Spread by Anopheles mosquitoes, malaria parasites, including those of the species Plasmodium falciparum (Pf), can cause illness in people of any age. However, pregnant women, infants and very young children are especially vulnerable to life-threatening disease. Malarial parasitemia in pregnancy is estimated to cause up to 50,000 maternal deaths and 200,000 stillbirths in Africa each year.

The trials were co-led by investigators from the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and the University of Sciences, Techniques and Technologies, Bamako (USTTB), Mali. The investigational vaccine used in both trials was PfSPZ Vaccine, a radiation-attenuated vaccine based on Pf sporozoites (a stage of the parasite’s lifecycle), manufactured by Sanaria Inc., Rockville, Maryland. Multiple previous clinical trials of PfSPZ Vaccine have shown it to be safe, including in malaria-endemic countries such as Mali. In results published in 2022, for example, an NIAID-sponsored, placebo-controlled trial of a three-dose regimen of PfSPZ Vaccine in Burkina Faso found that the vaccine had up to 46% efficacy that lasted at least 18 months.

In the first year of the current trial, 55 women became pregnant within 24 weeks of the third vaccine dose. Among these women, vaccine efficacy against parasitemia (whether before or during pregnancy) was 65% in those who received the lower dose vaccine and 86% in those who received the higher dose. Among 155 women who became pregnant across both study years, vaccine efficacy was 57% for those who received lower dose vaccine and 49% in those in the higher dosage group.

Women who received the investigational vaccine at either of the dosages conceived sooner than those who received placebo, although this finding did not reach the level of statistical significance, reported the investigators. The researchers speculate that the PfSPZ Vaccine might avert malaria-related early pregnancy losses since parasitemia risk during the periconception period was reduced by 65 to 86%.

“Preconception immunization is a new strategy to reduce mortality for women with malaria in pregnancy,” the researchers note. They plan to investigate the safety of PfSPZ Vaccine administered during pregnancy, then examine the efficacy of PfSPZ given preconception or during pregnancy in larger clinical trials. “Existing measures are not protecting women from malaria in pregnancy,” they added. “A safe and effective vaccine is urgently needed, and our results indicate PfSPZ Vaccine might be a suitable candidate,” they conclude.

The PfSPZ Vaccine Study Team was led by Alassane Dicko, M.D., of the Malaria Research and Training Center (MRTC), USTTB, Mali, Stephen L. Hoffman, M.D., of Sanaria Inc., and Patrick E. Duffy, M.D., of the NIAID Laboratory of Malaria Immunology and Vaccinology. Joint co-first authors were Halimatou Diawara, M.D., of MRTC, and Sara A. Healy, M.D., NIAID.

Specifically, electronic and mobile health interventions can help people achieve:

• 1329 more steps / day
• 55 minutes more moderate-to-vigorous exercise / week
• 45 minutes more overall physical activity / week
• 7 hours less sedentary behaviour / week
• 103 fewer calories consumed / day
• 20% more fruits and vegetables consumed / day
• 5.5 grams less saturated fat consumed / day
• 1.9 kilograms of weight loss over 12 weeks
• Improved sleep quality
• Less severe insomnia.

With the global economic burden of chronic diseases estimated to exceed US $47 trillion by 2023, effective interventions are in high demand. According to the World Health Organization, one in eight people are now living with obesity; 422 million people have diabetes; and cardiovascular disease is the leading cause of death worldwide.

Lead researcher, UniSA’s Dr Ben Singh, says people’s health behaviours must change if we are to reduce the incidence of chronic disease.

“With the rise of preventable chronic diseases like obesity, cardiovascular disease, and type 2 diabetes, finding mechanisms that can help reduce people’s risk is important,” Dr Singh says.

“Our study found that digital and mobile health interventions can have a positive effect on people’s health and wellbeing, not only helping them to increase their physical activity and reduce sedentary behaviour, but also improving their diet and quality of sleep.

“Given the wide accessibility and popularity of health apps, their capability to tailor information and deliver timely reminders and prompts, and scalability to diverse populations, they could be a very effective intervention to promote better health.

“Making positive changes to your health and wellbeing can be a challenge — it’s always easier to add kilos to your waistline, than it is to reduce them — but by incorporating digital tools into your everyday life, you’re more likely to achieve positive outcomes.”

The research identified consistent findings across different age groups, health behaviours, interventions, and health populations, indicating that digital health apps could help underpin broader public health campaigns. While researchers recommend further investigation to better understand impacts among specific groups of people, at top line, digital health apps appear to be a win-win for all.

The team published their findings today (August 13) in the journal BMJ Open.

“One lesson we Americans can learn about life expectancy from looking at comparable countries is where the frontier of best performance lies,” said Jessica Ho, associate professor of sociology and demography at Penn State and senior author on the paper. “Yes, we’re doing badly, but this study shows what can we aim for. We know these gains in life expectancy are actually achievable because other large countries have already done it.”

The researchers compared life expectancy in the United States, Canada, Ireland, the United Kingdom, Australia and New Zealand using data from the Human Mortality Database and the World Health Organization Mortality Database between 1990 and 2019. They analyzed the data by sex, age and 18 individual and comprehensive cause of death categories, including cancers, drug- and alcohol-related deaths, firearms and motor vehicle collisions.

They also examined life expectancy within each country to identify geographical inequalities in life expectancy by region.

The researchers found that Australians had the longest life expectancy at birth over the study period, with women living nearly 4 more years and men 5 more years than their American counterparts. The Irish showed the largest gains in life expectancy, with men’s lifespans increasing by approximately 8 years and women’s lifespans by more than 6.5 years. Americans had the shortest life expectancy at birth, with women living an average of almost 81.5 years and men an average of nearly 76.5 years in 2019.

The United States also showed some of the largest geographical inequalities in life expectancy compared to the other countries, according to the researchers. Women and men in California and Hawaii had some of the highest life expectancies at birth, with women averaging 83 to 83.9 years and men averaging 77.5 to 78.4 years. States in the American Southeast saw some of the lowest life expectancies at birth of all subnational regions studied, with women averaging 72.6 to 79.9 years and men averaging 69.3 to 74.4 years.

“One of the main drivers of why American longevity is so much shorter than in other high-income countries is our younger people die at higher rates from largely preventable causes of death, like drug overdose, car accidents and homicide,” said Ho, who is also an associate of Penn State’s Social Science Research Institute.

In midlife — the 45 to 64 age range — some of these causes continue, like high death rates from drug- and alcohol-related mortality, Ho explained, adding that Americans also see higher rates of cardiovascular disease mortality.

“Some of the latter could be related to sedentary lifestyle, high rates of obesity, unhealthy diet, stress and a history of smoking,” she said. “It’s likely that these patterns of unhealthy behaviors put Americans at a disadvantage in terms of their health and vitality.”

Australia offers the U.S. a model for improving its life expectancy, Ho added. Like the U.S., Australia is large in terms of land area and has a comparable history of personal vehicle ownership. The two countries have some cultural similarities, including historically greater use of firearms. However, Australia implemented a number of policies in recent decades including gun law reforms that helped vault them to the top of the life expectancy rankings.

“What the study shows is that a peer country like Australia far outperforms the U.S. and was able to get its young adult mortality under control,” Ho said. “It has really low levels of gun deaths and homicides, lower levels of drug and alcohol use and better performance on chronic diseases, the latter of which points to lifestyle factors, health behaviors and health care performance.”

Ho said policies like investing in public transit infrastructure, adding more roundabouts and having fewer large cars on the road could decrease traffic deaths in the United States. More support for programs designed to reduce drug dependence and reducing barriers to treatment and prevention of drug overdose could help lower drug-related mortality, she said. And having a strong combination of public health effort, health care access and community interventions to encourage healthier lifestyles and the use of preventive medicine could reduce cardiovascular disease mortality, she added.

“Australia is a model for how Americans can do better and achieve not only a higher life expectancy but also lower geographic inequality in life expectancy,” Ho said.

Rachel Wilkie, a doctoral student at the University of Southern California, also contributed to this research. The National Institute on Aging of the National Institutes of Health supported this work.

This discovery, recently published in the journal Theriogenology, is significant because of the time and money that horse owners often invest in assisted reproduction.

Just like humans, horses sometimes need help from science in order to reproduce. When they do, special steps are needed for a successful pregnancy because of the unique properties of equine sex cells.

“In horses, the process of in-vitro fertilization (IVF) is more complex than it is in humans,” said Dr. Luisa Ramirez-Agamez, a Ph.D. candidate in the VMBS’ Department of Large Animal Clinical Sciences (VLCS) studying equine reproduction. “First, a mare’s oocytes need approximately 30 hours to mature in the laboratory once they have been collected before they can be fertilized. Then, we have to inject the eggs with sperm to induce fertilization, a process known as Intracytoplasmic Sperm Injection (ICSI).

“We discovered that phenylbutazone, commonly known as bute, can affect both the ability of a mare’s eggs to mature correctly when cultured and whether the fertilized eggs will develop into a viable embryo,” she explained. “In either of those cases, the eggs affected by bute cannot be used in assisted reproduction.”

The Value Of Equine Assisted Reproduction

Assisted reproduction is an important resource for many horse owners, especially those who make a living from their herds. Many horse owners also care deeply about producing offspring from their favorite horses in order to carry on their legacies.

In some cases, mares who are chronically lame and unable to support a pregnancy themselves may become egg donors, with their eggs fertilized in a laboratory and carried to term by a surrogate.

“This is one of the specific situations impacted by our discovery,” Ramirez said. “Mares who are chronically lame are likely going to be on bute because it helps with pain management — especially in the musculoskeletal system — which, according to our results, will hinder their ability to participate in assisted reproduction programs.

“In a future study, we hope to determine an alternative to bute that supplies the same level of pain management but does not interfere with reproduction,” she said.

The good news is that bute’s effect on equine oocytes appears to wear off within a few weeks.

“We collected the eggs at three days post treatment, then 33 days, and then 77 days,” she said. “We found that eggs collected three days after administration of bute were not able to produce embryos, but those collected at 33 days were successful. We hope to find a more exact answer in terms of how bute affects egg cell quality in a future study.”

Implications For Human Medicine

Looking to the future, Ramirez is interested in collaborating with researchers in human medicine because of the possible implications of her discovery for IVF in women.

“NSAIDs are often given to women during IVF to slow down their ovulation cycle, which is the ovaries’ release of an egg each month,” she explained. “Under normal circumstances, most women only produce one egg cell each month, but IVF is expensive and time-consuming, so women are given hormones that cause them to produce more than one egg each cycle. This way, there is more than one egg to collect. NSAIDs help prevent women from ovulating early so they don’t lose those eggs.”

But after her recent discovery about NSAIDs and horse reproduction, Ramirez wonders if NSAIDs could also have unknown negative effects on IVF.

“NSAIDs are generally thought to have a positive impact on IVF in women, but our results suggest that these drugs are not as benign for reproduction in horses,” Ramirez said. “Some NSAIDs, like Banamine, actually cause anovulatory follicles in horses — follicles in the ovaries that don’t release egg cells during ovulation as they are supposed to.

“This is not the case in women, and so NSAIDs are thought to be safe. But now we know that bute can actually keep fertilized eggs from becoming embryos, and it’s possible that some NSAIDs could have a similar effect in women,” she said. “This is something I want to find out.”