New research from the University of Sydney reveals that obesity, having a knee injury and occupational risks such as shift work and lifting heavy loads are primary causes of knee osteoarthritis.
The study also found that following a mediterranean diet, drinking green tea and eating dark bread could reduce the risk of developing knee osteoarthritis.
Using data from 131 studies conducted between 1988 to 2024, the researchers examined over 150 risk factors in participants ranging from 20 to 80 years old to determine which were associated with an increased risk of developing knee osteoarthritis.
“Our research found that while factors such as eating ultra-processed foods and being overweight increase the risk, addressing lifestyle factors – such as losing weight or adopting a better diet – could significantly improve people’s health,” Associate Professor Abdel Shaheed said.
Co-author Professor David Hunter, a researcher at the Kolling Institute and Professor of Medicine at the University of Sydney, said: “Women were twice as likely to develop the condition than men, and older age was only mildly associated with increased risk.”
Reducing the risk of knee osteoarthritis
Dr Duong, lead author and post-doctoral researcher at the Kolling Institute, said: “Eliminating obesity and knee injuries combined could potentially reduce the risk of developing knee osteoarthritis by 14 percent across the population.
“We urge governments and the healthcare sector to take this seriously and to implement policy reforms that address occupational risks, subsidise knee injury prevention programs, and promote healthy eating and physical activity to reduce obesity.”
Trade unions, medical associations and universities are raising the alarm that Gauteng budget cuts at the cost of doctors’ take-home pay will have dire consequences for public sector health. Meanwhile, the National Minister of Health has convened a committee to review the future of overtime for state doctors.
Dysfunction in the Gauteng Department of Health hit home hard for many public sector doctors on 29 April when their overtime payments due for the month went unpaid.
The non-payment came without notice and affected medical staff in facilities across the province, according to the South African Medical Association (SAMA). Only by 6 May did some doctors start to see payments reflect in their bank accounts. More payments are expected soon given that, according to the Basic Conditions of Employment Act, the employer has seven days to settle, said SAMA.
But tensions are rising as this payment blunder follows a protracted row over the department’s unilateral decision to cut and change the terms of commuted overtime in the province. Proposals to cut down on commuted overtime come in the light of a very tight provincial health budget. As with most other provincial health departments, Gauteng’s health budget has been shrinking in real terms for several years.
The delayed payments and the ongoing review of cuts and changes to commuted overtime pay has led to threats of protests and legal action. SAMA says they will make civil claims for salaries owed, including for interest and legal costs. Registrars and medical officers at Dr George Mukhari Academic Hospital in Ga-Rankuwa collectively wrote to the hospital giving notice of withdrawal of overtime services until the non-payment issue is completely resolved. By 7 May, the head of anaesthesiology at Sefako Makgatho Health Sciences University wrote to the CEO of George Mukhari Hospital informing him that no anaesthesia services would take place at the hospital starting 8 May, given the decision by registrars and medical officers to down tools outside of regular work hours.
Those from the medical fraternity that Spotlight spoke to have set out a series of concerns. These include resignations; an exodus of doctors, especially specialists from the public sector; plummeting staff morale; negative impacts on the training of doctors as fewer consultants and seniors are available to supervise – which then puts universities’ training accreditations at risk. Ultimately, several sources point out, it is the services offered to the public that suffer.
Committee appointed
By the beginning of April, there appeared to be some walking back by the Gauteng health department of its unilateral cutback proposals after meeting with the South African Medical Association Trade Union (SAMATU). In the same week, a circular was issued announcing that the national health department was conducting a review of its own, instructing provinces to hold off on their plans. Health Minister Dr Aaron Motsoaledi then set up a committee of experts to review certain human resource policies in the public healthcare sector. This includes a review of community service, commuted overtime, remunerative work outside the public service for health professionals, and rural and related allowances.
Commuted overtime is a pre-determined amount of overtime that doctors employed by provincial health departments are allowed to work. The amount is historically decided by hospital management and is based on an employee’s role, seniority, the department they work in and the amount of overtime they are allowed to safely work. It’s a fixed rate of 1.3 times the applicable hourly tariff for a specific work grade.
There are five contract options. A is no overtime worked; B is overtime of between four and eight hours a week; C is overtime between 9 and 12 hours a week; D is overtime between 13 and 20 hours per week; and an option E is where, on approval, a doctor can be authorised to work more than 20 hours of overtime a week.
As a fixed amount, commuted overtime is predictable supplemental income and for many doctors, it amounts to about a third of their take-home pay.
The long rumblings to cut their overtime pay has seen doctors being required to motivate why they should remain on contracts that pay for more overtime hours and junior doctors say they are being pressured to sign option C contracts, which will pay for fewer overtime hours. There are also proposals to change some of the terms relating to overtime, including scrapping overtime payments for doctors who are on call but not physically present at a facility.
Many doctors already exceed the maximum hours of their contracts because of the emergency nature of their work, gross understaffing and backlogs at their hospitals.
Costly, but essential?
The commuted overtime pay model has been contentious for years because it adds up to a sizeable chunk of the healthcare budget. According to a spending review conducted in 2022 on behalf of National Treasury, the country’s health departments spent R6.9 billion on commuted overtime in 2021. This made up about 70% of the total R9.9 billion spent on all types of overtime.
In an editorial published in the South African Medical Journal in April 2025, health sciences academics, associations, and unions slammed the Gauteng health department’s handling of pay issues. They argue that the basic salaries of medical professionals in the public health sector are already much lower than what would be considered fair pay.
“COT [commuted overtime] has long served as a critical mechanism to ensure that doctors are available beyond the standard workday, safeguarding round-the-clock care in the public health system…The abrupt curtailment of this framework risks hollowing out the after-hours safety net, leaving emergency rooms, wards and clinics dangerously under-resourced,” they wrote.
A co-author of the editorial, SAMA CEO Dr Mzulungile Nodikida, told Spotlight: “Medical doctors in South Africa’s public sector are severely underpaid. A study by SAMA has shown that even the annual cost of living adjustments that have been made on the salaries have not matched inflation in the last 5 years. Commuted overtime has had the effect of masking a deficient salary.”
He said the Gauteng health department has shown itself to be an “unreliable employer”, adding that its relationship with doctors remains fractured as a loss of confidence in the department deepens.
“This breach of the most basic employment obligation: timely remuneration, has cascading effects. It jeopardises morale, compromises service delivery, and calls into question the department’s commitment to its workforce. Doctors now operate under a cloud of uncertainty, unsure whether they will receive their salaries at month-end. This anxiety permeates every aspect of the employment relationship, from retention efforts to the willingness to engage in additional responsibilities,” said Nodikida.
View from the wards
Two doctors who spoke to Spotlight independently, and from two different Gauteng hospitals, say the commuted overtime pay disaster is yet another symptom of weak human resources and poor management from the department of health. For them, proposals to cut commuted overtime is the department shirking from addressing the staffing crisis; the need to improve human resources systems; and rooting out corruption, maladministration and wasteful expenditure. Both doctors asked not to be named for fear of reprisals.
Dr A, who is based at Charlotte Maxeke Johannesburg Academic Hospital, said: “Instead of having a system in place to record how many hours each doctor is actually working and what overtime that person should be paid, the department pays everyone this commuted overtime fixed sum….[Y]ou could be a dermatologist or a psychologist and have very few overtime hours or be a surgeon who is doing a lot of overtime but you all get paid the same if you’re on the same contract option,” she said. “But right now, in my career I’m working way more overtime hours than my contract and I’m not being reimbursed for any of it.”
Dr A said the overtime pay cuts and proposed changes will impact her decision to stay in the public sector.
“It used to be the case that you were happy, once specialised, to stay because the overall lump sum of money from your salary and commuted overtime made up a decent pay – not comparable to what you could earn in private – but decent enough to stay,” she said.
She said she feels like doctors are now being under-valued and coming under attack by their own employer. “The message we are getting is that ‘if you’re not happy, there’s the door’ – but what the department doesn’t understand is that you can’t just replace someone with 10 years’ experience or someone who has 30 years’ experience, it has a huge impact,” she said.
“Our patients are suffering; and every day it’s like a game of Survivor. We run multiple clinics in one clinic space at Charlotte Maxeke, but you can’t offer a functioning service like that. It’s noisy, the computers don’t work, and the intercom is going off the whole time.
“The other day, I had a 90-year-old patient have a panic attack in the waiting room. He had been waiting for a while and left his wife, who is blind, in the car. He had to park far from the hospital building because the parking lot from the hospital fire [in April 2021] is still not properly repaired and he was overcome with worry,” she said.
Dr B works at Chris Hani Baragwanath Hospital and he said the debacle over doctors’ overtime pay has pushed him to the edge. He said doctors are already overworked and disheartened from working within a failing system. He sent photos to Spotlight of theatres and wards in darkness as power went off at the Soweto hospital for days at the end of April.
Chris Hani Baragwanath Hospital plunged in darkness after days-long power outage in late April. (Supplied)
He said staff bring in their own toilet paper because they’re told there’s none. Most alarming, he said “doctors are not getting the training and supervision they need” and regularly perform surgeries and procedures without adequate experience and with no supervision.
“They are overwhelmed, overworked and doing way too many overtime hours that they’re not being paid for. Then they go home overtired, eat a pizza and crash, sleep a few hours then do it all over again the next day, and the next day,” he said.
“We, doctors, are literally the ones putting patients’ lives at risk,” he said, adding that he is “surviving on anti-depressants” and has sometimes shut himself away in hospital storerooms crying tears of sheer frustration, exhaustion and exasperation.
Dr B does still count the wins though. It’s days when he clears an impossibly long patient list of children who need procedures done. It’s when he and his colleagues decide to push through to make sure no child’s procedure gets cancelled.
“Those are the good days – they’re just few and far between. And now the department is coming for us by cutting our overtime pay and forcing us to sign contracts to downgrade our overtime pay,” he said.
Resignations and impact on training
Professor Shabir Madhi is dean of the faculty of Health Sciences at the University of Witwatersrand. He said the proposed cuts and freezing of posts and changes to commuted overtime pay has already resulted in resignations of some senior staff at state hospitals.
“If we don’t have the proper consultant staff complement in these hospitals who can provide supervision throughout the day, it compromises our training of specialists as well as of undergraduate students.
“If the Health Professions Council of South Africa were to do an audit and find that there isn’t adequate consultant cover and supervision, they could remove the accreditation of the training programmes offered by the universities.
“The medical schools are completely dependent on the Gauteng Department of Health to retain consultants and other categories of staff, and to ensure that staff are allocated time for supervision and training of future medical doctors, including specialist, as well as other academic activities.
“It means decision-making around cuts to overtime pay need to be cognisant of the overall impact that it would have, and not only in how it would assess budget constraints. This situation needs meaningful and informed decision-making,” he said.
Dr Phuti Ratshabedi, Gauteng chairperson of SAMATU, said the non-payment of commuted overtime pay in April was a slap in the face from the provincial health department as the union had a meeting with the department that month and left with the department agreeing to uphold their contractual agreements to leave contracts terms for commuted overtime pay unchanged at least till the end of March 2026 – the end of the financial year.
“What we saw is that the department will promise one thing and do another. But we will be holding them to what they stated in their own circular or we will look to legal action.
“What we want to see in this review period is that they go after departments [where overtime is not being performed, but being paid for] but leave other departments alone – they cannot put everyone under the same blanket.
“If the government is able to bail out over and over things like Eskom and Transnet, how can they not prioritise healthcare – this sets our country way back and we doctors will no longer be silent about this,” said Ratshabedi.
Spotlight sent questions to the Gauteng health department, including on how the payment delay happened; the number of people affected; how the department is addressing the wide-spread knock-on effects of their proposed commuted overtime cuts; and what amendments they hope will come out of the national review. Despite several reminders, the department did not respond to our questions.
Healthy hearts are adaptable, and heartbeats exhibit complex variation as they adjust to tiny changes in the body and environment. Mass General Brigham researchers have applied a new way to measure the complexity of pulse rates, using data collected through wearable pulse oximetry devices. The new method, published in the Journal of the American Heart Association, provides a more detailed peek into heart health than traditional measures, uncovering a link between reduced complexity and future cognitive decline.
“Heart rate complexity is a hallmark of healthy physiology,” said senior author Peng Li, PhD, of the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital (MGH) and the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital (BWH). “Our hearts must balance between spontaneity and adaptability, incorporating internal needs and external stressors.”
The study used data from 503 participants (average age 82, 76% women) in the Rush Memory and Aging Project. The researchers analysed overnight pulse rate measurements – collected by a fingertip pulse oximetry device known as the Itamar WatchPAT 300 device – and comprehensive measures of cognitive functions, collected around the same time as the pulse rate measurement and at least one annual follow-up visit up to 4.5 years later.
The team found that people with greater complexity in their heartbeats at baseline tend to experience slower cognitive decline over time. They determined that the conventional measures of heart rate variability did not predict this effect, indicating their measure was more sensitive in capturing heart functions predictive of cognitive decline.
The researchers plan to investigate whether pulse rate complexity can predict development of dementia, which would make it useful for identifying people at an early stage who might benefit from therapeutic interventions.
“The findings underscore the usefulness of our approach as a noninvasive measure for how flexible the heart is in responding to nervous system cues,” said lead author Chenlu Gao, PhD, also in the Department of Anesthesia, Critical Care and Pain Medicine at MGH. “It is suitable for future studies aimed at understanding the interplay between heart health and cognitive aging.”
Having a larger waistline, high blood pressure and other risk factors that make up metabolic syndrome is associated with an increased risk of young-onset dementia, according to a study published on April 23, 2025, online in Neurology®, the medical journal of the American Academy of Neurology. Young-onset dementia is diagnosed before the age of 65. The study does not prove that metabolic syndrome causes young-onset dementia, it only shows an association.
Metabolic syndrome is defined as having excess belly fat plus two or more of the following risk factors: high blood pressure, high blood sugar, higher than normal triglycerides, which are a type of fat found in the blood, and low high-density lipoprotein (HDL) cholesterol, or “good” cholesterol.
“While most dementia is diagnosed in older age, young-onset dementia occurs while a person is still working and perhaps raising a family,” said study author Minwoo Lee, MD, PhD, of Hallym University Sacred Heart Hospital in Anyang, South Korea. “Our study found having metabolic syndrome in middle age is a risk factor for young-onset dementia.”
For the study, researchers reviewed national health insurance data in South Korea to identify nearly two million people between the ages of 40 and 60 who had a health check-up. The check-up included measurements of waist circumference, blood pressure, blood sugar, triglyceride and cholesterol levels. Of all participants, 25% had metabolic syndrome.
Over an average follow-up period of eight years, 8921 people, or 0.45% of all participants, developed dementia. For those with metabolic syndrome, the incidence rate was 0.86 cases per 1000 person-years, compared to 0.49 cases for those without metabolic syndrome. Person-years represent both the number of people in the study and the amount of time each person spends in the study.
After adjusting for age, education and health factors such as level of physical activity, depression and stroke, researchers found metabolic syndrome was associated with a 24% higher risk of dementia. When looking at specific types of dementia, it was associated with a 12% increased risk of Alzheimer’s disease and a 21% increased risk of vascular dementia.
Researchers found female participants with metabolic syndrome had a 34% increased risk of dementia compared to male participants who had a 15% increased risk. People in their 40s had a greater risk than people in their 50s.
Researchers found each component of metabolic syndrome was associated with an increased risk of dementia, which was cumulative. People with all five components had a 70% increased risk of dementia.
“Our findings suggest that lifestyle changes to reduce the risk of metabolic syndrome, such as eating a healthy diet, exercising regularly, maintaining a healthy weight, quitting smoking and reducing stress, may help reduce the risk of young-onset dementia,” said Lee. “Future research that follows people over longer periods of time and uses brain scans to look for biomarkers of dementia is needed to confirm and expand upon our findings.”
A limitation of the study was that researchers did not review genetic risk factors for Alzheimer’s disease.
The study was supported by the Korean National Research Foundation.
In the first study of its kind, scientists analysed the genetic information of more than 70 000 infants. They identified 11 genetic markers influencing when babies start walking, thus offering multiple targets for future in-depth biological investigation.
In a paper published in Nature Human Behaviour, the study found that genetics accounts for about a quarter of the differences in when children take their first steps.
For years, researchers knew that environmental factors could influence when babies begin to walk, but this new finding shows that genetics also has a major impact. It suggests that, just like with other traits such as height, some children may naturally start walking earlier or later because of their genetic propensity.
Professor Angelica Ronald, Professor of Psychology and Genetics, said: “Most babies take their first step sometime between ages 8 months and 24 months, so it is a wide window in which this exciting milestone happens. It is a big moment for both parents and baby; it symbolises a new phase in a child’s life.”
Dr Anna Gui, an author of the study and a researcher at the University of Rome Tor Vergata and Birkbeck, University of London said: “Until now, we didn’t understand what causes the wide differences between children in when they take their first step. Parents might often worry that walking early or late is a bad sign or that they have done something wrong. We see that genetics play a considerable role in influencing the timing of this milestone.“
Walking isn’t just a key milestone in the development of a child, but it is connected in terms of genetic influences with many other important aspects of human development. The study found that the genetic factors influencing when children take their first step are partly the same genetic factors that influence brain development including the amount of folding and ridges in the outer surface of the brain (the “cortex”). Moreover, walking later within the typical range was linked genetically with less chance of developing ADHD. Finally, the study showed that relatively later onset of walking was influenced by some of the same genes involved in higher educational attainment.
Prof Ronald added: “It is exciting to be able to discover the genes that influence when children learn to walk. Starting to walk independently is a major milestone for young children. We hope these new genetic findings can advance fundamental understanding about the causes of walking and be used to better support children with motor disorders and learning disabilities.”
She added that parents should still see a GP if there was concern, there is a lot of variety in when children take their first unaided step,
Led by scientists in the UK, the study was made possible through a large collaboration with scientists in the UK, Netherlands and Norway, and through UK and international funding including from the Simons Foundation for Autism Research Initiative.
Current treatments to prevent organ transplant rejection focus mainly on suppressing T cells, part of the adaptive immune system. However, the innate immune system – the body’s first line of defence that triggers early inflammation after transplantation – has largely remained untargeted by modern therapies.
In a new study, researchers from Mass General Brigham identified a natural “brake” within the innate immune system: the inhibitory receptor Siglec-E (SigE) and its human counterparts, Siglec-7 and Siglec-9. This receptor helps prevent overactivation of immune cells that drive rejection. When this brake is missing, inflammation worsens, leading to faster rejection in preclinical models. Importantly, transplant patients with higher levels of Siglec-7 and Siglec-9 showed better graft survival, highlighting this pathway as a promising target for new therapies. Results are published in Science Translational Medicine.
“For decades, we’ve focused almost exclusively on controlling T cells to prevent rejection,” said Leonardo Riella, MD, PhD, medical director of Kidney Transplantation at Massachusetts General Hospital (MGH). Riella is also the Chair in Transplantation at Harvard Medical School. “Our research shows that the innate immune system plays a pivotal role. By harnessing natural inhibitory pathways like Siglec-E, we can develop safer, more precise therapies that protect transplanted organs without compromising overall immune health.”
To conduct their studies, the researchers, led by first author Thiago J. Borges, PhD, of the Center for Transplantation Sciences at MGH, used mouse models of heart, kidney, and skin transplantation to study the roles of SigE, the murine equivalent of Siglec-7 and Siglec-9. Recipients deficient in SigE had accelerated acute rejection and increased inflammation. The researchers also looked at the levels of the receptors in samples from human transplant biopsies, finding that higher levels of the receptors were associated with improved allograft survival, suggesting that the findings in mice will be translatable to organ transplants in humans.
“This discovery paves the way for next-generation treatments that address both arms of the immune system, offering hope for longer-lasting transplant success and reducing the need for lifelong immunosuppression,” said Riella.
A study co-led by Indiana University School of Medicine researchers presents a potential new strategy to prevent or slow the progression of Type 1 diabetes by targeting an inflammation-related protein known to drive the disease. The findings, recently published in eBioMedicine, may help inform clinical trials of a drug that is already approved by the U.S. Food and Drug Administration for psoriasis as a treatment for Type 1 diabetes.
In laboratory studies using human cells and mouse models, the researchers found that applying a molecular method to block inflammation signalling through the tyrosine kinase 2 (TYK2) protein reduced harmful inflammation in the pancreas. This strategy not only protected the beta cells in the pancreas but also reduced the immune system’s attack on those cells. A medication that inhibits TYK2 is already approved for the treatment of psoriasis, an autoimmune condition that causes skin inflammation.
“Our study showed that targeting TYK2 could be a powerful way to protect insulin-producing beta cells while calming inflammation in the immune system at the same time,” said Carmella Evans-Molina, MD, PhD, co-author of the study and director of the Indiana Diabetes Research Center and the Eli Lilly and Company Professor of Pediatric Diabetes at the IU School of Medicine. “This finding is exciting because there is already a drug on the market that does this for psoriasis, which could help us move more quickly toward testing it for Type 1 diabetes.”
Past genetic studies have already shown that people with naturally lower TYK2 activity are less likely to develop Type 1 diabetes, further supporting the group’s approach for future treatments using this TYK2 inhibitor approach.
“Our preclinical models suggest that the treatment might work in people as well,” said Farooq Syed, PhD, lead author of the study and assistant professor in the Department of Diabetes-Immunology at the Arthur-Riggs Diabetes and Metabolic Research Institute of the City of Hope. “The next step is to initiate translational studies to evaluate the impact of TYK2 inhibition alone or in combination with other already approved drugs in individuals at-risk or with recent onset Type 1 diabetes.”
Some acute post-ayahuasca “adverse effects” like visual distortions and hallucinations were associated with better reported mental health at a later date, while other adverse effects like feeling isolated or energetically attacked were associated with worse mental health later on
Mounting evidence supports ayahuasca’s potential to improve mental health, but its long-term effects are shaped by both individual mental health history and the context in which the psychedelic is used, according to a study published on April 30, 2025 in the open-access journal PLOS Mental Health by Óscar Andión from Research Sherpas, Spain; José Carlos Bouso from the International Centre for Ethnobotanical Education, Research, and Services (ICEERS) and the University of Rovira i Virgili, Spain; Daniel Perkins from the University of Melbourne and Swinburne University; and colleagues.
Ayahuasca, a psychedelic medicine traditionally used by Indigenous communities in South America, has received increasing interest from Western researchers and clinicians for its potential mental health benefits, but its potential risks and adverse effects remain understudied. In a previous review of adverse effects reported in a global survey of ayahuasca ceremony participants, José Carlos Bouso, Andión, and colleagues found that over half reported adverse mental states after ayahuasca use, with greater adverse experiences associated with a history of mental illness and using the drug in non-traditional settings. Importantly, potential adverse effects reported ranged from visual distortions or hallucinations to “feeling down, depressed, or hopeless”, “feeling disconnected or alone”, and “feeling energetically attacked”.
In their new analysis, the authors applied machine learning and classical statistical approaches to the same dataset to better understand the mediating factors shaping the relationship between adverse events and mental health outcomes in ayahuasca users. The survey included 10 836 participants, of whom 5400 with complete data were included in the final analysis. Among these, 14.2% had a prior anxiety disorder and 19.7% a prior depressive disorder.. Although the Global Ayahuasca Survey reflects a large, diverse population of users, it was voluntary and administered potentially years after an individual’s ayahuasca experience, introducing self-selection and recall biases.
The researchers found that participants with a history of anxiety or depression, as well as those using ayahuasca in non-traditional settings, were more likely to report adverse mental states after use. Some “adverse effects” like visual distortions, however, were associated with significantly better mental health outcomes reported in the present. Adverse effects like “feeling down”, “feeling disconnected”, and “feeling energetically attacked” however, were associated with poorer mental health in participants in the longer term. The authors suggest that the context in which ayahuasca is used, as well as factors like age and mental health history, influence whether an individual experiences psychological benefits following an ayahuasca experience, and note that “adverse” effects of ayahuasca may be subjective.
Their findings appear to indicate that it would be more beneficial to use ayahuasca under the supervision of experienced users who can provide additional support to those with a history of depression, who may otherwise face a higher risk of negative outcomes. They propose that, while psychedelics are becoming increasingly medicalised, ayahuasca is most often consumed in group or community settings. Therefore, future studies should examine the effects of ayahuasca use in these real-life communal contexts.
Dr José Carlos Bouso notes: “What stood out most to us was the significant difference in mental health outcomes between users who had supportive environments [during their use] and those who didn’t. This emphasises the importance of a responsible and well-prepared setting for those seeking healing through ayahuasca.”
On the role of spirituality, Dr Buoso says: “Our research also highlights that the spiritual significance of ayahuasca ceremonies plays a protective role, reducing adverse emotional states like anxiety, depression, and disconnection, thus contributing to overall mental health improvement.
The authors add: “Our study reveals that the post-ayahuasca mental states, traditionally seen as adverse, can contribute to improved mental health, especially in individuals with previous anxiety and depressive disorders. This suggests the need for a more nuanced understanding of these states as potentially beneficial experiences.”
In many countries, males are more likely than females to get sick and die from three common conditions, and less likely to get medical care, according to a new study by Angela Chang of the University of Southern Denmark, and colleagues, published May 1st in the open-access journal PLOS Medicine.
Many health policies are the same for males and females, even though there is strong evidence that sex and gender can substantially influence a person’s health outcomes. In the new study, researchers gathered global health data for people of different sexes and ages for three conditions, hypertension, diabetes, and HIV and AIDS. By comparing rates of diseases between males and females and differences in diagnosis and treatment, the researchers sought to illuminate and reduce health inequities between the sexes.
The analysis identified significant differences between the sexes at each step in the “health pathway,” which includes exposure to a risk factor, development of the condition, diagnosis, treatment and death. Males and females received different care for hypertension, diabetes and HIV and AIDS in 200, 39, and 76 countries, respectively. Males had higher rates of disease and higher rates of death compared to females, and in some countries, were less likely to seek out health care and adhere to treatment. In most countries, males were also more likely to smoke, while females were more like to be obese and engage in unsafe sex.
Overall, the study suggests that public health professionals need to develop strategies to encourage males to participate in preventive and health care services. The researchers also highlight the importance of examining health data by sex to understand health inequities and guide appropriate interventions at multiple points along the health pathway. They conclude that we need more comprehensive datasets for these and other conditions so that we can monitor for sex differences and implement equitable health care policies.
Professors Kent Buse and Sarah Hawkes, co-founders and co-CEOs of Global 50/50 say, “We have long advocated the benefits of publishing sex disaggregated data. As our Gendered Health Pathways demonstrates, such data can reveal where the health journeys of men and women diverge be it in relation to the risk factors they are exposed to, their health care seeking behaviors or their experiences in health care systems. That is an important first step towards health equity. Most of these differences are not explained by sex (biology) alone, but by socially-constructed gender – highlighting the importance of taking a gender justice approach to reducing health inequities. A gender analysis can help to shape systems of health for all.”
Angela Chang, senior author, adds, “The evidence is clear: sex differences persist at nearly every point along the health pathway, from higher smoking rates in men to higher obesity prevalence in women, yet interventions rarely reflect this. Without sex-disaggregated cascade data, we’re flying blind – unable to detect who is falling through the cracks in prevention, diagnosis, and care.”
Research team finds moderate risk for preterm birth, low birth weight
Photo by Thought Catalog on Unsplash
An updated systematic review finds that consuming cannabis while pregnant appears to increase the odds of preterm birth, low birth weight and infant death. This study by researchers at Oregon Health & Science University appears in JAMA Pediatrics.
Study lead author Jamie Lo, MD, MCR, is a physician-scientist who provides prenatal care for high-risk pregnancies at OHSU.
“Patients are coming to me in their prenatal visits saying, ‘I quit smoking and drinking, but is it safe to still use cannabis?’” said Lo, associate professor of obstetrics and gynaecology (maternal-foetal medicine) in the OHSU School of Medicine. “Until direct harms have been proven, they perceive it to be safe to use.”
In fact, cannabis remains one of the most common substances used in pregnancy that’s still illegal under federal law, and, unlike declines in prenatal use of alcohol or nicotine, cannabis use is continuing to increase. Lo said many of her patients are reluctant to give up cannabis during pregnancy because it helps to reduce common prenatal symptoms such as nausea, insomnia and pain.
Researchers updated the systematic review and meta-analysis, drawing on a total of 51 observational studies involving 21.1 million people to examine the potential adverse effects of cannabis use in pregnancy. The researchers found eight new studies since their previous update, raising the certainty of evidence from “very-low-to-low” to “moderate” for increased odds of low birth weight, preterm birth and babies being small for their gestational age.
The updated review also indicated increased odds of newborn mortality, though still with low certainty.
Researchers noted that the new systematic review includes a larger proportion of human observational studies examining people who only use cannabis, but don’t also use nicotine. And even though the evidence is low to moderate for adverse outcomes, Lo noted that the findings are consistent with definitive evidence in nonhuman primate models exposed to THC, the main psychoactive compound in cannabis.
The related research in animal models included standard prenatal ultrasound and MRI imaging that revealed a detrimental effect on the placenta, in terms of blood flow and availability of oxygen in addition to decreased volume of amniotic fluid.
“These findings tell me as an obstetrician that the placenta is not functioning as it normally would in pregnancy,” Lo said. “When the placenta isn’t functioning well, it can affect the baby’s development and growth.”
Even though cannabis remains a Schedule 1 substance under the federal Controlled Substances Act, Oregon is one of several states that have legalised it under state law for medicinal and recreational use. Lo said she recommends a harm-reduction approach to patients. For those who cannot abstain, she advises them to reduce the amount and frequency of use to help reduce the risk of prenatal and infant complications.
“Even using less can mitigate the risk,” she said. “Abstinence is ideal, but it’s not realistic for many patients.”
