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Why err on the side of caution as COVID-19 looms in health-care workplaces – CBC.ca

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Hospitals, long-term care homes and other workplaces in Canada need to err on the side of caution or risk being paralyzed in the face of uncertainty from COVID-19, some doctors say.

Six months after the country’s first presumed case, more than 8,900 devastating deaths have occurred mainly among elders and 98,000 others have recovered. Restrictions to everyday routines curbed transmission and avoided overwhelming health-care systems, but public health officials warn people still need to protect themselves to keep case numbers low.

COVID-19 is a tricky disease. Its symptoms can be absent or vague, its course remains unpredictable to physicians and its exact methods and timing of transmission haven’t been nailed down.

Those lingering uncertainties are on Dr. Lauren Crosby’s mind as Calgary ramps up day and elective surgeries.

“When you’re working in the context of scientific uncertainty, especially in the case of an impending and serious threat to health, it’s unreasonable to clarify, to wait for the answers to all your questions before you take action to avert the threat,” said Crosby, an anesthesia resident in Calgary.

Reassurance of higher-level precautions

That’s why Crosby and her father, Dr. Edward Crosby, an anesthesiologist at Ottawa Hospital, wrote an opinion piece last week in the Canadian Journal of Anesthesiology titled “Applying the precautionary principle to personal protective equipment (PPE) guidance during the COVID-19 pandemic: did we learn the lessons of SARS?”

“If we can’t be certain then we should be safe,” she said.

For the Crosbys, one of the lessons from the 44 deaths from SARS in Toronto in 2003 is that when health-care workers are asked to put themselves at risk of infection to care for others, PPE like masks, gowns and gloves should be provided. It’s an application of the precautionary principle — the idea of erring on the side of caution to protect public health.

Justice Horace Krever first recommended the precautionary principle during the Commission of Inquiry on the Blood System in Canada in 1997.

Justice Archie Campbell’s 2006 SARS Commission also called for the health concerns of health-care workers to be taken seriously so they feel safe, even if that requires higher levels of precautions, Crosby said.

Friends and family members of residents at Extendicare Guildwood Long-Term Care home, in Toronto, hold a rally on June 12. They say including long-term care in the Canada Health Act could better protect residents. (Evan Mitsui/CBC)

If health-care workers become sick with COVID-19, they pose a “triple threat” as vectors for more disease transmission, reduced capacity in the health-care system and by becoming patients.

“Scarcity is not a valid reason to limit protective equipment and to limit access to that equipment,” Crosby said.

Instead, she said, to prepare for a second wave, PPE should be used as efficiently as possible, including decontaminating and repurposing it and using other barriers during procedures that spray infectious aerosols.

Fostering public trust

People working in any industry need to feel involved in decision making and have their concerns addressed, Crosby said. Otherwise, there can be a loss of public trust, low morale, anxiety and confusion. In health-care settings, the stress can lead to burnout of workers who are particularly in demand during the pandemic.

WATCH | Lives remembered in Quebec:

Staff and family laid 101 flowers — one for each of the seniors who lost their lives at CHSLD Sainte-Dorothée in Laval, the Quebec long-term care home hit hardest by COVID-19. 1:17

Dr. Roger Wong, a clinical professor of geriatric medicine at the University of British Columbia, called the idea of applying the precautionary principle an important and timely conversation because COVID-19 has already hit long-term care homes and other shared living facilities hard.

“We have an opportunity, a very narrow window,” Wong said in an interview. “We should take action now.”

How? Wong told a ” target=”_blank”>Senate committee reviewing the government’s response to COVID-19 that he’d like to see systemic changes, such as including long-term care within the Canada Health Act.

The federal government is well positioned to set standards in areas like collecting physical and mental health outcome data, including social isolation and loneliness. Then, the data can drive policy change and better protect those who are most vulnerable, Wong said.

Wong was also involved in updating the federal government’s COVID-19 guidance for long-term care homes.

Be transparent as evidence evolves

Tim Caulfield, Canada research chair in health law and policy, supports applying the precautionary principle.

He said it has an intuitive appeal. During COVID-19, it’s been raised in the context of wearing masks and weighing the use of pharmaceutical treatments like hydroxychloroquine.

“If you’re going to do that, then you have to take extra care to ensure that you’re being transparent about the information that you’re using, the evidence you’re using to make the decision,” Caulfield said. “You want to make sure that you are open to change as the evidence evolves.”

He pointed to an association between jurisdictions around the world, such as Australia and regions of France, which have been the most successful in containing the disease so far, and public trust in key institutions and decision makers.

“In the face of uncertainty, we still have to march forward and we have to do it in a manner that benefits the most, and I think that we can’t allow uncertainty to paralyze us,” Caulfield said.

(CBC News)

Dr. Timothy Paul Hanna, a clinician and scientist at Queen’s University Cancer Research Institute, applied the precautionary principle to help guide Ontario’s prioritization plans for cancer care during COVID-19.

Potential risks to patients include:

  • Infection risk by leaving their homes to come for treatment.
  • Possible side-effects of treatment, such as radiation for lung cancer that further diminishes lung function after getting COVID-19.
  • Treatment and diagnostic delays associated with rationing care when hospitals scale back.

“We’re really fortunate across Canada,” Hanna said. ‘We weren’t left as single institutions or single physicians to proceed based on our own opinion when resources became limited. I think that that’s a real plus of our universal health-care system.”

Provincial prioritization frameworks weighed factors he wrote about such as the magnitude of benefit from treatment, if the treatment is meant to be curative or palliative, patient considerations such as age, comorbidity, and preferences as well as the availability of human resources and equipment to treat cancers.

Canada has a narrow window of opportunity to better protect its most vulnerable, says Dr. Roger Wong. (Submitted by UBC)

“Regardless of how we discover how well we might have done, I think the mental health effects and social stress, the impacts on patients and their families having to wait or having to experience care in maybe a different way, like through telemedicine or other virtual means, I’m sure we’ll find has been hard on patients.”

Canadians are touched not only as patients, but as employees and citizens, too.

Soma Ray-Ellis, chair of the employment group at Gardiner Roberts LLP in Toronto, said that as non-essential employees return to work and social gatherings occur, more direction is needed on applying precautionary principles together with human rights, occupational health and safety and privacy legislations.

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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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