A new study presented at the SLEEP 2025 annual meeting found that teens who get moderate, but not excessive, catch-up sleep on weekends have fewer symptoms of anxiety symptoms.
Results show that teens who got up to two more hours of sleep on weekends than on weekdays exhibited fewer anxiety symptoms compared with those who did not sleep longer on weekends. However, longer durations of catch-up sleep on weekends were associated with slightly more internalising symptoms.
“The results show that both sleeping less on weekends than weekdays and sleeping substantially more on weekends were associated with higher anxiety symptoms,” said lead author Sojeong Kim, a doctoral candidate in the department of clinical psychology and psychology graduate advisor at the University of Oregon in Eugene. “In contrast, moderate catch-up sleep – defined as less than two hours – was associated with lower anxiety symptoms, suggesting that some weekend recovery sleep may be beneficial.”
The American Academy of Sleep Medicine recommends that teenagers 13 to 18 years of age should sleep 8 to 10 hours on a regular basis to promote optimal health. However, CDC data show that only 23% of high school students get sufficient sleep on an average school night.
“Many teens try to make up for lost sleep by sleeping in on weekends,” Kim said.
Consistently getting sufficient sleep is associated with better health outcomes including improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. In contrast, insufficient sleep in teenagers is associated with increased risks of problems such as depression and suicidal thoughts.
The study involved 1877 adolescents with a mean age of 13.5 years. Sleep duration was estimated using Fitbit devices, while internalising symptoms were assessed using the Child Behavior Checklist survey. Weekend catch-up sleep was calculated as the difference between weekend and weekday sleep duration.
Kim noted that it is important to identify the right amount of catch-up sleep that is beneficial to teens who restrict their sleep during the week.
“Too little or too much sleep variability from weekday to weekend may contribute to the symptoms someone is trying to combat, like physical or mental fatigue and feelings of anxiety,” she said.
Phase 2 trial reveals that a single dose of psilocybin offers long-term relief from symptoms of depression and anxiety.
Photo by Marek Piwnicki: https://www.pexels.com/photo/macro-photography-of-a-psilocybin-mushroom-13695325/
New results from a clinical trial reveal that a single dose of psilocybin can provide sustained reductions in depression and anxiety in individuals with cancer suffering from major depressive disorder. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
People with cancer often struggle with depression. In this phase 2 trial, 28 patients with cancer and major depressive disorder received psychological support from a therapist prior to, during, and following a single 25mg dose of psilocybin.
During clinical interviews conducted 2 years later, 15 (53.6%) patients demonstrated a significant reduction in depression, and 14 (50%) had sustained depression reduction as well as remission. Similarly, psilocybin reduced anxiety for 12 (42.9%) patients at 2 years.
An ongoing randomised, double-blind trial is currently evaluating up to two doses of 25mg of psilocybin versus placebo as treatment for depression and anxiety in patients with cancer. This study is building on the single-dose study in an effort to bring a larger majority of the patients into remission of depression and anxiety.
“One dose of psilocybin with psychological support to treat depression has a long-term positive impact on relieving depression for as much as 2 years for a substantial portion of patients with cancer, and we’re exploring whether repeating the treatment resolves depression for more than half of the patients,” said lead author Manish Agrawal, MD, of Sunstone Therapies. “If randomised testing shows similar results, this could lead to greater use of psilocybin to treat depression in patients with cancer.”
Access to affordable, quality healthcare in South Africa is a challenge for millions of people. Medical aid is out of reach for low-income earners, and while initiatives like the Low-Cost Benefit Option (LCBO) and the National Health Insurance (NHI) have been proposed, complexity has caused many delays in their implementation. As a result, the Demarcation Exemption Framework was introduced to help bridge the gap, which allows certain insurance products that technically fall under the definition of a medical scheme to operate outside of the Medical Schemes Act.
While it was originally set to expire on 31 March 2025, the Exemption Renewal Framework was recently extended for another two years to 31 March 2027. South Africans can continue to access cost-effective primary healthcare solutions, but in this shifting landscape, brokers play a vital role in guiding their clients toward the best solutions for their needs and budget.
Addressing the healthcare coverage gap
The proposed LCBO framework aims to provide affordable, regulated primary healthcare coverage to lower-income South Africans. It was designed to address the gap between expensive medical aid plans and basic healthcare needs so that more people have access to essential medical services. Unfortunately, it has faced continuous delays, partly because of challenges with integrating it into the NHI. At the same time, the NHI is still a work in progress, and there is no clear timeline for its implementation.
“While South Africa’s regulatory frameworks evolve and have the worthy goal of providing healthcare access to all, the reality is that people need access to affordable primary healthcare solutions today. The extension of the Demarcation Regulations is an important step. It means people can continue to receive the healthcare services they need, like GP consultations, chronic medication, basic health screenings and more, while the challenges with LCBO and NHI are resolved. It also means health insurance providers and brokers can carry on improving affordability and access with innovative product offerings,” says Reo Botes, Managing Executive of Essential Employee Benefits.
Solutions for the now
Under the Demarcation Exemption Framework there are many innovative primary healthcare insurance products that act as a bridge while LCBO and NHI are still being developed. They are by no means a replacement for medical schemes, but they play a very important role in helping people mitigate primary health risks.
“By giving you access to affordable and flexible cover for day-to-day medical expenses, healthcare insurance can provide protection from unexpected medical costs, giving you peace of mind to focus on your health, rather than worrying about bills,” says Len Deacon, head of the health division at Lion of Africa Life Assurance “These products also often cover preventative care, like vaccinations, screenings, and check-ups, which can help detect and prevent illnesses early on. The upshot is that they can improve health outcomes by allowing people to seek treatment without worrying about the financial impact, potentially preventing more serious problems down the line.”
Navigating the uncertainty
When or if LCBO will come to fruition is not clear, and the timeline for the implementation of the NHI remains uncertain. The role of brokers is more important than ever in helping clients to understand their options, simplify processes and find the right cover for their needs during these times. Brokers assess individual needs, compare plans, provide expert advice, and assist with ongoing support, claims, policy adjustments and more.
While we wait for industry reforms to take effect, primary healthcare insurance options offer exceptional value and a variety of products to protect financial and physical wellbeing. The expertise of brokers is invaluable in helping clients to secure affordable and effective primary healthcare that works for now and in navigating this changing landscape in the future.
A review from Murdoch University has stressed that agricultural soils now hold around 23 times more microplastics than oceans.
Amongst the revelations in the comprehensive evaluation is that plastics in soil may be exposed to up to 10 000 chemical additives, most of which are unregulated in agriculture.
“These microplastics are turning food-producing land into a plastic sink,” said PhD candidate Joseph Boctor, who led the study, which appears in Environmental Sciences Europe.
Both microplastics and nanoplastics have now been found in lettuce, wheat and carrot crops. This happens through various means, from plastic mulching, fertilisers and even through being dropped by clouds.
This is particularly concerning when combined with findings of these plastics in the human lungs, brain, heart, blood, and even placenta.
“And BPA-free does not equal risk free,” Mr Boctor said.
“Replacement chemicals like BPF and BPS show comparable or greater endocrine-disrupting activity.”
The challenge is that regulations are slower than science, and industry is faster than both.
In addition to this, assessing additive toxicity is often overlooked, Mr Boctor said, due to the lack of transparency in the plastic industry and large number of additives produced.
“This makes the plastic crisis unchecked, and human health exposed,” he said.
“This review tries to bring this creeping danger under the radar and shine a flashlight on regulators.”
Alongside endocrine disruptors, the review pinpointed other additives in soil such as Phthalates (linked to reproductive issues), and PBDEs (neurotoxic flame retardants).
These additives have been linked with neurodegenerative disease, increased risks of stroke and heart attack and early death.
“These are not distant possibilities – they are unfolding within biological systems – silently and systematically,” Mr Boctor said.
To address this crisis, Mr Boctor is working alongside his colleagues at the Bioplastics Innovation Hub to create a type of plastic that is not only safe, but also decomposes in soil, land and water, leaving behind no legacy.
One innovation currently under development is the Smart Sprays Project – which will demonstrate and test a non-toxic, bioplastic-based spray for soil which forms a water barrier to harvest rainfall and reduce evaporation that can be easily applied with existing farm equipment.
The hope is that through the Hub’s work, they will introduce a green plastic to the market that will minimise and eventually negate the need for non-sustainable plastic production worldwide.
“This review highlights the urgent need for coordinated scientific and regulatory efforts,” Joseph said.
“Regulators, scientists and industry must collaborate to close the loopholes before plastic pollution further entrenches itself in the global food chain.”
Heat takes it out of you. After a long, hot day, we feel tired and grumpy.
But sustained periods of heat do more than that – they age us faster. Cumulative heat stress changes our epigenetics – how our cells turn on or off gene switches in response to environmental pressure.
Now, new research from the United States explores the pressing question of how extreme heat affects humans. The findings are concerning. The more days of intense heat a participant endured, the faster they aged. Longer periods of extreme heat accelerated ageing in older people by more than two years.
As the climate heats up, humans will be exposed to more and more heat – and our bodies will respond to these stresses by ageing faster. These findings are especially pertinent to Australia, where heatwaves are expected to become more frequent and intense in a warmer world.
How, exactly, does heat age us?
Ageing is natural. But the rate of ageing varies from human to human. As we go through life, our bodies are affected by stresses and shocks. For instance, if we don’t get enough sleep over a long period, we will age faster.
While heat can directly sicken or kill us, it also has a long tail. Sustained heat stresses our bodies and make them less efficient at doing the many jobs needed to stay alive. This is what we mean when we say it accelerates biological ageing. This deterioration is likely to precede the later development of diseases and disabilities.
What does that look like on a genetic level? You might think your genes don’t change over your life, and this is mostly true (apart from random mutations).
But what does change is how your genes are expressed. That is, while your DNA stays the same, your cells can switch some of its thousands of genes off or on in response to stresses. At any one time, only a fraction of the genes in any cell are turned on – meaning they’re busy making proteins.
This is known as epigenetics. The most common and best-understood pathway here is called DNA methylation (DNAm). Methylation here refers to a chemical our cells can use to block a DNA sequence from activating and producing proteins with various functions.
Cellular changes in DNAm can lead to proteins being produced more or less, which in turn can flow on to affect physiological functions and our health status. This can be both bad or good.
Heat stress can alter the pattern of which genes are turned off or on, which in turn can affect our rate of ageing.
Severe heat stress can be remembered in cells, leading them to change their DNAm patterns over time. In laboratory testing, the effect is pronounced in fish, chickens, guinea pigs, and mice.
To date, much research on how heat affects epigenetics has focused on animals and plants. Here, the evidence is clear – even a single episode of extreme heat has been shown to have a long-lasting effect on mice.
But only a couple of studies have been carried out involving humans, and they have been limited. This is the gap this new research is intended to help fill.
The study by researchers at the University of Southern California involved almost 3700 people, with an average age of 68 years.
Heat affects older people more than younger people. Our ability to control our body temperature drops as we age, and we are less resilient to outside stresses and shocks. We also know periods of extreme heat trigger a wave of illness and death, especially among older people.
The study set out to better-understand what happens to human bodies at a biological level when they’re exposed to intense heat over the short, medium, and longer term.
To do this, the researchers took blood samples and measured epigenetic changes at thousands of sites across the genome, which were used to calculate three clocks measuring biological age, named PcPhenoAge, PCGrimAge, and DunedinPACE.
Ageing is natural, but the speed at which we age can change. Photo: Bricolage/Shutterstock
Then, they looked at the levels of heat each participant would have been exposed to in their geographic areas over the preceding six years, which was 2010-16. They used the US heat index to assess heat, from caution (days up to 32°C), extreme caution (32–39°C), and danger (39–51°C). They used regression modelling to see how much faster people were ageing over the normal rate of ageing.
The effect of heat was clear in the three biological clocks. Longer-term exposure to intense heat increased biological age by 2.48 years over the six-year period of the study, according to PCPhenoAge; 1.09 years, according to PCGrimAge; and 0.05 years, according to DunedinPACE.
Over the period of the study, the effect was up to 2.48 years faster than normal ageing, where one calendar year equals one biological year of ageing. That is, rather than their bodies ageing the equivalent of six years over a six-year period, heat could have aged their bodies up to 8.48 years.
Importantly, the biological clocks differ quite substantially, and we don’t yet know why. The authors suggest the PCPhenoAge clock may capture a broader spectrum of biological ageing, covering both short-term and longer-term heat stress, while the other two may be more sensitive to long-term heat exposure.
The way these researchers have conducted their study gives us confidence in their findings – the study sample was large and representative, and the use of the heat index rather than air temperature is an improvement over previous studies.
However, the findings don’t account for whether the participants had airconditioning in their homes or spent much time outside.
We need to know more
Perhaps surprisingly, there’s been little research done to date on what heat does to human epigenetics.
In 2020, we conducted a systemic review of the science of how environment affects human epigenetics. We found only seven studies, with most focused on the effect of cold rather than heat.
Now we have this new research that sheds light on the extent to which heat ages us.
As we face a warmer future, our epigenetics will change in response. There’s still a lot of work to do to see how we can adapt to these changes – or if we even can, in some parts of the world. This article originally appeared on The Conversation, and was co-authored with Shuai Li, University of Melbourne.
An international study published in the New England Journal of Medicine sheds light on acute normovolaemic haemodilution, also known as ANH, a blood conservation technique. ANH involves removing a patient’s blood before the patient goes on heart-lung bypass, and then reinfusing it toward the end of heart surgery. Long debated for its effectiveness, ANH does not appear to reduce the need for red blood cell transfusion, according to results of the global clinical trial.
Nevertheless, study co-author Kenichi Tanaka, MD, professor and chair of the Department of Anesthesiology at the University of Oklahoma College of Medicine, said the outcomes necessitate further scrutiny and may not be applicable to US patients.
More than 2 million patients worldwide undergo heart surgery annually, and about 35% require at least one unit of red blood cells. Blood transfusions can lead to complications, are costly, and are sometimes affected by shortages. Previous retrospective studies and meta-analyses have shown mixed results about whether ANH reduces the need for blood transfusions in heart surgery.
Although the study did not show that ANH decreased infusions, several factors should be taken into consideration, said Kenichi Tanaka, MD, who co-led the United States’ participation in the trial along with researchers from the University of Virginia. Altogether, the study recruited 2010 patients from 11 countries in Europe, Asia, South America and North America.
“This trial may reduce the interest in doing another large, randomised study, but I think it does not exclude the possibility that ANH could help some patients,” he said.
Tanaka pointed to several aspects that may make the study less applicable to the U.S., where about 20% of medical centers use ANH:
US centres did not begin enrolling patients in the study until at least half of all participants had been enrolled. He estimates that less than 5% of participants are from the United States.
US patients are typically larger than patients from other countries and, paradoxically, larger body size is protective against surgical bleeding and the need for transfusions.
Smaller patients have less blood to give during ANH. This means a smaller volume is available to treat anaemia and bleeding that can occur while the patient is on a heart-lung bypass machine.
There was no standardised protocol for ANH or transfusion in the trial. Countries like the United States are more likely to use special clotting factor concentrates in combination with ANH, which has been shown to reduce the need for transfusions.
In supplemental information not included in the study, patients receiving ANH showed a slight trend toward better overall survival rates compared to those who received transfusions only.
Tanaka is preparing to publish a retrospective study showing that ANH reduced the need for transfusions in a US population.
“I plan to continue practising ANH,” he said. “It is also an option for Jehovah’s Witness patients whose beliefs stipulate they cannot receive blood transfusions (from donor blood). At the least, the study proved that there is no downside for ANH. I believe ANH can be part of a multi-pronged blood conservation strategy in the US, where blood product costs are very high.”
An investigational brain-computer interface (BCI) allows the study participant to communicate through a computer. Credit: UC Davis
Researchers at the University of California, Davis, have developed an investigational brain-computer interface that holds promise for restoring the ability to hold real-time conversations to people who have lost the ability to speak due to neurological conditions.
In a new study published in the scientific journal Nature, the researchers demonstrate how this new technology can instantaneously translate brain activity into voice as a person tries to speak – effectively creating a digital vocal tract with no detectable delay.
The system allowed the study participant, who has amyotrophic lateral sclerosis (ALS), to “speak” through a computer with his family in real time, change his intonation and “sing” simple melodies.
“Translating neural activity into text, which is how our previous speech brain-computer interface works, is akin to text messaging. It’s a big improvement compared to standard assistive technologies, but it still leads to delayed conversation. By comparison, this new real-time voice synthesis is more like a voice call,” said Sergey Stavisky, senior author of the paper and an assistant professor in the UC Davis Department of Neurological Surgery. Stavisky co-directs the UC Davis Neuroprosthetics Lab.
“With instantaneous voice synthesis, neuroprosthesis users will be able to be more included in a conversation. For example, they can interrupt, and people are less likely to interrupt them accidentally,” Stavisky said.
Decoding brain signals at heart of new technology
The man is enrolled in the BrainGate2 clinical trial at UC Davis Health. His ability to communicate through a computer has been made possible with an investigational brain-computer interface (BCI). It consists of four microelectrode arrays surgically implanted into the region of the brain responsible for producing speech.
These devices record the activity of neurons in the brain and send it to computers that interpret the signals to reconstruct voice.
“The main barrier to synthesising voice in real-time was not knowing exactly when and how the person with speech loss is trying to speak,” said Maitreyee Wairagkar, first author of the study and project scientist in the Neuroprosthetics Lab at UC Davis. “Our algorithms map neural activity to intended sounds at each moment of time. This makes it possible to synthesise nuances in speech and give the participant control over the cadence of his BCI-voice.”
Instantaneous, expressive speech with BCI shows promise
The brain-computer interface was able to translate the study participant’s neural signals into audible speech played through a speaker very quickly – one-fortieth of a second. This short delay is similar to the delay a person experiences when they speak and hear the sound of their own voice.
The technology also allowed the participant to say new words (words not already known to the system) and to make interjections. He was able to modulate the intonation of his generated computer voice to ask a question or emphasize specific words in a sentence.
The participant also took steps toward varying pitch by singing simple, short melodies.
His BCI-synthesized voice was often intelligible: Listeners could understand almost 60% of the synthesized words correctly (as opposed to 4% when he was not using the BCI).
Real-time speech helped by algorithms
The process of instantaneously translating brain activity into synthesized speech is helped by advanced artificial intelligence algorithms.
The algorithms for the new system were trained with data collected while the participant was asked to try to speak sentences shown to him on a computer screen. This gave the researchers information about what he was trying to say.
The electrodes measured the firing patterns of hundreds of neurons. The researchers aligned those patterns with the speech sounds the participant was trying to produce at that moment in time. This helped the algorithm learn to accurately reconstruct the participant’s voice from just his neural signals.
Clinical trial offers hope
“Our voice is part of what makes us who we are. Losing the ability to speak is devastating for people living with neurological conditions,” said David Brandman, co-director of the UC Davis Neuroprosthetics Lab and the neurosurgeon who performed the participant’s implant.
“The results of this research provide hope for people who want to talk but can’t. We showed how a paralyzed man was empowered to speak with a synthesized version of his voice. This kind of technology could be transformative for people living with paralysis.”
Brandman is an assistant professor in the Department of Neurological Surgery and is the site-responsible principal investigator of the BrainGate2 clinical trial.
Limitations
The researchers note that although the findings are promising, brain-to-voice neuroprostheses remain in an early phase. A key limitation is that the research was performed with a single participant with ALS. It will be crucial to replicate these results with more participants, including those who have speech loss from other causes, such as stroke.
Twenty years ago, cosmetic surgery was still a subject of taboo, whispered about behind closed doors. Today, that silence has been replaced by honest conversations about beauty, confidence, ageing, empowerment, and personal choice, as South Africans openly embrace a wide range of aesthetic enhancements. And what South Africans are choosing might surprise you.
Leading plastic and reconstructive surgeon Professor Chrysis Sofianos shares insights from his own practice, revealing how cosmetic surgery trends are evolving across age and race – and what that means for the future of beauty.
“Cosmetic surgery is no longer about fitting a single mould, but about choosing how we, as individuals, want to age, restore, or refine. Today’s patients are more informed, intentional, and unapologetic about their tastes, and wanting to feel good in their own skin,” he says.
Aesthetic choices by age
Gone are the days where cosmetic procedures were the exclusive domain of patients of a certain age. According to Professor Sofianos, the modern approach views aesthetics as a journey, although age still plays a major role in shaping the types of treatments individuals may seek:
20s: Patients in their twenties are often navigating early self-image issues, driven by social media influences. The most requested procedures include breast augmentations, lip fillers, and occasional rhinoplasties to address long-held insecurities.
30s: Often post-pregnancy or in the midst of career and family life, this group leans toward tummy tucks, mommy makeovers, and the start of anti-ageing injections, cosmetic fillers, and preventative treatments. Restoration without exaggeration is usually the goal.
40s: This is the decade of refinement. Liposuction, eyelid lifts, and more assertive facial rejuvenation procedures become common, as patients seek to stay ahead of midlife volume loss and skin laxity.
50s and beyond: For those who want long-term, natural results, the deep plane facelift, neck lifts, and biostimulators become top of mind. “Our approach is structural, not superficial,” he notes. “It’s about restoring facial harmony without compromising identity.”
“What fascinates me is how differently my patients may define beauty. A 22-year-old influencer and a 55-year-old executive might sit in the same waiting room, but their goals couldn’t be more different. We’re not selling a standard look – we’re facilitating personal choices, and sometimes, those choices may even challenge conventional aesthetic norms.”
Understanding patient preferences: A cultural lens
Perhaps the most significant change is how different communities and racial groups are approaching enhancement in South Africa, reflecting new trends in beauty ideals. For example, African women are increasingly choosing breast reductions, prioritising comfort and opting for a different aesthetic from more traditional beauty standards which often favour a fuller figure or more pronounced curves.
Indian patients are leading the way in tummy tucks and body contouring, while Caucasian patients tend to focus on breast augmentations and high-definition liposuction, particularly around the waistline and abdomen, to refine their silhouette and definition.
“What’s beautiful about this shift is how it reflects our diversity. We’re not seeing patients trying to look like someone else – they’re choosing procedures that enhance their natural features and fit their lifestyles,” says Sofianos. “Critically, there is no one-size-fits-all in aesthetic medicine. The more we understand the nuances of each patient’s background and goals, the better we can serve them.”
Why winter is the most strategic time for surgery
No matter your personal objectives, an insider tip could make a huge difference in your surgical recovery: while people mistakenly tend to plan procedures for December – unaware that most surgeons do not operate after November due to holiday closures and the necessity of post-operative care – smart patients are booking for winter.
Cooler temperatures help to reduce swelling, promote easier healing, and generally mean less downtime. Patients also benefit from increased coverage beneath bulkier clothing, allowing them to recover more discreetly while still going about their daily lives. With fewer social commitments and sunnier distractions, winter becomes the ideal window for surgical recovery.
“If you want to look and feel your best by summer, now is the time to plan,” he advises. “Winter is a strategic opportunity for recovery.”
As aesthetic surgery continues to evolve in South Africa, Professor Sofianos believes that education, access, and authenticity are key pillars moving forward.
“My role is to guide patients through their options, help them make informed choices, and deliver results that are both technically excellent and emotionally empowering. The most rewarding part of my practice isn’t about creating one particular look, but about helping people become more confident versions of themselves. Whether that means a subtle enhancement or a more significant change, the choice is truly personal.”
New research from the Icahn School of Medicine at Mount Sinai reveals that patients with moderate-to-severe atopic dermatitis (eczema) who did not initially respond to biologic treatment may still achieve significant clinical improvements with continued therapy.
The findings, published in the latest issue of Journal of the American Academy of Dermatology (JAAD), highlight the efficacy of extended lebrikizumab treatment up to 52 weeks and pave the way for more personalised, patient-centred approaches to managing this chronic skin condition.
Lebrikizumab is designed to treat moderate-to-severe eczema by targeting a key source of inflammation in the body. It works by blocking interleukin-13 (IL-13), a protein that plays a central role in the itching, redness, and skin damage seen in atopic dermatitis.
“This is a significant breakthrough because it shows that people who do not respond to lebrikizumab treatment right away should not give up,” says lead author Professor Emma Guttman-Yassky, MD, PhD, at Mount Sinai. “Initial non-response at 16 weeks does not mean treatment failure. By sticking with treatment longer (52 weeks), most patients saw their eczema improve significantly.”
Researchers analysed data from two international clinical trials. At 16 weeks, 38.1% of lebrikizumab-treated patients failed to meet strict trial criteria for response. However, 58.1% had already achieved at least a 50% improvement in their Eczema Area and Severity Index (EASI) scores. By 52 weeks, 75.5% had reached a 75% improvement (EASI 75), 44.2% had achieved a 90% improvement (EASI 90), and 66.4% reported a significant reduction in itching.
“This research supports a more personalised approach to care,” Dr. Guttman-Yassky says. “It offers new hope for patients with difficult-to-treat eczema and may help guide treatment decisions in clinical practice.”
Corresponding author Kiri Ness, PT, PhD, FAPTA, St. Jude Department of Epidemiology and Cancer Control, working with a patient.
Space has inspired and delighted people for centuries. The much-anticipated advent of crewed spaceflight taught invaluable lessons, even for the most unexpected groups back on terra firma. In the 1960s, astronauts returned from microgravity with decreased bone density. This decrease revealed that bones must undergo constant stress to grow and maintain themselves.
Survivors of childhood cancer, while seemingly unrelated to astronauts in the weightlessness of space, are one group unexpectedly impacted by this revelation. These two distinct groups share a connection in the loss of bone density occurring during a significant life event. Children receiving cancer treatment are often sedentary due to their therapy. Their listlessness mimics microgravity’s effect on astronauts, while the treatment itself may also negatively impact their bone health.
Recent research spearheaded by first author Chelsea Goodenough, PhD, St. Jude Department of Epidemiology and Cancer Control, characterised bone mineral density loss in survivors of childhood cancer. Published in JAMA Network Open, her study looked at survivors five or more years after treatment using the St. Jude Lifetime Cohort Study (St. Jude LIFE). She found that survivors were more likely than age-matched peers to experience low bone mineral density. Low bone mineral density predicted a higher chance of lacking independence, including being unemployed or requiring a personal care attendant, highlighting the need to find ways to intervene to protect and promote survivors’ bone health.
“Glucocorticoids given during cancer therapy can act as a giant hammer to bone mineral density,” said corresponding author Kiri Ness, PT, PhD, FAPTA, St. Jude Department of Epidemiology and Cancer Control. “We found that this loss could have long-term consequences for survivors. We saw 30-year-olds that functionally looked like they were in their 70s and 80s, showing the need for early interventions after treatment.”
Modifiable factors influence survivors’ bone mineral density
“The unique aspect of this study is that we calculated the extent to which different factors contributed to loss of bone density,” Ness said. “That gives us a starting place to design interventions.”
Bone loss decades after treatment could be related to therapy, something investigators can’t change after the fact, but potentially modifiable factors could also be contributing. The St. Jude researchers wanted to see if they could identify any modifiable factors that could point to protective interventions for further investigation.
“We found that about 33% of bone density loss was due to cranial radiation for those who received it,” Ness explained. “But about 25% of the deficit was related to hormone deficiencies, such as hypogonadism.” Hypogonadism is a common consequence of childhood cancer therapy. During treatment, the patient receives hormone-disrupting chemicals, sometimes resulting in an extended deficiency of testosterone or oestrogen and human growth hormone. These three hormones are known to have significant impacts on bone health. Since hormone replacement therapies already exist, the study has identified an area for potential pharmaceutical intervention to address hypogonadism to improve bone density among survivors of childhood cancer.
Lifestyle changes can impact bone health
“Compared to hypogonadism, smoking and sedentary behaviour were responsible for a smaller but still significant decrease in bone density,” Ness said. “But we already have interventions for both; we just need to test them for their effect on bone mineral density.”
Sedentary behaviour is a common experience during treatment. “Understandably, kids don’t feel good during cancer therapy,” Ness explained. “So, they lay in bed.” Lying in bed acts like microgravity: The kids don’t put stress on their bones, resulting in bone loss. However, survivors can prevent this with physical activity. Exercise has already been shown to help protect cardiovascular health among survivors, so the research provides another potential motivation for exercise.
Ness, whose research focuses on lifestyle interventions to support survivors of childhood cancer, already promotes the positives of physical activity. Her insistence, bolstered by this study, has gained her a reputation among patients. “The kids on the floor call me the ‘exercise lady,’” Ness proudly acknowledged. “When they see me, they say, ‘Here she comes, the exercise lady is here.’”
Physical activity to improve bone health could be as simple as jumping or as elaborate as a dedicated heavy weight-lifting programme. The increased activity will likely promote bone maintenance and, hopefully, growth, a parallel to the exercise programme astronauts undergo upon returning from space to re-establish their bone mass.
While exercise is one way in which survivors can improve their bone health, the study also suggested that those who develop a smoking habit may have one more reason to quit. Survivors who smoked were more likely to have a moderate or severe bone mineral density deficit, along with a host of other problems.
“Smoking is just a bad idea for survivors,” Ness said. “Smoking causes a lot of ill effects, not just bone loss. So, we need to encourage young cancer survivors never to start and give cessation interventions to those that have.” Over 20% of survivors in the study currently smoked, indicating a significant opportunity for intervention.
Better understanding means more chances to help
By attributing the sources of bone mineral density loss, the St. Jude scientists have created a roadmap for exploring potential interventions. The ultimate goal is to give survivors of childhood cancer as much independence as possible to take control of their futures.
“I want survivors to know that if they have low bone mineral density, it’s not an insurmountable problem,” Ness said. “You can be proactive – by being physically active, avoiding smoking and making sure your physician understands your chronic health condition. That’s how you give yourself the best chance of having an independent life as an adult, chasing your dreams.”
Maybe, one day, they could even become an astronaut.
