Health
Clinical Improvement Seen in Study of 1st Year of COVID-19 Pandemic | Better Lung Function, BMI in CF Patients Came After Increased Telehealth Use
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Twelve months into the COVID-19 pandemic, Australian adults and children with cystic fibrosis (CF) showed improved lung function and body mass index (BMI), as well as a lower hospitalization rate, a study reports.
“Differing models of care and major changes in community interactions both have the potential to influence clinical outcomes in chronic disease,” the researchers wrote. “This study has demonstrated that the COVID-19 pandemic forced a change in the CF model of clinical care delivery.”
Monitoring CF patients typically involves regular face-to-face clinical visits, both in inpatient and outpatient settings. However, it can also be provided by telehealth, through video or a phone call.
Telehealth benefits include improving access to specialty care, early detection of clinical alterations, and a lower risk of cross-infection.
“However, there are concerns from CF clinicians about widespread use of telehealth, including ability to complete comprehensive patient assessment and ensuring equitable access,” the researchers wrote.
In Australia, about 30% of people live outside major cities. As such, the COVID-19 pandemic required increasing use of telehealth as a replacement for clinical visits, due to travel restrictions and limited access to healthcare facilities.
Early feedback on telehealth during the pandemic indicated that CF patients were highly satisfied, showing stability in lung function and decreased pulmonary exacerbations (times when symptoms get worse, usually associated with infections).
The study and its results
Aiming to report on the impact on clinical outcomes at a national level 12 months after the onset of the pandemic, a research team in Australia used the Australian Cystic Fibrosis Data Registry, which has data from approximately 95% of adults and children with CF.
In total, data were available for 3,662 patients — 1,930 males and 1,732 females with a mean age of 20.2 years, ranging from 0 to 82. March 16, 2020, was chosen as the start date to assess outcomes, as that was when the Australian government limited the number of people allowed to gather publicly and when funding was approved to encourage telehealth evaluations.
Lung function — determined by the percent predicted forced expiratory volume in one second (ppFEV1), which is how much air is forced from the lungs in one second — and BMI, a measure of body fat, were compared 24 months before versus 12 months after the pandemic onset.
Other parameters, including the number of hospitalizations and virtual consultations, were compared 12 months before versus 12 months after the start date.
The researchers found ppFEV1 to be improved in adults (mean study entry value of 66.1%) and in children 5 to 12 (92.2%) after 12 months of COVID-19. In both, ppFEV1 went from a mean annual decline before study start of 0.38% and 0.46%, respectively, to an improvement in lung function of 1.29% in adults and 0.97% in children.
In children 12 to 17, whose mean study entry ppFEV1 was 81.7%, the annual ppFEV1 slope improved further from 0.99% to 3.78%.
As for BMI, patients 17 and older showed a significant increase in one year — 0.03 kg per square meter (kg/m2) vs. 0.30 kg/m2, with a mean entry BMI of 20.1 kg/m2. In younger patients, BMI (measured as a Z-score, the difference between a CF child’s BMI at a certain age to healthy growth reference values) was already improving before the pandemic and continued after — 0.05 kg/m2 vs. 0.12 kg/m2.
In addition, the number of hospitalizations one year after the start date dropped significantly (2,656 vs. 1,957), including a 26% reduction in those requiring into-the-vein antibiotics.
Before the pandemic, 92% of outpatient CF monitoring was done face to face, with 8% through telehealth. But one year into the pandemic in Australia, in-person visits decreased to 53%, with virtual consultations increasing to 47%.
Overall, “in the 12-months following the onset of the COVID-19 pandemic, there was an improvement in the clinical outcomes of people with CF when compared to the pre-pandemic period,” the research team wrote.
European studies also showed an increase in lung function. However, this was shown after two to three months of pandemic-related lockdown and using single lung-function values, while the Australian study used national data from a longer period of time.
Despite the observed benefits of COVID-19 restrictions and telehealth in CF, “due to the retrospective design of the study, no conclusions are able to be drawn regarding the cause of the improved clinical outcomes,” the researchers concluded. A retrospective study is one that uses data compiled from the past.
“Multiple factors, including reduced [community] interaction and reduced exposure to respiratory viruses, as well as a change to a more remote model of care may have contributed to the findings. However … causation is unable to be determined,” the scientists concluded.
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Grande Prairie RCMP issued a warning Friday after it was revealed fentanyl linked to a deadly overdose was mixed with a chemical that doesn’t respond to naloxone treatment.
The drugs were initially seized on Feb. 28 after a fatal overdose, and this week, Health Canada reported back to Mounties that the fentanyl had been mixed with Bromazolam, which is a benzodiazepine.
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Mounties say this is the first recorded instance of Bromazolam in Alberta. The drug has previously been linked to nine fatal overdoses in New Brunswick in 2022.
The pills seized in Alberta were oval-shaped and stamped with “20” and “SS,” though Mounties say it can come in other forms.
Naloxone treatment, given in many cases of opioid toxicity, is not effective in reversing the effects of Bromazalam, Mounties said, and therefore, any fentanyl mixed with the benzodiazepine “would see a reduced effectiveness of naloxone, requiring the use of additional doses and may still result in a fatality.”
From January to November of last year, there were 1,706 opioid-related deaths in Alberta, and 57 linked to benzodiazepine, up from 1,375 and 43, respectively, in 2022.
Mounties say officers responded to about 1,100 opioid-related calls for service, last year with a third of those proving fatal. RCMP officers also used naloxone 67 times while in the field, a jump of nearly a third over the previous year.
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Health
CFIA continues surveillance for HPAI in cattle, while sticking with original name for disease – RealAgriculture
The Canada Food Inspection Agency will continue to refer to highly pathogenic avian influenza in cattle as HPAI in cattle, and not refer to it as bovine influenza A virus (BIAV), as suggested by the American Association of Bovine Practitioners earlier this month.
Dr. Martin Appelt, senior director for the Canadian Food Inspection Agency, in the interview below, says at this time Canada will stick with “HPAI in cattle” when referencing the disease that’s been confirmed in dairy cattle in multiple states in the U.S.
The CFIA’s naming policy is consistent with the agency’s U.S. counterparts’, as the U.S. Animal and Plant Health Inspection Service has also said it will continue referring to it as HPAI or H5N1.
Appelt explains how the CFIA is learning from the U.S. experience to-date, and how it is working with veterinarians across Canada to stay vigilant for signs of the disease in dairy and beef cattle.
As of April 19, there has not been a confirmed case of HPAI in cattle in Canada. Appelt says it’s too soon to say if an eventual positive case will significantly restrict animal movement, as is the case with positive poultry cases.
This is a major concern for the cattle industry, as beef cattle especially move north and south across the U.S. border by the thousands. Appelt says that CFIA will address an infection in each species differently in conjunction with how the disease is spread and the threat to neighbouring farms or livestock.
Currently, provincial dairy organizations have advised producers to postpone any non-essential tours of dairy barns, as a precaution, in addition to other biosecurity measures to reduce the risk of cattle contracting HPAI.
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Health
Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star
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Canada has seen a concerning rise in measles cases in the first months of 2024.
By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.
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