Nine years of working in coal mines destroyed Will Goddard’s lungs, but with the help of a specialist clinic in Rotherham he was able to get a double lung transplant.

South Africa has its own tales of athletes suffering serious brain damage. Sport24 cites former Springbok lock Krynauw Otto, whose short career as a professional rugby player came to an abrupt end in 2000 when he suffered a subdural haematoma in the left frontal area of his brain on Springbok duty against the Wallabies.

Researchers have shown that brain inflammation from football head trauma may lead to the development of chronic traumatic encephalopathy, a devastating degenerative brain disease.

According to a recent study, rugby involves similar risks, and bouncing the ball off of the head in soccer may not be as harmless to the brain as was previously thought.

A growing concern

Evidence of the dangers of contact sport is mounting, and now Canadian researchers report that playing sports like football or ice hockey can alter the structure and function of the brain.

Brain scans showed that these changes were particularly pronounced in sports that have the greatest risk of body contact.

“There is growing concern about the risk of collisions in sport. However, most of the research has focused on retired professional athletes with decades of exposure to head impacts,” said lead researcher Nathan Churchill. He’s a post-doctoral fellow in the neuroscience research program at St. Michael’s Hospital in Toronto.

“Far less is known about the consequences of repeated body-to-body contact for young, active athletes,” he said.

Participants in this study didn’t report major health problems. This suggests that the biological effects of collisions don’t lead to impaired day-to-day function, he said.

The report was published in the journal Frontiers of Neurology.

Differences in brain structure and function

For the study, Churchill and his colleagues scanned the brains of 65 varsity athletes before the playing season began.

“None of the participants had a recent concussion or any major health issues,” Churchill said.

Among the young men and women in the study, 23 played collision sports, such as football and ice hockey, involving routine body-to-body contact.

Twenty-two played contact sports where contact is allowed but isn’t a necessary part of the game, such as basketball, soccer and field hockey. Twenty played non-contact sports, such as volleyball.

The brain scans showed that people who played collision and contact sports had differences in brain structure and function compared to people who took part in non-contact sports.

Reduced communication between brain areas

“They also showed changes in brain chemicals that are usually associated with concussion and brain injury,” Churchill said.

These differences included changes in the structure of the brain’s white matter, the fibres that connect different parts of the brain, allowing them to communicate with each another.

Compared with people in non-contact sports, those who played sports involving a lot of body contact also had signs of reduced communication between brain areas, the study authors said.

In addition, athletes in sports with higher levels of contact had signs of decreased activity in brain areas involved in vision and motor function, the researchers found.

This is a step towards understanding the long-term consequences of repeated head impacts, “and may help us better understand why a small number of athletes in contact and collision sports go on to develop significant health problems,” he said.

One specialist thinks this study doesn’t go far enough in accounting for the consequences of these changes in the brain that result from playing contact sports.

Long-term effects unknown

The role of prior concussions and head trauma may also figure into long-term mental function – something the study authors tried to control for, but is still a limitation of this research, he said.

The brain is able to repair itself, Glatter noted. “It’s more important to look at their symptoms and clinical picture after an impact to truly evaluate whether such structural changes are meaningful in the big picture,” he said.

Contact sports that involve potential body contact – such as soccer, basketball and field hockey – may also place athletes at risk for structural brain injury, Glatter said.

“What we don’t know are the long-term effects clinically. This certainly deserves additional study,” he said.

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South African-born Tammy Fry , is based in Australia with her two sons and husband. She’s also vegan — and so is her family. Here, her tips on raising a family on a plant-based diet.

Prep food on Sundays

Most healthy people are no strangers to meal prepping, and Tammy does the same. On a Sunday, she cooks up a big batch of soy mince bolognese, with beans, chickpeas, courgettes, tomato, onion and grated carrots.

She’ll also make a big quinoa salad cooked in vegetable broth, mixed with coconut, coriander and chopped carrots.

Next, Tammy makes small batches of chia pots, with a vanilla pod, rice milk syrup for sweetness, and coconut milk. 

These make up the base of meals for the week. With these, she can create a range of different meals, like salads, or as sides to things like vegan schnitzels, nuggets or sweet potato. “Every meal should have a carb, protein and fat,” says Tammy. “Meat alternatives are a quick way to get proteins into meals.”

Read more: Actually, you’ve been wrong about soy this whole time

Whip up quick meals 

One upside to only eating veggies? They have a way smaller cooking time. Tammy loves mixing up post-school meals for the kids with smoothies and snacks. “Food needs to look nice,” says Tammy.

One pretty meal is the oft-Instagrammed smoothie bowl. Tammy adds dragon fruit, mango and banana to hers. Or, for breakfast, she makes a fibre-rich smoothie with banana, oats, almond milk and flax seeds, sunflower seeds, and almonds.

Read more: 8 foods you thought were ‘clean’ – but actually aren’t

Don’t try too hard 

Tammy doesn’t go through tons of effort. Most meals are whipped up quickly but are still nutritious. “Health needs to be sustainable,” she says.

“When you try too hard, it becomes difficult. You need that flexibility.”

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^{This article orginally appeared on www.womenshealthsa.co.za}

Michelle October

Els van der Heijden, who has cystic fibrosis, struggled to breathe as her lungs filled with thick, sticky mucus. Despite taking more than a dozen pills a day and using inhalers, the 53-year-old was not making any progress.

Doctors did not want to try a new, expensive drug because it hasn’t been proven to work in people with the rare type of cystic fibrosis that van der Heijden had.

New gut from cells

Instead, they scraped a few cells from van der Heijden and used them to grow a mini version of her large intestine in a petri dish. When van der Heijden’s “mini gut” responded to treatment, doctors knew it would help her too.

This experiment to help people with rare forms of cystic fibrosis in the Netherlands aims to grow mini intestines for every Dutch patient with the disease to figure out, in part, what treatment might work for them. It’s an early application of a technique now being worked on in labs all over the world, as researchers learn to grow organs outside of the body for treatment – and maybe someday for transplants.

     ^{So-called “mini guts” grown in petri dishes could be used to treat cystic fibrosis, instead of expensive drugs.}

Small but complete

So far, doctors have grown mini guts – just the size of a pencil point – for 450 of the Netherlands’ roughly 1 500 cystic fibrosis patients.

“The mini guts are small, but they are complete,” said Dr Hans Clevers of the Hubrecht Institute, who pioneered the technique. Except for muscles and blood vessels, the tiny organs “have everything you would expect to see in a real gut, only on a really small scale”.

These so-called organoids mimic features of full-size organs, but don’t function the same way. Although many of the tiny replicas are closer to undeveloped organs found in an embryo than adult ones, they are helping scientists unravel how organs mature and providing clues on how certain diseases might be treated.

Not a new technique

Previous Health24 articles mention studies where organs were grown to treat diseases. 

In Australia, mini kidneys are being grown that could be used to test drugs. Researchers in the US are experimenting with tiny bits of livers that might be used to boost failing organs.

At Cambridge University in England, scientists have created hundreds of mini brains to study how neurons form and better understand disorders like autism. During the height of the Zika epidemic last year, mini brains were used to show how the virus causes malformed brains in babies.

Cutting costs

In the Netherlands, the mini guts are used as a stand-in for cystic fibrosis patients to see if those with rare mutations might benefit from a number of pricey drugs.

Making a single mini gut and testing whether the patient would benefit from certain drugs costs a couple of thousand euros. The program is paid for by groups including health insurance companies, patient foundations and the government. The idea is to find a possible treatment for patients, and avoid putting them on expensive drugs that wouldn’t work for them.

About 50 to 60 patients across the Netherlands have been treated after drugs were tested on organoids using their cells, said Dr Kors van der Ent, a cystic fibrosis specialist at the Wilhelmina Children’s Hospital, who leads the research.

Clevers made a discovery about a decade ago that got researchers on their way. They found pockets of stem cells, which can turn into many types of other cells, in the gut. They then homed in a growing environment in the lab that spurred these cells to reproduce rapidly and develop.

“To our surprise, the stem cells started building a mini version of the gut,” Clevers recalled.

Idea sounds promising

Cystic fibrosis is caused by mutations in a single gene that produces a protein called CFTR, responsible for balancing the salt content of cells lining the lungs and other organs.

To see if certain drugs might help cystic fibrosis patients, the medicines are given to their custom-made organoids in the lab. If the mini organs puff up, it’s a sign the cells are now correctly balancing salt and water. That means the drugs are working, and could help the patient from whom the mini-gut was made.

Researchers are also using the mini guts to try another approach they hope will someday work in people – using a gene editing technique to repair the faulty cystic fibrosis gene in the organoid cells.

While the idea sounds promising, some scientists said there are obstacles to using mini organs to study cancer.

Growing a mini cancer tumour, for example, would be far more challenging because scientists have found it difficult to make tumours in the lab that behave like in real life, said Mathew Garnett of the Wellcome Trust Sanger Institute, who has studied cancer in mini organs but is not connected to Clevers’ research.

Also, growing the cells and testing them must happen faster for cancer patients who might not have much time to live, he said.

The dream of life-size organs

Meanwhile, Clevers wants to one day make organs that are not so mini.

“My dream would be to be able to custom-make organs,” he said, imagining a future where doctors might have a “freezer full of livers” to choose from when sick patients arrive.

Others said while such a vision is theoretically possible, huge hurdles remain.

“There are still enormous challenges in tissue engineering with regards to the size of the structure we’re able to grow,” said Jim Wells, a paediatrics professor at the Cincinnati Children’s Hospital Medical Center. He said the mini organs are far smaller than what would be needed to transplant into people and it’s unclear if scientists can make a working, life-sized organ in the lab.

There are other limitations to growing miniature organs in a dish, said Madeline Lancaster at Cambridge University.

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Hospitals in London and Southampton think they have found a way of resolving disputes over children’s care.

Our weak economy threatens to undermine the significant progress made in the public health sector over the past decade, including a 10-year increase in life expectancy.

The SA Health Review 2017, released on 23 August, paints a sober picture of a sector battling to deliver services and contain costs in the face of low economic growth.

Additional revenue streams

Health expenditure will increase in this financial year by a mere 1.1%. By next year, this increase will be a tiny 0.8% and in 2018/19, there will be a cut in spending of R142-million (0.1%).

“The slowdown in growth may last for a long time, impacting on health budgets negatively, but the National Health Insurance (NHI) has the potential to reverse this trend through additional revenue streams to fund health services,” argue Treasury official Mark Bletcher and colleagues in the SAHR.

Proposed financing for the NHI is from a reduction in tax breaks for medical scheme members, a VAT increase, payroll tax and personal income tax surcharge.

The 38% depreciation of the Rand against the US Dollar between 2012 and 2016 has posed a huge challenge to the price of medicines, observe Bletcher and colleagues.

At the same time, an extra 400 000 patients per year are joining the HIV treatment programme and a number of new children’s vaccines have been introduced.

Staff the biggest expense

“Control of medicine price increases has generally been one of the Department of Health’s greatest successes,” note Bletcher and colleagues. This has been done largely through the central procurement of medicines.

“Prices of ARVS are generally considered the lowest in the world and overall public sector medicine prices have been said to be 87% lower than average OECD prices,” they note.

Staff costs are the biggest expense, with national salary increases for certain categories of health professionals resulting in increases of 38% between 2005 and 2012.

“Most provinces have imposed some form of restriction in terms of filling vacant posts,” says Bletcher, with posts declining by around half a percent a year since 2012. This has translated into a loss of 5 500 positions over the past four years.

Spending on infrastructure has been cut, while more patients are being channelled to clinics rather than hospitals to cut costs.

At the same time, clinic visits have been cut by three million over the past two years, in part due to the introduction of a new medicine dispensing programme that enables stable chronic patients to get their medicines from designated pick-up points such as private pharmacies and schools, rather than clinics. The programme is implemented in 700 facilities and covers over half-a-million patients at present. – Health-e News.

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Kerry Cullinan