Mind & body, in brief

Care moving out of hospitals

Antivenom moved into four Indigenous health units in the Amazon and three in four patients were treated within six hours. [1] Nurses telephoning every week or two held on to more people than a monthly palliative clinic did. [15] Village health workers in Somaliland were trained to treat malnourished children in their own villages. [51]

Exercise instead of pills

Calcium and vitamin D made little or no difference to fractures across 69 trials and 153,902 adults. [28] Exercise cut fall-related fractures by 44% across 29 trials. [29] Physical activity was one of six things that cleared a meaningful bar for the quiet symptoms of schizophrenia. [42]

Money running out for treatment

Snakebite treatment cost an Indian family 27,400 rupees in a private hospital and 3,900 in a public one. [4] Child malnutrition in Nepal reached what surveyors called alarming levels after nutrition aid was cut. [50] Deaths from malnutrition among older Americans rose 22.5% a year between 2013 and 2021. [54]

Few treatments for women's conditions

Polycystic ovary syndrome affects 10 to 13% of women and is still managed mostly with a hormone pill and a diabetes drug. [36][41] Leaking urine affects up to one adult woman in three, and the training that treats it is widely underused. [26][20]

One pressure seen across the day runs through Mind & body too.

• Treatment that exists and still does not arriveHigh ↑ · seen in 3 beats→

1. 1Antivenom has worked for a hundred years, and in the Amazon what decided who lived was how far away it was kept
2. 2A nurse on the phone matched the clinic
3. 3Child deaths fell by half, then slowed
4. 4Village workers treated malnourished children
5. 5Nepal's child nutrition worsened after aid cuts

In four Indigenous health districts in the Brazilian Amazon, health workers were trained to store antivenom and give it themselves instead of sending patients to a city hospital. [1]

Watch whether Brazil's health ministry stocks antivenom beyond the four pilot areas - the researchers report that managers at every level said they were willing, and the test is whether the supply and the cold storage follow.

Also seen in Biotech and Food.

In a US trial called EMPallA, 1,283 people aged 50 and over with advanced cancer or failing organs were randomly given one of two kinds of palliative care after an emergency visit.

Palliative care treats symptoms and comfort rather than the disease itself. One group got a nurse telephoning every week or two for six months.

The other was offered a monthly appointment with a specialist. 68% stayed with the phone calls; 53% of the clinic group attended even one visit. [15]

Quality of life improved by about the same amount in both groups, so the telephone version was not better.

It was simply easier to reach, and specialist palliative staff are far too few for the number of people who need them. [15][16]

Today's trials take treatments that already work in hospitals, move them to a phone or a village clinic, and ask whether they still work.

If the version that travels is weaker, or the person handing it over cannot manage a rare bad reaction, moving it costs more than it saves.

The ones who turned back, or never set out, are in nobody's records, and that includes every one of us who has decided that a trip was too far to bother with.

The United Nations published new estimates in March showing 4.9 million children died before their fifth birthday in 2024, including 2.3 million newborns.

Deaths of under-fives worldwide have more than halved since 2000. Since 2015 the rate of improvement has slowed.

It was the first time the report broke down the leading causes of under-five deaths in full, and most of them are preventable with cheap, proven treatment. [49]

Most of these deaths are preventable with treatments that already exist and cost little. What is missing is access to decent care, which the report names directly. [49]

In rural Somaliland, researchers ran a cluster-randomised trial called SETiPlus.

Community health workers, who already treat childhood diarrhoea and pneumonia in their own villages, were also trained to find and treat acute malnutrition.

Children found in the intervention villages were more likely to start treatment than children in the comparison villages.

But the workers' diagnosis was often wrong, so some children were treated who did not need it. [51]

Fewer cases turned up than the researchers expected, so the trial could not prove that overall coverage rose.

It lands on families who live hours from the nearest clinic, which is where most untreated malnutrition sits. [51]

A survey reported in June found child malnutrition in Nepal at what its authors called alarming levels, after foreign aid for nutrition programmes was cut.

Nepal had been one of the clearest successes in the field: deaths among under-fives there fell 72% between 1996 and 2022.

The programmes that produced that fall were largely paid for from outside the country. [50]

Under-five deaths in Nepal had fallen 72% between 1996 and 2022. Those gains rested on money that can be withdrawn in a single budget round. [50]

A review in The BMJ pooled 69 randomised trials covering 153,902 adults who were not already on osteoporosis drugs. Osteoporosis is bone thinned to the point where it breaks easily.

Vitamin D alone made no difference to the risk of any fracture across 36 trials and 92,045 people.

Calcium alone and the two combined showed little or no effect either, and none of them reduced falls. The authors rated most of this evidence as high or moderate certainty. [28]

Almost a third of adults over 65 fall at least once a year, and half of women will break a bone at some point from a low-impact injury.

This is the largest test yet of whether the supplements prevent that. [28]

A meta-analysis pooled 29 randomised trials of exercise programmes for older people living at home, covering 6,367 participants.

Exercise cut all fall-related injuries by 13%, injuries needing medical attention by 29%, severe injuries by 33% and fall-related fractures by 44%.

The trials ranged across balance work, strength training and mixed programmes. Heterogeneity between the studies was low to moderate, meaning the trials broadly agreed with each other. [29]

This is the comparison that matters against supplements: the pill did nothing for fractures and the exercise cut them by nearly half.

Both were tested in older people living in their own homes. [28][29]

A German trial called DINKS enrolled 194 adults, all assigned female at birth and all leaking urine at least once a day.

They were randomly assigned to an app called Kranus Mictera on top of usual care, or to usual care alone.

The app taught pelvic floor exercises, bladder habits and relaxation over 12 weeks.

The trial was funded by the app's maker. [20]

Pelvic floor training is the recommended first treatment for leaking and is often never offered. An app costs one download and does not need a physiotherapist's appointment. [20][26]

A trial across nine hospitals in China randomly assigned 764 women expecting a first baby to a supervised pelvic floor programme from 28 weeks of pregnancy, or to usual care.

The pelvic floor is the sheet of muscle that holds the bladder outlet shut when belly pressure rises.

Six weeks after birth, 8.7% of the exercise group leaked urine on effort against 13.9% of the control group.

Muscle strength scores were more than twice as likely to be good. [21]

Muscle training is the recommended first treatment for leaking during pregnancy and after it. This trial gave it before the problem started rather than after. [21][27]

Polycystic ovary syndrome is being renamed polyendocrine metabolic ovarian syndrome.

The Mayo Clinic, one of the largest hospital groups in the United States, now uses the new name and its initials, PMOS, throughout its patient pages.

The old name points at cysts, but the dark circles on a scan are follicles, the fluid-filled sacs an ovary makes anyway.

The World Health Organization says 10 to 13% of women have the condition. [37][36]

The name told women the problem was their ovaries.

The condition also involves insulin resistance, higher male-type hormones and long-term diabetes risk, which is what the new name is trying to say. [36][37]

Researchers clustered nine clinical measurements from 11,908 women with polycystic ovary syndrome and found four reproducible subtypes, checked against five international groups of patients.

One is driven by high male-type hormones, one by obesity, one by a hormone-carrying blood protein and one by two reproductive hormones.

Followed for 6.5 years, the groups diverged sharply: the hormone-driven type had the highest risk of losing a pregnancy in the middle months, the obesity type the worst metabolic complications and the lowest live birth rate. [38]

Women given one label have been given one treatment plan. These four groups had different pregnancy outcomes and different diabetes risk, which is an argument for splitting the diagnosis. [38][41]

Luvadaxistat, an experimental drug for the memory and concentration problems that come with schizophrenia, missed its target in a phase 2 trial called ERUDITE.

203 adults already on antipsychotic medicine were randomly given placebo or one of two doses for 12 weeks.

On the main measure of thinking, neither dose beat the dummy pill; both were very slightly worse. About a third of participants in each group reported a side effect. [43]

Antipsychotics reduce hallucinations and delusions reliably and do much less for thinking and memory. This was one of the serious attempts at that gap. [43][47]

A meta-analysis in Molecular Psychiatry pooled 451 randomised trials covering 42,566 people, all aimed at what psychiatrists call negative symptoms: loss of drive, loss of pleasure, withdrawal from other people and flattened speech.

The authors worked out how big an effect has to be before a clinician would notice it, then measured which treatments cleared that bar.

Antibiotics, combined psychosocial programmes, antidepressants, physical activity, brain stimulation and immune-system drugs did, usually added on top of antipsychotics. [42]

These are among the most disabling features of schizophrenia and there are no agreed treatment guidelines for them.

The things that cleared the bar were mostly added on top of antipsychotics rather than replacing them. [42][47]

LB-102, a new drug that blocks three receptor types in the brain, was tested in 359 adults during an acute episode of schizophrenia.

Over four weeks, the 50 mg and 75 mg doses beat placebo on the standard symptom scale, and on every secondary measure the trial recorded.

The drug was reported as generally safe and tolerated at all doses over that short period. It is a chemical relative of amisulpride, an older antipsychotic. [44]

Four weeks is long enough to show an effect on an acute episode and too short to show weight gain or movement problems, which are among the reasons people stop taking these drugs. [44][48]

A Dutch trial followed 347 people who had recovered from a first episode of psychosis. Half were guided through reducing or stopping their antipsychotic; half stayed on the maintenance dose.

In the short term the reduction group relapsed more often and rated their quality of life lower. From three years onwards, researchers rated their day-to-day functioning better.

Medication use was similar in both groups from 12 months on. [45]

Because the drugs ended up the same after a year, the authors think the later gain came from having tried a guided taper, not from the dose itself. [45]

A trial across five centres in Egypt enrolled 1,000 people aged 16 to 40 who had just had a psychotic episode brought on by drugs, or a brief one.

Half received usual care: standard antipsychotics, monthly appointments and case management.

Half received that plus monthly family teaching sessions, weekly talking therapy and a low dose of risperidone with blood-level monitoring.

After two years, 26.3% overall had gone on to a schizophrenia diagnosis; the intensive group's risk was 39% lower. [46]

Cannabis-related cases had the highest rate of all, at 38.1%. The trial suggests the two years after a first episode are when the course can still be changed. [46]

American coral snake antivenom stopped being made in 2003, and the shortage forced doctors in Florida to wait for symptoms rather than dose every bite.

Researchers compared 301 cases reported to Florida poison centres between 1998 and 2021.

Patients dosed straight away were about three times as likely to end up in intensive care, with no difference in breathing tubes needed or in deaths.

Of 191 people given the antivenom, 38 had a reaction and eight of those were anaphylaxis. [7]

Antivenom carries its own risk of a serious reaction. When it is scarce, the question changes from how fast to give it to whether this patient needs it at all. [7][2]

A review pulled together 100 published studies describing 130 people who had a stroke after a snakebite.

Vipers caused 96.4% of them, mostly Russell's viper in South Asia and lance-headed vipers in South America. Nine in ten of the patients had received antivenom.

Clot-type strokes were commoner than bleeds, and 23.4% of the patients died. Just over a fifth of survivors were left with lasting weakness or paralysis. [6]

Venom damages blood vessels and the clotting system, so a bite on the foot can end as brain damage.

Cases came from 22 countries, led by India, Brazil and Sri Lanka. [6]

Researchers gathered hospital records on 40,817 snakebite patients across 11 provinces of southern China and the Yangtze basin, the first large multi-centre count the country has done.

Almost half the cases came from three provinces: Jiangxi, Hunan and Guizhou, which are mountainous, wet, densely populated and farming-dependent.

For more than half the patients, nobody recorded which snake had bitten them. [8]

China is working towards the global goal of halving snakebite deaths and disability by 2030, and a country cannot stock the right antivenom without knowing which snakes are biting. [8]

Kenyan researchers added two questions about snakebite to mass drug administration campaigns already running for trachoma, schistosomiasis and worms.

That reached 13.1 million people across 17 counties, about 28% of Kenya's population, between July 2022 and August 2023. Communities reported 4,667 bites in the previous year.

Turkana county reported 412.9 cases per 100,000 people and Vihiga county 3.7, a difference of more than a hundredfold. [9]

What people said about going to a health facility did not match what the facilities had recorded.

Piggy-backing on an existing campaign cost almost nothing and covered a quarter of the country. [9]

A study examined every snakebite notification in Brazil's national reporting system between 2007 and 2023. Sex and age were recorded almost every time.

Education, occupation, race and the actual clinical signs of poisoning were recorded poorly or very poorly.

Agreement with the separate deaths database was excellent overall, but weaker in the north, north-east, south-east and centre-west. [10]

Antivenom is distributed on the basis of these records. The regions where the data agree least are the ones with the longest journeys to a hospital that stocks it. [10][1]

Researchers reviewed the records of 2,684 snakebite patients seen between 2016 and 2020 at two referral hospitals in northern Ghana, in the Upper West and North East regions.

Snakebite is among the five commonest emergencies there. About 90% of cases were caused by snakes whose venom attacks the blood, and 91% of patients were admitted to a ward.

Swelling, severe pain and bleeding were the commonest signs on arrival. [11]

Treatment practice in the region had almost no published clinical data behind it until now, which makes it hard to tell whether the national guideline is being followed. [11]

A community survey led by frontline health workers covered 25 districts in 11 Indian states and a population of 60 million for a year.

It recorded 7,094 snakebites and a death rate of 0.33 per 100,000 people. Nearly half the deaths happened outside a hospital.

86.4% of victims sought hospital care and 60.2% received antivenom, of whom 17.2% had a side effect.

Average out-of-pocket cost was 6,500 rupees, and 47.5% of victims lived below the poverty line. [4]

For a farming household that gap decides which building you go to, and how long you argue about it first. [4]

Tim Friede, a former window cleaner in Wisconsin, spent nearly 20 years letting some of the world's deadliest snakes bite him on purpose, to build antibodies in his own blood.

The attempt nearly killed him, put him in a coma and almost cost him a leg and his fingers.

Centivax, a Californian vaccine company he now works for, is using his antibodies to build an antivenom that covers many species at once. [13]

Antivenom today must roughly match the snake that bit, and several hundred species can seriously wound a person.

A near-universal one would mean a clinic stocking one product instead of a shelf of them. [13][2]

Researchers tested drugs originally developed for other purposes against the venom of Bothrops, the lance-headed vipers responsible for most serious bites in Central and South America.

Marimastat and DMPS, which block the enzymes that break down tissue, and varespladib, which blocks another venom enzyme, neutralised venom from every species tested in laboratory assays.

The tissue-enzyme blockers also protected against clotting and bleeding effects in further laboratory tests. [14]

These are laboratory and animal results, not patients.

What makes them interesting is that a small molecule can be a tablet in a health post, where antivenom needs a fridge and a drip. [14][1]

A meta-analysis pooled seven randomised trials covering 125,666 patients, all testing whether an automatic flag in the hospital record could identify people who need palliative care.

The flags roughly doubled palliative care consultations for patients without cancer and raised them more than fivefold for cancer patients. Documentation of do-not-resuscitate decisions rose by 22%.

Effects on hospice use and on deaths in hospital were marginal. Families reported no change on the psychological measures the trials used. [18]

Randomised trials had already shown that this care helps; what was missing was the referral. Automating the referral changed the referral and little else. [18][16]

Researchers looked at the 603 patients randomly assigned to the specialist clinic arm of the EMPallA trial and asked who actually attended. About 54% came to at least one visit.

People without a high school education were less than half as likely to come as graduates, and so were people who needed considerable help with daily life.

Older patients, women and people who had never married came back for fewer follow-up visits. [19]

A clinic appointment is not a neutral offer. The people least likely to take it up had less schooling, needed more help with daily life, and had less social support. [19][15]

A German trial called EPCOG randomly assigned 217 people newly diagnosed with glioblastoma, the most aggressive brain cancer, to standard care or standard care plus palliative care from within four weeks of diagnosis.

Six university hospitals took part. Quality of life at six months favoured the palliative group but did not reach statistical significance.

The control group happened to live longer, and once the analysis allowed for that, the quality of life result did become significant. [17]

Mood and symptom problems improved most after the intervention ended.

Caregivers showed no benefit, which is a result worth reporting because caregiver strain is one of the main reasons this care is offered. [17]

A meta-analysis pooled 12 randomised trials covering 1,647 women, comparing phone apps that deliver pelvic floor training with usual care.

The apps cut the severity of leaking and reduced episodes by about two a day. Women using them were 42% more likely to stick with the exercises.

Quality of life improved.

A separate review of 18 studies and 2,308 people found the same pattern for severity and adherence, but no difference in quality of life or muscle strength, and rated its own evidence as low quality. [22][23]

The two reviews agree on the thing the app is for, which is getting people to keep doing the exercises, and disagree on whether life gets better. [22][23]