Children's heart failure may be overlooked in ER

Half of children with heart failure will die or need a heart transplant, an outcome that has prompted new guidelines for emergency room doctors to help recognize the problem.

The Canadian Cardiovascular Society released the guidelines Tuesday during its meeting in Toronto.

About half of children with severe heart failure will die or need a transplant within five years, said Paul Kantor, who chaired the guidelines and is head of pediatric cardiology at Stollery Children's Hospital at the University of Alberta in Edmonton.

Football player Matthew Keene campaigned to get life-saving defibrillators into schools after he was revived with one in 2006. Canadian doctors say it's important to get the devices into other public places as well. (Jim Cole/Associated Press)

In comparison, the death rate from cancer in children is less than 15 per cent, he added.

"We know that by catching heart failure earlier we're dealing with children whose heart is by definition less damaged," Kantor said in an interview. "It hasn't undergone the final changes of swelling up and remodelling that make it so severe and gives us a much better opportunity to help them."

Often children brought to emergency with shortness of breath and cough are thought to have asthma but they actually have severe heart failure, Kantor said.

An unusually fast heart rate and low blood pressure are the clues that are sometimes overlooked.

Unlike structural problems with the heart that are exceptionally well treated by surgeons, heart failure hasn't gained the same attention, Kantor said.

The new guidelines provide a framework to help doctors recognize heart failure sooner and treat it with medications.

Early recognition is key for conditions such as:

• Cardiomyopathy or heart muscle disease, one of the main causes of heart failure in children that should be considered when a child has unexplained rapid heart rate or rapid breathing. It can be caused by gene abnormalities.
• Myocarditis, a viral infection of the heart muscle that may be present when children have abdominal pain and vomiting with signs of poor circulation.

Doctors need to order specialized tests called pediatric echocardiography to exclude heart failure, the group said.

Raising awareness

The son of Rosamund Witchel of Toronto, Philip, was born in London, England, in 2001 and had myocarditis, caused by a virus. Witchel said she recognized that the baby was crying and fussy, and then a midwife saw he was turning blue.

"It was well after midnight of that day that the attending physician there told us that our son had a heart attack and that it was possibly only the second time that he had seen that," Witchel recalled.

After Philip was transferred, he spent 2½ months in ICU and stabilized. But at eight months of age, his heart's left ventricle or pumping chamber was damaged, he wasn't growing properly and Witchel knew his condition was failing again.

The family moved to Toronto and waited for a heart transplant, but Philip died in his mother's arms at 18 months.

"I think the guidelines would have helped," said Witchel, who started a research foundation in her son's name.

Doctors "need to be aware because there's also drugs that they can give to minimize the effects early on," she said.

On Monday, researchers at the conference presented a study suggesting 72 per cent of sudden cardiac deaths among those aged two to 40 occurred at home, even though the cases that grab attention are typically of young athletes who suddenly collapse and die.

Researcher Dr. Andrew Krahn of the University of British Columbia said it's important to have defibrillators in malls and workplaces as well as sporting venues, and that coaches and teachers should be aware of possible warning signs such as fainting.

When the heart beats erratically, which stops the organ from pumping blood, it can lead to sudden death.

"Most people don't report when they faint," Krahn said. "A quarter of people who've had this kind of fatal event have had some kind of fainting event beforehand."

Since the signs are often vague and there is no reliable screening test, those attending the conference are also hoping to increase awareness.

The conference runs through Wednesday.

With files from CBC's Kelly Crowe and Marijka Hurko

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Health care spending slows

Growth of spending on physicians, hospitals and drug all slowed. (Baz Ratner/Reuters)

The pace of health care spending in Canada continues to slow, according to a new report.

The Canadian Institute for Health Information released its report on health expenditures on Tuesday, saying it is expected to reach $207 billion in 2012.

Health care spending as a share of the economy and of provincial government spending has fallen, said Dr. Michael Rachlis, a health policy consultant in Toronto commenting on the report.

"The current perceived wisdom is that health care costs are just rising inexorably out of control. So that's why a data release that's saying something moderate about moderating spending data is of news."

The proportion of Canada's gross domestic product or GDP spent on health care is expected to reach 11.6 per cent this year compared with an all-time high of 11.9 per cent in 2010, the institute said, as provincial and territorial governments focus on controlling health care costs.

"Weaker prospects for economic growth combined with fiscal deficits and fewer savings from debt service charges could have a dampening effect on the future growth of public-sector health spending," the report's authors concluded.

"Managing health-specific price inflation for core medicare goods and services, including doctors, nurses, other health care professionals and advanced diagnostics, will be a challenge."

The growth of spending on physicians, 14.4 per cent, hospitals, 29.2 per cent, and drugs, 15.9 per cent, all slowed but continued to account for the largest share of health dollars.

In 2012, hospital spending will grow by 3.1 per cent and physicians by 3.6 per cent — the lowest rates of growth since the late 1990s, CIHI said.

The growth rate of drug spending will fall to 3.3 per cent this year down from four per cent last year, continuing a downward trend over the last decade. The decline is likely due to fewer drugs coming on the market, blockbuster drugs coming off patent and provinces introducing generic price controls.

Aging like a glacier

The report's authors called population aging a "modest cost driver overall," that accounted for 0.9 per cent of average annual growth in spending from 2000 to 2010. It was more significant in the Maritimes and Quebec than in Ontario and the West, they said.

"Aging is like a glacier not a tsunami," Rachlis said. "We have lots of time to prepare and adapt our health system."

Today's elderly are also healthier with longer life expectancies and less disability thanks to better diets and less smoking, he added.

Spending for seniors does increase with age, from $6,223 for those aged 65 to 69 to $20,113 for those aged 80 and older, the report noted.

In terms of international comparisons, Canada was in the top quartile for spending per person on health at $4,445 US, which was similar to other OECD countries in 2010.

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Organ donor changes lives of 2 friends

Two young friends in Halifax have forged an even stronger bond after their lives were saved by the same organ donor recently.

Lisa Walsh-Kirk, 24, had been waiting for five years for a kidney donation, spending three days a week on dialysis. Finally, her pager went off and she was told to report to the hospital the next morning.

She said she could hardly believe her life-changing moment had finally arrived.

"It was shocking," she said. "It didn't really set in until I was at the hospital the next day."

But Walsh-Kirk was in for a second surprise. As she walked into the hospital, she ran into one of her best friends, who was also on the waiting list for a kidney transplant.

"We pieced it together," she said. "Basically, we're the same blood type. We got our calls 10 minutes apart. We got the same donor."

The women first became friends when they were 12. Both had kidney transplants that later failed. Both were desperate for a new organ.

"It was meant to be," said Walsh-Kirk. "It was like someone was watching over us."

The friends both pulled through their operations successfully and were put in the same room for their recovery.

Rare coincidence

The twist of fate is something Denice Klavano has never seen before. Klavano is a board member for Life: Pass It On, an organization that promotes donation.

Denice Klavano says she's never heard of friends receiving donations from the same person. (CBC)

"I don't think there can be anything that's more touching, really, than what I've heard of this story with these two friends from childhood," she said. "The odds against that have got to be pretty remote."

The identity of the donor is protected by law. CBC News also cannot report when the operations occurred. But Klavano hopes this story will touch others who are uncertain about signing donor cards.

"I get shivers when I think of this," she said. "What better living legacy can there be."

Klavano said Nova Scotia's rates for donation are strong compared with most of Canada.

"But not what it could be," she said. "At any given time, there's probably about 4,000 people waiting for transplants across Canada. That's pretty sorry."

Walsh-Kirk said she's going to continue to advocate for organ donation. She hopes to one day meet the family of her donor.

"I'm sorry you lost your loved one," she said, vowing to treat her body well and keep the kidney safe. "I want to thank anyone who signs their donor cards."

Walsh-Kirk said her friend, Jessica, spent Tuesday celebrating her husband's birthday with their daughter.

As for her own plans, Walsh-Kirk is thrilled that she'll be able to get married next October. She also plans to travel.

"I get to live again."

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Novartis flu shots OK'd by Health Canada

Novartis is supplying 20 per cent of Canada's total flu vaccine supply this year. (Jeff McIntosh/Canadian Press)

It's safe to use two seasonal flu vaccines that were pulled from distribution, Health Canada says.

Novartis temporarily withheld Agriflu and Fluad products last week as a precaution after anomalies were found in batches of the vaccines made in Italy.

"Health Canada looked at the results of its own testing, conducted a health risk assessment, and reviewed information from its European partners and data submitted by Novartis in making its decision," the department said in a release Wednesday.

"None of the information reviewed indicated a safety issue."

The Public Health Agency of Canada said health care professionals can start to use the vaccines again, following labeling directions such as:

• Allow the vaccine to come to room temperature before use.
• Shake the products.
• Check for any white floating material before injecting.

In Canada, Agriflu and is authorized for use in people older than six months. Fluad is licensed for use in Canadians 65 years of age or older.

Fluad contains an adjuvant or booster that health officials say is more effective at preventing flu in seniors, who do not mount the same immune response as other adults.

Following the announcement, Saskatchewan said that it would resume offering flu clinics it cancelled last week. Alberta is also reinstating use of Agriflu.

Novartis is supplying 20 per cent of Canada's total flu vaccine supply this year.

With files from the Canadian Press

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Children's heart failure may be overlooked in ER

Half of children with heart failure will die or need a heart transplant, an outcome that has prompted new guidelines for emergency room doctors to help recognize the problem.

The Canadian Cardiovascular Society released the guidelines Tuesday during its meeting in Toronto.

About half of children with severe heart failure will die or need a transplant within five years, said Paul Kantor, who chaired the guidelines and is head of pediatric cardiology at Stollery Children's Hospital at the University of Alberta in Edmonton.

In comparison, the death rate from cancer in children is less than 15 per cent, he added.

Football player Matthew Keene campaigned to get life-saving defibrillators into schools after he has revived with one in 2006. Canadian doctors say it's important to get the devices into other public places as well. (Jim Cole/Associated Press)

Often children brought to emergency with shortness of breath and cough are thought to have asthma but they actually have severe heart failure, Kantor said.

An unusually fast heart rate and low blood pressure are the clues that are sometimes overlooked.

Unlike structural problems with the heart that are exceptionally well treated by surgeons, heart failure hasn't gained the same attention, Kantor said.

The new guidelines provide a framework to help doctors recognize heart failure sooner and treat it with medications.

Early recognition is key for conditions such as:

• Cardiomyopathy or heart muscle disease, one of the main causes of heart failure in children that should be considered when a child has unexplained rapid heart rate or rapid breathing. It can be caused by gene abnormalities.
• Myocarditis, a viral infection of the heart muscle that may be present when children have abdominal pain and vomiting with signs of poor circulation.

Doctors need to order specialized tests called pediatric echocardiography to exclude heart failure, the group said.

The son of Rosamund Witchel of Toronto, Philip, was born in London, England in 2001 and had myocarditis, caused by a virus. Witchel said she recognized that the baby was crying and fussy and then a midwife saw he was turning blue.

Raising awareness

"It was well after midnight of that day that the attending physician there told us that our son had a heart attack and that it was possibly only the second time that he had seen that," Witchel recalled.

After Philip was transferred, he spent 2½ months in ICU and stabilized. But at eight months age, the heart's left ventricle or pumping chamber was damaged, he wasn't growing properly and Witchel knew his condition was failing again.

The family moved to Toronto and waited for a heart transplant but Philip died in his mother's arms.

"I think the guidelines would have helped," said Witchel, who started a research foundation in her son's name.

Doctors "need to be aware because there's also drugs that they can give to minimize the effects early on," she said.

On Monday, researchers at the conference presented a study suggesting 72 per cent of sudden cardiac deaths among those aged two to 40 occurred at home, even though the cases that grab attention are typically of young athletes who suddenly collapse and die.

Researcher Dr. Andrew Krahn of the University of British Columbia said it's important to have defibrillators in malls and workplaces as well as sporting venues, and that coaches and teachers should be aware of possible warning signs such as fainting.

In sudden cardiac death, the heart beats irregularly, which stops the organ from pumping blood.

The conference runs through Wednesday.

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UN atlas ties climate change to spread of disease

The two UN agencies for health and weather services have created a new "atlas" of scientific data that they say offers fresh evidence of the links between climate change to outbreaks of meningitis, malaria and other diseases.

The World Health Organization director-general says the manual, which includes maps, tables and graphs, provides a practical guide to "climate-sensitive diseases" that decision-makers and leaders can use as a tool for prevention.

Malaria, dengue and malnutrition are sensitive to climate and are expected to worsen as the climate changes, the World Health Organization says. (Katrina Manson/Reuters)

Dr. Margaret Chan told reporters Monday in Geneva that 80 per cent of the infectious diseases currently found in humans have come from animals — and the scientific research for managing disease in ecosystems has been "underutilized."

World Meteorological Association Secretary-General Michel Jarraud says the atlas is meant to spread information buried in the agencies' technical documents.

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Mandate flu vaccines for health-care workers, journal says

Flu vaccines should be compulsory for all health-care workers because their patients' lives are at risk, a Canadian medical journal editor says.

In Monday's issue of the Canadian Medical Association Journal, senior associate editor Dr. Ken Flegel argues for mandatory seasonal influenza vaccination, urging that the "time has come for health care institutions to demand that all health care workers be vaccinated. Our patients' lives depend on this change."

More than half of doctors don't get a flu shot, a journal editorial says. (I.Lopez/Associated Press)

Flegel points to a 2010 study published in the same journal that concluded 55 per cent to 65 per cent of doctors don't get an annual flu shot.

But each season, 20 per cent of health workers get the flu, he said. A 2006 review on flu vaccination in health-care workers published in a Cochrane database suggested that some may shed the flu virus up to a day before symptoms begin, which can expose vulnerable hospitalized patients to the virus when they're less able to resist infection, he added.

Flegel cited a 2010 research report, which found that voluntary campaigns increased vaccination rates by 22 per cent to 52 per cent, compared with more than 95 per cent at teaching hospitals in Philadelphia that required flu vaccines. With such figures in mind, he said compulsory vaccination against flu in health-care workers is justified.

"Why would you want people in the hospital who could shed the virus that causes the disease when we have a way of drastically reducing the number of people in the hospital who can do that?" Flegel said.

Hospitals have tried to entice workers to get a flu shot using prizes but vaccination rates remain low, said Dr. Todd Hatchette, director of virology and immunology at QEII Health Sciences Centre in Halifax.

Health workers' autonomy

Health authorities in British Columbia announced earlier this year that health-care workers who come into contact with patients will need to get the influenza vaccine. The B.C. Nurses' Union said it wasn't happy about the move, although nurses who aren't vaccinated may wear a mask during the flu season instead of getting vaccinated.

"I think that any time anything is put into a person's body, they should have sovereignty over their body and have the right to decide for themselves whether or not it's an appropriate thing to do," said Debra McPherson, a cardiac care nurse in Vancouver and president of the BC Nurses' Union.

Anytime health care decisions are made mandatory, it also raises questions about the evidence and whether it's the best use of money, McPherson added.

In 2002, an Ontario labour board ruled that mandatory flu shots for health-care workers in Hamilton, Ont., invaded their rights.

Flegel acknowledges that the autonomy of health-care workers may conflict with patients' rights. But he argues that patients' rights take precedence in similar situations, such as policies that prevent a surgeon who is infected with HIV or hepatitis from operating on patients.

Flegel, a professor of medicine at McGill University in Montreal, said the adverse effects associated with flu vaccines tend to be mostly fevers and runny noses. Serious complications like Guillian Barré syndrome occur at a rate close to the background level of one in 100,000 annually, he said.

People who can't be vaccinated because of medical reasons, or for deeply held religious or philosophical convictions, could be granted exemptions, he said.

The 2006 Cochrane review concluded that, "there is no credible evidence that vaccination of healthy people under the age of 60, who are health care workers caring for the elderly, affects influenza complications in those cared for.

"However, as vaccinating the elderly in institutions reduces the complications of influenza and vaccinating healthy persons under 60 reduces cases of influenza, those with the responsibility of caring for the elderly in institutions may want to increase vaccine coverage and assess its effects in well-designed studies."

While the Cochrane reviewers concluded there was no specific effect from flu vaccines, there was a drop in all cause mortality, and that's what matters for those caring for sick, elderly patients suffering who are dying from influenza, Flegel said.

The Association of Medical Microbiology and Infectious Disease Canada, which represents professionals in the field, endorsed a mandatory flu vaccination policy, Hatchette said.

With files from CBC's Kelly Crowe

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Mammograms save 1 life for 3 unnecessary ones

Breast cancer screening for women over 50 saves lives, an independent panel in Britain has concluded, confirming findings in U.S. and other studies.

But that screening comes with a cost: The review found that for every life saved, roughly three other women were overdiagnosed, meaning they were unnecessarily treated for a cancer that would never have threatened their lives.

Researchers estimated that for every 10,000 women in the UK aged 50 years invited to screening for 20 years, 43 deaths from breast cancer would be prevented and 129 would be treated for cancer that would never have caused harm if undetected. (Eric Gaillard/Reuters)

The expert panel was commissioned by Cancer Research U.K. and Britain's department of health and analyzed evidence from 11 trials in Canada, Sweden, the U.K. and the U.S.

In Britain, mammograms are usually offered to women aged 50 to 70 every three years as part of the state-funded breast cancer screening program.

Scientists said the British program saves about 1,300 women every year from dying of breast cancer while about 4,000 women are overdiagnosed. By that term, experts mean women treated for cancers that grow too slowly to ever put their lives at risk. This is different from another screening problem: false alarms, which occur when suspicious mammograms lead to biopsies and follow-up tests to rule out cancers that were not present. The study did not look at the false alarm rate.

"It's clear that screening saves lives," said Harpal Kumar, chief executive of Cancer Research U.K. "But some cancers will be treated that would never have caused any harm and unfortunately, we can't yet tell which cancers are harmful and which are not."

Each year, more than 300,000 women aged 50 to 52 are offered a mammogram through the British program. During the next 20 years of screening every three years, 1 per cent of them will get unnecessary treatment such as chemotherapy, surgery or radiation for a breast cancer that wouldn't ever be dangerous.

The review was published online Tuesday in the Lancet journal.

Some critics said the review was a step in the right direction.

"Cancer charities and public health authorities have been misleading women for the past two decades by giving too rosy a picture of the benefits," said Karsten Jorgensen, a researcher at the Nordic Cochrane Centre in Copenhagen who has previously published papers on overdiagnosis.

"It's important they have at least acknowledged screening causes substantial harms," he said, adding that countries should now re-evaluate their own breast cancer programs.

In the U.S., a government-appointed task force of experts recommends women at average risk of cancer get mammograms every two years starting at age 50. But the American Cancer Society and other groups advise women to get annual mammograms starting at age 40.

In recent years, the British breast screening program has been slammed for focusing on the benefits of mammograms and downplaying the risks.

Maggie Wilcox, a breast cancer survivor and member of the expert panel, said the current information on mammograms given to British women was inadequate.

"I went into [screening] blindly without knowing about the possibility of overdiagnosis," said Wilcox, 70, who had a mastectomy several years ago. "I just thought, 'it's good for you, so you do it."'

Knowing what she knows now about the problem of overtreatment, Wilcox says she still would have chosen to get screened. "But I would have wanted to know enough to make an informed choice for myself."

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Health Canada pulls distribution of Novartis flu vaccines

Canada is following the lead of several European countries and suspending distribution of flu vaccine made by the pharmaceutical firm Novartis.

The decision relates to the discovery by the company of tiny clumps of virus particles in some batches of flu vaccines made at the Novartis production facility in Italy.

Health Canada, which announced the move, said Novartis has agreed to suspend distribution of its vaccines — sold in Canada as Fluad and Agriflu — while the department investigates the situation. All the Novartis vaccine Canada purchases is made at the Italian plant.

The department is also telling doctors and others who administer flu shots to hold off using Novartis product for the time being.

"We think it's prudent, given the response of certain European countries to . . . request of Novartis — and they will be complying — to stop distributing and then to recommend to practitioners to refrain from using the (Novartis) vaccine just until this review is completed," Dr. Paul Gully, senior medical advisory for Health Canada, said Friday.

Vaccine may not work as well as it should

Dr. Allison McGeer, an infectious disease consultant at Toronto's Mount Sinai Hospital, told CBC News that people who have had the Novartis shots should not worry about adverse side effects.

The worst she sees happening is the shot won't work as well as it should.

McGeer stressed that the agency's move signals its tendency to be extra cautious when it comes to flu shots, and she feels people are in more danger from avoiding the flu shot than from having a Novartis shot.

Health authorities in Italy, Germany and Switzerland have suspended distribution of some Novartis flu vaccine, and in the case of Germany recalled some lots of vaccine, after the clumping issue came to light.

In a statement issued Friday night, the company said more than one million doses of its flu vaccines have been administered in Europe so far this season and no unexpected adverse events have been reported.

As well, it said that it has already delivered about 70 per cent of its Canadian order (roughly 1.5 million doses), again without hearing of problems in people who have received Novartis flu shots. The company said people who have received Novartis flu shots are not at risk.

Company says clumping not unusual

Novartis said finding minute clumps of virus protein in vaccines is not unusual. They said their vaccines passed quality inspections and they are confident the products are safe.

"We think that there's no adverse consequence, no side effects, because we do occasionally see [particles], so we want to find out exactly what the Europeans saw and why they took the decisions that they did," said Dr. Paul Gully, the senior medical advisor for Health Canada.

"The aggregate proteins are predominantly influenza virus-derived (mainly hemagglutinin), all normal and necessary components of influenza vaccines," the company said. "Aggregation of these proteins is not unusual in vaccines manufacturing."

Hemagglutinin is the protein on the outside of flu viruses that locks onto cells in the human respiratory tract to start the process of infection. Flu vaccines are designed to provoke the immune system to produce antibodies to hemagglutinin to protect against infection.

In fact, this isn't the first time protein clumping has disrupted Canada's flu vaccine supply.

During the 2009 pandemic, there was a delay in delivery of unadjuvanted vaccine for pregnant women when GlaxoSmithKline, Canada's pandemic vaccine supplier, found visible protein aggregation in some of the vaccine.

Adjuvants are compounds that boost the response a vaccine generates. Canada used adjuvanted vaccine during the pandemic, but bought some unboosted product for pregnant women as a precaution.

Novartis makes only about 20 per cent of Canada's annual flu vaccine purchase. GlaxoSmithKline makes the bulk of Canada's seasonal flu vaccine, though a variety of other suppliers have a share of the Canadian market.

Still, because of the way vaccine orders are placed, the hold on Novartis vaccine could put some provinces and territories in a position where they face a temporary vaccine shortfall, just at the time when flu shot programs are getting underway, Gully admitted.

He said Health Canada hopes there is a rapid resolution of the situation. But if provinces or territories have a problem with supply, efforts will be made to share across jurisdictions, he said.

Both Fluad and Agriflu are sold in single-dose formulations, pre-loaded into a syringe.

Fluad contains an adjuvant and is licensed for use in people 65 and older. Older adults do not mount a good response to flu vaccine and the inclusion of an adjuvant is an effort to improve the protection they get from flu shots.

With files from CBC News

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Calories poorly grasped for maintaining weight

People often don't know how many calories they're eating, how many they burn off, or what they need, say doctors who are calling for prominent calorie labels at the point of sale.

The Canadian Obesity Network, a group of obesity experts, showed people examples of foods and asked them to guess how many calories the items contained.

Many people don't know their recommended daily intake of calories. (Lee Jae Won/Reuters)

"A lot of Canadians were quite off the mark," said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta in Edmonton.

"When we showed people food labels and asked them to calculate how many calories they'd be getting if they consumed say a can of soup, very few Canadians were able to figure out that number."

Sharma is concerned about the consequences of caloric illiteracy considering two-thirds of Canadians are carrying extra pounds and a quarter of adults are considered to be medically obese, according to Statistics Canada.

"Ultimately calories are the currency of weight management," Sharma said. "If you don't know how many calories you're eating, you don't know what your body's doing with the calories, you don't know where the calories are going. That's like trying to manage your bank account without knowing how much money you make or how much money things cost."

Guessing calories

The average woman needs to take in about 2,000 calories a day and the average man 2,400, Sharma said.

A single chicken wing contains about 100 calories, which would take a 20-minute bike ride or 1½-kilometre run to burn off, he added.

At the University of Waterloo, David Hammond found people consumed 11 per cent fewer calories when nutrition information was posted on restaurant menus compared with a control group, a difference of about 100 calories. An earlier U.S. study found the same result.

Hammond agreed that many people don't know their recommended daily intake of calories, but they can compare items, such as 210 calories for a small muffin versus 240 calories in a large muffin.

Gaining that relative sense of calories when making purchasing decisions helps make the information sink in and drives smarter choices, he said.

Gaining a relative sense of calories when making purchasing decisions may help people to make smarter choices, says David Hammond. (CBC)

Another option is to use a traffic light pattern with calories in green, amber and red, the way pre-packaged foods are labeled in UK grocery stores.

"It's very difficult if not impossible to guess how many calories are in a meal, even trained dieticians can't do that," said Hammond. "The best way of giving that information to people is on the menu at the time they're making their food decisions."

Consumers may assume that a salad at a fast food restaurant is going to have fewer calories than a burger but that is not always the case, he said.

Many large restaurant chains now voluntarily provide nutrition information but they often put it in places that are difficult for consumers to find, such as on their websites and on posters away from the check outs, said Bill Jeffrey, national coordinator for the Centre for Science in the Public Interest, which is lobbying governments to make restaurants post nutrition information on their menus.

In the U.S., federal regulation will soon require calorie counts to be reported beside standard menu items at large chain restaurants.

In Canada, voluntary measures have been in place for several years, but Jeffrey called them "largely ineffective."

Last month, McDonald's in the U.S. announced it will unveil menu board labels in American restaurants in advance of the U.S. federal regulations.

"With regard to nutrition information in restaurants the conversation has progressed differently in Canada than it has in the U.S.," McDonald's Canada said in a statement at the time.

"McDonald's Canada is actively working with all levels of government, NGOs and industry stakeholders to develop an appropriate 'Made-in-Canada' solution to displaying comprehensive nutrition information that is easily accessible to customers prior to purchase."

Sharma cautioned he doesn't want people to obsessively count calories, but to have an idea of how many calories are in the foods when deciding what to eat.

With files from CBC's Kelly Crowe and Pauline Dakin

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Quitting smoking 'works extraordinarily well' for saving lives

Smoking cigarettes throughout adulthood reduces life expectancy by about 11 years in women but quitting avoids much of the extra risk, a new large study shows.

The Million Women Study in the UK recruited 1.3 million British women who were born in the early 1940s to look at the hazards of smoking and the benefits of stopping at various ages.

Women in North America took up smoking decades later than men. (Jonathan Alcorn/Reuters)

In most of Europe, Canada and the U.S., the popularity of smoking among young women reached its peak in the 1960s, decades later than for men.

Among women in the study who smoked cigarettes through their adult lives, the mortality rate was three times that of women who never smoked or who stopped well before middle age, Sir Richard Peto of the University of Oxford and his co-authors said in Saturday's issue of the journal Lancet.

"Stopping before 40 years of age, and preferably well before, avoids more than 90 per cent of this excess mortality; stopping before 30 years of age avoids more than 97 per cent of it," the study's authors concluded.

"This does not, however, mean that it is safe to smoke until 40 years and then stop, for women who do so have throughout the next few decades a mortality rate 1.2 times that of never-smokers."

Study participants were recruited from 1996 to 2001. They filled in questionnaires about the lifestyle, medical and social factors and were resurveyed by mail three and eight years later.

At the start of the study, 20 per cent of them were smokers, 28 per cent were ex-smokers and 52 per cent had never smoked. By 2011 six per cent had died.

The excess mortality among smokers was mainly from diseases that are known to be affected by smoking, such as lung cancer, chronic lung disease, heart disease and stroke, the researchers said. A little of the excess wouldn't be caused by smoking, they added.

Quitting sooner the better

Smokers were more likely to live in economically poor areas, drink more than 14 units of alcohol a week and avoid strenuous exercises. Those factors were taken into account in the analysis.

A journal commentary accompanying the study called the main findings "simple and unequivocal."

Even women considered social smokers having a handful of cigarettes a day had twice the mortality rate of never smokers, Professor Rachel Huxley at the University of Minnesota in Minneapolis said in her commentary.

"For adults who already smoke, stopping works extraordinarily well — and the sooner the better," Huxley wrote.

Women who smoke have more than four times the risk of dying of heart disease in the near future than nonsmokers the same age, she said, compared with nearly double the odds in men. Huxley speculated physiological or behavioural differences could explain the gender gap.

The research was funded by Cancer Research UK and Medical Research Council.

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UN atlas ties climate change to spread of disease

The two UN agencies for health and weather services have created a new "atlas" of scientific data that they say offers fresh evidence of the links between climate change to outbreaks of meningitis, malaria and other diseases.

The World Health Organization director-general says the manual, which includes maps, tables and graphs, provides a practical guide to "climate-sensitive diseases" that decision-makers and leaders can use as a tool for prevention.

Malaria, dengue and malnutrition are sensitive to climate and are expected to worsen as the climate changes, the World Health Organization says. (Katrina Manson/Reuters)

Dr. Margaret Chan told reporters Monday in Geneva that 80 per cent of the infectious diseases currently found in humans have come from animals — and the scientific research for managing disease in ecosystems has been "underutilized."

World Meteorological Association Secretary-General Michel Jarraud says the atlas is meant to spread information buried in the agencies' technical documents.

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Quitting smoking 'works extraordinarily well' for saving lives

Smoking cigarettes throughout adulthood reduces life expectancy by about 11 years in women but quitting avoids much of the extra risk, a new large study shows.

The Million Women Study in the UK recruited 1.3 million British women who were born in the early 1940s to look at the hazards of smoking and the benefits of stopping at various ages.

Women in North America took up smoking decades later than men. (Jonathan Alcorn/Reuters)

In most of Europe, Canada and the U.S., the popularity of smoking among young women reached its peak in the 1960s, decades later than for men.

Among women in the study who smoked cigarettes through their adult lives, the mortality rate was three times that of women who never smoked or who stopped well before middle age, Sir Richard Peto of the University of Oxford and his co-authors said in Saturday's issue of the journal Lancet.

"Stopping before 40 years of age, and preferably well before, avoids more than 90 per cent of this excess mortality; stopping before 30 years of age avoids more than 97 per cent of it," the study's authors concluded.

"This does not, however, mean that it is safe to smoke until 40 years and then stop, for women who do so have throughout the next few decades a mortality rate 1.2 times that of never-smokers."

Study participants were recruited from 1996 to 2001. They filled in questionnaires about the lifestyle, medical and social factors and were resurveyed by mail three and eight years later.

At the start of the study, 20 per cent of them were smokers, 28 per cent were ex-smokers and 52 per cent had never smoked. By 2011 six per cent had died.

The excess mortality among smokers was mainly from diseases that are known to be affected by smoking, such as lung cancer, chronic lung disease, heart disease and stroke, the researchers said. A little of the excess wouldn't be caused by smoking, they added.

Quitting sooner the better

Smokers were more likely to live in economically poor areas, drink more than 14 units of alcohol a week and avoid strenuous exercises. Those factors were taken into account in the analysis.

A journal commentary accompanying the study called the main findings "simple and unequivocal."

Even women considered social smokers having a handful of cigarettes a day had twice the mortality rate of never smokers, Professor Rachel Huxley at the University of Minnesota in Minneapolis said in her commentary.

"For adults who already smoke, stopping works extraordinarily well — and the sooner the better," Huxley wrote.

Women who smoke have more than four times the risk of dying of heart disease in the near future than nonsmokers the same age, she said, compared with nearly double the odds in men. Huxley speculated physiological or behavioural differences could explain the gender gap.

The research was funded by Cancer Research UK and Medical Research Council.

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Organic food offers few advantages for kids, says U.S. study

Another study has cast doubt on the benefits of organic food, finding "no direct evidence" that it leads to better health in children — contrary to what some well-meaning, high-spending parents might think.

The American Academy of Pediatrics this week weighed in for the first time on the supposed benefits of eating organic, but said it's unclear whether parents are actually getting healthier food for the extra cost.

The report said organic foods have the same vitamins, minerals and other nutrients as conventional foods — though they also have lower levels of pesticides and are less likely to carry certain types of bacteria, which may be important for growing children.

Organic foods also contain more vitamin C and phosphorus than conventional foods, but the report found scant evidence this provides any "meaningful" benefits.

In the long run "there is no direct evidence that consuming an organic diet leads to improved health or lower risk of disease," said the study, which appeared Monday in the AAP's journal Pediatrics.

Researchers say it is more important that kids eat a healthy diet with lots of fruit, vegetables, whole grains and low-fat dairy products — whether organic or not.

"This type of diet has proven health benefits," said Dr. Janet Silverstein, one of the lead authors of the study, in a statement.

"Many families have a limited food budget, and we do not want families to choose to consume smaller amounts of more expensive organic foods and thus reduce their overall intake of healthy foods like produce," she added.

The study follows similar research released last month through Stanford University, which found no signs of added nutrition in organic food, though it also noted lower levels of pesticides and antibiotics.

The AAP study looked at organic meat, produce and dairy products. It also said organic farming is less harmful to the environment through, among other things, reduced use of pesticides and fossil fuels.

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Health Canada pulls distribution of Novartis flu vaccines

Canada is following the lead of several European countries and suspending distribution of flu vaccine made by the pharmaceutical firm Novartis.

The decision relates to the discovery by the company of tiny clumps of virus particles in some batches of flu vaccines made at the Novartis production facility in Italy.

Health Canada, which announced the move, said Novartis has agreed to suspend distribution of its vaccines — sold in Canada as Fluad and Agriflu — while the department investigates the situation. All the Novartis vaccine Canada purchases is made at the Italian plant.

The department is also telling doctors and others who administer flu shots to hold off using Novartis product for the time being.

"We think it's prudent, given the response of certain European countries to . . . request of Novartis — and they will be complying — to stop distributing and then to recommend to practitioners to refrain from using the (Novartis) vaccine just until this review is completed," Dr. Paul Gully, senior medical advisory for Health Canada, said Friday.

Vaccine may not work as well as it should

Dr. Allison McGeer, an infectious disease consultant at Toronto's Mount Sinai Hospital, told CBC News that people who have had the Novartis shots should not worry about adverse side effects.

The worst she sees happening is the shot won't work as well as it should.

McGeer stressed that the agency's move signals its tendency to be extra cautious when it comes to flu shots, and she feels people are in more danger from avoiding the flu shot than from having a Novartis shot.

Health authorities in Italy, Germany and Switzerland have suspended distribution of some Novartis flu vaccine, and in the case of Germany recalled some lots of vaccine, after the clumping issue came to light.

In a statement issued Friday night, the company said more than one million doses of its flu vaccines have been administered in Europe so far this season and no unexpected adverse events have been reported.

As well, it said that it has already delivered about 70 per cent of its Canadian order (roughly 1.5 million doses), again without hearing of problems in people who have received Novartis flu shots. The company said people who have received Novartis flu shots are not at risk.

Company says clumping not unusual

Novartis said finding minute clumps of virus protein in vaccines is not unusual. They said their vaccines passed quality inspections and they are confident the products are safe.

"We think that there's no adverse consequence, no side effects, because we do occasionally see [particles], so we want to find out exactly what the Europeans saw and why they took the decisions that they did," said Dr. Paul Gully, the senior medical advisor for Health Canada.

"The aggregate proteins are predominantly influenza virus-derived (mainly hemagglutinin), all normal and necessary components of influenza vaccines," the company said. "Aggregation of these proteins is not unusual in vaccines manufacturing."

Hemagglutinin is the protein on the outside of flu viruses that locks onto cells in the human respiratory tract to start the process of infection. Flu vaccines are designed to provoke the immune system to produce antibodies to hemagglutinin to protect against infection.

In fact, this isn't the first time protein clumping has disrupted Canada's flu vaccine supply.

During the 2009 pandemic, there was a delay in delivery of unadjuvanted vaccine for pregnant women when GlaxoSmithKline, Canada's pandemic vaccine supplier, found visible protein aggregation in some of the vaccine.

Adjuvants are compounds that boost the response a vaccine generates. Canada used adjuvanted vaccine during the pandemic, but bought some unboosted product for pregnant women as a precaution.

Novartis makes only about 20 per cent of Canada's annual flu vaccine purchase. GlaxoSmithKline makes the bulk of Canada's seasonal flu vaccine, though a variety of other suppliers have a share of the Canadian market.

Still, because of the way vaccine orders are placed, the hold on Novartis vaccine could put some provinces and territories in a position where they face a temporary vaccine shortfall, just at the time when flu shot programs are getting underway, Gully admitted.

He said Health Canada hopes there is a rapid resolution of the situation. But if provinces or territories have a problem with supply, efforts will be made to share across jurisdictions, he said.

Both Fluad and Agriflu are sold in single-dose formulations, pre-loaded into a syringe.

Fluad contains an adjuvant and is licensed for use in people 65 and older. Older adults do not mount a good response to flu vaccine and the inclusion of an adjuvant is an effort to improve the protection they get from flu shots.

With files from CBC News

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Calories poorly grasped for maintaining weight

People often don't know how many calories they're eating, how much they need or how much they burn off, say doctors who are calling for prominent calorie labels at the point of sale.

The Canadian Obesity Network, a group of obesity experts, showed people examples of foods and asked them to guess how many calories the items contained.

Many people don't know their recommended daily intake of calories. (Lee Jae Won/Reuters)

"A lot of Canadians were quite off the mark," said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta in Edmonton.

"When we showed people food labels and asked them to calculate how many calories they'd be getting if they consumed say a can of soup, very few Canadians were able to figure out that number."

Sharma is concerned about the consequences of caloric illiteracy considering two-thirds of Canadians are carrying extra pounds and a quarter of adults are considered to be medically obese, according to Statistics Canada.

"Ultimately calories are the currency of weight management," Sharma said. "If you don't know how many calories you're eating, you don't know what your body's doing with the calories, you don't know where the calories are going. That's like trying to manage your bank account without knowing how much money you make or how much money things cost."

Guessing calories

The average women needs to take in about 2,000 calories a day and the average man 2,400, Sharma said.

At the University of Waterloo, David Hammond found people consumed 11 per cent fewer calories when nutrition information was posted on restaurant menus compared with a control group, a difference of about 100 calories. An earlier U.S. study found the same result.

Hammond agreed that many people don't know their recommended daily intake of calories, but they can compare items, such as 210 calories for a small muffin versus 240 calories in a large muffin.

Gaining that relative sense of calories when making purchasing decisions helps make the information sink in and drives smarter choices, he said.

Gaining a relative sense of calories when making purchasing decisions may help people to make smarter choices, says David Hammond. (CBC)

Another option is to use a traffic light pattern with calories in green, amber and red, the way pre-packaged foods are labeled in UK grocery stores.

"It's very difficult if not impossible to guess how many calories are in a meal, even trained dieticians can't do that," said Hammond. "The best way of giving that information to people is on the menu at the time they're making their food decisions."

Consumers may assume that a salad at a fast food restaurant is going to have fewer calories than a burger but that is not always the case, he said.

Many large restaurant chains now voluntarily provide nutrition information but they often put it in places that are difficult for consumers to find, such as on their websites and on posters away from the check outs, said Bill Jeffrey, national coordinator for the Centre for Science in the Public Interest, which is lobbying governments to make restaurants post nutrition information on their menus.

In the U.S., federal regulation will soon require calorie counts to be reported beside standard menu items at large chain restaurants.

In Canada, voluntary measures have been in place for several years, but Jeffrey called them "largely ineffective."

Last month, McDonald's in the U.S. announced it will unveil menu board labels in American restaurants in advance of the U.S. federal regulations.

"With regard to nutrition information in restaurants the conversation has progressed differently in Canada than it has in the U.S.," McDonald's Canada said in a statement at the time.

"McDonald's Canada is actively working with all levels of government, NGOs and industry stakeholders to develop an appropriate 'Made-in-Canada' solution to displaying comprehensive nutrition information that is easily accessible to customers prior to purchase."

Sharma cautioned he doesn't want people to obsessively count calories, but to have an idea of how many calories are in the foods when deciding what to eat.

With files from CBC's Kelly Crowe and Pauline Dakin

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Quitting smoking 'works extraordinarily well' for saving lives

Smoking cigarettes throughout adulthood reduces life expectancy by about 11 years in women but quitting avoids much of the extra risk, a new large study shows.

The Million Women Study in the UK recruited 1.3 million British women who were born in the early 1940s to look at the hazards of smoking and the benefits of stopping at various ages.

Women in North America took up smoking decades later than men. (Jonathan Alcorn/Reuters)

In most of Europe, Canada and the U.S., the popularity of smoking among young women reached its peak in the 1960s, decades later than for men.

Among women in the study who smoked cigarettes through their adult lives, the mortality rate was three times that of women who never smoked or who stopped well before middle age, Sir Richard Peto of the University of Oxford and his co-authors said in Saturday's issue of the journal Lancet.

"Stopping before 40 years of age, and preferably well before, avoids more than 90 per cent of this excess mortality; stopping before 30 years of age avoids more than 97 per cent of it," the study's authors concluded.

"This does not, however, mean that it is safe to smoke until 40 years and then stop, for women who do so have throughout the next few decades a mortality rate 1.2 times that of never-smokers."

Study participants were recruited from 1996 to 2001. They filled in questionnaires about the lifestyle, medical and social factors and were resurveyed by mail three and eight years later.

At the start of the study, 20 per cent of them were smokers, 28 per cent were ex-smokers and 52 per cent had never smoked. By 2011 six per cent had died.

The excess mortality among smokers was mainly from diseases that are known to be affected by smoking, such as lung cancer, chronic lung disease, heart disease and stroke, the researchers said. A little of the excess wouldn't be caused by smoking, they added.

Quitting sooner the better

Smokers were more likely to live in economically poor areas, drink more than 14 units of alcohol a week and avoid strenuous exercises. Those factors were taken into account in the analysis.

A journal commentary accompanying the study called the main findings "simple and unequivocal."

Even women considered social smokers having a handful of cigarettes a day had twice the mortality rate of never smokers, Professor Rachel Huxley at the University of Minnesota in Minneapolis said in her commentary.

"For adults who already smoke, stopping works extraordinarily well — and the sooner the better," Huxley wrote.

Women who smoke have more than four times the risk of dying of heart disease in the near future than nonsmokers the same age, she said, compared with nearly double the odds in men. Huxley speculated physiological or behavioural differences could explain the gender gap.

The research was funded by Cancer Research UK and Medical Research Council.

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Red Bull rage prompts Korean student's deportation

A Korean student studying at Cape Breton University in Nova Scotia is expected to be deported today after an outburst at the school cafeteria that his lawyer blames on drinking too many Red Bull energy drinks.

Halifax lawyer Joel Pink said drinking too many of the caffeinated beverages triggered his client, Jyong Chul Lee, to have an outburst and threaten his residence adviser at the school on Sept. 10.

"I have never seen a case where a person has been drinking as much Red Bull that Mr. Lee has been drinking," Pink said Thursday.

Lee, 25, was expelled from the university and charged with mischief, creating a disturbance and criminal harassment. He pleaded guilty to the charges Thursday in Sydney provincial court.

In handing down her sentence, Judge Jean Whalen agreed to a joint request from the Crown and defence that Lee be sent back to Korea. He's expected to be escorted home on Friday.

Underwent psychiatric evaluation

Lee had been in custody since the September incident. In that time, he underwent a month-long psychiatric examination at the East Coast Forensic Hospital in Dartmouth.

"According to the psychiatric report, basically it showed that he was under — at the time — a caffeine overdose or what we call caffeine intoxication," Pink told reporters outside the courtroom Thursday.

'I have never seen a case where a person has been drinking as much Red Bull that Mr. Lee has been drinking,' Halifax lawyer Joel Pink said about student Jyong Chul Lee. (CBC)

"That, of course, would affect his mood, affect his personality. The way I would look at it based on the forensic hospital's report that he had consumed so much that he was irritable, suffering from anxiety, things of that sort."

Pink described his client as a perfectionist and said Lee drank copious quantities of Red Bull so he could stay up longer to study, believing that would ensure he got the best possible marks in the courses he was taking.

Drank loads of caffeine

The lawyer said Lee's psychiatric report suggested 500 to 600 mg of caffeine a day could cause caffeine intoxication. Pink said he was surprised to learn of the report's findings.

"I've never read any cases in the last 40 years where the defence of caffeine intoxication was ever raised," said Pink.

"Not to say it hasn't, but I've never seen it. I've seen it in some cases in the U.S., but not here in Canada."

Pink believes proving caffeine intoxication in court still remains a challenge, but said he's pleased the judge took it into consideration in handing down her sentence.

"I take it from my review of the matter in total that if it wasn't for the caffeine that he was drinking in sizeable amounts, that he in fact would never have been in this position," Pink said.

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Ritz questioned about labels for tenderized beef

Agriculture Minister Gerry Ritz was in Regina Friday where he discussed the issue of the E. coli risk of tenderized meat. (CBC)

Canada's agriculture minister is weighing in on the heightened E. coli risk in mechanically tenderized meat and what options are being explored.

In Regina on Friday, reporters continued to ask Gerry Ritz about the E. coli outbreak at the XL Foods plant in Alberta, which was the largest of its kind in years and resulted in the temporary closure of the plant. Reporters also asked him about the health risks of tenderized beef and about labelling.

Four people in Edmonton got sick after eating tenderized steaks that were purchased at Costco, but originally came from the XL plant.

Health Canada says that when E. coli is on a steak or a roast, it's typically on the surface and is killed when cooked, even at a "rare" setting.

However, the department also says the mechanical process to tenderize steaks and roasts can drive E. coli from the surface of meat to the centre.

The means greater precaution must be taken, Ritz said.

"When it's needled in or pressed into the meat and you cook it to medium-rare ... you don't kill it, you don't get to the temperature that you need," he said.

He noted that health officials in the United States and Canada are looking at better labeling to inform consumers that medium-rare won't be enough.

"There's talk about making sure that people understand that if you're buying this tenderized product ... it should be labelled to warn you to cook it beyond the temperature that should be required [for non-tenderized meat]."

Health Canada said last week it's doing a scientific review on meat tenderizing, but in the meantime, it wants people to cook tenderized cuts to an internal temperature of 71 degrees C. (160 degrees F.).

The department said it's working with the retail and restaurant industry to identify tenderized beef through labels, signs or other means.

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Organic food offers few advantages for kids, says U.S. study

Another study has cast doubt on the benefits of organic food, finding "no direct evidence" that it leads to better health in children — contrary to what some well-meaning, high-spending parents might think.

The American Academy of Pediatrics this week weighed in for the first time on the supposed benefits of eating organic, but said it's unclear whether parents are actually getting healthier food for the extra cost.

The report said organic foods have the same vitamins, minerals and other nutrients as conventional foods — though they also have lower levels of pesticides and are less likely to carry certain types of bacteria, which may be important for growing children.

Organic foods also contain more vitamin C and phosphorus than conventional foods, but the report found scant evidence this provides any "meaningful" benefits.

In the long run "there is no direct evidence that consuming an organic diet leads to improved health or lower risk of disease," said the study, which appeared Monday in the AAP's journal Pediatrics.

Researchers say it is more important that kids eat a healthy diet with lots of fruit, vegetables, whole grains and low-fat dairy products — whether organic or not.

"This type of diet has proven health benefits," said Dr. Janet Silverstein, one of the lead authors of the study, in a statement.

"Many families have a limited food budget, and we do not want families to choose to consume smaller amounts of more expensive organic foods and thus reduce their overall intake of healthy foods like produce," she added.

The study follows similar research released last month through Stanford University, which found no signs of added nutrition in organic food, though it also noted lower levels of pesticides and antibiotics.

The AAP study looked at organic meat, produce and dairy products. It also said organic farming is less harmful to the environment through, among other things, reduced use of pesticides and fossil fuels.

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Aspirin may help colon cancer survival if gene mutated

Aspirin, one of the world's oldest and cheapest drugs, has shown remarkable promise in treating colon cancer in people with mutations in a gene that's thought to play a role in the disease.

Among patients with the mutations, those who regularly took Aspirin lived longer than those who didn't, a major study found. Five years after their cancers were diagnosed, 97 per cent of the Aspirin users were still alive versus 74 per cent of those not taking the drug.

Aspirin is often recommended for people who have colon cancer but it's not advised for wider use, or for cancer prevention, because it can cause serious bleeding in the stomach and gut. (M. Spencer Green/Associated Press)

Aspirin seemed to make no difference in patients who did not have the mutations.

This sort of study can't prove that the drug caused the better survival, and doctors say more research must confirm the findings before Aspirin can be recommended more widely. The study wasn't designed to test Aspirin; people were taking it on their own for various reasons.

Still, the results suggest that this simple medicine might be the cheapest gene-targeting therapy ever found for cancer. About one-sixth of all colon cancer patients have the mutated gene and might be helped. And Aspirin costs just pennies a day.

"It's exciting to think that something that's already in the medicine cabinet may really have an important effect" beyond relieving pain and helping to prevent heart attacks, said Dr. Andrew Chan of Massachusetts General Hospital. He and others from Harvard Medical School led the study, which appears in Thursday's New England Journal of Medicine.

Cancers of the colon or rectum are a leading cause of cancer deaths worldwide. More than 140,000 new cases and 51,000 deaths from them are expected this year in the United States.

'I figured, what have I got to lose by taking some Aspirin?'— L. Stewart Keefe

Several studies suggest that Aspirin may help fight cancer, especially colorectal tumours. It is often recommended for people who have colon cancer and others at high risk of developing it. But it's not advised for wider use, or for cancer prevention, because it can cause serious bleeding in the stomach and gut.

What has been lacking, doctors say, is a good way to tell which people might benefit the most, so Aspirin's risks would be justified. Chan's study suggests a way to do that.

Simple gene test

It involved 964 people diagnosed with various stages of colon cancer who were among nearly 175,000 participants in two health studies based at Harvard that began in the 1980s. Every two years, they filled out surveys on their health habits, including Aspirin use.

Most had surgery for their cancer, and many also had chemotherapy. They gave tumour tissue samples that could be tested for gene activity. Researchers focused on one gene, PIK3CA, that is involved in a key pathway that fuels cancer's growth and spread. Aspirin seems to blunt that pathway, so the scientists looked at its use in relation to the gene.

In those whose tumors had a mutation in that gene, regular Aspirin use cut the risk of dying of colon cancer by 82 per cent and of dying of any cause by 46 per cent during the study period of about 13 years.

Only two of the 62 regular users whose tumors had the mutated gene died within five years of their cancer diagnosis versus 23 of 90 non-Aspirin users with such a mutation.

The results are "quite exciting," said Dr. Boris Pasche, a cancer specialist at the University of Alabama at Birmingham who wrote an editorial that appears with the study in the medical journal. Half a dozen drugs are used to treat colon cancer, but only one meaningfully extends survival in people whose cancers have not widely spread, he said.

"Now we may have Aspirin. That's why it's a big deal," Pasche said.

In the study, the dose of Aspirin — baby or regular — didn't seem to matter, just whether any was regularly used.

The test for the gene is not expensive and is simple enough that most cancer centres should be able to do it, Chan and Pasche said.

The U.S. National Institutes of Health and several foundations paid for the study. One of the 17 authors consults for Bayer, a leading Aspirin maker. Pasche has been a paid speaker for two companies that make cancer treatments and has two patent applications under review related to cancer treatment.

Researchers warn that Aspirin may not be responsible for the improved survival seen in this study. Differences in how the patients' cancer was treated could have played a role.

For that reason, they say the next step should be a study where some people with the mutated gene are given Aspirin and others are not, so their cancer outcomes can be compared more directly.

One colon cancer patient, L. Stewart Keefe, 60, a retired interior decorator and painter from Alton, N.H., decided several years ago to try it.

"I figured, what have I got to lose by taking some Aspirin? It just seems like it was a simple enough thing to take," she said. "For me the bleeding risk is a very small possible consequence" compared with the risk of cancer coming back, she said.

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Catholic parents to be consulted on HPV vaccine in schools

Calgary's Catholic school board is revisiting if they will offer HPV vaccines in its schools.

The board agreed Wednesday night to begin surveying parents on their thoughts about the controversial vaccine.

Girls in Calgary public schools can already receive the human papillomavirus shot, but girls in the Calgary Catholic School District don't have the option.

The vaccine, normally administered in Grade 5, helps prevent against diseases and even the development of cervical cancer by stopping a virus transferred mainly through sexual contact.

"We're concerned about our kids," said parent Calvin Vass. "I definitely think that is something that should be offered to all kids, for sure. The school board needs to take a look at the health of the kids before the actual religious part of it."

Another parent, Alexandra Espinoza, says it's preventative, so anything that helps is a good thing.

"I think you can combine both — your ethical and moral values — with really trying to help girls and their decisions," she said.

Legal threat

Pro-vaccination group HPV Calgary has threatened to take legal action against the school board for not offering the shot.

Juliet Guichon said she's optimistic the parent survey will lead Catholic schools to offer the vaccine.

"I'm hoping that the trustees are appreciating how serious this matter is that people will get sick and 16,000 children who were deprived of easy access to the vaccine, some of those people will get sick and a few of them will die."

Guichon said school immunizations are the most effective and cost-efficient method of providing vaccinations to kids.

Support from Bishop

Local Bishop Fred Henry says he supports the Catholic board's decision although he has said in the past the vaccine might compromise the church's teachings on chastity.

In a written statement the Bishop said he still believes the original decision to not provide the vaccine is the right course of action.

"However, given … the lack of a consistent policy and practice by Catholic school districts in our province, concerns, diffrerences of opinion, divisions and threats of legal action, I am also supporting the recent motion," said Bishop Henry on Wednesday.

The consultation with parents will start in a few weeks.

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Hamilton experts hope to keep mental health momentum going

Local experts say they hope the momentum keeps going after a Hamilton community discussion about youth mental health.

Community members who work in youth mental health say they hope people keep talking about the issue in Hamilton. They're also mulling over the personal stories they heard during the CBC Hamilton session "Mental Health 101: Youth and the Hidden Crisis in Our Community" at Mohawk College, and ways to address them.

Terry McGurk, executive director of COAST, said he heard a need for more health promotion in schools around the issue of mental illness. He also heard what he already knew — that there can be a disconnect between hospital and community-based services.

"I think we — all service providers — need to talk about how we can work more effectively," he said.

Dr. Sheila Harms, a child and adolescent psychiatrist with McMaster Children's Hospital, was one of four panelists at the town hall.

She'd like to see the feedback analyzed to identify themes and key points, and possibly another forum with decision makers and key community members.

"Any time we're talking meaningfully and intentionally about issues pertaining to mental health, it's helpful," she said. "It would be helpful if we can get some traction and make sure changes emerge from the discussion."

About 140 people attended the session in-person. More than 200 people participated online, many with their own stories about struggles with mental illness. Common themes included difficulty accessing services, discrimination in school and the need to reduce stigma. Online participants also discussed mental health and First Nations youth.

Cecilia Marie Flynn, co-ordinator of the Suicide Prevention Council of Hamilton, was an invited guest at the town hall.

She sees a momentum in society around the issue and hopes it continues.

When it comes to suicide, "what I would like to see is more people in the community — parents, youth, teachers, caregivers — actively seek out a greater understanding of how they can recognize the signs and intervene," she said.

"I would love them to continue the conversation as much as they're able to," she said. "They can do it in their workplaces, in the volunteer organization they're part of, in their church, in their family. We would love to have materials in every workplace in the city."

The council is also competing for Aviva Community Fund to train 3,000 youth and families in suicide prevention. Vote for the suicide prevention initiative here.

The other panelists were Mariette Lee, McMaster student and president of COPE: A Student Mental Health Initiative; Sarah Cannon, executive director of Parent's for Children's Mental Health, and David Hoy, manager of the social work services department at the Hamilton-Wentworth District School Board.

The town hall was hosted by Heather Hiscox from CBC News Now and produced by Karin Chykaliuk.

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Winnipeg health authority ads urge teens to use condoms

The Winnipeg Regional Health Authority has launched its latest round of sexual-health advertisements, reminding teenagers to use condoms, but some say ads are not enough.

The WRHA's campaign, unveiled on Thursday, is aimed at battling high rates of sexually transmitted infections among teens.

The advertisements tell youth that since the symptoms of an STI can come unexpectedly, using condoms during sexual activity is the best way to be safe.

Dr. Pierre Plourde, a medical health officer with the WHRA, said the health authority will be following up with teens to find out if the ads work.

"Are they having, you know, less sexual relations, or the same? And if [it's] the same, are they using condoms more often? So we are keeping track of that," Plourde said.

The WRHA says Manitoba tends to have the highest rates of chlamydia in Canada, especially in teens, and gonorrhea rates are also high.

The advertisements will appear in movie trailers, on shelters and on the radio. There is also a website, GetSomeCondoms.com, with more information.

Some Winnipeg teens told CBC News they think the ads won't be as effective as sexual-education courses at school.

"Last night I was doing bio questions, and it was about sexually transmitted stuff," said Dylan Buhay, a Grade 11 student at Sisler High School.

"It's honestly kind of gross to me that we don't know enough about it."

Jonelle Giddings, another Grade 11 student at Sisler, said it may be more effective for students to hear from people who have had sexually transmitted infections.

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OPP suicides higher than on-duty deaths, ombudsman says

Ontario Ombudsman André Marin said today that 23 OPP officers have committed suicide since 1989, a total that exceeds the number of officers killed on duty over the same time period.

Marin was speaking Wednesday afternoon at a news conference at Queen's Park in Toronto to release a report on his investigation into how the province and the OPP have addressed operational stress injuries of police officers.

"The Ontario Provincial Police and the Ministry of Community Safety and Correctional Service both say they take the issue of operational stress injury seriously," Marin said.

"But my investigation shows they are failing and the results are frankly tragic. My investigation reveals for the first time that 23 OPP officers have committed suicide since 1989, two more than have been killed on duty."

The ombudsman has issued a new report, entitled In the Line of Duty, which makes 34 recommendations to provide better support to officers and to end the "persistent stigma" against operational stress injuries.

"This is about supporting the people who put their lives on the line in the most difficult kind of public service and keeping them healthy and functioning," he said.

"It's hard to think of a better public investment."

OPP Commissioner Chris Lewis said the police force welcomes the report from the ombudsman and will review its recommendations.

"The OPP is committed to supporting its workforce and this includes addressing operational stress injuries," Lewis said in a statement released Wednesday.

"I am proud of the efforts of our employees to deliver programs and resources relating to wellness, stress management, and critical or traumatic incidents. But I also acknowledge that, while we continue to make significant progress in this area, we can still do better — and we will."

Lack of data

Marin said the OPP doesn't formally keep track of the number of officers that have taken their own lives.

But his investigation has confirmed the 23 instances since 1989 in which retired and active officers have taken their own lives, including five such cases in the past 18 months.

Marin has also learned that the OPP has only one staff psychologist who is primarily assigned to screen new recruits, not to deal with front-line officers.

"The OPP is made up of over 8,000 members, it's a powerful, sophisticated organization and it just fails to deliver when it comes to taking care of its own members," said Marin.

Former OPP Det.-Insp. Bruce Kruger has firsthand experience with the kind of stressful experiences that Marin is talking about.

During his 29-year career with the provincial police, Kruger faced repeated dangerous and traumatizing experiences — including one occasion in which he found his partner's body in a snowbank, after he had been shot to death.

He suffered greatly as a result of these collective incidents, becoming at times anxious, angry and depressed.

"I just never ever want to see another police officer or police family go through the horrendous experiences that we did with no help," Kruger told CBC News.

"There's help out there, there's great doctors, medication and support systems. Let's use them and get our police back into proper shape."

Ten years ago, Marin released a report on post-traumatic stress within the Canadian military.

Back then, Marin said the Canadian military used to have a "culture of denial" with respect to operational stress injuries.

But he said the military changed and caught up with the times.

"If the military culture can evolve, I am optimistic that police culture can, too," he said.

"But we certainly cannot afford to wait another 10 years."

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Embryo from 2 women and 1 man made in lab

Scientists in Oregon have created embryos with genes from one man and two women, using a provocative technique that could someday be used to prevent babies from inheriting certain rare incurable diseases.

The researchers at Oregon Health & Sciences University said they are not using the embryos to produce children, and it is not clear when or even if this technique will be put to use. But it has already stirred a debate over its risks and ethics in Britain, where scientists did similar work a few years ago.

Faint white blotch in the tube at right is DNA that has been removed from a human egg. The red dot is from a laser used in the procedure. (Oregon Health & Science University/Associated Press)

The British experiments, reported in 2008, led to headlines about the possibility someday of babies with three parents. But that's an overstatement. The DNA from the second woman amounts to less than 1 per cent of the embryo's genes, and it isn't the sort that makes a child look like Mom or Dad.

The procedure is simply a way of replacing some defective genes that sabotage the normal workings of cells.

The British government is asking for public comment on the technology before it decides whether to allow its use in the future. One concern it cites is whether such DNA alteration could be an early step down a slippery slope toward "designer babies" — ordering up, say, a petite, blue-eyed girl or tall, dark-haired boy.

Questions have also arisen about the safety of the technique, not only for the baby who results from the egg, but also for the child's descendants.

In June, an influential British bioethics group concluded that the technology would be ethical to use if proven safe and effective. An expert panel in Britain said in 2011 that there was no evidence the technology was unsafe but urged further study.

Laurie Zoloth, a bioethicist at Northwestern University in Evanston, Ill., said in an interview that safety problems might not show up for several generations. She said she hopes the United States will follow Britain's lead in having a wide-ranging discussion of the technology.

While the kind of diseases it seeks to fight can be terrible, "this might not be the best way to address it," Zoloth said.

Over the past few years, scientists have reported that such experiments produced healthy monkeys and that tests in human eggs showed encouraging results. The Oregon scientists reported Wednesday that they have produced about a dozen early human embryos and found the technique is highly effective in replacing DNA.

The genes they want to replace aren't the kind most people think of, which are found in the nucleus of cells and influence traits such as eye color and height. Rather, these genes reside outside the nucleus in energy-producing structures called mitochondria. These genes are passed along only by mothers, not fathers.

About 1 in every 5,000 children inherits a disease caused by defective mitochondrial genes. The defects can cause many rare diseases with a host of symptoms, including strokes, epilepsy, dementia, blindness, deafness, kidney failure and heart disease.

Early embryos formed

The new technique, if approved someday for routine use, would allow a woman to give birth to a baby who inherits her nucleus DNA but not her mitochondrial DNA. Here's how it would work:

Doctors would need unfertilized eggs from the patient and a healthy donor. They would remove the nucleus DNA from the donor eggs and replace it with nucleus DNA from the patient's eggs. So, they would end up with eggs that have the prospective mother's nucleus DNA, but the donor's healthy mitochondrial DNA.

In a report published online Wednesday by the journal Nature, Shoukhrat Mitalipov and others at OHSU report transplanting nucleus DNA into 64 unfertilized eggs from healthy donors. After fertilization, 13 eggs showed normal development and went on to form early embryos.

The researchers also reported that four monkeys born in 2009 from eggs that had DNA transplants remain healthy, giving some assurance on safety.

Mitalipov said in an interview that the researchers hope to get federal approval to test the procedure in women, but that current restrictions on using federal money on human embryo research stand in the way of such studies.

The research was funded by the university and the Leducq Foundation in Paris.

Dr. Douglass Turnbull of Newcastle University in Britain, whose team has transplanted DNA between eggs using a different technique, called the new research "very important and encouraging" in showing that such transplants could work.

But "clearly, safety is an issue" with either technique if it is applied to humans, he said.

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Drug-resistant HIV strain plagues Sudbury patients

Public health officials in Sudbury say a local rise in drug resistant strains of HIV should be a wakeup call.

A study by the Ontario HIV Epidemiologic Monitoring Unit shows Sudbury has an alarming number of patients who don't respond to the most commonly used medications for the virus.

A total of 50 per cent of HIV patients in Sudbury show resistance to common medications, a number significantly higher than the 5 per cent of drug-resistant HIV patients across the rest of Ontario.

"I think what this tells us is that it is incredibly important to prevent HIV, to get tested, to know your status, to go on effective medications, and to stay on those medications," said Dr. Penny Sutcliffe, Sudbury's medical officer of health.

The drug resistant strains were found most often in injection drug users and women.

Sudbury doctor Robert Remis said for those patients who have an HIV strain that is resistant to at least one treatment drug, treatment can be difficult.

"The problem is … if there are further mutations, it could make the virus very untreatable," he said.

"So it takes away your margin of safety in terms of having drugs that really can suppress the multiplying of HIV."

Each year, an average of 11 people are diagnosed with HIV in the city.

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Aspirin may help colon cancer survival if gene mutated

Aspirin, one of the world's oldest and cheapest drugs, has shown remarkable promise in treating colon cancer in people with mutations in a gene that's thought to play a role in the disease.

Among patients with the mutations, those who regularly took Aspirin lived longer than those who didn't, a major study found. Five years after their cancers were diagnosed, 97 per cent of the Aspirin users were still alive versus 74 per cent of those not taking the drug.

Aspirin is often recommended for people who have colon cancer but it's not advised for wider use, or for cancer prevention, because it can cause serious bleeding in the stomach and gut. (M. Spencer Green/Associated Press)

Aspirin seemed to make no difference in patients who did not have the mutations.

This sort of study can't prove that the drug caused the better survival, and doctors say more research must confirm the findings before Aspirin can be recommended more widely. The study wasn't designed to test Aspirin; people were taking it on their own for various reasons.

Still, the results suggest that this simple medicine might be the cheapest gene-targeting therapy ever found for cancer. About one-sixth of all colon cancer patients have the mutated gene and might be helped. And Aspirin costs just pennies a day.

"It's exciting to think that something that's already in the medicine cabinet may really have an important effect" beyond relieving pain and helping to prevent heart attacks, said Dr. Andrew Chan of Massachusetts General Hospital. He and others from Harvard Medical School led the study, which appears in Thursday's New England Journal of Medicine.

Cancers of the colon or rectum are a leading cause of cancer deaths worldwide. More than 140,000 new cases and 51,000 deaths from them are expected this year in the United States.

'I figured, what have I got to lose by taking some Aspirin?'— L. Stewart Keefe

Several studies suggest that Aspirin may help fight cancer, especially colorectal tumours. It is often recommended for people who have colon cancer and others at high risk of developing it. But it's not advised for wider use, or for cancer prevention, because it can cause serious bleeding in the stomach and gut.

What has been lacking, doctors say, is a good way to tell which people might benefit the most, so Aspirin's risks would be justified. Chan's study suggests a way to do that.

Simple gene test

It involved 964 people diagnosed with various stages of colon cancer who were among nearly 175,000 participants in two health studies based at Harvard that began in the 1980s. Every two years, they filled out surveys on their health habits, including Aspirin use.

Most had surgery for their cancer, and many also had chemotherapy. They gave tumour tissue samples that could be tested for gene activity. Researchers focused on one gene, PIK3CA, that is involved in a key pathway that fuels cancer's growth and spread. Aspirin seems to blunt that pathway, so the scientists looked at its use in relation to the gene.

In those whose tumors had a mutation in that gene, regular Aspirin use cut the risk of dying of colon cancer by 82 per cent and of dying of any cause by 46 per cent during the study period of about 13 years.

Only two of the 62 regular users whose tumors had the mutated gene died within five years of their cancer diagnosis versus 23 of 90 non-Aspirin users with such a mutation.

The results are "quite exciting," said Dr. Boris Pasche, a cancer specialist at the University of Alabama at Birmingham who wrote an editorial that appears with the study in the medical journal. Half a dozen drugs are used to treat colon cancer, but only one meaningfully extends survival in people whose cancers have not widely spread, he said.

"Now we may have Aspirin. That's why it's a big deal," Pasche said.

In the study, the dose of Aspirin — baby or regular — didn't seem to matter, just whether any was regularly used.

The test for the gene is not expensive and is simple enough that most cancer centres should be able to do it, Chan and Pasche said.

The U.S. National Institutes of Health and several foundations paid for the study. One of the 17 authors consults for Bayer, a leading Aspirin maker. Pasche has been a paid speaker for two companies that make cancer treatments and has two patent applications under review related to cancer treatment.

Researchers warn that Aspirin may not be responsible for the improved survival seen in this study. Differences in how the patients' cancer was treated could have played a role.

For that reason, they say the next step should be a study where some people with the mutated gene are given Aspirin and others are not, so their cancer outcomes can be compared more directly.

One colon cancer patient, L. Stewart Keefe, 60, a retired interior decorator and painter from Alton, N.H., decided several years ago to try it.

"I figured, what have I got to lose by taking some Aspirin? It just seems like it was a simple enough thing to take," she said. "For me the bleeding risk is a very small possible consequence" compared with the risk of cancer coming back, she said.

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Pap tests should be less frequent for most

Most women can wait three to five years between checks for cervical cancer, depending on their age and test choice, new U.S. guidelines say.

Many medical groups have long recommended a Pap test every three years for most women. The new advice from the American College of Obstetricians and Gynecologists says that's true for women ages 21 to 29 whose Paps show no sign of trouble.

In a Pap test, cells are scraped from the cervix to look for early signs of cancer. (Craig Lassig/College of American Pathologists/Associated Press)

But for healthy women ages 30 to 65, the preferred check is a Pap plus a test for the cancer-causing HPV virus, the group concluded. If both show everything's fine, they can wait five years for further screening.

The guidelines from the largest OB-GYN organization in the U.S. agree with advice issued earlier this year by a government panel, the American Cancer Society and other medical groups — showing growing consensus that it's safe for the right women to wait longer between Paps.

Cervical cancer grows so slowly that regular Pap smears, which examine cells scraped from the cervix, can find signs early enough to treat before a tumour even forms.

Canadian guidelines recommend that a woman begin having Pap tests within three years of becoming sexually active or by age 21. A woman should have a Pap test once per year until she has had two normal test results in a row, and then she need only be tested every three years.

Women should continue having tests until they are at least 70 years of age, the Federation of Medical Women of Canada and the Society of Obstetricians and Gynecologists of Canada said Tuesday.

Certain strains of HPV, the human papillomavirus, cause most cervical cancer, but the infection has to persist for a number of years to do its damage. HPV is a common virus in young women, whose bodies usually clear the infection on their own. Thus, health groups don't recommend routinely testing 20-somethings for HPV because it would cause too many false alarms.

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Quebec's plan to standardize ambulances draws warnings

Quebec is embarking on an ambitious plan to standardize every ambulance in the province over the next five years, at a cost of nearly $70 million.

But some critics say the common current model of ambulance has problems and shouldn't be relied on to overhaul the 500 vehicles from Rouyn-Noranda to the Magdalen Islands.

A CBC News investigation found that there's a number of concerns with that kind of ambulance, which is gradually replacing older vehicles, particularly in the fleet of Montreal and Laval.

Chief among the issues raised by paramedics: that the rear suspension is too stiff and can cause patients to be jostled around.

The new ambulances are based on a chassis made by General Motors called the Chevrolet Express 4500. Urgences Santé, the ambulance service for Montreal and Laval and the biggest paramedic agency in the province, already has 30 of the Chevys in its fleet of 154 and is expecting up to 40 more by the end of next year.

The agency had to switch from a Ford-based vehicle two years ago because Ford stopped making a diesel-powered version, and it acknowledges the Chevy has drawn complaints from staff.

But there are options. The company that assembles the ambulances for Urgences Santé, Beloeil, Que.-based Demers Ambulances, says in tests it's run, a different model of Chevy, the 3500, is closer to the Ford in terms of the smoothness of the ride.

"You'll have a softer spring suspension, so you will have a little bit less harsh ride, and you'll feel the difference when you're actually in the back of the ambulance," said Michel Pelletier, head of engineering for Demers.

Less payload

The problem is that the 3500 is rated to carry 860 kilograms less weight, meaning ambulance services across the province would have to dump equipment from their vehicles. Pelletier said it's doable, though.

"We look at the design, we look at the different aspects of the ambulance, and we figure out where can we take away some material, where can we lighten it up and keep it safe at the same time, to be able to give them either more usable payload capacity or a better ride."

'Everybody has a taste for what they like,' Urgences Santé spokesperson David Sasson says of competing visions for a new standardized Quebec ambulance. (CBC)

Paramedics aren't entirely sold, however, on the idea of one province, one ambulance.

The head of Quebec's paramedics union says different communities have different needs. In a remote town, where it could take half an hour or more to get to a hospital, ambulances should be stocked with lots of supplies and medicines. In cities, the ride to the hospital is mere minutes.

"From Ste-Anne-des-Monts to Gaspé, or from anywhere in Abitibi to Val-d'Or, where they have a lot of travelling to do, they need a lot more pharmacy," said François Trudelle, president of the Federation of Paramedic Service Employees of Quebec.

Meanwhile a sleeker vehicle would do better on the narrow streets of Quebec City or Old Montreal, Trudelle said.

"You don't need the same truck all over Quebec, or you don't need the same truck to do everything that is being done right now with the ambulance. You could split."

'A good thing'

Ambulance manufacturers, emergency medical responders and their agencies, and the Health Ministry are working on the specifications for the new provincially standardized vehicle. It's supposed to be ready by early next year, following which Quebec will put out a tender call for a new provincial fleet.

Ambulances on the assembly line at Demers Ambulances in Beloeil, Que. One dilemma is that a chassis with a more supple suspension gives a smoother ride but can take less equipment. (CBC)

"We believe it is a good thing, definitely is," Urgences Santé spokesperson David Sasson said of the standardization process.

But he acknowledged it will be difficult to find a vehicle that everyone's happy with.

"Everybody has a taste for what they like, and that's normal for us," he said. "We've done different evaluations and different tests of what the vehicle should be…. At the end of the day, we're going to please as many people as we can."

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