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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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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

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

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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