What employers need to know about alopecia areata – Benefits Canada
“It was a really difficult transition going from someone who was a redhead . . . to having no hair, no eyebrows, no eyelashes and staring [in the mirror] at someone I just didn’t know,” recalled Krahn, now the owner of Image Evolution by Freedom Wigs, during Benefits Canada’s 2023 Chronic Disease at Work conference in early February. “It was devastating and it really took me out and made me a shell of my current self.”
Read: Webinar coverage: How can alopecia areata affect benefits plan members?
Alopecia areata is an autoimmune disease caused by the body’s immune system attacking the hair follicles. Affecting roughly two per cent of people globally, the disease is typically chronic in nature and can start at any age, said Jeff Donovan, dermatologist at Donovan Hair Clinic, also speaking during the session, which was supported by Pfizer Canada Inc.
There are three types of alopecia: areata, which involves small or medium patches of hair loss that eventually grow back on their own or with treatment; totalis, which means complete hair loss on the head; and universalis, which is when someone experiences complete hair loss all over their body. Roughly five to 10 per cent of patients progress to total hair loss.
People who have one autoimmune condition are more likely to also experience others, something that’s true for those living with alopecia, said Donovan, noting many alopecia patients also have autoimmune thyroid disease. Eczema or atopic dermatitis, rheumatoid arthritis and pernicious anemia also occur in smaller numbers of patients.
Alopecia can be treated with cortisone creams or injections to reduce inflammation around the hair follicles, minoxidil to stimulate hair growth and, in cases of significant hair loss, immunosuppressive medications that are also used for other autoimmune conditions like rheumatoid arthritis or inflammatory bowel disease.
Read: A primer for plan sponsors on autoimmune conditions
But Donovan noted that, while small patches of hair loss may respond well to treatment, it’s often much harder to treat significant hair loss. “We have a long way to go to improve the outcomes that we are able to achieve, but certainly new medications are on the horizon.”
Indeed, he noted no Health Canada-approved treatments for alopecia currently exist, but treatment is key for many patients because it helps to reduce some of the psychological impacts associated with the disease. Given the profound emotional impact of hair loss, people living with alopecia face an increased risk of developing anxiety and depression.
A 2020 study in the Journal of Investigative Dermatology found 62 per cent of alopecia areata patients made “major life decisions” about their relationships, education and/or career due to their disease. Some studies have suggested more than 75 per cent have experienced a change in their quality of life after developing alopecia. And the impact is more severe for younger patients, women and patients who lose their eyebrows and eyelashes.
Alopecia may also prompt employees to take more time off work, according to multiple studies of alopecia in the workplace. One study of 5,000 adults with the disease found they also experienced an up to 12 per cent reduction in productivity while at work.
“The more feelings of self-consciousness, embarrassment, sadness or frustration [a person with alopecia reported], the more they had impairment in their productivity at work,” said Donovan, noting some studies have found alopecia patients make career decisions specifically to take on roles with less public visibility.
Read: Panel: Should drug coverage for certain conditions still be optional?
Krahn encouraged plan sponsors to support employees with alopecia through their benefits plans by covering the cost of wigs or hair pieces — which can range from $1,000 to $10,000 — and existing and future treatments for the condition. Some workplace benefits plans may consider hairpieces cosmetic rather than medical, she said, but argued that was the wrong approach.
“Hair is part of our identity . . . and it’s very much attached to our mental health, though you don’t realize that until it’s going and you’re experiencing all the feelings associated with that loss. Just to treat it as aesthetic would be incorrect. If we realized that, I think we’d be making [strides] and there’d be so many more people who would be [comfortable] working in the workplace.”
For Krahn, finally finding a good hair piece allowed her to feel confident again and to feel comfortable returning to her teaching career. “It’s been a difficult process to go through, but it’s been rewarding at the same time to get to the other side of that loss.”
Read more coverage of the 2023 Chronic Disease at Work conference.
New stroke treatment helps more Canadian patients return home to their normal lives – CBC.ca
The Current19:05Calls for greater access to life-saving treatment for stroke
When Marleen Conacher was taken to a hospital for major stroke treatment for the second time in a week in 2021, she wasn’t treated with a clot-busting drug like she was previously given at North Battleford Hospital in Saskatchewan.
Instead, she was transported directly to Royal University Hospital in Saskatoon, where a stroke team performed an endovascular thrombectomy (EVT).
The procedure involved passing small devices through one of the arteries in her groin, and then using suction, or tubes called stents to pull the stroke-causing blood clot out.
“I don’t recall when they, they put the little claw-like thing up through my groin and it went up through the artery and, and into my brain,” she said. “But I do remember feeling when they had got to it and were pulling it out.”
“It was a great deal of pressure. It did not hurt, but it was a great deal of pressure,” she told The Current‘s Matt Galloway.
Within a few days of the stroke, Conacher was out of the hospital, walking on her own and ready to go shopping.
She said she doesn’t think about the stroke much these days.
“I don’t spend a lot of time, you know, thinking about having a stroke or whatever or that time,” she said. “I just thank the good Lord that I am here.”
EVT procedures are a relatively new option in the field of ischemic stroke treatment. In 2015, a study known as the escape stroke trial led by the University of Calgary’s Hotchkiss Brain Institute found that, overall, positive outcomes for stroke patients increased from 20 per cent to 55 per cent thanks to EVTs.
Today, EVTs are used in about 25 to 30 major hospitals across Canada — and according to the senior study author and stroke specialist Dr. Michael Hill, it’s had a “massive treatment effect.”
“People would come in and they were paralyzed on one side, they couldn’t speak or they were severely affected, and they were leaving the hospital in two or three days,” he told Galloway.
“That was a visible change … whereas [before] people would have stayed many days and weeks for their recovery and rehab, if they survived at all.”
Speed is critical
Hill said the key to this procedure’s success is speed, as “10 or 15 minutes makes a difference.”
That’s why a patient is often greeted at the door by a team of emergency department nurses, physicians and the stroke specialist.
“When we’re alerted to a stroke or suspected stroke syndrome and we’re meeting somebody in the emergency room, we’re hustling to get there and be there before the patient or just after the patient arrives,” said Hill, who is a neurologist at the Foothills Medical Centre in Calgary.
WATCH: Dr. Michael Mayich explains how clots that cause strokes can be removed
From there, medical personnel conduct a clinical and imaging assessment to confirm if a patient has a blood clot and where it may be.
If the clot is in a location that is “amenable to a vascular treatment,” then an EVT will be offered.
Sedation can be approached in two ways, he said.
“Sometimes, patients are completely co-operative and we can do it completely awake. Sometimes they require some degree of sedation to keep them still.”
“You can imagine it’s important to do this procedure with your head relatively still. You can’t have them thrashing around.”
Hill said EVTs have a lot of potential in improving stroke treatment, as positive outcomes are a lot more frequent.
“So it’s terrific, right? We get people back to their lives,” he said.
In an ideal world, of course it’s available everywhere because you don’t have a stroke just because you live in the middle of Calgary or the middle of Toronto, right?-Dr. Michael Hill, stroke physician
At the moment, EVTs aren’t available for all Canadians. Hill said the procedure is usually reserved for patients with the most severe forms of ischemic stroke, which occurs when the blood supply to part of the brain is interrupted or reduced.
“It’s a tertiary-level procedure. You’re not going to see it in a small, rural hospital,” he said.
But part of that has to do with the volume of cases needed in order to develop expertise in this field, and it’s big hospitals in major cities that tend to see the most patients.
“So if you’re just doing one a year, you’re more likely to have complications than you are to be successful,” he said. “Whereas if you’re doing 150 a year … everyone’s ready for these things to occur because you’re doing it so frequently.”
Still, it’s important to balance that expertise with availability.
“In an ideal world, of course [EVT is] available everywhere because you don’t have a stroke just because you live in the middle of Calgary or the middle of Toronto, right?” He said.
For the time being, Conacher is content with how the procedure turned out — it’s been nearly two years and the only major impact the stroke has had is a bit of memory loss.
Furthermore, as someone who saw her dad suffer paralysis in his left side due to stroke, she’s pleased with the way stroke treatment is evolving.
“If they had things like this, I think he would have been just as fine as I was,” she said.
Produced by Ines Colabrese.
Study shows well-established protective gene for Alzheimer's only safeguards against cognitive decline in men – Sunnybrook Research Institute – Sunnybrook Hospital
The gene variant is one of three that can affect the chances of a person developing Alzheimer’s disease.
A new study led by Sunnybrook researchers has found that APOE ε2, a gene variant known to be protective against Alzheimer’s disease, is only protective in men and not women. The research was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association today.
“Previous research has shown that women have an increased risk of developing Alzheimer’s disease,” says Dr. Jennifer Rabin, senior author of the study and a scientist in the Hurvitz Brain Sciences Program at Sunnybrook Research Institute. “Although factors such as longer survival may contribute to why women are more likely to develop the disease, recent research suggests biological mechanisms may also impact sex differences in Alzheimer’s risk and progression.”
APOE ε2 is one of three inherited gene variants that can affect the chances of a person developing Alzheimer’s disease. Having the APOE ε2 variant decreases risk, whereas having the APOE ε4 variant increases risk. APOE ε3, the most common variant, is believed to have a neutral effect on the disease.
The collaborative study team, which included researchers from Canada and the United States, looked at whether sex modifies the association between the protective APOE ε2 gene variant and cognitive decline, using publicly available data from cognitively unimpaired adults that were part of four observational research sources.
The authors found that across two independent samples of participants, men with APOE ε2 were more protected against cognitive decline compared to women with the same APOE ε2 variant. In addition, men with APOE ε2 were more protected compared to men with the neutral gene variant (APOE ε3/ε3). However, this was not the case in women. In women, those with APOE ε2 were no more protected than those with the neutral gene variant (APOE ε3/ε3). The reasons for these sex-specific effects remain unclear. However, one possibility is that declining estrogen levels that occur with menopause may be a contributing factor given that estrogen has neuroprotective effects.
“These results suggest that the longstanding view that APOE ε2 provides protection against Alzheimer’s disease may require reevaluation,” says Madeline Wood, a graduate student at Sunnybrook and lead author of the study. “Our findings have important implications for developing sex-specific strategies to prevent and treat Alzheimer’s disease, particularly given that women are at a higher risk than men.”
The authors say the next step in their research is to continue to replicate the findings in large and diverse samples and to further investigate the sex-specific effects of APOE ε2 on Alzheimer’s disease biomarkers.
Funding for this study was supported by The Harquail Centre for Neuromodulation, the Dr. Sandra Black Centre for Brain Resilience & Recovery, Canadian Institutes of Health Research, and the Alzheimer’s Society of Canada.
Communications Manager, Sunnybrook Research Institute
WHO says medium-risk adults do not need extra COVID jabs – The Jakarta Post – The Jakarta Post
The World Health Organization said on Tuesday it is no longer recommending additional COVID-19 vaccine booster doses for regular, medium-risk adults as the benefit was marginal.
For such people who have received their primary vaccination course and one booster dose, there is no risk in having further jabs but the returns are slight, WHO’s vaccine experts said.
The United Nations health agency’s Strategic Advisory Group of Experts on Immunization (SAGE) issued updated recommendations after its regular biannual meeting.
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