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Ciprofloxacin and Cefotaxime Drive Resistance in Hospital Wastewater Bacteria

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Escherichia coli. Photo by CDC on Unsplash

Antibiotics excreted by patients promote antibiotic-resistant bacteria in hospital sewers, according to a new study by researchers at the University of Gothenburg. Ultimately, this may contribute to the development and spread of drug-resistant pathogens. Pinpointing the responsible antibiotics paves the way for targeted measures.

“To my best knowledge, this is the first direct field evidence in over 25 years conclusively linking observed environmental effects to pharmaceuticals excreted from humans”, says Joakim Larsson, Professor of Environmental Pharmacology at the University of Gothenburg and Director of Centre for Antibiotic Resistance Research, CARe. 

The study, published in Nature Communications, examined sewer systems and wastewater from hospitals and municipal treatment plants in eight Swedish cities. Sewage from all ten hospitals promoted antibiotic-resistant bacteria, while no such effects were found after exposure to sewage from the corresponding municipal treatment plants.

Paves the way for tailored measures

International guidelines emphasise the need to limit selection for antibiotic-resistance in the environment, as antibiotic pollution could ultimately render antibiotics ineffective. The observation of strong resistance selection in hospital sewer systems, but not in municipal ones, is significant for where measures should be prioritised. While advanced treatment at municipal sites can reduce the further spread of antibiotics and other pharmaceuticals, it cannot prevent the resistance evolution that has already taken place in hospital sewage. The results therefore point to hospital sewage systems as a critical site for future targeted interventions.

“Knowing where resistant bacteria are promoted – and where they are less likely to be – is crucial when deciding how resources and efforts should be allocated to limit risks for antibiotic resistance development,” says Joakim Larsson.

Similar selection likely occurs in hospital sewers worldwide

When the researchers made a sensitive E. coli strain resistant to fluoroquinolones and penicillin-like antibiotics it was able to grow well in hospital sewage where it otherwise could not. This showed that it was primarily these antibiotic classes that were responsible for giving resistant bacteria an advantage. Ciprofloxacin was identified as a key driver, a commonly used antibiotic in the fluoroquinolone group often prescribed for urinary tract infections. Cefotaxime, a penicillin-like antibiotic only used at hospitals, also contributed. Several independent lines of evidence, including chemical analyses and studies of bacterial cell responses, pointed in the same direction.

“The findings suggest that similar resistance selection occurs in the sewers of most hospitals worldwide. In Sweden, total antibiotic use is relatively low, but hospital use is comparable to that in many other European countries,” explains Joakim Larsson.

“Antibiotic use must always be guided by patients’ medical needs,” he continues. “But now that we know which types of drugs drive resistance selection in sewage, we can also develop more targeted solutions to mitigate risks.”

The research team is currently working intensively to develop a simple, targeted treatment method to reduce the selection pressure in the sewers.

Rare direct evidence in the environment

Most conclusions about environmental effects of pharmaceuticals are based on experiments where researchers intentionally add drugs at concentrations matching those measured in the environment. Such studies show what effects drugs can cause, but not whether those effects actually occur under real-world environmental conditions. The current study goes one step further by documenting effects directly within hospital sewer pipes. Resistant E. coli were enriched in biofilms in hospital sewers compared with the wastewater, whereas no corresponding enrichment was observed at municipal treatment plants.

The last clear field evidence of a similar nature dates back to the late 1990s, when feminisation of fish downstream of treatment plants was linked to pharmaceuticals from human use. Then, as now, Joakim Larsson contributed to identifying the substance responsible, in that case the contraceptive hormone ethinylestradiol.

Link to the study: Widespread selection of antibiotic resistance within hospital sewers in Nature Communications. 

Source: University of Gothenburg

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How Have Diagnostic and Treatment Decisions for Prostate Cancer Changed in Recent Years?

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Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

An analysis of United States data reveals a broad shift away from overtreatment of low-risk prostate cancer. The analysis published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, indicates a shift toward surveillance in response to concerns of overdiagnosis and overtreatment that have hindered screening in the recent past.

During the 2010s, recommendations supporting prostate-specific antigen–based screening for prostate cancer wavered due to growing concerns about the use of unnecessary treatment for slow-growing, localised cancers that posed no threat to patients’ lives. As a result, guidelines supported active surveillance for such low-risk prostate cancer.

To assess the extent to which this shift has translated into reduced treatment among patients, investigators analysed localised prostate cancer cases across the US. in the Surveillance, Epidemiology, and End Results Program (SEER; 2010–2023), the Veterans Affairs health system (VA; 2010–2024), and the Michigan Radiation Oncology Quality Consortium (MROQC; 2021-2025).

The researchers found that since 2010, low-risk prostate cancer has become less common at the time of diagnosis, while patients diagnosed with low-risk cancer increasingly avoid treatment. Specifically, low-risk prostate cancer at diagnosis declined from 28.8% to 24.0% in SEER and from 32.3% to 21.9% in the VA. Among patients diagnosed with low-risk cancer, receipt of neither radiation nor prostate removal increased from 33.6% to 83.4% in 2023 in SEER and from 51.6% to 96.3% in 2024 in the VA. Among 207 196 patients treated with radiation for localised prostate cancer, the proportion with low-risk disease declined from 33.7% to 6.5% in SEER and from 22.9% to 2.0% in the VA. In the more recent MROQC cohort, the proportion remained low, 2.8% to 4.2%, between 2021 and 2025.

“These data reflect broad changes in how prostate cancer is diagnosed and managed in the United States,” said lead author Steven M. Monda, MD, MSCI, of the University of Michigan. “We are seeing a moderate decline in the amount of low-risk prostate cancer being diagnosed, likely reflecting more magnetic resonance imaging use in screening. Moreso however, we are seeing that most of the low-risk prostate cancer is now being appropriately observed and not treated. This is a big win for patients because it means patients are avoiding the harms of unnecessary treatment for cancers that are unlikely to ever affect them.”

Source: Wiley

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New Therapeutic Melanoma Vaccine Cuts Risk of Recurrence or Death by 42%

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Photo by Bermix Studio on Unsplash

In a world-first international trial, adding a therapeutic cancer vaccine to standard immunotherapy after surgery for high-risk melanoma reduced the risk of recurrence or death by 42%. The trial findings herald a foundational shift in how cancer is treated. Proven in melanoma, these results establish a new personalised approach, opening the door for potential new treatments for other cancers.

Intismeran is an mRNA-based individualised neoantigen therapy, a type of personalised therapeutic cancer vaccine. It is designed specifically for each patient, based on the unique identity of their tumour, to train and activate the immune system to recognise and fight cancer.

Adding intismeran to pembrolizumab immunotherapy after surgery for high-risk melanoma reduced the risk of melanoma recurrence or death by 42% compared with pembrolizumab alone.

Professor Georgina Long AO, Medical Director at Melanoma Institute Australia (MIA) and Chair of Melanoma Medical Oncology and Translational Research at The University of Sydney, presented the results of the phase 3 INTerpath-001 clinical trial at the ESMO (European Society for Medical Oncology) Congress 2026.

“These findings are a foundational shift in our approach to cancer: harnessing the immune system in a more personalised way to reduce the risk of melanoma recurrence or death. This has not been achieved before in the history of cancer drug development. It is the coming together of technology, our biological understanding of cancer and the immune system, and the courage to take this idea into the clinic.”

– Professor Georgina Long

This clinical trial included 1137 patients whose melanoma had been surgically removed, but who were at very high risk of it returning (stage IIB to IV). These patients had not previously received any cancer drug treatment. The trial compared treatment with a type of personalised therapeutic cancer vaccine, intismeran, given with pembrolizumab immunotherapy versus treatment with pembrolizumab alone.

Unlike a traditional vaccine that prevents disease in healthy people, intismeran is a therapeutic vaccine, designed for people after a cancer diagnosis who are at high risk of the cancer returning after surgery. It helps the immune system find and kill melanoma cancer cells, so the cancer is less likely to return or to spread to an advanced stage.

A melanoma is considered high risk if it has invaded a deeper layer of skin, has spread to nearby tissue and structures such as lymph nodes, or has metastasised to other areas of the body such as organs.

A 42% reduction in risk

The phase 3 INTerpath-001 results are a landmark moment for cancer treatment. The trial showed adding intismeran to pembrolizumab reduced the risk of melanoma recurrence or death by 42% (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.45–0.75; p < 0.001) compared with pembrolizumab alone. For patients who remained recurrence-free beyond six months from the start of treatment, the reduction in the risk of recurrence or death was even greater, at 58% (HR 0.42) compared with pembrolizumab alone.

Importantly, pembrolizumab side effects were not increased by the vaccine. Treatment was generally well tolerated in patients, with the vaccine causing transient low grade side effects (injection site pain, headache, and chills in some patients).

“These results showed that patients with earlier-stage melanoma can be treated after surgery in a fundamentally new way. But these results are more than a landmark for melanoma, they mark a foundational shift for cancer medicine. The INTerpath-001 trial shows that treatment built from the unique signature of a patient’s own tumour, working alongside checkpoint inhibitor immunotherapy, can sharpen the immune system to find and destroy any remaining cancer cells. Just as email transformed how we communicate, individualised neoantigen therapy has the potential to transform how we treat cancer.”

– Professor Georgina Long

How does this new treatment work?

Abnormal proteins, called neoantigens, give every melanoma its own unique identity, like a fingerprint. The vaccine (also known as individualised neoantigen therapy) is created using mRNA technology.

“We analyse a sample of each patient’s tumour to read its unique neoantigen fingerprint, then create a ‘wanted poster’ of the cancer. This is delivered as mRNA, so the body’s own cells display the poster to the immune system, showing it exactly what to look out for and attack.”

– Professor Georgina Long

The vaccine helps the immune system to identify the individual patient’s tumour cells. Meanwhile pembrolizumab releases the brakes the tumour places on immune cells.

“Cancer can fool the immune system with a fake friendly handshake, so the immune system thinks the cancer cell is normal. Pembrolizumab blocks the handshake, allowing immune cells to recognise the cancer and attack it, but it is the same drug for everyone. The vaccine gives a patient’s immune cells a personalised wanted poster of their cancer, so the combination works in more patients.”

– Professor Georgina Long

The investigational mRNA-based individualised neoantigen therapy (also known as intismeran autogene, intismeran, V940, mRNA-4157, or personalised therapeutic cancer vaccine) is being jointly developed by MSD (tradename of Merck & Co) and Moderna, and is used in combination with MSD’s anti-PD-1 checkpoint inhibitor immunotherapy pembrolizumab.

An international trial

The INTerpath-001 phase 3 clinical trial was an international trial across 157 sites around the world. Professor Georgina Long AO was the global Principal Investigator of this international trial and Chair of the Trial Steering Committee.

“This is the first phase 3 study to show that a treatment built from the unique ‘fingerprint’ of a patient’s own tumour can reduce the risk of recurrence or death from cancer. That fingerprint is read by sequencing the tumour, then a ‘wanted poster’ of the cancer is made as mRNA, showing the immune system exactly what to look for and attack. Having succeeded in melanoma, this proof of concept could mark the beginning of a foundational shift in how we treat cancer, helping patients remain cancer-free for longer.” – Professor Georgina Long

Melanoma leading the way for new cancer treatments

Melanoma is Australia’s cancer. Australia has one of the highest melanoma rates in the world, with one person diagnosed every 30 minutes and one person dying every 6 hours from the disease. It is also the most common cancer in Australians aged 20 to 39.

Progress in melanoma treatment over the past decade has been extraordinary, driven by research led by Melanoma Institute Australia.

Fifteen years ago, survival after a stage IV advanced melanoma diagnosis, where the melanoma has spread to other parts of the body, was measured in months. Today nearly 55% of patients with advanced melanoma are effectively cured.

First came BRAF-targeted drug therapies, followed by checkpoint inhibitor immunotherapies, which harness the body’s own immune system to fight cancer. A recent ground-breaking advance was neoadjuvant immunotherapy, giving immunotherapy before surgery rather than after. Breakthroughs, such as immunotherapy, have transformed outcomes not only for melanoma, but also for cancers such as lung and kidney cancer.

What’s next?

These results now enter a regulatory review process which may take several years, depending on the country. Until then the treatment is not available. Patients with melanoma who want to know more should talk to their medical oncologist. Results will be published in the New England Journal of Medicine (NEJM).

Source: University of Sydney

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Corticosteroid Achilles Injections Show no Meaningful Benefit over Placebo

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Results suggest short lived benefit with steroid injections, but no sustained improvement and possible longer term harm 

Achilles tendon injury. Credit: Scientific Animations CC0

Commonly used injections for Achilles tendinopathy – pain, stiffness and swelling in the Achilles tendon – offer no meaningful clinical advantage over placebo (sham) treatment, finds a clinical trial published by The BMJ.

The results show that high volume injections – delivering saline, local anaesthetic, and sometimes a low dose of corticosteroid around the Achilles tendon – did not improve pain and disability compared with sham injection at 12 months, and therefore do not support routine use.

Achilles tendinopathy is a leading cause of persistent lower limb pain that affects around 6% of people during their lives and disrupts everyday activities such as walking. While exercise based therapy is recommended, up to 44% of patients do not recover and many seek alternative options, including injection therapy.

Some data suggest that corticosteroid containing injections may provide short term symptom improvement, but the longer term clinical effects and cost effectiveness of high volume injections with or without corticosteroid remains uncertain.

To address this, researchers enrolled 192 adults (mean age 49; 55% male) with midportion Achilles tendinopathy from a radiology clinic in Melbourne, Australia between December 2019 and July 2022. Participants were randomly assigned to three groups: sham injection (64), high volume injection without corticosteroid (63), or high volume injection with corticosteroid (65).

All groups received the same exercise programme, education and activity modification advice.

The main outcome of interest was self-reported pain and disability at 52 weeks based on the Victoria Institute of Sport Assessment-Achilles (VISA_A) scale (0-100, where 100 is no pain or disability). Cost per quality-adjusted life-year (QALY) – a combined measure of quantity and quality of life – was also assessed.

At the start of the trial, participants reported moderate to high pain and disability (mean VISA-A score 48.7) and a median symptom duration of two years.

VISA-A data for 181 of 192 (94%) participants at 12 months showed no clear differences between sham and high volume injection either with or without corticosteroid, and between the two injections.

High volume injection with no corticosteroid showed no benefit over sham at any timepoint. High volume injection with corticosteroid provided small, short term improvements over sham at six weeks, but worse outcomes than high volume injection without corticosteroid at 26 weeks.

High volume injection with corticosteroid was more effective (QALYs gained) and less costly than sham, but the overall clinical findings do not support routine use. No serious trial related adverse events were recorded.

The authors acknowledge that they recruited participants primarily via social media, potentially limiting generalisability, they were unable to mask injection providers, and there is a risk that some effects may reflect chance rather than true treatment effects.

However, they say this evidence “should prompt clinicians to reconsider the rationale for using these injections in people with Achilles tendinopathy.”

Corticosteroids are neither all-good, nor all-bad and must be used only in the correct context (where short term needs predominate over longer term needs), says John Orchard at the University of Sydney in a linked editorial.

Crucially, he stresses that a patient should never be told that a corticosteroid will fix or cure a tendinopathy.

“All clinicians recommending or performing corticosteroid injections for tendinopathy need to understand this trade-off and make every effort to explain the broader overview to the patient as part of the informed consent process,” he concludes.

Source: BMJ Group

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How Sex-based Biology Shapes the Brain’s Response to Injury

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Female and male brains seen to activate different hormone networks after traumatic brain injury.

ASU researchers found that patterns of hormone changes and gene activity in the brain differed between males and females after traumatic brain injury. The findings offer clues to how biological sex may influence the response to injury. Graphic generated with Grok AI.

Injury-induced stress cascades through the body by activating immune responses, shifting energy away from less urgent concerns to prioritise healing. In traumatic brain injury, or TBI, the brain, home to the signaling hubs that manage those safety processes, is the site of the incident.

Time is suddenly of the essence. Hormone levels in the blood shift.  Some genes prioritise structural support, including the tight seals of the blood-brain barrier, the lining that controls what passes from the bloodstream into the brain. As injury breaks those seals down, immune cells can move in, and they can help or harm. 

Which pathways the body activates can support tissue repair or contribute to further damage, influencing the brain’s healing journey. 

In a recent Science Advances publication, researchers Sarah Stabenfeldt and Christopher Plaisier outline their study suggesting that patterns of hormone changes and gene activity in the brain differed between males and females after traumatic brain injury.

Stabenfeldt, an assistant vice president and President’s Professor of biomedical engineering, and Plaisier, an associate professor of biomedical engineering, both in the School of Biological and Health Systems Engineering, part of the Ira A. Fulton Schools of Engineering at Arizona State University, say mapping out the affected biological pathways in the brain will advance understanding of how sex-based factors like hormones contribute to the body’s unique injury response.

“Better understanding the drivers of injury with studies such as ours will enable the development of therapeutics and interventions,” Stabenfelt says. “We aim to get the right treatment to the right patient at the right time.”

Tapping into dynamic networks

Hormones sit at the center of a much larger biological network.

“Our hormones do not act alone,” Stabenfeldt says. “The biological networks that control hormone regulation are integrated with almost every other system in the body, meaning sex-based differences have a major influence on our overall biology and how we respond to illness and injury.”

Those whole-body connections come into play long after the initial injury.

“Many people think a TBI starts and ends with the accident, but surviving the initial impact is just the beginning,” Stabenfeldt says. “Damage to key pathways in the brain can trigger(?) secondary damage cascades that may contribute to long-term symptoms and complications for TBI patients.”

After a traumatic brain injury, damage to vital brain pathways can cause swelling, abnormal bleeding and disrupted nutrient delivery, leading to further complications.

Focusing on what matters 

The researchers tackled these mechanisms by looking into the cellular and molecular differences in male and female mice after a traumatic brain injury at various time intervals. They documented changes in hormone concentrations and gene expression within the cerebral cortex, along with the expression of genes involved in immune responses and tissue remodeling, including those that maintain the blood-brain barrier. 

They observed that female mice exhibited a decrease in progesterone and testosterone, and males displayed a delayed decrease in oestradiol. Signaling changes in those three pathways have an established link to adverse outcomes in brain injury. 

“There is strong evidence that TBI affects males and females differently, but we still do not fully understand why,” Plaisier says. “Our study takes a broad look at the biological changes that occur after TBI and identifies connections between changes in hormone levels and biological processes that may help explain these sex differences.”

Thinking long-term

The study gives researchers a new avenue to further understand the body’s early response to traumatic brain injury, revealing how hormone shifts and changes in brain gene activity may work together after an injury. By identifying which processes change, when they change and how those patterns differ between male and female mice, the findings create new opportunities to investigate the biological factors that shape recovery.

That foundation could help researchers identify biological markers that signal how an injury is progressing, determine when particular treatments may be most effective and design preclinical studies that better represent the people those treatments are intended to help. 

Future studies will need to determine how those relationships influence recovery, account for factors such as hormonal fluctuations and test whether changing specific pathways improves outcomes.

“Understanding how sex-based biology influences brain trauma is no longer optional – it is essential,” Stabenfeldt says. “Identifying the specific hormonal and molecular networks at play will help us decode why women experience prolonged symptoms compared to men, opening the door to targeted treatments that account for hormonal and biological differences.”

Original written by Hannah Weisman

Source: Arizona State University

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Narrower Surgical Margins May be Possible Without Increased Risk of Recurrence

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Study explores margin extent in sarcoma surgery, risk of local cancer recurrence in children and youth

The standard treatment for non-rhabdomyosarcoma soft tissue sarcomas is surgery with a complete resection. Photo by Javid Hashimov

It’s a question that surgeons often face: How much surrounding healthy tissue should they take out when removing a patient’s cancer to be sure it is fully eliminated? Removing more can sacrifice nearby nerves, blood vessels, tendons and even joints, with lasting effects on quality of life.

A new study led by UC Davis researchers finds that in at least one type of cancer, control may be achieved with much narrower margins than previously thought.

Until now, surgeons have had no scientific evidence on the optimal surgical margins for paediatric patients with non-rhabdomyosarcoma soft tissue sarcomas (NRSTS).

It is very exciting to find that getting close to the tumour – within a millimetre – can potentially save a blood vessel or healthy tissue and meet the standard of care, something that had never been shown before.”

R. Lor Randall, chair, Department of Orthopaedic Surgery.

In this first-ever large prospective clinical trial, scientists evaluated the risk of local cancer recurrence after surgical and chemoradiation therapies to non-metastatic NRSTS in children and young adult patients.

The trial (ARST0332) by the Children’s Oncology Group showed that close surgical margins as little as a millimetre – less than one tenth of the traditional surgical margin – would preserve precious healthy tissue and maintain low risk of recurrence. The findings were published in JAMA Surgery.

“When we remove a tumour, our goal is to leave no cancer behind. So, when we operate on a child or young adult with soft tissue sarcomas, we ask how surgically aggressive we need to be in obtaining this negative margin?” said UC Davis Health orthopaedic surgeon R. Lor Randall, the study’s senior author.

He specialises in paediatric oncology and is The David Linn Endowed Chair for Orthopaedic Surgery. Randall is also a professor and chair of the Department of Orthopaedic Surgery and director of Sarcoma Advanced Research and Clinical Fellowships at UC Davis Health.

“For a child, a few millimetres can make a lifelong difference when a tumour is next to an important nerve or blood vessel. These findings give us more evidence to help remove the cancer while protecting as much healthy tissue as possible,” Randall said.

About non-rhabdomyosarcomas therapies

NRSTS include many different types of cancers that start in tissues that normally develop into muscles, nerves and tendons. They make up over half of soft tissue cancers in children and young adults. Every year, around 550 new cases are diagnosed in children in the United States alone. 

The standard treatment for NRSTS is surgery with a complete resection (known as R0) to fully remove the tumour with no cancer cells at the microscopic edges of the removed tissue. This is called a negative, or cancer-free margin. Traditionally, the recommended protocol is to have a 1-2 centimetre margin when feasible. However, in a child’s smaller body, this may be difficult to do without damaging important structures.

Some patients also need chemotherapy and radiation therapy. This will depend on the type of cancer, size and grade, as well as whether it can be completely removed. The objective is to prevent cancer from returning.

First study in children looking at non-rhabdomyosarcomas

This is the largest prospective trial to evaluate surgical margins in relation to risk of cancer recurrence.

The researchers assessed the impact of margin extent on local cancer recurrence and survival outcomes in 266 patients. The patients were under the age of 30 (median age 13.7 years) and had non-metastatic NRSTS. All had their tumors completely removed (via resection) with no cancer cells at the margins. Of these, 178 received surgery alone. The other 88 also received chemotherapy and radiation, either before or after surgery.

The team reviewed the patients’ diagnostic imaging, tumor biopsies and resection specimens and operative records. They followed the patients for a median of 6.2 years. They classified them into three groups: low risk with surgery and no other treatment; intermediate risk with upfront surgery followed by chemoradiation; and intermediate risk with upfront chemoradiation followed by surgery.

Low rates of cancer returning with narrow margins

Exact margin widths were available for 132 patients, about half of those studied. In this group, the estimated risk of cancer returning at the surgical site within five years was 4.9% with a 1-millimeter margin, 2.0% with a 2- to 5-millimeter margin, and 0% with a margin of 6 millimeters or more.

“For the first time, we have evidence from a large prospective trial to help answer how closely we can safely get to these tumors,” Randall explained. “So, it is very exciting to find that getting close to the tumor — within a millimeter — can potentially save a blood vessel or healthy tissue and meet the standard of care, something that had never been shown before.”

Randall explained that most smaller tumors (less than 5 cm) do well with close margins even without chemotherapy and radiation. Larger tumors (more than 5 cm), on the other hand, would likely require chemotherapy and radiation.

The study also showed that with surgery and no chemoradiation treatment, the risk of local return of cancer was 5.6% for patients with smaller tumors. For patients with large tumors and who received chemotherapy, the risk of local recurrence was 3.7%.

Randall noted that wider margins may also be more important for patients treated with surgery alone.

“These findings can help surgeons decide when a close, but cancer free margin may be enough, allowing them to preserve more of a young person’s limb and its function,” said Sheri Spunt, coauthor and principal investigator on the trial. Spunt was an endowed professor of pediatric cancer at Stanford University and is now a senior medical director at AbbVie.

By Nadine A Yehya

SOurce:

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Health Experts Call for Pragmatic Harm Reduction Policies as South Africa Confronts Healthcare and Economic Pressures

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MEC for Health Gauteng, Faith Mazibuko

Johannesburg, 23 October 2026 – South Africa needs to strengthen its focus on prevention, adopt evidence-based harm reduction approaches and recognise the economic benefits of investing in healthier communities, according to discussions at a health and wellness colloquium hosted by the Progressive Business Forum (PBF) in Johannesburg on Thursday.

The colloquium, held under the theme “Investing in Health and Wellness: Advancing Economic Prosperity, Prevention and Sustainable Development”, brought together policymakers, health professionals and business representatives to examine how prevention, community-based interventions and collaboration between government and industry can contribute to better health outcomes and economic prosperity.

A central theme emerging from the discussions was the need to move beyond approaches that focus predominantly on treating illness, towards policies and interventions that prevent disease, reduce avoidable harm and address the underlying social and economic factors affecting health.

ANC Treasurer-General and PBF Chairperson Dr Gwen Ramokgopa highlighted the importance of industry investment in health and initiatives aimed at reducing harm, linking improved health outcomes to sustainable economic growth and prosperity.

She welcomed the willingness of industries to engage with society and take an active role in addressing public health challenges, acknowledging those that are stepping forward to contribute to harm reduction efforts. She emphasised the importance of collaboration between government, business and communities in developing practical solutions that improve health outcomes and support economic development.

Gauteng’s Health MEC, Faith Mazibuko, drew attention to the considerable pressure on the province’s public healthcare system, highlighting the millions of patients accessing hospitals, clinics and other healthcare services. She emphasised the importance of strengthening primary healthcare and community outreach programmes to improve access to services and alleviate pressure on hospitals.

Minister of Trade, Industry and Competition Parks Tau highlighted the relationship between poverty, inequality, substance dependence and economic participation.

He noted that the impact of substance use is not experienced equally across society, with poorer communities often exposed to particularly harmful substances and the associated social and economic consequences.

Tau emphasised the importance of targeted interventions that reduce substance dependence and enable greater participation in economic activity.

“We have to and are working on programmes that reduce dependence on these substances as a means to ensure greater economic activity,” he said.

He also questioned whether enforcement alone could adequately address substance dependence, arguing that interventions should be informed by scientific evidence and an understanding of the circumstances affecting individuals.

Reflecting on approaches that rely on forcing people to stop using harmful substances, Tau said: “For as long as we think we’re going to force you, that you will stop because we forced you, science suggests that it does not work that way.”

His remarks reinforced the need for evidence-informed policies that address the underlying causes of substance dependence, while recognising the connection between health, employment, economic opportunity and the social conditions in which people live.

Harm reduction and differentiated risk

Health policy expert and clinician Dr Confidence Moloko argued that harm reduction should be recognised as an important component of public health policy, drawing attention to international approaches that seek to reduce the negative consequences associated with substance use.

Moloko noted that international organisations, including the World Health Organization (WHO), UNAIDS and the United Nations Office on Drugs and Crime, recognise harm reduction as an important component of public health responses to addiction.

However, he questioned what he described as an inconsistency between this recognition and the approach taken under the WHO Framework Convention on Tobacco Control, arguing that harm reduction principles should also be considered in addressing tobacco dependence.

Referring to international approaches, Moloko said: “Now, we cannot have a good approach being reserved for developed countries and not being used in the developing countries.”

His comments came amid broader discussions about the importance of recognising different levels of risk associated with substances, particularly tobacco, and the need for public health policies to respond accordingly.

With the Tobacco Products and Electronic Delivery Systems Control Bill currently before Parliament, Moloko was asked about product differentiation. In response, he pointed to South Africa’s taxation framework as an example of policy that, in his view, already recognises differential harm.

He said the structure of the taxation regime provided an opportunity to examine how differing levels of harm are recognised in policy.

Professor Monique Marks, who addressed the social and economic impact of community-based health and wellness interventions, argued that South Africa’s healthcare system places too much emphasis on treatment rather than prevention, lifestyle management and sustained recovery.

She called for a more integrated approach that considers physical and mental health, social circumstances and the underlying causes of substance dependence.

Marks emphasised the importance of “reducing harm without moralising”, arguing that practitioners should work collaboratively with individuals to identify underlying problems and support measurable improvements in their health and wellbeing.

Drawing on her experience with community-based harm reduction programmes, Marks highlighted how such interventions can improve quality of life and encourage people to access essential healthcare services.

She also argued that investing in lifestyle management and early intervention could reduce avoidable hospital admissions and the long-term costs associated with chronic illness.

The colloquium considered a series of proposed actions to translate discussions into practical interventions.

These included establishing a multisectoral task team involving government, business, academic institutions and the PBF; strengthening public-private partnerships in employee wellness and community health; advancing research into the economic benefits of prevention; and integrating mental health and harm reduction principles into broader health policy.

The discussions highlighted a broader policy challenge: ensuring that South Africa’s response to preventable illness and substance-related harm is informed by evidence, recognises differing risks and prioritises interventions that can improve health outcomes while reducing the long-term economic burden.

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Little Evidence that Common Workplace Ergonomics Help with Pain

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Specialised equipment, standing desks and ergonomic education may do little to ease workplace aches and pains

Photo by TheStandingDesk on Unsplash


An updated Cochrane review has found that ergonomic interventions show no meaningful benefit for pain, function, recovery or sick leave in workers with work-related complaints of the arm, neck or shoulder (CANS), compared with no treatment.

CANS covers disorders that develop from repetitive movements, awkward postures or external forces such as vibrating tools. They significantly affect working populations worldwide. 

Workplaces heavily invest in ergonomic interventions, such as office furniture changes and biomechanical or ergonomic education, to help office workers with CANS. 

No clear benefit for pain, function or sick leave

Led by researchers from the University of Technology Sydney, the review analysed 20 trials, 16 of which looked at non-specific CANS, involving a total of 2478 people with work-related CANS. The participants included workers who frequently use computers in their job.

The review found that, compared with no treatment, usual care or placebo, ergonomic interventions may make little to no difference to short-term pain. They probably make little to no difference to functional status, sick leave or recovery. 

Low-certainty evidence points to possible benefits for quality of life and health care use. Results were mixed, however, and one analysis showed a reduction in health care consumption while another showed little to no difference.

Overall, ergonomic approaches appear less effective than exercise, though small benefits may occur in specific subgroups, such as people with rotator cuff tendinitis.

“When we pooled the best available trials, ergonomic interventions made little to no difference to pain, function, recovery or sick leave compared with no treatment. The certainty of that evidence ranges from low to moderate, so this is a clear signal that the case for these interventions is weaker than many people assume,” says Dr Poonam Mehta, lead author from University of Technology Sydney. 

She continues: “We’d need more evidence to confirm this, as there is not much high-quality research in this area.”

A big investment for companies

Many companies push for and invest heavily in ergonomic interventions. Some examples include ergonomic training, sit-stand desks and specialised equipment such as mouses and ergonomic keyboards.

Repetitive strain injuries can lead to worker absenteeism, a higher turnover and more compensation claims. Workers can also be less productive when they’re in pain. 

“Ergonomic interventions can be a big financial burden for organisations,” continues Dr Mehta. “Our findings suggest that, on current evidence, these measures alone shouldn’t be expected to reduce pain or sick leave in the short term. Employers may want to weigh that against the cost.”

Co-author Dr Peter Stubbs also stated that “the methodological flaws and high risk of bias downgrade the confidence in the results.” 

No data were available on recurrence of injury or complaint, and little data on work-related outcomes beyond sick leave.

Ergonomic strategies may still have value in specific subgroups, or as part of a broader workplace or rehabilitation program, but supporting evidence is limited and uncertain.

The authors call for high-quality, well-designed trials to establish the role of ergonomic strategies in managing CANS.

Read the review

By Mia Parkinson

Source: Cochrane

Categories : Cardiovascular DiseaseTags : Leave a comment

Dual SGLT1/2 Inhibitor May Decrease Risk of Heart Attack and Stroke

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Thrombophilia. Credit: Scientific Animations CC4.0.

Researchers at Michigan Medicine have identified a mechanism that may explain why sotagliflozin, an approved dual SGLT1/2 inhibitor, reduces the risk of myocardial infarction and stroke. Laboratory experiments showed that the drug limits excessive platelet activation and aggregation, processes that promote arterial thrombosis.

Over the past decade, sodium-glucose cotransporter (SGLT)-2 inhibitors, such as empagliflozin and dapagliflozin, have become a mainstay of type 2 diabetes treatment. Over 20% of patients are taking the medications.

Sotagliflozin, a common diabetes medication, has demonstrated an unusual ability in clinical trials. Unlike medications that only target SGLT2, the drug reduced the risk of ischaemic events such as heart attack and stroke.

Sotagliflozin reduced platelet activation in samples from healthy volunteers and people with type 2 diabetes. The team also found that sotagliflozin made platelets less likely to stick together and form blood clots. In mice with injured blood vessels, the drug reduced clot formation by approximately 60%, compared with just 5-10% in animals treated with empagliflozin. 

Genetic or pharmacological SGLT1 blockade in platelets reproduced only part of the effect, indicating additional mechanisms, possibly involving endothelial SGLT1.

“These experiments showed that sotagliflozin has a unique effect, and blocking SGLT2 alone is not enough to inhibit platelet aggregation,” said Eugene Chen, MD, PhD, co-senior author and Frederick G. L. Huetwell Professor of Cardiovascular Medicine at U-M Medical School. 

“Sotagliflozin may offer additional protection against blood clots, potentially lowering the risk of heart attack and stroke.”

Dr Michael Holinstat (co-senior author) noted that a single agent addressing both glycaemic control and ischaemic risk could be advantageous. Dr Eugene Chen (co-senior author) emphasised that SGLT2 inhibition alone is insufficient for anti-platelet activity. Sotagliflozin is already indicated for heart failure, type 2 diabetes, chronic kidney disease and elevated cardiovascular risk; the authors suggest further evaluation in atrial fibrillation and other settings. The work appears in the Journal of Clinical Investigation.

Source: Michigan Medicine

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The Heart’s Unusual Carbohydrate Metabolism Helps It Stay Strong

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Microscope image of heart tissue showing mitochondria (striped oblongs in top right corner). Image credit: Gregory Ducker, PhD.

The heart is the hardest-working muscle in the body, beating constantly no matter what the body’s energy reserves look like. Maintaining energy flow to the heart is a complex process that can break down during common but severe cardiovascular disease conditions like heart failure. 

Researchers previously knew that heart muscle seems to do an unusual metabolic trick to always get enough energy: using two carbohydrate energy sources, glucose and lactate, at the same time. In most human tissues, using more glucose makes it harder to use lactate, and vice versa, but the heart is different.

Now, researchers have found a unique cell-level difference that helps keep heart muscle fuelled up: the ability to burn glucose in the cytosol while burning lactate in the mitochondria. This spatial separation allows both energy-generating reactions to happen simultaneously, helping keep the heart fuelled up no matter the energy source. While mostly dispensable to daily life, this process is crucial to preventing heart failure when the heart is stressed.

The results are published in Nature.

“This appears to be a critical backup system for heart function,” says Gregory Ducker, PhD, assistant professor of biochemistry at University of Utah Health and senior author on a paper describing the results. “In an emergency, we would really, really rely on this.”

The researchers found that the separation between glucose and lactate metabolism depends on a molecule called MCT1, which moves lactate to the inside of the mitochondria. Genetic mutations in MCT1 prevent lactate from entering the mitochondria and disrupt the heart’s energy balance, leading to heart failure when stressed. These results uncover a new requirement for lactate to fuel the injured heart and suggest new therapeutic targets to re-energise the heart during heart failure.   

“Our findings help point to new areas in which we could target the heart muscle to benefit and repair itself by allowing it to use lactate better. That’s the long-term goal: to help the heart muscle heal.”

Gregory Ducker, PhD

The discovery of a new pathway through which the heart muscle can use lactate to generate energy opens promising opportunities for developing new treatments for serious heart conditions, including heart failure and heart attacks.

“Rather than simply releasing lactate into the bloodstream as a waste product, we may be able to enhance the heart’s ability to use it as a valuable source of energy,” says Stavros Drakos, MD, PhD, professor of medicine at University of Utah Health and co-senior author of the study. “By optimising this process, we could potentially improve heart muscle function in patients suffering from heart failure or heart attacks.”

Source: University of Utah Health