Penting Sehat

Diet rich in iron may prevent PMS

Written By Unknown on Kamis, 28 Februari 2013 | 22.45

Women who consume more iron from plant-based sources could be less likely to feel pre-menstrual symptoms like bloating and depression than those having less of the nutrient, a U.S. study suggests.

With data from the Nurses Health Study II on diet and lifestyle, researchers at the University of Massachusetts Amherst assessed the mineral intake of about 3,000 women aged 25 to 42 using food questionnaires. None of the women had PMS at the outset and 1,057 women were diagnosed with it over the 10-year study period.

Vegetables such as peas and spinach contain nonheme iron. A diet rich in the mineral may help protect against PMS. (Nguyen Huy Kham/Reuters)

Previous research suggests that PMS affects an estimated 8 per cent to 15 per cent of women during their reproductive years, leading to symptoms such as breast tenderness, abdominal bloating, appetite changes, depression and anxiety that can interfere with regular activities.

"The present study suggests that high intakes of nonheme iron and perhaps zinc may be associated with a lower risk of PMS, whereas a high potassium intake may be associated with a higher risk," the study's senior author Elizabeth Bertone-Johnson and her co-authors concluded in Tuesday's online issue of the American Journal of Epidemiology. Nonheme iron is iron from certain vegetables or supplements but not meat.

Bertone-Johnson suggested that women consume a balanced diet. Health Canada's list of foods containing nonheme iron includes legumes such as bean and lentils, cereal, nuts and seeds.

Iron may be related to PMS because it is involved in producing serotonin, a neurotransmitter that helps to regulate mood, the researchers said.

They said they aren't aware of any previous studies looking at how iron intake may relate to PMS but that low iron levels have been associated with higher risk of postpartum depression.

In the study, risk of developing PMS was lowest in women who consumed more than 20 milligrams of iron daily. The researchers said a serving of iron-fortified cereal provides this level but it may otherwise be difficult to reach the level from food alone.

Keep minerals balanced

The recommended dietary allowance for women aged 19 to 49 who are not pregnant is 18 milligrams per day.

The heme iron from red meat and poultry did not show the same effect. Other minerals also seemed to have no effect.

High iron and zinc intake can be harmful, Bertone-Johnson cautioned.

"PMS is probably multifactorial, and it's probably way more complicated than one or two supplements or mineral deficiencies might cause," Dr. Fredric Moon, medical director of general obstetrics and gynecology at Winthrop University Hospital in Mineola, N.Y., told Health Day News.

The study relied on participants to self report their food and supplement intakes. Women also had to recall menstrual symptoms from previous years in combination with clinical diagnosis of PMS.

The findings were only in women aged 25 and may not apply to those who develop PMS in adolescence or early adulthood who weren't studied.

The researchers considered factors such as calcium intake, age, smoking, weight, pregnancy history and use of oral contraceptives in their analysis. The study does not prove any cause and effect relationships.

The study was funded by grants from GlaxoSmithKline Consumer Healthcare, Rexall/Cellasene settlement litigation and the U.S. National Cancer Institute.

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Obesity rates at historic levels in Canada

Obesity rates are still climbing in Canada, particularly in the Maritimes and territories, according to a new study.

Researchers at the University of British Columbia mapped self-reported obesity rates for adults across Canada since 1998.

The colour-coded obesity maps could help health authorities monitor regional trends, says Carolyn Gotay. (Courtesy UBC)

The Maritimes and the two territories had the highest obesity rates from 2000 to 2011 — more than 30 per cent of the population in these regions is estimated to be obese, Prof. Carolyn Gotay of UBC's School of Population and Public Health and her co-authors said in today's issue of the Canadian Journal of Public Health.

British Columbia had the lowest overall rates. In B.C., obesity increased from less than 20 per cent to almost 25 per cent.

In Quebec, rates remained below 24 per cent.

Gotay said the colour-coded maps are meant to personalize the data in a way that transcends language differences.

Obesity rates could be levelling off, the researchers said. For the past four years, the percentage of Canadians estimated to be obese varied from 24.2 per cent to 25.3 per cent compared with steeper climbs previously.

"The impact of obesity on chronic disease incidence takes time to emerge, and even if rates level off, they are historic highs," the researchers concluded.

The study did not include data on aboriginals living on reserves or Canadians in remote areas.

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Sodium in Canadian restaurant foods 'alarmingly high'

Sodium levels in many foods served at Canadian restaurant chains exceed the amount an adult should take in during a day, a new study finds.

Researchers examined the salt levels in more than 9,000 foods sold at 65 fast-food restaurants and 20 sit-down restaurant chains with at least 20 locations across the country.

Considering how common it is to dine out, along with the pervasiveness of hypertension and its health risks, the study authors said it was important to take a systematic look at sodium levels to assess progress towards the federal, provincial and territorial target of lowering sodium intake to 2,300 milligrams per person per day by 2016.

It is recommended that people eat up to 1,500 milligrams of sodium per day, which is called the daily adequate intake (AI)level, or the minimum amount the body needs. People aged 14 and older should not eat more than 2,300 mg sodium per day, the daily tolerable upper intake level or UL, as that level is likely to pose a health risk.

Sandwiches, wraps, stir fry entrees and ribs topped the sodium levels at sit-down restaurants. (Graham Hughes/Canadian Press)

More than 22 per cent of sandwiches or wraps, ribs and pasta entrees with meat or seafood exceeded the UL for sodium at sit-down restaurants. On average, meal items not including side dishes contained 1,455 milligrams of sodium per serving or 97 per cent of an adult's daily AI. Seafood, beef and salad entrees were the categories with the lowest sodium levels per serving.

At fast food restaurants, the highest categories were stir fry entrees, poutine or fries with toppings, tacos and burritos, sandwiches or wraps and salads with meat or seafood.

Study authors Mary L'Abbé, chair of the nutritional sciences at the University of Toronto, and graduate student Mary Scourboutakos took the systematic look at sodium levels provided by industry in 2010 and early 2011.

Since Canada has not yet established targets or implemented a reduction strategy for the restaurant sector, L'Abbé and Scourboutakos used the U.S. targets.

Searching out healthier options

"Because of the prevalence of eating out, as well as the high rates of hypertension and cardiovascular disease, addressing the exceedingly high sodium levels in restaurant foods is essential in order to decrease the burden of chronic disease," they concluded in Wednesday's issue of the Canadian Journal of Public Health.

The majority of establishments exceeded targets for sodium density in baked goods such as bagels, croissants and cookies, fried potatoes, other sandwiches, fries, sandwiches with luncheon meat and pizza.

Because of the high sodium density, reducing portion sizes alone won't work to meet the targets, the researchers said.

Fries with toppings from fast food chains had more than 1,500 milligrams of sodium. (Peter Dejong/Associated Press)

L'Abbé had a few suggestions for consumers looking for lower sodium options when eating in restaurants.

"First, they can ask restaurants if they have lower sodium offerings, because if you go out and eat out and consumers start asking for lower sodium offerings, I think they will hear us. When you actually taste something and it tastes too salty, tell them."

Asking for sauces and dressings on the side also helps, she said. Items that may seem healthier, like salads, aren't necessarily the best option. Diners also need to consider other nutritional aspects like saturated fat and sugar.

At the Nota Bene restaurant in Toronto, executive chef David Lee offers lunch menu items that cut back on salt, such as grilled organic salmon on salad.

"It's a healthier option," Lee said. "For me, that would involve, in terms of the sodium, maybe cut back just a little bit and implement maybe some more herbs or a little bit more olive oil."

For children's items, on average the items contained 32 per cent of the daily recommended amount of sodium, which L'Abbé said shows the need to establish targets specifically for children. Previous research suggests teens who often eat fast food may alter their taste perception, promoting a preference for salt but that introducing small to moderate reductions slowly aren't easily detected.

The researchers acknowledged that they relied on food establishments to provide accurate data and that sodium levels could vary. They called for more research to see how much market share influences the results.

At a Jack Astor's Bar & Grill, one of the chains in the study, Myles Sam said the restaurant is trying to use less salt.

"We leave it to the guest," said Sam, the assistant kitchen manager. "There's salt on the table if you want to add more."

The Centre for Science in the Public Interest estimated that three-quarters of the excess sodium in the Canadian food supply is added by food manufacturers and restaurants.

Next month, a vote is expected on federal NDP health critic Libby Davies' private member's bill, which requires food manufacturers to meet sodium reduction targets.

The Canadian Restaurant and Foodservices Association is opposed to the bill, saying that restaurants are already working closely with suppliers to reduce sodium levels in menu items.

The research was funded by the Canadian Institutes of Health Research, Canadian Stroke Network and the University of Toronto.

With files from CBC's Kim Brunhuber

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Japan nuclear disaster poses 'small' cancer risk

People exposed to the highest doses of radiation during Japan's Fukushima nuclear plant disaster in 2011 may have a slightly higher risk of cancer that is so small it probably won't be detectable, according to a new report from the World Health Organization released Thursday.

A group of experts convened by the agency assessed the risk of various cancers based on estimates of how much radiation people at the epicentre of the nuclear disaster received, namely those directly under the plumes of radiation in the most affected communities in Fukushima, a rural agricultural area about 240 kilometres north of Tokyo.

Some 110,000 people living around the Fukushima Daiichi nuclear plant were evacuated after the massive March 11, 2011, earthquake and tsunami knocked out the plant's power and cooling systems, causing meltdowns in three reactors and spewing radiation into the surrounding air, soil and water.

'It's more important not to start smoking than having been in Fukushima.'—Richard Wakeford, WHO report co-author

Experts calculated that people in the most affected regions had an additional four to seven per cent overall risk of developing cancers including leukemia and breast cancer. In Japan, men have about a 41 per cent lifetime risk of developing cancer of an organ while a woman's lifetime risk is about 29 per cent. For those most hit by the radiation after Fukushima, their chances of cancer would rise by about 1 per cent.

"These are pretty small proportional increases," said Richard Wakeford of the University of Manchester, one of the authors of the report.

"The additional risk is quite small and will probably be hidden by the noise of other (cancer) risks like people's lifestyle choices and statistical fluctuations," he said. "It's more important not to start smoking than having been in Fukushima."

Experts had been particularly worried about a spike in thyroid cancer, since iodine released in nuclear accidents is absorbed by the thyroid, especially in children. After the Chornobyl disaster, about 6,000 children exposed to radiation later developed thyroid cancer, because many drank contaminated milk after the accident.

For people beyond the most directly affected areas of Fukushima, the cancer risks drop dramatically. (Associated Press)

In Japan, dairy radiation levels were closely monitored and children are not big milk drinkers anyway.

WHO estimated that women exposed as infants to the most radiation after the Fukushima accident would have a 70 per cent higher chance of getting thyroid cancer in their lifetimes. But thyroid cancer is extremely rare and the normal lifetime risk of developing it is about 0.75 per cent. That would rise to 0.5 per cent for those women who got the highest radiation doses as babies.

Wakeford said the increase in such cancers may be so small they will probably not be observable.

Risks outside immediate area 'infinitesimal'

For people beyond the most directly affected areas of Fukushima, Wakeford said the risk dropped dramatically. "The risks to everyone else were just infinitesimal."

Some experts said it was surprising that any increase in cancer was even predicted and believe that the low-dose radiation people in Fukushima received hasn't been proven to raise the chances of cancer.

"On the basis of the radiation doses people have received, there is no reason to think there would be an increase in cancer in the next 50 years," said Wade Allison, an emeritus professor of physics at Oxford University, who was not connected to the WHO report. "The very small increase in cancers means that it's even less than the risk of crossing the road," he said.

Gerry Thomas, a professor of molecular pathology at Imperial College London accused the WHO of hyping the cancer risk.

"It's understandable that WHO wants to err on the side of caution, but telling the Japanese about a barely significant personal risk may not be helpful," she said.

Thomas said the WHO report used inflated estimates of radiation doses and didn't properly take into account Japan's quick evacuation of people from Fukushima. "This will fuel fears in Japan that could be more dangerous than the physical effects of radiation," she said, noting that people living under stress have higher rates of heart problems, suicide and mental illness.

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Calcium and vitamin D won't help most older women

Written By Unknown on Rabu, 27 Februari 2013 | 22.45

Most healthy, postmenopausal women don't need to take calcium or vitamin D supplements to prevent broken bones, a U.S. advisory group concludes.

Doctors have long prescribed calcium supplements to prevent and treat osteoporosis. It's estimated that half of women 50 and older will experience an osteoporosis-related fracture in their lifetime.

A U.S. government advisory group says doses found in dietary supplements don't prevent broken bones in women after menopause. (Bebeto Matthewss/Associated Press)

Now the U.S. Preventive Services Task Force has reviewed research on the supplements and concluded that taking 400 IU of vitamin D or less and 1,000 milligrams of calcium seems to slightly increase the risk for kidney stones in postmenopausal women and should not be taken.

There wasn't enough evidence to judge the effects of daily supplements with more than 400 IU of vitamin D and more than 1,000 milligrams of calcium.

For men and premenopausal women, Dr. Virginia Moyer of Baylor College of Medicine and her panel also found a lack of evidence for fracture prevention.

"Regrettably, we don't have as much information as we would like to have about a substance that has been around a long time and we used to think we understood," said Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force. "Turns out, there's a lot more to learn."

Last year, the Endocrine Society also concluded that the non-skeletal benefits of vitamin D are unclear.

Unlike that group, the task force's recommendations were based on hard end points of fractures rather than blood levels of vitamin D, Marion Nestle of New York University and Malden Nesheim of Cornell University in New York said in a commentary published with the study in Monday's Annals of Internal Medicine.

Re-think calcium and vitamin advice

From a nutritional perspective, Nestle said it's important to consider the diet as a whole rather than focusing on a single nutrient. The amount of vitamin D that we absorb from sunlight on the skin is another key factor although it is hard to measure.

The multiple recommendations from different groups confuse health care practitioners and the public, the commentary said.

The task force's "cautious, evidence-based advice should encourage clinicians to think carefully before advising calcium and vitamin D supplementation for healthy individuals," Nestle and Nesheim concluded.

These recommendations don't apply to those at high risk of weak bones, including older adults who have previously broken a bone and are at risk for another fracture, said Dr. Sundeep Khosla of the American Society for Bone and Mineral Research. Those people should consult a doctor, said Khosla, a bone specialist at the Mayo Clinic who wasn't part of the panel.

The Institute of Medicine, which advises the U.S. and Canadian governments, recommends about 1,000 mg of calcium, 1,300 for postmenopausal women, every day. For vitamin D, the goal is 600 IUs of vitamin D every day, increasing to 800 after age 70.

Kholsa said most people should get enough calcium from foods including:

Orange juice fortified with calcium and D.
Milk, yogurt and cheese.
Certain fish including salmon.
Fortified breakfast cereals.

Physical activity is also recommended for bone health.

The task force is still studying vitamin D's potential to prevent cancer. So far, the observational evidence strongest for vitamin D reducing colorectal cancer but the proof is weak or inconsistent for cancer overall and breast and prostate tumours, according to the Endocrine Society.

With files from The Associated Press

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Sleep deprivation plays havoc with genes

Sleep deprivation affects hundreds of genes involved with inflammation, immunity and cells' response to stress, British researchers have found.

The findings might help explain why some people who do not get enough sleep have an increased risk for obesity, heart disease and cognitive impairment.

Sleep expert Derk-Jan Dijk and colleagues from the University of Surrey took whole-blood RNA samples from 26 participants after they had spent a week sleeping 8.5 hours a night, and the same participants after a week of sleeping for just 5.7 hours.

The expression of genes in blood offers a view into what is happening in other organs of the body, including the brain and liver, which are more difficult to test repeatedly, the authors note.

After each week, 10 blood samples were taken from each participant at three-hourly intervals, during a period of total sleep deprivation that helped the researchers control the effects of light, activity and food on gene expression.

The experimental conditions mimic what many people experience on a regular basis, the researchers note in their article.

Circadian rhythms affected

"According to the Centers for Disease Control and Prevention, 30 per cent of civilian adults in the United States report an average sleep duration of six hours or less."

Comparing the two sets of samples, the researchers found that 444 genes were down-regulated after the sleepless week, and 267 were up-regulated.

Their study appears in the latest issue of the journal Proceedings of the National Academy of Sciences.

Genes related to circadian rhythms, metabolism, inflammation, immune response and stress were all affected by the experiment.

"The identified biological processes may be involved with the negative effects of sleep loss on health," the researchers say.

Window to biological mechanisms

The results "contribute to the developing evidence that poor or insufficient sleep is a health risk," comments Australian sleep researcher John Trinder from the University of Melbourne.

The new findings also open a window into the mechanisms that underpin the harmful effects of sleep deprivation, notes sleep researcher Andrew Vakulin from the Woolcock Institute of Medical Research in Sydney.

"It's a snapshot of what's going on," he tells the Australian Broadcasting Corporation. "It's summarizing what's getting turned off and on and gives us the ability to look at things much more closely now."

The new study also offers scientists avenues for studying why different individuals are more susceptible to the consequences of sleep deprivation, says Vakulin.

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Judge calls for update on mental health services

Provincial Court Judge Michael McKee is calling on the New Brunswick government to provide an update on how it is improving mental health care in the province.

McKee issued a report in February 2009 called, "Together into the future," which included recommendations to transform the mental health system.

In the four years since then, New Brunswick has had four health ministers and a change in government but McKee says little has changed, and the politicians don't seem to be talking about it.

Former health minister Madeleine Dubé announced an action plan for mental health services in 2011 but Judge Michael McKee said it's not moving quickly enough. (CBC)

"Where do they intend to go in the near future with this? I think it's important for the general public to know because it is troubling and disconcerting to people like myself. I haven't heard very much coming from the people that I would expect," said McKee.

A Department of Health spokesperson said the provincial government has responded to McKee's report with a seven-year action plan. The second year of investment in that plan will be announced in the spring budget.

Families running out of time

McKee said during consultations with the public for his report, he was struck by the frustration of families who were left waiting for treatment.

"I've had people tell me that her daughter committed suicide while she was on the waiting list to get some therapy," McKee said.

"It was so sad. And sad because there is something that we can do. That's what I find very sad. Silence about mental health issues is no longer an option."

Vickie Carter is part of one of those families who have been left waiting.

She's been asking the provincial government for therapy for her 17-year-old son, who suffers from bipolar disorder and is on the autism spectrum, since he was 11.

Carter said in the past five years her son has received that therapy for only three months.

"I don't feel as much like a failure as I used to because I know I'm not the only parent that goes through this and I think it's becoming more and more known that there's a lot more families like mine," said Carter.

The therapy is called applied behavioural analysis and in New Brunswick it's offered to autistic children before the age of five but Carter's son was diagnosed too late. She said without it she fears her son won't have a future.

"He takes medication but without the therapy to go with it it's like giving a child a bicycle without wheels and saying go. They can't move forward unless they have both. They go hand in hand and we're still denying them," she said.

Carter said it's very difficult right now because her son is asking for more help so he can move on after highschool to a job.

"He said, I need more help. I need help now,'" Carter said.

"And when your child says that to you what do you say? You pick yourself up, you dust yourself off, you put your boxing gloves back on and step back in the ring. That's what parents like me are up against. We fight every step of way for everything we get."

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Advanced breast cancer edges up in younger women in U.S.

Dr. Rebecca Johnson, a cancer specialist at Seattle Children's Hospital, was diagnosed with early-stage breast cancer at age 27, 17 years ago. (Elaine Thompson/Associated Press)

Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumours tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women in the U.S. in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumour to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Changes in childbearing practices

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the U.S. Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients.

More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumour that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

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New coronavirus cases tracked closely

Written By Unknown on Selasa, 26 Februari 2013 | 22.45

An infectious disease specialist in Toronto is trying to predict where new cases of a respiratory infection could crop up next.

The Geneva-based World Health Organization has encouraged countries to be on the lookout for NCoV, a coronavirus known to have infected 13 people in Saudi Arabia, Qatar, Jordan and the United Kingdom. There have been seven deaths.

Coronaviruses are a cause of the common cold but can also be the cause of more severe illnesses (Beth Fischer/Canadian Press)

Last week, WHO urged countries to consider molecular tests for the virus if someone has unexplained pneumonia or a severe respiratory infection that doesn't respond to treatment, particularly if the patient has recently travelled or come from affected countries.

Without a blood test to detect antibodies to the virus, cases can only be reliably determined using sophisticated and rapid diagnostic capabilities that may not be widely accessible in more resource-limited areas of the world such as South Asia.

"Our work has identified that about 50 per cent of all the travellers that leave Saudi Arabia, Qatar and Jordan end up going to resource-limited countries — low and lower income countries that don't really have robust public health and medical systems," said Dr. Kamran Khan, an infectious disease specialist and scientist at St. Michael's Hospital in Toronto.

"Being vigilant and really directing some of your resources to areas that have the highest risk, that is really going to offer you the greater potential of anticipating where this virus might show up and perhaps mitigate its impact."

In the U.K., a man who had recently travelled to Pakistan and Saudi Arabia became severely ill after his return. He tested positive for the coronavirus, as did two other members of his family who had not travelled abroad. Another female family member recovered after a mild illness, according to the UK Health Authority.

It's important to keep in mind that the total number of infections is unknown and the full spectrum of illness is unclear, Khan said.

"If there are a larger number of people with mild infectious they may go undetected," Khan said. "They may still be capable of spreading the virus to others, but they may not necessarily come to the attention of public health officials and health providers."

If so, the mortality rate from the virus is lower than it currently seems.

The Public Health Agency of Canada is advising people travelling to areas with confirmed infections to seek medical attention if they develop symptoms that include difficulty breathing.

Coronaviruses are a cause of the common cold but can also be the cause of more severe illnesses. So far, all cases of the new coroanvirus have experienced flu-like illness — coughing, mucous, shortness of breath, malaise, chest pain and/or fever.

It is difficult to distinguish between symptoms of the new coronavirus and seasonal respiratory infections, said Todd Hatchette, director of virology and immunology at the QE2 Health Science Centre in Halifax.

"You really have to look for the key features that would suggest they're at risk for this particular virus and right now that's travel to an area where someone has been infected or attached to a cluster of the infections."

Hatchette and Khan agreed Canadians should not be alarmed. They suggest common-sense precautions such as staying home when sick and seeking general travel medical advice before leaving.

With files from CBC's Pauline Dakin

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Wealthy may have an edge over poor for medical appointments

Financially better-off individuals seeking a family doctor appear more likely to get an appointment than those who are poor, even though Canada's universal health system offers no monetary incentive for cherry-picking patients, a study suggests.

The study found that individuals who called a physician's office asking to be seen as a new patient were more than 50 per cent more likely to get an appointment if they presented themselves as having a well-paying job.

'It is not appropriate for physicians to screen potential patients because it can compromise public trust in the profession.' - College of Family Physicians of Canada

"Our study provides very strong evidence of discrimination, but it does not identify specific offices that are discriminating," said principal researcher Dr. Stephen Hwang, a specialist in inner-city health at St. Michael's Hospital in Toronto.

"It simply shows that you are more likely to get an appointment if you are of high socioeconomic status," he said. "We think this indicates pretty clearly that there is preferential access to primary care."

To conduct the study, published Monday in the Canadian Medical Association Journal, researchers phoned 375 family physician and general practitioner offices in Toronto, posing as a bank employee or a welfare recipient, either with chronic health conditions or needing only routine care.

"So every physician's office got a call from one person and there were four possible scenarios that they could be randomly assigned to," said Hwang, noting that the doctors' offices were chosen at random and most responses were from receptionists or other administrative staff.

The proportion of calls resulting in an appointment offer was greater for those posing as bank employees — 23 per cent — than for those presenting themselves as welfare recipients — 14 per cent.

When including those who were offered a screening visit or a spot on a waiting list, 37 per cent of so-called better-off callers got a positive response compared to 24 per cent for those of more limited income.

"Typically, the caller who was turned down would be told: 'I'm sorry, but Dr. X is not accepting patients currently' or 'The practice is not open to new patients,"' Hwang said.

"That's what they would be told, but what we observed is that you're more likely to be told that if you're of low socioeconomic status than if you're of high socioeconomic status."

Hwang stressed he was not trying to single out family physicians or suggest they discriminate more than other physicians or professions.

Health problems got priority

"We don't know if this is a subconscious bias on the part of the receptionist or if they're carrying out instructions that are given to them or if it's conscious bias. We don't know."

Dr. Marie-Dominique Beaulieu, president of the College of Family Physicians of Canada, said her organization promotes patient equality and would frown on any of its 28,000 members across the country choosing patients based on their social or financial profile.

"Socioeconomic status or any other [patient] characteristic shouldn't be considered" when a physician is in a position to accept new patients, Beaulieu said from Montreal, where she practises family medicine.

The study has some limitations, including the fact that doctors' offices were called only once with a single scenario, not twice by two different researchers posing as patients on relatively opposite sides of the socioeconomic coin.

Hwang conceded that two calls would have been ideal — providing a "smoking gun" if each caller got a different response — but there were logistical pitfalls, including time constraints and concern about detection if the calls were made too close together.

"I think we have to take this study for what it is," said Beaulieu, "which is a small study that maybe adds to a body of knowledge, but certainly cannot be considered as conclusive at demonstrating bias."

Unexpectedly, researchers who said they had chronic health conditions — in this case, diabetes and low back pain — were more likely to receive appointment offers than those seeking routine care, such as a check-up (24 per cent versus 13 per cent).

"We were very surprised by that," said Hwang, who had hypothesized that patients without complex health problems would be more likely to be accepted as patients.

"We thought because patients with chronic health conditions take more time and more effort that physicians might be preferentially seeking to enrol healthy patients in their practices.

"But we were pleased to see the opposite, that physician offices were appropriately giving priority to people with health problems over those who did not have immediate health problems."

College does not support cherry-picking

Beaulieu said the fact that patients with complex health-care needs were more likely to be offered an appointment is reassuring.

"So this would not support the idea of cherry-picking," she said.

The study found no evidence that the length of time a doctor had been practising nor the socioeconomic status of the neighbourhood where offices were located had any bearing on whether a patient was accepted.

Hwang said the College of Physicians and Surgeons of Ontario, for one, recommends against doctors cherry-picking patients based on their health status, socioeconomic profile or other factors.

"They say 'it is not appropriate for physicians to screen potential patients because it can compromise public trust in the profession, especially at a time when access to care is a concern."'

The College of Physicians and Surgeons has a clear policy that new patients should be taken on a first-come, first-served basis, but the policy does not appear to be enforced, he said.

"I think the first thing is we need to recognize is …[that we're] all prone to treating people differently and discriminating," Hwang said.

"Socially, within the realm of health care, we feel that that's inappropriate."

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11-year surgery wait has N.S. woman speaking out

Wendy Berringer says Nova Scotia needs more specialists. (CBC)

A woman who has waited more than 11 years for foot surgery is speaking out on how the wait has affected her life.

Wendy Berringer has waited more than a decade for surgery to fix a bone deformation on her left foot.

She said she has lived with increasing pain for a long time.

"You're awake every hour, hour and a half. You just can't sleep right," she said.

"In the beginning, I actually thought they lost me in the system because it was 10 years."

Berringer has suffered with bunions — not something that would put her at the top of the list.

Her foot problems got a lot worse while she was waiting to see Dr. Mark Glazebrook, who's about to become the province's only foot and ankle surgeon.

"This is going to make a problem that was unsustainable, much more critical. We'll be down to one by the fall of 2013. With that, we must recruit, in my opinion, more orthopedic surgeons," said Glazebrook.

A year ago Berringer was sent to a new foot surgeon in Kentville, Dr. Andrea Veljkovic.

The surgery was set for January or February. She learned three weeks ago that Veljkovic's position wasn't being funded any longer and Veljkovic is moving to Toronto.

She now has to go back on Glazebrook's 3,500-person waiting list.

"I actually sat there and cried," said Berringer. "I said, 'I did this for a whole year now, over a year, going back and forth there, only to find this out?'"

Health and Wellness Minister Dave Wilson acknowledged last week that more work needs to be done.

"Orthopedic surgeons, they assess their patients and the most urgent cases are dealt with immediately," he said.

Berringer said she thinks she waited too long.

"You get to be urgent, to be on that urgent list, by not having the simple [procedure] done first," she said.

"We need more doctors here, more specialists."

The government said its orthopedic working group will meet in the coming months to talk about the number of doctors in the province.

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Synthetic pot widely available amid legal grey area

The sale of herbal incense that may give a high similar to marijuana remains in a regulatory void in Canada, despite a crackdown on similar substances south of the border.

A CBC News investigation has found that the product is available to buy in stores from St. John's to Vancouver.

Packages of the herbal incense contain explicit health warnings that it is not for human consumption.

Federal agents from the DEA remove sacks from a warehouse in Tampa on July 25, 2012. Agents were raiding several properties as part of an operation targeting people making synthetic marijuana. (AP Photo/The Tampa Bay Times)

But undercover CBC reporters found stores where staff suggested it is meant to be smoked.

Herbal incense is sold in foil packages at prices ranging from roughly $12 and $16 a gram.

It goes under brand names like Happy Shaman, K2 Grape Xtreme, Project 420, Fusion Atomic Green and Kick Ass White Rabbit.

Similar products in the United States have faced legislative action, with the vast majority of states taking action to ban them.

And last July, the U.S. Drug Enforcement Administration carried out Operation Log Jam, with law enforcement officers in 109 cities taking part and more than 90 arrests made.

A total of 4.8 million packages of synthetic cannabinoids, and the chemicals to make 13.6 million more, were seized. So was $36 million US in cash.

Police reaction in Canada

Police in this country have not been on the same page when it comes to products claiming to be an alternative to marijuana.

Calgary police carried out a series of raids in 2011, but the Alberta Crown office said it did not appear that any charges or conviction resulted.

And today, different police forces are taking different stands about whether the product is, in fact, legal.

The Winnipeg Police Service initially told CBC News that synthetic marijuana is not a controlled substance.

The Zap'r herbal incense blend has this label on the back of the package. (CBC)

Now, in the wake of CBC inquiries, the force says it is concerned, is not sure about the legal status, and will look into it.

Police in Windsor, Ont., along with two other police services in that province, are starting a crackdown on convenience stores this week.

Windsor Police Insp. John McQuire says the force's drug unit has sent away samples to Health Canada, which have tested positive for synthetic cannabinoid.

"It's illegal to have or to sell," McQuire said.

The package tested in Windsor carried the brand name "The Izms."

But The Izms chief executive Adam Wookey told CBC News his product is completely legal.

"The claim that it's legal is based on its ingredients," Wookey said.

"The active ingredients are synthetic cannibinoids that have no similar structure to THC. Because of that, they are not considered to be similar synthetic preparation and, therefore, not illegal. The problem with basing laws on pharmacological effect is that it's extremely dubious."

Wookey said that based on pharmacological effect, coffee and cocaine would be "similar."

"It would open the door to vitamins and things we use … in everyday life. If you started regulating stimulants ... it would open the door for a range of stimulants to be illegal."

Legal grey area

In Canada, products claiming to be marijuana alternatives seem to exist in a legal grey area.

According to the RCMP's Sgt. Ken Cornell, not all synthetic cannabinoids have been declared by Health Canada in schedule II of the Controlled Drugs and Substances Act (CDSA).

Although they may have a similar chemical structure and make-up, he notes, pharmacologically they react very differently in the body.

This herbal incense was bought in Newfoundland within the past month. (CBC)

"This is likely where importers/users are trying to argue that their substances are unregulated," Cornell said in an emailed statement.

He works as national chemical diversion co-ordinator with the RCMP's drug branch, federal and international operations.

"Also confusion may come into play with police departments or detachments that are aware of some of the typical synthetic cannabinoids being declared and others not."

Health Canada says smoking synthetic cannabinoids can result in symptoms that range from seizures to hallucinations to acute psychosis.

Proponents of the product — also known as "spice," or K2 — stress that it is legal.

But Health Canada considers it a controlled substance if it gives the same effect as marijuana.

CBC News is taking steps to securely destroy the packages it purchased during this investigation.

Big issue south of the border

The issue with similar products is much better known in the United States.

According to the Drug Abuse Warning Network, 11,406 Americans went to the emergency room with side effects from synthetic marijuana in 2010.

Earlier this month, the U.S. Centers for Disease Control issued a warning after finding that 16 synthetic marijuana users in six states suffered acute kidney injuries last year.

"Public health practitioners, poison center staff members, and clinicians should be aware of the potential for renal or other unusual toxicities in users of [these] products," the CDC report noted.

Karen Dobner's son Max died in a car crash after smoking synthetic marijuana. The Illinois woman has since started a foundation in Max's name, and lobbied the state government to bring in tough new legislation. (CBC)

For Karen Dobner, synthetic marijuana has had a more personal impact.

The Illinois woman's teenage son Max died in 2011 after smoking it.

Just a half-hour before Max's death, he called his older brother to tell him his heart was pounding, and he was freaking out.

But Max got in the car and started driving "like a maniac" though town, Dobner recalls.

'They think that just because it is sold in stores it is safe.'—Parent Karen Dobner

The car reached speeds of up to 160 kilometres an hour before coming to the end of a road. Max didn't brake. The car flew more than 25 metres through the air before crashing into a house, causing $100,000 US worth of damage. Max died almost instantly.

Her son "was one of those kids that never got into any trouble," Dobner told CBC News.

"When I found out he went to the mall and was talked into purchasing this product by the store owner, I immediately jumped into action. I thought, 'How could they be selling something so dangerous?'"

Dobner started a foundation in her son's name. She began lobbying the Illinois state government to bring in rules that she says are now the toughest in the country.

"They're not usually the kids that are getting into trouble. They are using synthetic marijuana because they don't want to get in trouble. Those kids, they think that just because it is sold in stores it is safe."

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Herbal tea recalled due to salmonella warning

Written By Unknown on Senin, 25 Februari 2013 | 22.45

A batch of Tega brand Organic Lemon Hibiscus Green Rooibos Herbal Tea could be tainted by salmonella. (Nu-tea.com)

A brand of herbal tea sold in B.C. is being recalled voluntarily on the recommendation from the Canadian Food Inspection Agency who advised consumers not to drink it because of potential of salmonella poisoning.

The CFIA issued a warning about Tega brand Organic Lemon Hibiscus Green Rooibos Herbal Tea saying that the product is a concern.

Nu-Tea Company Ltd. of Abbotsford, B.C., is recalling the product from the marketplace following the health alert.

The tea is sold in packages of 24 tea bags and bear the UPC 6 64322 10406 0. The suspect packages have the best before dates of 2014FE01, 2014MR27, and 2014MR28.

This product has been distributed in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Quebec.

There have been no reported illnesses associated with the consumption of this product.

The CFIA warned that food contaminated with salmonella may not look or smell spoiled and that ingesting the bacteria may cause illness.

Young children, the elderly and people with weakened immune systems may suffer serious and sometimes deadly infections.

Healthy adults might experience short-term symptoms such as high fever, severe headache, vomiting, nausea, abdominal pain and diarrhea.

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Payment for blood donors comes to Canada

Two Canadian companies are willing to pay blood donors to get their plasma.

Canadian Plasma Resources in Toronto and CanGene Plasma in Winnipeg are both promoting compensation for plasma donors on their websites, although neither company lists the amount of payment being offered. Canadian Plasma Resources declined a request from CBC for an interview but allowed its facility to be filmed. Cangene Plasma Resources did not respond to an interview request.

While legal, the move to payments is fuelling concerns that compensation could spur people to lie on screening questionnaires, designed to check for risks to the blood supply.

"You don't know if people are telling the truth or not, or if they are motivated simply to earn money by donating plasma," said Rick Janson, a spokesperson for the Ontario Public Service Employees Union, which represents employees of Canadian Blood Services, a national, not-for-profit charitable organization that manages the blood supply in all provinces and territories except for Quebec.

The safety and quality of blood collection is regulated, but payment is not. (Fabrizio Bensch/Reuters)

Plasma is the portion of the blood that transports water and nutrients to all the cells in the body. It is composed of about 90 per cent salt water and 10 per cent protein and electrolytes. Plasma contains many specialized proteins (antibodies) that aid in fighting infections and can be used to make life saving medical products, according to Cangene.

Starting in the 1980s, thousands of Canadians became infected with HIV and hepatitis C from tainted blood and plasma imported from the U.S., where donors are paid.

In the wake of the scandal and an inquiry, Justice Horace Krever set out conditions for a safer blood supply in 1997. One of the key recommendations from the inquiry was that "significant efforts be made to ensure that blood components and blood products used in Canada are made from the blood and plasma collected from unpaid donors."

Krever told CBC News he still stands by that recommendation.

Mike McCarthy has hemophilia and contracted hepatitis C from contaminated blood. McCarthy lost two uncles because of bad plasma collected from prisoners in Arkansas. The Toronto man believes there should be a law preventing payment for blood donations.

"We are potentially heading down another slippery slope where consumer or commercial aspects take precedence over the safety and well-being of Canadians who depend on a safe blood system," McCarthy told CBC News.

Canadian Plasma Resources has a list of potential plasma donors, beds, sterile equipment and staff. It's expecting to open for business in a few months near a university and homeless shelter in Toronto after Health Canada approves the facility to handle blood.

Financial incentives questioned

Plasma can be processed in the U.S. into immunoglobulin, an expensive intravenous drug used to treat cancer and other diseases.

Hematologist Dr. Lois Shepherd, a pathology professor at Queen's University in Kingston, Ont., is dismayed by the move away from the altruistic donation model previously embraced in Canada. She considers the safety concerns surrounding volunteer versus paid donors to be somewhat moot since all blood is thoroughly checked for transmissible diseases.

"For me, the bigger concern is that we do rely on volunteer blood donors in Canada, and if we're attracting younger people to be paid donors as plasma donors they are going to be pulled out of a population of people that might potentially be committed red cell whole blood donors."

Shepherd noted that Canadian hospitals are top users worldwide of drug products derived from plasma and demand is constantly increasing. She said it's hard to watch the voluntary system be "nibbled away."

"This is an incredible change in the way we are delivering health care from the blood system," Janson said. "Nobody even knows this is happening."

Health Canada said in an email that its mandate is to regulate the safety and quality of the plasma that is collected for the purposes of transfusion or use in the manufacture of a human drug, which does not extend to corporate or operational decisions such as compensation to donors.

Ron Vezina, director of communications for Canadian Blood Services, said his organization has "no plans at this time" to buy plasma from the new Toronto operation.

With files from CBC's Kelly Crowe and Melanie Glanz

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Major grocers sell canned fish years past shelf life

A woman who bought lobster pâté at a Wal-Mart recently and felt ill after eating it said she was shocked to find the can should have been pulled from circulation more than a year ago.

"It was scary. Very frightening," said Margaret Radomski, 78, of Leduc, Alta. "So, then I thought, how did this get on the shelf? There is something wrong here."

Radomski said the Clover Leaf pâté smelled and tasted too fishy. A few hours after eating it, she said she felt odd.

"I started to see stars in my eyes … a crawling sensation on my face," she said. "I got weak in my legs."

Radomski is convinced it was the pâté that made her feel sick, because she said she is normally healthy and has no allergies.

She checked the bottom of the can and found it had a "best before" date of July 2011 — a year and a half before she bought it.

Long past shelf life

This can of pâté recently purchased by Radomski should have been pulled from the shelf in July 2011. (CBC)

"I would have never bought this can of lobster pâté if I had seen the date on it … because I'm usually pretty careful about that," said Radomski.

"I feel insecure now. When I go to the store, I've got to study more of what I am buying."

Radomski said she refused Wal-Mart's offer of $50 compensation and decided instead to go public to warn others.

Wal-Mart spokeswoman Felicia Fefer said the company's policy is not to sell any products past their best before date..

"We take this issue very seriously," she said. "We regret this incident, and remain committed to ensuring outdated products are removed from our shelves."

Not an isolated case

Walmart said it regrets what happened and its policy is to not sell any products past their best before date. (CBC)

Go Public visited 17 major grocery stores in the Vancouver area and found one-third had outdated cans of fish and seafood on their shelves.

Old cans of tuna and shrimp, stamped "best before" 2010 to 2012, were found mixed in with new ones, which were stamped with best before dates as late as 2015.

"When Clover Leaf is notified that product is on a store shelf that is past its best before date we will send an employee to that store to co-ordinate that product's removal," said Peter Clarke, the company's marketing director.

Manufacturers say canned tuna and seafood has an approximate shelf life of three years after packing, before the best before date kicks in.

After that, manufacturers say the taste, texture and nutritional value deteriorates. Unless the can is damaged, Clarke said it is still safe to eat, indefinitely.

"This has nothing to do with product safety in any way. We do this because consumers do not wish to purchase product that has passed its best before date … best before does not imply bad after."

The store where Go Public found the most outdated products was Safeway. Three locations were selling canned tuna and shrimp between one and three years out of date.

Stores respond

"We are very disappointed with your findings and are taking this issue very seriously," said Safeway public affairs manager Betty Kellsey.

Go Public found outdated cans of fish and seafood in five Vancouver area grocery chain stores. (CBC)

One Safeway in Coquitlam, B.C., had canned shrimp from Indonesia, with a shelf life that ended in August 2010.

"Our stores conduct rotating weekly date checks," wrote Kellsey. "Products that are nearing the best before dates are pulled from the shelf and discarded.

"Your investigation has identified opportunities for improvement."

Go Public also found outdated cans at one Thrifty's and one Price Smart, which are owned by major grocery chains. Both said outdated food is not supposed to be sold.

"It is pulled and sent back to the vendor or recycled or discarded," said Thrifty's communications manager Erin Kelly. "If a consumer finds it, they can bring it back for a full refund."

A statement from Overwaitea, which owns Price Smart, said: "The last date of sale for a best before date of tomorrow is end of day today. Tomorrow morning we remove all products with that date."

No rules on outdated goods

Cans of imported shrimp dated best before August 2010 were found on a Safeway store shelf in Coquitlam, B.C. (CBC)

In Canada, there are no government rules against selling outdated canned goods. Most manufacturers stamp best before dates on cans voluntarily, however, some dates are embedded in a code that consumers can't decipher.

Food safety experts say there is no proof eating canned fish or seafood after the best before date has passed will make anyone sick. However, they say there are no independent studies proving it won't.

"There is not enough data, so it's hard to judge," said University of B.C. professor of food engineering Siyun Wang. "It certainly is not good to have food past the best by date in terms of the quality."

"There can be BPA [Bisphenol A] in containers, particularly from imported canned fish," said Xiaonan Lu, another UBC expert. Canada has declared BPA a toxic substance.

Consumer group urges diligence

After being contacted by Go Public, the Consumers' Association of Canada also checked seven major stores in various cities and found outdated canned fish in every one.

"One of the stores in particular had stuff five years out of date, so how long had that been in the can?" said president Bruce Cran.

Safeway has initiated a Canada-wide audit of all canned fish, seafood and meat on store shelves, as a result of Go Public's findings. (CBC)

Because grocers have to absorb the cost of pulling old product and getting rid of it, he said there is little financial incentive for stores to be more diligent.

"If they are doing a weekly check, then how come some of this stuff is years out of date?" said Cran. "Some of what the stores are telling us doesn't make any sense.

"The big message for consumers here is to check the dates on the back of the can. That's what the dates are there for, even if we can't figure out why."

As a result of Go Public inquiries, Safeway is undertaking a national audit.

"We are very concerned about this situation. As a result, we have immediately initiated an audit of the best before dates of all of our canned meat and fish inventory across our Canadian operations."

Submit your story ideas to Kathy Tomlinson at Go Public

Follow @CBCGoPublic on Twitter

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Tanning bed warning labels welcomed by Canadian dermatologists

The Canadian Dermatology Association is welcoming plans to put stricter warning labels on indoor tanning equipment.

The group calls the announcement by the federal Health Minister Leona Aglukkaq an important first step, but says more needs to be done.

The proposed warning label for tanning beds would say, 'Tanning Equipment Can Cause Cancer.' (Jonathan Hayward/Canadian Press)

It wants a nationwide ban on anyone under 18 using tanning beds — a step several provinces have already taken.

Aglukkaq announced Sunday that Health Canada will soon require that all tanning beds carry warnings about skin cancer and other potential dangers.

Research has shown that for those under the age of 35 who use the tanning beds, there is a significant added risk of developing melanoma skin cancer.

The regulation of tanning beds for commercial use falls under provincial jurisdiction.

However, Health Canada regulates the sale, lease and import of tanning beds.

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Palliative care volunteers needed at Horizon hospitals

Written By Unknown on Minggu, 24 Februari 2013 | 22.45

The Horizon Health Network is attempting to find new ways to attract volunteers to help in palliative care wards.

In New Brunswick, there are more than 4,000 hospital volunteers, but at the Saint John Regional Hospital there are no evening shifts of volunteers in the palliative care ward.

A one-day workshop is being held on Friday to help train potential volunteers, who could come in and spend time with terminal patients and their families.

Elizabeth Cormier will be broadcasting a training session across the province on Friday for potential palliative volunteers.

Ina Mortimer, centre, has volunteered in the palliative care ward for 25 years. (CBC)

This is the first time the training will be offered via teleconferencing.

Cormier said she is hoping to be able to offer the training more frequently because she can reach more people than she could by travelling between cities.

Cormier said so far 70 people have already signed up for the teleconference training.

She said she understands the importance of volunteers spending time with patients in the palliative care ward.

Cormier spent days with her dying mother and she remembers the role a hospital volunteer played during the time.

"I drove back to the hospital and ran up the stairs and stopped in my tracks and saw one of my volunteers sitting beside my mother holding her hand. And she was calm and she was relaxed and he wasn't doing anything special, just being present," she said.

"And to me, that was huge. It had a profound effect on me, and the way I feel about volunteers and the work they do."

The volunteer training offered by the health authority will include an introduction to palliative care, education on death, dying and grief and the development of communication and support skills.

Ina Mortimer has been volunteering on the palliative care floor for 25 years. She said it has been 25 years of tears, joy and a lot of memories.

Mortimer recalled a time when her husband was asked to play in a wedding on the floor.

"Jim played, 'Here Comes the Bride' and they wheeled her bed into the living room and the pastor performed the ceremony, lots of smiles and tears both," Mortimer said.

"Sadly, she didn't live very long after that, but she had her last wish."

With an ever increasing demand on hospital nurses, Mortimer said it's the volunteers who have time to sit and listen to patient.

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Pap tests at age 25 too late say ob-gyns

The Society of Obstetricians and Gynecologists of Canada and two related medical organizations are taking issue with a national task force's recommendations that women wait until age 25 to start cervical cancer screening.

In a newly released position paper, the SOGC, the Society of Gynecologic Oncology and the Society of Canadian Colposcopists say age 25 is too late to begin Pap testing because precancerous and cancerous lesions may have developed earlier in some women.

Pap smears are done to check for abnormal tissue from cervical cancer precursors. (Bizuayehu Tesfaye/AP Images for College of American Pathologists)

The groups say young women should have their first Pap smear at age 21 and have them done every two to three years.

The Canadian Task Force on Preventive Health Care, which issued national guidelines in early January, advises that women wait three years between screenings, which should continue to age 69. For years, women were told to get annual Pap smears, though that interval has been stretched in recent years in a number of countries.

Dr. Jennifer Blake, CEO of SOGC, said the task force was correct in saying that waiting until 25 would have little effect on the number of women under 25 who die from cervical cancer, which usually is a relatively slow-growing cancer.

"But we do think that you can find — and we do find — advanced lesions in young girls or even if we find early lesions in young girls, just by doing very minor things, removing those abnormal cells even in the process of a biopsy, you impact the natural history of the disease," Blake said Thursday from Ottawa.

"And what can happen then is if you do end up needing to treat, treatment is less destructive," she said, explaining that having to remove a larger part of an otherwise healthy cervix can affect a woman's fertility.

That was a major concern of the task force, which suggested that Pap smears that turn up abnormal tissue can lead to overly aggressive treatment in young women that can affect future fertility. Treatment can result in an inability to carry a pregnancy to term.

"That doesn't mean you don't start screening," said Blake. "That means you don't over treat."

"So we now say that if you are seeing problems in younger women, you can safely watch them with conservative treatment, just doing a biopsy and watching."

Cervical cancer relatively rare

But Dr. James Dickinson, chair of the task force, said age 25 was recommended because evidence shows that cervical cancer is rare in young women, even up to age 30, and "vigorous screening has not reduced cancer much at these young ages."

Dickinson, a professor of family medicine at the University of Calgary, said 10 per cent of Pap smears are positive in women up to age 30 and require at least one cervical biopsy and possible treatment that can lead for some to miscarriage or premature labour.

"Those women, those young women, have a risk that this can cause trouble because the cervix has a function — it holds babies in. And part of that function may be lost," Dickinson said from Gold Coast, Australia, where he is on sabbatical at Bond University's Centre for Research in Evidence-Based Practice.

Women can also suffer psychological harm, worrying about whether they have cancer as they wait for biopsy results, he said.

Dr. Betsy Brydon, president of the Society of Canadian Colposcopists — the doctors who perform cervical biopsies — said new guidelines were issued in December aimed at reducing potential harm from diagnostic and treatment procedures, and discouraging aggressive treatment unless clearly warranted.

"So we try not to treat when we don't need to treat, and when we do treat, we try to limit the amount of skin that we remove [from the] cervix," she said from Regina.

Dickinson said the task force, which bases its recommendations on international studies and epidemiological evidence, attempts to balance potential benefits against potential harms.

Much of the data comes from other countries, and the three medical organizations called that evidence "weak."

Blake said there is no data on Canada's female population that would show it is safe to wait until age 25 to start screening or for waiting three years between tests — an interval she suggested women would find difficult to remember.

"We should not be interpreting evidence from other countries and applying it to our own young women unless we really have very good certainty that it's a safe thing to do," she said.

"We're saying let's err on the side of being conservative … because [cervical cancer] remains the second most common cancer in young women (aged 20 to 44) and it still has a significant impact on mortality and loss of fertility and sexual function."

Dickinson said citing the 20-44 figure is misleading because cervical cancer is still relatively rare: without screening, a woman's lifetime risk of developing cervical cancer is 1.5 per cent.

The Pap smear is one of the most effective screening procedures that doctors have, he said, and it's reduced the incidence of cervical cancer by 80 per cent.

"That's really great. But we've got to balance that against the fact that for 98 per cent of women who are never going to get it, having Pap smears is just a thorough nuisance and causes some harm."

HPV testing

The Canadian Cancer Society estimated that in 2012, 1,350 Canadian women were diagnosed with cervical cancer and 390 died from the disease.

Research shows most of the benefit of cervical cancer screening occurs for women in their 40s and older, the point at which most cervical cancer cases are diagnosed.

However, abnormal test results are not uncommon in younger women because the Pap smears pick up lesions caused by infections with the human papillomaviruses (HPV), which can cause cervical cancer.

Many of those lesions would heal on their own and would not go on to become cancer. But once they are found, women often need additional testing and treatments, some of which can make it hard for a woman to later carry a pregnancy to term.

As vaccines to prevent HPV infection become more widely used — they are now recommended for females age nine to 49 and males nine to 26 — screening guidelines will likely change.

Meanwhile, screening with the Pap smear and expanding HPV testing across Canada remain critical for preventing cases of cervical cancer and cervical cancer deaths, she said.

Blake said the emphasis needs to be put on getting females to have regular Pap smears: more than half of Canadian women diagnosed with cervical cancer had never been screened, while the rest of those diagnosed could have had a Pap test, but it either was not done recently or there had been a false negative.

As well, a recent Toronto study showed one-quarter of women who had an abnormal Pap smear did not have follow-up tests or treatment.

"The biggest problem with cervical cancer in Canada isn't the frequency of screening, it's not the age of initiation of screening, it's not whether or not we do HPV co-testing," said Brydon. "The problem is that women don't go for testing."

That's one thing Dickinson agrees with — a push is needed to identify groups of women who are not getting tested, possibly because of living in rural or isolated communities with poor access to services or for socioeconomic reasons.

Blake conceded that young women may be confused by the conflicting advice being given by two groups of credible medical professionals, making them unsure when they should start being tested or how often.

"I think the message is that there's a difference of opinion and you may want to talk to your doctor and make a decision yourselves," she said.

Brydon suggested women go online to check screening guidelines being used by their individual province or territory or ask their doctors.

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Family doctors available to all by 2015, province promises

The provincial government and the B.C. Medical Association have announced a new $132-million pilot program they say will ensure everyone who wants a family doctor will be able to access one by 2015.

The provincial health ministry Minister of Health Margaret MacDiarmid says 'A GP for Me' is based on the success of a pilot that matched physicians to more than 9,000 patients in the Cowichan Valley, Prince George and White Rock–South Surrey who were seeking general practitioners.

The province says the plan will improve access to general practitioners by putting $22 million towards funding phone consultations.

"Patients will now be able to consult with their family doctor over the telephone and the family doctor will be able to be compensated for that," MacDiarmid said.

Physicians will be able to bill $15 per phone consultation, and are capped at a total of 500 calls per year.

Doctors will also be able to bill the province $40 per 15-minute patient conference for the purposes of co-ordinating care planning with other health care providers, up to a total of three hours per patient per calendar year.

Financial incentives for complex cases

MacDiarmid said the program also allocated $20 million toward creating incentives for physicians to take on patients with more complex care needs.

"There are going to be supports provided for patients who don't have family doctors and who have specific conditions, like cancer, severe disabilities and mental health issues," she said.

Doctors who agree to become the primary health care provider for members of vulnerable populations — including frail elderly patients; patients with cancer, severe disabilities, mental health or substance use patterns; and pregnant patients — will receive $200 per patient.

Another $18.5 million will go to expanding the current complex care management fee for a wider range of high-needs patients, including those with cancer and pregnant women. Physicians will receive $315 per patient per calendar year.

MacDiarmid says the ministry is also launching an in-patient care program to better co-ordinate patient care as they move and transition from hospital settings back into the community and to their family doctors' care.

The new program is supported by $132.4 million in funding, most of which comes from the existing physician master agreement negotiated with the B.C. Medical Association in 2012.

The program launches on Apr. 1.

With files from the CBC's Lisa Johnson