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Modelling masters

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A Memorial research team has developed mathematical models to inspire future public health responses to infectious diseases.

Dr. Amy Hurford, an expert in infectious disease modelling in the Department of Biology, Faculty of Science, is working in partnership with Julien Arino and post-doctoral fellow in the Department of Mathematics, Dr. Maria Martignoni.

From left are Drs. Amy Hurford and Maria Martignoni.Photo: Rich Blenkinsopp

It has been over four years since the onset of the COVID-19 pandemic, and public health responses and policies continue to vary worldwide.

The effects of these policies are far-reaching and are still felt in every corner of the province, country and world.

These policies can be boiled down to two unique strategies: infection elimination or mitigation.

Led by Dr. Martignoni, the research team identified the need for guidelines that evaluate the appropriateness of an elimination or mitigation strategy early in the pandemic and have been aiding government officials and working groups in Canada to navigate the implementation of policies since 2020.

Their research has now culminated in a quantitative analysis and modelling that will change how future public health policies are implemented.

Mathematical modelling

Elimination strategies, which aim for zero community transmission, have been successful in regions with low travel volumes and strict border control measures, they say.

On the other hand, mitigation strategies, which focus on reducing transmission to manageable levels, are more suited to well-connected and densely populated areas.

“Different public health responses are appropriate for different local contexts.” — Dr. Amy Hurford

Recognizing the importance of building connections between the two modelling frameworks of disease mitigation or elimination, Drs. Hurford and Martignoni developed a theoretical framework based on research conducted throughout the COVID-19 pandemic relating to implemented health policies around the world.

Their manuscript published June 19  in the prestigious journal Royal Society Open Science details the modelling, including common errors and misconceptions that bias against recommending one strategy over another.

The study, Is SARS-CoV-2 Elimination or Mitigation Best? Regional and Disease Characteristics Determine the Recommended Strategy, offers a detailed analysis of elimination versus mitigation approaches, tailored to regional characteristics and specifics of the SARS-CoV-2 virus and variants.

The publication in Royal Society Open Science not only highlights the innovative work being done at Memorial University, but also reinforces the critical role of evidence-based quantitative research in guiding public health policy, the researchers say.

Key findings

The findings emphasize that the effectiveness of COVID-19 strategies depends heavily on local factors.

Infection severity, health care capacity, the efficiency of case detection, the vaccination status of a population and the economic and societal costs of public health measures all have a fundamental role in determining which strategy should be implemented, and when.

The paper provides a comprehensive framework to guide policy-makers in deciding between elimination and mitigation, taking into account the economic and social costs associated with each approach.

“Elimination can be a valid public health strategy in some regions, and mitigation equally valid in others. Our work supports all regions by highlighting that different public health responses are appropriate for different local contexts,” explained Dr. Hurford.

Local application

For Drs. Hurford and Dr. Martignoni, Canada provided the perfect field of study for their research.

“In Canada, many public health decisions were made at the provincial level,” said Dr. Martignoni. “The COVID-19 pandemic in Canada was fairly unique in that there was a need for a modelling that could support both elimination and mitigation approaches.”

The researchers applied their framework to Canadian provinces and territories, highlighting the diverse responses across the country.

For instance, the Atlantic provinces and northern Canada successfully implemented elimination strategies early in the pandemic, benefiting from their geographical isolation and lower population density.

In contrast, provinces like Ontario and Quebec adopted mitigation strategies due to their large urban centers and high connectivity, making elimination impractical.

The study underscores the importance of flexible and adaptive public health policies that consider regional characteristics.

The authors also stress the need for ongoing reassessment of strategies as the virus evolves and new variants emerge.

Inspiration for future policy

This publication marks a significant contribution to the field of public health, providing valuable insights that can help shape future responses to pandemics or infectious diseases in general.

The framework developed by Drs. Martignoni and Hurford offers a valuable tool for policy-makers worldwide, enabling them to make informed decisions that balance public health needs with economic and social considerations.

“This work has inspired future modelling,” said Dr. Hurford. “It helped lead to the formation of a new working group and has inspired applications to other diseases and in other settings.”

Dr. Martignoni agrees.“We want other people to read our work and think: ‘That’s something I want to contribute to!’ We want them to get inspired, such that we can join forces to produce a body of work that will help us better determine the circumstances under which disease elimination or mitigation is best, to optimize future pandemic responses.”

 

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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Alberta to launch new primary care agency by next month in health overhaul

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CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.

Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.

Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.

LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.

The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.

Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.

This report by The Canadian Press was first published Oct. 15, 2024.

The Canadian Press. All rights reserved.

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Experts urge streamlined, more compassionate miscarriage care in Canada

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Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.

Her fetus’s heartbeat had stopped.

“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.

“That was the last I heard from our maternity physician, with no further followup,” she says.

But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.

Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.

Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.

An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.

The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.

But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.

She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.

But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.

She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.

“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.

Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.

“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”

The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.

Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.

“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.

At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”

Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.

In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.

Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.

“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.

“It was really validating.”

This report by The Canadian Press was first published Oct. 15, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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