Author: ModernMedia

Categories : Healthcare Politics and Regulations HIVTags :

Inside SA’s Multi-million Rand Plan to Fill US Funding Void

On By ModernMedia
Photo by Miguel Á. Padriñán

By Jesse Copelyn

In response to US funding cuts for South African health services and research projects, National Treasury has provided the National Department of Health with hundreds of millions of rands in emergency funds. Spotlight and GroundUp look at how precisely the government intends to spend this money.

Health Minister Dr Aaron Motsoaledi recently announced that National Treasury had released roughly R753 million to help plug the gap left by US funding cuts to South Africa’s health system. Another R268 million is also being released in the following two years for researchers that lost their US grants.

But this may only constitute the first round of emergency funds from government, according to sources we spoke to. The health department is planning on submitting a bid for an additional allocation later on, which will be considered by Treasury. But this will likely only be approved if the first tranche of funding is properly used.

So how is the money supposed to be used? To find out, we spoke with officials from the National Treasury, the National Department of Health and the South African Medical Research Council (SAMRC).

Money for provinces is for saving jobs at government clinics

The current tranche of money comes from Treasury’s contingency reserve, which exists partially to deal with unforeseen funding shortfalls. It was released in terms of Section 16 of the Public Finance Management Act.

Of the R753 million that’s been announced for this year, Motsoaledi stated that R590 million would be going to provincial health departments via the District Health Programme Grant – a conditional grant for funding the country’s public health efforts, particularly HIV, TB, and other communicable diseases. Such conditional grants typically give the health department more say over how provincial departments spend money than is the case with most other health funding in provinces.

To explain how government officials arrived at this figure, it’s worth recapping what services the US previously supported within provinces.

Prior to Donald Trump becoming US president on 20 January, the US Agency for International Development (USAID) had financed health programmes in specific districts with high rates of HIV. These districts were scattered across all South Africa’s provinces, save for the Northern Cape.

The funds were typically channelled by USAID to non-governmental organisations (NGOs), which used the money to assist the districts in two ways.

The first is that NGOs would hire and deploy health workers at government clinics. The second is that the NGOs would run independent mobile clinics and drop-in centres, which assisted so-called key populations, such as men who have sex with men, sex workers, transgender people, and people who inject drugs.

Following the US funding cuts, thousands of NGO-funded health workers lost their jobs at government clinics, while many of the health centres catering to key populations were forced to close.

In response, the health department began negotiations with Treasury to get emergency funding to restore some of these services. As part of its application, the health department submitted proposals for each province, which specified how much money was needed and how it would be used. (Though this only took place after significant delay and confusion).

Since Treasury couldn’t afford to plug the entire gap left by the US funding cuts, the provincial-level proposals only requested money for some of the services that had been terminated. For instance, funding was not requested for the key populations health centres. Instead, the priority was to secure the jobs that had been lost at government health facilities.

As such, the total amount that was requested from Treasury for each province was largely calculated by taking the total number of health workers that NGOs had hired at clinics and working out how much it would cost to rehire them for 12 months.

Rather than paying the NGOs a grant to deploy these workers as was done by USAID, the health department proposed hiring them directly. This meant that they calculated their wages according to standard government pay scales, which is less than what these workers would have earned from the NGOs.

The total came to just under R1.2 billion for all the provinces combined.

Treasury awarded roughly half of this on the basis that the money would be used to finance these wages for six months, rather than 12. This amounts to the R590 million for provinces that was announced by Motsoaledi.

If all goes smoothly and this money is used effectively to hire these staff over the next six months, then a new tranche of Section 16 funding could be released in order to continue hiring them. Funds might also be released to fund the key populations health sites.

A concern, however, is that the money may just be used by provinces to augment their ordinary budgets. If the funds aren’t actually used to respond to the US cuts, then it is much less likely that more emergency funding will be released.

At this stage, it is too early to tell how provinces will use the money, particularly given that it appears that at least some of them haven’t gotten it yet.

Spotlight and GroundUp sent questions to several provincial health departments. Only the Western Cape responded. The province’s MEC for Health and Wellness, Mireille Wenger, said that the funds have not yet been received by her department, but that once they were, they would be directed to several key priority areas, including digitisation of health records, and the strengthening of the primary healthcare system.

It’s thus not clear whether the province will be using any of the funds to employ health staff axed by US-funded NGOs. In response to a question about this, Wenger stated that “further clarity is still required from the National Department of Health and National Treasury regarding the precise provincial allocations and conditions tied to the additional funding”.

What about research?

Of the R753 million that’s been released for this year, R132 million has been allocated to mitigate the funding cuts for research by US federal institutions, primarily the National Institutes for Health (NIH). Unlike USAID, the NIH is not an aid body. It provides grants to researchers who are testing new treatments and medical interventions that ultimately benefit everyone. These grants can be awarded to researchers in the US or abroad as part of a highly competitive application process.

Researchers in South Africa are awarded a few billion rands worth of grants from the NIH each year, largely due to their expertise in HIV and TB. But over the last few months, much of this funding has been terminated or left in limbo. (See a detailed explanation of the situation here).

The R132 million issued by Treasury is supposed to assist some of these researchers. It will be followed by another R268 million over the following two years. The Gates Foundation and Wellcome Trust are chipping in an additional R100 million each – though in their case, the funds are being provided upfront.

All of this money – R600 million in total – is being channelled to the SAMRC, which will release it to researchers via a competitive grant allocation system.

According to SAMRC spokesperson Tendani Tsedu, they have already received the R132 million from Treasury, though they are still “finalizing the processes with the Gates Foundation and Wellcome Trust for receipt of [their donations]”.

The SAMRC is also in negotiation with a French research body about securing more funds, though these talks are ongoing.

In the meantime, the SAMRC has sent out a request for grant applications from researchers who have lost their US money. The memo states: “Applicants may apply for funding support for up to 12 months to continue, wind down or complete critical research activities and sustain the projects until U.S. funding is resumed or alternative funds are sourced.”

“The plan,” Tsedu said, “is to award these grants as soon as possible this year.”

Professor Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, told us that the hope is that the grants could fill some of the gaps. “This is a bridge and it is certainly going to save some people’s jobs, and some research,” she said, but “it isn’t going to completely fill the gap”.

Indeed, the SAMRC has made clear that its grants aren’t intended to replace the US funding awards entirely. This is unsurprising given that the money that’s being made available is a tiny fraction of the total grant funding awarded by the NIH.

It’s unlikely that research projects will continue to operate as before, and will instead be pared down, said Bekker.

“It’s going to be about getting the absolute minimum done so you either save the outcome, or get an outcome rather than no outcome,” she said.

In other cases, the funds may simply “allow you to more ethically close [the research project] down,” Bekker added.

For some, this funding may also have come too late. Many researchers have already had to lay off staff. Additionally, patients who had been on experimental treatments may have already been transitioned back into routine care. It’s unclear how such projects could be resumed months later.

In response, Tsedu stated: “For projects that have already closed as a result of the funding cuts, the principal investigator will need to motivate whether the study can be appropriately resurrected if new funds are secured.”

The SAMRC has established a steering committee which will adjudicate bids. They will be considering a range of criteria, Tsedu said, including how beneficial the research might be for the South African health system, and how heavily the project was impacted by the US funding cuts. They will also consider how an SAMRC grant could “be leveraged for future sustainability of the project, personnel or unit”, added Tsedu.

An endless back and forth

The job of the SAMRC steering committee will likely be made a lot more complicated by the erratic policy changes within the NIH. On 25 March, the body sent a memo to staff – leaked to Nature and Bhekisisa – instructing them to hold all funding awards to researchers in South Africa. After this, numerous researchers in the country said they couldn’t renew their grants.

However, last month, Science reported that a new memo had been sent to NIH staff which said that while South African researchers still couldn’t get new grants, active awards could be resumed.

Since then, some funds appear to be trickling back into the country, but certainly not all. For instance, Spotlight and GroundUp spoke to one researcher who had two active NIH awards before the cuts. He stated that one of these was resumed last month, while the other is still paused.

Bekker also told us that she had heard of one or two research grants being resumed in the last week, though she said the bulk of active awards to South Africa are still pending.

“Where people are the prime recipients [of an NIH grant] without a sub awardee, there seems to be a queue and backlog but some [of those awards] are coming through,” said Bekker. “But how long this is going to take and when it might come through, we’re waiting to hear.” She said a strategy might be to apply for the SAMRC bridging funding and “if by some miracle the [NIH funding is resumed]” then researchers could then presumably retract their SAMRC application.

In the meantime, health researchers will have to continue spending their time working out how to respond to the abrupt and increasingly confusing changes to funding guidelines that have dogged them since Trump assumed office.

“It’s such a dreadful waste of energy,” said Bekker. “If we were just getting on with the research, it would be so much better.”

This article was jointly produced by Spotlight and GroundUp.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Categories : RheumatologyTags :

Small Changes in Walking Technique May Help Treat Knee Osteoarthritis

On By ModernMedia
Photo by Kampus Production on Pexels

Gait analysis and pain measures show that subtly adjusting the angle of the foot during walking may reduce knee pain caused by osteoarthritis, an approach which may also slow progression of the incurable condition.

Led by a team of researchers at NYU Langone Health, the University of Utah, and Stanford University, a new study explored whether changing the way patients position their feet when walking could lessen extra loading, helping to treat the disease.

For the investigation, the scientists tested this intervention in 68 men and women with mild to moderate knee osteoarthritis and then used advanced MRI scans to track how well it worked.

The results suggest that those trained to angle their feet slightly inward or outward from their natural alignment experienced slower cartilage degeneration in the inner part of their knee compared with those who were encouraged to walk more frequently without changing their foot position. The study is reported online in The Lancet Rheumatology.

“Although our results will have to be confirmed in future studies, they raise the possibility that the new, noninvasive treatment could help delay surgery,” said study co-lead author Valentina Mazzoli, PhD.

Dr. Mazzoli, an assistant professor in the Department of Radiology at NYU Grossman School of Medicine, notes that the earlier patients receive a knee replacement, the more likely they are to require additional procedures in the future.

The findings also revealed that those who adjusted their foot angle reduced their pain score by 2.5 points on a 10-point scale, an effect equivalent to that of over-the-counter pain medications. By contrast, those who did not change their gait reduced their pain scores by little more than a point.

“Altogether, our findings suggest that helping patients find their best foot angle to reduce stress on their knees may offer an easy and fairly inexpensive way to address early-stage osteoarthritis,” added Dr. Mazzoli.

About one in seven Americans have some form of osteoarthritis, commonly in the inner side of the knee, according to the U.S. Centers for Disease Control and Prevention. A leading cause of disability, the disease is often managed with pharmaceutical pain relievers, physical therapy, and in the most severe cases, knee-replacement surgery. Experts believe that excess loading can over time contribute to the condition.

Past research has offered little evidence that changes in gait can effectively reduce knee pain caused by osteoarthritis, says Dr. Mazzoli. Some previous trials trained all participants to adopt the same foot angle and found no relief, while others did not compare the intervention to a control group or only followed the participants for a month.

The new study is the first to show that tailoring each patient’s foot angle to their unique walking pattern can alleviate the disease’s symptoms in the long term and may slow cartilage breakdown, the authors say.

Dr Mazzoli adds that this technique may have a significant advantage over pharmaceutical painkillers. These drugs, she says, do not address the underlying disease and can cause liver and kidney damage, stomach ulcers, and other unwanted side effects when taken for long periods.

For the study, the research team recorded the participants walking on a treadmill at a specialized gait-assessment laboratory. A computer program simulated their walking patterns and calculated the maximum loading that occurred in the inner side of their knees. Next, the team generated computer models of four new foot positions—angled inward or outward by either 5 or 10 degrees—and estimated which option reduced loading the most.

The patients were then randomly divided into two groups. Half were trained in six sessions to walk with their ideal angle, while the other half were instructed to continue walking naturally. Pain scores and MRI scans were taken at the beginning of the study period and one year after the intervention.

Study findings showed those who adjusted their gait reduced the maximum loading in the knees by 4 percent, while those who kept their normal walking pattern increased their loading by more than 3 percent.

“These results highlight the importance of personalizing treatment instead of taking a one-size-fits-all approach to osteoarthritis,” said Dr. Mazzoli. “While this strategy may sound challenging, recent advances in detecting the motion of different body parts using artificial intelligence may make it easier and faster than ever before.”

While the authors relied on a specialized laboratory for the new study, AI software that estimates joint loading using smartphone videos is now available and can allow clinicians to perform a gait analysis in the clinic.

The researchers next plan to test whether these tools can indeed identify the most effective walking method for osteoarthritis patients, says Dr. Mazzoli. They also plan to expand their study to people with obesity.

Source: NYU Langone Health

Categories : OphthalmologyTags :

Blinking and Eyelid Function Is Enabled by Complex Control of Muscles

On By ModernMedia

Discovery could help pave the way for a prosthetic device to restore blink function lost to injury or disease

Muscle activation and movement patterns over time across the upper and lower eyelids, shown under different actions. Credit: Anatomical Engineering Group/UCLA

A blink of an eye is vital to protecting the eye by keeping it from drying out. This simple function seems natural and instantaneous, but is it?

Now, a team of UCLA biomechanical engineers and ophthalmologists has uncovered new details about the muscle that controls blinking, offering a pathway toward developing blink-assisting prostheses. Published in PNAS, the study found that the orbicularis oculi – the muscle that controls eyelid movement – contracts in complex patterns that vary by action and move the eyelid in more than just a simple up-and-down motion.

The researchers studied how this muscle behaves differently across various actions including spontaneous blinks, protective rapid closures and squeezed shut-eye motions.

“The eyelid’s motion is both more complex and more precisely controlled by the nervous system than previously understood,” said study corresponding author Tyler Clites, an assistant professor of mechanical and aerospace engineering at the UCLA Samueli School of Engineering. “Different parts of the muscle activate in carefully timed sequences depending on what the eye is doing. This level of muscle control has never been recorded in the human eyelid. Now that we have this information in rich detail, we can move forward in designing neuroprostheses that help restore natural eyelid function.”

In experiments with volunteers, the researchers looked at five different ways the eyes close:

  • Spontaneous blink: An automatic, unconscious blink that occurs regularly to keep the eye lubricated
  • Voluntary blink: An intentional blink, as when someone is asked to blink on command
  • Reflexive blink: A rapid, involuntary blink triggered to protect the eye from a collision
  • Soft closure: A gentle, slow eyelid descent, similar to the beginning of sleep
  • A forced closure: A deliberate squeezing of the eyelids tightly shut

To record activity in the orbicularis oculi with high precision, an ophthalmic surgeon inserted tiny wire electrodes into the eyelid. The researchers then used a motion-capture system to track eyelid movement in ultraslow motion. These tools allowed the team to measure subtle differences in eyelid movement, including speed, direction, and which part of the muscle initiated the action.

Video of spontaneous blink – dynamic muscle activation patterns and eyelid kinematics. Credit: Anatomical Engineering Group/UCLA

“People can lose the ability to blink due to a stroke, tumour, infection or injury. The condition is painful in the short term and can damage the eyes enough to cause vision loss,” said study co-author Dr Daniel Rootman, an associate professor of ophthalmology at the David Geffen School of Medicine at UCLA and director of the UCLA Orbital Disease Center. “We know that a small electric pulse can stimulate the orbicularis oculi muscle to move, but designing one that works well has been elusive. What we now have is a good roadmap to such a device, including where exactly to place electrodes, how to time them, and how strong the pulse should be. These guidelines could help pave the way for the development and clinical testing of such a device, with the ultimate goal of providing real relief for patients.”

With this fundamental knowledge of eyelid biomechanics in hand, the researchers can now work on refining a prototype neuroprosthesis to assist people with blinking.

“Understanding how the eyelid works is crucial to designing an accurate stimulation pattern for a prosthesis, as well as for diagnostic purposes,” said study first author Jinyoung Kim, a UCLA mechanical engineering doctoral student and member of Clites’ research group, the Anatomical Engineering Group at UCLA. “We are more than excited to bridge this gap and move forward to work with patients who have facial paralysis and help improve their lives.”

Source: UCLA Samueli School of Engineering

Categories : COVID VaccinesTags :

Over 2.5 Million COVID Deaths Prevented Worldwide Thanks to Vaccines

On By ModernMedia
Gloved hand holding vial of Janssen COVID vaccine
Photo by Spencer Davis on Unsplash

Thanks to vaccinations against SARS-CoV-2 in the period 2020-2024, 2.533 million deaths were prevented at the global level, one death was avoided for every 5400 doses of vaccine administered. The 82% of the lives saved by vaccines involved people vaccinated before encountering the virus, 57% during the Omicron period, and 90% involved people aged 60 years and older. In all, vaccines have saved 14.8 million years of life (one year of life saved for 900 doses of vaccine administered).

These are some of the data released in an unprecedented study published in the journal Jama Health Forum and coordinated by Prof Stefania Boccia, Professor of General and Applied Hygiene at Università Cattolica, with contributions from Dr Angelo Maria Pezzullo, Researcher in General and Applied Hygiene, and D. Antonio Cristiano, a medical resident in Hygiene and Preventive Medicine. The two researchers spent a period at Stanford University, collaborating directly with the group of Professor John P.A. Ioannidis, director of the Meta-Research Innovation Center (METRICS), in the context of the project “European network staff eXchange for integrAting precision health in the health Care sysTems- ExACT” funded by the European Research Excellence Programme RISE project-Marie Slodowska Curie and coordinated by Professor Stefania Boccia.

Professor Boccia and Dr Pezzullo explain: “Before ours, several studies tried to estimate lives saved by vaccines with different models and in different periods or parts of the world, but this one is the most comprehensive because it is based on worldwide data, it also covers the Omicron period, it also calculates the number of years of life that was saved, and it is based on fewer assumptions about the pandemic trend.”

The experts studied worldwide population data, applying a series of statistical methods to figure out who among the people who became ill with COVID did either before or after getting vaccinated, before or after Omicron period, and how many of them died (and at what age). ‘We compared this data with the estimated data modeled in the absence of COVID vaccination and were then able to calculate the numbers of people who were saved by COVID vaccines and the years of life gained as a result of them,’ Dr Pezzullo explains.

It also turned out that most of the saved years of life (76%) involved people over 60 years of age, but residents in long-term care facilities contributed only with 2% of the total number. Children and adolescents (0.01% of lives saved and 0.1% of life years saved) and young adults aged 20-29 (0.07% of lives saved and 0.3% of life years saved) contributed very little to the total benefit.

Professor Boccia concludes: ‘These estimates are substantially more conservative than previous calculations that focused mainly on the first year of vaccination, but clearly demonstrate an important overall benefit from COVID-19 vaccination over the period 2020-2024. Most of the benefits, in terms of lives and life-years saved, have been secured for a portion of the global population who is typically more fragile, the elderly’.

Source: EurekAlert!

Categories : Surgeries & Procedures UrogenitalTags :

Study Ranks Kidney Stone Surgical Interventions for Children and Adolescents

On By ModernMedia
Human kidney. Credit: Scientific Animations CC0

Researchers at Children’s Hospital of Philadelphia (CHOP), along with several academic partners, announced the primary results of the Pediatric KIDney Stone (PKIDS) trial, the largest comparative effectiveness study of surgical interventions for children and adolescents with kidney stones. The CHOP-led PKIDS trial, with two published studies, marks a significant breakthrough by offering stronger evidence for treating stones of varying sizes, including new information on patient experiences after surgery, thus reducing uncertainty and empowering informed decision-making for patients, caregivers, and physicians.

Kidney stones were once largely a disease that affected adults. However, kidney stones in children have been on the rise in recent decades, doubling the likelihood that a child will develop a kidney stone. As a result, CHOP founded the PKIDS Care Improvement Network in 2019, which now includes 31 sites in the United States and Canada.   

Ureteroscopy (an endoscopic outpatient procedure), shockwave lithotripsy (a noninvasive outpatient procedure) and percutaneous nephrolithotomy (a minimally invasive surgery with a short hospital stays) are the procedures used to treat children and adults with kidney stones. Most children and adolescents with kidney and ureteral stones are treated with ureteroscopy despite uncertainty of which procedure is more effective and their impact on patients’ lives.  As pioneers in urology, CHOP leaders aimed to enhance pediatric patient and caregiver decision-making for kidney stone surgeries while enabling urologists to adopt techniques for optimal outcomes, including patient-selected experiences.

In the first study in JAMA Network Open, Tasian and his team enrolled 1142 patients aged 8 to 21 with kidney and/or ureteral stones between 2020 and 2023 at all 31 sites in the United States and Canada. Researchers evaluated ureteroscopy against shockwave lithotripsy and found that shockwave lithotripsy was associated with less pain and fewer urinary symptoms compared with those who had ureteroscopy. No meaningful differences were detected in stone-free rates for the procedures. 

In the other CHOP-led study in JAMA Network Open, Jonathan S. Ellison, MD, an Associate Professor of Urology at the Medical College of Wisconsin and Pediatric Urologist at Children’s Wisconsin, and the PKIDS team compared percutaneous nephrolithotomy (PCNL) and ureteroscopy. That study found that for children with larger stones, PCNL not only cleared more stones effectively but also led to a better overall recovery experience than ureteroscopy.

Overall, the authors emphasised the post-surgery experiences of children, noting that quality of life factors, such as the loss of school time for children and work time for caregivers, are crucial in determining effective treatment options. While the authors are planning further research, they also hope these findings will lead to immediate improvements for families. 

“The PKIDS trial demonstrated that ureteroscopy and shockwave lithotripsy remove stones equally well and that patients having shockwave lithotripsy recover more quickly after surgery with less pain and fewer urinary symptoms. Our findings provide new information that allow for tailored approaches to kidney stone treatment for children and their families,” said Gregory E. Tasian, MD, MSc, MSCE, Director of the PKIDS network and an attending pediatric urologist in the Division of Urology at Children’s Hospital of Philadelphia. “Although future clinical trials are important, we hope that clinical practice guidelines will consider outcomes that matter to patients.” 

Source: Children’s Hospital of Philadelphia

Categories : Exercise RheumatologyTags :

Exercise Breakthrough Offers Relief for People with Rheumatoid Arthritis

On By ModernMedia
The novel exercise involves applying a pneumatic cuff to restrict the flow of blood. Credit: University of South Australia

New research from the University of South Australia is offering fresh hope to people living with rheumatoid arthritis (RA).

Evaluating the effectiveness of a novel form of exercise – blood flow restricted resistance training – among people with RA, researchers found that this alternative workout method not only improved their strength and physical performance, but also reduced their pain.

Blood flow restricted resistance training involves placing a pneumatic cuff – much like a blood pressure cuff – around the top of the working limb. The cuff is then inflated so that it restricts blood flow out of the limb, creating a highly metabolic environment which forces the muscles to work harder, even when using lighter weights or less effort.

The Arthritis Australia-funded study is the first to trial blood flow restricted resistance training on both the upper and lower limbs in people with RA, using five exercises – leg press, machine hamstring curl, machine knee extension, cable tricep extension, and cable bicep curl – with gradually increasing weights.

All participants in the study reported that they “liked” the programme, and the group showed clear improvements in strength, movement and pain levels.

Lead researcher UniSA’s Dr Hunter Bennett says the training offers a practical and achievable option for people with RA.

“RA can cause a loss of muscle mass and strength, which affects day-to-day activities, independence, and increases the risk of falls and fractures,” he says.

“Resistance training is one of the best ways to rebuild that strength, but for people with RA, using heavy weights can be difficult or harmful due to pain, fatigue or injury risk. This is where blood flow restricted resistance training can help.”

Dr Bennett says this approach is ideal for people who need to do resistance exercises but find it hard to lift weights.

“Many people with health conditions are understandably deterred by exercise, yet it is often one of the best things they can do to improve their condition,” he says.

And while this exercise might look unusual, the research shows that it works.

“This kind of training could be a game-changer for people with rheumatoid arthritis.

“It offers a way to build strength and reduce pain without pushing through discomfort – and that’s incredibly empowering for people who’ve often been limited by their condition.”

While this was a small-scale trial, researchers say the results are promising and lay the foundations for a larger trial comparing blood flow restricted resistance exercise to more traditional exercise approaches.

Source: University of South Australia

Categories : General Interest PaediatricsTags :

“I Looked at Those Tiny Feet”: How a Joburg Mother’s Journey Helped Thousands of Children Walk Without Pain

On By ModernMedia
Dr Saul Kaplan (left) stands next to Dr Kenny Beck, with mother Zukiswa Panyaza as her baby receives a full leg cast at the clubfoot clinic in Tygerberg Hospital’s Division of Orthopedic Surgery, while medical students observe. (Photo: Sue Segar/Spotlight)

By Sue Segar

When Karen Mara Moss’s son was diagnosed with clubfoot, she travelled to the US in search of a life-changing treatment. She made a promise to bring it home and two decades on, her non-profit is at the heart of a remarkable success story.

“I looked at those tiny feet. They were turned over and rigidly pointing inwards,” recalls Karen Mara Moss about the day her son Alex was born in 2003.

For her, the memory is as vivid today as it was then. Within moments of his birth, a concerned obstetrician commented on Alex’s feet. Then the paediatrician diagnosed Alex with bilateral clubfoot, a condition in which a baby is born with one or both feet twisted inward and downward.

“I remember thinking: Will he walk with a limp? Will people mock him?” Moss tells Spotlight. “It was a traumatic time.”

She says the paediatrician told her not to worry. “He said they’d have to cut his feet and straighten them, and it would all be perfect,” says Moss.

Despite having several prenatal scans and tests, the condition had not been picked up before birth.

The most common form of clubfoot present at birth is idiopathic clubfoot, medically known as talipes equinovarus. It is when a baby’s foot is pointed in and down because the tissues connecting the muscles to the bone are shorter than usual, leading to pain and reduced mobility if left untreated, according to a review study published in The Lancet medical journal. In most cases, the cause of this congenital anomaly which ranges from mild to severe, is unknown, baby boys are twice as likely to be born with clubfoot as baby girls, and about half of children with clubfoot have it in both feet. Globally, an estimated 176 000 babies are born with the condition every year.

Eight days after Alex was born, Moss says she met with a paediatric orthopaedic surgeon. She says he told her he’d fixed many clubfeet using the Kite method and even had one patient playing first-team rugby. The Kite method was developed in the 1930s and uses manipulations and castings to achieve a sequential and gradual full correction of the forefoot, then the hindfoot, and finally, the ankle. After the casting is done, the baby wears a special splint to keep the feet pointing slightly outward and upward, but, critically, many would also require further surgery.

Back then, the standard of care for clubfoot was surgical management, says Dr Pieter Maré, an orthopaedic surgeon who heads up the clubfoot clinic at Greys Hospital in Pietermaritzburg, Kwazulu-Natal. “The reality was that a large number of children required extensive surgery before the Ponseti method,” he says.

Moss followed the doctor’s advice, and during that first appointment, she says he began applying casts up to Alex’s knees. “He started wrenching Alex’s foot, holding the back, whilst pushing the front of the foot, and plastering the foot. Alex was blue in the face from screaming. I was crying while holding him down,” she says.

Another way

But after two months and seven casts, she says there was little improvement in Alex’s feet. That is when Moss began searching for answers herself. Doing research on the internet, she discovered the University of Iowa Children’s Hospital website, where she read about a technique developed by Dr Ignacio Ponseti, which he claimed could help children have pain-free, functional feet without surgery.

The Ponseti method was developed in the 1950s but only became more widely used in the United States in the 1990s, and later in much of the rest of the world. The technique uses gentle manipulations and plaster casts to correct the midfoot, hindfoot, and forefoot simultaneously, while the ankle is treated afterwards. In some cases, before the last cast is applied, it may require a percutaneous tenotomy which is a minimally invasive procedure to cut the heel cord that is resistant to stretching. A brace is then fitted the same day as the last cast is taken off.

“The Kite method was developed to correct clubfoot but over time it was realised that this method was using the wrong anatomical methods,” explains Professor Anria Horn, a consultant orthopaedic surgeon at the Red Cross Children’s Hospital in Cape Town.

“There are multiple joints in the foot and the Kite method was, effectively, manipulating the wrong joint in an attempt to bring about the correction in the foot. Ponseti discovered that the manipulation should occur at a different joint,” she says.

Back in 2003, Moss emailed Ponseti, and a few days later called his office. “I was put through to a man with a Spanish accent. He said he’d read my email, and that he’d seen the photos I sent of my son’s feet; that what we’d done was not the way his method worked. He suggested I go to Iowa because nobody in South Africa was practising his method,” she says.

Not long after this, Moss and her husband travelled with ten-week-old Alex for 10 000 miles from sunny South Africa to an unseasonable snowstorm in Iowa.

The idea of travelling to a foreign country to see a “special” doctor that one read about on the internet, with a treatment carrying his name, may raise red flags for some. There are after all no shortage of quacks out there exploiting vulnerable people with just this type of story of an underutilised treatment. Ponseti, however, was a serious scientist and, even by 2003, his method had performed well in several studies and had been quite widely adopted by doctors in the United States.

Moss says in that first visit, Ponseti eventually did a cast all the way up Alex’s leg. “He looked like a little turtle with his legs sticking out. By the time he’d done the second cast, Alex was asleep,” Moss recalls.

“Dr Ponseti’s normal protocol was to remove the cast every week, then re-manipulate the foot into a different position, and reapply the cast. For out-of-town patients, he accelerated the treatment and changed the cast every five days,” she adds.

After just one cast, Alex’s foot looked different, says Moss. “They did another cast, and five days later, it was time for the third cast. Dr Ponseti took the second cast off and then did the percutaneous tenotomy, as well as the third and final cast.”

After this procedure and with Alex now in his final casts, they were told they could return to South Africa and take the casts off three weeks later. Moss said an orthotist measured Alex’s feet before the tenotomy and gave her instructions on how to fit the clubfoot brace he would wear for four years while sleeping.

Three weeks later, back home, Moss soaked the casts off and started to put the brace on at night. She says Alex’s feet were straight.

‘A parting gift’

On her final day in Iowa, Moss recalls Ponseti telling her: “You’re the first South African that’s ever been here. Please go back home and tell the doctors not to operate on clubfoot”. He gave her his book, copies of his research papers, and CDs demonstrating his casting method – a parting gift that would shape the course of her life.

Determined to share her what she had learnt, Moss created a website to provide information on clubfoot. The website gained traction and soon she started getting requests from parents across southern Africa for help to access the Ponseti method.

At the time, Moss says she knew of only one doctor using the method, whom she recommended parents consult. “I’d met him soon after my return to South Africa in 2003 and had lent him Dr Ponseti’s book and papers. He’d then gone to the US to attend a Ponseti training workshop and started using the method. I was sending everyone to him.”

The founding of STEPS

Moss realised the best solution was to bring the training directly to South Africa. In 2005, despite having no experience in running a non-profit organisation, she founded STEPS, driven by her commitment to introduce the Ponseti method across the country.

Moss says STEPS held its first two-day Ponseti training course in 2006, with about 60 paediatric orthopaedic surgeons attending. “Three Ponseti experts came from Canada, Brazil and the UK to give the training. They taught a lot of theory and used bone models to demonstrate the method,” she says.

The second STEPS Ponseti workshop in 2007 focused on public health facilities. Moss says the training took place at the Charlotte Maxeke Johannesburg Academic Hospital.

Partly due to the workshops, partly due to the strength of the accumulating scientific evidence, the method caught on in the country. In 2012, the South African Paediatric Orthopaedic Society officially endorsed the method. A Cochrane Review published in the same year found that, while the available evidence was far from complete, it did indicate that the method works well. Cochrane Reviews are a highly regarded type of study that attempts to assess evidence from all randomised clinical trials relating to a specific medical question.

“The Ponseti method has become the gold standard for the treatment of idiopathic clubfoot,” stated an article published in the World Journal of Orthopedics in 2014. And according to the Lancet study cited earlier, “the Ponseti method is widely recognised as an effective conservative treatment approach for clubfoot that avoids corrective surgery in over 90% of cases”.

Today, Horn says the Kite method isn’t used in South Africa any more, having been replaced by the Ponseti method. “STEPS has played a big part in promoting the Ponseti method in South Africa, as well as providing training, workshops and conferences and supporting clubfoot clinics across the country. Our job would have been much harder without the support that STEPS provides,” she adds.

Ponseti in the public sector

Given the equipment and know-how involved, making the Ponseti method available in South Africa’s public sector was a challenge. In 2013, Moss launched a support programme to help government clinics offer the treatment. STEPS began by partnering with just six clinics. With support from donors, they recruited staff to visit each clinic weekly to guide families or trained someone on-site to do so. They also provided educational materials to help raise awareness. Over time, this led to STEPS helping develop standard systems and processes for running the clinics, making care more consistent and accessible. When some clinics couldn’t provide braces, STEPS arranged for it to be donated.

Today, STEPS has 48 partner clinics across South Africa, ranging from a tiny rural clinic in Lusikisiki in the Eastern Cape to bigger clinics in Gauteng and the Western Cape. “Lusikisiki might see three patients a week, and Chris Hani Baragwanath Academic Hospital could see 80. They all open once a week, except for some small, rural clinics,” Moss says.

Based on stats that STEPS collected, Moss estimates that at least 2 000 children are born every year with clubfoot in South Africa. Through the help of her organisation, she says: “More than 20 500 children have accessed effective treatment. We’ve … distributed 22 628 clubfoot braces. In 2024, we supported 4 592 children at partner clinics in different stages of the four-year treatment protocol.”

Moss adds that STEPS has conducted over 20 training sessions across South Africa, Namibia, Botswana, and the Seychelles, with more than 2 000 healthcare professionals. “Parents were bringing their children over the border as they couldn’t access treatment back home. We worked with the ministries of health in those countries to teach the Ponseti method there,” she says.

Though separated by an ocean, Moss says she stayed in close contact with Ponseti. She says the last time they saw each other was at a clubfoot symposium in Iowa in 2007. Two years later, he passed away at the age of 95.

“I felt as if I’d lost a member of my family,” Moss says. “He was the master, and he inspired me in my work to improve the lives of children born with clubfoot.” She said she would always carry the ache of missing him, but bringing his method to South Africa, just as she had promised, was something that gave her a deep sense of purpose and peace.

That promise, purpose and peace started with Alex who is today in his final year of a Bachelor of Commerce degree and who, in his own words, “enjoys being active outdoors with my friends”, likes playing padel, and going on hikes.

*This article is part of Spotlight’s 2025 Women in Health series, featuring the remarkable contributions of women to healthcare and science.

Republished from Spotlight under a Creative Commons license.

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Categories : NeurologyTags :

Brain Study Shows TV and Gaming Boosts Young Adults’ Focus, Social Media Hinders It

On By ModernMedia
Photo by Freestocks on Unsplash

A world-first Swinburne-led study into young adults’ brain activity has found that TV and gaming are associated with increased focus, while social media is associated with decreased focus. 

In this study, published in Nature, 18-25 year olds exposed to phone screens for only three minutes experienced changes in mood, energy, tension, focus and happiness, explains one of the lead researchers Swinburne’s Dr Alexandra Gaillard. 

“Our study was the first to record brain activity during different forms of screen use on young adults using functional near-infrared spectroscopy (fNIRS). We found that different forms of screen use, including social media, are associated with distinct patterns in activity and mood states.” 

“Almost everyone owns a smart phone which they use for at least three hours a day for entertainment. Mood disorders are increasing in prevalence worldwide and we shouldn’t rule out the possibility that phones are a contributor.” 

The study found that oxygenated haemoglobin (HbO) levels increased more following social media use and gaming compared to TV viewing, while deoxygenated haemoglobin (HbR) levels increased more following gaming. 

“These findings suggest that interactive types of entertainment really do get the brain more engaged,” says Dr Gaillard.  

“Interestingly, though, when it came to social media, people reported feeling less focused—and those who felt less focused also showed lower levels of brain activity. On the flip side, gaming actually helped boost focus and showed a rise in deoxygenated haemoglobin, which means the brain was actively using more of the oxygen it was getting. In other words, gaming seemed to get the brain working harder in a good way.” 

With six months to go until Australia’s impending teen social media ban, there are still no clear pathways for age-checking tools and the positive impacts of the policy on different types of technology and platforms.  

Dr Gaillard says that while this study looked at young adults, these findings suggest a similar outcome to teenagers which should be considered by experts when implementing the ban. 

“If this is the effect on a fully developed brain, we urgently need to consider the impacts on teenagers and children who are increasingly using these technologies.” 

The Swinburne research team is calling for further research to understand the complex and nuanced relationship between screen activities and how they engage they brain. 

“Excessive screen time can negatively impact cognitive abilities, attention and executive functioning, but we also know how invaluable they can be in forming connections and a sense of belonging as well as improving educational outcomes.” 

“This isn’t a call for blanket reductions; screens certainly serve a purpose for unwinding and leisure. We ask that young people are conscious of how their activity impacts them and that they make choices that are right for them.” 

Source: Swinburne University

Categories : General Interest HospitalsTags :

Patients Still View Doctor’s White Coat as Symbol of Professionalism and Trust

On By ModernMedia

But women doctors in this attire are often misidentified as nurses or medical assistants. And preferences for doctors’ dress strongly influenced by clinical context/medical specialty

Photo by cottonbro studio

Patients are still more likely to trust doctors and consider them more professional when they wear white coats, although women doctors in this attire are often misidentified as nurses or medical assistants, finds a review of the available research on the topic, published in the open-access journal BMJ Open.

But patient preferences for doctors’ attire seem to be strongly influenced by clinical context and medical specialty, with a growing acceptance of scrubs, especially in emergency or high-risk settings, the findings indicate.

In the 19th century, doctors primarily wore black, because medical encounters were viewed as serious and formal occasions. But with the growing emphasis on hygiene and scientific advancements in medicine, white coats represented cleanliness and professionalism and became standard attire for doctors worldwide in the 20th century, note the researchers.

Since the publication of a previous comprehensive review of published research on the impact of doctors’ attire at work, which highlighted the significant role this has in patient satisfaction, trust, and adherence to medical advice, health care practices and societal expectations have evolved, they explain.

The researchers therefore wanted to update those findings, broadening the scope to include diverse clinical contexts, in a bid to gain a deeper understanding of how doctors’ attire might influence interactions with patients and treatment outcomes.

They scoured research databases for relevant studies published between January 2015 and August 2024. From an initial haul of 724 studies, 32 were eligible for inclusion in the review.

Most of the studies were carried out in the U.S. (17); two each came from Japan, China, and Pakistan; and the rest were carried out in Indonesia, India, Ethiopia, Korea, Germany, Malaysia, Saudi Arabia, Singapore and Switzerland.

Clinical setting had some bearing on patient preferences. For example, palliative care doctors’ attire didn’t affect patients’ trust, or assessments of the practitioner’s capabilities, but patients preferred emergency care doctors to wear white coats or scrubs. And they were happy for primary care doctors to be dressed casually and to wear white coats.

Specialty also seemed to influence perceptions, with patient preferences for doctors to wear white coats observed in orthopedics, surgery, dermatology, ophthalmology, and obstetrics and gynecology, for example.

The included studies indicated a distinct preference among patients for male doctors to wear suits. One study indicated that accessories, such as watches and glasses worn by male doctors, significantly enhanced perceived professionalism and trustworthiness, which aligns with the findings of previously published studies, note the researchers.

The UK, however, has implemented a ‘bare below the elbows’ policy, which bans doctors from wearing white coats, watches, ties and long sleeves to minimize infection risks.

And even when male and female doctors wore identical attire, female doctors were still more likely to be misidentified as nurses or medical assistants—a misidentification that was consistently observed across different cultural settings.

But patients preferred white coats over business or casual attire for both male and female doctors, and irrespective of gender, they favored doctors wearing white coats, perceiving these practitioners to be trustworthy, respectful, skilled, communicative and empathetic.

Notably, male surgeons wearing a white coat over scrubs were looked on less favorably than those wearing a suit with a white coat, scrubs, or just a suit. On the other hand, female surgeons in white coats over scrubs were preferred over those in suits or casual attire.

“This preference aligns with recent evidence indicating that female physicians are often judged more on appearance than their male counterparts. The way female physicians dress significantly influences perceptions of competence and professionalism, highlighting the gendered expectations that patients hold,” write the researchers.

“These gender-specific preferences for surgical attire were each supported by a single study and warrant further validation… Nonetheless, gender-related perceptions of physician attire were consistently reported across studies with a low risk of bias, supporting the robustness of this theme,” they add.

A few studies explored doctors’ attire during the COVID-19 pandemic, when numerous doctors reported a preference for wearing scrubs to prioritize hygiene and ease of movement.

These studies consistently reported a shift in patient preference towards practical and hygienic attire, such as scrubs and face masks, reflecting heightened sensitivity to infection control, say the researchers.

The researchers acknowledge various limitations to their findings, in particular the fact that most of the included studies were carried out in the U.S., there were none from South America, and only a few from European, Asian, and African countries. Many of the studies also relied on self-reported data, and none included children or patients with mental health issues.

“While the traditional white coat is seen as a symbol of professionalism and trust, patients have increasingly accepted scrubs, especially in emergency or high-risk settings,” they write.

“The expectations regarding attire are often gendered, particularly affecting the recognition and respect given to female physicians, which highlights the importance of institutional initiatives aimed at reducing bias and fostering equitable perceptions among patients,” they add.

Medical institutions should consider adopting flexible dress codes that align with patient preferences for different clinical environments and medical specialties, they suggest.

Source: The BMJ

Categories : NeurologyTags :

Getting Vital Creatine into the Brain is a Weighty Problem

On By ModernMedia
Photo by Jonathan Borba on Unsplash

Creatine is popularly known as a muscle-building supplement, but its influence on human muscle function can be a matter of life or death. But getting it to one particular organ that needs it – the brain – is challenging.

“Creatine is very crucial for energy-consuming cells in skeletal muscle throughout the body, but also in the brain and in the heart,” said Chin-Yi Chen, a research scientist at Virginia Tech’s Fralin Biomedical Research Institute at VTC.

Chen is part of a research team working to develop a technique that uses focused ultrasound to deliver creatine directly to the brain. The work, being conducted in the lab of Fralin Biomedical Research Institute Assistant Professor Cheng-Chia “Fred” Wu, will be supported by a $30 000 grant from the Association for Creatine Deficiencies.

Creatine plays a vital role in the brain, where it interacts with phosphoric acid to help create the key energy molecule adenosine triphosphate (ATP). In addition to its role in energy production, creatine also influences neurotransmitter systems.

For example, creatine influences the brain’s major inhibitory pathways that use the neurotransmitter gamma-aminobutyric acid (GABA), which limits neuronal excitability in the central nervous system. It may play a role in a variety of functions, including seizure control, learning, memory, and brain development.

A growing body of research suggests that creatine may itself function as a neurotransmitter, as it is delivered to neurons from glial cells in the brain and can influence signalling processes between other neurons. While creatine deficiency disorders can weaken the skeletal muscle and the heart, they can also severely affect the brain. Many patients see increased muscle mass and body weight with creatine supplements, but they often continue to face neurodevelopmental challenges that can hinder their ability to speak, read, or write.

This is largely caused by the brain’s protective blood-brain barrier preventing creatine entry.

Wu studies therapeutic focused ultrasound, which precisely directs sound waves to temporarily accessed areas of the brain. The process allows drugs to reach diseased tissue without harming surrounding healthy cells. While Wu is investigating this method as a potential treatment for paediatric brain cancer, he also sees potential in applying it to creatine deficiency.

“Through the partnership between Virginia Tech and Children’s National Hospital, I was able to present our work in focused ultrasound at the Children’s National Research & Innovation Campus,” Wu said. “There, I met Dr Seth Berger, a medical geneticist, who introduced me to creatine transporter deficiency. Together, we saw the promise that focused ultrasound had to offer.”

The Focused Ultrasound Foundation has recognised Virginia Tech and Children’s National as Centers of Excellence. Wu said the two organisations bring together clinical specialists, trial experts, and research scientists who can design experiments that could inform future clinical trials.

“It was a moment that made me really excited – that I had found a lab where I could move from basic research to something that could help patients,” Chen said. “When Fred asked me, ‘Are you interested in this project?’ I said, ‘Yes, of course.’”

Because creatine deficiencies can impair brain development, the early stages of Chen’s project will concentrate on using focused ultrasound to deliver creatine across the blood-brain barrier. Chen hopes the technique will restore normal brain mass in models of creatine deficiency.

Source: Virginia Tech