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Looking back: Toronto’s 2003 SARS outbreak – Global News

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A new coronavirus, which emerged in December from China, has drawn comparison to the 2003 outbreak of SARS.

Here, Global News looks at how SARS affected Torontonians nearly 20 years ago:

What is SARS?

The SARS coronavirus, or Severe Acute Respiratory Syndrome, is thought to be a virus from an animal reservoir that spread to other animals and first infected humans in Guangdong, China in 2002, according to the World Health Organization.

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READ MORE:
Doctor on front lines of SARS outbreak says Canadian hospitals prepared for coronavirus

The epidemic resulted in more than 8,000 cases in 2003 and affected 26 countries, one of which was Canada.

In Canada, there were 438 probable and suspect SARS cases reported, which included 44 deaths.

Start of the virus and its transmission to Toronto

SARS first infected humans in the Guangdong province in southern China in 2002.

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A 65-year-old doctor, who had treated atypical pneumonia patients in Guangdong, travelled to Hong Kong to attend his nephew’s wedding. When he checked into the hotel he was staying at, he didn’t feel well. The doctor ended up infecting at least 12 others from several different countries, including a 78-year-old Canadian woman.

The woman returned to Toronto from Hong Kong on Feb. 23, 2003. Two days after she got back home, she developed a high fever. She visited her family doctor five days later, and by that time, she was also complaining of muscle aches and a dry cough.


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‘Too early’ to declare China coronavirus a global health emergency: WHO

The woman’s condition continued to deteriorate, and she died at home on March 5, 2003. Two days later, her 44-year-old son went to the Scarborough Hospital, Grace Division’s emergency department to complain of a high fever, a severe cough and difficulty breathing.

The man was kept in the open observation ward of the emergency department for 18 to 20 hours, but by the next day, his condition had deteriorated significantly, and he was admitted to intensive care.

The woman’s son died on March 13, 2003, and by this time, several other family members were also sick.

“It was then clear that there was a cluster of illness in that family, and at about the same time, the outbreak was recognized in Hong Kong,” said Allison McGeer, an infectious disease consultant at Sinai Health System, who was at the forefront of the Toronto outbreak.

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On March 12, 2003, the World Health Organization issued a global alert about “cases of atypical pneumonia.”

In Toronto, the virus continued to spread to others, including hospital staff

Public health response

On March 13, 2003, Health Canada was notified of the Toronto cluster.

SARS continued to spread throughout the Scarborough Hospital, which led to it closing its emergency and intensive care services on March 23 and to refusing new patients and transfers from other hospitals. Anyone who entered the hospital after March 16 was asked to adhere to a 10-day home quarantine.

On March 25, 2003, the Ontario government designated SARS as a reportable, communicable and virulent disease under the Health Protection and Promotion Act, which allowed public health officials to track infected people and issue orders to prevent them from engaging in activities that might transmit the illness.






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What the coronavirus is, and is Canada ready for it?


What the coronavirus is, and is Canada ready for it?

One day later, Ontario’s then-premier Ernie Eves declared SARS a provincial emergency. Overnight, the province’s ministry of health and long-term care required all hospitals to create units to care for SARS patients. The province also activated its multi-ministry provincial operations centre for emergency response.

All hospitals in the Greater Toronto Area and Simcoe County were instructed to activate “Code Orange” emergency plans, which meant that the involved hospitals suspend non-essential services.

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They were also required to limit visitors, create isolation units for possible SARS patients and to implement protective clothing for exposed staff. Four days later, officials implemented the access restrictions on all hospitals in Ontario.

Looking back and forward

Looking at Toronto’s 2003 SARS outbreak, McGeer said officials got a lot of things right in the sense that they were able to control it.

“They clearly did enough right things to control the outbreak,” McGeer said. “Some of the things that were done were not necessary, but there was no way of knowing at the time that they were not necessary.”

According to the doctor, one thing that wasn’t necessary was quarantine.

“When we learned more about the disease, it turns out that SARS is among the unusual infections that was not infectious before people got sick,” McGeer said.

“Retrospectively, we needn’t have quarantined all of those people who were exposed.”


READ MORE:
Mass quarantines won’t happen in Canada if coronavirus is discovered: authorities

McGeer said officials could have just told people who exhibited SARS symptoms to separate themselves from others.

Another thing that was unnecessary, according to the doctor, was the extent of hospital closures. If officials had data on likely patterns of spread between hospitals, they probably could have managed a different system that would’ve resulted in less hospitals being closed, causing less of a disruption to general care, McGeer said.

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“These are not things where I would say the government should not have done them, but with the wisdom of hindsight, now that we’ve had the chance to look at it afterwards, you can say we didn’t need to do them,” McGeer added.






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A background on the coronavirus and its symptoms


A background on the coronavirus and its symptoms

© 2020 Global News, a division of Corus Entertainment Inc.

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Ultra-Processed Foods May Be Linked to Increased Risk of Cancer

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Summary: High consumption of ultra-processed foods, including soda, chips, and some white bread products, was associated with an increased risk of developing and dying from certain kinds of cancer, including brain cancer.

Source: Imperial College London

Higher consumption of ultra-processed foods may be linked to an increased risk of developing and dying from cancer, an Imperial College London-led observational study suggests.

Researchers from Imperial’s School of Public Health have produced the most comprehensive assessment to date of the association between ultra-processed foods and the risk of developing cancers.

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Ultra-processed foods are food items which have been heavily processed during their production, such as fizzy drinks, mass-produced packaged breads, many ready meals and most breakfast cereals.

Ultra-processed foods are often relatively cheap, convenient, and heavily marketed, often as healthy options. But these foods are also generally higher in salt, fat, sugar, and contain artificial additives. It is now well documented that they are linked with a range of poor health outcomes including obesity, type 2 diabetes and cardiovascular disease.

The first UK study of its kind used UK Biobank records to collect information on the diets of 200,000 middle-aged adult participants. Researchers monitored participants’ health over a 10-year period, looking at the risk of developing any cancer overall as well as the specific risk of developing 34 types of cancer. They also looked at the risk of people dying from cancer.

The study found that higher consumption of ultra-processed foods was associated with a greater risk of developing cancer overall, and specifically with ovarian and brain cancers. It was also associated with an increased risk of dying from cancer, most notably with ovarian and breast cancers.

For every 10 percent increase in ultra-processed food in a person’s diet, there was an increased incidence of 2 percent for cancer overall, and a 19 percent increase for ovarian cancer specifically.

Each 10 percent increase in ultra-processed food consumption was also associated with increased mortality for cancer overall by 6 percent, alongside a 16 percent increase for breast cancer and a 30 percent increase for ovarian cancer.

These links remained after adjusting for a range of socio-economic, behavioral and dietary factors, such as smoking status, physical activity and body mass index (BMI).

The Imperial team carried out the study, which is published in eClinicalMedicine, in collaboration with researchers from the International Agency for Research on Cancer (IARC), University of São Paulo, and NOVA University Lisbon.

Previous research from the team reported the levels of consumption of ultra-processed foods in the UK, which are the highest in Europe for both adults and children. The team also found that higher consumption of ultra-processed foods was associated with a greater risk of developing obesity and type 2 diabetes in UK adults, and a greater weight gain in UK children extending from childhood to young adulthood.

Dr. Eszter Vamos, lead senior author for the study, from Imperial College London’s School of Public Health, said, “This study adds to the growing evidence that ultra-processed foods are likely to negatively impact our health including our risk for cancer. Given the high levels of consumption in UK adults and children, this has important implications for future health outcomes.

“Although our study cannot prove causation, other available evidence shows that reducing ultra-processed foods in our diet could provide important health benefits. Further research is needed to confirm these findings and understand the best public health strategies to reduce the widespread presence and harms of ultra-processed foods in our diet.”

Dr. Kiara Chang, first author for the study, from Imperial College London’s School of Public Health, said, “The average person in the UK consumes more than half of their daily energy intake from ultra-processed foods.

“This is exceptionally high and concerning as ultra-processed foods are produced with industrially derived ingredients and often use food additives to adjust color, flavor, consistency, texture, or extend shelf life.

See also

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The study found that higher consumption of ultra-processed foods was associated with a greater risk of developing cancer overall, and specifically with ovarian and brain cancers. Image is in the public domain

“Our bodies may not react the same way to these ultra-processed ingredients and additives as they do to fresh and nutritious minimally processed foods. However, ultra-processed foods are everywhere and highly marketed with cheap price and attractive packaging to promote consumption. This shows our food environment needs urgent reform to protect the population from ultra-processed foods.”

The World Health Organization and the United Nations’ Food and Agriculture Organization has previously recommended restricting ultra-processed foods as part of a healthy sustainable diet.

There are ongoing efforts to reduce ultra-processed food consumption around the world, with countries such as Brazil, France and Canada updating their national dietary guidelines with recommendations to limit such foods. Brazil has also banned the marketing of ultra-processed foods in schools. There are currently no similar measures to tackle ultra-processed foods in the UK.

Dr. Chang added, “We need clear front of pack warning labels for ultra-processed foods to aid consumer choices, and our sugar tax should be extended to cover ultra-processed fizzy drinks, fruit-based and milk-based drinks, as well as other ultra-processed products.

“Lower income households are particularly vulnerable to these cheap and unhealthy ultra-processed foods. Minimally processed and freshly prepared meals should be subsidized to ensure everyone has access to healthy, nutritious and affordable options.”

The researchers note that their study is observational, so does not show a causal link between ultra-processed foods and cancer due to the observational nature of the research. More work is needed in this area to establish a causal link.

About this diet and brain cancer research news

Author: Press Office
Source: Imperial College London
Contact: Press Office – Imperial College London
Image: The image is in the public domain

Original Research: The findings will appear in eClinicalMedicine

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ER closure for Seaforth’s emergency department due to COVID-19 outbreak

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Starting on Feb. 1, Seaforth’s emergency department will be closed in the overnight hours.

The Huron Perth Healthcare Alliance said due to “sudden health human resource shortages related to COVID-19,” the Seaforth Community Hospital’s emergency department will be closed from 5 p.m. to 7 a.m., from Feb. 1st to Feb. 6, when regular hours are expected to resume.

On Jan. 28, a COVID-19 outbreak was declared in Seaforth’s inpatient unit, closing all admissions to the unit. On Tuesday, a COVID-19 outbreak was declared at the Clinton General Hospital’s inpatient unit, also closing it to admissions.

In total, 10 people are in Huron-Perth hospitals dealing with COVID-19.

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Two long-term care homes in the region are also dealing with COVID-19 outbreaks at the moment. Since Jan. 1, eight Huron-Perth residents, most of them over the age of 75, have died due to COVID-19, according to the Huron Perth Health Unit.

“I extend my condolences to the loved ones of these individuals,” said Dr. Miriam Klassen, medical officer of health for the Huron Perth Health Unit.

She added, “COVID-19 remains a serious illness for some people, especially those who are older. While we are seeing signs of improvement, it is important to keep taking actions to protect those who are most vulnerable to severe outcomes from this virus.”

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GLP-1 Agonists Protected Kidneys in T2D With Advanced DKD

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Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.

Key Takeaways

  • In patients with advanced diabetic kidney disease (DKD; estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73m2), treatment with a glucagon-like peptide-1 (GLP-1) agonist had a neutral effect on cardiovascular outcomes but significantly linked with preservation of kidney function and improved survival in a propensity-score matched, retrospective analysis of observational data from more than 2000 people with type 2 diabetes in Taiwan.

Why This Matters

  • Cardiovascular disease is a leading cause of mortality in people with type 2 diabetes and among those with chronic kidney disease.
  • GLP-1 agonists reduce all-cause mortality and cardiovascular death in people with type 2 diabetes, but their role in patients with advanced DKD is controversial.
  • Research on the effect of GLP-1 agonists on cardiovascular outcomes in patients with advanced DKD is limited. Trials that have assessed GLP-1 agonists in people with type 2 diabetes have generally excluded those with advanced DKD and completely excluded those with end-stage kidney disease (eGFR < 30 mL/min/1.73m2).
  • Treatment with GLP-1 agonists has been associated with a significant reduction in composite cardiovascular outcomes in people with type 2 diabetes and relatively fair kidney function (eGFR > 30 mL/min/1.73m2), but among people with type 2 diabetes and lower levels of kidney function, research has shown neutral composite cardiovascular outcomes levels. However, limitations of previous studies include being mainly based on subgroup analysis or including a limited sample of patients.

Study Design

  • Retrospective analysis of observational data from nearly 9000 people in Taiwan with type 2 diabetes and an eGFR < 30 mL/min/1.73m2 who received a first prescription for a GLP-1 agonist or dipeptidyl peptidase 4 (DPP-4) inhibitor in 2012-2021 and had the data necessary for this analysis in their records.
  • The data came from the largest multi-institutional electronic medical record database in Taiwan, which includes two medical centers and five general hospitals and information on more than 11 million patients, from 2001 to 2019.
  • Researchers used propensity scoring to match 602 people treated with a GLP-1 agonist with 1479 people treated with a DPP-4 inhibitor.

Key Results

  • During a mean follow-up of 2.1 years, the rate of the composite cardiovascular outcome (cardiovascular death, myocardial infarction, and ischemic stroke) did not significantly differ between the GLP-1 agonist and DPP-4 inhibitor groups, with incidence rates of 13.0% and 13.8%, respectively, and a nonsignificant hazard ratio of 0.88. Rates of each of the three components of the composite endpoint also did not significantly differ between the two groups.
  • Progression to end-stage kidney disease with dialysis was significantly lower in those treated with a GLP-1 agonist compared with a DPP-4 inhibitor, with incidence rates of 23.4% and 27.5%, respectively, and a significant hazard ratio of 0.72.
  • The incidence of a greater than 50% drop in eGFR from baseline was 32.2% with GLP-1 agonist treatment compared to 35.9% with a DPP-4 inhibitor, with a significant hazard ratio of 0.74.
  • Median time until patients needed new-onset dialysis was 1.9 years with GLP-1 agonist treatment and 1.3 years with DPP-4 inhibitor treatment, which was a significant difference.
  • The rate of all-cause death was 18.4% with GLP-1 agonist treatment compared with 25.1% with DPP-4 inhibitor treatment, a hazard ratio of 0.71 that was significant.

Limitations

  • Because the study was a retrospective analysis of observational data it cannot prove causality.
  • The study could be subject to residual confounding despite propensity-score matching.
  • The data came from health records that could have included coding errors.
  • Treatment compliance was unknown.

Disclosures

This is a summary of a preprint research study, “The cardiovascular and renal effects of glucagon-like peptide 1 receptor agonists in patients with advanced diabetic kidney disease,” by researchers in Taiwan on Research Square and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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