Concussions in young athletes need 'to be taken seriously'

Youth athletes, parents, coaches and trainers need to change the culture around reporting concussions, a U.S. panel of experts says.

The U.S. Institute of Medicine reviewed evidence on concussions in athletes aged five to 21 and released its findings on Wednesday in Washington.

Helmets protect against skull fractures but there isn't solid evidence for concussions, experts say. (Greg Lindstrom/Concorn Monitor/Associated Press)

The committee chairman, Dr. Robert Graham, urged parents, schools, athletic departments, and the public to treat concussions seriously so young athletes don't hide their symptoms.

"Concussion is an injury that needs to be taken seriously. If an athlete has a torn ACL [ligament] on the field, you don't expect him to tape it up and play," said Graham, who directs the Aligning Forces for Quality national program office at George Washington University.

Concussions are brain injuries from rattling of the brain inside the skull. Most young athletes recover from a concussion within two weeks of the injury, but in 10 per cent to 20 per cent of cases, concussion symptoms persist, the review showed.

Athletes who return to play before their brain has fully healed may place themselves at increased risk for prolonged recovery or more serious consequences if they sustain a second brain injury.

Concussions in children watch list

• Listlessness, easy to tire.
• Irritability, crankiness.
• A change in eating or sleeping patterns.
• A lack of interest in favourite toys.
• A loss of balance or unsteady walking.

Graham said youth themselves can help change the culture by making decisions about the style of play, type of sport, how they protect themselves and encouraging teammates to look out for each other.

But the report's authors found a gap in information about concussion rates in younger players before high school, and recommended a national system to better track sports-related concussions.

The panel's suggestions for parents included:

• Learn the warnings signs of concussion and pay attention if a child is acting differently.
• Encourage a child to tell you if you have symptoms after getting hit in game and emphasize the need to sit out and get checked by a qualified health professional who understands concussion.
• Check that coaches and leagues have a return to play protocol and follow it.

The panel found little evidence that current helmet designs and face masks prevent concussions, even though some equipment makers make such claims. They stressed helmets are important for doing their job of preventing skull fractures and face injuries but there isn't yet data to evaluate how they might protect against rotational impacts that contribute to concussions.

Concussion rates appear higher for youths with a history of prior concussions and among female athletes, although its unclear whether girls may be more likely to report the injury than boys. 

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7.3 million teens give birth in developing world

An unnamed teenager holds her son in Bangkok in March. Every day, 20,000 girls below age 18 give birth in developing countries, the United Nations Population Fund says. (Chaiwat Subprasom/Reuters)

Teen pregnancies in the developing world are declining, but more than 7 million girls under the age of 18 are still giving birth each year, according to a United Nations report released Wednesday.

The U.N. Population Fund expressed particular alarm about the dangers facing girls 14 or younger, who account for 2 million of the 7.3 million births to women under 18 in developing countries. This group faces the gravest long-term social and health consequences from giving birth as teens.

"A girl who is pregnant at 14 is a girl whose rights have been violated and whose future is derailed," the fund's executive director, Dr. Babatunde Osotimehin, said in London.

The report looked at births to women under 18 worldwide, the underlying causes of teen pregnancy, and possible solutions to the problem, which the U.N. said is part of a vicious cycle of rights violations.

"The reality is that adolescent pregnancy is most often not the result of a deliberate choice, but rather the absence of choices, and of circumstances beyond a girl's control," Osotimehin wrote in the report. "It is a consequence of little or no access to school, employment, quality information and health care."

The report said that high rates of adolescent pregnancies correspond with other social problems: "Early pregnancies reflect powerlessness, poverty and pressures — from partners, peers, families and communities. And in too many instances, they are the result of sexual violence or coercion."

The issue is most evident in the developing world — with 95 per cent of births to women under 18 occurring there. Ten per cent of women ages 20-24 in the Middle East reported at least one birth before age 18, while 22 per cent did in South Asia and 28 per cent did in Western and Central Africa, the report says.

Every day, 20,000 girls below age 18 give birth in developing countries. Nine in 10 of these births occur within a marriage or a union — highlighting the scourge of child marriage.

Osotimehin noted a positive World Health Organization report saying that some countries have seen a rapid decline over the past decade in the percentage of women reporting birth before age 15 — a trend attributed largely to a decrease in early and arranged marriages. But its overall tone set out the case for urgent action.

"The birth or pregnancy in one adolescent is unacceptable. One," Osotimehin told reporters in London. "Whether it's going up or down is not the issue — 7.3 million is huge."

The U.N. report was careful to note that some girls under 18 want to become pregnant. It stressed the benefits of waiting — such as better health, educational and future income opportunities — and called for a new approach to curbing teen pregnancies that minimizes the emphasis placed on girls' behaviour as an underlying cause.

"Childhood must never be derailed by motherhood," it said, calling for greater efforts to end child marriage and more action on gender equality.

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NYC votes to raise cigarette buying age to 21

Smokers younger than 21 in New York City will soon be barred from buying cigarettes after the city council voted overwhelmingly Wednesday to raise the tobacco-purchasing age to higher than all but a few other places in the United States.

City lawmakers approved the bill — which raises from 18 to 21 the purchasing age for cigarettes, certain tobacco products and even electronic-vapour smokes — and another that sets a minimum $10.50-a-pack price for tobacco cigarettes and steps up law enforcement on illegal tobacco sales.

"This will literally save many, many lives," said an emotional City Councilman James Gennaro, the bill's sponsor, whose mother and father died from tobacco-related illnesses. "I've lived with it, I've seen it ... but I feel good today."

Still needs Bloomberg's signature

Mayor Michael Bloomberg, who is a strong supporter of the tough smoking restrictions, has 30 days to sign the bills into law. The minimum age bill will take effect 180 days after enactment.

"We know that tobacco dependence can begin very soon after a young person first tries smoking so it's critical that we stop young people from smoking before they ever start," Bloomberg said in a statement.

With Wednesday's vote, New York is by far the biggest city to bar cigarette sales to 19- and 20-year-olds. Similar legislation is expected to come to a vote in Hawaii this December. The tobacco-buying age is 21 in Needham, Mass., and is poised to rise to 21 in January in nearby Canton, Mass. The state of New Jersey is also considering a similar proposal.

Lawmakers who pushed for the change site city statistics that show youth smoking rates have plateaued at 8.5 per cent since 2007.

"We have to do more and that's what we're doing today," said City Council Speaker Christine Quinn. "We have a real chance of leading the country and the world."

The city's current age limit is 18, a federal minimum that's standard in many places. Smoking in city parks and beaches is already prohibited as it is in restaurants.

Advocates say higher age limits help prevent, or at least delay, young people from taking up a habit that remains the leading cause of preventable deaths nationwide. And supporters point to drinking-age laws as a precedent for setting the bar at 21.

Age change could drive black market

But cigarette manufacturers have suggested young adult smokers may just turn to black-market merchants. And some smokers say it's unfair and patronizing to tell people considered mature enough to vote and serve in the military that they're not old enough to decide whether to smoke.

"New York City already has the highest cigarette tax rate and the highest cigarette smuggling rate in the country," said Bryan D. Hatchell , a spokesman for R.J. Reynolds Tobacco Company, which makes Camel and other brands. "Those go hand in hand and this new law will only make the problem worse."

A coalition of bodegas and tobacco store owners funded by tobacco-manufactures also slammed the council's vote Wednesday, particularly the bill that sets the minimum prices and bans tobacco product discounts and coupons.

Ramon Murphy, president of the Bodega Association of the U.S., said the new rules will drive people to illegal sellers who do not care about the age of their buyers.

Another anti-smoking initiative pushed by the Bloomberg administration was previously shelved ahead of Wednesday's vote.

The mayor proposed in March a bill modelled on laws in Iceland, Canada, England and Ireland to require shops to keep tobacco products in cabinets, drawers, under the counter, behind a curtain or in other concealed spots until a customer asked for them. He said the displays "invite young people to experiment with tobacco."

But a similar measure had been rescinded in suburban Haverstraw, N.Y., after cigarette manufacturers sued. They said it violated their companies' free speech rights to communicate with consumers about their products' availability and prices.

The city Health Department said in a statement that the measure was taken off the table because "with the arrival of e-cigarettes, more time is needed to determine how best to address this problem."

E-cigarette makers say their products are healthier than tobacco, and a trade association leader bristled at the city's proposal to prevent people under 21 from buying them.

"Is 21 the right number? People can join the Army at 18," said Ray Story, founder of the Atlanta-based Tobacco Vapor Electronic Cigarette Association.

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Is hockey's start-stop nature hard on the heart?

The start/stop nature of pickup hockey may not be as risky to the hearts of middle-aged men as feared, a Toronto researcher says.

When Marshall Garnick, 62, had a heart attack two years ago, he had a stent put in, participated in cardiac rehab, took a stress test at the doctor's office and was cleared to lace up again. He also heard a warning.

"One of the cardio rehab people said hockey is a disaster because of the stopping and starting," Garnick recalled. "It's hard on the heart."

Jack Goodman studied the impact of hockey on the hearts of middle-aged men, and found it isn't as strenuous as previously thought. (CBC)

The conventional wisdom is that the stop-start nature of a hockey game is dangerous because the heart rate is high when you skate and blood pressure drops when you stop.

Garnick's linemate, Jack Goodman, studies cardiac risk. Recognizing a dearth of research on the impact of hockey on the hearts of middle-aged men, he recruited 24 players, including some teammates, to monitor their heart rates and blood pressure during pickup games.

"The key finding is that you get to very, very high levels, and the heart rate progresses throughout the game no matter what happens on the bench," said Goodman, a professor in the University of Toronto's faculty of kinesiology and physical education.

He estimates about 500,000 middle-aged men play regular pickup hockey. Despite anecdotal stories of people dropping dead on the ice, the number of cardiac events is few and probably less than among people shovelling snow, Goodman said.

"The cardiac events that take place during exercise are very rare and the benefits of exercise far outweigh the risks," Goodman said.

"Is it dangerous going to close to the maximal level for a sustained period of time? Not if you're healthy. And that's the rub, finding the disease that's hidden in the population has always been a challenge."

Since the players' heart rates, both skating and resting, were much higher than they would be during a doctor's stress test, experts like Goodman recommend warming up and having a good fitness base before hitting the ice.

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Doctor-assisted suicide ban to be appealed in B.C.

The B.C. Civil Liberties Association will appeal a high court ruling that upholds Canada's ban on doctor-assisted suicide — and is urging that the wheels of justice should turn quickly.

The legal rights group says the outcome of the appeal is of extreme urgency to gravely ill Canadians, such as multiple sclerosis patient Elayne Shapray.

Shapray has filed an affidavit as the association seeks to expedite the hearing process at the Supreme Court of Canada.

The 67-year-old grandmother wants the right to have a physician-assisted death before she becomes too horribly trapped in her own body.

'My choices for bringing about my death unassisted are self-starvation, over-medication or some violent self-inflicted injury.'— Elayne Shapray

"I can no longer turn over or even move in bed — or find comfort in any position for any period of time," says Shapray.

"My choices for bringing about my death unassisted are self-starvation, over-medication or some violent self-inflicted injury."

The B.C. Court of Appeal ruled earlier this month that the 1993 decision in the Sue Rodriguez case is binding — physicians cannot intervene to help patients end their lives — and the court does not have the authority to overturn that law.

Since the ruling, former Supreme Court of Canada justice Jack Major, who was on the bench for the Rodriguez decision, has added his voice to those calling on the federal government to modernize the law on assisted suicide.

Shapray can no longer turn over or even move in bed. (CBC)

Major sided with a narrow majority of judges, 5-4, in the decision on the case brought by a B.C. woman who was diagnosed with the terminal disease amyotrophic lateral sclerosis (ALS) in 1991.

Speaking Tuesday, BCCLA lawyer Grace Pastine said she thinks the current ban is woefully out of date, and that Canada needs to change with the times, as other jurisdictions have.

"These are not abstract legal issues," said Pastine, sitting beside Shapray at a Vancouver news conference.

"This is a case about real people with serious illnesses, who through a change in the law can find some measure of peace and comfort at the end of life in knowing that they have a choice."

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7.3 million teens give birth in developing world

An unnamed teenager holds her son in Bangkok in March. Every day, 20,000 girls below age 18 give birth in developing countries, the United Nations Population Fund says. (Chaiwat Subprasom/Reuters)

Teen pregnancies in the developing world are declining, but more than 7 million girls under the age of 18 are still giving birth each year, according to a United Nations report released Wednesday.

The U.N. Population Fund expressed particular alarm about the dangers facing girls 14 or younger, who account for 2 million of the 7.3 million births to women under 18 in developing countries. This group faces the gravest long-term social and health consequences from giving birth as teens.

"A girl who is pregnant at 14 is a girl whose rights have been violated and whose future is derailed," the fund's executive director, Dr. Babatunde Osotimehin, said in London.

The report looked at births to women under 18 worldwide, the underlying causes of teen pregnancy, and possible solutions to the problem, which the U.N. said is part of a vicious cycle of rights violations.

"The reality is that adolescent pregnancy is most often not the result of a deliberate choice, but rather the absence of choices, and of circumstances beyond a girl's control," Osotimehin wrote in the report. "It is a consequence of little or no access to school, employment, quality information and health care."

The report said that high rates of adolescent pregnancies correspond with other social problems: "Early pregnancies reflect powerlessness, poverty and pressures — from partners, peers, families and communities. And in too many instances, they are the result of sexual violence or coercion."

The issue is most evident in the developing world — with 95 per cent of births to women under 18 occurring there. Ten per cent of women ages 20-24 in the Middle East reported at least one birth before age 18, while 22 per cent did in South Asia and 28 per cent did in Western and Central Africa, the report says.

Every day, 20,000 girls below age 18 give birth in developing countries. Nine in 10 of these births occur within a marriage or a union — highlighting the scourge of child marriage.

Osotimehin noted a positive World Health Organization report saying that some countries have seen a rapid decline over the past decade in the percentage of women reporting birth before age 15 — a trend attributed largely to a decrease in early and arranged marriages. But its overall tone set out the case for urgent action.

"The birth or pregnancy in one adolescent is unacceptable. One," Osotimehin told reporters in London. "Whether it's going up or down is not the issue — 7.3 million is huge."

The U.N. report was careful to note that some girls under 18 want to become pregnant. It stressed the benefits of waiting — such as better health, educational and future income opportunities — and called for a new approach to curbing teen pregnancies that minimizes the emphasis placed on girls' behaviour as an underlying cause.

"Childhood must never be derailed by motherhood," it said, calling for greater efforts to end child marriage and more action on gender equality.

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Health spending expected to reach $211B in 2013

The growth of health care spending in Canada slowed to its lowest rate in nearly 15 years, according to a new report.

In 2013, total health spending is expected to reach a record $211 billion or $5,988 per person, the Canadian Institute for Health Information said in its report Tuesday on national trends in health expenditures from 1975 to 2013.

Total health spending is expected to rise by 2.6 per cent this year, less than half the average growth of seven per cent per year between 2000 and 2010.

Managing health-specific price inflation, such as for doctors, nurses and other health-care professionals, will be a challenge, a new report says. (Alan Rogers/Casper Star-Tribune/Associated Press)

Christopher Kuchciak, the institute's manager of health expenditures, attributed the slower pace to Canada's modest economic growth and government efforts to balance budgets.
 
The public sector pays for about 70 per cent of health care in the country, $148 billion. The remaining 30 per cent, $63 billion, comes from sources such as private insurance and patients paying without reimbursement.
 
Hospitals, drugs and physicians are three main categories of total health spending.  
 
"Managing health-specific price inflation for goods and services, including doctors, nurses, other health-care professionals and advanced diagnostics will be a challenge," the report's authors said.

It's the third consecutive year where the growth in health spending has not kept pace with inflation and population growth, they said.

The report's findings can be seen as good news and bad news, said Dr. Michael Rachlis, a health policy consultant in Toronto, commenting on the report.

"It's good news because with health-care costs being more sustainable, being a lower share of our economy and a slightly lower share of government spending, it means that it's more affordable," Rachlis said. "But of course the bigger question … is are we spending the money better or in fact are the cuts being made on services that are really important to people?"

 Rachlis believes both are true. On the positive side, wait times for some surgeries have gone down. However, provincial governments also continue to offload services, such as outpatient physiotherapy or counselling that isn't offered by a psychiatrist.

Spending for seniors aged 80 and older in 2011 was $20,387 per person, which was more than three times that for younger seniors aged 65 to 69. 

As the percentage of the population age 80 and older increases, the report's authors said decision-makers will also face a challenge of determining the best ways to provide care for older adults.

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Eating disorder training dated, doctors worry

A P.E.I. woman who's struggled with an eating disorder says she didn't get the help she needed from the health-care system, and many health professionals agree up-to-date training is needed.

Natalie Sullivan saw six health professionals on P.E.I., but none could help her with her eating disorder. (CBC)

Natalie Sullivan saw six different Island health professionals to try to control her anorexia. She saw her family doctor, a psychologist, a dietician, a mental health counsellor and two psychiatrists. They all tried their best, said Sullivan, but none could offer a solution.

"I knew that I needed to eat more, but what I needed was for someone to tell me how I could do that without feeling like the world was ending," Sullivan told CBC News.

Sullivan believes P.E.I. health professionals need more training in this complex and dangerous mental illness. Anorexia has the highest mortality of any psychiatric illness, due to physical complications and suicide.

Dr. Rachel Kasner, the past president of the Medical Society agrees. As a family doctor, Kasner said she could use more information to help the large number of her own patients struggling with eating disorders.

"I think it's a wonderful idea," she said.

"We have so many things we have to cover in medical school we cannot cover everything."

Doctors could certainly use more training in dealing with eating disorders, says Dr. Rachel Kassner, past president of the P.E.I. Medical Society (CBC)

The last professional training on P.E.I. was a one-day conference more than a decade ago. Summerside Community Mental Health therapist Sonia Myers agrees it's time for more.

"Treatment modalities have changed over the years," said Myers.

"It's really important to be able to treat people based on up-to-date information."

Nadine DeWolfe, president of the Psychological Association of P.E.I., plans to pitch a joint training session with social workers and counsellors for next September.

"This is not an easy problem to fix," said DeWolfe.

How would you rate your knowledge of eating disorders?

"You can't just tell someone to stop. It takes a lot of highly-developed skills."

Sullivan said there needs to be more awareness in the general public about eating disorders as well. She said people would compliment her when she was at a very low weight, something she said ignores the health risks she was welcoming.

Sullivan has created a web site where people can learn more about anorexia and other eating disorders.

For mobile device users: How would you rate your knowledge of eating disorders?

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Syria hit by polio outbreak, UN confirms

The UN's health agency said Tuesday it has confirmed 10 polio cases in northeast Syria, the first confirmed outbreak of the highly contagious disease in the country in 14 years, and a top UN official urged warring sides to grant health workers access to 500,000 children who have never received immunization.

Officials are awaiting lab results on another 12 people showing polio symptoms, said World Health Organization spokesman Oliver Rosenbauer. He said the confirmed cases involve babies and toddlers, all under two. Syria's civil war, which began nearly three years ago, has caused medical and other government services in many areas to collapse.

The announcement came as UN-Arab League envoy to Syria Lakhdar Brahimi met with a senior opposition figure in Damascus as part of a diplomatic push to convince all sides in the country's civil war to attend an international peace conference being held in Geneva next month.

CBC reporter Sasa Petricic said the "awful" conditions inside Syria are likely contributing to the outbreak. "There are many refugees inside the country itself who don't have access to clean drinking water or to fresh food, and that is exactly how polio is transmitted," he said.

The polio virus usually infects children in unsanitary conditions through the consumption of food or liquid contaminated with feces. It attacks the nerves and can kill or paralyze, and can spread widely and unnoticed before it starts crippling children.

"This is a communicable disease — with population movements it can travel to other areas," said Rosenbauer. "So the risk is high of spread across the region."

Vaccination campaign

UNICEF executive director Anthony Lake, on a visit to Damascus, said the polio outbreak "now is not only a desperate issue for Syria, but it becomes part of the global issue as well."

In an interview with The Associated Press, he said the UN children's agency and WHO plan to immunize 2.4 million children throughout the country, of whom over 500,000 have never been vaccinated against the disease.

Lake said that he held "businesslike and encouraging" discussions with senior Syrian officials over issues concerning access to war zones, where children live in often desperate conditions. He said negotiations with the rebels still have to be conducted.

"Vaccinations and immunizations have absolutely no political content, they have no relationship to any military issues and therefore there is every reason ... [to] believe we will gain access into these communities," he said.

"Anytime you have half a million or more children who have not been reached with lifesaving vaccinations, then it is very urgent that you be able to get in to vaccinate them," he added.

With thousands of refugee children fleeing Syria to neighbouring countries such as Turkey, Jordan and Lebanon, there are fears that the disease could spread beyond the war-torn nation's borders, Petricic said.  

"So it is a very grave threat, one that the World Health Organization is flagging right now," he added.

Syria had launched a vaccination campaign around the country days after the Geneva-based WHO said it had received reports of children showing symptoms of polio in Syria's Deir el-Zour province, but the campaign faces difficulty with lack of access in many parts of the war-torn country.

Nearly all Syrian children were vaccinated against the disease before the civil war began more than 2½ years ago. Polio was last reported in Syria in 1999.

The Syrian conflict, which began as a largely peaceful uprising against President Bashar Assad in March 2011, has triggered a humanitarian crisis on a massive scale, killing more than 100,000 people, driving nearly seven million more from their homes and devastating cities and towns.

UN officials have warned of the spread of disease in Syria because of lack of access to basic hygiene and vaccinations.

Peace talks

Meanwhile, UN-Arab League envoy Brahimi held talks with Hassan Abdul-Azim, head of the Damascus-based National Co-ordination Body for Democratic Change in Syria. The group has called for regime change through peaceful means and is not part of the Western-backed opposition Syrian National Coalition or affiliated with rebel groups fighting to topple the Syrian president.

Abdul-Azim said Brahimi told him the U.S. and Russia are determined to hold the peace conference next month.

One of the key sticking points in getting the opposition to agree to the talks is the issue of Assad's future. Much of the opposition rejects any transition plan in which he or his close associates are involved.

Abdul-Azim told The Associated Press that Assad's position "will be dealt with through negotiations with Syrian sides who will decide the fate of the president and the regime."

The trip is part of Brahimi's efforts to convene a long-delayed peace Geneva conference, although fundamental disagreements over the agenda and participants remain, making it unclear whether the gathering will indeed take place.

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6 ways parents can give kids a healthy 'media diet'

Parents should limit the total entertainment screen time to less than one to two hours per day, pediatricians recommend. (Marcus Donner/Reuters)

Concerns about children's use of media are increasingly urgent in the digital age, say U.S. pediatricians who now recommend that parents establish a media consumption.

The American Academy of Pediatrics released its revised policy statement on children, adolescents and the media on Monday at a conference in Orlando.

In 2010, a U.S. study showed the average eight- to 10-year-old spends nearly eight hours a day with different media, such as TV, cellphones, iPads and social media. Older children and teens spend more than 11 hours per day.

"A healthy approach to children's media use should both minimize potential health risks and foster appropriate and positive media use — in other words, it should promote a healthy 'media diet,'" Dr. Marjorie Hogan, a co-author of the policy, said in a release.

Co-author Dr. Victor Strasburger,  a University of New Mexico adolescent medicine specialist, said that for nearly three decades, the academy has expressed concerns about the amount of time that children and teenagers spend with media and about some of the content they are viewing, which is more pressing in the digital age. 

"I guarantee you that if you have a 14-year-old boy and he has an Internet connection in his bedroom, he is looking at
pornography," Strasburger said.

Two-thirds of children and teenagers report that their parents have "no rules" about time spent with media. In another study, more than 60 per cent of teenagers send or receive text messages after "lights out," and they report increased levels of tiredness, including at school.

Tips to help guide parents

The academy said pediatricians should recommend that parents:

• Limit the amount of total entertainment screen time to less than one to two hours per day. Online homework is an exception.
• Discourage screen media exposure for children under two  years of age.
• Keep the TV set and internet-connected electronic devices out of the child's bedroom.
• Monitor what media their children are using and accessing, including web site and social media sites.
• Co-view TV, movies and videos with children and teens, and use this as a way of discussing important family values.
• Establish a family home use plan for all media that includes enforcement of a mealtime and bedtime "curfew" for all media devices, including cellphones. Set "reasonable but firm" rules about cellphones, texting, internet and social media use.

The authors said there's considerable evidence that a bedroom TV increases the risk for obesity, substance use and exposure to sexual content. Given that, they encouraged pediatricians to ask two media questions during every visit:

• How much recreational screen time does your child or teenager consume daily?
• Is there a television set or internet-connected device in the child's bedroom?

Curbing web use could be 'catastrophic'

Strasburger said he realizes many children will scoff at advice from adults they consider "media-Neanderthals," but he hopes the policy statement will lead to more limits from parents and schools as well as more government research on the effects of media.

The group said shows like Sesame Street can help children learn letters and numbers, and the media can also teach empathy, racial and ethnic tolerance, and interpersonal skills.

For teens, listening to positive rather than neutral song lyrics can foster helping behaviours, and positive information about adolescent health is increasingly available available on YouTube and cellphone text message campaigns. 

Mark Risinger, 16, of Glenview, Ill., who is allowed to use his smartphone and laptop in his room, said the two-hour limit on internet use "would be catastrophic," adding children will find a way around it.

His mother, Amy Risinger, said she agrees with restricting time on social media, but that parents should be able to take their children's maturity level into account when setting media limits. 

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Brain development affected in poor children, researchers find

Early childhood poverty has been linked to smaller brain size by U.S. researchers who are pointing to the importance of nurturing from caregivers as a protective factor.
 
Children exposed to poverty tend to have poorer cognitive outcomes and school performance. To learn more about the biology of how, researchers started tracking the emotional and brain development of 145 preschoolers in metropolitan St. Louis for 10 years.

During a 'waiting task,' investigators took note of what strategies a parent used to help their child wait patiently instead of acting on the impulse to tear open a gift immediately. (iStock)

Household poverty was measured by the income-to-needs ratio. Children were assessed each year for thee to six years before they received an MRI and questionnaires. A parent and child were also observed during a lab task that required the child (age four to seven)  to wait for eight minutes before opening a brightly wrapped gift within arm's reach while the parent filled in questionnaires.  
 
"These study findings demonstrated that exposure to poverty during early childhood is associated with smaller white matter, cortical grey matter, and hippocampal and amygdala volumes," Dr. Joan Luby of the psychiatry department at Washington University School of Medicine in St. Louis and her co-authors concluded in Monday's issue of the journal JAMA Pediatrics.
 
The findings were consistent with an earlier study by the same team that suggested supportive parenting also plays an important role in the development of the hippocampus in childhood independent of income. The brain's hippocampus is important for learning and memory and how we respond to stress.
 
In the study, the effects of poverty on hippocampal volume was influenced by caregiving support or hospitality in the brain's light and right hemispheres and stressful life events on the left. Caregiver education was not a significant mediator.  

Children who receive more nurturing caregiving may also be protected from exposure to stressful life events, the researchers said.

Since the data came from a larger study on symptoms of depression, the researchers acknowledged the findings may not apply more widely.
 
The study began when the children were in preschool, but there is every reason to believe the mediating effects of caregiving quality and stress began much earlier in life, Charles Nelson of Boston Children's Hospital said in a journal editorial accompanying the study.
 
"If we wish to protect our children's brains, we must work hard to protect their young minds," Nelson said. "Exposure to early life adversity should be considered no less toxic than exposure to lead, alcohol or cocaine, and, as such, it merits similar attention from public health authorities," when designing screening and intervention strategies for high-risk families.  

Last year, the American Academy of Pediatrics concluded that strong and frequent stress for children, such as from living in substandard housing with adults who are also stressed, can disrupt healthy brain development.

The study was funded by the U.S. National Institutes of Health.

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Medical images could be a rich data vein for science

A Canadian expert is suggesting scientists are missing a chance to see the big picture when it comes to medical images.

Dr. Alan Moody says X-rays, MRIs and CT scans could provide a treasure trove of information if they were systematically studied.

Researchers might be able to tell what an early Alzheimer's brain looks like by checking series of brains scans over time. (Adrian Wyld/Canadian Press)

But currently medical images are used simply to diagnose or rule out a problem for an individual, then gather dust in the patient's file.

Moody says if databases of images were amassed, they could be studied in the way researchers currently mine anonymized patient records for clues to drug efficacy or side-effects and other medical questions.

He says part of the beauty of such a system would be the images have already been paid for, so this would be low-cost research.

Moody, who is chairman of the department of medical imaging at the University of Toronto, is making the argument in a commentary published in the journal Nature.

Medicine has long stored preserved tissue samples taken from biopsies for study. Medical images could be used in the same manner, Moody said in an interview.

"Akin to pathology specimens which are sitting there, this is even richer data in a sense. We have whole body scans, we have brain scans, we have fundamental whole organ information," Moody says.

"The power of that comes when you put a lot of that data all in one space and then analyze that data, which is this 'Big data, big picture' idea."

One example of how images could be used in this way relates to the study of dementia. If researchers could look at brain scans of individuals who have experienced early symptoms of what might be Alzheimer's disease and are being followed, the scientists might be able to identify what an early Alzheimer's brain looks like.

"Often we see snapshots of individuals coming with a plethora of different signs which in that small snapshot cannot be put together to give you any larger information. But if you imagine instead of that one patient … in Toronto alone we'd probably have a thousand of these patients a year," Moody says.

"You would then have this large data bank of brain scans that would then start giving you the bigger picture."

Moody says a system would need to be developed whereby images could be shared in a way that didn't jeopardize individual patient privacy. But these kinds of systems are already in place for the study of other types of data.

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Mental health disorders spike in post-high school transitions

Jason Novick has seen the darkness that mental health disorders can create.

The 27-year-old Toronto man has also seen how advocacy — by himself and by others — has been vital in helping him cope with bipolar disorder, general anxiety disorder, mania and depression, particular during the stressful transition from his teenage years to leaving home for post-secondary school.

Jason Novick says advocacy by yourself and others is important while coping with a mental health disorder. (Courtesy Jason Novick)

"Mental health awareness … is still an issue that's largely misunderstood," he said in a recent interview.

"There's a lot of [post-secondary] administrative workers and professors and program co-ordinators and what have you who won't know the first thing about such issues, so your best ally is probably going to be yourself a lot of the time."

Another ally can also be a caring friend or family member who steps up to help others understand the larger situation. Novick remembers going with his mother to "set the record straight" with a college professor.

They wanted to explain to the instructor that it was his mental health that was his problem, not any lack of interest in the course.

"It was my mental health that was causing me to be so withdrawn, that was causing me to be so unmotivated. I was passionate about the subject, but I was not passionate about life and living."

Novick, who says he contemplated suicide at one point and has been in closed hospital wards three times because of his disorders, is much more passionate about life and living now, particularly after having completed an inpatient program at the Centre for Addiction and Mental Health in Toronto.

Tough transition

But he knows from personal experience how difficult coping with a mental health disorder can be, particularly for young people as they make the transition from life at home to being on their own and facing the pressures of school or work.

'Many of the disorders are treatable.'- Dr. David Wolfe

"The incidence in terms of new cases per year … certainly rises between roughly ages 16 to 24," says Dr. David Wolfe, a psychologist, senior scientist and director of CAMH's Centre for Prevention Science in London, Ont.

Bipolar disorders, schizophrenia, anxiety and depression often become much more apparent during that period.

"Prior to that, there may have been signs of it because a lot of these do originate in childhood," says Wolfe. "But they emerge once the person is in a more stressful situation such as the military, university, college or job, and they don't have the ability to cope as well."

Figures from Statistics Canada show that in 2009, 87,859 young people aged 12 to 19 were diagnosed with a mood disorder such as depression, bipolar disorder, mania or dysthymia (persistent depressive disorder). In 2012, that number had risen to 111,930.

Other 2012 figures from Statistics Canada show that 315,928 Canadians aged 15 to 24 had a major depressive episode within the previous 12 months. For bipolar disorder, that number stood at 109,967. 

Not everyone with a mental health disorder will be diagnosed, or will need to be diagnosed — some people may find the support they need on their own, Wolfe said.

But overall, Wolfe suggests, the key is early diagnosis of these disorders, which results from recognizing a pattern of behaviour and the difference between a normal response to a stressful situation and an abnormal one.

"Typically," said Wolfe, "it's when it impedes on everyday function" — such as someone not being able to get out of bed or go to work or school — that help is needed.

Learning to manage

"If they get help, then of course they can learn to manage, typically. Many of the disorders are treatable. They're not curable, but they're treatable and allow the person to get back to work or school."

Dr. David Wolfe says there are many more entry points into the mental health system now. (Centre for Addiction and Mental Health)

Novick was diagnosed with bipolar disorder when he was 16. He was later diagnosed with general anxiety disorder. He also experienced mania and depression. He saw a social worker. A psychiatrist, too. There were many medications — some with difficult side effects.

He was hospitalized for the first time at 18. The second hospitalization came just days before he was set to start studying journalism at Humber College.

"The anxiety just built up so much that even before my college career began, mental health took its toll. I didn't even have to go to a class," Novick said.

Society, he suggests, puts ""so much importance on degrees and diplomas, and I think the pressure of that really got to me. "

There's also the whole new social world that post-secondary life offers up, the need to meet new people and make new friends.

"I was not in a place where that was very easy," says Novick.

"I was still severely depressed. I was still self-harming and I was still prone to bouts of mania and all of that just created a perfect storm of mental health problems that imploded a few days before I was supposed to start, and I wound up back in Sunnybrook [hospital] for the second time."

More time in hospital

Novick did eventually enrol at Humber, and has good things to say about many staff members he encountered who offered him help and support.

But ultimately, he says, he found that his major was "no longer within my capability," particularly because he recognized that his difficulties with memory and recall would not serve him well as a journalist.

'"I think it's important to keep family and close friends in the loop about your mental health.'- Jason Novick

Later, there was a second, ill-fated, post-secondary experience and another hospitalization. Still later, in the spring of 2012, with help and support from his mother, he checked himself into the Centre for Addiction and Mental Health. He was recommended for CAMH's Alternate Inpatient Milieu program, a 28-day service for individuals with mood and anxiety disorders.

"That is the program that changed me," Novick said.

"It was magnificent. It emphasizes cognitive behavioural therapy very heavily, which I took to very quickly, and the outpatient programs that followed were also in that vein. I loved them."

Since then, Novick has been in therapy, and completed a CAMH outpatient program. He's also volunteering in the mental health field, "working with people who have been in my situation."

For those who find themselves in a similar situation, he suggests it is vital to tell as many people as they can.

"I think it's important to keep family and close friends in the loop about your mental health, if you are comfortable with that, because if you do then I find you feel less isolated and you have more support around you."

More help now

He also suggests that students with a mental health problem should make sure they get assessed as a student with a disability at their post-secondary institutions as soon as possible. That assessment is something that can clear the way for extensions on tests and assignments, or other assistance.

Wolfe also notes how help is available on campuses, much more so than in the past.

"There's a lot more entry points into the mental health system today than there were even a decade ago," he says.

"College campuses, universities, all have counselling centres and my understanding is they're very busy these days because there is more news that they're available."

Some people suggest there is more of an epidemic of cases, says Wolfe, while others suggest the situation is more reflective of increased awareness and people being more knowledgable about getting help.

"It's hard to say what it is, but there is help there and it doesn't have to be a tragedy or a crisis in order to get it….

"That's good. You have to have a system that people can enter into without a crisis."

Mental health disorders

What is bipolar disorder?

Everyone has ups and downs in mood. Bipolar disorder, or manic-depressive illness, is a serious medical condition that causes people to have extreme mood swings. Bipolar disorder typically consists of three states:

• a high state, called mania
• a low state, called depression
• a well state, during which the person feels normal and functions well.

In adolescents and young adults, the symptoms may be less typical and may be mistaken for teenage distress or rebellion.

What is depression?

Clinical depression, sometimes called major depression, is a complex mood disorder caused by many factors, including genetic predisposition, personality, stress and brain chemistry. While it can suddenly go into remission, depression is not something that people can "get over" by their own effort.

Types of depression:

• Seasonal affective disorder: This type of depression is usually affected by the weather and time of the year.
• Postpartum depression: This occurs in women, following the birth of a child. About 13 per cent of women will experience it.
• Depression with psychosis: In some cases, depression may become so severe that a person loses touch with reality and experiences hallucinations (hearing voices or seeing people or objects that are not really there) or delusions (beliefs that have no basis in reality).
• Dysthymia: This is a chronically low mood with moderate symptoms of depression.

What is schizophrenia?

Schizophrenia is a long-term mental health problem. People with schizophrenia can have a range of symptoms including periods when they cannot tell the difference between what is real and what is imagined. Schizophrenia seriously disturbs the way people think, feel and relate to others.

What are anxiety disorders?

Everyone experiences symptoms of anxiety but they are generally occasional and short-lived, and do not cause problems. But when the cognitive, physical and behavioural symptoms of anxiety are persistent and severe, and anxiety causes distress in a person's life to the point that it negatively affects his or her ability to work or study, socialize and manage daily tasks, it may be beyond the normal range.

Types of anxiety disorders:

• phobias
• panic disorder (with or without agoraphobia)
• generalized anxiety disorder
• obsessive-compulsive disorder
• acute stress disorder
• post-traumatic stress disorder

Source: Centre for Addiction and Mental Health

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Kidney payment ethics questions raised

Before Canadians consider paying for kidneys, other options for reducing waits should be carefully considered, a transplant recipient and a bioethicist say.

Helen Sklarz, 60, said the nine years she spent on dialysis were bittersweet.

"It filtered and cleansed my blood and it removed toxins so I could stay alive but it took away my quality of life," Sklarz said Friday. She received a kidney 16 months ago.

Organ donation in Canada has always been routed in voluntarism, says bioethicst Linda Wright. (CBC)

Sklarz inherited polycystic kidney disease from her father. It left her with fluid-filled cysts that were triple the normal size at times.

Dialysis meant being tethered to a machine for four hours, three weeknights a week, which Sklarz said was exhausting. Dialysis can lead to headaches and severe foot and leg cramps. Sklarz also needed angioplasty to clear clogged vessels so her dialysis access site wouldn't be blocked.

She also had to keep a restricted diet. Even the fluid in a bunch of grapes could be too much on a hot day, she recalled.

In contrast, after the transplant,  Sklarz says her life is "incredibly wonderful." She's able to renew old friendships, make new ones, enjoy long weekends away, hike, garden, travel and volunteer — activities she'd severely curtailed before receiving the kidney.

On Thursday, researchers in Calgary published a modelling study that suggested paying $10,000 to living donors would increase the number of transplants performed among wait-listed dialysis patients by five per cent, and would be less costly and more effective than the current organ donation system.

"Our model found that a strategy of paying living donors for their kidneys not only saves money for the health-care system, but that the outcomes including quality of life for patients is improved," said study author Lianne Barnieh of the University of Calgary.

Despite the long wait, Sklarz isn't comfortable with the idea of paying for organs.

"This to me doesn't feel ethically correct," Sklarz said. "There's the potential for so many financially strapped and vulnerable populations to make a rash decision for cash."

Slarz said she'd rather governments ease wait times for people in need of organ transplants by educating Canadians to help overcome fears and encouraging people to register their consent to donate upon death, when organs can potentially save eight lives.

Paying kidney donors is socially divisive and needs to be carefully thought through, said Linda Wright, director of bioethics at Toronto's University Health Network.

"Organ donation has always been routed in voluntarism and altruism and this is changing it in a very fundamental way," Wright said of the proposal.

Iran is the only country where paying for organs is legal.

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Quality of life of breast cancer survivors 'reassuring'

Women who survived breast cancer are welcoming the findings of a long-term Canadian study suggesting the quality of life of survivors is similar to that of women without the disease.

Dr. Pam Goodwin of Mount Sinai Hospital in Toronto led the study of 285 women with breast cancer who were given questionnaires about factors such as pain, fatigue and overall quality of life one year after diagnosis and then an average of 12.5 years after diagnosis.

Dianne Mowat started exercising more strenuously and more often after her breast cancer diagnosis. (CBC)

A second group of women who were the same age and had never been diagnosed with breast cancer filled out the same questionnaires. "The quality of life of women with breast cancer was almost the same as the quality of life of women without breast cancer," said Goodwin.

While quality of life was impaired initially after diagnosis and treatment, there was a rapid improvement in almost all aspects the researchers considered.

There were small differences in finances and cognition between the two groups, the study's authors said.

While the long-term nature of the study and its comparison to women of the same age were a unique aspect of the study, the researchers said, the findings were consistent with other studies showing most breast cancer survivors return to work within the first year after diagnosis.

"Our results are reassuring," the study's authors concluded in the Journal of Clinical Oncology.

Breast cancer death rates are at the lowest levels seen since records started to be kept in the 1950s. Goodwin attributes the better outcomes to the introduction of new treatments, early diagnosis and women generally being more aware of their breast health.

Dianne Mowat, 59, of Toronto, was diagnosed with breast cancer in 2002. Mowat said breast cancer changed her life in a positive way.

"I think my life is better, and I don't want to say I'm glad I had breast cancer because I've lost a lot of friends who've succumbed to this," Mowat said. "My quality of life has improved. I enjoy life way more than I did before."

When she returned to work, Mowat dyed her hair "toxic pink" — not for breast care awareness, but so co-workers would ask about her new hairstyle instead of dwelling on her health.

Mowat also took up dragon boat racing and pushes herself through cardio and weight routines with a trainer at a downtown gym.

At a breast cancer foodie fundraiser in Toronto this week, survivors also talked about improvements in quality of life.

Tracey Kumer came dressed as cupcake. "The fact though that I got a second chance, I am grateful for it and so I am living my life, I am living it well and healthfully and trying to take care of myself where I didn't before." 

Florianne Yeung wore a medieval-style costume with a crown. "Right now, I realize that life is too short, life is precious and I just have to enjoy life and live to the fullest. That's what breast cancer taught me."

"It just makes you more aware of life that you have to live it because we don't know what's going to happen tomorrow. I eat better. I still like my glass of wine though," Joanna Chyrstal said with a laugh.

The study was published in the Journal of Clinical Oncology.

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6 ways parents can give kids a healthy 'media diet'

Parents should limit the total entertainment screen time to less than one to two hours per day, pediatricians recommend. (Marcus Donner/Reuters)

Concerns about children's use of media are increasingly urgent in the digital age, say U.S. pediatricians who now recommend that parents establish a media consumption.

The American Academy of Pediatrics released its revised policy statement on children, adolescents and the media on Monday at a conference in Orlando.

In 2010, a U.S. study showed the average eight- to 10-year-old spends nearly eight hours a day with different media, such as TV, cellphones, iPads and social media. Older children and teens spend more than 11 hours per day.

"A healthy approach to children's media use should both minimize potential health risks and foster appropriate and positive media use — in other words, it should promote a healthy 'media diet,'" Dr. Marjorie Hogan, a co-author of the policy, said in a release.

Co-author Dr. Victor Strasburger,  a University of New Mexico adolescent medicine specialist, said that for nearly three decades, the academy has expressed concerns about the amount of time that children and teenagers spend with media and about some of the content they are viewing, which is more pressing in the digital age. 

"I guarantee you that if you have a 14-year-old boy and he has an Internet connection in his bedroom, he is looking at
pornography," Strasburger said.

Two-thirds of children and teenagers report that their parents have "no rules" about time spent with media. In another study, more than 60 per cent of teenagers send or receive text messages after "lights out," and they report increased levels of tiredness, including at school.

Tips to help guide parents

The academy said pediatricians should recommend that parents:

• Limit the amount of total entertainment screen time to less than one to two hours per day. Online homework is an exception.
• Discourage screen media exposure for children under two  years of age.
• Keep the TV set and internet-connected electronic devices out of the child's bedroom.
• Monitor what media their children are using and accessing, including web site and social media sites.
• Co-view TV, movies and videos with children and teens, and use this as a way of discussing important family values.
• Establish a family home use plan for all media that includes enforcement of a mealtime and bedtime "curfew" for all media devices, including cellphones. Set "reasonable but firm" rules about cellphones, texting, internet and social media use.

The authors said there's considerable evidence that a bedroom TV increases the risk for obesity, substance use and exposure to sexual content. Given that, they encouraged pediatricians to ask two media questions during every visit:

• How much recreational screen time does your child or teenager consume daily?
• Is there a television set or internet-connected device in the child's bedroom?

Curbing web use could be 'catastrophic'

Strasburger said he realizes many children will scoff at advice from adults they consider "media-Neanderthals," but he hopes the policy statement will lead to more limits from parents and schools as well as more government research on the effects of media.

The group said shows like Sesame Street can help children learn letters and numbers, and the media can also teach empathy, racial and ethnic tolerance, and interpersonal skills.

For teens, listening to positive rather than neutral song lyrics can foster helping behaviours, and positive information about adolescent health is increasingly available available on YouTube and cellphone text message campaigns. 

Mark Risinger, 16, of Glenview, Ill., who is allowed to use his smartphone and laptop in his room, said the two-hour limit on internet use "would be catastrophic," adding children will find a way around it.

His mother, Amy Risinger, said she agrees with restricting time on social media, but that parents should be able to take their children's maturity level into account when setting media limits. 

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Hand sanitizer ingestion linked to 2 Ontario deaths

Bodico brand contained toxic ingredient methanol

CBC News Posted: Oct 25, 2013 6:52 PM ET Last Updated: Oct 25, 2013 4:34 PM ET

External Links

(Note: CBC does not endorse and is not responsible for the content of external links.)

Two Ontario residents have died after ingesting hand sanitizer that contained a highly toxic and undeclared ingredient, Health Canada has confirmed.

Tests conducted by Ontario's Centre of Forensic Sciences on two eight-ounce bottles of Bodico Hand Sanitizer found it contained deadly methanol rather than ethyl alcohol, the active ingredient listed on the product.

Dirk Huyer, Ontario's Interim Chief Coroner, warned that ingesting methanol can cause blindness or death.

"Hand sanitizers should never be ingested," he said.

Despite warnings from health-care professionals, however, a quick search on YouTube turns up many online videos featuring teenagers ingesting hand sanitizers to get intoxicated.

California's Children's Hospital reported that as many as six teenagers were hospitalized with alcohol poisoning after consuming hand sanitizer.

Health Canada has issued a warning to consumers to be on the lookout for eight-ounce bottles of hand sanitizer with the labels Bodico Hand Sanitizer and Bodico Hand Sanitizer with Aloe & Vitamin E.

With files from CBC's Priya Sankaran, The Canadian Press

Comments on this story are pre-moderated. Before they appear, comments are reviewed by moderators to ensure they meet our submission guidelines. Comments are open and welcome for three days after the story is published. We reserve the right to close comments before then.

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Note: The CBC does not necessarily endorse any of the views posted. By submitting your comments, you acknowledge that CBC has the right to reproduce, broadcast and publicize those comments or any part thereof in any manner whatsoever. Please note that comments are moderated and published according to our submission guidelines.

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Fentanyl abuse an 'epidemic' in south Ottawa high school

Prescription drug abuse continues to grow among high school students, according to speakers at a parents' information session in south Ottawa.

CBC Ottawa will explore the extensive problems with opioids on Ottawa streets. Steve Fischer looks at the underground market for these prescription painkillers. 

Some are calling the issue an epidemic 14 months after a student from South Carleton High School died from an overdose of the prescription drug, fentanyl.

Fentanyl patches, first developed a decade ago, are designed to slowly release the drug over 72 hours. But in the last five years drug users discovered the prescription narcotic could be chewed, smoked, injected or otherwise consumed all at once.

The results, according to health officials, can be disastrous, particularly for first-time users.

Tyler Campbell had only tried the drug "a few times" when he died, his family said Thursday evening.

"Whenever I hear of another death by overdose my heart breaks all over again," said Campbell's mother, Joanne. "Some teens are lucky enough to live, but Tyler didn't."

Some parents are aware of the spread of fentanyl, but others are not. Parent Susan Rabb said she thought Oxycontin was the drug to watch out for.

From 2009 to 2011, an estimated 253 deaths in Ontario were linked to fentanyl, according to the province's Office of the Chief Coroner.

That's more than three times the number of deaths linked to heroin. During that time, only the more widespread oxycodone was connected to more deaths.

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Kidney payment ethics questions raised

Before Canadians consider paying for kidneys, other options for reducing waits should be carefully considered, a transplant recipient and a bioethicist say.

Helen Sklarz, 60, said the nine years she spent on dialysis were bittersweet.

"It filtered and cleansed my blood and it removed toxins so I could stay alive but it took away my quality of life," Sklarz said Friday. She received a kidney 16 months ago.

Organ donation in Canada has always been routed in voluntarism, says bioethicst Linda Wright. (CBC)

Sklarz inherited polycystic kidney disease from her father. It left her with fluid-filled cysts that were triple the normal size at times.

Dialysis meant being tethered to a machine for four hours, three weeknights a week, which Sklarz said was exhausting. Dialysis can lead to headaches and severe foot and leg cramps. Sklarz also needed angioplasty to clear clogged vessels so her dialysis access site wouldn't be blocked.

She also had to keep a restricted diet. Even the fluid in a bunch of grapes could be too much on a hot day, she recalled.

In contrast, after the transplant,  Sklarz says her life is "incredibly wonderful." She's able to renew old friendships, make new ones, enjoy long weekends away, hike, garden, travel and volunteer — activities she'd severely curtailed before receiving the kidney.

On Thursday, researchers in Calgary published a modelling study that suggested paying $10,000 to living donors would increase the number of transplants performed among wait-listed dialysis patients by five per cent, and would be less costly and more effective than the current organ donation system.

"Our model found that a strategy of paying living donors for their kidneys not only saves money for the health-care system, but that the outcomes including quality of life for patients is improved," said study author Lianne Barnieh of the University of Calgary.

Despite the long wait, Sklarz isn't comfortable with the idea of paying for organs.

"This to me doesn't feel ethically correct," Sklarz said. "There's the potential for so many financially strapped and vulnerable populations to make a rash decision for cash."

Slarz said she'd rather governments ease wait times for people in need of organ transplants by educating Canadians to help overcome fears and encouraging people to register their consent to donate upon death, when organs can potentially save eight lives.

Paying kidney donors is socially divisive and needs to be carefully thought through, said Linda Wright, director of bioethics at Toronto's University Health Network.

"Organ donation has always been routed in voluntarism and altruism and this is changing it in a very fundamental way," Wright said of the proposal.

Iran is the only country where paying for organs is legal.

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Halloween face paints can contain heavy metals, eco group warns

As Halloween approaches, a Canadian environmental group is cautioning that some face paints might not be safe.

According to Sierra Club Canada, studies have found toxins and heavy metals like lead in some face paint.

"If you pick up a package of makeup and it doesn't list all the ingredients, put it back down," advised John Bennett, the organization's executive director.

"Studies have found that cadmium, chromium, lead, other heavy metals, other toxic chemicals — that can get into a child's body by putting these creams on their faces."

Under the federal Food and Drugs Act, it is illegal to import or sell face paints or Halloween costume paints that have lead, cadmium, chromium or other heavy metals in as an ingredient.

But trace amounts can work their way into cosmetics because they're sometimes found in other ingredients.

Bennett said without widespread testing, it's up to consumers to be aware.

"Health Canada doesn't test these products as they come into the country. None of this is actually manufactured in Canada."

If toxic levels are present in the body, heavy metals can cause damage to the nervous system and kidneys, among other things, and in children can lead to problems with brain development.

Toronto dermatologist Sandy Skotnicki said there's little cause for worry, however, from using face paint once for Halloween.

"Is that one application of that going to cause any harm? No. And it actually really bothers us as physicians when you get all that fear-mongering. Let the kids have fun," she said.

"There's not going to an issue with one application of Halloween makeup… I think it's good to worry about it for long-term use but not for a night of Halloween."

She said any cosmetic when used for the first time can cause a reaction on someone's skin, especially on the sensitive skin of children, and that might include itching, burning or redness. But "it's not the end of the world," Skotnicki said.

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Kidney payment ethics questions raised

Before Canadians consider paying for kidneys, other options for reducing waits should be carefully considered, a transplant recipient and a bioethicist say.

Helen Sklarz, 60, said the nine years she spent on dialysis were bittersweet.

"It filtered and cleansed my blood and it removed toxins so I could stay alive but it took away my quality of life," Sklarz said Friday. She received a kidney 16 months ago.

Organ donation in Canada has always been routed in voluntarism, says bioethicst Linda Wright. (CBC)

Sklarz inherited polycystic kidney disease from her father. It left her with fluid-filled cysts that were triple the normal size at times.

Dialysis meant being tethered to a machine for four hours, three weeknights a week, which Sklarz said was exhausting. Dialysis can lead to headaches and severe foot and leg cramps. Sklarz also needed angioplasty to clear clogged vessels so her dialysis access site wouldn't be blocked.

She also had to keep a restricted diet. Even the fluid in a bunch of grapes could be too much on a hot day, she recalled.

In contrast, after the transplant,  Sklarz says her life is "incredibly wonderful." She's able to renew old friendships, make new ones, enjoy long weekends away, hike, garden, travel and volunteer — activities she'd severely curtailed before receiving the kidney.

On Thursday, researchers in Calgary published a modelling study that suggested paying $10,000 to living donors would increase the number of transplants performed among wait-listed dialysis patients by five per cent, and would be less costly and more effective than the current organ donation system.

"Our model found that a strategy of paying living donors for their kidneys not only saves money for the health-care system, but that the outcomes including quality of life for patients is improved," said study author Lianne Barnieh of the University of Calgary.

Despite the long wait, Sklarz isn't comfortable with the idea of paying for organs.

"This to me doesn't feel ethically correct," Sklarz said. "There's the potential for so many financially strapped and vulnerable populations to make a rash decision for cash."

Slarz said she'd rather governments ease wait times for people in need of organ transplants by educating Canadians to help overcome fears and encouraging people to register their consent to donate upon death, when organs can potentially save eight lives.

Paying kidney donors is socially divisive and needs to be carefully thought through, said Linda Wright, director of bioethics at Toronto's University Health Network.

"Organ donation has always been routed in voluntarism and altruism and this is changing it in a very fundamental way," Wright said of the proposal.

Iran is the only country where paying for organs is legal.

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Spray foam insulation can make some homes unlivable

A CBC Marketplace investigation has found that for some homeowners, a "green" way to make their houses more energy efficient has left them out in the cold.

The growing popularity of spray polyurethane foam insulation may be creating an emerging problem in Canada. While the majority of spray foam installations occur without incident, problems can be costly and difficult to repair, and have led to a string of lawsuits in the U.S. as homeowners attempt to recover costs.

Watch Marketplace

To see how a Canadian family got caught up in a spray foam nightmare, and how you can protect yourself from disaster, watch Marketplace's episode, Renovation Horror Story, Friday at 8 p.m. (8:30 p.m. in Newfoundland and Labrador).

When installed incorrectly, spray foam insulation can result in a strong, unpleasant fishy smell from off-gassing that has driven some people from their homes, some complaining of difficulty breathing and other health problems. When contractors fail to address installation problems, homeowners can have little recourse.

"We thought we were doing something to improve our home and instead basically destroyed my home," one homeowner tells Marketplace co-host Tom Harrington. "They ruined it. We can't live in it anymore."

Spray foam insulation is applied with a hose that mixes two chemical compounds. Installing the material properly is a process that requires precise mixing, layering and temperature of the chemicals. If installed incorrectly, the material fails to properly cure and can crack, off-gas or cause other problems.

"It's not simple," says Alex Schuts, who has been in the insulation industry for more than 20 years. "You don't just pick up the gun and start spraying."

Alex Schuts, who has been in the insulation industry for more than 20 years, says some green marketing claims about spray foam insulation can be "misleading." (CBC)

"It can be kind of a game of Russian roulette," says Bernie Bloom, a Maryland-based indoor air quality scientist and a specialist in spray foam problems. The full investigation, Renovation Horror Story, airs Friday at 8pm (8:30pm NT) on CBC Television.

Spray foam popularity boosted by reality shows, eco claims

The Canadian Urethane Foam Contractors Association (CUFCA) estimates that spray foam insulation is installed in between 300,000 and 400,000 Canadian homes every year, a number that has been growing by 30 to 40 per cent every year over the last decade.

Part of the product's appeal is that, when properly installed, spray foam insulation can reduce heating and cooling costs by up to 50 per cent, according to CUFCA. The product has also received glowing endorsements on a variety of home renovation TV shows and from celebrity contractors such as Mike Holmes.

As consumer awareness has grown, some companies have aggressively marketed spray foam insulation as a green choice.

But some of those green claims may send consumers the wrong message, says Schuts, who works on home renovation shows including Holmes on Homes and Disaster DIY. He points to marketing that implies that the ingredients are natural and non-toxic, such as soy.

"It's very misleading," Schuts says. "The truth of it is there's only a very small percentage of soy in the spray foams that are out there." Schuts says that "soy-based" foams can contain less than two per cent soy.

Not all green claims are false, however, says Schuts. When installed correctly, spray foam can significantly increase the energy efficiency of a house. And unlike other kinds of insulation, which can settle, spray foam insulation lasts longer and resists deterioration.

However, the Marketplace investigation has discovered that some contractors may be emphasizing "green" claims while neglecting to provide customers with proper safety information, including telling people to stay out of the house during and after spraying. If this advice is not given or followed, exposure to the chemicals can cause serious health problems.

According to the U.S. Environmental Protection Agency (EPA), "exposures to [spray foam insulation (SPF)'s] key ingredient, isocyanates, and other SPF chemicals in vapors, aerosols, and dust during and after installation can cause asthma, sensitization, lung damage, other respiratory and breathing problems, and skin and eye irritation."

Industry protocols lacking

Despite the growing popularity of spray foam insulation, there are no industry standards for its removal. The Marketplace investigation discovered that when contractors fail to address problems, homeowners may have difficulty finding companies that are willing to help because of the lack of protocols for removing improperly installed spray foam insulation.

Bernie Bloom, an air quality scientist based in Maryland, says that spray foam insulation can be "a game of Russian roulette." (CBC)

Finding another contractor who will come to remove the insulation can also cost thousands of dollars.

The product's durability -- one of its advantages over other kinds of insulation -- can make it difficult to remove if it has been installed incorrectly. In some cases, including that of one family featured in the Marketplace investigation, homeowners ended up removing their roof and having the spray foam scraped out manually. However, this can raise additional concerns.

"If you try to hack the foam out mechanically, you make foam dust, and the foam dust travels," Bloom says. "Air moves through the house, and you wind up with foam dust in house dust. "

In the U.S., problems with spray foam installation -- and contractors who are unwilling to fix problems -- have provoked some distraught homeowners to join class-action lawsuits, some of which are currently underway.

In Canada, a contractor must be trained, licensed and certified in order to install certain kinds of spray foam insulation. As the popularity of the insulation has increased, the number of licensed installers has also risen. Some courses require only a few days of training.

According to CUFCA, the association receives only a handful of complaints from consumers about installation problems, noting that it tries to assist consumers who have a problem with CUFCA-certified installers.

The association advises consumers to choose an installer carefully, and review the guarantees the contractor offers if installation problems do occur.

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Fentanyl abuse an 'epidemic' in south Ottawa high school

Prescription drug abuse continues to grow among high school students, according to speakers at a parents' information session in south Ottawa.

CBC Ottawa will explore the extensive problems with opioids on Ottawa streets. Steve Fischer looks at the underground market for these prescription painkillers. 

Some are calling the issue an epidemic 14 months after a student from South Carleton High School died from an overdose of the prescription drug, fentanyl.

Fentanyl patches, first developed a decade ago, are designed to slowly release the drug over 72 hours. But in the last five years drug users discovered the prescription narcotic could be chewed, smoked, injected or otherwise consumed all at once.

The results, according to health officials, can be disastrous, particularly for first-time users.

Tyler Campbell had only tried the drug "a few times" when he died, his family said Thursday evening.

"Whenever I hear of another death by overdose my heart breaks all over again," said Campbell's mother, Joanne. "Some teens are lucky enough to live, but Tyler didn't."

Some parents are aware of the spread of fentanyl, but others are not. Parent Susan Rabb said she thought Oxycontin was the drug to watch out for.

From 2009 to 2011, an estimated 253 deaths in Ontario were linked to fentanyl, according to the province's Office of the Chief Coroner.

That's more than three times the number of deaths linked to heroin. During that time, only the more widespread oxycodone was connected to more deaths.

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Hand sanitizer ingestion linked to 2 Ontario deaths

Bodico brand contained toxic ingredient methanol

CBC News Posted: Oct 25, 2013 6:52 PM ET Last Updated: Oct 25, 2013 4:34 PM ET

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Two Ontario residents have died after ingesting hand sanitizer that contained a highly toxic and undeclared ingredient, Health Canada has confirmed.

Tests conducted by Ontario's Centre of Forensic Sciences on two eight-ounce bottles of Bodico Hand Sanitizer found it contained deadly methanol rather than ethyl alcohol, the active ingredient listed on the product.

Dirk Huyer, Ontario's Interim Chief Coroner, warned that ingesting methanol can cause blindness or death.

"Hand sanitizers should never be ingested," he said.

Despite warnings from health-care professionals, however, a quick search on YouTube turns up many online videos featuring teenagers ingesting hand sanitizers to get intoxicated.

California's Children's Hospital reported that as many as six teenagers were hospitalized with alcohol poisoning after consuming hand sanitizer.

Health Canada has issued a warning to consumers to be on the lookout for eight-ounce bottles of hand sanitizer with the labels Bodico Hand Sanitizer and Bodico Hand Sanitizer with Aloe & Vitamin E.

With files from CBC's Priya Sankaran, The Canadian Press

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Strokes affecting more young people worldwide

The number of young people affected by strokes is increasing worldwide, according to an 11-year study released today.

The Global and Regional Burden of Stroke in 1999-2010 study is in Thursday's issue of the medical journal The Lancet, which takes a comprehensive look at stroke rates by country and region.

Neurologists say 90 per cent of strokes can be avoided through lifestyle changes. (Suzanne Plunkett/Reuters)

"Now we have over 80,000 children and youth affected by stroke every year," said study author Prof. Valery Feigin, director of the National Institute for Stroke and Applied Neurosciences at Auckland University of Technology in New Zealand. "This is incredible."

Strokes are normally associated with the elderly.

But a journal commentary accompanying the study called the global increase of 25 per cent in the incidence of stroke in those aged 25 to 64 "a worrying finding."  

Feigin said the epidemic of obesity, and Type 2 diabetes in children and young people is increasing worldwide, which will be important risk factors for stroke 20 or 30 years down the road.

"Stroke burden worldwide continues to increase," Feigin said in an interview. "It's increasing at an increased pace, more than we expected, disproportionately affecting low- to middle-income countries."

Signs of stroke include sudden:

• Weakness.
• Difficulty speaking.
• Vision problems.
• Severe and unusual headache.
• Loss of balance.

Source: Heart and Stroke Foundation

If the trends in low-income and middle-income countries continue, by 2030, there will be almost 12 million stroke deaths and 70 million stroke survivors worldwide, the researchers projected.
 
More than 90 per cent of strokes are preventable through lifestyle changes such as avoiding fast food and quitting smoking, Feigin said.  
 
In the most wealthy countries, incidence of stroke decreased by 12 per cent from 1990 to 2010. The researchers suggest that good health services and stroke prevention such as quitting smoking, controlling blood pressure, most likely explain the reduction.

"In view of the worldwide epidemic of diabetes, and increasing prevalence of other cardiovascular risk factors in young adults and overall, especially in low-income and middle-income countries, the shift in stroke burden towards younger populations is likely to continue globally unless effective preventive strategies are urgently implemented," the study's authors concluded.

Stroke prevention and care

"Urgent preventive measures and acute stroke care should be promoted in low-income and middle-income countries, and the provision of chronic stroke care should be developed worldwide," Maurice Giroud, Agnes Jacquin, and Yannick Béjot from the University of Burgundy in France agreed in a journal commentary.

In 2009, more than 14,000 Canadians died from stroke, Statistics Canada said. 

According to the Heart and Stroke Foundation, there are two main types of stroke:

• Hemorrhagic, whereby blood vessels in the brain rupture.
• Ischemic, an interruption of blood flow to the brain. 

In a second study also in Thursday's Lancet, the New Zealand-led team said most stroke burden in terms of illness and death were hemorrhagic, the deadliest form that is mainly caused by high blood pressure.

Again, the bulk of hemorrhagic stroke incidence and deaths in the study were in low- and middle-income countries.  

The average age that people suffered both types of strokes was three to five years younger in poorer countries compared to the high-income countries.  

The researchers acknowledged that high-quality data from low- and middle-income countries is scarce.
 
The studies were funded by the Bill & Melinda Gates Foundation.

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Child death reviews 'important in all regions'

B.C. Chief Coroner Lisa Lapointe speaks about the B.C. Coroners Service report on child and youth suicide last month. A Canadian Pediatric Society panel called for child death reviews that include coroners, police, prosecutors, child protective services, local public health officials and doctors. (Darryl Dyck/Canadian Press)

Deaths of children and young people in the U.S. from causes such as heart disease or epilepsy will be added to a national registry, but such a registry is in its infancy in Canada, pediatricians say.  
 
On Thursday, the U.S. National Institutes of Health and Centers for Disease Control and Prevention announced the launch of a registry to collect comprehensive information on sudden unexpected deaths in youth up to age of 24 in as many as 15 states or major cities. 
 
The registry will be a resource for scientists to learn more about the causes of sudden death in the young, with the aim of developing better diagnostic and prevention approaches.  
 
Earlier this month, the Canadian Pediatric Society's injury prevention committe published a position statement that called for formal, organized child and youth death reviews in every region of Canada to help strengthen injury and death prevention efforts. 
 
"The process of child and youth death review is much more entrenched in the United States than it is Canada," said Dr. Amy Ornstein, a co-author of the statement and a consultant pediatrician in Halifax. 
 
There are currently no national standards for child death investigations in Canada. 
 
"For the health and safety of our children and youth, this should be something that is important in all regions in the country," Ornstein said.  
 
Some provinces, such as B.C and Ontario, have death reviews for certain age groups. But since child deaths are so rare, many cases need to be collected to try to identify any meaningful similarities between cases before coming up with recommendations for prevention, Ornstein said.  
 
Previous child death reviews in Canada resulted in recommendations in areas such as safe cribs, water safety, smoke detectors and how teachers should respond to students experiencing a mental health crisis.  
 
The Canadian pediatric group is seeking a child and death review that includes linkable databases and  designated financial support from all levels of government. 
 
In the U.S., state public health agencies will be able to apply to the CDC to participate in the registry in 2014.

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Paying kidney donors could be 'less costly, more effective'

Paying living kidney donors $10,000 could boost donations and cost effectively improve quality of life for people who would otherwise be on dialysis, say Canadian doctors who modelled the idea.  
 
Kidney transplants offer better outcomes than dialysis for people with kidney failure, but donation rates from living and deceased donors haven't changed much over the last decade, doctors say.

 
Currently, there is no compensation or incentives for donors in Canada although donors' expenses can be reimbursed. 
 
"Our model demonstrated that a strategy where living donors are paid $10,000, with a corresponding assumption this strategy would increase the number of transplants performed among wait-listed dialysis patients by five per cent, would be less costly and more effective than the current organ donation system," Lianne Barnieh of the University of Calgary and her co-authors concluded in an upcoming issue of the Clinical Journal of the American Society of Nephrology.
 
Money would be saved from reduction in dialysis costs, Barnieh said. The length and quality of life for patients with end-stage renal disease would also increase.
 
The researchers used $10,000 because in an earlier survey, they found 54 per cent of respondents who previously would not consider giving a kidney might consider doing so for a relative for a payment of $10,000.
 
The cost of administering the system isn't known and wasn't included. The researchers used 2010 Canadian dollars.  

Kidney transplants offer better outcomes than dialysis for people with kidney failure, doctors say. (Dave Polcyn/Mansfield News Journal/Associated Press)

 
In an editorial published with the study, Dr. Peter Reese of the University of Pennsylvania noted there are four main critiques of paying for living kidney donation:

• "Undue inducement" – coercing individuals into accepting risks they would otherwise find unacceptable or in short, "everyone has his price." 
• "Undue inducement" – people of lower socioeconomic status may be particularly vulnerable because they have no choice but to sell a kidney.
• "Crowding out" – if payments are introduced, in short, "dollars will destroy altruism."
• Commodification – allowing someone to sell the body or part of it degrades that person's dignity or in short, the body is sacred and money is dirty.

 The first three critiques could be verified through a trial of financial incentives for kidney donation but the commodification isn't empirically testable, Reese said. Studies don't provide support for the main critiques, he added.
 
Trends in use of financial incentives in medicine, such as to quit smoking or lose weight, suggest "the time is ripe for new consideration of payments for living kidney donation," Reese concluded.

In 2011, about 3,000 people were on the wait list for a kidney transplant, according to the Canadian Institute for Health Information.

Nearly 3,400 Canadians are waiting for a kidney transplant, according to the Kidney Foundation of Canada.

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Nutrition tool for parents launches online

There's a new online tool for parents who want to check whether their preschoolers and toddlers are eating well.

Nutri-eSTEP, launched by Dietitians of Canada, aims to give parents guidance on how to improve eating behaviours and link them to resources.

Nutri-eSTEP is billed as a fast way to assess eating habits and identify potential nutrition problems in young children. (Courtesy Nutri-eSTEP)

Parents of preschoolers (aged three to five years) and toddlers (18 to 35 months) answer multiple choice questions about daily food choices, screen time and physical activity, growth and other related factors.

"In less than 10 minutes, parents or a caregiver can complete an easy-to-use online questionnaire, receive immediate feedback on 'What is Going Well' and 'What to Work On,' and then be linked to healthy eating resources and community services," Helen Haresign, director of EatRight Ontario, said Thursday in a release.

It's billed as a fast way to assess eating habits and identify potential nutrition problems in young children.

Previously the questionnaires were provided to parents by staff in some clinics, public health or daycares, but were not available to all parents.

Parents can receive written feedback and tips from registered dietitians, and follow up links to articles, videos, kid-friendly recipes and community services. There is information on how to contact nutrition services in their community.

There's also a questionnaire for people who are over age 50 to assess whether their food choices are letting them stay healthy and active.

Dietitians of Canada (www.dietitians.ca) represents about 6,000 professional members at the local, provincial and national level. It operates EatRight Ontario.

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