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Indigenous men diagnosed with more advanced prostate cancer, Canadian study says

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Indigenous men have more serious and later-stage prostate cancer when they’re diagnosed than non-Indigenous men, a new Canadian study says.

“It is very clear from this data that Indigenous men are at higher risk of developing aggressive prostate cancer than non-Indigenous men,” said Dr. Adam Kinnaird, senior author of the study and the Frank and Carla Sojonky Chair in Prostate Cancer Research at the University of Alberta.

The study, published Monday in the journal Cancer, looked at prostate cancer screening data among almost 1.5 million men in Alberta between 2014 and 2022. They were all between 50 and 70 years old.

Using postal codes, the researchers found that men in First Nations and Métis communities were much less likely to have had a prostate-specific antigen (PSA) test — the method used to screen for prostate cancer — than men living outside of Indigenous communities.

“Non-Indigenous men are having their PSA test done 50 per cent more often than Indigenous men are. And that’s a pretty big difference,” Kinnaird said.

The lack of screening, he said, could be a contributing factor to the study’s other major finding — that at the time of diagnosis, prostate cancer in Indigenous men was more advanced and more aggressive than in non-Indigenous men.

That finding was based on the tumour characteristics of 6,049 men diagnosed with prostate cancer who were seen at urology referral centres at the University of Alberta in Edmonton and at the University of Calgary.

Dr. Jason Pennington, a surgeon at the Scarborough Health Network and the Indigenous lead for the Central East Regional Cancer Program in Ontario, said the results are “not surprising.”

“(They are) actually supporting findings that we’ve been getting from Ontario,” said Pennington, who was not involved in the study and is a member of the Huron-Wendat Nation.

“This is what we see across Canada and across Indigenous populations around the world.”

One weakness of the study, Kinnaird said, is that because it relied on postal codes, it couldn’t compare the rate of PSA testing between Indigenous and non-Indigenous men living in cities.

About half of the Indigenous population lives in cities, he said, and researchers will be looking at data in another Alberta study to try to find testing rates for urban Indigenous men.

Kinnaird’s team also plans additional research to determine whether or not there might be a genetic factor that could make Indigenous men more prone to aggressive prostate cancer, he said.

That’s something that occurs in the Ashkenazi Jewish population, he said.

The study did not look at whether or not prostate cancer was more or less prevalent overall among Indigenous men — just at screening rates and severity at diagnosis.

There are many possible reasons Indigenous men are both tested less and suffer more advanced prostate cancer, Pennington said.

Lack of access to a primary-care provider to get screened is a likely factor, he said, along with social determinants of health, such as poverty, which could make it difficult for someone to take time off work to get a PSA test.

Kinnaird said it’s critical that health-care providers are aware of the inequity of prostate cancer screening.

“It’s something that’s important for Indigenous men, for family physicians, for nurse practitioners and for urologists to bear in mind that when you are seeing an Indigenous man in your clinic that you are really thinking about whether you need to screen for prostate cancer,” he said.

Indigenous distrust of the health-care system is another potential factor behind lower screening rates, Pennington said.

“Every Indigenous person I know, every Indigenous family I know, has had negative experiences in our health-care system,” he said.

One promising solution is holding community screening days, Pennington said, where Indigenous “patient navigators” and Indigenous nursing staff are present to answer questions and provide a culturally safe environment. Families can go together to help them feel more comfortable, he said.

That approach also works in remote Indigenous communities with mobile screening buses, he said.

Pennington said the time has come to implement more of these types of culturally safe Indigenous strategies and measure their success.

“We’re starting to have quite a bit of evidence now regarding the lower screening, the higher stages (of cancer), the poor outcomes,” he said.

“It’s about time we start doing something about it.”

This report by The Canadian Press was first published July 10, 2023.

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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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.

The Canadian Press. All rights reserved.

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