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Experts Outline Strategies for Boosting Equity in Chronic Kidney Disease

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Physicians and advocates explored ways to improve access to clinical trials, dialysis, and transplants for racial and ethnic minorities with chronic kidney disease during a webinar hosted by U.S. News & World Report and sponsored by the American Kidney Fund (AKF).

When the COVID-19 pandemic struck, people with chronic kidney disease, particularly those in kidney failure, could not isolate the way other people could because they needed to go to dialysis or other medical appointments, explained LaVarne Burton, president and CEO of the AKF.

During the first year of the pandemic, people with kidney failure were far more likely to contract COVID than other patients on Medicare and more likely to die from it. People of color, especially Black and Latino Americans, were also more likely to get and die from COVID.

“So, if you were a patient who had kidney failure, and you were a patient of color, it was devastating,” Burton said.

Inequities in Wait Lists and Transplantation

One obvious solution for addressing kidney failure is, of course, kidney transplant. The problem is that there are 100,000 people on the transplant list, most of whom are seeking kidneys, and only about 25,000 people received kidney transplants last year, Burton said. “So, we just don’t have enough organs to go around.”

People of color, women, and older adults have historically been disadvantaged on wait lists for both living and deceased donor transplantations, said Elaine Ku, MD, of the University of California San Francisco.

Policy changes were implemented to the kidney allocation system and wait list rules to try to improve inequities in access to kidney transplantation beginning in 2014, and included allowing patients on dialysis to have their wait time back-dated to the date they started dialysis, rather than when they were first referred and validated by a transplant center.

Those changes, Ku noted, have helped to reduce some of the racial inequities in access.

In addition, last year clinicians began using a race-free equation to assess kidney function — specifically estimated glomerular filtration rate (eGFR) values — to determine eligibility for organ donation, Ku said. Previous calculations incorporated misguided thinking about African Americans’ muscle mass that led to results showing less severe kidney disease in this population.

“So, I think that there has been efforts to try to address some of the inequities that were introduced through the use of a race-inclusive equation to estimate kidney function and there have been some changes there,” Ku added.

Live Organ Donation

According to Burton, live organ donation is economically, medically, and socially one of the most effective options for transplantation, but it also has its challenges.

One of the “most awful things,” she explained, is that a person can donate an organ and then be penalized in terms of access to certain insurance, or unable to take time off work. They might also struggle financially with the costs they bear as part of the donation process, she added.

The AKF has lobbied for legislation to protect living donors from insurance discrimination, and to allow them to take time off work. Today, close to 30 states have passed laws that encourage and protect live donors, Burton said.

Access for Undocumented Patients

Lilia Cervantes, MD, of the University of Colorado, Anschutz Medical Campus in Aurora, noted that roughly 180 to 200 undocumented patients in Colorado find themselves critically ill in the emergency department each week in need of emergency dialysis. In February 2019, Colorado opted to expand access to dialysis to undocumented immigrants with kidney failure. Since then, 20 states have passed similar laws.

“I think people realized that it’s important to keep undocumented immigrant patients receiving good care but also outside of the emergency department, especially during the pandemic when ED resources were quite tight,” she said. Coalition building around these issues has also led to “lots of really great legislation.”

Advocates also helped pass the Health Benefits for Children and Pregnant Persons or the “Cover All Coloradans” bill, which expanded Medicaid for all children and pregnant persons no matter their immigration status, as well as the Health Insurance Affordability Enterprise, which gives 10,000 uninsured people access to free insurance on the healthcare exchange.

Furthermore, the AKF also offers the Health Insurance Premium Program, which provides financial support to people in kidney failure to help them pay their insurance premiums. In 2022, AKF supported 60,000 people facing such challenges, Burton said.

Clinical Trials, Prevention

As for clinical trials, Burton said she’s seen the research become more inclusive of patients of color compared with past years.

“It’s very important that as new therapies are developed, that they are appropriate and effective for all of those dealing with kidney disease and especially for those populations that are most disproportionately affected,” she noted.

To that end, Deidra C. Crews, MD, ScM, of the Johns Hopkins Center for Health Equity in Baltimore, highlighted the need for early engagement.

Instead of asking for patient feedback after a clinical trial has been developed, she recommended asking patients to “co-design” trials so that they focus on outcomes and issues that matter most to patients.

She also recommended that researchers consider study designs that allow for more remote data collection or allow data to be collected at “a time and place that’s convenient for broader groups of people.”

Finally, the panelists spoke about prevention and the importance of educating patients and communities about kidney disease. This is the reason that the AKF developed its Health Equity Coalition, Burton said.

“One of the great positives about kidney disease is that, in an awful lot of cases, it is actually preventable,” she noted. “Or if not totally preventable, you can slow down the progression, if you know your risk, and if you follow the regimens that are recommended for you, as well as some lifestyle changes.”

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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