Health of Toronto neighbourhoods ranked by St. Michael's research

Out of Toronto's 140 listed neighbourhoods, 23 have a very high premature death rate affected in part by other factors within their immediate community, according to research from St. Michael's hospital.

Urban HEART @ Toronto is a tool to examine neighbourhoods and diagnose key problems in specific areas that affect the health and well being of the local population.

The tool measures Toronto's neighbourhoods according to five categories: economic opportunities, social and human development, governance and civic engagement and physical environment and infrastructure and and population health.

"A quick look at the dashboard tells us that every neighbourhood in Toronto has strengths and assets to build on, but there is also troubling inequity in our city," said Dr. O'Campo, an epidemiologist.

"Too many neighbourhoods are vulnerable and falling behind. In fact, almost half of all of Toronto's neighbourhoods are experiencing yellow caution indicators across all domains. This doesn't necessarily mean these neighbourhoods are at risk — but they are areas that are experiencing some issues of concern, and need a closer look to find out why."

Premature mortality rates represent the number of deaths among people under the age of 75.  Approximately 72 per cent of deaths of people under age 75 are avoidable and 65 per cent preventable, according to the research.

The project, released online, rates each neighbourhood with a green, yellow or red marker,

Green, as you'd expect, means the area is doing quite well, yellow has room for improvement in many areas and red reveals there are a lot of problems in the neighbourhood contributing to the health of the residents.

While many cities have a high rate of poverty in their urban core, Toronto's most vulnerable neighbourhoods mainly surround the more affluent downtown.  

It's a "U-shaped" distribution of poverty, according to the report.

In Toronto, like most places in the world, the areas with the lowest income and higher rates of unemployment suffer the most in terms of health and well-being.

The study adds that the challenges for many neighbourhoods are cyclical.

"Our chances of encountering diseases such as tuberculosis, or developing chronic conditions like diabetes or heart disease increase when we don't have the resources necessary to foster  well-being," it suggests.

"These resources can include stable housing, safe streets, economic security, and healthy food. Moreover, these challenges are cyclical: poor health can, in turn, lead to lost wages, isolation, and increased difficulty taking care of ourselves and our families."

The tool was developed by a United Nations agency and modelled on a similar one made by the World Health Organization. According to O'Campo this will benefit Toronto, as the city will be able to draw on the experience of other cities and consistent methods.

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Nutrition labels on food packaging under microscope in U.S., Canada

Nutrition labels that are found on just about every piece of packaged food could be getting a new look in the U.S., with a greater focus on calories and added sugar.

The changes, proposed by the Obama administration, would see calories printed in a larger and bolder type and consumers would be able to know whether foods have added sugars.

Canada's Health Minister Rona Ambrose said she is happy about the news from the U.S.

"I welcome the efforts by the FDA to update U.S. nutrition food labels and am especially encouraged by some of the new components to make labels easier to read and understand, like portion sizes."

She added that the Canadian government launched its own process a few months ago, consulting with consumers to improve nutrition labels here.

"Over the coming months, we'll use the information we receive directly from Canadians to update our labels that will help parents and consumers make healthier and informed food choices," she said.

David Hammon, an associate professor at the School of Public Health and Health Systems at the University of Waterloo, Ont., told CBC News that hopefully what is happening in the U.S. will work as "an impetus" for Canada.

"I think most people in the public health community would like to see Health Canada move a little more quickly and a little bit more forcefully," he said.

Added sugars

The proposed American labels would also update serving sizes to more realistic standards of how people actually eat.

"Our guiding principle here is very simple, that you as a parent and a consumer should be able to walk into your local grocery store, pick up an item off the shelf and be able to tell whether it's good for your family," said Michelle Obama, who announced the proposed changes Thursday at the White House.

She made the announcement as part of her Let's Move initiative to combat child obesity, which is celebrating its fourth anniversary. On Tuesday, she announced new Agriculture Department rules that would reduce marketing of unhealthy foods in schools.

The other big shift is the focus on added sugars. Consumers will finally be able to see how much sugar is added to a  product.

Marion Nestle, professor in the Department of Nutrition, Food Studies, and Public Health at New York University, was please and surprised by the FDA's move, adding it has been something nutrition advocates have been seeking for a long time.

"I'm just astonished that the FDA was able to do this and delighted with what they were able to do," Nestle told CBC News. "Advocates in the United States have been hoping that the FDA would put added sugar on labels for years now, and we'd sort of given up that they would do it, but here they are."

According to the Agriculture Department's 2010 Dietary Guidelines for Americans, added sugars contribute an average of 16 per cent of the total calories in U.S. diets. Though those naturally occurring sugars and the added sugars act the same in the body, the USDA says the added sugars are just empty calories while naturally occurring ones usually come along with other nutrients.

As for how much changing the label will change the population's eating habits, Nestle said it depends.

"We don't know whether people are going to change their behaviour because of the labels, but there's plenty of research on the old label, that showed that people looked at trans fats for example when trans fat was put on and we were extremely concerned that food products still had trans fats in them," she said.

"I think there will be a lot of consumer interest. Obviously if people don't look at the label, it's not going to have an effect on their behaviour … but for people who do look on the label it will."

2 years to comply

The new nutrition labels are still a few years away. The FDA will take comments on the proposed changes for 90 days, and a final ruling could take another year. Once it's final, the agency has proposed giving industry two years to comply.

The FDA projects food companies will have to pay around $2 billion to change the labels.

The Grocery Manufacturers Association, the industry group that represents the nation's largest food companies, did not respond to any specific parts of the proposal but called it a "thoughtful review."

President Pamela Bailey also said it was important to the food companies that the labels "ultimately serve to inform, and not confuse, consumers."

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Manitoba drug stores may need to advertise dispensing fees

The Manitoba government is facing pressure from supporters to get pharmacies to list dispensing fees so that consumers can shop around for the best price. (Mark Blinch/Reuters)

Manitoba is looking at becoming one of the first provinces in Canada to force pharmacies to disclose how much people have to pay to get their prescriptions filled.

The NDP government is facing pressure from supporters to get pharmacies to list their dispensing fees so consumers can shop around for the best price. A spokeswoman for Consumer Protection Minister Ron Lemieux says the government is looking into how to make the fees more transparent.

Rachel Morgan said Lemieux has been asked to look into the issue.

"We are looking … to see what role the Manitoba government can play in helping Manitobans get a clear, upfront understanding of pharmacy dispensing fees and fair prices on medications," she said in an emailed statement.

Lemieux was out of town and unavailable for comment, said Morgan, who declined to say what options the province is weighing.

No other province has forced pharmacies to advertise their dispensing fees, Morgan said. But the bylaws of the College of Ontario Pharmacists require druggists to post their fees and break out the fee if they advertise drug costs, she added.

Pressure is growing on Manitoba to do something. A survey by Royal Bank last year found the province's residents pay the highest average dispensing fees in the country — anywhere between $4.50 and $13 a prescription.

Delegates at a recent NDP policy convention in Winnipeg passed a non-binding resolution calling on the government to look at protecting consumers from "excessive fees and price gouging" by forcing pharmacies to display their dispensing fees.

The resolution also urged the province to ban filling year-long prescriptions in three-month increments, forcing consumers to repeatedly pay dispensing fees, unless there is a medical reason to do so.

Winnipeg NDP backbencher Deanne Crothers said she has been pushing for the government to do something after hearing concerns from seniors in her community. She points out that high dispensing fees can add up for anyone, especially for those with repeat — and routine — prescriptions.

"I have a six- and a four-year-old going through ear infections and strep throat. It isn't always obvious what the fee is," Crothers said.

"It's just fair that we find a way to make sure pharmacies are plainly stating how much their handling fee is, so if someone is on a limited budget, particularly someone who is dealing with a health issue … they can … make an educated choice about where to get their prescriptions filled."

Crothers said she has talked to Lemieux and is hopeful the government will do something.

Ronald Guse, registrar of the College of Pharmacists of Manitoba, said the college hasn't been consulted so far by the government on this issue. Regulations already exist which spell out how a pharmacy can advertise its fees and a pharmacy must outline the fees if asked by a patient, he said.

"We're not opposed to it, we just want to know a little more about what they have in mind and what they're trying to accomplish," Guse said. "If it is to inform the public, we want to make sure that the information the public is getting is helpful and useful for them."

Ron Schuler, consumer protection critic for the Opposition Conservatives, said the law already allows pharmacies to spell out their dispensing fees. The last prescription receipt he got clearly broke down the cost, he said.

"It's something they're doing already voluntarily," Schuler said. "I don't know what's broken that they're trying to fix."

Noralou Roos had never given much thought to dispensing fees until she took a prescription for thyroid medication she has been on since high school to a new pharmacy last year. Roos said she was told the pharmacy could not fill the year-long prescription in anything other than three-month increments.

That meant she had to pay the dispensing fee four times instead of just once.

"I was really irritated," said Roos, a professor in the Faculty of Medicine at the University of Manitoba and a founding director of the Manitoba Centre for Health Policy.

"I went home and I realized I had just paid essentially as much for the three months as I had for my previous full-year prescription, because it's a cheap medication and the prescription dispensing fee was $20."

Roos said she discovered the issue was a bit more complex after talking to some colleagues in the pharmacy department. She was told that as pharmacists are asked to take on a greater role in health care, the best way to compensate them is through dispensing fees.

"It's a big issue that nobody has figured out how to appropriately pay pharmacists."

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Women's brains more resilient to higher levels of genetic defects: study

Women are able to carry higher levels of genetic defects without getting brain development disorders such as autism, supporting the possibility of a 'female protective effect', finds a new study.

The study gives clues as to why fifty per cent more males typically have an intellectual disability than females, and why boys are four times more likely to have autism than girls.

Professor Evan Eichler of the University of Washington, USA, led a Swiss-US collaboration which published their results in The American Journal of Human Genetics today.

Better protected

The team looked for genetic defects in 15,585 people who had been diagnosed with a range of disorders all thought to be due to faulty brain development — known as neurodevelopmental disorders. Some of these people had autism spectrum disorders but they were not separated out from the rest.

The defects they were looking for were large 'copy number variants' (CNVs) — sections of chromosomes carrying perhaps a dozen genes which are either missing, or present as multiple copies.

Surprisingly, the females in the sample had more CNVs than the males. Although both sexes in the study had neurodevelopmental disorders, the females were carrying a bigger 'burden' of genetic damage.

Eichler says this fits with females somehow being better protected from the effects of the CNVs. "It takes a lot more mutational hits to make a woman cross the threshold for a [neurodevelopmental] disorder," he says.

"The next question was... do you see this in autism?" says Eichler.

The team then focussed on autism alone using a separate group of 762 families with autism spectrum disorders. The females in this group carried an even greater burden of CNVs than the men.

These women were also more likely to carry tiny harmful mutations, affecting just a couple of base pairs in the DNA, than the men in the group.

Why are males more vulnerable?

Eichler now wants to do more research on thousands rather than hundreds of people with autism spectrum disorder, to validate and extend the results. He'd like to pinpoint the genes that most put people at risk of the disease.

'This is basically saying females need more genetic damage to have autism or a neurodevelopmental disorder than do the males — it provides a clue.'-  Professor Cheryl Dissanayake

As to why females are protected - he speculates that hormonal influences may be involved and adds "there is some data to suggest that we are hard-wired differently, but this is not my area of expertise."

And females are "genetically more robust because they have two X chromosomes while males are stuck with a single X and all the mutations...that are on it".

Commenting on the paper, Professor Cheryl Dissanayake, director of the Olga Tennison Autism Research Centre at La Trobe University, says she is not a geneticist but believes the paper sheds light on the question of why males are more affected than females.

"We've often speculated about a 'female protective factor' but never really understood why that might be."

"This is basically saying females need more genetic damage to have autism or a neurodevelopmental disorder than do the males — it provides a clue".

The question that now needs to be answered, she agrees, is "what makes males more vulnerable to these genetic defects than females?"

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Health sector should learn from banks when it comes to service

A new report says the health sector should take a page from the banking industry when it comes to serving patients.

It says people can bank online, access their personal information from anywhere and get customized services — and so should patients.

The report says patients are already using digital tools to manage their health and should have a bigger say in how they're treated.

The International Centre for Health Innovation at Western University's Ivey Business School says personalizing the health system will improve care, outcomes and save money.

Chairwoman Anne Snowdon says the health care system needs to move into the 21st century and start tailoring to the needs of the individual.

Sometimes what's considered to be a success story for a doctor isn't necessarily a success for the patient.

Surgery may seem to be the right treatment for an elderly woman with an arthritic knee, but not if her daily routine revolves around attending mass at church, she said.

"Everything goes beautifully, she can now walk to church, she doesn't have any pain, great range of motion," Snowdon said. "She goes to 7 a.m. mass, she can no longer kneel."

"So for that little 84-year-old lady, it was not a success at all because what was central to her and most valuable to her was being able to kneel to pray," Snowdon added.

Stacy Murphy, whose son Kayne was born three months premature, said she and her husband felt shut out by health-care providers during their ordeal.

They were left out of the loop and weren't made aware of just how bad things were for their son, Murphy said. The team caring for her son wouldn't include them in their meetings.

'Start with the person. What's important to them, what are their goals, how to we help them get to that goals and mobilize the knowledge we have to help them make really good decisions.'- Chairwoman Anne Snowdon, International Centre for Health Innovation

She was asked to leave her son's side for routine procedures like IV changes and more serious ones like spinal taps, she said.

Not all parents can keep calm and stay out of the way of medical staff, Murphy said. But she knew she could.

"So when it over, I could be there to cuddle him and support him through it," she said. If he didn't make it, at least she have been there when he died.

The couple also had to fight against doctors' recommendations to not resuscitate her son, she said.

Finally one of the doctors advised the medical team to listen to them, she said.

After months in hospital, they told her that Kayne, who had chronic lung disease, would likely die in hospital. Murphy and her husband took their son home and took over his care, learning to use the ventilator and do the procedures he needed to survive.

Kayne is now five years old, she said.

Stories like Murphy's show that there needs to be a significant shift in the health sector, Snowdon said.

"Start with the person," she said. "What's important to them, what are their goals, how to we help them get to that goals and mobilize the knowledge we have to help them make really good decisions."

Patients often walk into the doctor's office armed with questions they got on the Internet — what's jokingly referred to as "Dr. Google," she said. Some doctors are posting signs on their doors telling patients they will only take three questions.

"Even an ATM at a bank will ask you, would you like another transaction," she said.

And this is an "empowered" group of consumers who want information and have very specific goals, she said.

"They're not patients, because 'patients' really suggests that physicians are in charge," Snowdon said. "I think those days are fading quickly behind us."

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Concerned about kids' screen time? The antidote is nature

While experts worry about the ills of the internet age and the health problems linked to kids' hours of screen time, Richard Louv says there is an antidote - and it's free.

Louv is the author of Last Child in the Woods and The Nature Principle, and he coined the term "nature deficit disorder." He says spending time in nature has a wide range of benefits for physical and mental health.

Richard Louv is the author of Last Child in the Woods and The Nature Principle, and he coined the term "nature deficit disorder." He says spending time in nature has a wide range of benefits for physical and mental health. (Courtesy Richard Louv)

​"The symptoms of attention deficit disorder go down in kids as young as five. In schools, first there's evidence it's connected to cognitive development, the ability to learn, and executive development which is the ability to control ourselves," Louv says.

At the same time, there's growing evidence that lack of time in nature is linked to rising rates of depression, attention deficit disorder and other health conditions, Louv says.

"An emerging body of scientific evidence suggests not spending much time outdoors connected to the natural world can be connected to rising rates of depression, attention deficit disorder, Vitamin D deficiency (an epidemic in the world), and child obesity."

How do you help kids manage or curb their screen time? Kids, what do you think it would it be like to put down your screens for a week? Send your tips and suggestions to community@cbc.ca or tweet us with the hashtag #CBCRewired.

There are a couple of theories about why exposure to nature is so beneficial.

The "biophilia" theory says humans are hard-wired genetically for an affiliation with the natural world and suffer when they're deprived of it.

A second school of thought is called Attention Restoration Theory (ART), which has been the basis of recent studies by Canadian researcher Marc Berman. It suggests the brain relaxes in nature, entering a state of contemplative attention that is restorative or refreshing. In contrast, in busy urban settings the brain's working memory is bombarded with distractions and attention systems are on alert.

Berman's research found a walk in nature could improve memory and mood in people diagnosed with depression.

Louv says there's enough evidence of the physical and mental health benefits of time in nature that schools should be mandated to include it in the standard curriculum.

He suggests families also make time for outings in wild places. He suggests creating or joining one of the growing number of family nature clubs that are popping up around the world (see a directory of them here).

Audio: Hear Richard Louv talking about the effects of a good dose of nature:

Louv says families are so busy, spending time in nature has to be a conscious choice. But it's one he passionately advocates.

Audio: Hear Richard Louv tell his personal story of how he became convinced of the benefits of nature:

You can watch a video about Louv's work here, and hear him describe the sense of wonder that nature inspires in many people.

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Ritalin shortage prompts call for Health Canada changes

Pharmacists say the impact of a current Canada-wide Ritalin drug shortage could have been reduced if Health Canada took a tougher stance on pharmaceutical companies.

The current shortage affects 10 milligram doses of the brand name medication Ritalin, which is made by Novartis Pharmaceuticals, as well as the generic form of methylphenidate hydrochloride.

Ritalin, a stimulant, is commonly prescribed to help treat attention deficit hyperactivity disorder (ADHD).

The shortage is listed on drugshortages.ca, a website backed by Health Canada, where drug makers can voluntarily post shortage information.

According to the online database, the shortage is expected to last 37 days. The shortage is blamed on an "unexpected increase in demand caused by Gx [generic drug] back order."

According to Diane Lamarre, the president of the Quebec Order of Pharmacists, Health Canada needs to change its policies to prevent something like this from happening again.

Health Canada does not currently require pharmaceutical companies to report drug shortages, although drug makers may opt to voluntarily alert doctors and pharmacists. 

Lamarre said that makes it difficult for pharmacists to deal with shortages.

"It's a problem. It's difficult to evaluate clearly," she said.

"When there are drug shortages we may have time to import it from other countries … but each week, each day is important in terms of having time to import this medication."

For now, Lamarre says patients who use Ritalin will have to rely on alternatives by doubling smaller doses or using long-acting versions of their medication.

Lamarre adds that while using alternative medication might not be ideal, patients have few options.

"It might not suit a child perfectly. Medication choice should be tailored."

She said patients can ask for a doubled 5-milligram dose, although she warns that supplies could soon run out for that as well.

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Nutrition labels on food packages would now highlight calories and sugars

Those "Nutrition Facts" labels that are plastered on nearly every food package found in grocery stores are getting a new look from American lawmakers.

Calories would be in larger, bolder type, and consumers for the first time would know whether foods have added sugars under label changes being proposed by the Obama administration. Serving sizes would be updated to make them more realistic. A serving of ice cream, for example, would double to a full cup, closer to what people actually eat.

The proposed overhaul comes as science has shifted. While fat was the focus two decades ago when the labels were created, nutritionists are now more concerned with how many calories we eat. And serving sizes have long been misleading, with many single-serving packages listing multiple servings, so the calorie count is lower.

The idea isn't that people should eat more; it's that they should understand how many calories are in what they are actually eating. The Food and Drug Administration says that by law, serving sizes must be based on actual consumption, not ideal consumption.

"Our guiding principle here is very simple, that you as a parent and a consumer should be able to walk into your local grocery store, pick up an item off the shelf and be able to tell whether it's good for your family," said first lady Michelle Obama, who was to join the Food and Drug Administration in announcing the proposed changes Thursday at the White House.

Mrs. Obama was making the announcement as part of her Let's Move initiative to combat child obesity, which is celebrating its fourth anniversary. On Tuesday, she announced new Agriculture Department rules that would reduce marketing of unhealthy foods in schools.

Two years to comply

The new nutrition labels are likely several years away. The FDA will take comments on the proposal for 90 days, and a final rule could take another year. Once it's final, the agency has proposed giving industry two years to comply.

The FDA projects food companies will have to pay around $2 billion as they change the labels.

The Grocery Manufacturers Association, the industry group that represents the nation's largest food companies, did not respond to any specific parts of the proposal but called it a "thoughtful review."

President Pamela Bailey also said it was important to the food companies that the labels "ultimately serve to inform, and not confuse, consumers."

It was still not yet clear what the final labels would look like. The FDA offered two labels in its proposal — one that looks similar to the current version but is shorter and clearer and another that groups the nutrients into a "quick facts" category for things like fat, carbohydrates, sugars and proteins. There also would be an "avoid too much" category for saturated fats, trans fats, cholesterol, sodium and added sugars; and a "get enough" section with vitamin D, potassium, calcium, iron and fibre.

Both versions list calories above all of those nutrients in a large, bold type.

List of added sugars

The proposed rules would also overhaul serving sizes for soda and single-serving packages. Both 12-ounce and 20-ounce sodas would be considered one serving, and many single-serving packages — a bag of chips, a can of soup or a frozen entree, for example — would either be listed as a single serving or list nutrient information by serving and by container.

The inclusion of added sugars to the label was one of the biggest revisions. Nutrition advocates have long asked for that line on the label because it's impossible for consumers to know how much sugar in an item is naturally occurring, like that in fruit and dairy products, and how much is added by the manufacturer. Think an apple vs. apple sauce, which comes in sweetened and unsweetened varieties.

According to the Agriculture Department's 2010 Dietary Guidelines for Americans, added sugars contribute an average of 16 per cent of the total calories in U.S. diets. Though those naturally occurring sugars and the added sugars act the same in the body, the USDA says the added sugars are just empty calories while naturally occurring ones usually come along with other nutrients.

David Kessler, who was FDA commissioner when the first Nutrition Facts labels were unveiled in the early 1990s, said he thinks focusing on added sugars and calories will have a "demonstrative public health benefit."

Kessler said the added sweetness, like added salt, drives overeating. And companies will adjust their recipes to get those numbers down.

"No food company wants products to look bad," he said.

While some may ignore the panels, there's evidence that more people are reading them in recent years as there has been a heightened interest in nutrition.

A USDA study released earlier this year said 42 per cent of working adults used the panel always or most of the time in 2009 and 2010, up from 34 per cent two years earlier. Older adults were more likely to use it.

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Organ transplants in Canada see 'moderate' increase

Organ transplants are on the rise in Canada thanks to an increase in the number of deceased donors, a new study says, but there is still a "significant gap" between the number of donors and patients who need new organs.

The Canadian Institute for Health Information released a report Tuesday on end-stage organ failure treatment from 2003 to 2012. It shows the rate of deceased organ donors has risen 17 per cent in the last decade.

The institute says that's significant because deceased donors can provide up to eight organs, while a living donor can provide only one. 

"It's positive news in the sense that we're seeing upward trends in the number of deceased donors, but there is still a gap between Canada's deceased donor rates and what we see in places like Spain and the U.S," said Greg Webster, a director with the institute whose portfolio includes the Canadian Organ Replacement Register.

There were 15.5 deceased organ donors in Canada per million population in 2012, compared to 26 per million in the U.S. and 36 per million in Spain, the country with the highest donation rate.

Webster described some of the increases as "moderate positive improvement."

• There were 2,225 organ transplants in Canada in 2012, up almost five per cent over the previous year.
• The number of transplants has increased annually over the last four years.
• Deceased donors totalled 540 compared to 539 live donors, marking the first year where deceased donors outnumbered live ones.
• The 1,079 organ donors resulted in 2,225 organ transplants. 

Webster said the living donor rate has also increased slightly and measures up well with other countries, but that there is still room for improvement.

Two hundred and thirty Canadians died waiting for an organ transplant in 2012, while 4,612 were waiting for organs at the end of the year.  

	Transplants	Waiting list	Deaths while waiting
Heart	164	183	15
Lungs	194	329	69
Liver	494	492	62
Kidneys	1,358	3,428	84

(Above chart does not include numbers for pancreas or small-intestine transplants) 

The vast majority of people waiting for a transplant need a kidney.

By the end of 2012, there were more than 41,000 people living with end-stage kidney disease — 42 per cent with a kidney transplant, 58 per cent on dialysis.

The institute said transplants improve outcomes and quality of life for patients compared to dialysis, and they also have a cost benefit. 

"People living with a kidney transplant cost the health-care system approximately $50,000 less a year," he said.

Aside from further promoting organ donations, Webster said another response is to deal with Type 2 diabetes, which is largely preventable and the No. 1 cause of end-stage kidney disease in Canada. 

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Concerned about kids' screen time? The antidote is nature

While experts worry about the ills of the internet age and the health problems linked to kids' hours of screen time, Richard Louv says there is an antidote - and it's free.

Louv is the author of Last Child in the Woods and The Nature Principle, and he coined the term "nature deficit disorder." He says spending time in nature has a wide range of benefits for physical and mental health.

Richard Louv is the author of Last Child in the Woods and The Nature Principle, and he coined the term "nature deficit disorder." He says spending time in nature has a wide range of benefits for physical and mental health. (Courtesy Richard Louv)

​"The symptoms of attention deficit disorder go down in kids as young as five. In schools, first there's evidence it's connected to cognitive development, the ability to learn, and executive development which is the ability to control ourselves," Louv says.

At the same time, there's growing evidence that lack of time in nature is linked to rising rates of depression, attention deficit disorder and other health conditions, Louv says.

"An emerging body of scientific evidence suggests not spending much time outdoors connected to the natural world can be connected to rising rates of depression, attention deficit disorder, Vitamin D deficiency (an epidemic in the world), and child obesity."

How do you help kids manage or curb their screen time? Kids, what do you think it would it be like to put down your screens for a week? Send your tips and suggestions to community@cbc.ca or tweet us with the hashtag #CBCRewired.

There are a couple of theories about why exposure to nature is so beneficial.

The "biophilia" theory says humans are hard-wired genetically for an affiliation with the natural world and suffer when they're deprived of it.

A second school of thought is called Attention Restoration Theory (ART), which has been the basis of recent studies by Canadian researcher Marc Berman. It suggests the brain relaxes in nature, entering a state of contemplative attention that is restorative or refreshing. In contrast, in busy urban settings the brain's working memory is bombarded with distractions and attention systems are on alert.

Berman's research found a walk in nature could improve memory and mood in people diagnosed with depression.

Louv says there's enough evidence of the physical and mental health benefits of time in nature that schools should be mandated to include it in the standard curriculum.

He suggests families also make time for outings in wild places. He suggests creating or joining one of the growing number of family nature clubs that are popping up around the world (see a directory of them here).

Audio: Hear Richard Louv talking about the effects of a good dose of nature:

Louv says families are so busy, spending time in nature has to be a conscious choice. But it's one he passionately advocates.

Audio: Hear Richard Louv tell his personal story of how he became convinced of the benefits of nature:

You can watch a video about Louv's work here, and hear him describe the sense of wonder that nature inspires in many people.

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Caesar salad recalled over possible Listeria contamination

A third brand of salad on the recall list due to possible Listeria contamination. (Canadian Food Inspection Agency)

The Canadian Food Inspection Agency has put a recall notice on three brands of caesar salad products because of possible Listeria contamination. 

One of the caesar salad brands recalled due to possible Listeria. (Canadian Food Inspection Agency )

These products have been sold in Buy-Low Foods and Nesters Market stores in British Columbia and Alberta.

They were also sold at at the Safeway and St. Martin's Family Food stores in Alberta, British Columbia, Manitoba, Ontario and Saskatchewan. 

The agency said people should check to see if they have these products in their homes. If so, they should throw them out or return them to the store where they purchased them. 

Food contaminated with Listeria may not look or smell spoiled, but it can make people sick. 

Symptoms include: vomiting, nausea, persistent fever, muscle aches, severe headache and neck stiffness. 

Pregnant women, elderly people, and those with compromised immune systems are particularly at risk

Recalled products should be thrown out or returned to the store.

Here are the brands to look out for. Spelling follows the actual labels: 

Brand Name	Common Name	Size	Code(s) on Product	UPC
Signature Cafe	Chicken Caesar Salad	140 g	Best Before dates  up to and including MR01	0 58200 131451 0
Signature Cafe	Chicken Caesar Salad	300 g	Best Before dates  up to and including  MR01	0 58200 13119 2
Fresh 'n Delicious	Ceasar Salad	100 g	Best Before Dates  up to and including FEB 28/14	Starts with 2 06430
Fresh 'n Delicious	Ceasar Salad	205 g	Best Before Dates  up to and including FEB 28/14	Starts with 2 06419
Fresh 'n Delicious	Chicken Ceasar Salad	280 g	Best Before Dates  up to and including FEB 28/14	Starts with 2 06422
Nester's Own	Ceasar Salad	100 g	Best Before Dates  up to and including FEB 28/14	Starts with 2 06430
Nester's Own	Ceasar Salad	205 g	Best Before Dates  up to and including FEB 28/14	Starts with 2 06419
Nester's Own	Chicken Ceasar Salad	280 g	Best Before Dates  up to and including FEB 28/14	Starts with 2 06422

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Health sector should learn from banks when it comes to service

A new report says the health sector should take a page from the banking industry when it comes to serving patients.

It says people can bank online, access their personal information from anywhere and get customized services — and so should patients.

The report says patients are already using digital tools to manage their health and should have a bigger say in how they're treated.

The International Centre for Health Innovation at Western University's Ivey Business School says personalizing the health system will improve care, outcomes and save money.

Chairwoman Anne Snowdon says the health care system needs to move into the 21st century and start tailoring to the needs of the individual.

Sometimes what's considered to be a success story for a doctor isn't necessarily a success for the patient.

Surgery may seem to be the right treatment for an elderly woman with an arthritic knee, but not if her daily routine revolves around attending mass at church, she said.

"Everything goes beautifully, she can now walk to church, she doesn't have any pain, great range of motion," Snowdon said. "She goes to 7 a.m. mass, she can no longer kneel."

"So for that little 84-year-old lady, it was not a success at all because what was central to her and most valuable to her was being able to kneel to pray," Snowdon added.

Stacy Murphy, whose son Kayne was born three months premature, said she and her husband felt shut out by health-care providers during their ordeal.

They were left out of the loop and weren't made aware of just how bad things were for their son, Murphy said. The team caring for her son wouldn't include them in their meetings.

'Start with the person. What's important to them, what are their goals, how to we help them get to that goals and mobilize the knowledge we have to help them make really good decisions.'- Chairwoman Anne Snowdon, International Centre for Health Innovation

She was asked to leave her son's side for routine procedures like IV changes and more serious ones like spinal taps, she said.

Not all parents can keep calm and stay out of the way of medical staff, Murphy said. But she knew she could.

"So when it over, I could be there to cuddle him and support him through it," she said. If he didn't make it, at least she have been there when he died.

The couple also had to fight against doctors' recommendations to not resuscitate her son, she said.

Finally one of the doctors advised the medical team to listen to them, she said.

After months in hospital, they told her that Kayne, who had chronic lung disease, would likely die in hospital. Murphy and her husband took their son home and took over his care, learning to use the ventilator and do the procedures he needed to survive.

Kayne is now five years old, she said.

Stories like Murphy's show that there needs to be a significant shift in the health sector, Snowdon said.

"Start with the person," she said. "What's important to them, what are their goals, how to we help them get to that goals and mobilize the knowledge we have to help them make really good decisions."

Patients often walk into the doctor's office armed with questions they got on the Internet — what's jokingly referred to as "Dr. Google," she said. Some doctors are posting signs on their doors telling patients they will only take three questions.

"Even an ATM at a bank will ask you, would you like another transaction," she said.

And this is an "empowered" group of consumers who want information and have very specific goals, she said.

"They're not patients, because 'patients' really suggests that physicians are in charge," Snowdon said. "I think those days are fading quickly behind us."

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Acetaminophen use in pregnancy studied for ADHD risk

Taking acetaminophen during pregnancy is linked to a slightly higher risk of children being diagnosed with ADHD and behaviour problems, but it is still the pain reliever of choice when expecting, doctors say.

Acetaminophen, found in Tylenol and some cold medications, is the most commonly used medication for pain and fever during pregnancy. While it has no known links to birth defects, studies in humans and animals suggest it could affect hormones that are key to brain development.

To learn more, researchers in Denmark, the U.S., Spain and Taiwan studied 64,322 children and mothers in the Danish National Birth Cohort who were followed with questionnaires and checks of hospital and prescription records. The focus was on the children's risk of developing attention-deficit hyperactivity disorder-like behaviour problems or a severe form of ADHD called hyperkinetic disorder or HKD.

"In this large pregnancy cohort with prospective data, children born to mothers who used acetaminophen during pregnancy were at higher risk for receiving a hospital diagnosis of HKD, ADHD medications, or having ADHD-like behaviours during followup," Dr. Jorn Olsen of the Institute of Public Health at the University of Aarhus and his co-authors concluded in Monday's online issue of the journal JAMA Pediatrics.

While the Danish database was large, by age seven only 551 children were diagnosed with HDK among the pain reliever group compared with 283 in those who never used it.

"At this stage, I do not believe that a study of this type of quality can cause us to change what we tell women," said Dr. Gideon Koren, director of the Motherrisk program at the Hospital for Sick Children in Toronto, which provides advice to women and health professionals on the safety of drugs during pregnancy and breastfeeding.

"Use of acetaminophen in low dose over a short period of time is safe. If women need a medication for longer period of time, she should see her physician. There may be an issue there."

The database findings run counter to acetaminophen's long track record of use worldwide, Koren notes."Here comes a database that correlates with very small risk."

In the study, the associations were stronger when the drug was used for more than one trimester.

ADHD can also run in families, a variable that wasn't fully accounted for in the study.

"Findings from this study should be interpreted cautiously and should not change practice," concludes an accompanying editorial by psychiatric researcher Miriam Cooper and colleagues at Cardiff University in the United Kingdom.  "However, they underline the importance of not taking a drug's safety during pregnancy for granted."

Other pain relievers, such as Aspirin and ibuprofen, can increase the risk of bleeding, Koren said. 

The researchers considered why women were taking the drugs, such as fever, infections and inflammatory conditions, but there could be other reasons, Cooper said.

For pain in pregnancy, non-medical options include massage, heat, and physiotherapy.

The study was funded by the Danish Medical Research Council.

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Social media affecting teens' concepts of friendship, intimacy

Social media is affecting the way kids look at friendship and intimacy, according to researchers.

The typical teenager has 300 Facebook friends and 79 Twitter followers, the Pew Internet and American Life project found in its report, Teens, Social Media, and Privacy.

And some have many more.

The 2013 study also says the norms around privacy are changing, and the majority of teens post photos and personal information about themselves for all their on-line contacts to see.

More recent survey data released last week by the Canadian non-profit digital literacy group MediaSmarts shows Canadian youth do take some steps to protect their privacy - for example, by not posting their contact information on social media.

How do you help kids manage or curb their screen time? Kids, what do you think it would it be like to put down your screens for a week? Send your tips and suggestions to community@cbc.ca or tweet us with the hashtag #CBCRewired.

But the paper, Online Privacy, Online Publicity, also points out that most kids have only a limited understanding of things such as privacy policies, geo-location services and the implications of sharing their passwords. 

The research contributes to an emerging picture of how teens' ideas about friendship and intimacy have been influenced by their immersion in the on-line world, says Patricia Greenfield, a UCLA developmental psychologist and the director of the Children's Digital Media Center @ Los Angeles.

In her own research, Greenfield has found that young people feel socially supported by having large networks of on-line friends, and these are not necessarily friends they ever see face-to-face.

"We found in our study that people, college students, are not getting a sense of social support from being on the phone. They're getting social support through bigger networks and having a sense that their audience is large."

Patricia Greenfield, a UCLA developmental psychologist, has seen a decline in intimate friendships between young people as a result of their use of social media. Instead, many young people now derive personal support and affirmation from "likes" and feedback to their postings. (CBC)

The result is a decline in intimate friendships, Greenfield says. Instead, many young people now derive personal support and affirmation from "likes" and feedback to their postings.

"The whole idea behind intimacy is self-disclosure. Now they're doing self-disclosure to an audience of hundreds."

Other research at UCLA shows teens' increasingly preferred mode of communication with their friends, texting, makes them feel less connected and bonded than face-to-face communication.

Graduate student Lauren Sherman studied various forms of communication between pairs of friends. She found the closer the experience was to in-person conversation, the more emotionally connected the friends felt. For example, video chat rated higher than a phone call, but the phone created a closer connection than texting.

"I don't think digital communication in itself is a bad thing," said Sherman, "but if we're losing out on opportunities to connect with people as well as we can, that's a problem."

Studies have estimated teens typically send more than 3,000 texts a month.

Greenfield says that indicates kids are opting for efficiency of connection over intimacy.

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Vitalité Health Network informs patients of privacy breach

The Vitalité Health Network is informing some patients their personal medical records were accessed without authorization.

The privacy breach was discovered a year ago.

A doctor at the Dr. Georges-L.-Dumont University Hospital Centre gained unauthorized access to patient information, ranging from diagnosis to medicare number and address. (CBC)

​"We wish to assure you that the privacy of personal information and personal health information has been our priority in all decisions in this matter," a letter sent to patients earlier this month states.

A doctor with the Dr. Georges-L.-Dumont University Hospital Centre gained unauthorized access to the files using two hospital computers between Sept. 6, 2010 and Nov. 30, 2012, the letter signed by Vitalité CEO Rino Volpé states.

The compromised information could include the reason a patient was referred, the types of tests or examinations the patient underwent, the results, and the diagnosis, according to the three-page letter.

It could also include their medicare number, as well as demographic information, such as name, age, address, and telephone number.

"Since the discovery of this access, Vitalité Health Network has taken corrective action to protect patients' personal information and has implemented restrictions and monitoring governing the physician's access," Volpé states in the letter.

"To date, no proof or facts have emerged to suggest that the information was shared or used in any other manner," he said.

"We also envisage taking the appropriate disciplinary action under the circumstances."

Vitalité officials refused to say whether the doctor is still working at the Dr. Georges-L.-Dumont University Hospital Centre.

The regional health authority is expected to speak publicly about the case on Tuesday.

There were 142 incidents of unauthorized access, New Brunswick's Privacy Commissioner Anne Bertrand told CBC News on Monday. She declined to say whether that meant 142 patients were involved.

Bertrand was notified by Vitalité about the privacy breach last March — one month after the regional health authority became aware of the situation.

"The fact that there was an allegation that a doctor was having … access that might be unauthorized at the time really raised an alarm," said Bertrand, whose office is investigating.

"Patient health records that contain the most private personal information a person can hold — it goes to the very heart of how we want to run our health care system here in New Brunswick," she said.

"Patients have to feel comfortable to share their information with their doctors, with their nurses, with the hospitals, with the health care centres. And if there is any kind of reservation on that part, [they're] not going to be that forthcoming."

Bertrand expects to release a full report on the case within a few months.

It's unclear why the doctor wanted people's personal information, but experts in health policy say there could be many reasons.

"It may be merely out of interest. It may be that the physician was wanting to sell the information to an insurance company, to a pharmaceutical corporation. There are lots and lots of reasons," said Elaine Gibson, a professor at Dalhousie University's Health Law Institute.

The Dr. Georges-L.-Dumont University Hospital Centre is one of the province's largest hospitals.

"Vitalité deeply regrets the incident and offers its most sincere apologies for any inconvenience it may have caused you," the letter to affected patients states.

Patients are encouraged to contact the privacy office of Vitalité if they want more information.

They may also file a complaint with the privacy commissioner if they are dissatisfied with the investigation and follow-up, it states.

There are 180 doctors at the Dr. Georges-L.-Dumont University Hospital Centre.

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Polio-like disease appears in California children

An extremely rare, polio-like disease has appeared in more than a dozen California children within the past year, and each of them suffered paralysis to one or more arms or legs, Stanford University researchers say. But public health officials haven't identified any common causes connecting the cases.

The illness is still being investigated and appears to be very unusual, but Dr. Keith Van Haren at Lucile Packard Children's Hospital at Stanford University warned Monday that any child showing a sudden onset of weakness in their limbs or symptoms of paralysis should be immediately seen by a doctor.

"The disease resembles but is not the same as polio," he said. "But this is serious. Most of the children we've seen so far have not recovered use of their arm or their leg."

'At the moment it does not appear to represent a major epidemic but only a very rare phenomenon.'- Dr. Keith Van Haren, Lucile Packard Children's Hospital

But doctors are not sure if it's a virus or something else, he said. Van Haren said he has studied five cases from Monterey up through the San Francisco Bay Area, including two that were identified as the disease enterovirus-68, which is from the same family as the polio viruses. He said there have been about 20 cases statewide.

"We want to temper the concern, because at the moment, it does not appear to represent a major epidemic but only a very rare phenomenon," he said, noting similar outbreaks in Asia and Australia.

But for some children, like Sofia Jarvis, 4, of Berkeley, rare doesn't mean safe.

She first developed what looked like asthma two years ago, but then her left arm stopped moving, and it has remained paralyzed ever since.

"You can imagine. We had two boys that are very healthy, and Sofia was healthy until that point," said her mother, Jessica Tomei. "We did not realize what we were in store for. We did not realize her arm would be permanently paralyzed."

Van Haren, who diagnosed Sofia, said polio vaccines do not protect children from the mystery disease, but he stressed that it is still important for children to receive that vaccine.

Dr. Jane Seward of the Centers for Disease Control and Prevention in Atlanta said Monday that the research is still underway in California, and there are a variety of infectious diseases that can cause childhood paralysis.

Any of a number of illnesses could be at work, and it's possible some of the cases had one infection and some had another. Regarding the presence of EV-68 in at least two cases, "it could be an incidental finding," Seward said.

Jeff Jarvis of Berkeley, Calif., holds his 4-year-old daughter, Sofia Jarvis, one of a handful of California children who has been diagnosed with a rare polio-like syndrome that has left her arm paralyzed. (Martha Mendoza/Associated Press)

Until officials get more information, Seward said they are not looking around the U.S. for similar cases of EV-68.

The California Department of Public Health has not identified any common causes that suggest that the cases are linked, said Dr. Gil Chavez, the deputy director of the Center for Infectious Disease and state epidemiologist.

"Physicians and public health officials who have encountered similar illnesses have submitted 20 reports to CDPH, and CDPH has conducted preliminary tests on 15 of these specimens," he said. "Thus far, the department has not identified any common causes that suggest that the cases are linked."

University of California, San Francisco, neurology professor Emmanuelle Waubant said doctors believe, but don't have proof, that it's a virus that for most children shows up only as a benign cold. She said a few children, due to their biological makeup, are having much more serious symptoms and she hoped doctors would look for them.

"For a lot of the neurologists who have trained in the last 30 years, it's extremely rare to see polio or polio-like syndrome," she said.

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Sports drinks unnecessary, counterproductive for most people

If you're grabbing a sports drink to replenish your electrolytes after exercise, you could actually be working against your workout.

A CBC Marketplace investigation found that the vast majority of Canadians don't exercise hard enough to need the colourful drinks, and an average workout does not deplete the body enough to require additional energy and electrolytes.

"The benefit of getting physically active – [which] improves your body composition, makes you healthier, makes you fitter and all that – that's fantastic, but unfortunately, drinking sugary, salty drinks actually does the opposite to the average person," sports physiologist Dr. Greg Wells told Marketplace co-host Tom Harrington.

WATCH 

Marketplace's episode Farther, Faster, Fitter? airs Friday at 8 p.m. (8:30 p.m. in N.L.). Follow the conversation on Twitter by using the hashtag #sportperformance.

What's more, sports drinks can be high in sugar and sodium. Gatorade's Glacier Cherry Perform drink contains 41 g of sugar per serving -- more than 10 teaspoons of sugar -- and 330 mg of sodium, more than a McDonald's medium fries and more than a serving of Doritos Cool Ranch chips.

Marketplace teamed up with Canadian Olympians Clara Hughes and Simon Whitfield to investigate popular products -- including sports drinks, protein bars and high-tech running shoes -- that promise to enhance athletic performance. The full investigation, Farther, Faster, Fitter? airs Friday at 8 p.m. (8:30 p.m. NL) on CBC Television.

Performance product trials

Sports drinks promise to rehydrate, provide energy to muscles in the form of sugar and replenish electrolytes lost during exercise. Canadians guzzle more than $450 million in sports drinks every year.

Popular choices such as Gatorade are extensively promoted for their ability to help athletes refuel. Gatorade boasts their beverage is "scientifically formulated" and will "provide optimal quantities of sodium, potassium and carbohydrate to support exercise." Powerade promises an "advanced electrolyte system designed to help replenish four electrolytes lost in sweat."

Electrolytes are minerals, such as potassium and sodium, that carry an electrical charge and are important for body function. They can be depleted through sweat during intense exercise over a long period of time or in the hot sun.

Canadian Olympic medallist Simon Whitfield joined CBC Marketplace's investigation on sports performance products, including sports drinks, protein bars and high-tech running shoes. (CBC)

To test how many electrolytes are actually lost during exercise, Marketplace recruited a team of recreational runners and tested their blood before and after a 45-minute run. None of the runners depleted either their glucose or electrolyte levels enough to require a sports drink to replenish them. In many cases, electrolyte and glucose levels increased in the blood. The test revealed that they could have benefited from water alone.

Wells, who is a researcher with the Human Physiology Research Unit at the University of Toronto and has worked with elite athletes, says that the body is very good at providing itself with what it needs to fuel moderate exercise.

"Your body is very, very good at making the changes it needs to make in order to keep you exercising safely all on its own," he says.

Marketplace also tested the blood of an elite triathlete during intense cycling and discovered that it would take about two hours of strenuous activity before she would benefit from the electrolytes in a sports drink.

Sports drinks popular with kids

Promoted by professional sports stars such as Sidney Crosby and LeBron James, sports drinks are a popular choice among young athletes.

The Canadian Paediatric Society recommends the use of sports drinks for young athletes when they are exercising in intense heat and humidity or for longer than 60 minutes, but it also cautions against overuse.

"For non-athletes, routine ingestion of carbohydrate-containing sports drinks can result in consumption of excessive calories," the group warns, "increasing the risks of overweight and obesity, as well as dental caries and, therefore, should be avoided."

Wells cautions that younger kids shouldn't be using sports drinks for normal sports activities. "We know that children don't sweat as much as adults do," he says. "So, they don't actually need it as much as adults do. And kids' events are typically shorter and not long enough to require them. We're giving our kids a lot of sugar, lots of salt, so we need to be very, very careful with that."

Helpful for intense exercise only

"Sports drinks are marketed as beverages formulated for athletes and those who are physically active," the Canadian Beverage Association (CBA) wrote in a statement to Marketplace.

"Hydration is essential for good health, and science shows that the water, carbohydrates and electrolytes in sports drinks provide significant hydration and athletic performance benefits for active individuals."

Canadian Olympic medallist Clara Hughes teamed up with Marketplace to investigate the claims behind popular sports performance products. (CBC)

The CBA also notes that sodium in sports drinks is an electrolyte that helps enhance fluid absorption, and while many drinks do contain sugar to fuel muscles, many companies "also provide a wide variety of low and no calorie hydrating beverages so that consumers can choose the product that is right for them depending on activity levels and caloric needs."

Wells agrees, to a point. "Sports drinks are fantastic for keeping electrolytes levels well, rehydrating you and giving you sugar that you need to exercise," he says. "But the average person, in a gym, typical spin class, yoga class, going to lift some weights, you need water."

Wells says that while sports drinks are widely available, they're only really helpful to a small minority of athletes. "Eighty-five per cent of Canadians don't get enough exercise to begin with, so they don't need sports drinks. The remaining 15 per cent that actually do exercise, you probably have one or two per cent exercising really hard, really intensely enough to really need those sports drinks. In that group, probably a small subset of them are exercising long enough to need it."

"In the scientific community, we generally don't recommend sport drinks for anything less than 90 minutes, if you are exercising really intensely, if you are exercising in the heat, if you are exercising for a very long period of time."

Wells says most of us are better off with water. "An average person like you, during a workout, you need to be drinking a lot of water; that's pretty much all your body needs. That's what your body needs for your muscles to work really, really well. That's what your blood needs to circulate really well."

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Superbug outbreak reports at Canadian hospitals not shared

A potentially deadly class of superbug has some Canadian hospitals stepping up screening, as infectious disease experts call for a reliable national warning system to report outbreaks.

At Fraser Health in B.C.'s Lower Mainland, hospitals have intermittently found cases of multidrug-resistant bacteria called Carbapenem resistant enterobacteriaceae or CRE. From summer 2012 until the end of 2013, 41 affected patients have been identified.

David Ricci, who picked up a superbug infection in Calcutta, says doctors had to resort to surgical treatment from the pre-antibiotic era. (Courtesy David Ricci)

The overall group of bacteria normally live in the human digestive system. If those bacteria get into the wrong areas of the body, such as the blood or bladder, severe infections can occur. Some of these bacteria also have enzymes that give them resistance to last-resort antibiotics called carbapenems. The director of the U.S. Centers for Disease Control last year called the superbugs "nightmare bacteria."

"To reduce the risk of the organism spreading, Fraser Health is currently implementing a screening process for all patients admitted into our hospitals, particularly those being treated in our intensive care units," a spokeswoman for Fraser Health said in an email to CBC News on Thursday.

"The screening process will involve asking whether or not patients have been admitted into a hospital or received renal dialysis outside of Canada within the past six months. Anyone who answers yes to the screening question will be tested for CRE."

The screening is important in treating patients such as David Ricci, 22, of Seattle, who was infected with CRE in 2011. Ricci was taking a shortcut to his volunteer job at an HIV/AIDS clinic in Calcutta when his leg was pinched under a train in an accident, severing the arteries.

After he was airlifted home for treatment, doctors were in the dark about how to treat the thigh infection once they discovered he tested positive for CRE.

"The antibiotics that they did have didn't do anything. The only way to remove the infection was to surgically cut it out," Ricci said. He now has a prosthetic leg and is studying with the goal of going to medical school for a career in infectious disease.

In the U.S, the CDC maps states with confirmed cases of CRE.

"There's not a lot of apparent and transparent information available in Canada yet," said Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta in Edmonton. "Perhaps because of fear of alienating the public and creating a crisis of confidence in the public, there is a bit of a tendency to try and minimize issues like this and try to avoid widespread knowledge about such outbreaks."

To have a culture of safety, information about outbreaks and how the risks are being managed needs to be communicated, Saxinger said.

"Often these outbreaks may be occurring and we don't even know about them," said Dr. Michael Gardam, an infectious disease specialist at Toronto General Hospital.

When hospitals across Canada are left unaware of cases at other Canadian hospitals, they don't screen for CRE, and people who are colonized and not ill can spread the resistant bacteria to other patients and health-care workers, Gardam said.

"We're looking at potentially expanding that [beyond travellers] and starting to screen all patients coming to certain parts of the hospital," such as the ICU, he said, since travel history alone may no longer reflect the risk. The goal is to stay one step ahead of resistant bacteria.

The Public Health Agency of Canada has limited surveillance of 57 mainly teaching hospitals. The agency's latest published data shows three deaths where CRE was the main or contributing cause of death between 2010 and 2012. There were 160 cases reported during that period.

The national information doesn't provide real-time information that doctors want, Gardam said.

In the U.S., several states have CRE surveillance set up and Europe is a little farther ahead, Saxinger said. 

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'I'm dying:' Woman seeks $60K online for eating disorder care

Canadians with eating disorders can face such long wait times for publicly funded treatment spots that many patients depend on personal assets and private funding to get access to facilities.

Many end up with deep debt after emerging from treatment for psychological disorders. So Ingrid Davidson has turned to online fundraising at Indiegogo to generate cash to pay for her care.

"I'm dying ... and there's no help," says Ingrid Davidson, a 23-year-old diagnosed with anorexia, depression and an anxiety disorder. 

"It makes me so upset that so many people are suffering so greatly, and there is no help — unless they're able to wait for months for funded treatment or they're able to pay."

According to the National Eating Disorder Information Centre, the prevalence of anorexia (self-starvation) and bulimia (binging and purging) is estimated to be 0.3 per cent and one per cent among adolescent and young women, respectively.

"Prevalence rates of anorexia and bulimia appear to increase during the transition from adolescence to young adulthood," says the centre, a non-profit organization that raises awareness about the different types of eating disorders, including through its Eating Disorder Awareness Week that starts Feb. 2 this year.

Davidson, who has relapsed into an eating disorder first diagnosed in 2009, is now living in a Hamilton hospital and hopes to use the campaign to generate $60,000 for specialized private in-patient treatment before the disorder kills her.

Davidson admitted herself to the hospital when she learned a publicly funded outpatient program couldn't accept her until March. While she didn't want her precise weight revealed, her body mass index dropped below what is considered a healthy range.

She is enrolled in the hospital's mood disorders inpatient program, which helps patients control mood disorder symptoms. But, she says it is not equipped to deal with her severe eating disorder. St. Joseph's Healthcare only has an outpatient eating disorder program, which offers weekly group therapy sessions.

Davidson says she's accustomed to long waits for publicly funded spaces. It once took about a year and a half for her name to move to the top of Homewood Health Centre's wait list for an in-patient eating disorders treatment program. At Homewood, patients get weighed regularly, eat supervised meals in a communal dining hall and attend multiple therapy groups daily.

Scarcity of publicly funded spaces

Homewood, Canada's largest in-patient treatment centre for people with eating disorders, has 21 beds allotted for patients struggling with eating issues, centre spokesman Ric Ament wrote in an email.

Ward beds are fully funded by OHIP, Ontario's health insurance program​. Beds in semi-private or private rooms carry additional costs of $260 a day and $310 a day, respectively, for Ontario patients, who must pay the added costs or have their supplementary health insurance plans do so, Ament wrote.

Ingrid Davidson's struggle with her eating disorder started during her first year of university when she searched for something to make her feel in control. (Ingrid Davidson)

Ament declined to specify how many of each bed exist in the program, but said there were more semi-private and private beds than publicly supported ward beds.

The waiting list both for privately and publicly funded beds is generally long, he wrote.

In Manitoba, CBC News has learned, patients can wait up to a year for publicly funded treatment — even in an outpatient program.

The Ontario Ministry of Health and Long-Term Care has made steps towards improving wait times. It has almost tripled its investment in eating disorders treatment since 2003-04, wrote ministry spokesman David Jensen in an email.

Thanks to the funding, the province will have the most publicly funded beds for in-patient treatment in Canada, he wrote — 24 adult beds and 24 pediatric beds. Jensen did not say how many beds currently exist or when the new beds will be available.

Private treatment costs thousands

The scarcity of beds makes long wait times, like Davidson's, "very typical," said Aziza Kajan, an employee at Hope's Garden, a support centre in London, Ont., for people with eating disorders.

The centre's site lists average wait times for various programs across Canada, ranging from several weeks to years depending on the intensity of treatment.

Patients willing to pay out of pocket or with supplementary health insurance for treatment at Homewood wait about two to five months before being admitted, according to the centre's site, while patients relying on OHIP wait between two and three years.

Kajan explains this discrepancy by saying fewer people can afford to pay privately, so the queue is shorter, while there's a backlog for in-demand publicly funded spaces.

Long wait times for publicly funded spots mean people who need treatment but can't afford to pay for it themselves don't get the help they need, said Kajan.

$35K of debt for 1st bout of treatment

In 2012, when Homewood finally offered Davidson a spot after about 18 months of waiting, she learned it was not for one of the coveted OHIP-funded beds. Her treatment would cost about $35,0000.

Davidson's mother, 55-year-old home-care worker Susan Nelson, acquired a line of credit to pay for her daughter's treatment. Others chipped in to pay for some of the treatment as well.

"It was at the point where I was dying and we had no option," Davidson says of her mother's sacrifice. Her mother is now "seriously in debt."

Davidson spent 3-1/2 months at Homewood, and left the healthiest she had ever been.

"My head was in such a different place," she recalls, explaining how she was no longer constantly preoccupied with food. "It was so different, so different. It was amazing."

But she quickly relapsed, unable to find enough support from services after Homewood's 24/7 care.

Ingrid Davidson now weighs less than she ever has since her eating disorder started in 2009. She fears she won't survive until a spot in a publicly funded treatment program opens up for her. (Ingrid Davidson)

While she waited two months for another bed to open up at Homewood, Davidson's eating disorder escalated. Sometimes she would go as long as 72 hours without eating.

"I was almost dead," she explains. "I could have had a heart attack really easily."

She spent December 2012 in Homewood's care, but her mother couldn't afford to pay for further treatment.

After she left, she continued seeing a psychologist, but wasn't making much progress. She moved to Toronto and was put on a wait list for an outpatient program at a hospital. The program can't accommodate her until March, she says.

"I honestly don't think I would make it," she says. "I really, really don't think that I would make it until March."

$60K fundraiser a last resort

Even if she did, Davidson is convinced the outpatient day program won't be enough support for the severity of her illness and that another extended stay is her best chance for a full recovery.

'This is one of the worst feelings any parent can imagine.'- Susan Nelson, Ingrid Davidson's mother

Homewood has told Davidson and her mother that a spot could become available in the next several weeks.

"This is one of the worst feelings any parent can imagine," Nelson wrote on Indiegogo for the fundraising campaign, which she hopes raises $60,000 by Feb. 27. So far, nearly $33,000 has been raised.

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Morning-after pill under review by Health Canada

Health Canada says if it decides action needs to be taken, it will work with manufacturers to update labels on emergency contraception and inform consumers. (CBC)

Health Canada says it is studying the effectiveness of the so-called "morning after" contraceptive pills in the wake of
news they aren't as effective in larger women.

The federal drug regulator says it is assessing new data that suggests a higher body weight could reduce the effectiveness of emergency contraceptives.

Health Canada says it is also looking at whether labelling changes are needed for all brands of the pills to reflect the
problem.

The department's statement comes two months after French manufacturer HRA Pharma announced its emergency contraception pill doesn't work in women who weigh more than 176 pounds.

There are four brands of morning-after pills available without prescription in Canada: Next Choice, from Cobalt Pharmaceuticals; HRA Pharma's Norlevo; Option 2, from Perrigo International and Plan B from Women's Health Inc.

Health Canada says if it decides action needs to be taken, it will work with manufacturers to update labels and inform consumers.

The pills contain higher levels of levonorgestrel than standard oral contraceptives and work by preventing ovulation or
fertilization of an egg. They can be taken up to 72 hours after unprotected sex or a contraceptive accident such as a condom breaking.

The pills do not have any impact if a woman has already become pregnant.

Health Canada says it is aware of a recent statement from the European Medicine's Agency alerting consumers to the fact that Norlevo's labelling had been altered to make reference to the observation that weight affects the efficacy of the medication.

The added wording says the pill's efficacy is reduced in women weighing 75 kgs or more, and the pill doesn't work for women who weigh more than 80 kgs.

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