Staying #Up2Date 🚨

1. Trip hazard

In this retrospective cohort study of 2.5 million older adults, those who experienced serious falls were more likely to be diagnosed with dementia within 1 year compared to those with other traumatic injuries (11% vs. 6%). After adjusting for various sociodemographic and clinical factors, the risk of dementia diagnosis was 21% higher in the falls group. These findings suggest that falls may be an early marker of cognitive decline or undiagnosed dementia. 

2. Missed beat

The GUARD-AF trial assessed whether screening for afib using a 14-day patch monitor reduced stroke risk in 12K patients aged ≥70. Screening improved AF detection (5.0% vs. 3.3%) and led to more frequent anticoagulation prescriptions (4.2% vs. 2.8%), but the incidence of stroke and hospitalized bleeds was similar between the screened and unscreened groups. 

3. Guideline watch

The ACG recently released updated guidelines on H. pylori infections. Here’s the tea:

• All who test positive should be treated (H. pylori is associated with gastric cancer).

• A 14-day course of a bismuth salt, metronidazole or tinidazole, tetracycline, and a proton-pump inhibitor (PPI) is recommended for a first infection.

• A 10-day course is no longer considered adequate, and substitution of doxycycline for tetracycline weakens the regimen. 

• Test of cure 1 month after tx with a breath test, fecal antigen test, or tissue-based test.

Colon Craze

Why it might be time to decrease the age of colon cancer screening

What happened: A new US study has found that younger people are getting colonoscopies after the age for screening was lowered. 

Why it’s interesting: In 2021, the US lowered the screening age to 45. Since then, rates among people aged 45-49 increased to about 1.5% in just a year and a half, according to a new study. One doctor said these results are promising, since it helps spread awareness against colon cancer. 

But: Up here in the North, there has been a growing call for lowering the screening age for colonoscopies. In February, a petition with over 1,000 signatures was signed asking Ontario’s provincial legislature to lower the test from 50 to 30. Colorectal cancer is the 4th most common form of cancer in Canada. In 2023, it was estimated that there were 24,000 cases of the disease with 9,300 deaths. 

Despite the public's outcry, the Canadian Task Force on Preventive Health Care still asks that anyone who is not high risk for colorectal cancer and has no symptoms should wait until they’re between the ages of 50 to 74 to get screened. The task force said guidelines cannot be changed without analysis of scientific evidence, including help from knowledgeable specialists and health professionals.

A doctor from Sunnybrook who works at the Young Adult Colorectal Cancer Clinic said he’s seen many patients in their 20s and 30s diagnosed with the disease, and the diagnosis is almost always made late.

Due to the increased rates of colorectal cancer in younger people, many Canadian doctors say the country should look into decreasing the age of screening.

Bottom line: We might hate to admit it, but we could learn something from our neighbours, giving people the choice to receive a colonoscopy screening earlier to save lives.

Hot Off The Press

1: 🧫 US biologists Victor Ambros and Gary Ruvkun just won the 2024 Nobel Prize in Medicine for discovering microRNA — a game-changer in how genes are controlled. This discovery — described as a complete shock to the scientific community — is already being explored in clinical trials and could pave the way for innovative gene therapies in the near future.

2: 🍊 Scurvy isn’t just an ancient sailor’s disease — it’s showing up in Canadian patients due to rising food insecurity, warns a new CMAJ report. With more families struggling to access fresh produce, doctors should be on alert for symptoms like fatigue, bruising, and bleeding gums, especially in at-risk groups.

3: 🗑️ A team of researchers took an unconventional approach to tracking the spread of mpox — by analyzing DNA from nearly 21,000 used condoms in 16 countries. The study confirmed that mpox is sexually transmitted and often found alongside other STIs. The findings give public health officials a new tool for monitoring outbreaks, especially in areas with limited resources. It’s not exactly dinner conversation, but definitely a fresh take on disease surveillance!

4: 🏠 Toronto’s University Health Network is opening 51 permanent apartments for homeless people who often end up in the ER, thanks to a partnership with housing non-profit Fred Victor. It’ll provide 51 apartments with medical and social support, aiming to reduce hospital strain and offer stable homes to those with complex needs.

Notable Numbers 🔢

1 in 8: the number of American adults who’ve used weight loss drugs. The US adult obesity rate has fallen by roughly 2 percentage points between 2020 and 2023 — a potential public health breakthrough comparable to the decline in cigarette smoking. The drop might be linked to the use of weight loss drugs like Wegovy and Zepbound, though no direct evidence confirms this.

$72M: how much the US Department of Health & Human Services is providing to vaccine manufacturers like CSL Seqirus, Sanofi, and GSK to prepare bird flu vaccines for rapid distribution, if needed — though the risk to the public still remains low.

25th: Hollywood star Keanu Reeves’s placement in the Toyota GR Cup in Indianapolis, where he made his professional auto racing debut on Saturday. He spun out a little more than halfway through the race, but don’t worry, this Canadian treasure was completely uninjured and is ready for his next race.

💬 In Our Community

A physician shared frustrations about the proposed ~2% across-the-board fee increase, arguing it’s inadequate given the rising overhead costs since the pandemic. They believe a more equitable approach would be at least a 5% increase universally, with certain specialties receiving more when it’s appropriate. Here’s what others had to say:

• One physician disagreed, arguing that disproportionate pay increases are essential for equity, warning that many generalists, including family physicians, may leave medicine if this does not get addressed, negatively impacting specialists who rely on their referrals. This view gained support from family physicians and other generalists, while some specialists countered that they "underestimate [their] ability to adapt.”

• Another physician criticized the current OMA plan as too conservative, noting that, at their institution, “radiologists make over $1 million a year. No overhead. The psychiatrists make on average just over $150K. Same years of training.” They also called out the OMA and MOH for allowing relativity to be a minor issue for years, blaming this for the current disparities.

• Another viewpoint highlighted that underfunding foundational specialties like family medicine and psychiatry undermines the entire system, especially during the ongoing mental health/addictions crisis. They also criticized the idea of relativity, claiming it offers no real redistribution or equity — rather, that it’s a facade to appear active while avoiding upsetting high-earning practitioners.

Postcall Picks

😭 Laugh: at the appreciation day classic served by hospitals.

✈️ Travel: to Southeast Asia to earn 15 CME credits and experience a life-time of adventure! Register before Oct. 28 to save $1,000/couple.

🧠 Learn: how to address workplace microaggressions, including with microaffirmations, in the upcoming OMA Women Webinar on Oct. 10. 

🤑 Save: on the Google Pixel Buds Pros – only $100 (original $260) on Amazon!

🏡 Get Paid: Up to $4,100 in cashback when you secure your mortgage with BMO! Until Nov. 5, get exclusive savings on new purchases, switches, or refinances. Email Helen Sy at [email protected]. **

** This is sponsored content

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