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  • Science can drive development and unity in Africa — as it does in the US and Europe

    Science can drive development and unity in Africa — as it does in the US and Europe

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    Indian Prime Minister Nehru and Ghana Premier Nkrumah at the Hotel Carlyle, New York City, in 1960.

    Kwame Nkrumah, pictured with Jawaharlal Nehru, India’s first prime minister after independence from Britain.Credit: Everett Collection Historical/Alamy

    It is within the possibility of science and technology to make even the Sahara bloom into a vast field with verdant vegetation.” These words, which still hold true today, were spoken by Kwame Nkrumah, educator, political theorist and the first president of independent Ghana. Nkrumah made the remarks in a landmark speech some 60 years ago at the launch of the Organisation of African Unity (OAU). The OAU has since been succeeded by the African Union (AU), and the leaders of its 55 member states met last weekend for their annual summit in Addis Ababa.

    There have been some notable successes in advancing Nkrumah and his successors’ vision for scientific cooperation across Africa. One is the creation of the Africa Centres for Disease Control and Prevention, based in Addis Ababa, in 2016. The founding of the African Institute for Mathematical Sciences, which is now more than two decades old, is another. An African Medicines Agency that would harmonize approvals for new medicines is at an advanced stage of development. And the Great Green Wall project to tackle land degradation across borders, although beset by many problems, offers another example of states willingly setting aside their differences in an effort to achieve shared goals.

    Is Africa’s Great Green Wall project withering?

    But funding, especially for smaller-scale collaborations, remains a perennial sticking point. African countries share many challenges that science can help to overcome, among them food insecurity, climate adaptation and conflict, which are also priorities for the United Nations Sustainable Development Goals (SDGs).

    Studies show that researchers in low- and middle-income countries are more focused on the SDGs than are their counterparts in high-income nations. However, the AU does not have a continent-wide fund that would allow African researchers to work together on these shared challenges. Such a fund would not necessarily need to run to hundreds of millions of dollars. It could start small, providing grants for travel to meetings and conferences, for example, or for the development of larger research proposals, or fees to pay for specific training courses. But it is needed.

    A decade ago, the AU and the African Development Bank, based in Abidjan, Côte d’Ivoire, began work on establishing a research and innovation fund. Its scope has since been expanded to include education, and it is now called the African Education, Science, Technology and Innovation Fund. Countries were asked to contribute US$2 million each, which would be matched by the bank from its own sources. Progress has been slow. So far, only Botswana and Ghana have committed funding. The fund’s overall size has been set at $300 million, but who else will contribute and eligibility criteria for funding applications are yet to be worked out. The fund needs to become a priority, say the authors of a review of AU science policies over the past decade, commissioned by the AU and the UN science agency UNESCO, and published at the end of last year (see go.nature.com/3sixqis). Ultimately, that means more heads of government will need to authorize the required finance.

    A row is raging over Africa’s largest dam — science has a solution

    The continent’s leaders do, of course, have more immediate concerns. Many countries are still gripped by an economic crisis that followed the COVID-19 pandemic and Russia’s 2022 invasion of Ukraine. There are also tensions between some of the union’s bigger and more influential member states. Ethiopia, which hosts the AU’s head offices, is at loggerheads with Egypt over the construction of a dam, and with Somalia over access to a seaport. Other nations have problems at home. In Sudan, some 13,000 people have been killed and 6 million displaced since April 2023, as a result of armed conflict. And this week, Senegal has seen huge protests after President Macky Sall controversially decided to delay elections. But there must be room on the agenda for forward-looking projects, too.

    These are also rocky times for other regional unions, not least the European Union, which works closely with — and provides considerable financial support to — the AU. It has lost one of its biggest members, the United Kingdom, as a result of Brexit, and is considering taking legal action against Hungary for violating democratic principles. Europe is also seeing a rise in popular support for parties that do not agree with many EU laws.

    Rifts in national and regional unions inevitably affect scientific cooperation between members. But in the history of such unions, including both the EU and the AU, leaders have generally recognized that there is more to be gained by permitting collaboration between people and institutions than by stopping it.

    By the 1960s, Nkrumah, who had spent a decade studying in the United States in the 1930s and 1940s, wanted for Africa what he saw the United States and European nations achieving. When he spoke at the OAU’s launch in 1963, he noted that “there is hardly any African state without a frontier problem with its adjacent neighbours”. He helped African countries to establish the OAU despite the divisions that existed between them.

    The continent’s researchers need their leaders to show that they are capable of the same forward-thinking now. Science is crucial to solving shared challenges such as hunger and environmental degradation. An Africa-wide fund, even a modest one, will also spark collaborations that could help to create or strengthen bonds of unity. And that alone would be no small win.

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  • Making cities mental health friendly for adolescents and young adults

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  • Survey of US adults reveals common cognitive symptoms in post-COVID-19 patients, linked to impaired daily functioning and depression

    Survey of US adults reveals common cognitive symptoms in post-COVID-19 patients, linked to impaired daily functioning and depression

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    In a recent study published in the journal JAMA Network Open, a team of scientists examined how prevalent self-reported cognitive symptoms were in individuals with post-coronavirus disease 2019 (COVID-19) condition as compared to individuals who had prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections but had not developed post-COVID-19 condition. They also evaluated the impact of these cognitive symptoms on mood, function, and employment status.

    Study: Cognitive Symptoms of Post–COVID-19 Condition and Daily Functioning. Image Credit: PeopleImages.com - Yuri A/Shutterstock.com
    Study: Cognitive Symptoms of Post–COVID-19 Condition and Daily Functioning. Image Credit: PeopleImages.com – Yuri A/Shutterstock.com

    Background

    One of the long-term impacts of the COVID-19 pandemic has been post-COVID-19 condition, commonly referred to as long coronavirus disease (long COVID), where the symptoms of acute SARS-CoV-2 infections persist or remerge months after recovering from the initial infection. The condition consists of wide-ranging symptoms affecting numerous organ systems, with fatigue, shortness of breath, and post-exertional malaise being the most common symptoms.

    Changes in mood and cognitive impairments have also been reported, with studies confirming the long-lasting impact of SARS-CoV-2 infections on neurological health. These persistent physical and neurological symptoms continue to have a significant impact on the functioning and quality of life of the patients long after they have recovered from the initial infection. Understanding how this condition impacts the individual’s productivity or employment status is essential to forming effective treatment mechanisms and public health strategies.

    About the study

    In the present study, the researchers used data from a survey conducted across the United States (U.S.) during two COVID-19 waves among individuals who had reported post-COVID-19 condition symptoms and those who reported complete recovery after a SARS-CoV-2 infection. The data was collected between December 2022 and January 2023 and then again from April to May 2023 across 50 U.S. states.

    The participants were above 18 years of age, and the study population was balanced for demographic factors such as gender, age, race, and ethnicity. A validated measure for patient-reported outcomes was used to design the questions on cognitive symptoms, which largely included questions on how often patients experienced specific symptoms over the previous week with replies on a five-point scale.

    The questions addressed the prevalence of symptoms such as trouble remembering, trouble starting tasks, slowed thinking, finding multitasking difficult, decision-making problems, and needing to pay extra attention to avoid errors. The number of symptoms and presence of these symptoms based on an occurrence rate of at least once a day were recorded for each patient.

    A nine-item questionnaire was also used to assess depressive symptoms in patients. Additionally, the patients were asked to describe how these cognitive post-COVID-19 symptoms interfered with their daily activities. The employment status of the participants was also recorded and categorized as full-time, contract, part-time, self-employed, homemaker, student, retired, or unemployed.

    Sociodemographic information collected from the participants included self-reported race and ethnicity data. The initial SARS-CoV-2 infection and post-COVID-19 condition were defined based on self-reported symptoms from the participants, such as reports of positive test results for COVID-19.

    Results

    The results showed that cognitive symptoms were prevalent in individuals experiencing post-COVID-19 conditions, and these symptoms were associated with functional impairments and a lower likelihood of holding full-time employment. The severity of depressive symptoms was also greater for individuals with cognitive post-COVID-19 symptoms.

    The number of individuals with post-COVID-19 condition who reported experiencing cognitive impairments was significantly higher than those who reported cognitive symptoms but did not have post-COVID-19 condition. Furthermore, women, younger individuals, and people with lower income levels showed a higher prevalence of cognitive symptoms than those in other sociodemographic groups.

    The researchers believe that the higher prevalence of cognitive impairments reported among younger individuals could be due to the notable change from the baseline measurements before the COVID-19 pandemic. Among older individuals, who might already be experiencing cognitive decline associated with age, the cognitive impairments due to post-COVID-19 condition might not be as apparent as in younger individuals.

    The study also suggested that the association between increased prevalence of cognitive impairments among individuals from lower-income households could reflect the influence of economic stress on the vulnerability to cognitive symptoms of post-COVID-19 conditions.

    Conclusions

    Overall, the study found that cognitive decline was highly prevalent among individuals with long COVID or post-COVID-19 conditions, especially among younger individuals, women, and those from low-income households.

    Furthermore, the probability of full-time employment was found to be lower among individuals experiencing cognitive impairments due to long COVID, highlighting the need for public health strategies and treatment measures to improve the quality of life and functional abilities of individuals suffering from post-COVID-19 condition.

    Journal reference:

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  • Pilates lowers blood pressure in hypertensive patients, study finds

    Pilates lowers blood pressure in hypertensive patients, study finds

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    A study published in the Journal of Human Hypertension reveals that Pilates training programs are safe for patients with hypertension and that these programs can be incorporated as a part of their rehabilitation.

    Study: The efficacy of Pilates method in patients with hypertension: systematic review and meta-analysis. Image Credit: ESB Professional / ShutterstockStudy: The efficacy of Pilates method in patients with hypertension: systematic review and meta-analysis. Image Credit: ESB Professional / Shutterstock

    Background

    Hypertension or high blood pressure is a major public health concern because of its widespread prevalence. The condition significantly increases the risk of cardiovascular disease and associated disability and mortality. Although medicines can effectively treat hypertension, consistent treatment adherence is the primary requisite for optimal outcomes.

    Available evidence indicates that a combination of pharmacological and non-pharmacological interventions is highly effective in managing all risk factors associated with hypertension. In particular, physical exercise is considered to be an excellent intervention to reduce blood pressure in hypertensive patients. This intervention effectively reduces blood pressure even in patients who are low responsive to anti-hypertension medications.

    Among various types of physical activities, aerobic exercise is considered the primary option for managing blood pressure. In addition, isometric exercise, dynamic resistance exercise, and high-intensity interval training have shown positive effects in hypertensive patients. However, despite many health benefits, these physical activities are generally associated with a low adherence rate.

    In this systematic review and meta-analysis, scientists have explored the effectiveness of Pilates training programs in managing blood pressure in hypertensive patients. They have considered Pilates an alternative physical exercise option because of its adaptability in various conditions, such as rehabilitation and fitness.   

    Study design

    The scientists searched across four electronic databases for randomized clinical trials and comparative studies that investigated the effect of Pilates training on blood pressure in patients with hypertension.

    A total of four randomized clinical trials and seven comparative studies were included in the final analysis. All these studies were published between 2015 and 2023. Regarding the methodological quality of selected studies, one was low quality, four were good quality, and six were high quality.

    The selected studies included a total of 458 participants with decompensated hypertension, arterial hypertension, or normal tension. All arterial hypertensive participants received anti-hypertensive treatment during the Pilates training.

    Nine out of eleven selected studies used Pilates-based Mat as their study intervention; one used Pilates with apparatus, and one used both. In comparative studies, the control groups performed aerobic exercises or daily life activities.   

    Important observations

    A considerable proportion of selected studies described the positive impacts of Pilates training programs in managing blood pressure in hypertensive patients. Data from three randomized controlled trials and two comparative studies was included in the meta-analysis.

    The findings revealed that Pilates has significantly higher potency in reducing systolic, diastolic, and mean blood pressure compared to other physical activity interventions employed in control groups.

    The meta-analysis of data from four comparative studies indicated that Pilates exerts similar blood pressure-lowering effects in hypertensive and normotensive participants. However, these effects were not statistically significant.

    Study significance

    The meta-analysis finds that Pilates is safe and effective for managing blood pressure in hypertensive patients. However, it might not necessarily have superior effects compared to other physical exercise interventions.

    Most studies included in the systematic review and meta-analysis highlight the significant positive effects of Mat Pilates on blood pressure. This suggests that the incorporation of exercises that require isometric strength could be helpful in lowering blood pressure.

    Mat Pilates is a low-to-moderate-intensity exercise. In contrast, Pilates with apparatus is a high-intensity exercise. Studies that employed Pilates with apparatus could not find any significant blood pressure-lowering effects. This indicates that the intensity of Pilates is an important factor to consider while applying this intervention for blood pressure management. In support of this hypothesis, existing literature depicts that light or moderate aerobic exercise is more effective than high-intensity aerobic exercise in reducing blood pressure.

    Although the findings of the meta-analysis indicated blood pressure-lowering effects of Pilates, overall, it was found that Pilates does not have greater effects than aerobic exercises. Moreover, a combination of aerobic exercise and Pilates failed to demonstrate greater benefits.

    Based on these observations, scientists advise incorporating Pilates as a part of the rehabilitation approach to manage blood pressure in hypertensive patients. However, it should be noted that Pilates may not necessarily offer greater benefits than aerobic exercises and that it may not necessarily help improve adherence to training programs.

    Journal reference:

    • Daniel González-Devesa. 2024. The efficacy of Pilates method in patients with hypertension: systematic review and meta-analysis. Journal of Human Hypertension. DOI: 10.1038/s41371-024-00899-110.10,  https://www.nature.com/articles/s41371-024-00899-1

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  • A Virus Found in Wastewater Beat Back a Woman’s ‘Zombie’ Bacteria

    A Virus Found in Wastewater Beat Back a Woman’s ‘Zombie’ Bacteria

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    But Cole’s progress was short-lived. Her blood infection returned, and her doctors determined the phage-antibiotic combination was no longer effective. She passed away from pneumonia in March 2022, seven months after phage therapy was stopped. Cole’s case demonstrates both the hope and limitations of phage therapy.

    The problem this time wasn’t just bacterial evolution. When researchers ran follow-up lab tests on Cole’s blood, they found evidence of antibodies against the phage, meaning her immune system activated in a way that blocked the phage from attacking the bacteria. They suspect phage therapy may have a sort of tipping point, where giving too much of it could set off an immune reaction that prevents it from working.

    Madison Stellfox, a postdoctoral infectious diseases fellow at Pitt and lead author of the study, says that what they’ve learned from Cole’s case will help inform how to use phage therapy more effectively moving forward, especially as clinical trials of phages are underway at Pitt and elsewhere. “From two to four weeks is probably where we’re getting the most bang for our buck with the phages before the body starts making antibodies against them,” she says. In other words, phages might be better as short-term treatments.

    Two additional patients at other hospitals have since been treated with the same phage therapy that Cole received, and a third is about to be treated. About 20 patients total have been treated with phages across the University of Pittsburgh Medical Center’s hospitals, and 60 to 70 percent of them have responded to the therapy.

    “Infections are complicated,” says Erica Hartmann, a microbiologist at Northwestern University who studies phages and was not involved in Cole’s case. “It’s not as simple as, there’s a bad guy and we treat the bad guy with whatever weapons we have.”

    Persistent bacterial infections are difficult to treat because of the pathogen itself and conditions in the patient’s body. When a patient has an infection for a prolonged period of time, the bacteria has time to change and adapt. With heavy antibiotic use, bacteria evolve to thwart their effects. Add to that factors such as the person’s immune system, microbiome, and overall health—all of which affect how well they’re able to fight off the infection.

    Saima Aslam, an infectious disease specialist at the University of California, San Diego and clinical lead of the Center for Innovative Phage Applications and Therapeutics, says one way to avoid phage resistance is to use several phages at once against an infection.

    Bacteria can develop resistance to a phage by evolving to have different surface markers, so the phage can no longer recognize it. “Using a combination of three or four that have different ways of attaching to the bacteria is, I think, one way to overcome development or resistance,” Aslam says. If the bacteria changes such that one phage doesn’t recognize it, the others still should, she says.

    Aslam says clinical trials will help shed light on which patients and what types of infections may be best suited for phage therapy. Her center has treated 18 patients with around an 80 percent success rate.

    While phages are unlikely to ever replace antibiotics, they could be a powerful tool in combating drug-resistant bacterial infections—if researchers can figure out how best to deploy them.

    For Cole’s daughter Mya, her final beach trip with her mom was a special one. Even though phage therapy didn’t save her, Mya is grateful for that extra time. “I’m very hopeful that what my mom was able to test out will be helpful for other patients so that they can be cured,” she says.

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  • Smoking scars the immune system for years after quitting

    Smoking scars the immune system for years after quitting

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    Close up of a man as he smokes a cigarette in Sundbyberg, near Stockholm.

    The immune-system signature of cigarette smoking persists for many years after a person kicks the habit.Credit: Jonathan Nackstrand/AFP via Getty

    The impacts of cigarette smoking on the immune system lingers long after a smoker’s last puff, according to a study of the immune responses of 1,000 people1.

    The analysis, published in Nature on 14 February, is part of an effort to determine why immune responses vary so widely from person to person. In addition to cigarette smoking, the study found that having a higher-than-average body mass index and having previously been infected with a typically benign virus called cytomegalovirus also affect the immune response.

    “This highlights the importance of considering not only the immediate effects, but also the enduring consequences of lifestyle choices on immune function,” says Yang Luo, a computational immunologist at the University of Oxford, UK, who was not involved in the research.

    Shrugging off an illness

    The COVID-19 pandemic laid bare how divergent immune responses can be, with some people becoming seriously ill after a SARS-CoV-2 infection, whereas others had no symptoms. Previous studies have highlighted the importance of sex, genetics and age in explaining part of this diversity in immune responses, but the role of other factors has not been defined fully.

    Why is COVID life-threatening for some people? Genetics study offers clues

    Computational biologist Violaine Saint-André at the Pasteur Institute in Paris and her colleagues analysed blood samples and questionnaires collected by the Milieu Intérieur Consortium from 1,000 healthy people who live in Brittany, France. The researchers exposed the blood samples to molecules, microorganisms and viruses known to activate the immune system. They then measured the effect of each molecule or pathogen on the production of proteins called cytokines, which regulate the body’s inflammatory responses.

    The authors combined these results with information about 136 personal traits drawn from demographic, environmental and clinical data. They found that three traits stood out as having particularly strong associations with cytokine responses: cigarette smoking, body mass index and previous cytomegalovirus infection.

    The data on cigarette consumption were particularly striking: the effect of smoking on cytokine responses was as large as the effects of age, sex and genetics. And these effects lingered for years after participants had given up cigarettes. Saint-André and her team found that these factors correlated with patterns of chemical tags, called methyl groups, that were added to the cells’ DNA in certain regions. The addition of such methyl groups can alter gene activity.

    Nature plus nurture

    “It is a very important piece of work,” says Vinod Kumar, a geneticist at Radboud University Medical Center in Nijmegen, the Netherlands, not only because of the specific results about smoking, but also because of the overall effort to track sources of variability in immune responses. The study found that individual environmental factors, for example, can affect different cytokines to different degrees. “It makes me wonder how much detail we should consider when we are looking at targeted therapy or personalized medicine,” he says.

    But the study still needs to be repeated to ensure that the results are generalizable, says Saint-André. And, in future, it should include a more ethnically and racially diverse group of participants. The team has now expanded their study to include participants from Senegal and Hong Kong, she says. The researchers have also gone back to the original participants, and have collected fresh blood samples from 415 of them 10 years after the original samples were taken.

    It would be valuable to learn more about how smoking influences immune cell function, and, in turn, what the body’s responses to infection and vaccination are, says Luo. “That could offer valuable insights into the broader health consequences of smoking.”

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  • Interpersonal distrust from childhood bullying linked to mental health problems in teens

    Interpersonal distrust from childhood bullying linked to mental health problems in teens

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    A new study, co-led by UCLA Health and the University of Glasgow, found that young teenagers who develop a strong distrust of other people as a result of childhood bullying are substantially more likely to have significant mental health problems as they enter adulthood compared to those who do not develop interpersonal trust issues.

    The study, published in the journal Nature Mental Health on Feb. 13, is believed to be the first to examine the link between peer bullying, interpersonal distrust, and the subsequent development of mental health problems, such as anxiety, depression, hyperactivity and anger.

    Researchers used data from 10,000 children in the United Kingdom who were studied for nearly two decades as part of the Millennium Cohort Study. From these data, the researchers found that adolescents who were bullied at age 11 and in turn developed greater interpersonal distrust by age 14 were around 3.5 times more likely to experience clinically significant mental health problems at age 17 compared to those who developed less distrust.

    The findings could help schools and other institutions to develop new evidence-based interventions to counter the negative mental health impacts of bullying, according to the study’s senior author Dr. George Slavich, who directs UCLA Health’s Laboratory for Stress Assessment and Research.

    There are few public health topics more important than youth mental health right now. In order to help teens reach their fullest potential, we need to invest in research that identifies risk factors for poor health and that translates this knowledge into prevention programs that can improve lifelong health and resilience.”


    Dr. George Slavich,  study’s senior author

    The findings come amid growing public health concerns about the mental health of youth. Recent studies by the U.S. Centers for Disease Control and Prevention found that 44.2% of sampled high school students in the U.S. reported being depressed for at least two weeks in 2021, with one in 10 students who were surveyed having reported attempted suicide that year.

    In this new study, the researchers viewed these alarming trends from the perspective of Social Safety Theory, which hypothesizes that social threats, such as bullying, impact mental health partly by instilling the belief that other people cannot be trusted, or that the world is an unfriendly, dangerous or unpredictable place.

    Prior research has identified associations between bullying and mental and behavioral health issues among youth, including its impact on substance abuse, depression, anxiety, self-harm and suicidal thoughts. However, following youth over time, this study is the first to confirm the suspected pathway of how bullying leads to distrust and, in turn, mental health problems in late adolescence.

    Slavich said when people develop clinically significant mental health problems during the teenage years, it can increase their risk of experiencing both mental and physical health issues across the entire lifespan if left unaddressed.

    In addition to interpersonal distrust, the authors examined if diet, sleep or physical activity also linked peer bullying with subsequent mental health problems. However, only interpersonal distrust was found to relate bullying to greater risk of experiencing mental health problems at age 17.

    “What these data suggest is that we really need school-based programs that help foster a sense of interpersonal trust at the level of the classroom and school,” Slavich said. “One way to do that would be to develop evidence-based programs that are especially focused on the transition to high school and college, and that frame school as an opportunity to develop close, long-lasting relationships.”

    The study was co-authored by Dr. George Slavich, Professor of Psychiatry and Biobehavioral Sciences at UCLA, and Dr. Dimitris Tsomokos, a researcher at the University of Glasgow.

    Source:

    University of California – Los Angeles Health Sciences

    Journal reference:

    Tsomokos, D. I., & Slavich, G. M. (2024). Bullying fosters interpersonal distrust and degrades adolescent mental health as predicted by Social Safety Theory. Nature Mental Health. doi.org/10.1038/s44220-024-00203-7.

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  • CDC releases new syphilis testing guidelines to combat rising cases

    CDC releases new syphilis testing guidelines to combat rising cases

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    In a recent report published in the Morbidity and Mortality Weekly Report (MMWR), the United States (US) Centers for Disease Control and Prevention (CDC) shares its recommendations for the tests and protocols required to diagnose syphilis in the US. The recommendations build upon existing conventional serologic algorithms and involve the combined use of nontreponemal and treponemal tests to identify if the patient’s immune response indicates a current untreated infection or a past-treated one. Additionally, recommendations for the direct microscopic detection of Treponema pallidum, the causative pathogen of syphilis, are included. These recommendations will help clinical laboratory directors, clinicians, laboratory staff, disease control personnel, and patients combat this dreadful disease.

    CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. Image Credit: Peddalanka Ramesh Babu / ShutterstockCDC Laboratory Recommendations for Syphilis Testing, United States, 2024. Image Credit: Peddalanka Ramesh Babu / Shutterstock

    Why do we need these recommendations?

    Syphilis is a bacterial sexually transmitted infection (STI) that progresses in stages from a painless sore (stage 1) to a severe disease that may attack the brain, liver, nerves, eyes, or cardiovascular system (stage 3). Caused by the bacterium Treponema pallidum subspecies pallidum, the disease has been further associated with congenital complications such as stillbirths, spontaneous abortions, and miscarriages.

    Alarmingly, the global burden of syphilis is rising rapidly, especially in wealthy and developed countries, with approximately 6 million new cases in 2021 alone. Reports from the United States of America (US) observe an increase of 2,140% in syphilis incidence rates between 2000 (n = 5,979) and 2020 (n = 133,945), suggesting a local epidemic within the country. Research has characterized this epidemic as displaying significant health disparities, with gender and sexual minorities being the worst affected.

    The laboratory diagnosis of syphilis represents a crucial effort in the war against the disease. Timely diagnoses, especially before the onset of stage 3 syphilis, are critical for positive disease outcomes. Public health reporting by laboratories provides the Centers for Disease Control and Prevention (CDC) and other government agencies the information needed to enact policies to attenuate local outbreaks and monitor epidemic trends.

    About the report

    The current report details the CDC’s first-ever recommendations for syphilis testing and includes optimal methods for point-of-care (POC) tests, laboratory-based tests, sample processing, and reporting. These recommendations were formulated by CDC scientists in collaboration with the Association of Public Health Laboratories (APHL) after reviewing up-to-date peer-reviewed literature, especially publications published by the US Food and Drug Administration (FDA).

    Serologic Laboratory Testing

    The first section of the report summarises progress in syphilis serological testing since the invention of the Wassermann test through to current nontreponemal (lipoidal antigen) and treponemal tests. In brief, when patients display symptoms or signs of syphilis or have had known sexual contact with a diagnosed syphilis patient, nontreponemal (lipoidal antigen) tests are recommended for laboratory screening. These tests are also recommended when assessing reinfections or reporting outcomes during clinical trials.

    “Nontreponemal (lipoidal antigen) tests might be less sensitive than treponemal tests in early primary syphilis and tend to wane with time regardless of treatment. Before testing, test and specimen type should be carefully considered because serum and plasma cannot always be used interchangeably, and certain nontreponemal (lipoidal antigen) tests require heat treatment of specimens. One caveat of nontreponemal (lipoidal antigen) tests is that a reactive result could be a false positive because of recent conditions (e.g., infections, vaccinations or injection drug use, or underlying autoimmune or other chronic conditions).”

    Nontreponemal tests are usually carried out manually, but some test versions (e.g., the rapid plasma reagin [RPR] test) may be automated to increase throughput. In the latter (automated) case especially, care must be taken to ensure that samples are maintained at optimal conditions and coinfections are accounted for to ensure diagnostic performance and prevent false positives. Treatment outcomes are best reported by comparing nontreponemal antibody titers at baseline and 12 months following treatment, at which time titers are expected to reduce fourfold.

    Treponemal tests are used to validate nontreponemal test results and to diagnose early syphilis infections that cannot (yet) be detected by nontreponemal tests. Most of these tests are conducted manually, but some can be automated for high throughput. In most patients, treponemal antibodies are detectable for life and are helpful to indicate a past, successfully treated syphilis infection. All donations to blood banks must undergo treponemal screening to ensure that volunteered blood is free of syphilis antibodies.

    Syphilis screening algorithms

    The traditional algorithm for syphilis screening involved nontreponemal tests followed by treponemal tests to confirm any dubious or contentious nontreponemal results. This is because the former is comparatively inexpensive and rapid, while the latter is manually labor-intensive, expensive, and limited in number. However, recent advancements in automated treponemal immunoassays have bridged the time and monetary gap between these techniques, resulting in the more recent ‘reverse’ algorithm for syphilis screening, wherein nontreponemal tests are used to validate the results of treponemal tests further.

    Building upon these methodologies, the report provides recommendations for the optimal screening, clinical care, and recording of patients suffering from neurosyphilis, ocular syphilis, otosyphilis, and congenital syphilis. Pregnancy status, in particular, is noted as a condition that should not influence the standard interpretation of nontreponemal and treponemal test results due to scientific evidence that their functioning is not altered during pregnancy.

    Direct detection tests

    Immunohistochemistry and microscopy techniques for detecting syphilis from biopsies and other preserved samples are outlined with a particular focus on darkfield microscopy (the most widely used method for direct syphilis detection) and silver staining. Darkfield microscopy has been found to outperform antibody screening approaches, especially in the early stages of infection, thereby presenting itself as an ideal tool for early disease detection.

    While Nucleic Acid Amplification Tests (NAATs) have shown great potential in accurately diagnosing syphilis infection, no FDA-approved NAATs currently exist. These recommendations are expected to be updated once FDA-approved NAATs enter the market.

    Journal reference:

    • Papp JR, Park IU, Fakile Y, Pereira L, Pillay A, Bolan GA. CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. MMWR Recomm Rep 2024;73(No. RR-1):1–32,  DOI: 10.15585/mmwr.rr7301a1, https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

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  • Eco-Friendly or Health Hazard? Scientists Uncover Hidden Dangers of “Green” Cleaning Products

    Eco-Friendly or Health Hazard? Scientists Uncover Hidden Dangers of “Green” Cleaning Products

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    Green Cleaning Products

    New research has shown that “green” cleaning products emit as many harmful chemicals as regular products, challenging the perception that they are safer for health and the environment. The study highlights the need for better regulation and consumer guidance, as these products can degrade indoor air quality and potentially pose health risks.

    New research indicates that many cleaning products marketed as “green” release the same amount of hazardous chemicals as conventional cleaning products.

    Researchers say there needs to be better regulation and more guidance for consumers about how safe cleaning products really are.

    Potentially harmful

    The study, published by The Royal Society of Chemistry in the journal Environmental Science: Processes & Impact, found that fragranced cleaning products can be potentially harmful for the air quality in people’s homes.

    Cleaning products emit a wide range of volatile organic compounds (VOCs), including some which are hazardous or can undergo chemical transformations to generate harmful secondary pollutants. In recent years, “green” cleaners have become increasingly popular, with an implicit assumption that these are better for our health and the environment. But the University of York research found this was not the case.

    Secondary pollutants

    As part of the study, the VOC composition of 10 regular and 13 green cleaners was examined by researchers. Green cleaners generally emitted more monoterpenes than regular cleaners, resulting in increases in harmful secondary pollutant concentrations following use, such as formaldehyde and peroxyacyl nitrates.

    The study found that the fragrance ingredients of these products were the source of the volatile monoterpenes. As levels of these types of pollutants increase in the home, susceptible people can develop breathing problems or irritation of the eyes, nose, throat, or skin. Repeated exposure to high concentrations of formaldehyde can possibly lead to cancer in some cases.

    Misleading consumers

    Ellen Harding-Smith, Environmental Chemistry researcher from the Department of Environment & Geography, said: “Our research found there is no strong evidence to suggest that clean green products are better for indoor air quality compared to regular products.

    “In fact, there was very little difference. Many consumers are being misled by the marketing of these products which could be damaging the air quality in their homes as a result – potentially putting their health at risk. For so many products on the supermarket shelves, green doesn’t mean clean.”

    Compositional differences

    The research was funded by the EPSRC and the project is called IMPeCCABLE. It is a collaboration between the University of York’s Department of Environment and Geography, the Department of Chemistry, and the Wolfson Atmospheric Chemistry Laboratory.

    Miss Harding-Smith, who is a PhD Candidate, added: “The study highlights potential compositional differences in the formulations of regular and green cleaners, for which there is currently very little information on in the available literature.

    Mitigating harm

    “Manufacturers really need to be so much clearer about what’s in these products and make clear how to mitigate their harm. For example, just improving ventilation and opening windows when using these cleaning products makes air quality at home so much better.”

    Reference: “Does green mean clean? Volatile organic emissions from regular versus green cleaning products” by Ellen Harding-Smith, David R. Shaw, Marvin Shaw, Terry J. Dillonb and Nicola Carslaw, Environmental Science: Processes & Impacts.
    DOI: 10.1039/D3EM00439B



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  • do billionaire philanthropists skew global health research?

    do billionaire philanthropists skew global health research?

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    Microsoft founder Bill Gates speaks during the World Economic Forum in Davos, Switzerland in January 2024.

    Bill Gates and other wealthy individuals who spend vast sums on research often back some types of solution over others.Credit: Halil Sagirkaya/Anadolu/Getty

    The Bill Gates Problem: Reckoning with the Myth of the Good Billionaire Tim Schwab Metropolitan Books (2023)

    Global wealth, power and privilege are increasingly concentrated in the hands of a few hyper-billionaires. Some, including Microsoft founder Bill Gates, come across as generous philanthropists. But, as investigative journalist Tim Schwab shows in his latest book, charitable foundations led by billionaires that direct vast amounts of money towards a narrow range of selective ‘solutions’ might aggravate global health and other societal issues as much as they might alleviate them.

    In The Bill Gates Problem, Schwab explores this concern compellingly with a focus on Gates, who co-founded the technology giant Microsoft in 1975 and set up the William H. Gates Foundation (now the Bill & Melinda Gates Foundation) in 1994. The foundation spends billions of dollars each year (US$7 billion in 2022) on global projects aimed at a range of challenges, from improving health outcomes to reducing poverty — with pledges totalling almost $80 billion since its inception.

    Schwab offers a counterpoint to the prevailing popular narrative, pointing out how much of the ostensible generosity of philanthropists is effectively underwritten by taxpayers. In the United States, for example, 100,000 private foundations together control close to $1 trillion in assets. Yet up to three-quarters of these funds are offset against tax. US laws also require only sparse scrutiny of how charities spend this money.

    CRISPR-edited crops break new ground in Africa

    Had that tax been retained, Schwab reasons, the government might have invested it in more diverse and accountable ways. Instead, the dispersal of these funds is being driven mainly by the personal interests of a handful of super-rich individuals. By entrenching particular pathways and sidelining others, philanthropy is restricting progress towards the global Sustainable Development Goals by limiting options (see also strings.org.uk).

    Many Gates foundation programmes are shaped and evaluated using data from the US Institute for Health Metrics and Evaluation (IHME), which was founded — and is lavishly funded — by the foundation. Schwab suggests that such arrangements could be considered conflicts of interest, because in-house ‘evaluations’ often tend to justify current projects. In the case of malaria, for instance, the numbers of bed nets distributed in tropical countries — a metric tracked by the IHME — can become a proxy for lives saved. Such circularity risks exaggerating the efficiency of programmes that aim to tackle high-profile diseases, including HIV/AIDS, potentially at the expense of other treatable conditions for which solutions might remain unexplored (see also Philip Stevens’s 2008 book Fighting the Diseases of Poverty).

    Limited scope

    Similarly restricted views exist in other areas, too. In the energy sector, for instance, Gates flouts comparative performance trends to back exorbitantly expensive nuclear power instead of much more affordable, reliable and rapidly improving renewable sources and energy storage. In agriculture, grants tend to support corporate-controlled gene-modification programmes instead of promoting farmer-driven ecological farming, the use of open-source seeds or land reform. African expertise in many locally adapted staples is sidelined in favour of a few supposedly optimized transnational commodity crops.

    Furthermore, the Gates foundation’s support for treatments that offer the best chances of accumulating returns on intellectual property risks eclipsing the development of preventive public-health solutions, Schwab notes. For example, the foundation promotes contraceptive implants that control women’s fertility, instead of methods that empower women to take control over their own bodies. Similarly, the foundation often backs for-profit, Internet-based education strategies rather than teacher-led initiatives that are guided by local communities.

    Throughout its history, the Gates foundation’s emphasis on ‘accelerating’ innovations and ‘scaling up’ technologies, as noted on its website (gatesfoundation.org), obscures real-world uncertainties and complexities, and ignores the costs of lost opportunities. For example, Gates’s aim to eradicate polio is laudable. But pharma-based actions are slow — and can come at the expense of practical solutions for less ‘glamorous’ yet serious scourges, such as dirty water, air pollution or poor housing conditions.

    A Kenyan health worker prepares to administer a dose of the Oxford/AstraZeneca vaccine to her colleagues, Nairobi.

    Transparency is scarce on whether charitable investments in vaccine companies might benefit philanthropists or their contacts.Credit: Simon Maina/AFP/Getty

    Thus, by promoting interventions associated with the technological processes of extraction, concentration and accumulation that underpinned his own corporate success, Gates helps to tilt the playing field. His foundation tends to neglect strategies built on economic redistribution, institutional reform, cultural change or democratic renewal. Yet in areas such as public health, disaster resilience and education, respect for diverse strategies, multifaceted views, collective action and open accountability could be more effective than the type of technology-intensive, profit-oriented, competitive individualism that Gates favours.

    Schwab traces the origins of this ‘Gates problem’ to the 1990s. At that time, he writes, Gates faced hearings in the US Congress that challenged anti-competitive practices at Microsoft and was lampooned as a “monopoly nerd” in the animated sitcom The Simpsons for his proclivity to buy out competitors. By setting up the Gates foundation, he pulled off a huge communications coup — rebranding himself from an archetypal acquisitive capitalist to an iconic planetary saviour by promoting stories of the foundation’s positive impact in the media.

    Genetic modification can improve crop yields — but stop overselling it

    Yet since then, Schwab shows, Gates has pursued a charitable monopoly similar to the one he built in the corporate world. He has shown that in philanthropy — just as in business — concentrated power can manufacture ‘success’ by skewing news coverage, absorbing peers and neutralizing oversight. For instance, Schwab documents how the voices of some non-governmental organizations, academia and news media have been muted because they depend on Gates’s money. While dismissing “unhinged conspiracy theories” about Gates, he describes a phenomenon that concerned activists and researchers call the “Bill chill”. By micromanaging research and dictating methods of analysis, the foundation effectively forces scientists to go down one path — towards the results and conclusions that the charity might prefer.

    These issues are exacerbated by Gates applying the same energy that he used in business to coax huge sums from other celebrity donors, which further concentrates the kinds of innovation that benefit from such funding. But Schwab has found that transparency is scarce on whether or how Gates’s private investments or those of his contacts might benefit from his philanthropy. Questions arise over the presence of people with personal ties to Gates or the foundation on the board of start-up companies funded by the charity, for example.

    Bigger picture

    One minor gripe with the book is that although Schwab excels in forensically recounting the specific circumstances of Gates’s charitable empire, he is less clear on the wider political forces at work or the alternative directions for transformation that have been potentially overlooked. Schwab often implies that Gates’s altruism is insincere and rightly critiques the entrepreneur’s self-serving “colonial mindset” (see, for example, S. Arora and A. Stirling Environ. Innov. Soc. Transit. 48, 100733; 2023). But in this, Gates is a product of his circumstances. As Schwab writes, “the world needs Bill Gates’s money. But it doesn’t need Bill Gates”. Yet maybe the real problem lies less in the man than in the conditions that produced him. A similar ‘tech bro’ could easily replace Gates.

    The challenges facing scientists in the elimination of malaria

    Perhaps what is most at issue here is not the romanticized intentions of a particular individual, but the general lack of recognition for more distributed and collective political agency. And more than any single person’s overblown ego, perhaps it is the global forces of appropriation, extraction and accumulation that drive the current hyper-billionaire surge that must be curbed (see also A. Stirling Energy Res. Soc. Sci. 58, 101239; 2019).

    Resolution of the Bill Gates problem might need a cultural transformation. Emphasis on equality, for instance, could be more enabling than billionaire-inspired idealizations of superiority. Respect for diversity might be preferable to philanthropic monopolies that dictate which options and values count. Precautionary humility can be more valuable than science-based technocratic hubris about ‘what works’. Flourishing could serve as a better guiding aim than corporate-shaped obsessions with growth. Caring actions towards fellow beings and Earth can be more progressive than urges to control. If so, Schwab’s excellent exposé of hyper-billionaire ‘myths’ could yet help to catalyse political murmurations towards these more collective ends.

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