids: Providing quality prostheses, education access, and sport opportunities to children living with limb loss, giving them the tools to build confident, successful futures.
Rejuvenate SA: Founded on the belief that movement is a basic human right, Rejuvenate SA supplies mobility aids to those who cannot afford them, restoring dignity and independence.
Zimele: Meaning “independence” in Xhosa, Zimele supports adults with physical disabilities to regain control over their lives, reintegrate into society and build economic self-sufficiency.
Together, these six athletes across three teams are redefining what’s possible.
Team 1: Rentia Retief & Travis Warwick-Oliver
Rentia (33, Somerset West), an artist and amputee athlete, who survived a cycling accident in 2023. Her journey is a testament to courage and the belief that mobility is a right every person deserves. Partnering with her is Travis (32, Durban), founder of Rejuvenate SA, adaptive athlete, and two-time UTMB finisher who has transformed his own amputation into a mission to help others move freely and live without limitations.
Team 2: Mhlengi Gwala & Kean Dry
Mhlengi (34, Durban), an international para-triathlete and multiple African champion who continues to defy all odds after a 2018 attack that led to the amputation of his right leg. Riding alongside him is Kean (30, Cape Town), a dedicated endurance athlete and community motivator whose story of resilience inspires thousands to believe that adversity does not define possibility.
Team 3: Brian Style & Rudi Joubert
Brian (40, Springs), a passionate cyclist who has rebuilt his life through mountain biking, uses sport as a platform for giving back. He rides with Rudi (42, Secunda), a determined amputee athlete known for his positivity, teamwork, and commitment to raising funds for mobility solutions.
“These riders are not just racing, they are raising their voices for those who cannot and shining a spotlight on organisations that restore dignity, independence, and hope,” says Knoetze. Össur South Africa is inviting the public, corporates, partners, and communities to be part of this extraordinary movement. Whether through donations, corporate partnerships, fundraising initiatives, or simply sharing the message, every contribution helps someone stand, walk, run, play, work, or dream again.
“‘What’s Your Epic?’ is about pushing boundaries; not just on the bike, but in society,” adds Knoetze. “When we support mobility, we support access. We support inclusion. We support futures. We are asking South Africa to back our riders, our NPOs, and the belief that everyone deserves the freedom to move.”
Donate, fundraise, or get involved as an individual and/ or company. Your support can help someone take their first step, return to work, join a sport, or believe in possibility again. Össur Donations, ABSA Bank, Account number: 4123 215 542, Branch code: 632005 Reference: company name and contact number
Please contact Amelda Potgieter (apotgieter@ossur.com) for more information and/ or Section 18A certificates.
This is more than a race. It’s a movement. What’s your Epic?
People living with HIV are at an increased risk of developing anal cancer, particularly if they have compromised immune systems. Photo by Lorenzo Turroni on Unsplash
By Elna Schütz
South Africa has the world’s largest population of people living with HIV, which both heightens the risk of anal cancers and their severity. However, neither the collection of data nor the efforts for prevention and screening are in line with the likely impact. Experts say significant change is needed.
“Almost everyone has an anus,” Dr Daniel Surridge, a colorectal surgeon at Joburg Colorectal, says with a smile. He is one of a group of specialists trying to draw attention to arguably one of the most neglected areas in cancer.
“We’re quite a weird niche group who talk about bums all day, but most people are really in denial that they have an anus,” jokes Dr Tim Forgan, another colorectal surgeon, working in the private and public sector in Cape Town.
“It’s such an essential part of your daily life and you need your anus,” adds Dr Mark Faesen, specialist gynaecologist with the Clinical HIV Research Unit (CHRU), who runs an anal cancer screening clinic at Helen Joseph Hospital in Johannesburg, as far as we know, the only one in the country.
The stigma surrounding this particular body part, unfortunately, does no one any favours when it comes to cancer awareness and treatment.
A tricky hidden cancer
Anal cancers occur in the last few centimetres towards the external opening of the rectum. They can be associated with rectal, colon, or genital issues.
Professor Michael Herbst, health specialist consultant for the Cancer Association of South Africa, explains that the vast majority of these cancers are anal squamous cell carcinomas, meaning they develop in the skin cells of the anal canal.
Most anal cancers are caused by Human Papillomavirus (HPV), a virus that also causes most cases of cervical cancer.
“Patients and doctors often misdiagnose those early symptoms as haemorrhoids,” Herbst says, explaining that the disease is asymptomatic at first. Later, it may present with itching, discharge, bleeding or a palpable lump.
Ideally, a diagnosis is made of a pre-malignant lesion, which is a fairly flat, slightly dark growth. This can be found through a rectal exam or smear. A biopsy under anaesthesia may be needed to confirm the diagnosis.
Premalignant lesions can be treated topically if caught early. Otherwise, the skin may have to be surgically removed, which is often a difficult and risky surgery in this part of the body.
Once a lesion has progressed to cancer, treatment involves high doses of chemotherapy and radiation, which Surridge says is intense and only treats about half of patients effectively. “The rest go to a surgery where you have to remove the anus along with the rectum and put in a permanent colostomy bag,” he says.
In comparison to the rectal and colon cancers that Surridge sees in his work, he describes anal cancers as less predictable and more aggressive, with painful consequences. “It’s going to hurt like hell,” he says. “It stinks like you’re rotting from the inside, so no one wants to come near you.”
Anal cancers are also particularly resistant to chemotherapy, Surridge says, and run the risk of spreading through the lymph system, leading to a dismal outcome, possibly leading to death.
People living with HIV are at an increased risk of developing anal cancer, especially if they have compromised immune systems.
Faesen says that internationally, in the general population, the incidence of anal cancer is around 2 per 100 000 people per year. “If you’re HIV positive long enough, so over the age of 45, the risk is 20 to 40 per 100 000 per year,” he says. For men who have sex with men, the incidence can be as high as 60 or 130 per 100 000.
Those with HPV and patients with immune systems not working as well as they should, such as those who have received an organ transplant, are at risk. Furthermore, groups who engage in high-risk sexual activities, like men who have anal sex with multiple male partners, should be aware of the risk. However, sexual orientation and anal sex do not directly lead to an increase in anal cancer risk.
Rare but not that rare
Anal cancer may be considered a rare cancer, but the few local experts on it see it as a concerning cancer because of South Africa’s high number of people who are at increased risk.
“Anal cancer is strangely common in South Africa. It’s not extremely common, but it is reasonably common,” says Forgan.
The National Cancer Registry’s latest numbers, from 2023, has the cancer reported in around 300 women and 220 men, making up less than 0,7% of reported cancers. A recent analysis of the registry’s numbers found that the cancer’s incidence has significantly increased between 1994 and 2021. The paper found that younger black women and older white women were most likely to get the cancer. A study at the University of the Witwatersrand in 2023 found that three-quarters of their anal cancer cohort were female and 80% were HIV positive.
“We don’t actually know the true incidence in South Africa,” says Dr James Pattinson, Head of Colorectal Surgery at Chris Hani Baragwanath Academic Hospital, explaining that the disease is likely under-reported. Anecdotally, he says the cancer seems common in Gauteng. He says his unit alone sees around 100 new cases of anal cancer a year, making up around 30% of new reported colorectal cancers.
Surridge says it is getting more common, and “it is certainly raging through Gauteng”.
The challenges
The doctors agree that the reported numbers are likely lower than the real prevalence and that many cases could be avoided or caught early with intervention. A key factor is the lack of education and patient hesitancy to get tested. “The natural stigma and embarrassment associated with anal conditions cause patients to wait until the condition is severe before seeking medical help,” Pattinson says.
“The lack of awareness doesn’t stop at the door of the Department of Health,” Faesen says. He laments that few healthcare workers are well-informed about this cancer. This leads to misdiagnoses and problems being missed. This is aggravated by financial and resource constraints. But, he says, this is not a “blame game”, since the greater awareness of anal cancer is fairly new.
In that study, of over 4 000 people, progression to anal cancer was more than 50% lower in people who received treatment for precancerous lesions than in people who did not. The study provided a compelling rationale for increased screening, since it is only through finding precancerous lesions in the first place that they can be treated and progression to cancer be prevented.
Reaching the level of common-place awareness for anal screening that there is around cervical pap smears is still a while away. “It took 50 to 60 years to get there, but we’ve just started,” Faesen says. “We are at the absolute beginning of anal cancer awareness.” He does however note that the incidence of anal cancer in some South African populations is already much higher than that of cervical cancer when routine screening for that was started.
What to do
The lack of screening for anal cancer is one clear issue that needs to be addressed. “Hopefully, we can demonstrate with more and more screening that there is a need for it,” Faesen says. He hopes that this will catch the problem before it progresses to a serious disease in more patients.
However, Pattinson notes that screening in other countries has been historically focused on high-risk populations such as men who have sex with men. “This is obviously not feasible in South Africa, as high-risk individuals are the millions of people living with HIV.”
Screening could potentially be focused on certain sites, like HIV-specific clinics or doctors who particularly work with HPV and cervical screening. Expanding screenings for high-risk groups to include anal would not be incredibly expensive but would add an extra burden on staff, Forgan says. “And it’s a very easy thing to screen for. You just have a look.”
There is also a preventative solution, the HPV vaccine. A two-strain form of this vaccine is already offered to girls aged 9 to 12 years old by the Department of Health. This does not cover other strains and is mostly focused on cervical cancer.
Surridge says that focusing on vaccinating only girls means boys aren’t protected, and creates a possible lag in protection against anal cancer. He says the vaccine, ideally one with more strains, if possible, should be given to as many people as possible.
“If you’re in a higher risk group, like those (who are) immuno-suppressed, with HIV, or solid organ transplant recipients, you should be vaccinated,” Forgan says. “Then you wouldn’t need a screening programme, per se, because you had prevented it from happening.”
Beyond this, increasing education around the disease and eventually instituting local guidelines would be crucial.
The National Department of Health did not respond to questions from Spotlight about their plans relating to anal cancer.
Research shows that greater subjective well-being can lead to enhanced immune function and a lower incidence of chronic disease. But when does happiness start to exert its positive influence, and is there a point when this effect caps out? Researchers looked at national level data from 123 countries and found there is: on a scale from zero to 10, people started gaining health benefits once they surpassed a threshold that lies at around 2.7. Once above, each 1% of additional happiness could lead to a small decrease in mortality risk from non-communicable diseases.
Heart disease, cancer, asthma, and diabetes: All are chronic or non-communicable diseases (NCD), which accounted for about 75% of non-pandemic related deaths in 2021. They may result from genetic, environmental, and behavioural factors, or a combination thereof. But can other factors also influence disease risk?
Now, a new Frontiers in Medicine study has investigated the relationship between happiness and health to find out if happier always means healthier and to determine if happiness and co-occurring health benefits are linear or follow a specific pattern.
“We show that subjective well-being, or happiness, appears to function as a population health asset only once a minimum threshold of approximately 2.7 on the Life Ladder scale is surpassed,” said first author Prof Iulia Iuga, a researcher at 1 Decembrie 1918 University of Alba Iulia. “Above this tipping point, increased happiness is associated with a decrease in NCD mortality.”
Happy equals healthy
“The life ladder can be imaged as a simple zero to 10 happiness ruler, where zero means the worst possible life and 10 means the best possible life,” explained Iuga. “People imagine where they currently stand on that ladder.” The team used data sourced from different health organisations, global development statistics, and public opinion polls. The data came from 123 countries and was collected between 2006 and 2021.
A score of 2.7 can be found towards the lower end of the ladder, and people or countries finding themselves there are generally considered unhappy or struggling. “An adjective that fits this level could be ‘barely coping’,” said Iuga. Nevertheless, already at this point, improvements in happiness begin to translate into measurable health benefits.
Once the threshold is surpassed and a country’s collective happiness rises above it, the study found that each 1% increase in subjective well-being is linked to an estimated 0.43% decrease in that country’s 30-to-70-year NCD mortality rate. This rate refers to the percentage of deaths due to NCDs among individuals aged between 30 and 70.
“Within the observed range, we found no evidence of adverse effects from ‘excessive’ happiness,” Iuga added. Below the 2.7-point threshold, small improvements in happiness (for example, from a score of 2 to 2.2) do not translate to measurable reduction in NCD deaths, the data indicated. Before measurable changes can be unlocked, very low well-being needs to be remedied, the study suggested.
Countries that exceeded this threshold tend to have higher per person health spending, stronger social safety nets, and more stable governance as opposed to the countries falling below it. The average life ladder score across the examined countries during the study period was 5.45, with a minimum of 2.18 and a maximum of 7.97.
There are several ways that governments could raise countries above a score of 2.7, for example through promoting healthy living by expanding obesity prevention and tightening alcohol availability; improving the environment through stricter air-quality standard; and increasing their per capita health spending. The authors said their insights could help guide health and social policies and might aid to integrate well-being into nations’ agendas.
The authors pointed out that the life ladder scores making up their data were self-reported, which may have resulted in measurement errors, differences in cross-cultural response styles, or reporting bias. It is also possible that subnational differences between populations were captured inadequately. In the future, studies should include more measures, such as years lived with disability or hospital admission records, include subnational micro-data, and expand coverage to low-income or conflict states, which may have been overlooked in the data they used, the team pointed out.
Nevertheless, identifying the protective effects of happiness could be an important step towards healthier people. “Identifying this tipping point could provide more accurate evidence for health policy,” concluded Iuga. “Happiness is not just a personal feeling but also a measurable public health resource.”
A new model combining a dozen metrics measures differences in white matter structure between older CAD patients and healthy controls
Source: Wikimedia CC0
Although coronary artery disease (CAD) increases the risks of strokes, cognitive impairment and dementia, the link between CAD and cognitive function is not fully understood. A new study led by Concordia researchers looks at how the disease affects the brain’s white matter, the network of nerve fibres that connects different regions of the brains and is critical to transmitting information efficiently.
The study, published in the Journal of Neuroscience, applied a novel multivariate approach using 12 separate metrics. The researchers compared test results and MRI scans of 43 patients with CAD to those of 36 healthy individuals. All participants were over age 50.
The researchers found that individuals with CAD had widespread structural changes in their white matter compared to their healthy counterparts. The changes were particularly noticeable in the parts of the brain fed by the middle cerebral (MCA) and anterior cerebral arteries. Both regions are key for cognitive and motor functions.
“This makes sense because those regions, especially the MCA territory, are most prone to strokes,” says PhD candidate Zacharie Potvin-Jutras, the study’s co-lead author. “We made sure that there was no history of strokes in our CAD cohort.
“Our goal is to examine conditions at the onset of a heart disease, before there has been any significant impact on the brain,” he says.
Stéfanie Tremblay, a 2023 Concordia Public Scholar now a postdoctoral researcher at McGill University, is the study’s other co-lead author.
Small measurements provide a bigger picture
The multivariate approach of bundling individual white matter metrics into one overarching metric provides advantages over past univariate studies. It allows the researchers to simplify complex aspects of brain health into a single metric that can be compared to the same metric in healthy controls. While individual metric variations between CAD patients and healthy controls may be very small, when seen together, they can provide significant indicators of early stages of cognitive impairment.
“The metrics are often overlapping, meaning they measure things that are related to each other,” says corresponding author Claudine Gauthier, an associate professor in the Department of Physics. “Having one single metric that captures many aspects of brain health allows us to identify differences between patients and controls that reflect a complex combination of changes in a single analysis. Then we can unpack it and see which aspects of white matter health drove the difference more than the others.”
The researchers found that the changes were mainly linked to reduced myelin content, the fatty envelope surrounding nerve fibres. Myelin loss can slow communication between brain cells and is often an early sign of cognitive ageing.
Interestingly, participants with higher measures of myelin integrity (specifically, in a marker called R1) performed better on tests of processing speed, a key aspect of thinking and attention. However, no significant differences were observed between groups in overall cognitive scores, suggesting that brain changes may precede noticeable symptoms.
“This study adds mechanistic insight into our understanding of how CAD affects white matter health,” says Gauthier. “Now that we know that myelin content is a good biomarker for coronary heart disease, the next step is to focus on potential interventions. If we have a preventive lifestyle intervention, we can optimize the intensity to improve myelin health and maintain cognitive function.”
The Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada and Brain Canada supported this research.
When hospitals were randomly assigned to treat patients undergoing higher-risk non-cardiac surgery with tranexamic acid (TXA) or a placebo, patients who received TXA needed significantly fewer blood transfusions and saw no increase in potentially life-threatening blood clots (thrombosis) after 90 days of follow-up, according to research presented at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition.
“Our findings confirm that TXA reduces the need for blood transfusion in patients undergoing higher-risk non-cardiac surgery,” said lead study author Brett Houston, MD, PhD, an assistant professor at the University of Manitoba and a scientist with the Paul Albrechtsen Research Institute in Winnipeg, Canada. “We were also able to show that giving TXA is safe and does not increase the occurrence of dangerous blood clots within the three-month high-risk period after surgery.”
TXA is a generic drug that promotes blood clotting, which is essential to stop blood loss from injuries or during surgery, but blood clots can be life-threatening.
A 2019 international study of 40 000 patients found major bleeding to be the most common life-threatening complication following non-cardiac surgery. Another large international randomised trial, known as POISE-3, showed that, compared with patients who received a placebo, patients who received TXA immediately before and after non-cardiac surgery had significantly less serious bleeding and needed fewer blood transfusions, with no significant increase in heart attacks, strokes, or blood clots at 30 days.
The current study, known as TRACTION, was designed to build on the findings of POISE-3, Dr Houston said. Participating hospitals – 10 medical centres in Canada – were randomly assigned to administer either TXA or a placebo to adult patients undergoing major non-cardiac surgical procedures that posed an elevated risk for post-surgical bleeding complications and blood clots. Every four weeks, hospitals in the TXA group switched to the placebo group and vice versa.
Patients received a first dose of TXA or the placebo intravenously within minutes of surgery initiation. At the discretion of the attending anaesthesiologist, they then received a second dose either at the conclusion of the operation or as a continuous infusion throughout the procedure.
The study’s primary endpoints were the number of patients needing blood transfusions during their hospital stay and the number diagnosed with blood clots within 90 days.
Secondary endpoints included the number of units of blood transfused; the number of patients diagnosed with a heart attack, stroke, or blood clot while in the hospital; the number of patients admitted to intensive care; the number surviving at 90 days after surgery; and patients’ length of stay in the hospital.
The study’s results are based on the evaluation of 8273 patients treated across the 10 participating hospitals. More than 60% of the patients underwent cancer surgery. Among patients treated with TXA, 7.4% received a blood transfusion while in the hospital compared with 9.8% of those treated with the placebo, a statistically significant difference. Patients treated with TXA needed significantly fewer units of blood (0.34 units on average) than those in the placebo group (2.5 units on average). The proportion of patients diagnosed with blood clots within 90 days was the same (2.1%) in both the TXA and placebo groups. No significant differences were seen in any of the secondary endpoints.
The finding that TXA use does not increase risk for blood clots during the 90-day post-surgical period of elevated risk may reassure many practitioners who have previously been hesitant to adopt the drug, Dr Houston said. “We hope this data will also set practitioners’ minds at rest that giving the drug is safe,” she said.
Although the study was limited to Canada, it evaluated bleeding risk across a broad range of types of higher-risk non-cardiac surgery, Dr Houston said, including gynaecologic, urologic, spinal, blood-vessel, and cancer surgery. In addition, participating hospitals included both academic medical centres and community hospitals.
A limitation of the study is that participation was restricted to hospitals with sophisticated electronic medical records systems in place to transmit study data.
Findings from other studies suggest that the use of TXA could be successfully introduced as a hospital-level policy in the same way that other surgical safety practices, such as antibiotic administration to prevent infection and the use of surgical checklists have been adopted, Dr Houston said. As a next step, she and her colleagues plan to work on educating physicians about the TRACTION findings and promoting the adoption of TXA administration as a standard practice during higher-risk non-cardiac surgery.
