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Young and old more likely to face severe flu. Here’s why doctors think it happens

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Canadians have been getting sick enough with seasonal flu to land in hospital, say doctors with suggestions on who is most at risk and what it could mean for festive gatherings.

“We’re starting to now see the effect of flu on certain populations, particularly very young children and very older people, in making them sick enough that they need to come into hospital,” said Dr. Gerald Evans, chair of the division of infectious diseases at Queen’s University and Kingston Health Sciences Centre.

During the depths of the COVID-19 pandemic, air travel declined. It’s one of the suspected reasons that influenza all but disappeared, Evans said.

Flu viruses need human hosts travelling between the southern and northern hemispheres to gain a foothold during winter on both ends of the planet, according to influenza experts.

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Dr. Upton Allen, head of infectious diseases at Sick Kids Hospital, said the H3N2 strain of influenza might be associated with more severe disease than other strains. (SickKids)

For about 100 years, doctors have known that the youngest and oldest are most at risk for serious flu. Why hasn’t been nailed down, but there are a few possible reasons — including what strains were circulating when you were first exposed.

Generational effects explored

Canadian and international research on humans as well as in animal models suggest that the first strain of flu virus you’re infected with tends to prime or shape the immune system. The result is that our immune system responds best to the original type of flu infection it faced.

“That’s why we believe that older people who are mostly primed with H1N1 don’t do very well during an H3N2 year like we’re having this year,” Evans said.

Staff at pediatric hospitals like Sick Kids continue to face pressures from pandemic backlogs of surgeries. (Michael Wilson/CBC)

The 2009 H1N1 pandemic also continues to affect how younger ones do with flu.

Those aged 13 and under were probably primed to H1N1 after 2009, just as their grandparents were in their childhoods, Evans said.

If so, today’s kids could be more vulnerable to severe disease from flu now than their parents’ generation who first encountered an H3N2 strain.

Evans added it’s also thought that older people may have more severe outcomes from flu because of underlying problems such as heart disease, lung disease or treatments for cancer.

Youngest hadn’t been exposed

Another reason why young children are being hit hard by flu and RSV this year: recent pandemic public health measures meant those under two haven’t seen flu at all and preschoolers haven’t experienced it or another respiratory virus known as respiratory syncytial virus, or RSV, for a couple seasons.

“The boost of immunity they get from having had some prior exposures in the year before are missing and so they’re tending to get infected more,” Evans said.

Dr. Upton Allen, chief of infectious diseases at the Hospital for Sick Children in Toronto, pointed to a few other possibilities.

One is the strain of flu virus that’s mainly circulating. It’s officially called Influenza A H3N2, which Allen said might be associated with more severe disease.

Also, our immune system is considered weakest at the extremes of life.

“The overwhelming majority of kids who get the flu will get it mild, but some people can get it severe,” Allen said.

 

 

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If a child is breathing very quickly, having trouble breathing, weak, doesn’t wake up or respond then those might indicate a more severe bout. “Call 911 or go to the nearest emergency department,” Allen said.

The Public Health Agency of Canada reports fewer than five influenza-associated deaths among those aged 16 and younger for the week ending Nov. 19.

“Each year the number of deaths generally are in single digits,” for that age group in Canada, Allen said.

Doctor’s holiday flu forecast

Marie Tarrant, a professor in the nursing school at the University of British Columbia Okanagan, is concerned about the uptick in hospitalizations from flu for patients and health-care systems.

“The other side of that is just the burden that is putting on a healthcare system that has been maximally strained for the last 2 ½ years.”

A lab technician at work.
A lab technician works in the H1N1 laboratory at the British Columbia Centre for Disease Control in Vancouver in 2009. This year’s flu season started earlier than the norm. (Darryl Dyck/The Canadian Press)

People with flu, RSV and other infections have a “compounding effect” of burdening hospitals, she said. Like Canada’s National Advisory Committee on Immunization, Tarrant recommends those aged six months and older who are eligible get a flu shot.

“Flu vaccines prevent about 40 to 60 per cent of serious illness and hospitalization,” she said. “They do work.”

Evans has similar advice.

“Get your flu shot,” he said. “It’s not going to be for everybody, but it’s going to prevent a lot of people getting infected and that’s going to help of course alleviate the stresses that we’re seeing in trying to provide care to everybody.”

It’s also not too late to get a flu shot, clinicians say.

Plus, flu season started earlier than it typically does this year, which could (eventually) offer a yuletide bright spot. Evans said seasonal flu usually disappears after a period of about six weeks. Canada is now about two weeks into a surge.

“By the time the holidays come around, we should be seeing a waning down of numbers of influenza infections, if it follows the pattern that we have seen now literally for decades.”

The good news? “As long as you’re feeling OK and you don’t have signs and symptoms of a cold, I think gathering together is fine.”

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Ultra-Processed Foods May Be Linked to Increased Risk of Cancer

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Summary: High consumption of ultra-processed foods, including soda, chips, and some white bread products, was associated with an increased risk of developing and dying from certain kinds of cancer, including brain cancer.

Source: Imperial College London

Higher consumption of ultra-processed foods may be linked to an increased risk of developing and dying from cancer, an Imperial College London-led observational study suggests.

Researchers from Imperial’s School of Public Health have produced the most comprehensive assessment to date of the association between ultra-processed foods and the risk of developing cancers.

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Ultra-processed foods are food items which have been heavily processed during their production, such as fizzy drinks, mass-produced packaged breads, many ready meals and most breakfast cereals.

Ultra-processed foods are often relatively cheap, convenient, and heavily marketed, often as healthy options. But these foods are also generally higher in salt, fat, sugar, and contain artificial additives. It is now well documented that they are linked with a range of poor health outcomes including obesity, type 2 diabetes and cardiovascular disease.

The first UK study of its kind used UK Biobank records to collect information on the diets of 200,000 middle-aged adult participants. Researchers monitored participants’ health over a 10-year period, looking at the risk of developing any cancer overall as well as the specific risk of developing 34 types of cancer. They also looked at the risk of people dying from cancer.

The study found that higher consumption of ultra-processed foods was associated with a greater risk of developing cancer overall, and specifically with ovarian and brain cancers. It was also associated with an increased risk of dying from cancer, most notably with ovarian and breast cancers.

For every 10 percent increase in ultra-processed food in a person’s diet, there was an increased incidence of 2 percent for cancer overall, and a 19 percent increase for ovarian cancer specifically.

Each 10 percent increase in ultra-processed food consumption was also associated with increased mortality for cancer overall by 6 percent, alongside a 16 percent increase for breast cancer and a 30 percent increase for ovarian cancer.

These links remained after adjusting for a range of socio-economic, behavioral and dietary factors, such as smoking status, physical activity and body mass index (BMI).

The Imperial team carried out the study, which is published in eClinicalMedicine, in collaboration with researchers from the International Agency for Research on Cancer (IARC), University of São Paulo, and NOVA University Lisbon.

Previous research from the team reported the levels of consumption of ultra-processed foods in the UK, which are the highest in Europe for both adults and children. The team also found that higher consumption of ultra-processed foods was associated with a greater risk of developing obesity and type 2 diabetes in UK adults, and a greater weight gain in UK children extending from childhood to young adulthood.

Dr. Eszter Vamos, lead senior author for the study, from Imperial College London’s School of Public Health, said, “This study adds to the growing evidence that ultra-processed foods are likely to negatively impact our health including our risk for cancer. Given the high levels of consumption in UK adults and children, this has important implications for future health outcomes.

“Although our study cannot prove causation, other available evidence shows that reducing ultra-processed foods in our diet could provide important health benefits. Further research is needed to confirm these findings and understand the best public health strategies to reduce the widespread presence and harms of ultra-processed foods in our diet.”

Dr. Kiara Chang, first author for the study, from Imperial College London’s School of Public Health, said, “The average person in the UK consumes more than half of their daily energy intake from ultra-processed foods.

“This is exceptionally high and concerning as ultra-processed foods are produced with industrially derived ingredients and often use food additives to adjust color, flavor, consistency, texture, or extend shelf life.

See also

This shows chips
The study found that higher consumption of ultra-processed foods was associated with a greater risk of developing cancer overall, and specifically with ovarian and brain cancers. Image is in the public domain

“Our bodies may not react the same way to these ultra-processed ingredients and additives as they do to fresh and nutritious minimally processed foods. However, ultra-processed foods are everywhere and highly marketed with cheap price and attractive packaging to promote consumption. This shows our food environment needs urgent reform to protect the population from ultra-processed foods.”

The World Health Organization and the United Nations’ Food and Agriculture Organization has previously recommended restricting ultra-processed foods as part of a healthy sustainable diet.

There are ongoing efforts to reduce ultra-processed food consumption around the world, with countries such as Brazil, France and Canada updating their national dietary guidelines with recommendations to limit such foods. Brazil has also banned the marketing of ultra-processed foods in schools. There are currently no similar measures to tackle ultra-processed foods in the UK.

Dr. Chang added, “We need clear front of pack warning labels for ultra-processed foods to aid consumer choices, and our sugar tax should be extended to cover ultra-processed fizzy drinks, fruit-based and milk-based drinks, as well as other ultra-processed products.

“Lower income households are particularly vulnerable to these cheap and unhealthy ultra-processed foods. Minimally processed and freshly prepared meals should be subsidized to ensure everyone has access to healthy, nutritious and affordable options.”

The researchers note that their study is observational, so does not show a causal link between ultra-processed foods and cancer due to the observational nature of the research. More work is needed in this area to establish a causal link.

About this diet and brain cancer research news

Author: Press Office
Source: Imperial College London
Contact: Press Office – Imperial College London
Image: The image is in the public domain

Original Research: The findings will appear in eClinicalMedicine

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ER closure for Seaforth’s emergency department due to COVID-19 outbreak

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Starting on Feb. 1, Seaforth’s emergency department will be closed in the overnight hours.

The Huron Perth Healthcare Alliance said due to “sudden health human resource shortages related to COVID-19,” the Seaforth Community Hospital’s emergency department will be closed from 5 p.m. to 7 a.m., from Feb. 1st to Feb. 6, when regular hours are expected to resume.

On Jan. 28, a COVID-19 outbreak was declared in Seaforth’s inpatient unit, closing all admissions to the unit. On Tuesday, a COVID-19 outbreak was declared at the Clinton General Hospital’s inpatient unit, also closing it to admissions.

In total, 10 people are in Huron-Perth hospitals dealing with COVID-19.

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Two long-term care homes in the region are also dealing with COVID-19 outbreaks at the moment. Since Jan. 1, eight Huron-Perth residents, most of them over the age of 75, have died due to COVID-19, according to the Huron Perth Health Unit.

“I extend my condolences to the loved ones of these individuals,” said Dr. Miriam Klassen, medical officer of health for the Huron Perth Health Unit.

She added, “COVID-19 remains a serious illness for some people, especially those who are older. While we are seeing signs of improvement, it is important to keep taking actions to protect those who are most vulnerable to severe outcomes from this virus.”

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GLP-1 Agonists Protected Kidneys in T2D With Advanced DKD

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Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.

Key Takeaways

  • In patients with advanced diabetic kidney disease (DKD; estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73m2), treatment with a glucagon-like peptide-1 (GLP-1) agonist had a neutral effect on cardiovascular outcomes but significantly linked with preservation of kidney function and improved survival in a propensity-score matched, retrospective analysis of observational data from more than 2000 people with type 2 diabetes in Taiwan.

Why This Matters

  • Cardiovascular disease is a leading cause of mortality in people with type 2 diabetes and among those with chronic kidney disease.
  • GLP-1 agonists reduce all-cause mortality and cardiovascular death in people with type 2 diabetes, but their role in patients with advanced DKD is controversial.
  • Research on the effect of GLP-1 agonists on cardiovascular outcomes in patients with advanced DKD is limited. Trials that have assessed GLP-1 agonists in people with type 2 diabetes have generally excluded those with advanced DKD and completely excluded those with end-stage kidney disease (eGFR < 30 mL/min/1.73m2).
  • Treatment with GLP-1 agonists has been associated with a significant reduction in composite cardiovascular outcomes in people with type 2 diabetes and relatively fair kidney function (eGFR > 30 mL/min/1.73m2), but among people with type 2 diabetes and lower levels of kidney function, research has shown neutral composite cardiovascular outcomes levels. However, limitations of previous studies include being mainly based on subgroup analysis or including a limited sample of patients.

Study Design

  • Retrospective analysis of observational data from nearly 9000 people in Taiwan with type 2 diabetes and an eGFR < 30 mL/min/1.73m2 who received a first prescription for a GLP-1 agonist or dipeptidyl peptidase 4 (DPP-4) inhibitor in 2012-2021 and had the data necessary for this analysis in their records.
  • The data came from the largest multi-institutional electronic medical record database in Taiwan, which includes two medical centers and five general hospitals and information on more than 11 million patients, from 2001 to 2019.
  • Researchers used propensity scoring to match 602 people treated with a GLP-1 agonist with 1479 people treated with a DPP-4 inhibitor.

Key Results

  • During a mean follow-up of 2.1 years, the rate of the composite cardiovascular outcome (cardiovascular death, myocardial infarction, and ischemic stroke) did not significantly differ between the GLP-1 agonist and DPP-4 inhibitor groups, with incidence rates of 13.0% and 13.8%, respectively, and a nonsignificant hazard ratio of 0.88. Rates of each of the three components of the composite endpoint also did not significantly differ between the two groups.
  • Progression to end-stage kidney disease with dialysis was significantly lower in those treated with a GLP-1 agonist compared with a DPP-4 inhibitor, with incidence rates of 23.4% and 27.5%, respectively, and a significant hazard ratio of 0.72.
  • The incidence of a greater than 50% drop in eGFR from baseline was 32.2% with GLP-1 agonist treatment compared to 35.9% with a DPP-4 inhibitor, with a significant hazard ratio of 0.74.
  • Median time until patients needed new-onset dialysis was 1.9 years with GLP-1 agonist treatment and 1.3 years with DPP-4 inhibitor treatment, which was a significant difference.
  • The rate of all-cause death was 18.4% with GLP-1 agonist treatment compared with 25.1% with DPP-4 inhibitor treatment, a hazard ratio of 0.71 that was significant.

Limitations

  • Because the study was a retrospective analysis of observational data it cannot prove causality.
  • The study could be subject to residual confounding despite propensity-score matching.
  • The data came from health records that could have included coding errors.
  • Treatment compliance was unknown.

Disclosures

This is a summary of a preprint research study, “The cardiovascular and renal effects of glucagon-like peptide 1 receptor agonists in patients with advanced diabetic kidney disease,” by researchers in Taiwan on Research Square and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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