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Air pollution raises risk of type 2 diabetes, says landmark Indian stud

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Inhaling polluted air increases the risk of type 2 diabetes, the first study of its kind in India has found. Research conducted in Delhi and the southern city of Chennai found that inhaling air with high amounts of PM2.5 particles led to high blood sugar levels and increased type 2 diabetes incidence.

When inhaled, PM2.5 particles – which are 30 times thinner than a strand of hair – can enter the bloodstream and cause several respiratory and cardiovascular diseases.

The study is part of ongoing research into chronic diseases in India that began in 2010. It is the first to focus on the link between exposure to ambient PM2.5 and type 2 diabetes in India, one of the worst countries in the world for air pollution.

The average annual PM2.5 levels in Delhi was 82-100μg/m3 and in Chennai was 30-40μg/m3, according to the study, many times the WHO limits of 5μg/m3. India’s national air quality standards are 40μg/m3.

There is also a high burden of non-communicable diseases, including diabetes, hypertension and heart disease in India; 11.4% of the population – 101 million people – are living with diabetes, and about 136 million are pre-diabetic, according to a paper published in the Lancet in June. The average diabetes prevalence in the European Union was 6.2% in 2019, and 8.6% in the UK in 2016.

The Lancet study found India’s diabetes prevalence to be higher than previous estimations and showed a higher number of diabetics in urban than rural India.

In the BMJ study, the researchers followed a cohort of 12,000 men and women in Delhi and Chennai from 2010 to 2017 and measured their blood sugar levels periodically. Using satellite data and air pollution exposure models, they determined the air pollution in the locality of each participant in that timeframe.

They found that one month of exposure to PM2.5 led to elevated levels of blood sugar and prolonged exposure of one year or more led to increased risk of diabetes. They found for every 10μg/m3 increase in annual average PM2.5 level in the two cities, the risk for diabetes increased by 22%.

“Given the pathophysiology of Indians – low BMI with a high proportion of fat – we are more prone to diabetes than the western population,” said Siddhartha Mandal, lead investigator of the study and a researcher at Centre for Chronic Disease Control, Delhi.

The addition of air pollution – an environmental factor – with lifestyle changes in the past 20 to 30 years is fuelling the increasing burden of diabetes, he said.

“Until now, we had assumed that diet, obesity and physical exercise were some of the factors explaining why urban Indians had higher prevalence of diabetes than rural Indians,” said Dr V Mohan, chairman of the Madras Diabetes Research Foundation and one of the authors of the paper. “This study is an eye-opener because now we have found a new cause for diabetes that is pollution.”

Another study on the same cohort in Delhi, found average annual exposure to PM2.5 in Delhi (92μg/m3) led to increase in blood pressure levels and higher likelihood of developing hypertension.

Together, the studies show that the higher than safe levels of PM2.5 in the air in Indian cities cause diabetes and hypertension that could lead to atherosclerosis (the build up of fatty deposits in the arteries), heart attacks and heart failures, said Mandal.

PM2.5 contains sulfates, nitrates, heavy metals and black carbon that can damage the lining of blood vessels and increase blood pressure by stiffening the arteries. The particles can get deposited in the fat cells and cause inflammation and can also attack the heart muscle directly, said Dr Dorairaj Prabhakaran, cardiologist and executive director of the Centre for Chronic Disease Control and one of the authors of the paper.

Acting as an endocrine disruptor, PM2.5 hampers insulin production in the body as well as its effect.

In urban India there has been a rise of hypothyroidism, polycystic ovarian syndrome (PCOS) and gestational diabetes. This study shows that pollution may play a part in causing all of these as it disrupts the endocrine system that produces all hormones in the body, said Mohan.

The researchers are now working to understand the impact of pollution on cholesterol and vitamin D levels in the body, and its impact on the life cycle of individuals, including birth weight, pregnant women’s health, insulin resistance in adolescents, and the risk for Parkinson’s and Alzheimer’s disease, among others.

While its findings are alarming, the study gives scientists hope that bringing down pollution can decrease the burden of diabetes, as well as other non-communicable diseases, said Prabhakaran.

Some public policy initiatives have shown results. Since a public outcry about air pollution in 2016, the central and Delhi government have banned older diesel vehicles, limited construction, built highways that bypass the city, and banned the burning of crops. Reports suggest there was a 22% reduction in PM2.5 levels between 2016 and 2021.

“This is a modest but welcome reduction. Similar measures adapted to local conditions are urgently needed across the country,” said Prabhakaran.

 

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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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