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Why saliva testing for COVID-19 in Canada won't be a panacea for long lineups any time soon – CBC.ca

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Canadians in several provinces face long lines for a swab to help diagnose COVID-19 as school and workplaces open. While new testing technologies could help, doctors say they won’t be a silver bullet. 

The gold standard swab of the nose or throat can be uncomfortable. In contrast, a key promise of saliva tests is that people could collect saliva themselves so that fewer nurses and other health professionals would be needed at assessment centres, as staffing is one of the factors that can drive up wait times.

But that ideal won’t happen immediately. Currently in Canada, both saliva collection and testing remain a research project that regulators are closely evaluating. 

There are three main barriers to overcome before saliva tests roll out widely. 

Gobs of saliva vary in how fluid they can be, so collecting a high-quality sample can be a challenge even for something as non-invasive as spitting into a cup. The next hurdle for scientists is to get accurate and consistent results on the presence of the virus. Finally, clinicians need to determine how well the test results help them to correctly identify those with the disease. 

Dr. Mel Krajden, medical director of the public health laboratory at the BC Centre for Disease Control, said health professionals face a quandary in finding the best ways to support a return to school, with all of its formative benefits for students, while protecting the oldest people at highest risk for severe consequences from COVID-19, such as grandparents or parents who are vulnerable because they have other health conditions.

Dr. Mel Krajden, medical director of the public health laboratory at the BC Centre for Disease Control. The Vancouver lab is exploring whether a saline gargle might work better than saliva testing itself. (Ben Nelms/CBC)

Krajden said in his experience, saliva testing works better with COVID-19 patients in hospital than on people living in the community who’ve tried it as part of a research project. His Vancouver lab is working on a simpler approach to collection than the traditional nasal swab using a saline gargle that seems to work in older children. 

On Thursday, British Columbia announced it’s introducing a new mouth rinse, gargle and spit test for students from kindergarten to Grade 12 to make it easier for children and teenagers to check whether they have COVID-19.  But this new test is only offered to school age kids, and only in B.C.

“What we need to be thinking through is what is the best mixture of tests and how are they best supplied?” Krajden said. “You want to have the right balance between convenience and sensitivity.”

Unresolved questions about saliva tests

Health Minister Patty Hajdu said on Wednesday that Health Canada will not approve a test that endangers Canadians’ health because they are inaccurate or offer a false sense of security.

In Canada, the mobile Spartan Cube was recalled because of reliability problems with its swab for the lab-in-a-box PCR test (also known as a polymerase chain reaction test) that was billed as providing results in less than an hour. In the United States, wide-scale problems early on with another PCR test developed by the Centers for Disease Control and Prevention hampered containment efforts.

A different technology, a molecular test launched by Illinois-based Abbott that the company says can deliver positive results in as little as five minutes, was also subject to a recall. It aims to detect the virus during active infection.

The outstanding questions about saliva tests include: How good an alternative could they be to a nasal or throat swab, who would benefit — such as different age groups or those who show symptoms — and when would they be available? 

For governments and clinicians globally and across Canada, the challenge now is to organize all kinds of testing to allow society to function while preventing transmission to those at highest risk of severe consequences.

For the majority of young people, COVID-19 is like a common cold, Krajden said. It’s older adults and those who are vulnerable because of other health conditions that can face serious infection or death.

Policy-makers urged to shift gears

Dr. Larissa Matukas, head of the microbiology division at St. Michael’s Hospital, Unity Health Toronto, said experts and policy-makers need to shift gears to understand where cases are multiplying and shut them down quickly by moving resources, including testing, to where there are signs of concern.

“I’m not sure that’s actually happening right now,” Matukas said.

Dr. Larissa Matukas, head of the microbiology division at St. Michael’s Hospital, Unity Health Toronto, says experts need to understand where cases are multiplying and shut them down quickly by moving resources, including testing, to where there are signs of concern. (Yuri Markarov/Unity Health Toronto)

“We should be shifting to a very aggressive finding of individuals, testing those who are symptomatic or testing those who’ve been in close contact with those who’ve been diagnosed with COVID and then isolating those individuals to really stop all the chains of transmission,” she and her co-authors wrote in an editorial last week in CMAJ

Matukas said the first step is finding cases by improving access to diagnostic nasal or throat swabs or having a health-care professional evaluate symptoms. 

“Unfortunately, there’s been this drive, particularly in Ontario, to reach a particular number of tests per day indiscriminately of who is actually being tested,” she said.

Other, equally important parts of containment have been neglected, Matukas said, such as governments communicating a clear need for all people with symptoms compatible with COVID-19 to get tested immediately and to self-isolate while they wait for the test result.

Dr. David Williams, Ontario’s chief medical officer of health, said Thursday that people who haven’t been in contact with a case, aren’t connected to an outbreak, haven’t received a notification from the COVID Alert app and don’t have symptoms “might want to defer your visit” until the demand for tests falls.

Dr. David Williams, Ontario’s chief medical officer of health, said Thursday that people who haven’t been in contact with a case, aren’t connected to an outbreak, haven’t received a notification from the COVID Alert app and don’t have symptoms might want to delay testing until the demand falls. (Government of Ontario)

‘New technologies are always welcomed’

The level of disease in a particular community also makes a difference in misdiagnosing COVID-19 — another accuracy wrinkle to overcome in adopting quick, at-home saliva-based antigen tests for use in Canada.

“All new technologies are always welcomed,” Matukas said. “They always need to be evaluated in an objective, independent evaluation, and that’s the purpose of not just Health Canada, but that’s my job.”

As a medical microbiologist, Matukas carefully evaluates every diagnostic test introduced to ensure it meets the performance characteristics patients need in hospital. As part of her evaluation, new technologies are compared with  a standard way of testing as a reference. 

Lab workers need to do the same quality-assurance steps to check tests and equipment from all manufacturers. The goal is to ensure they perform well under real-life conditions, not just optimal ones.

Antigen tests that are used to identify mid-infection as the microbe multiplies, such as rapid tests for strep throat, is another technology under evaluation to help detect people likely infected with COVID-19 in schools, long-term care homes or other high-risk environments.

A laboratory worker shows a prototype of a self-test that will use saliva in a rapid COVID-19 test, which could replace more commonly used swabs, at the University of Liege, Belgium, in August. In Canada, saliva tools are also still being researched. (Yves Herman/Reuters)

Krajden, of the BCCDC, said more data is needed to determine when it makes sense to deploy antigen tests to quickly inform decisions.

Matukas said people living in long-term care will continue to be a priority for diagnostic testing.

Living in an area with a high prevalence of the disease, taking part in certain activities — such as waiting tables, driving a cab or attending a large gathering —  and not using personal protective equipment also contribute to the risk.

On the other hand, scolding people for breakdowns that can’t be controlled could drive some people underground and make it harder to detect cases, Matukas said.

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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.

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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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