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Publicly funded genetic test for suitable antidepressants would save health-care costs: study

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Linda Riches, shown in this handout image, tried at least 12 different antidepressants before one worked for her.HO/The Canadian Press

Loss. That’s the word that comes to mind when Linda Riches thinks of the debilitating depression that robbed her of the ability to fully care for her son, advance in her career and pursue her goal of a PhD in education.

Riches, 67, said she was prescribed at least a dozen antidepressants, starting in her 30s, but they failed to lift her mood while she missed a lot of days in her job as a high school teacher. When she would return to work, she felt isolated and alone among co-workers she believed would have responded differently if she’d had a physical illness.

“If you’ve been off because of a mental health issue, people just don’t want to talk about it. So they ignore it. Nobody wants to come and say, ‘Is there anything I can do to help you?’ ” she said from her home near Prince George, B.C.

Years went by as she started to lose hope before one medication turned out to be the right fit.

Now, Riches says she hopes others can avoid a trial-and-error experience by having a genetic test to help predict which drugs would likely work best for them and cause fewer side-effects.

Known as pharmacogenomic testing, such personalized treatment is available for a fee. A lab examines DNA obtained from a sample such as from blood, saliva or a cheek swab to identify the genetic variants that affect how the patient would metabolize and respond to specific medications.

Riches is one of three patients who took part in a University of British Columbia study into the cost savings offered if pharmacogenomic testing were to be publicly funded.

A study published Tuesday in the Canadian Medical Association Journal suggests that providing the test as a standard part of care could save $956-million over 20 years for the health-care system in British Columbia alone. That excludes all the personal and economic savings from people returning to work, being able to afford child care and having a better quality of life.

Stirling Bryan, a senior author on the study, said more than 35 antidepressants are available in Canada but nearly half of patients do not respond to the first medication they are prescribed and about a quarter of those report intolerable side-effects.

Genes are responsible for about 42 per cent of the variation in how people respond to antidepressants, said Bryan, a professor at UBC’s school of population and public health and a senior scientist at Vancouver Coastal Health Research Institute.

Researchers accessed about 194,000 patients’ health data from 2015 to 2020. It included medications they were typically prescribed for major depression as well as clinical trial data linking genetic information to appropriate antidepressants. From that, they developed a simulation model for how people would fare over 20 years if they did not have pharmacogenomic testing compared with predictable outcomes with that testing.

Bryan said about 37 per cent of patients who don’t respond to various medications are deemed to have treatment-resistant depression, sometimes after they give up trying out of frustration, at which point they may need more doctors’ visits, including psychotherapy. They could also end up in hospital for electroconvulsive therapy (ECT) or other treatment, adding to health-care costs.

“One in 10 Canadians will experience major depression in their lifetime,” said Stirling, believing that widespread availability of pharmacogenomic testing could save billions of dollars throughout the country.

Beyond the financial savings, the study showed that an anticipated 1,869 lives would be saved over 20 years, Bryan said.

Few patients get a genetic test to determine which antidepressants could be best suited to them, but more people are choosing that option, usually by spitting into a tube they mail to a lab.

However, doctors may not know how to interpret someone’s genetic profile to help guide their prescribing decisions, said Bryan, urging more education on that through a program that would fund the testing.

Research on pharmacogenomic testing is also under way elsewhere in Canada.

Dr. Paul Arnold, a child and adolescent psychiatrist and director of the University of Calgary’s Mathison Centre for Mental Health Research and Education, is involved in a study for patients between ages six and 24 who are either starting on medication or about to switch to a different drug.

DNA samples have so far been collected from about 1,000 patients in Alberta, British Columbia, Saskatchewan and Alberta, but the goal is torecruitanother 2,000 children and young adults, Arnold said.

The study initially included participants up to age 18 but expanded because most mental illnesses start before age 25.

The samples are being tested by a publicly funded lab but the hope is that costs could eventually be covered by the Alberta government depending on findingsafter researchers analyze prescribing patterns and changes in use of health-care services, Arnold said.

“The exciting thing about pharmacogenomic research is that you can see the immediate impact,” he said. “The goal is to catch (patients) early, before they go through that journey of having been on multiple medications without success.”

Dr. Jitender Sareen, a psychiatrist who is medical director of the mental health program for the Winnipeg Regional Health Authority, said plans are under way to launch a study that would determine the impact of pharmacogenomic testing for hospitalized adults, including seniors taking medications for multiple conditions.

“Our aim is to recruit all adults but we wanted to start on our inpatient units because there is mixed evidence about whether this kind of pharmacogenomic testing can actually reduce the length of hospitalization,” he said.

Pharmacogenomic testing currently costs between $200 and $400, but providing it to everyone who needs antidepressants would benefits the health-care system, care providers in the community as well as patients, Sareen said.

“People get tired of trying different medications and this could at least help guide treatment.”

 

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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.

___

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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