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wathe

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Posts posted by wathe

  1. Canadian update:

    In my province, we've started doing mixed dose regimens.  It's been very hard for the public to accept.

    Those who had AZ for a first dose are recommended to get mRNA for a second dose.  That's been generally well accepted.

    Those who've had mRNA for a first dose, get mRNA for the second dose, but not necessarily the same product.  We had a lot of Pfizer initially, so a lot of people had that for their first dose. We now have a plentiful Moderna supply, and a shortage of Pfizer.  So people who had Pfizer for their first dose are showing up to mass vax appointments and being offered Moderna for their second dose (as per NACI guidelines).  They don't know this until they are in the chair (those who pay attention to media should know this was likely to happen, but many don't, apparently).  They are generally NOT happy about it. 

    We also have this weird thing where the public has latched onto Pfizer as "the best" and decline Moderna even for first doses.  I have had people walk out on me when we run Moderna clinics.

    I spent my day yesterday at a mass max clinic disappointing person after person after person who expected orhoped for Pfizer, and all I had to offer was Moderna.  Not a fun day for any of us.

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  2. 3 minutes ago, BaseballandHockey said:

    I do a lot of work with high school students with IDD who are trying to figure out their next step after graduation.  We start with just talking about dreams, because there's truth in dreams even if the dreams don't come literally true.  Often times, we start with dreams that are clearly impossible. My blind student is not going to become the lifeguard at the top of the waterslide, even if he loves the water slide.  My student who is a huge Beatles fan is not going to sell T-shirts at the Beatles reunion tour because John and George are dead.  But that doesn't mean that we can't use those dreams as a jumping off point to build a life that includes a position of respect (people listen to lifeguards!) and the sun on your face, or music, or whatever. 

    Said it better than I did!

  3. I think that the purpose of this sort of exercise is to dream impossibly big, identify the really meaningful bits, and pare down to make possible in real life.  A way to identify what will help provide meaning in your life, without the barrier of how.

    For example:

    Dream:  Buy up a huge chunk of forest and run it as a nature preserve, with public access and education programs (impossible!)

    Theme: nature preservation and public education

    Real life version:  Part time job (paid or volunteer) at local environmental organization.

    Or 

    Dream: run a free hospital in an impoverished nation that provides excellent free care to those in need (impossible)

    Theme: helping people access affordable healthcare

    Real life version: part time job at local public hospital or free clinic, or finding a way to use existing skills to assist a program like this.

     

    • Like 5
  4. 4 hours ago, Laura Corin said:

    We are not using AZ for younger people, so it's supply of Pfizer and Moderna that has been the issue.

    Right.  COVID vaccine supply in general.  Which is still an issue in much of the world, unlike in the US.

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  5. On 6/18/2021 at 5:31 PM, Laura Corin said:

    I suspect they don't have confidence in the vaccines developed in China and Russia,  and AZ got caught in the crossfire. 

    I think it was just a case of making a policy without really thinking.

    I see that New York State has amended their guidance to include both FDA and WHO authorized vaccines.  Though I don't see it on the NYS website - probably just don't know where to look to get the full policy details.

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  6. 13 minutes ago, Jean in Newcastle said:

     

    Were the young hospitality staff not eligible for vaccinations?  Because there is absolutely no reason why no one could have predicted this outcome and planned for it by vaccinating them.  And they should have required vaccinations from all of those attending and their support staff etc. 

    Probably not.  18+ eligibility started just 2 days ago in England.  

    Wikipedia isn't the most academic of sources, but this article does have a very nice timeline of which age-groups became eligible when in England.  Only very recently for those in their 20's.  I think that supply remains an issue.

     

    • Like 3
  7. 13 minutes ago, Pen said:

     

    since no vaccine is actually FDA-approved  they really should have a completely empty hall, I guess 

     

     

    bad faith in many shapes and forms seems abundant 

    Imo there are worse things than not getting to see a Broadway show though.

    some people had the NY nursing home tragedies to cope with 

    Many people are struggling with work, school, housing...

    our area as a farming area is struggling now - i 

     Children may be becoming guinea pigs

     

    i can’t say I feel especially sad about some public figure and his inability to see a Broadway show  — but maybe that will get more public compassion, than things I consider far far worse 

    “vaccine fun” seems an apt phrase perhaps for the mayor’s problems in the scheme of things

     

    Good catch re: approved.  They should have used 'authorized".

    It's not really about getting to see a show.  It's about the  use of FDA authorization as a proxy for efficacy, and limiting the movements of people based on this.  There are huge implications for travel, business, cross-border work, tourism economy, etc.

    • Like 4
  8. Here's some new vaccine fun:

    New York is declining to recognize those who've had a full course of AstraZeneca covid vaccine as vaccinated, and denying entry to venues based on that.  We'll see how this evolves.  There are huge implications for international travel (not to mention millions of angry Canadians - the USA sent us that much of that AZ after all)

    "David Screech had already selected his seats and put in his credit card information for Springsteen on Broadway tickets when he noticed the COVID-19 vaccine requirements: his two doses of AstraZeneca-Oxford wouldn't be enough for admission.

    Screech, the mayor of View Royal, B.C., and a Springsteen fan of 40 years, received his second AstraZeneca dose last week, but the Jujamcyn Theaters' website said it would only allow guests "fully vaccinated with an FDA-approved vaccine" — Pfizer-BioNTech, Moderna or Johnson & Johnson."

    "Live tapings of TV shows including Saturday Night Live and The Late Show with Stephen Colbert also snub AstraZeneca doses in rules listed on their websites, which say they're acting "at the direction of New York state."

     

    • Sad 8
  9. Thinking further, chiropractors, naturopaths, clinical psychologists and dentists all use the professional title "doctor" despite not being medical doctors, and the public doesn't have any trouble discerning the difference between their areas of clinical expertise - I don't anyone is confusing their dentist for a medical doctor.  They all have clinical degrees and the use of the title doctor is a social norm.

    I wonder what her PhD was.  Was it clinical?

    The use of the title "doctor" in healthcare is actually a bit of an issue.  In the context of healthcare, it's a restricted title here.  And that's not without controversy.  I think the reasoning is to protect the public from fraud.

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  10. I think it depends what you mean by "doctor". She has a PhD, so she is entitled to use the title "doctor".  Her RDN credential makes her a health care professional.  So she is someone who sees patients in a clinical context, and uses the title "doctor", but isn't a (medical) doctor in the colloquial healthcare sense.  

    Under which regulatory body does she hold her licence to practice?  That will probably answer your question.

    (Just like those with PhD's in nursing can use the title "doctor" and treat patients, but they are practicing as nurses, they are not medical doctors).  It can be confusing for patients.  ETA here they could get themselves into trouble if not very careful, the title doctor is protected here in the context of healthcare.

     

    • Like 7
  11.  I really think that much of the explosion in numbers of rapid onset gender dysphoria in girls is a reaction to how miserable female adolescence can be in a patriarchal and misogynistic society; and that the (relative) social acceptability of being a transgendered person presents a way out.  There also definitely does seem to be a certain amount of social contagion.

    Hating being a girl is not the same thing as being transgendered, but assuming a transgender identity might seem like a good way out for some hate-being-a-girl adolescent girls.  I think we will see a lot of de-transitioning in this population the next 10 years of so.  Along with suing of medical professionals who affirmed and assisted with physical transition (medical/surgical), that in retrospect, wasn't  indicated..

    Of course transitioning, including medical/surgical, really is the right choice for many transgendered people.  My worry is that many of the adolescent girls presenting as ROGD actually aren't transgendered, and that a policy of affirming without doing all the hard psychological work is really very harmful.

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  12. A few posters have alluded to family culture, and I think there is something to that.  My parents and DH's parents were very near to 30 before their first kid, and my grandparents were 25 for one set and 34 for the other at age of first kid.  All my cousins who've had kids were also in their 30's at the time of first kid.  And fewer than 50% of my cousins had kids at all.  Neither DH nor my sibs have kids, and aren't terribly likely to now (late 40's) - though DH's aunt and uncle adopted his cousin when they were just shy of 50, so still possible, of course.

    • Like 1
  13. 1 hour ago, regentrude said:

    I gave birth to my first child shortly before my 29th birthday. Does that count as delayed?
    My pregnancy happened exactly when I planned it: after I had completed my PhD and a two-year postdoc in a foreign country.
    I am very happy with that decision. I got to complete my education and travel before having family responsibilities.

    I lived in a country with universal healthcare where I did not pay a penny for prenatal care or birth, extensive fully paid maternity leave, three years job guarantee with parental leave, subsidized childcare. That did not affect the timing of my pregnancy because I wanted to complete my education first. (The fact that I decided not to embark on a career that made full use of this education is not relevant)

    There's a lot we, as a country, could do to make having children less of a financial risk for young mothers: paid maternity leave, universal healthcare, parental leave with job guarantee, child sick days, subsidized child care for low income families.... This won't get highly educated women to have children younger because it just takes a long time to get an advanced degree and doing so while mothering is very, very hard, but it would go a long way encouraging mothers who feel they cannot afford to get pregnant. Nobody should have to forgo having children because the cost of birth and the loss of postpartum income make that unaffordable.

    Universal healthcare here too.  Prenatal care and birth cost zero dollars out-of-pocket (other than the cost of parking!).  Maternity leave is less than what you describe, but not terrible (job guaranteed for up to 18 months combined pregnancy and parental leave, much of it paid).

    • Like 1
  14. First kid at 35 here.  I spent my 20's and early thirties in school and establishing my career.   No regrets.

    Almost all of my female colleagues have also delayed childbearing well into their 30's, so I don't really feel like and outlier.  

    I think my kids have benefitted from having parents who are well established - both financially and maturity-wise.  

    • Like 7
  15. 5 hours ago, Pen said:


    thank you! 
    your post crossed mine and the publication answered several of my questions — about National versus Provincial rules for example

     

    How did age 12 for consent to these vaccines emerge?
    The Ontario row (I think you are in Ontario) seems to indicate age 16 as being presumed as usually being capable of making medical decisions.  (And I also think age 16 is a better fit for a lot of children than 12– plus it is at least in states typical driving age with driving responsibilities.) 
     

    and I am still wondering how exactly the dialogue — especially with a child — patient works, what’s said about risks in ways a child can understand and so on?

     

    If it were later to turn out that there was not effective dialogue or appropriately informed consent, who gets into troubles for that? The physician who should have had a dialogue? The nurse who gave the injection? The national care system? 
     

     

    Quick reply:  There is no age of consent in my province.  The Health Care Consent Act, which governs consent, presumes capacity in all persons, including minors, unless there is reason to believe otherwise.

    The Substitute Decisions Act, presumes capacity above age 16 - that act is more about assigning powers-of-attorney though, I think. 

    People, especially minors,  may be capable of some decisions (ie vaccine) but not others (ie major surgery).

    Presuming that 12yo's are capable is within the letter of the law here, and makes it easy for public health to get vaccines into arms in schools. 

    The person getting the consent is evaluating the capacity of the person they are getting consent from while they are having  the consent discussion.  In covid mass vax clinics, the 12 year old is almost always accompanied by the parent of guardian (I've yet to see one unaccompanied), and the consent discussion is generally shared, with both parent and child involved.    It does mean that 12 year olds aren't forced to have vaccines they refuse, even if their parent wants them to have it (and, less commonly, that 12 year olds can opt to get vaccine, even if their parent doesn't want them to have it.  Though in practice, it would be hard for a 12 year old to book a vaccine appoinment and get themselves there without adult help)

    • Thanks 1
  16. 6 hours ago, SKL said:

    All of the sites we've used required consent, including parent/guardian consent for any minor.

    Just for clarity:

    Our sites also do require explicit consent.  The difference seems to be in how it's documented. 

    As a vaccinator, I ask, explicitly, "Do you consent to receive Pfizer covid 19 vaccine today?", and the patient says,"Yes!", and I tick the consent box on the electronic medical record, and administer the vaccine.  Or they say, "No", I document that they've declined, and I don't administer the vaccine to them - I've had a few decline.

    I can't remember the legal reasons why it's like this here, something to do with paper consent forms and signatures for minor procedures not meaning much in court, I think (link at end of post).  I mean, if the patient went to all trouble  and hassle to book an appointment, come to a covid vaccine clinic, sit in my chair, and roll up their sleeve and let me give them a needle, it's because they want the vaccine  (implied consent).  We still do get explicit consent, though.

    The minor consent thing really is different here, and it's caused some issues/controversy with immunization programs in schools.  Kids get HPV and Hep B series in grade 7 here.  The kids 12+ consent for themselves, unless there is an obvious capacity issue (ie developmental delay.) Parents are notified, but parental consent is not required.  I actually disagree with this.  I don't think that most 12-year-olds are capable of consenting to medical procedures for themselves (mine certainly isn't IMO).  The work around is that some parents will just have their kids stay home "sick" on vaccination day.  (I'm very pro-vaccine.  My boys will both get their HPV just as soon as they are eligible.  We homeschool, so I will have to arrange this myself)  

    From a Canadian medico-legal website (just because I find the differences between US and Canada interesting):

    Consent may be confirmed and validated adequately by means of a suitable contemporaneous notation by the treating physician in the patient's record.

    A consent form itself is not consent

    Consideration of a consent form to be signed by the patient should not obscure the important fact that the form itself is not the "consent." The explanation given by the physician, the dialogue between physician and patient about the proposed treatment, is the all important element of the consent process. The form is simply evidentiary, written confirmation that explanations were given and the patient agreed to what was proposed. A signed consent form will be of relatively little value later if the patient can convince a court the explanations were inadequate or, worse, were not given at all.

  17. 38 minutes ago, Pen said:

    thank you! 

    someone I know - where two family members had very different reactions  - (eta- both adults so not really right for 12 to 15 thread, but I hope you will answer if you know the answer) raised a different issue which was whether at some sites (USA) where less experienced people are doing the administration and especially with whichever type requires dilution (I can’t recall if it was Pfizer or Moderna) whether the mixing is thoroughly done by all people administering it, could one person may get more of the active ingredients part  while spouse perhaps gets more of the diluent? 

    I don't think so.

    Ours are mixed by hospital pharmacists, who definitely know what they are doing, then distributed to the vaccinators for administration.  The mixing is done very carefully, as per strict protocols.  

    • Like 3
  18. 32 minutes ago, Ausmumof3 said:

    That’s really surprising to me.  We’ve never had a vaccine that doesn’t involve a consent form.  Is it possible that one is being signed when they book an appointment?

    Quite sure.  DS and I got our vaccines through the same clinic.  No physical signing of anything (I also haven't ever physically signed anything for the kids childhood vaccines.  Those were verbal consent at the family doctor's office.  Consent was explicit, and documented in the chart, but no signatures)

    ETA the process is completely paperless.

    ETA again:  I do sign for flu shots at work, but I think that's because they're administered by my workplace and they are tracking who's had one and who hasn't.

    • Like 1
  19. @Pen

    I administer mRNA vaccines at a mass vaccination site.  Nobody is getting placebo!

    Our process doesn't involve any signatures.  Consent to receive vaccine is verbal.  Age 12+ consent for themselves, unless there is a capacity issue.

    Patients register (demographics and insurance) online or by phone when booking their appointment.  Information about the vaccines is available for review at that time.

    In clinic, vaccinators identify the patient, ask the screening questions, answer any questions, get explicit verbal consent for covid vaccine (specifically for either Pfizer of Moderna, whichever product we are using that day), and document all of this electronically.  There are paper copies of the product monograph and product information sheets on site for patients to review if they wish (I have yet to have a patient who has wanted to do this).  After their vaccination, patients get a printed and/or electronic receipt with their name and other demographics, product name, lot number, injection volume, injection site, location of the clinic and name of the vaccinator.  They also get a paper handout with a list of common side effects, a list of symptoms to watch that might suggest a serious reaction, and what to do about them.

    • Like 3
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  20. My oldest is 13.  So far, we've gone into the room with him, but I think he might be ready to go alone next time.  He'll decide for himself.

    I do all the booking, since I'm the one driving and I'm the one with the tricky schedule.

    Our family doctor is both sex-matched and race-matched to our kids (well, matched to the POC parent.  The kids are mixed race).  We didn't actively seek this, but I'm glad that's how it's worked out.

    Mine are boys.  But, regarding gynaecologists:  they don't do primary care here.  Pap tests, birth control, STD screening and management and other primary female reproductive health care is all done by family doctors here.  Gyne would be by referral only, generally only for issues that require surgical management or complex medical management.

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