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Self harm a ‘priority area’ for public health amid 4 affected youth visiting Hamilton EDs a week

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As Hamilton emergency departments (EDs) deal with up to four self-harm cases among youth per week, the city’s manager of mental well-being says public health will make the issue “a priority area of focus” in the coming year.

Melissa Biksa attributes the surge in cases to “unique challenges” that came with the COVID-19 pandemic causing “service delivery interruptions” limiting human interactions.

“A lack of typical programs … that run in the community may have been interrupted… (like) social spaces,” Biksa told 900 CHML’s Hamilton Today.

“We had significant interruption in schools, so I think all of those types of experiences over the past two years … are being attributed to further increases.”

Youth self-harm is connected with two of four priority health areas — youth growth and development and mental health and substance use — public health told councillors last week would be given increased focus in 2023.

Hamilton public health classifies ‘self-harm’ as an event attempting to harm oneself through negative behaviour but not necessarily with the intention to produce a life-ending outcome.

The agency used data from a 2020 population health assessment to outline the problem, suggesting recent increases affected predominantly youth aged four to 18 who regularly attend school.

There were 197 visits to an ED among students for self-harm, an annual rate of 2.1 visits per 1,000 students, equating to nearly four self-harm cases per week in the city.

The number was almost double what public health recorded more than a decade ago in 2009, when the annual rate was around one visit per 1,000.

An example of the surge was reported by McMaster Children’s Hospital (MCH) in early 2021, revealing 26 youth admissions for medical intervention and stabilization following suicide attempts from October 2020 through January 2021.

Females were most affected in 2020, with 3.8 episodes per 1,000 population, more than double the 1.5 cases per 1,000 reported in 2009.

Students residing in the city centre and east of the Red Hill (wards 2 and 5) have the highest potential for self-harm at rates of 9.6 per 1,000 and four per 1,000, respectively, as of 2020.

Biksa says in her experience, “continued social development” for youth in this age group is important as they develop most of the “problem-solving skills” they will need in their adult years.

“It’s such an intensive time of growth and development and really … relies on continued social development,” Biksa said.

“It’s an important time of social development and development of skills, of resiliency and empowerment that are so critical to develop in the early years.”

Hamilton public health’s potential solutions will begin with intervention and prevention programs focusing on early-life parenting initiatives and partnerships in schools.

It includes Ministry of Health-funded child and adolescent services providing counselling services for children and youth up to 17 years of age.

“I think that’s the work we’ll continue to do in this post-pandemic health system recovery,” Biksa said.

“That’s an important component of emergency response, is continuing to evaluate the outcomes and learn from this experience.”

 

Public health exploring state of emergency amid opioid crisis in Hamilton

Hamilton’s medical officer of health is exploring the possibility of declaring a state of emergency amid an opioid crisis that has seen paramedic calls almost double over the last two years.

Ward 9 Coun. Brad Clark pitched a motion in mid-January to investigate the thresholds of opioid deaths and overdoses, with the prospect of launching an “effective response” opening up city “funding resources.”

The motion carried unanimously and could potentially be ratified by Hamilton city council by Wednesday.

Paramedics responded to 814 incidents related to suspected opioid overdoses in 2022, according to city data, compared with 430 such incidents in 2017.

Opioid deaths have increased in Ontario by more than 100 per cent since 2017 and took a marked jump when the pandemic hit in March 2020.

The opioid-related death rate is 45 per cent greater in Hamilton compared with Ontario.

“Opioid-related deaths have increased exponentially from 26 in 2005 to 166 estimated in 2021,” said Julie Prieto, director of epidemiology and well-being. “An estimated 30 per cent increase in opioid-related deaths was seen in 2021 compared to 2020.”

The COVID-19 pandemic was particularly devastating for those with issues around mental health and substance abuse.

“The consequence of public health measures put in place to mitigate the spread and severity of the virus — for example, lockdowns, workplace closures and service disruptions — have further negatively impacted many Canadians’ mental health, particularly those who use drugs,” said Prieto.

 

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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