In an Arthritis & Rheumatology analysis of data on 60 980 US adults with autoimmune rheumatic conditions who developed COVID between December 2020 and August 2024, those who received booster or updated (2023-2024) COVID vaccines were less likely to be hospitalised for COVID compared to those who received only the initial series vaccines or who were unvaccinated.
Compared with no vaccination, completion of the initial series, booster vaccination, and updated vaccination were associated with 41%, 71%, and 69% lower adjusted odds of COVID-related hospitalisation, respectively. Among patients who had received only the initial vaccine series versus booster/updated vaccine, the absolute risk reduction was 5.6%.
“Our findings provide important real-world evidence that updated vaccines continue to offer substantial protection in this medically vulnerable population,” said corresponding author Maria I. Danila, MD, MSc, MSPH, of the University of Alabama at Birmingham. “These results underscore the need for continued efforts by clinicians, policymakers, and patient advocacy groups to help ensure that these patients remain current with updated COVID vaccines,” added first author Lesley E. Jackson, MD, MSPH, also of the University of Alabama at Birmingham.
Exposure to light during the nighttime is linked to important and potentially harmful changes to the structure and function of the heart, according to a study of more than 11 000 people published in the European Heart Journal today (Thursday).
The research was led by Professor Lu Qi from Tulane University, New Orleans, USA. He said: “Previous observational studies have linked nighttime light exposure with a higher risk of cardiovascular disease, but little is known about the related cardiac structure and functional changes. We carried out this research to find out what happens to the heart over time when people are exposed to too much light at nighttime.”
The research included 11 071 people who are part of the UK Biobank study. All participants wore a light sensor on their wrists for seven days to measure light levels over night. Three years later, participants were given a cardiac MRI scan to carefully examine the structures and functions of the heart.
Researchers compared people who were exposed to light levels of more than three lux with people exposed to almost no light at night.
This showed that people with high exposure to nighttime light had thickening of the wall of the left ventricle (one of the chambers of the heart), reducing the space inside of the chamber. There were signs that the heart muscle’s ability to flex during a heartbeat was reduced. This is an early indicator of heart dysfunction. Researchers also found changes in the right ventricles and left atria (two other chambers of the heart).
Professor Qi said: “This is the first study of its kind, and it shows that exposure to higher levels of light at nighttime is linked to cardiac remodelling. This is where the structure and function of the heart changes and we typically see it in response to chronic stress or injury to the heart. It’s our body’s way of adapting to that stress, but ultimately it weakens the heart and can lead to heart failure.
“Light pollution has emerged as a new risk factor for cardiovascular disease. Our findings, together with evidence from other studies, suggest that reduction of nighttime light exposure should be considered as one of the potential strategies for preventing heart disease by clinicians and policy makers.”
In an accompanying editorial Professor Thomas Münzel from University Medical Center Mainz, Germany and colleagues said: “It is time for clinicians, particularly those managing patients with heart failure or atrial fibrillation, to start asking about the sleep environment: how dark the bedroom is, whether the patient works night shifts, and how much screen use occurs after sunset. The advice is simple and inexpensive: blackout curtains, warm-coloured bedside lighting, and covering the small standby LEDs on household electronics. From a public health perspective, the implications are larger still. Light pollution is one of the few environmental hazards that cities can control directly and affordably. Shielded fixtures, warm-spectrum bulbs, and dimming or motion-activated streetlights are already available, energy-efficient, and climate-friendly.
“Ultimately, this study is more than an interesting observation. It provides a crucial link between what satellites already show us, i.e. a planet glowing ever brighter at night, and the clinical reality unfolding inside our chests: hearts that are becoming stiffer, weaker, and less efficient. The relationship is biologically coherent, the effect sizes are clinically meaningful, and the dose–response is unambiguous: more light, worse outcomes. The takeaway is clear, darkness deserves recognition as a vital sign, as essential to cardiovascular health as blood pressure control and clean air.”
When psychiatrists assess the same patient, they agree on the diagnosis in only about half of cases, according to a new study from the University of Copenhagen. The findings raise concerns about potential misdiagnosis, inappropriate treatment, and errors in psychiatric research.
In the 1970s, psychiatric diagnoses were marked by considerable uncertainty and disagreement. Since then, organisations such as the American Psychiatric Association and the World Health Organization (WHO) have worked to develop standardised diagnostic criteria that psychiatrists around the world can use.
These efforts have shaped modern psychiatry by establishing common, criteria-based systems for diagnosing mental disorders across institutions and national borders.
However, a new study, led by researchers at the University of Copenhagen, suggests that major challenges remain. In the study, 1038 psychiatrists and physicians working in psychiatry from 19 countries were presented with nine written patient case descriptions. Each participant was assigned two cases and asked to determine the most appropriate diagnosis.
The results surprised the researchers.
“Our study shows that when two psychiatrists diagnose the same patient, they will agree only 55% of the time. We consider that worryingly low. In fact, it is similar to the levels reported in some of the studies conducted in the 1970s, which prompted the development of standardised diagnostic criteria in the first place,” says Professor and Consultant Psychiatrist Julie Nordgaard.
“This is not about psychiatrists doing a poor job. Rather, it reflects the fact that, despite the existence of diagnostic systems, clinicians continue to differ in how they interpret symptoms and which features they consider most important. We need a greater degree of consensus, otherwise patients risk receiving changing diagnoses and treatments,” she adds.
Same symptoms, different diagnoses
The study found substantial variation in diagnostic agreement across different mental disorders. Diagnoses within the schizophrenia spectrum proved particularly challenging.
“Cases that could be diagnosed either as schizophrenia or schizotypal disorder generated especially high levels of disagreement. In many of these cases, agreement among participants was well below 50%,” says PhD candidate Mateo Boberg, the study’s first author.
According to Boberg, one reason is that symptoms frequently overlap across psychiatric disorders. For example, obsessive thoughts may occur in both obsessive-compulsive disorder (OCD) and schizophrenia.
“These are not random errors. There is a clear pattern to the disagreements. This likely reflects the fact that diagnostic categories are not as clearly defined as we have assumed, when experienced psychiatrists can interpret the same symptom presentations so differently.”
Diagnostic uncertainty undermines research
Disagreement about diagnoses is an obvious concern for patients. But the researchers argue that diagnostic uncertainty also threatens the reliability of some kinds of psychiatric research¸ explains Professor Mads Gram Henriksen:
“In research, it is essential that we know exactly what we are studying. If a considerable part of participants enrolled in a study on treatment of personality disorders actually suffer from schizophrenia, the study’s results become difficult to interpret. Which condition is the treatment having – or not having – an effect on? Personality disorders or schizophrenia?”
The researchers argue that progress in psychiatric research risks remaining limited until there is a clearer and more widely shared understanding of what mental disorders are and how they can be distinguished from one another. Greater diagnostic agreement, they say, is a prerequisite for the breakthroughs needed to improve patient care.
“WHO’s ICD-10 diagnostic system, which participants in the study used to assess the cases, contains more than 200 diagnoses, a complexity that may contribute to uncertainty. At the same time, many psychiatric conditions are inherently multifaceted,” says Julie Nordgaard and concludes:
“In our view, it is necessary to take a step back and develop more precise descriptions of psychiatric disorders so that clinicians can distinguish them more clearly. It may also be necessary to reduce the number of diagnostic categories.”
Modern medicine prides itself on being a universal science, built on evidence from clinical trials.
But there’s a bias in medical research. While Africa accounts for roughly 25% of the global disease burden and 19% of the global population, the continent’s people are largely invisible in some clinical trials.
The scale of the erasure is revealed in a landmark study of 2,472 randomised controlled trials globally published between 2019 and 2024.
I led this team of researchers, who scrutinised the world’s most influential medical publications to quantify African representation. They included the New England Journal of Medicine, The Lancet, the Journal of the American Medical Association, Nature Medicine, and the British Medical Journal. There were also three leading cardiovascular journals in the study: Circulation, the European Heart Journal and the Journal of the American College of Cardiology.
I am a physician-scientist working at the intersection of cardiometabolic epidemiology and biomedical data science. I also focus on large-scale population studies in Africa and data-driven cardiovascular prevention.
Randomised controlled trials are a cornerstone of evidence-based medicine. Introduced in the mid-20th century, they rigorously evaluate the safety and effectiveness of treatments by randomly assigning participants to different groups. This is done to minimise bias. Trials like these have been central to major medical breakthroughs, from cardiovascular therapies to vaccines. They continue to guide clinical decisions and the development of new treatments worldwide.
What we discovered
Our findings show a profound imbalance in the global clinical research landscape. Across the five most prestigious general medical journals, only 3.9% of trials were conducted exclusively in Africa. In cardiovascular health, the numbers drop to a statistical whisper. Of the major trials published in leading cardiology journals, just two studies (0.6%) were conducted solely on African soil.
This is a crisis of scientific accuracy. When clinical trials exclude African populations, they produce evidence that lacks “external validity”. This refers to how well the results of a study can be generalised beyond the participants. It asks whether findings from a clinical trial will still hold true when applied to different populations, settings, or real-world conditions.
Without that validity, doctors are essentially conducting unmonitored experiments on millions of patients every day.
Modern medicine cannot claim to be universal if entire populations remain invisible in the evidence base. Biology, health systems and disease patterns are not identical across the world.
The gap and why it matters
Many treatments used across the continent are based on evidence generated in non-African populations, raising concerns about their applicability.
Moreover, most Africa-based trials still focus on infectious diseases, despite the rising burden of non-communicable diseases such as cardiovascular disease.
Emerging evidence shows that genetics, environment and diet can radically alter how a body responds to a drug. It therefore makes no medical sense that an entire continent is left out of the trial net.
There’s also evidence showing that certain treatments have different safety profiles in Black patients. Diabetes and gout are just two examples. So are certain common blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors. Research shows that they carry a three- to four-fold higher risk of severe, life-threatening side effects in people of African descent compared to other populations.
When clinical trials exclude populations, doctors are forced to extrapolate findings from one population and apply them to another.
The study also highlights a dangerous lag between global research funding and the evolving reality of African health. The new data show that nearly 76% of trials conducted exclusively in Africa focused on infectious diseases. But the continent is undergoing a massive epidemiological shift. Non-communicable diseases – heart disease, stroke, and diabetes – now account for about 38% of all deaths in many African nations.
The middle class in Africa has tripled to 300 million people from roughly 100 million people in the early 2000s. More people are now living long enough with lifestyles that increase the risk of chronic conditions such as heart disease, diabetes, and hypertension. Consequently, there is a growing need and market for long-term treatments that manage these diseases, rather than short-term therapies for infections. Yet cardiovascular trials continue to be discouraged.
Even within the continent, the data show deep “black holes” of information. South Africa accounted for over 62% of all trials conducted on the continent. Central Africa, a region that’s home to more than 180 million people, was virtually non-existent in the global research record. It contributed less than 3% of the continent’s limited trial output. Possible reasons include South Africa’s decades of cumulative investment, seen in stronger academic hubs, research governance, experienced trial units, and more established sponsor relationships. Other regions face barriers like fewer resourced research institutions, less access to trial platforms, and sometimes language and publication issues that can reduce visibility in top-tier journals.
The inequity extends into the hierarchy of science itself. Even when African sites are included in large, multicontinental trials, they are often relegated to the role of “recruitment hubs” rather than scientific partners. Our study found that African scientists led only 3.6% of multicontinental trials that included an African site.
Towards a new era of African science
Africa should not simply be a location where studies are conducted.
It must be a place where research is conceived, led and interpreted. The current model creates a cycle of external dependence where international institutions manage the funding and the data. This leaves local research systems fragile and unable to translate evidence into national policy.
There is need for “ring-fenced” funding for African-led research, the development of regional trial networks, and a mandate for medical journals to report on the diversity of trial populations.
There are signs of a rising momentum. Organisations like Alliance for Medical Research in Africa are working to equip a new generation of African investigators. Africa must create a research ecosystem that is too important for the global community to ignore.
Every day in South Africa, an estimated 23 people die by suicide, while another 460 attempt suicide.
The impact is particularly concerning among younger people. Globally, suicide is the third-leading cause of death among people aged 15 to 29, according to the World Health Organization’s (WHO) latest estimates.[1] The South African Depression and Anxiety Group (SADAG) is also seeing the extent of the need first-hand as its helplines currently receive between 2 500 and 3 000 calls a day, with around one in four serious suicide-related calls.[2]
“People are crying out for help, and the calls we receive every day show us just how many people are struggling,” says SADAG’s Operations Director Cassey Chambers. “For us to make a meaningful difference and prevent suicides, we can’t just intervene at the point of crisis. People need help recognising the warning signs to make it easier to talk openly about suicide and know where they can turn for help. We need families, friends, schools, workplaces and communities to understand that talking about suicide is crucial and that asking someone directly if they are struggling can open the door to getting them the support they need.”
Every conversation counts
This World Suicide Prevention Day (10 September), Cipla is partnering with SADAG to encourage more of these conversations before someone reaches crisis point. The initiative supports SADAG’s 2026 World Suicide Prevention Day campaign, Every Conversation Counts, which provides South Africans with practical resources to help them understand what to say, how to respond and where to find support.[3]
As part of the campaign, Cipla is introducing the Postcard Wall of Hope, an interactive activation where members of the public can write and share messages of encouragement and support for people they may never meet.
“Sometimes, a few words can mean more than we realise. The Postcard Wall* of Hope is about sharing those words while they can still reach someone, reminding them that their life matters and that it is okay to speak about how they are feeling,” says Paul Miller, CEO of Cipla Africa.
Members of the public can read a postcard, take one that speaks to them or write a message for somebody else to find.
“You don’t have to know who will eventually read your postcard or what they may be going through,” says Miller. “It could simply remind someone that they matter or encourage them to keep going and reach out. The Wall is a way of showing that our words don’t only have to come when it is too late. We can use them now to start conversations and remind people that support is available.”
When to start the conversation
SADAG advises people to take changes in a loved one’s behaviour seriously. Warning signs can include talking about death or suicide, withdrawing from loved ones, risky or self-harming behaviour, giving away personal belongings or a sudden change in mood after a period of depression.[4]
“Importantly, asking somebody directly about suicide does not increase their likelihood of attempting it. SADAG encourages people to ask directly if they are thinking about suicide, listen without judgement and encourage them to seek professional help,” adds Cassey Chambers.
Starting a conversation doesn’t mean you need to know exactly what to say or have all the answers. It can begin with noticing that somebody isn’t themselves and asking how they are really doing. “What matters is that we don’t allow our fear of saying the wrong thing to stop us from saying anything at all,” concludes Miller.
Help is available
Anyone experiencing emotional distress, or concerned about someone they know, can contact SADAG for free telephonic counselling and support:
Cipla Mental Health WhatsApp: 076 882 2775 – daily, 08:00–17:00
For more mental health and suicide-prevention resources, visit the SADAG website: https://www.sadag.org
*The Postcard wall will be launched during Mental Health month in October as malls in Cape Town, Johannesburg and Durban.
References
[1] World Health Organization (2025), *Suicide worldwide in 2021: Global health estimates*. WHO reports suicide as the third-leading cause of death globally among people aged 15–29.
[2]South African Depression and Anxiety Group (SADAG), World Suicide Prevention Day 2026 media information.
[3] South African Depression and Anxiety Group (SADAG), *Every Conversation Counts: World Suicide Prevention Day 2026*.
[4] South African Depression and Anxiety Group (SADAG), *Understanding Suicide*, suicide warning signs and guidance on supporting somebody who may be suicidal.
