Rapid Rise in Syphilis Hits Native Americans Hardest

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From her base in Gallup, New Mexico, Melissa Wyaco supervises about two dozen public health nurses who crisscross the sprawling Navajo Nation searching for patients who have tested positive for or been exposed to a disease once nearly eradicated in the U.S.: syphilis.

Infection rates in this region of the Southwest — the 27,000-square-mile reservation encompasses parts of Arizona, New Mexico, and Utah — are among the nation’s highest. And they’re far worse than anything Wyaco, who is from Zuni Pueblo (about 40 miles south of Gallup) and is the nurse consultant for the Navajo Area Indian Health Service, has seen in her 30-year nursing career.

Syphilis infections nationwide have climbed rapidly in recent years, reaching a 70-year high in 2022, according to the most recent data from the Centers for Disease Control and Prevention. That rise comes amid a shortage of penicillin, the most effective treatment. Simultaneously, congenital syphilis — syphilis passed from a pregnant person to a baby — has similarly spun out of control. Untreated, congenital syphilis can cause bone deformities, severe anemia, jaundice, meningitis, and even death. In 2022, the CDC recorded 231 stillbirths and 51 infant deaths caused by syphilis, out of 3,761 congenital syphilis cases reported that year.

And while infections have risen across the U.S., no demographic has been hit harder than Native Americans. The CDC data released in January shows that the rate of congenital syphilis among American Indians and Alaska Natives was triple the rate for African Americans and nearly 12 times the rate for white babies in 2022.

“This is a disease we thought we were going to eradicate not that long ago, because we have a treatment that works really well,” said Meghan Curry O’Connell, a member of the Cherokee Nation and chief public health officer at the Great Plains Tribal Leaders’ Health Board, who is based in South Dakota.

Instead, the rate of congenital syphilis infections among Native Americans (644.7 cases per 100,000 people in 2022) is now comparable to the rate for the entire U.S. population in 1941 (651.1) — before doctors began using penicillin to cure syphilis. (The rate fell to 6.6 nationally in 1983.)

O’Connell said that’s why the Great Plains Tribal Leaders’ Health Board and tribal leaders from North Dakota, South Dakota, Nebraska, and Iowa have asked federal Health and Human Services Secretary Xavier Becerra to declare a public health emergency in their states. A declaration would expand staffing, funding, and access to contact tracing data across their region.

“Syphilis is deadly to babies. It’s highly infectious, and it causes very severe outcomes,” O’Connell said. “We need to have people doing boots-on-the-ground work” right now.

In 2022, New Mexico reported the highest rate of congenital syphilis among states. Primary and secondary syphilis infections, which are not passed to infants, were highest in South Dakota, which had the second-highest rate of congenital syphilis in 2022. In 2021, the most recent year for which demographic data is available, South Dakota had the second-worst rate nationwide (after the District of Columbia) — and numbers were highest among the state’s large Native population.

In an October news release, the New Mexico Department of Health noted that the state had “reported a 660% increase in cases of congenital syphilis over the past five years.” A year earlier, in 2017, New Mexico reported only one case — but by 2020, that number had risen to 43, then to 76 in 2022.

Starting in 2020, the covid-19 pandemic made things worse. “Public health across the country got almost 95% diverted to doing covid care,” said Jonathan Iralu, the Indian Health Service chief clinical consultant for infectious diseases, who is based at the Gallup Indian Medical Center. “This was a really hard-hit area.”

At one point early in the pandemic, the Navajo Nation reported the highest covid rate in the U.S. Iralu suspects patients with syphilis symptoms may have avoided seeing a doctor for fear of catching covid. That said, he doesn’t think it’s fair to blame the pandemic for the high rates of syphilis, or the high rates of women passing infections to their babies during pregnancy, that continue four years later.

Native Americans are more likely to live in rural areas, far from hospital obstetric units, than any other racial or ethnic group. As a result, many do not receive prenatal care until later in pregnancy, if at all. That often means providers cannot test and treat patients for syphilis before delivery.

In New Mexico, 23% of patients did not receive prenatal care until the fifth month of pregnancy or later, or received fewer than half the appropriate number of visits for the infant’s gestational age in 2023 (the national average is less than 16%).

Inadequate prenatal care is especially risky for Native Americans, who have a greater chance than other ethnic groups of passing on a syphilis infection if they become pregnant. That’s because, among Native communities, syphilis infections are just as common in women as in men. In every other ethnic group, men are at least twice as likely to contract syphilis, largely because men who have sex with men are more susceptible to infection. O’Connell said it’s not clear why women in Native communities are disproportionately affected by syphilis.

“The Navajo Nation is a maternal health desert,” said Amanda Singer, a Diné (Navajo) doula and lactation counselor in Arizona who is also executive director of the Navajo Breastfeeding Coalition/Diné Doula Collective. On some parts of the reservation, patients have to drive more than 100 miles to reach obstetric services. “There’s a really high number of pregnant women who don’t get prenatal care throughout the whole pregnancy.”

She said that’s due not only to a lack of services but also to a mistrust of health care providers who don’t understand Native culture. Some also worry that providers might report patients who use illicit substances during their pregnancies to the police or child welfare. But it’s also because of a shrinking network of facilities: Two of the Navajo area’s labor and delivery wards have closed in the past decade. According to a recent report, more than half of U.S. rural hospitals no longer offer labor and delivery services.

Singer and the other doulas in her network believe New Mexico and Arizona could combat the syphilis epidemic by expanding access to prenatal care in rural Indigenous communities. Singer imagines a system in which midwives, doulas, and lactation counselors are able to travel to families and offer prenatal care “in their own home.”

O’Connell added that data-sharing arrangements between tribes and state, federal, and IHS offices vary widely across the country, but have posed an additional challenge to tackling the epidemic in some Native communities, including her own. Her Tribal Epidemiology Center is fighting to access South Dakota’s state data.

In the Navajo Nation and surrounding area, Iralu said, IHS infectious disease doctors meet with tribal officials every month, and he recommends that all IHS service areas have regular meetings of state, tribal, and IHS providers and public health nurses to ensure every pregnant person in those areas has been tested and treated.

IHS now recommends all patients be tested for syphilis yearly, and tests pregnant patients three times. It also expanded rapid and express testing and started offering DoxyPEP, an antibiotic that transgender women and men who have sex with men can take up to 72 hours after sex and that has been shown to reduce syphilis transmission by 87%. But perhaps the most significant change IHS has made is offering testing and treatment in the field.

Today, the public health nurses Wyaco supervises can test and treat patients for syphilis at home — something she couldn’t do when she was one of them just three years ago.

“Why not bring the penicillin to the patient instead of trying to drag the patient in to the penicillin?” said Iralu.

It’s not a tactic IHS uses for every patient, but it’s been effective in treating those who might pass an infection on to a partner or baby.

Iralu expects to see an expansion in street medicine in urban areas and van outreach in rural areas, in coming years, bringing more testing to communities — as well as an effort to put tests in patients’ hands through vending machines and the mail.

“This is a radical departure from our past,” he said. “But I think that’s the wave of the future.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • Blackberries vs Blueberries – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing blackberries to blueberries, we picked the blackberries.

    Why?

    They’re both great! But the humble blackberry stands out (and is an example of “foods that are darker are often more nutrient-dense”).

    In terms of macronutrients, they’re quite similar, being both berry fruits that are mostly water, but blackberries do have 2x the fiber (and for what it’s worth, 2x the protein, though this is a small number obviously), while blueberries have 2x the carbohydrates. An easy win for blackberries.

    When it comes to vitamins, blackberries have notably more of vitamin A, B3, B5, B9, C, and E, as well as choline, while blueberries have a little more of vitamins B1, B2, and B6. A fair win for blackberries.

    In the category of minerals, blackberries have a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Blueberries are not higher in any minerals. Another easy win for blackberries.

    Blueberries are famous for their antioxidants, but blackberries actually equal them. The polyphenolic content varies from one fruit to another, but they are both loaded with an abundance (thousands) of antioxidants, especially anthocyanins. Blackberries and blueberries tie in this category.

    Adding up the sections makes for an easy, easy win for blackberries—but diversity is always best, so enjoy both!

    Want to learn more?

    You might like to read:

    Take care!

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  • How long does back pain last? And how can learning about pain increase the chance of recovery?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year.

    Chronic pain, of which back pain is the most common, is the world’s most disabling health problem. Its economic impact dwarfs other health conditions.

    If you get back pain, how long will it take to go away? We scoured the scientific literature to find out. We found data on almost 20,000 people, from 95 different studies and split them into three groups:

    • acute – those with back pain that started less than six weeks ago
    • subacute – where it started between six and 12 weeks ago
    • chronic – where it started between three months and one year ago.

    We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.

    Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.

    More pain doesn’t mean a more serious injury

    Most acute back pain episodes are not caused by serious injury or disease.

    There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.

    Factory worker deep-breathes with a sore back
    Your doctor or physio can rule out serious damage.
    DG fotostock/Shutterstock

    Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.

    The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.

    The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.

    Reduce your chance of lasting pain

    Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:

    • understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain
    • reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.

    How to reduce your pain sensitivity and learn about pain

    Learning about “how pain works” provides the most sustainable improvements in chronic back pain. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.

    Physio helps patient use an exercise strap
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    Halfpoint/Shutterstock

    These programs have been in development for years, but high-quality clinical trials are now emerging and it’s good news: they show most people with chronic back pain improve and many completely recover.

    But most clinicians aren’t equipped to deliver these effective programs – good pain education is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.

    When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just been told it’s all in their head.

    Community-driven not-for-profit organisations such as Pain Revolution are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than 80 local pain educators and supported them to bring greater understanding and improved care to their colleagues and community.

    But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.The Conversation

    Sarah Wallwork, Post-doctoral Researcher, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Focusing On Health In Our Sixties

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    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝What happens when you age in your sixties?❞

    The good news is, a lot of that depends on you!

    But, speaking on averages:

    While it’s common for people to describe being over 50 as being “over the hill”, halfway to a hundred, and many greetings cards and such reflect this… Biologically speaking, our 60s are more relevant as being halfway to our likely optimal lifespan of 120. Humans love round numbers, but nature doesn’t care for such.

    • In our 60s, we’re now usually the “wrong” side of the menopausal metabolic slump (usually starting at 45–55 and taking 5–10 years), or the corresponding “andropause” where testosterone levels drop (usually starting at 45 and a slow decline for 10–15 years).
    • In our 60s, women will now be at a higher risk of osteoporosis, due to the above. The risk is not nearly so severe for men.
    • In our 60s, if we’re ever going to get cancer, this is the most likely decade for us to find out.
    • In our 60s, approximately half of us will suffer some form of hearing loss
    • In our 60s, our body has all but stopped making new T-cells, which means our immune defenses drop (this is why many vaccines/boosters are offered to over-60s, but not to younger people)

    While at first glance this does not seem a cheery outlook, knowledge is power.

    • We can take HRT to avoid the health impact of the menopause/andropause
    • We can take extra care to look after our bone health and avoid osteoporosis
    • We can make sure we get the appropriate cancer screenings when we should
    • We can take hearing tests, and if appropriate find the right hearing aids for us
      • We can also learn to lip-read (this writer relies heavily on lip-reading!)
    • We can take advantage of those extra vaccinations/boosters
    • We can take extra care to boost immune health, too

    Your body has no idea how many times you’ve flown around the sun and nor does it care. What actually makes a difference to it, is how it has been treated.

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  • Before You Reach For That Tylenol…

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    First, on names: we’ve titled this with “Tylenol” because that’s a well-known brand name, but the drug name is paracetamol or acetaminophen:

    • paracetamol is the drug name used by the World Health Organization, and thus also most countries.
    • acetaminophen is the drug name used in Canada, Colombia, Iran, Japan, US, and Venezuela.

    They are absolutely the same drug.

    Firstly, obviously, do avoid overdose

    The safe dosage described on the packet is generally accurate (usually around 4g/day, spaced out at 1g per 4 hours), and the dose required for toxicity is generally about 10g, or 200mg/kg body weight, whichever is lower. Since a single dose usually contains 2x 500mg = 1g, that makes overdose all too easy.

    The amount required for toxicity can be misleading too, because that’s assuming…

    • a healthy liver
    • no other health problems
    • no other medications that interact or add to the toxicity
    • no medications that strain the liver (as with many pro-drugs, and drugs in general that are metabolized by the liver, which is lots).

    Which is a lot of assumptions! Especially given that the liver can only process so much at once, meaning that if your liver has a lot of things to do, it can get a backlog, and you think “I’m not taking anything with this painkiller that I shouldn’t” but your liver is still metabolizing the last of last night’s glass of wine and one of your regular medications from this morning, because previously it was still metabolizing things from the day before yesterday, and so on.

    See also: How To Regenerate Your Liver ← the liver is an incredible organ that does an amazing job, but it can’t do that if you don’t do this

    Please don’t overdose deliberately either. Intentional overdoses make up a very large portion of acetaminophen overdoses (exact figures vary from year to year and place to place, but it’s always high), and what a lot of people doing that don’t realize is:

    1. it’s a very unpleasant way to die. You’ll take it, you might get some initial symptoms within the first hours or you might not, then you’ll probably feel better, and then the next day or so, you’ll enter the organs-shutting-down stage that usually will take most of a week to kill you slowly and painfully. Often your kidneys will go first but it’ll usually be liver necrosis that deals the final blow.
    2. it’s very difficult to treat. Stomach-pumping might work if you get it within 1 hour of overdose, and activated charcoal might help if you get it within 2 hours. Acetylcysteine may reduce the toxicity if you get it within the 8–48 hour window (depending on the speed of gastric emptying), but whether or not that will help depends on the severity of the overdose and other factors, so this is not something to bet on. After 48 hours, a liver transplant is the last resort, without which, mortality is around 95%.

    Unfortunately, this means that a lot of people who do not fully intend to die horribly, and hoped to either die peacefully or else be saved, die horribly instead.

    Ok, that was not a cheerful topic but it is important, before moving on, we’ll just put this here for anyone it may benefit:

    How To Stay Alive (When You Really Don’t Want To) ← this is about suicidality, in yourself or others

    Secondly, that dosage is for occasional use only

    The problem often starts like this:

    ❝Due to its perceived safety, paracetamol has long been recommended as the first line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications❞

    People with chronic pain, whether high or low on the pain level of that chronic pain, can very easily get into a habit of “I’ll just take this to take the edge off”, for example when getting up in the morning (often a trigger for pain starting) or going to bed at night (one needs to sleep and the pain is a barrier to that).

    But… Those events, getting up and going to bed, it means that taking the drug also becomes part of one’s morning/evening routine—with many people even metering the doses out into pill organizers for the week, with this in mind.

    A large (n=582,961) study looked at two groups of people, all aged 65+:

    • 180,483 people who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months)
    • 402,478 people of the same age who had never been prescribed paracetamol repeatedly

    The findings? Bearing in mind that “≥2 prescriptions within six months” is not something generally considered excessive…

    ❝Acetaminophen use was associated with an increased risk of peptic ulcer bleeding (aHR 1.24; 95% CI 1.16, 1.34), uncomplicated peptic-ulcers (aHR 1.20; 95% CI 1.10, 1.31), lower gastrointestinal-bleeding (aHR 1.36; 95% CI 1.29, 1.46), heart-failure (aHR 1.09; 95% CI 1.06, 1.13), hypertension (aHR 1.07; 95% CI 1.04, 1.11), and chronic kidney disease (aHR 1.19; 95% CI 1.13, 1.24).❞

    The researchers concluded:

    ❝Despite its perceived safety, acetaminophen is associated with several serious complications. Given its minimal analgesic effectiveness, the use of acetaminophen as the first-line oral analgesic for long-term conditions in older people requires careful reconsideration.❞

    You can see the study itself here: Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink

    What to use instead?

    It’s been established that taking aspirin regularly isn’t great either:

    See: Low-Dose Aspirin & Anemia and Aspirin, CVD Risk, & Potential Counter-Risks

    And as for ibuprofen, we don’t have an article about that yet, but it’s gut-unhealthy (harms your microbiome), and besides, anything it can do, ginger can do as well or better (in head-to-head trials; we’re not speaking hyperbolically here):

    Ginger Does A Lot More Than You Think ← in fact, it was even found as effective as the combination of acetaminophen, ibuprofen, and caffeine

    There are other options though, and as pain is complicated and there’s no one-size-fits-all solution, we’ve compiled the following:

    Take care!

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  • Radiant Rebellion – by Karen Walrond

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    In health terms, we are often about fighting aging here. But to be more specific, what we’re fighting in those cases is not truly aging itself, so much as age-related decline.

    Karen Walrond makes a case that we’ve made from the very start of 10almonds (but she wrote a whole book about it), that there’s merit in looking at what we can and can’t control about aging, doing what we reasonably can, and embracing what we can’t.

    And yes, embracing, not merely accepting. This is not a downer of a book; it’s a call to revolution. It asks us to be proud of our grey hairs, to see our smile-lines around our eyes as the sign of a lived-in body, and even to embrace some of the unavoidable “actual decline” things as part of the journey of life. Maybe we’re not as strong as we used to be and now need a grippety-doodah to open jars; not everyone gets to live long enough to experience that! How lucky we are.

    Perhaps most importantly, she bids us be the change we want to see in the world, and inspire others with our choices and actions, and shake off ageist biases for good.

    Bottom line: if you want to foster a better attitude to aging not only for yourself, but also those around you, then this is a top-tier book for that.

    Click here to check out Radiant Rebellion, and reclaim aging!

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  • Intermittent Fasting for Women Over 50 – by Emma Sanchez

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    Intermittent fasting is promoted as a very healthful (evidence-based!) way to trim the fat and slow aging, along with other health benefits. But, physiologically and especially metabolically, the average woman is quite different from the average man! And most resources are aimed at men. So, what’s the difference?

    Emma Sanchez gives an overview not just of intermittent fasting, but also, how it goes with specifically female physiology. From hormonal cycles, to different body composition and fat distribution, to how we simply retain energy better—which can be a mixed blessing!

    We’re given advice about how to optimize all those things and more.

    She also covers issues that many writers on the topic of intermittent fasting will tend to shy away from, such as:

    • mood swings
    • risk of eating disorder
    • impact on cognitive thinking

    …and she does this evenly and fairly, making the case for intermittent fasting while acknowledging potential pitfalls that need to be recognized in order to be managed.

    Lastly, the “over 50” thing. This is covered in detail quite late in the book, but there are a lot of changes that occur (beyond the obvious!), and once again, Sanchez has tips and tricks for holding back the clock where possible, and working with it rather than against it, when appropriate.

    All in all, a great book for any woman over 50, or really also for women under 50, especially if that particular milestone is on the horizon.

    Get your copy of Intermittent Fasting for Women over 50 from Amazon today!

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