Morning-after pills less effective for heavier women, warning will say

Since the French contraceptive maker HRA Pharma alerted women that its morning-after pill is ineffective when taken by women who weigh more than 80 kilograms or 176 pounds, label changes were phased in. (Remy de la Mauviniere/Associated Press)

Emergency contraceptives or "morning-after" pills will soon carry a warning about their reduced effectiveness in heavier women, Health Canada says.

The regulator said it's asked four companies selling emergency contraceptives to add labels to their packaging to alert women that the pills are less effective in women weighing 165 to 176 pounds and are not effective in women over 176 pounds.

Doctors say women can take emergency contraceptives, ideally within 72 hours after unprotected sex or a contraceptive accident, such as a condom breaking.

These emergency contraceptive brands are available without a prescription in Canada:

• Next Choice (Cobalt Pharmaceuticals Company).
• Norlevo (Laboratoire HRA Pharma).
• Option 2 (Perrigo International).
• Plan B (Teva Women's Health Inc.)

Health Canada said it's evaluated new data from Laboratoire HRA Pharma and approved the company's submission to update the packaging and labelling for Norlevo with the new warning over the next several months.

The regulator has also asked the other three Canadian manufacturers to update the labels and packages for their products.

The pills contain higher levels of levonorgestrel than standard oral contraceptives. They work by preventing ovulation or fertilization of an egg.

In December 2013, French drug maker HRA Pharma warned its morning-after pill may be less effective in women who weigh more than 165 pounds and the medication is ineffective in women who weigh more than 176 pounds.

Women who weigh more than 165 pounds are advised to speak to a doctor or pharmacist about alternative methods of emergency contraception.

During the transition, current packages will stay on pharmacy shelves.

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Priority surgeries demand adds to wait time pressure

As degenerative arthritis is becoming increasingly common among those aged 55 to 65, the need for knee replacements is growing.

More Canadians are being referred for priority surgeries, which is increasing pressure on provinces trying to reduce wait times, says a new report.

Thursday's report from the Canadian Institute for Health Information, Wait Times for Priority Procedures in Canada, 2014, focuses on five priority areas for all provinces:

• Knee replacement.
• Hip replacement.
• Hip fracture repair.
• Cataract surgery.
• Radiation therapy.

"Over the past three years, wait times for priority procedures have remained virtually unchanged, while the number of procedures has continued to rise," the report's authors wrote.

"Ensuring that all patients receive priority procedures in a timely manner will continue to be a concern in the years ahead, especially since the number of patients continues to  grow."

Canadian doctors continued to meet higher demands, performing between five per cent and 17 per cent more procedures in 2013 than three years earlier.

Despite the effort, some patients are waiting longer than recommended.

For example, while half of patients received a knee replacement in 104 days, one out 10 waited 263 days or more.

Degenerative arthritis from the chronic breakdown of cartilage was the reason why 97 per cent of knee replacements were needed. The Arthritis Society notes degenerative arthritis is becoming increasingly common among those aged 55 to 65.

The Canadian Institute for Health Information says that for the first time, all provinces reported that at least 90 per cent of patients receiving radiation therapy were treated within 28 days.

Provinces are now turning to other cancer areas, such as cancer surgery wait times. Half of breast cancer surgery patients were treated in less than three weeks. Prostate cancer surgery patients waited longer than other cancer surgery patients, although the growing popularity of "watchful waiting" suggests men may have similar survival rates for the often slow-growing malignancy.

Over the last three years for cataract surgery, P.E.I., Ontario and Manitoba saw a decline in the proportion receiving the procedure within the 16-week benchmark for the procedure while Newfoundland and Labrador, Nova Scotia, Saskatchewan, Alberta and B.C. improved.  

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Smoking bans tied to reduced childhood asthma

Public smoking bans improve the health of children, say researchers who found fewer preterm births and hospital visits for childhood asthma attacks after those bans were enacted in North America and Europe.

Second-hand smoke is linked to stillbirth, preterm birth, birth defects, asthma and respiratory infections. Researchers recognized that laws against smoking in public places such as restaurants and work places could help but there hasn't been an in-depth check of how well the bans protect children.

Only a small minority of the world's population is covered by broad smoke-free laws.

In Friday's online issue of the medical journal The Lancet, researchers examined the effect of smoke-free legislation on child health by combing through five studies in North America and six European studies that described national bans.

The studies included more than 2.5 million births and more than 247,000 asthma-related visits to hospital.

"Pooled estimates suggest that rates of both preterm birth and pediatric hospital admissions for asthma were reduced by 10 per cent," after smoke-free legislation was introduced, Aziz Sheikh, the study's senior author and a physician-researcher at Brigham and Women's Hospital in Boston and his Dutch and Belgian co-authors concluded.

The researchers called smoking bans a cost-effective way to protect the health of children.

While 40 per cent of children worldwide regularly breathe second-hand smoke, the study's authors said only a small minority of the world's population is covered by broad smoke-free laws.

They added that while the findings point to the health potential of expanding smoke-free laws, the promise might need to be "tempered," given enforcement challenges and smoking patterns at home. 

The Public Health Agency of Canada's website says children regularly exposed to second-hand smoke are more likely to suffer damage to their lungs and to develop breathing problems such as asthma.

The research was funded by the Thrasher Research Fund, Lung Foundation Netherlands Long Term Fellowship, Maastricht University Medical Centre, and International Pediatric Research Foundation.

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Rural doctors learn from Alberta's disasters

Rural doctors from across Canada are in Banff this weekend discussing disasters — and two recent examples in Alberta are on the agenda.

The Rural and Remote Medicine Course is run by the Society of Rural Physicians of Canada. It gives rural doctors the chance to come together and share their stories of professional and personal challenges, including the 2011 Slave Lake wildfire and 2013 southern Alberta floods.

"We entered the hospital and there was thick smoke that was just descending all the way from the ceiling down and it was so black that you could taste it in your mouth," said Dr. Alim Nagji, who was finishing his medical residency in Slave Lake, Alta., when the massive wildfire burned through the town.

Dr. Kristine Woodley also shared her story of working at the High River hospital during last June's floods.

"As the water came up, we had to move the sandbags back until it penetrated the hospital," she said. "Then we were done."

The 2013 floods in southern Alberta are the costliest natural disaster in Canadian history, with property damage exceeding $1.3 billion. Several hospitals and regional care centres were forced to close during the flood. (Jonathan Hayward/Canadian Press)

The program is designed to foster stronger networks between rural doctors and their urban counterparts, as well as address common clinical problems and challenges in rural areas.

It also gives many people the opportunity to practice and prepare for emergencies they may not see very often.

"In rural Alberta or rural whatever, they don't see car crashes or really sick patients every single day," said Chad Hegge with STARS air rescue, which runs the portable, robotic patient simulator being used in the program. "This is an opportunity for them to practice in a safe environment."

The program wraps up Saturday.

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Priority surgeries demand adds to wait time pressure

As degenerative arthritis is becoming increasingly common among those aged 55 to 65, the need for knee replacements is growing.

More Canadians are being referred for priority surgeries, which is increasing pressure on provinces trying to reduce wait times, says a new report.

Thursday's report from the Canadian Institute for Health Information, Wait Times for Priority Procedures in Canada, 2014, focuses on five priority areas for all provinces:

• Knee replacement.
• Hip replacement.
• Hip fracture repair.
• Cataract surgery.
• Radiation therapy.

"Over the past three years, wait times for priority procedures have remained virtually unchanged, while the number of procedures has continued to rise," the report's authors wrote.

"Ensuring that all patients receive priority procedures in a timely manner will continue to be a concern in the years ahead, especially since the number of patients continues to  grow."

Canadian doctors continued to meet higher demands, performing between five per cent and 17 per cent more procedures in 2013 than three years earlier.

Despite the effort, some patients are waiting longer than recommended.

For example, while half of patients received a knee replacement in 104 days, one out 10 waited 263 days or more.

Degenerative arthritis from the chronic breakdown of cartilage was the reason why 97 per cent of knee replacements were needed. The Arthritis Society notes degenerative arthritis is becoming increasingly common among those aged 55 to 65.

The Canadian Institute for Health Information says that for the first time, all provinces reported that at least 90 per cent of patients receiving radiation therapy were treated within 28 days.

Provinces are now turning to other cancer areas, such as cancer surgery wait times. Half of breast cancer surgery patients were treated in less than three weeks. Prostate cancer surgery patients waited longer than other cancer surgery patients, although the growing popularity of "watchful waiting" suggests men may have similar survival rates for the often slow-growing malignancy.

Over the last three years for cataract surgery, P.E.I., Ontario and Manitoba saw a decline in the proportion receiving the procedure within the 16-week benchmark for the procedure while Newfoundland and Labrador, Nova Scotia, Saskatchewan, Alberta and B.C. improved.  

22.45 | 0 komentar | Read More

Morning-after pills less effective for heavier women, warning will say

Since the French contraceptive maker HRA Pharma alerted women that its morning-after pill is ineffective when taken by women who weigh more than 80 kilograms or 176 pounds, label changes were phased in. (Remy de la Mauviniere/Associated Press)

Emergency contraceptives or "morning-after" pills will soon carry a warning about their reduced effectiveness in heavier women, Health Canada says.

The regulator said it's asked four companies selling emergency contraceptives to add labels to their packaging to alert women that the pills are less effective in women weighing 165 to 176 pounds and are not effective in women over 176 pounds.

Doctors say women can take emergency contraceptives, ideally within 72 hours after unprotected sex or a contraceptive accident, such as a condom breaking.

These emergency contraceptive brands are available without a prescription in Canada:

• Next Choice (Cobalt Pharmaceuticals Company).
• Norlevo (Laboratoire HRA Pharma).
• Option 2 (Perrigo International).
• Plan B (Teva Women's Health Inc.)

Health Canada said it's evaluated new data from Laboratoire HRA Pharma and approved the company's submission to update the packaging and labelling for Norlevo with the new warning over the next several months.

The regulator has also asked the other three Canadian manufacturers to update the labels and packages for their products.

The pills contain higher levels of levonorgestrel than standard oral contraceptives. They work by preventing ovulation or fertilization of an egg.

In December 2013, French drug maker HRA Pharma warned its morning-after pill may be less effective in women who weigh more than 165 pounds and the medication is ineffective in women who weigh more than 176 pounds.

Women who weigh more than 165 pounds are advised to speak to a doctor or pharmacist about alternative methods of emergency contraception.

During the transition, current packages will stay on pharmacy shelves.

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Cystic fibrosis newborn screening wins father's applause

Newfoundland and Labrador will screen newborns for cystic fibrosis, a move welcomed by a St. John's father who has steadfastly lobbied to have the test done at birth.

"This is really, really important — this is why we lobbied hard over the past year or so. I'm really glad the provincial government stepped up to the plate and listened to our concerns and included this in the budget," said John Bennett, whose four-year-old son has the disease.

John Bennett, 4, was diagnosed with cystic fibrosis at the age of two and a half months. (CBC)

The Newfoundland and Labrador government announced Thursday during the 2014 budget speech that it will allocate $158,800 to expand the Newborn Screening Program.

Bennett's son was diagnosed when he was two and a half months old.

"We went through those two and a half months of not knowing, The issues that John had, relative to he couldn't gain weight," he said. "So I thought of those months, and all the ups and downs that we had as first-time parents, and then I thought about the people down the road, the parents that won't have to go through that. I think that was the biggest thing for me."

Cystic fibrosis attacks the lungs and digestive system, and is the most common fatal genetic disease affecting Canadian children and young adults. There is no cure.

'This is really, really important — this is why we lobbied hard over the past year or so' - John Bennett 

Bennett said some parents wait years for a diagnosis.

"Once cystic fibrosis gets added to the Newborn Screening Program, if there's a diagnosis, that should come back fairly quick. We'll be able to start treatment and medications right away, they will be healthier right away," Bennett said.

"The earlier you get diagnosed, the earlier the treatment can start, you know, medications. It improves height, weight, cognitive function, healthy respiratory function. I mean, the list can go on and on."  

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Smoking bans tied to reduced childhood asthma

Public smoking bans improve the health of children, say researchers who found fewer preterm births and hospital visits for childhood asthma attacks after those bans were enacted in North America and Europe.

Second-hand smoke is linked to stillbirth, preterm birth, birth defects, asthma and respiratory infections. Researchers recognized that laws against smoking in public places such as restaurants and work places could help but there hasn't been an in-depth check of how well the bans protect children.

Only a small minority of the world's population is covered by broad smoke-free laws.

In Friday's online issue of the medical journal The Lancet, researchers examined the effect of smoke-free legislation on child health by combing through five studies in North America and six European studies that described national bans.

The studies included more than 2.5 million births and more than 247,000 asthma-related visits to hospital.

"Pooled estimates suggest that rates of both preterm birth and pediatric hospital admissions for asthma were reduced by 10 per cent," after smoke-free legislation was introduced, Aziz Sheikh, the study's senior author and a physician-researcher at Brigham and Women's Hospital in Boston and his Dutch and Belgian co-authors concluded.

The researchers called smoking bans a cost-effective way to protect the health of children.

While 40 per cent of children worldwide regularly breathe second-hand smoke, the study's authors said only a small minority of the world's population is covered by broad smoke-free laws.

They added that while the findings point to the health potential of expanding smoke-free laws, the promise might need to be "tempered," given enforcement challenges and smoking patterns at home. 

The Public Health Agency of Canada's website says children regularly exposed to second-hand smoke are more likely to suffer damage to their lungs and to develop breathing problems such as asthma.

The research was funded by the Thrasher Research Fund, Lung Foundation Netherlands Long Term Fellowship, Maastricht University Medical Centre, and International Pediatric Research Foundation.

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MP Steven Fletcher says legal doctor-assisted suicide is 'inevitable'

Conservative MP Steven Fletcher says he believes physician-assisted suicide is "inevitable," on the same day he introduced two private member's bills on the issue in the House of Commons.

At a press conference on Thursday on Parliament Hill, Fletcher said it's "something Canadians are demanding more and more of."

"There is a demographic shift that's occurring in Canada where people who have been empowered their entire lives will find themselves not and they will ask for this," Fletcher said. 

"Not every baby boomer is going to die on the golf course," he added lightheartedly. 

Fletcher's bills go against government policy and were seconded by New Democrat critic for disability issues Manon Perreault, who joined him at the press conference, along with Wanda Morris from the organization Dying with Dignity.

One of the two bills deals specifically with the Criminal Code of Canada and would allow doctors to help patients end their lives under very strict circumstances. 

Fletcher said such an option would "only be open to people over the age of 18, competent adults who have a major illness or disability and have made this request numerous times."

The other piece of legislation would set up a commission to monitor a system of physician-assisted suicide across the country. According to Fletcher, it would collect data to create profiles of the people who file requests so that "hopefully we can have better public policy as we go forward."

Commission will 'shed light into the shadows'

The Manitoba MP said there are cases where that is already happening and "it's all sort of done in a nudge-nudge-wink-wink or under-the-table manner and this commission will shed light into the shadows."

"The people who are in these situations won't have to fear their families or the law or the institution," he said. 

"They will be able to die the way they wish."

Fletcher is a quadriplegic, paralyzed from the neck down after a car crash in 1996. He still requires 24-hour attendant care. 

It is unlikely Fletcher will see his bills debated in this session of Parliament, as they fall far down on the order of precedence at number 240. 

Even so, he said it's necessary that the bill is introduced at this time. 

"The reality in Canada is that this issue is going to be decided by the Supreme Court this fall by unelected, unaccountable judges," he said. 

"We should, as parliamentarians, look at this issue as one that affects all Canadians and the people who represent Canadians in Parliament should be able to discuss this issue with respect and understanding and knowledge. We really have not had that debate in Parliament and it's a long time overdue."

Supreme Court revisiting issue

In 1993, Canada's highest court ruled 5-4 on upholding a ban on assisted suicide in the case of Sue Rodriguez, who suffered from Lou Gherig's disease.

The British Columbia Supreme Court ruled in 2012 that provisions against doctor-assisted suicide violated the rights of the gravely ill. The federal government then appealed that decision in order to uphold the ban. 

A B.C. civil liberties association then appealed that ruling all way to the Supreme Court, which agreed in January to revisit the case after more than 20 years. 

Only one Supreme Court justice who ruled on the decades-old case remains on the bench today — Beverly McLachlin, who was one of the dissenters and is now chief justice.

However, alluding to last week's instances in which the Supreme Court overturned government legislation, Fletcher said he never knows what the court is going to do.

"It would be very unfortunate to not even have the debate in Canada before the courts made the decision. The debate may not happen in Parliament, but it is certainly going to happen within Canada and around the kitchen table."

Derailing palliative care strategy

New Democrat ethics critic Charlie Angus said he's worried the "hot button, black and white controversial issue" of assisted suicide will derail conversations about palliative care. 

Angus said the NDP is pushing a national strategy on palliative care, on pain management and providing support to families going through traumatic times. 

"This is the common sense solution staring us in the face. So before we go down the road saying, 'Well, if you're depressed or if you got an incurable illness, you should be able to die,' let's talk about how to help families actually live out those final years with dignity."

Justice Minister Peter MacKay said on Wednesday that he has "tremendous respect" for Fletcher and understands his personal circumstances inform his views on "this very emotional issue."

MacKay said though he's personally "hesitant to re-enter and reopen this debate" at this time, "this is an issue that, by virtue of this private member's bill coming forward, will follow the normal course." 

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Autism estimate increases to 1 in 68 children in U.S.

The U.S. government now estimates 1 in 68 children have autism spectrum disorder, which affect ability to communicate, understand language and relate to others. (David Goldman/Associated Press)

The U.S. government increased its autism estimate on Thursday to 1 in 68 U.S children.

That's a 30 per cent jump from the last federal estimate of 1 in 88 children with autism or a related disorder. The latest calculation means autism is more than twice as common as officials said it was just seven years go.

But health officials say the new number may not mean autism is occurring more often. Much of the increase is believed to be from a cultural and medical shift, with doctors diagnosing autism more frequently, especially in children with milder problems.

There are no blood or biologic tests for autism, so diagnosis is not an exact science. It's identified by making judgments about a child's behaviour.

This latest estimate by the Atlanta-based Centers for Disease Control and Prevention means autism affects roughly 1.2 million U.S. children and teens.

The CDC report released Thursday is considered the most comprehensive on the frequency of autism. Researchers gathered data in 2010 from areas in 11 states — Alabama, Arizona, Arkansas, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, Utah and Wisconsin.

The report focused on 8-year-olds because most autism is diagnosed by that age. The researchers checked health and school records to see which children met the criteria for autism, even if they hadn't been formally diagnosed. Then, the researchers calculated how common autism was in each place and overall.

The CDC started using this method in 2007 when it came up with an estimate of 1 in 150 children. Two years later, it went to 1 in 110.

For decades, autism meant kids with severe language, intellectual and social impairments and unusual, repetitious behaviours. But the definition has gradually expanded and now includes milder, related conditions.

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Morning-after pills less effective for heavier women, warning will say

Since the French contraceptive maker HRA Pharma alerted women that its morning-after pill is ineffective when taken by women who weigh more than 80 kilograms or 176 pounds, label changes were phased in. (Remy de la Mauviniere/Associated Press)

Emergency contraceptives or "morning-after" pills will soon carry a warning about their reduced effectiveness in heavier women, Health Canada says.

The regulator said it's asked four companies selling emergency contraceptives to add labels to their packaging to alert women that the pills are less effective in women weighing 165 to 176 pounds and are not effective in women over 176 pounds.

Doctors say women can take emergency contraceptives, ideally within 72 hours after unprotected sex or a contraceptive accident, such as a condom breaking.

These emergency contraceptive brands are available without a prescription in Canada:

• Next Choice (Cobalt Pharmaceuticals Company).
• Norlevo (Laboratoire HRA Pharma).
• Option 2 (Perrigo International).
• Plan B (Teva Women's Health Inc.)

Health Canada said it's evaluated new data from Laboratoire HRA Pharma and approved the company's submission to update the packaging and labelling for Norlevo with the new warning over the next several months.

The regulator has also asked the other three Canadian manufacturers to update the labels and packages for their products.

The pills contain higher levels of levonorgestrel than standard oral contraceptives. They work by preventing ovulation or fertilization of an egg.

In December 2013, French drug maker HRA Pharma warned its morning-after pill may be less effective in women who weigh more than 165 pounds and the medication is ineffective in women who weigh more than 176 pounds.

Women who weigh more than 165 pounds are advised to speak to a doctor or pharmacist about alternative methods of emergency contraception.

During the transition, current packages will stay on pharmacy shelves.

22.47 | 0 komentar | Read More

Priority surgeries demand adds to wait time pressure

As degenerative arthritis is becoming increasingly common among those aged 55 to 65, the need for knee replacements is growing.

More Canadians are being referred for priority surgeries, which is increasing pressure on provinces trying to reduce wait times, says a new report.

Thursday's report from the Canadian Institute for Health Information, Wait Times for Priority Procedures in Canada, 2014, focuses on five priority areas for all provinces:

• Knee replacement.
• Hip replacement.
• Hip fracture repair.
• Cataract surgery.
• Radiation therapy.

"Over the past three years, wait times for priority procedures have remained virtually unchanged, while the number of procedures has continued to rise," the report's authors wrote.

"Ensuring that all patients receive priority procedures in a timely manner will continue to be a concern in the years ahead, especially since the number of patients continues to  grow."

Canadian doctors continued to meet higher demands, performing between five per cent and 17 per cent more procedures in 2013 than three years earlier.

Despite the effort, some patients are waiting longer than recommended.

For example, while half of patients received a knee replacement in 104 days, one out 10 waited 263 days or more.

Degenerative arthritis from the chronic breakdown of cartilage was the reason why 97 per cent of knee replacements were needed. The Arthritis Society notes degenerative arthritis is becoming increasingly common among those aged 55 to 65.

The Canadian Institute for Health Information says that for the first time, all provinces reported that at least 90 per cent of patients receiving radiation therapy were treated within 28 days.

Provinces are now turning to other cancer areas, such as cancer surgery wait times. Half of breast cancer surgery patients were treated in less than three weeks. Prostate cancer surgery patients waited longer than other cancer surgery patients, although the growing popularity of "watchful waiting" suggests men may have similar survival rates for the often slow-growing malignancy.

Over the last three years for cataract surgery, P.E.I., Ontario and Manitoba saw a decline in the proportion receiving the procedure within the 16-week benchmark for the procedure while Newfoundland and Labrador, Nova Scotia, Saskatchewan, Alberta and B.C. improved.  

22.47 | 0 komentar | Read More

Morning-after pills less effective for heavier women, warning will say

Since the French contraceptive maker HRA Pharma alerted women that its morning-after pill is ineffective when taken by women who weigh more than 80 kilograms or 176 pounds, label changes were phased in. (Remy de la Mauviniere/Associated Press)

Emergency contraceptives or "morning-after" pills will soon carry a warning about their reduced effectiveness in heavier women, Health Canada says.

The regulator said it's asked four companies selling emergency contraceptives to add labels to their packaging to alert women that the pills are less effective in women weighing 165 to 176 pounds and are not effective in women over 176 pounds.

Doctors say women can take emergency contraceptives, ideally within 72 hours after unprotected sex or a contraceptive accident, such as a condom breaking.

These emergency contraceptive brands are available without a prescription in Canada:

• Next Choice (Cobalt Pharmaceuticals Company).
• Norlevo (Laboratoire HRA Pharma).
• Option 2 (Perrigo International).
• Plan B (Teva Women's Health Inc.)

Health Canada said it's evaluated new data from Laboratoire HRA Pharma and approved the company's submission to update the packaging and labelling for Norlevo with the new warning over the next several months.

The regulator has also asked the other three Canadian manufacturers to update the labels and packages for their products.

The pills contain higher levels of levonorgestrel than standard oral contraceptives. They work by preventing ovulation or fertilization of an egg.

In December 2013, French drug maker HRA Pharma warned its morning-after pill may be less effective in women who weigh more than 165 pounds and the medication is ineffective in women who weigh more than 176 pounds.

Women who weigh more than 165 pounds are advised to speak to a doctor or pharmacist about alternative methods of emergency contraception.

During the transition, current packages will stay on pharmacy shelves.

22.46 | 0 komentar | Read More

MP Steven Fletcher says legal doctor-assisted suicide is 'inevitable'

Conservative MP Steven Fletcher says he believes physician-assisted suicide is "inevitable," on the same day he introduced two private member's bills on the issue in the House of Commons.

At a press conference on Thursday on Parliament Hill, Fletcher said it's "something Canadians are demanding more and more of."

"There is a demographic shift that's occurring in Canada where people who have been empowered their entire lives will find themselves not and they will ask for this," Fletcher said. 

"Not every baby boomer is going to die on the golf course," he added lightheartedly. 

Fletcher's bills go against government policy and were seconded by New Democrat critic for disability issues Manon Perreault, who joined him at the press conference, along with Wanda Morris from the organization Dying with Dignity.

One of the two bills deals specifically with the Criminal Code of Canada and would allow doctors to help patients end their lives under very strict circumstances. 

Fletcher said such an option would "only be open to people over the age of 18, competent adults who have a major illness or disability and have made this request numerous times."

The other piece of legislation would set up a commission to monitor a system of physician-assisted suicide across the country. According to Fletcher, it would collect data to create profiles of the people who file requests so that "hopefully we can have better public policy as we go forward."

Commission will 'shed light into the shadows'

The Manitoba MP said there are cases where that is already happening and "it's all sort of done in a nudge-nudge-wink-wink or under-the-table manner and this commission will shed light into the shadows."

"The people who are in these situations won't have to fear their families or the law or the institution," he said. 

"They will be able to die the way they wish."

Fletcher is a quadriplegic, paralyzed from the neck down after a car crash in 1996. He still requires 24-hour attendant care. 

It is unlikely Fletcher will see his bills debated in this session of Parliament, as they fall far down on the order of precedence at number 240. 

Even so, he said it's necessary that the bill is introduced at this time. 

"The reality in Canada is that this issue is going to be decided by the Supreme Court this fall by unelected, unaccountable judges," he said. 

"We should, as parliamentarians, look at this issue as one that affects all Canadians and the people who represent Canadians in Parliament should be able to discuss this issue with respect and understanding and knowledge. We really have not had that debate in Parliament and it's a long time overdue."

Supreme Court revisiting issue

In 1993, Canada's highest court ruled 5-4 on upholding a ban on assisted suicide in the case of Sue Rodriguez, who suffered from Lou Gherig's disease.

The British Columbia Supreme Court ruled in 2012 that provisions against doctor-assisted suicide violated the rights of the gravely ill. The federal government then appealed that decision in order to uphold the ban. 

A B.C. civil liberties association then appealed that ruling all way to the Supreme Court, which agreed in January to revisit the case after more than 20 years. 

Only one Supreme Court justice who ruled on the decades-old case remains on the bench today — Beverly McLachlin, who was one of the dissenters and is now chief justice.

However, alluding to last week's instances in which the Supreme Court overturned government legislation, Fletcher said he never knows what the court is going to do.

"It would be very unfortunate to not even have the debate in Canada before the courts made the decision. The debate may not happen in Parliament, but it is certainly going to happen within Canada and around the kitchen table."

Derailing palliative care strategy

New Democrat ethics critic Charlie Angus said he's worried the "hot button, black and white controversial issue" of assisted suicide will derail conversations about palliative care. 

Angus said the NDP is pushing a national strategy on palliative care, on pain management and providing support to families going through traumatic times. 

"This is the common sense solution staring us in the face. So before we go down the road saying, 'Well, if you're depressed or if you got an incurable illness, you should be able to die,' let's talk about how to help families actually live out those final years with dignity."

Justice Minister Peter MacKay said on Wednesday that he has "tremendous respect" for Fletcher and understands his personal circumstances inform his views on "this very emotional issue."

MacKay said though he's personally "hesitant to re-enter and reopen this debate" at this time, "this is an issue that, by virtue of this private member's bill coming forward, will follow the normal course." 

22.46 | 0 komentar | Read More

Priority surgeries demand adds to wait time pressure

As degenerative arthritis is becoming increasingly common among those aged 55 to 65, the need for knee replacements is growing.

More Canadians are being referred for priority surgeries, which is increasing pressure on provinces trying to reduce wait times, says a new report.

Thursday's report from the Canadian Institute for Health Information, Wait Times for Priority Procedures in Canada, 2014, focuses on five priority areas for all provinces:

• Knee replacement.
• Hip replacement.
• Hip fracture repair.
• Cataract surgery.
• Radiation therapy.

"Over the past three years, wait times for priority procedures have remained virtually unchanged, while the number of procedures has continued to rise," the report's authors wrote.

"Ensuring that all patients receive priority procedures in a timely manner will continue to be a concern in the years ahead, especially since the number of patients continues to  grow."

Canadian doctors continued to meet higher demands, performing between five per cent and 17 per cent more procedures in 2013 than three years earlier.

Despite the effort, some patients are waiting longer than recommended.

For example, while half of patients received a knee replacement in 104 days, one out 10 waited 263 days or more.

Degenerative arthritis from the chronic breakdown of cartilage was the reason why 97 per cent of knee replacements were needed. The Arthritis Society notes degenerative arthritis is becoming increasingly common among those aged 55 to 65.

The Canadian Institute for Health Information says that for the first time, all provinces reported that at least 90 per cent of patients receiving radiation therapy were treated within 28 days.

Provinces are now turning to other cancer areas, such as cancer surgery wait times. Half of breast cancer surgery patients were treated in less than three weeks. Prostate cancer surgery patients waited longer than other cancer surgery patients, although the growing popularity of "watchful waiting" suggests men may have similar survival rates for the often slow-growing malignancy.

Over the last three years for cataract surgery, P.E.I., Ontario and Manitoba saw a decline in the proportion receiving the procedure within the 16-week benchmark for the procedure while Newfoundland and Labrador, Nova Scotia, Saskatchewan, Alberta and B.C. improved.  

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Autism estimate increases to 1 in 68 children in U.S.

The U.S. government now estimates 1 in 68 children have autism spectrum disorder, which affect ability to communicate, understand language and relate to others. (David Goldman/Associated Press)

The U.S. government increased its autism estimate on Thursday to 1 in 68 U.S children.

That's a 30 per cent jump from the last federal estimate of 1 in 88 children with autism or a related disorder. The latest calculation means autism is more than twice as common as officials said it was just seven years go.

But health officials say the new number may not mean autism is occurring more often. Much of the increase is believed to be from a cultural and medical shift, with doctors diagnosing autism more frequently, especially in children with milder problems.

There are no blood or biologic tests for autism, so diagnosis is not an exact science. It's identified by making judgments about a child's behaviour.

This latest estimate by the Atlanta-based Centers for Disease Control and Prevention means autism affects roughly 1.2 million U.S. children and teens.

The CDC report released Thursday is considered the most comprehensive on the frequency of autism. Researchers gathered data in 2010 from areas in 11 states — Alabama, Arizona, Arkansas, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, Utah and Wisconsin.

The report focused on 8-year-olds because most autism is diagnosed by that age. The researchers checked health and school records to see which children met the criteria for autism, even if they hadn't been formally diagnosed. Then, the researchers calculated how common autism was in each place and overall.

The CDC started using this method in 2007 when it came up with an estimate of 1 in 150 children. Two years later, it went to 1 in 110.

For decades, autism meant kids with severe language, intellectual and social impairments and unusual, repetitious behaviours. But the definition has gradually expanded and now includes milder, related conditions.

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B.C. measles outbreak reveals vulnerability of unvaccinated children

Widespread use of the measles vaccine has dramatically reduced the numbers of cases in Canada over the past 45 years. But the recent outbreak in British Columbia is underscoring how the highly contagious virus can very effectively seek out groups of unprotected children.

More than 200 cases of measles have been confirmed in the Fraser Valley, an outbreak health officials have linked to a region east of Vancouver where immunization rates are low in certain school and religious groups.

"It's in those pockets of unimmunized or under-immunized kids where measles can, because it's such an infectious disease …. get into those populations," says Dr. John Spika, director general of the centre for immunization and respiratory infectious diseases at the Public Health Agency of Canada.

The B.C. case appears to be linked to a similar community in the Netherlands that is also not vaccinated, he says.

Cases of measles have also been reported this year in Alberta, Saskatchewan, Manitoba and Ontario, and while many health officials generally talk of a 95-per-cent coverage rate for the measles vaccine across the country, these pockets of lesser protection are prompting concerns.

"There's certainly more religious communities where vaccination is not necessarily supported," says Dr. Kumanan Wilson, a senior scientist at the Ottawa Hospital Research Institute who holds a research chair in public health policy.

"We're also seeing with immigration, people coming from countries where vaccine-preventable diseases are occurring, and that also challenges our protection."

Diseases coming back

Until now, individual decisions not to vaccinate may not necessarily have had a significant impact on the larger population. Through the use of vaccines, people haven't been seeing many examples of disease, and perhaps they have been thinking it's not so important to get vaccinated.

"But of course, when several people start making that decision, then the diseases come back, and we're starting to see that happen," says Wilson.

"We're seeing the measles, we're seeing the mumps, we're seeing pertussis, whooping cough, come back. I think then it becomes apparent that this collective decision by several individuals starts to have a population-level effect."

In Canada last year, there were 83 cases of measles, with about half linked to a community in southern Alberta. The previous year, there were 10 cases.

Spika says the number and size of outbreaks in Canada recently are consistent with, and maybe even smaller than, what was statistically predicted for the country 15 years ago.

"What we're seeing is what one would expect in a country where there are a lot of travellers coming from places where measles has not yet been eliminated."

Public health officials of course hope as many people as possible will turn to vaccination to limit those outbreaks, but it is a complex issue, coming at the crossroads of medicine, personal choice and, for some, religious beliefs.

Public health progress

Health officials have also long argued that vaccination is one of the most significant public health accomplishments in modern times.

"They say it's the second-most effective measure to reduce illness after clean water," says Wilson.

Some diseases have been eliminated through vaccination, including smallpox. Vaccines have also dramatically reduced the number cases of measles, but not everywhere around the globe.

A girl receives a measles vaccine at a makeshift camp housing people displaced by violence at Don Bosco in Bangui, Central African Republic on Jan. 4, 2014, as part of a campaign run by Doctors Without Borders. (Rebecca Blackwell/Associated Press)

​"Measles, fortunately, has been largely controlled in the Western hemisphere, but it is a problem throughout the world particularly in countries where they don't vaccinate and there's a huge burden of illness due to it," says Wilson.

The U.S.-based Centers for Disease Control reported 240,000 deaths worldwide from the disease in 2006. It now says about 330 children die every day from measles, which is just over 120,000 a year.

In Canada, says Spika, the risk of brain infection from measles is one per 1,000 cases. The risk of death is about one in 3,000 cases.

"Even in populations like Canada that are well-nourished, measles is still a serious and deadly disease."

It also spreads very easily.

"It's one of our most infectious viruses," says Wilson. "In an unvaccinated population, for every individual that has measles, another 15 individuals will get infected." With the flu, he says, the corresponding number is two.

Looking for a high uptake

For public health officials, the need for a high uptake on vaccination is clear. But determining just exactly how well covered Canada is with the measles vaccine is not easy.

Generally speaking, officials consider the coverage rate to be about 95 per cent.

But a report last year from UNICEF suggested Canada's childhood immunization rate was stunningly low, coming in at 84 per cent and falling near the bottom of a list of more than 30 countries.

Spika questions the results of that study. "For a variety of reasons related to methodology used, we don't feel those figures truly represent what … our current status in Canada is."

But Wilson sees limitations on the current estimates of coverage and a need for better data.

"We have a hard time actually measuring that, and we don't have a national vaccine registry," something he considers would be important to implement.

Information on diseases like measles is gathered through surveys, and while some jurisdictions may have data on school-age children, they don't have it for those who are younger, an age range in which a lot of outbreaks occur.

The measles virus, seen here through an electron micrograph, is highly contagious and can be spread through coughing and sneezing. (Canadian Press)

Determining whether Canadian vaccination rates are up or down in recent years is problematic. Certainly, in Canada, there hasn't been the falloff that was observed in Britain after parents responded to a now widely discredited report on a possible link between the measles vaccine and autism.

"We haven't seen that kind of drop in relationship to that," says Spika.

But Wilson is sensing more "vaccine hesitancy."

"In the past, people would just get vaccinated," he says. "They would accept what their doctors told them about the importance of it. Now people are considering it more, and unfortunately they're going on the internet and getting a lot of misinformation … and this is making them think twice, delay their vaccination, sometimes forget to get vaccinated."

God's will?

Sometimes the decision not to vaccinate is based on personal attitudes or beliefs.

"We know in some communities getting measles is viewed as something that maybe is God's will," says Spika.

"Others believe that measles strengthens their child's immune status, and that it isn't a dangerous disease because you really don't see much of measles in a place like Canada because of our high rates of coverage."

Public health officials have to try to overcome some of those ideas and beliefs, he says.

But the key to overcoming such ideas, he says, is getting to know the specific concerns of a particular group and coming up with effective messages to help people change their opinion.

Studies have shown that a respectful, collaborative approach is the most effective. "If it becomes confrontational I think you'll see more and more people move toward the anti-vaccine camp," says Wilson.

While vaccination focuses first and foremost on protecting the individual getting the needle, Wilson says people also "need to get vaccinated to protect others."

Some children can't get vaccinated because they have certain diseases that affect their immune system or are vulnerable when they have chemotherapy or cancer.

These children are at "a particular risk of a very serious illness and I think that's a message that really needs to get out there," says Wilson. "I don't know how aware people are of that."

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Happiness challenge may lead to sadness, psychologists warn

The happiness challenge, a trendy online project that asks people to be happy for 100 days in a row, could backfire for some, Canadian psychologists say.

The happiness challenge is based on the premise that happiness is a choice. It asks participants to submit a photo every day of what made them happy, without trying to make others jealous.

100 Happy Days participant Julie Nadeau relished a moment of silence with her children. (CBC)

Julie Nadeau, a mother of three in Ottawa, is into her second week of the challenge. She thought it was an opportunity to slow down and relish the moment.

"I just was able to find a moment where there was silence, a golden minute, something I probably would have missed if I hadn't been on this challenge," Nadeau recalled of an otherwise difficult day at home with a grumpy and sick child.

Taking the time to savour a moment and appreciate what you have to be thankful for while recognizing life isn't "all lollipops and rainbows" works in principle and is encouraged when journalling, said Jamie Gruman, the Guelph, Ont.-based chair of the Canadian Positive Psychology Association.

But Gruman notes there's a risk in chaining yourself to doing it for 100 days straight. For example, self-affirmations such as Stuart Smalley's mock self-help sketches on Saturday Night Live ("I'm good enough, I'm strong enough,  and doggone it, people like me,") tend to backfire for those with low self-esteem.

"I think the main reason it's probably not going to be as effective for a whole bunch of people is because it's a hundred days, and that's a long time to be focus and disciplined," Gruman said. "I think that people can fall off the wagon and feel bad about that, and so maybe cutting back on the number of days might be an effective thing to try."

Trish Bekkers adapted the challenge for her fifth grade class at Musquodoboit Valley Education Centre in Nova Scotia. Instead of posting photos and videos, the students are writing down moments of happiness three or four times a week in class for 50 days.

"We do a lot of things to support positive relations between kids," Bekkers said.

Spending time with family, participating in sports and reflecting on friendships were popular sources of happiness for the students.

"I wanted them to see that it wasn't just the big trips that you take or the electronics that you buy, but it's the little things every day that make you happy."

Student Taylor Newman has learned one lesson from looking back at her journal. "I think doing the moments of happiness you realize that you're actually a lot happier than you think."

A long-term paradox is that the pursuit of happiness is a process that takes time, effort and realistic expectations just like any goal, said Ulrich Schimmack, a psychology professor at the University of Toronto where he researches scientific understanding of happiness.

"Eleanor Roosevelt said happiness is not a goal, it's a byproduct," Schimmack said. "Quite a few people have noted that actively pursuing happiness might actually be counterproductive."

It can be dangerous to be examining "am I as happy as I could be?" every minute, Schimmack cautioned.

"There's clearly constraints. Maybe there are ways to minimize the unpleasant moments and to maximize the happy moments. Our research suggests that this could lead to a small increase but a lasting increase in happiness."

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Canadians pay egg donors on the grey market

It's been illegal for 10 years in Canada to buy sperm or ova, but Radio-Canada's investigative program Enquête has learned that some clinics and agencies are helping infertile couples circumvent the law.

Alexis Rainwater, who lives in Missouri, came to Montreal in August to make a special delivery — her eggs.

Rainwater got $6,500 when she delivered them to an infertile Montreal woman, and said the recipient wanted to keep the transaction confidential at all costs.

"She wanted no paper trail that I had gotten paid. So the attorney was wired the money, and the attorney wired the money to me," Rainwater said.

Canadian law prohibits buying or trafficking eggs, and offenders could face severe penalties, although there is no penalty for selling one's eggs. 

Alexis Rainwater, an American from Missouri, came to Montreal last summer to sell her eggs for $6,500. (Radio-Canada)

Anyone who violates the Assisted Human Reproduction Act could be fined up to $500,000 or face 10 years in jail.

The law has led to a shortage of egg donors, and the trend of cross-border trading seems to be expanding to meet the growing demand.

When an Enquête employee called about 30 fertility clinics across Canada, posing as an infertile woman seeking an egg donor, five clinics referred her to specialized agencies based in the United States.

Many of the agencies send donors to Canada — and some even offer Canadian egg donors.

The legalities surrounding the use of American egg donor agencies are unclear.

Health Canada told Enquête in a written statement that "in general, there may not be any violation of the law if the financial transaction takes place entirely abroad."

Officials at the McGill Reproductive Centre say they prefer to adhere to strict rules.

"When we know that donors were remunerated for the process, we do not accept to take them on for treatment here," said Lise Doiron, a managing nurse that the McGill Reproductive Centre.

The Canadian fertility clinics that referred Enquête's caller to U.S. egg donor agencies refused to comment.

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Morning-after pills less effective for heavier women, warning will say

Since the French contraceptive maker HRA Pharma alerted women that its morning-after pill is ineffective when taken by women who weigh more than 80 kilograms or 176 pounds, label changes were phased in. (Remy de la Mauviniere/Associated Press)

Emergency contraceptives or "morning-after" pills will soon carry a warning about their reduced effectiveness in heavier women, Health Canada says.

The regulator said it's asked four companies selling emergency contraceptives to add labels to their packaging to alert women that the pills are less effective in women weighing 165 to 176 pounds and are not effective in women over 176 pounds.

Doctors say women can take emergency contraceptives, ideally within 72 hours after unprotected sex or a contraceptive accident, such as a condom breaking.

These emergency contraceptive brands are available without a prescription in Canada:

• Next Choice (Cobalt Pharmaceuticals Company).
• Norlevo (Laboratoire HRA Pharma).
• Option 2 (Perrigo International).
• Plan B (Teva Women's Health Inc.)

Health Canada said it's evaluated new data from Laboratoire HRA Pharma and approved the company's submission to update the packaging and labelling for Norlevo with the new warning over the next several months.

The regulator has also asked the other three Canadian manufacturers to update the labels and packages for their products.

The pills contain higher levels of levonorgestrel than standard oral contraceptives. They work by preventing ovulation or fertilization of an egg.

In December 2013, French drug maker HRA Pharma warned its morning-after pill may be less ineffective in women who weigh more than 165 pounds and the medication is ineffective in women who weigh more than 176 pounds.

Women who weigh more than 165 pounds are advised to speak to a doctor or pharmacist about alternative methods of emergency contraception.

During the transition, current packages will stay on pharmacy shelves.

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Newborn hearing screening 'insufficient' in most provinces

Too many Canadian babies aren't being screened for hearing problems at birth, a failure that jeopardizes their future success, say doctors who graded provincial and territorial programs.

Tuesday's report card from Speech-Language and Audiology Canada and the Canadian Academy of Audiologists finds "serious shortcomings" for newborn screening and comprehensive follow-up.

"The difference between early and late diagnosis of permanent hearing loss on a child's life is monumental," Dr. Hema Patel, a pediatrician at Montreal Children's Hospital and a mother of a son with hearing loss, told a news conference on Parliament Hill.

"As a country, we are failing our children."

To reach their full potential, all children deserve access to proper hearing screening and timely intervention, Patel said. The ability to communicate effectively with others is the foundation of a child's social, emotional and educational development.

Extended periods of auditory deprivation can have significant impact on a child's overall brain development, studies suggest.

Newborns are screened for hearing problems using quick and non-invasive tests that are done by a trained technician, ideally before the infant is discharged from the hospital.

The two hearing groups assigned a grade of "insufficient" to most provinces and territories that offer only localized programs or where the programs were considered to be substandard in quality.

British Columbia was the only jurisdiction to earn a grade of "excellent," for screening 97 per cent or more of babies across the province with a carefully designed program with clear standards, follow-up and tracking of births and outcomes.

Ontario, Nova Scotia, Prince Edward Island and New Brunswick were considered "good."

Newfoundland and Labrador, Yukon, Alberta, Quebec, Manitoba, Nunavut, Saskatchewan and Northwest Territories were graded "insufficient."

The report card is meant to encourage all provinces and territories and the federal government to strive for excellence in early hearing detection programs, Patel said.

Internationally, most universal newborn hearing screening programs recommend screening by one month of age, confirmation of the diagnosis by three months, and intervention by six months, according to the Canadian Paediatric Society's 2011 position statement.

The report card was endorsed by the Canadian Paediatric Society,  VOICE for Hearing  Impaired Children and the Elks and Royal Purple of Canada.

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B.C. prescription heroin trial participants ask to keep using

Health Canada granted special permission to continue, but federal government changed rules

The Canadian Press Posted: Mar 25, 2014 4:01 PM PT Last Updated: Mar 25, 2014 4:01 PM PT

Asking for access to prescription heroin 6:57

Asking for access to prescription heroin 6:57

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A lawyer representing several Vancouver drug addicts is asking a judge for an injunction that would allow them access to prescription heroin.

Joseph Arvay says his clients and others were part of a clinical trial that provided them with pharmaceutical heroin.

They were granted special permission by Health Canada to continue to receive the prescription drug after they left the clinical trial, but the federal government then changed the rules to prevent the drug's distribution.

Arvay is asking the judge to essentially force Health Canada to abide by the former rules and allow access to the drug until their case goes to trial.

He says the federal government's "knee jerk" reaction is a violation of provincial jurisdiction over health care and of his clients' charter rights.

Without the prescriptions, Arvay says the addicts will be back on the streets of the Downtown Eastside shooting illegal drugs.

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Ebola virus is scary, but ‘there are far worse diseases out there’

An outbreak of Ebola hemorrhagic fever in the west African nation of Guinea has revived fears of a global contagion, but infectious disease experts say Ebola poses little threat to travellers.

Although Ebola violently attacks the body, it kills up to 90 per cent of those infected and can only be transmitted via bodily fluids, which greatly reduces its ability to spread, says Jay Keystone, a travel physician and professor in the department of medicine at the University of Toronto.

"If we had a case in Canada we'd isolate the case, the patient would live or die, and we'd be highly unlikely to have it transmit," says Keystone.

In terms of transmission, he adds, "there are far worse diseases out there."

The biggest recorded outbreak of Ebola was in 2000 in Uganda, with 425 infected and 224 dying as a result, according to the World Health Organization (WHO). But large outbreaks like this have happened only about once per decade, and most years the WHO records a handful of cases or none at all.

In comparison, according to the WHO, malaria kills 1.2 million people annually, while 100,000 to 120,000 people die every year from cholera.

The Public Health Agency of Canada has posted a list of 32 of the most prominent diseases travellers need to be concerned about.

Mark Tyndall, head of the division of infectious diseases at the Ottawa Hospital, says that worried flyers should consult a travel physician to find out if there are specific health concerns and precautions for the regions they plan to visit.

"We have quite a good network in Canada of travel clinics, and if people are traveling, they should take advantage of these places where people know exactly what [travellers] should be concerned about for different countries," he says.

Here's a look at some of the most infectious diseases around the world.

Food- and water-borne diseases

Countries such as Mexico and Cuba are popular destinations for Canadian travellers, but visitors run the risk of contracting food- and water-borne illnesses due to bacteria such as E. Coli, which can contribute to so-called "traveller's diarrhea," as well as diseases such as hepatitis A, which in extreme cases can lead to liver damage.

A recent outbreak of the Ebola virus in Guinea has killed more than 50 people. (Centres for Disease Control and Prevention)

According to the Public Health Agency of Canada, E. Coli and hepatitis A thrive in "locations with poor sanitation or unsafe food handling practices."

There are immunizations available for hepatitis A.

As for those nasty E. Coli bacteria, Tyndall says "we can't do much about that other than equip people with some antibiotics to take with them in case they get diarrhea."

Tyndall says typhoid fever, a bacterial disease transmitted through food or water contaminated with the feces of an infected person, remains a particular concern in many Asian countries. A typhoid infection typically lasts four weeks, and can include severe stomach pain, internal hemorrhaging and even fits of delirium.

A typhoid vaccine is available, although it is not 100 per cent protective, says Tyndall.

Insect-borne diseases

"Vector-borne" diseases — or diseases transmitted by insects and ticks — affect millions of people every year.

Malaria, the most deadly vector-borne disease, kills more than 1.2 million people annually - mostly African children under the age of five, according to WHO.

Insect-borne diseases such as malaria and dengue fever are typically found in subtropical countries and are transmitted by mosquitoes. Both diseases can produce headaches, joint pain and vomiting, but the latter can develop into dengue hemorrhagic fever, which can lead to significant blood loss.

There is no effective vaccine for either disease.

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Airborne diseases

For many people, the most frightening diseases are those that are transmitted via the air. Spread by coughing and sneezing, measles is one of the most contagious viruses known to science.

Measles, which produces a fever and severe rashes, kills an estimated 122,000 children every year, according to the U.S.-based Measles & Rubella Initiative. Most North Americans are immunized as children against measles, but it remains a major concern in India and southern Africa.

Tuberculosis, another airborne disease, killed 1.3 million people in 2012, according to WHO. It is a leading killer of people with HIV. TB is caused by bacteria that typically affect the lungs, leading to chronic cough, fever and weight loss. Travellers can be vaccinated for TB.

Diseases transmitted by bodily fluids or blood

Although Ebola gets a lot of media attention, the Lassa hemorrhagic fever is far more prevalent, says Jeffrey Lee, an assistant professor in the department of laboratory medicine and pathobiology at the University of Toronto.

The Lassa virus, which is endemic in west African countries such as Sierra Leone, Guinea and Nigeria, infects between a quarter to half a million people a year and kills nearly 10,000 people annually, Lee says.

"With Ebola, we have these [small] outbreaks, but the Lassa virus is definitely more of an emerging virus," he adds.

As with Ebola, there is no vaccine for Lassa.

Like Ebola, human immunodeficiency virus (HIV) is transmitted by bodily fluids — typically through unprotected sex or the sharing of dirty needles. HIV can develop into auto-immune deficiency syndrome (AIDS), which weakens a person's immune system to the point where the body can no longer fight off infection. Although the death rate of HIV/AIDS has dropped significantly in the past decade, it still killed an estimated 1.6 million people in 2012, according to WHO.

HIV is a worldwide health concern, but Tyndall says that given the public awareness of it, he says he "can't remember seeing a return traveller who contracted HIV."

He acknowledges that "there's a lot of risky behaviour that people engage in," but when it comes to HIV, he advises travellers to simply use common sense.

"Whether you're in Canada or Nairobi, you probably don't want to have unprotected sex with people you don't know."

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Dr. Salim Yusuf, Canadian cardiovascular expert, wins Gairdner Award

A Canadian researcher who has spent more than three decades investigating how to prevent and treat cardiovascular
disease among populations around the world is among the winners of the 2014 Canada Gairdner Awards for significant medical research.

Dr. Salim Yusuf, director of the Population Health Research Institute at McMaster University, will receive the Canada Gairdner Wightman Award for leadership in global clinical trials and population studies that have shaped prevention and treatment of cardiovascular disease.

Dr. Salim Yusuf says it's unusual for clinical and population research to be recognized with major awards, despite the direct impact such work has on human health. (Canadian Press)

Yusuf's epidemiological work in about 85 countries has shown that most heart attacks result from similar risk factors, no matter where a person lives. One of the many studies he has led, the HOPE trial, showed that the ACE-inhibitor drug ramipril saved lives by preventing heart attacks and strokes among patients with stable heart disease.

"I was obviously very pleased," he said of the honour, noting that it's unusual for clinical and population research to be
recognized with major awards, despite the direct impact such work has on human health.

Selection committees "usually give them to people who make discoveries of a molecule or an enzyme or genetics," Yusuf said in an interview from Hamilton.

"So in a sense it's a recognition that improving human health is just as important as the elegance of a discovery … I'm pleased because it may be part of a cultural shift in recognizing what is valued in research."

Yusuf, who came to McMaster in 1992 after working at the U.S. National Institutes of Health and Oxford University in England, said the Gairdner may be in his name, but it really pays tribute to the entire international team that has conducted the research.

Recipients of the awards, which were created in 1959, each receive $100,000. Gairdners have been dubbed the "baby Nobels" because more than 80 recipients have gone on to win the world's most coveted scientific prize.

"The Canada Gairdner Awards distinguish Canada as a leader in biomedical research, raising the profile of science both nationally and on the world stage," said Dr. John Dirks, president and scientific director of the Gairdner Foundation. "This year's winners are an exceptional example of highly effective outcomes from translational research."

The winners of five other Gairdners also were announced Wednesday.

The Canada Gairdner International Awards, which recognize individuals from various fields for seminal discoveries or
contributions to medical science, go to:

• James P. Allison of the MD Anderson Cancer Center at the University of Texas in Houston for his development of an antibody that frees "blocked" immune cells so they can attack cancer cells. His discovery resulted in a drug to treat metastatic melanoma, which has also shown promise against prostate, kidney, lung and ovarian cancers.
•  Titia de Lange, Rockefeller University in New York, for her discovery of the mechanisms by which telomeres — the ends of chromosomes — are protected from deleterious DNA repair, which can lead to diseases such as cancer.
• Marc Feldmann and Ravinder Nath Maini, University of Oxford, for their discovery of a drug that protects against a molecule that drives inflammation and joint damage. The genetically engineered agent can reduce pain and improve mobility, without increasing the risk of heart attacks and strokes.
• Dr. Harold Fisher Dvorak, Harvard Medical School in Boston, and Dr. Napoleone Ferrara of the UC San Diego Moores Cancer Center in La Jolla, Calif., for the discovery of a key mediator of blood vessel formation, leading to the development of a therapy for cancer and wet macular degeneration.

The Canada Gairdner Global Health Award, which recognizes a scientific advancement that has had a significant impact on health in the developing world, goes to Satoshi Omura, professor emeritus at Kitasato University in Tokyo.

Omura led a team in the 1970s that discovered the micro-organism Streptomyces avermitilis, which was developed by Merck into the drug ivermectin to treat many parasitic diseases, including river blindness and elephantiasis. Ivermectin is also the drug of choice for treating scabies and head lice, and research is looking at its effectiveness against other tropical diseases.

The awards will be presented at a dinner in Toronto on Oct. 30 as part of the Gairdner National Program, a two-week lecture series given by Gairdner winners at 24 universities from St. John's to Vancouver. The  program makes "the superstars of science" accessible to students across the country, with the goal of inspiring the next generation of researchers.

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Drug-resistant TB infects as many as 32,000 kids globally, study finds

Women and children are attended by a nurse in Kuito, Angola in 2002. A huge proportion of children are suffering and dying from TB unnecessarily, according to a new study. (Marcelo Hernandez/Associated Press)

As many as 32,000 children worldwide become sick each year with a drug-resistant "superbug" strain of tuberculosis, according to new estimates by U.S. researchers that for the first time quantify rates of this difficult-to-treat form of TB.

Overall, as many as 1 million children become sick with TB each year, about twice the number previously thought, and of these, only a third of the cases are ever diagnosed, the study found.

"A huge proportion [of children] are suffering and dying from TB unnecessarily," said Helen Jenkins of Brigham and Women's Hospital's Division of Global Health Equity, the lead statistician on the study.

The findings, published as part of a special theme issue of Lancet to commemorate World TB Day on March 24, offer the clearest picture yet of the global burden of tuberculosis among its youngest victims, and for the first time estimate the burden of multidrug-resistant tuberculosis or MDR-TB.

"Despite children comprising approximately one quarter of the world's population, there have been no previous estimates of how many suffer from MDR-TB disease," said Dr. Ted Cohen, also of the Harvard-affiliated Brigham and Women's Hospital, and a co-author on the paper.

For decades, researchers had largely ignored tuberculosis infections in young children, in part because children are less likely to transmit the disease than adults.

TB infections are especially hard to diagnose in children because the infection looks different in children than adults.

The disease is caused by bacteria that typically attacks the lungs and is often spread through the air when people who have an active infection cough.

Tuberculosis typically attacks the lungs and is spread through the air when people who have an active infection cough.

"In kids, you are much more likely to have TB disease in other parts of the body, not necessarily in the lungs," Jenkins said. Even when children do have TB in their lungs, there are fewer TB pathogens present, "making kids with TB invisible" to current diagnostic methods, she said.

To arrive at their estimates, published on Sunday in the Lancet, Jenkins and colleagues scoured publicly available databases and devised a way to correct for chronic underreporting of TB in children.

"What we found was that whereas previous estimates for the total number of TB cases in kids were about half a million, when you account for [underreporting] in your estimates, it's more like 1 million children develop active TB disease every year," she said.

The World Health Organization estimates that 8.6 million people developed TB in 2012 and 1.3 million died from the disease. According to the WHO, half a million people became sick with dangerous superbug strains of tuberculosis in 2012, it estimates that up to 2 million people worldwide may be infected with drug-resistant TB by 2015.

Keeping track of TB rates in children is important for two reasons, Jenkins said. First, children with drug-sensitive forms of TB generally respond very well to treatment.

Second, because TB disease develops very quickly in children, often within weeks of exposure, finding an infected child can offer key clues about TB transmission within a community.

"That's telling you you've got some kind of system failure going on there," Jenkins said.

She said the findings illustrate the need for better methods of collecting data on childhood TB, including better diagnostics and more systematic data collection.

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Private health insurance inefficiencies cost Canadians billions

About 60 per cent of Canadians are covered by private health insurance for health-care services such as prescription drugs. (Jacques Boissinot/Canadian Press)

Private health insurance should be better regulated in Canada, say researchers who found the gap between premiums and payouts in claims reached $6.8 billion in 2011.

About 60 per cent of Canadians are covered by private health insurance for health-care services such as prescription drugs, health-care economists say. Most are insured through their employers, with for-profit firms dominating the industry, said study author Michael Law of the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver.

"When we looked across the for-profit insurers in Canada over the past 20 years, for the plans that are typically bought by individuals and small- or medium-sized employers, there was a pretty dramatic change in the gap between the premiums people paid in and the benefits that got paid back to them," Law said in an interview.

"Whereas Canadians were paying in a dollar and getting 92 cents back in 1991, they were paying a dollar and getting 74 cents in 2011."

Canadians need to realize those costs are ultimately passed on to them directly in higher premiums or indirectly as lower wages, Law stressed.

Obamacare insurance model

While most health care in Canada is paid for publicly, Law's team said private health insurance plays a major supporting role, particularly for prescription drugs, dental services and eye care. The expenditures totalled $22.7 billion in 2010 or about 12 per cent of health-care spending, according to the Canadian Institute for Health Information.

In the U.S., when a greater share of premium revenues goes toward administration and profits, under the Affordable Care Act, known as Obamacare, the excess has to be rebated to plan members to the tune of $1.1 billion in 2012. Canada has no such requirement, the study's authors noted in a study published Monday's in the Canadian Medical Association Journal, titled "The increasing inefficiency of private health insurance in Canada."

"We ought to consider regulating private insurance more effectively and I think the U.S. can provide a pretty good model because based on our numbers, Americans are now actually doing better than Canadians in terms of how much they're getting back out of their health insurance plan," Law said.

Options for better value

The study's authors said governments could take a couple of approaches to improving the situation: replace private insurance with more efficient public alternatives, or impose new regulations on the private insurance sector.

For prescription drugs, the authors said evidence supports savings from universal public coverage at a societal level. Regulation, such as provincial requirements for more transparency on non-medical spending from private insurance firms, would likely give Canadians better value, they said.

Law said when he started to see the findings, small business owners expressed frustrations to him about how their costs generally rose one or two per cent every year, benefits were going up five to 15 per cent every year.

When Jeff Chatterton of Kitchener, Ont., looked into health insurance coverage for his family, he decided the expense wasn't worth it for himself, his wife and sons, aged four and six.

"We were around $200 a month, and $2,400 buys a whole lot of dental care and orthotics," in a year, said Chatterton, owner of Checkmate Public Affairs, which specializes in crisis communications for the travel and tourism industry.

"The math didn't just not make sense. It didn't make any sense."

Chatterton said he'd like to have health insurance and he'd reconsider if the price went down or his family's needs change.

The researchers analyzed 20 years of reports from the Canadian Life and Health Insurance Association and adjusted for inflation.

The association said without private insurance coverage, pressures on scarce public resources would be greater.

The group called the study "misleading." In an email, a spokeswoman for the industry group said the researchers did not include data from the not-for-profit sector. As well, the group said that including income replacement benefits, such as disability and critical illness insurance that are not health-care expenses, "further skews the data."

Law countered that he wanted to look at for-profit insurance only for an apples-to-apples comparison. He said the association itself groups data such as critical illness insurance as related to health.

The research was funded by the Canadian Institutes of Health Research. Law has consulted for Health Canada on unrelated pharmaceutical policy research.

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Ebola virus: 5 things you should know

The deaths of more than 50 people in the West African nation of Guinea due to a violent fever has renewed concerns about the deadly Ebola virus, which caused global panic in the 1990s and early 2000s.

Guinean officials confirmed March 23 that samples from victims of a viral hemorrhagic fever have tested positive for the Ebola virus, marking the first time the virus has been detected in this African country.

Ebola hemorrhagic fever is a severe, often fatal illness that can occur in humans and primates such as monkeys and gorillas. According to the World Health Organization, Ebola fever has a fatality rate of up to 90 per cent. There is no known cure.

The virus gained worldwide attention in the 1990s after an outbreak in Kikwit, Zaire (now the Democratic Republic of Congo) killed 245 people. The severe, fast-acting nature of Ebola inspired a number of apocalyptic novels and movies, including the 1995 film Outbreak (1995).

There are five distinct strains of the Ebola virus: Bundibugyo, Ivory Coast, Reston, Sudan and Zaire.

While the virus hasn't generated as much media interest in the past decade, it's not for lack of outbreaks – prior to this latest one in Guinea, there were significant flare-ups in the Democratic Republic of Congo, Gabon, Uganda and Sudan in the 2000s. 

Here's a closer look at this dangerous and little-understood virus.

When did it first emerge?

A microscopic view of the Ebola virus. ((Tekmira Pharmaceuticals Corp.))

According to WHO, Ebola first appeared in 1976 in two areas at once: in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo (DRC). The latter was near the Ebola River, hence the name.

How is it transmitted?

Ebola is transmitted from person to person through bodily fluids.

Humans first got the virus through contact with the bodily fluids of infected animals. As WHO reports, "infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found dead or ill in the rainforest."

According to WHO, fruit bats are considered natural hosts for Ebola, and as a result, "the geographic distribution of Ebolaviruses may overlap with the range of the fruit bats."

What are the symptoms?

Three of the five Ebola strains have been associated with Ebola hemorrhagic fever (EHF), which is characterized by internal and external bleeding. The virus's incubation period lasts about a week, and early symptoms can include chills, low-back pain, fatigue, diarrhea and headaches.

As the infection intensifies, individuals can experience bleeding from the eyes, ears and nose, as well as the mouth and rectum.

"What happens, in any hemorrhagic fever, is your blood vessels start to leak, and so that's why you get bruises in the skin," says Dr. Jay Keystone, a renowned travel physician and professor in the department of medicine at the University of Toronto.

"If your blood vessels are leaking out of the gut, you're bleeding [out of the] rectum, and if your bleeding is in the stomach, you're vomiting up blood."

Illness sets in between two to 21 days after infection. In most cases, the time between the start of the symptoms and death is one to two weeks.

While EHF leads to a lot of blood loss, that's not usually the cause of death, Dr. Keystone says.

The World Health Organization reports that the Ebola hemorrhagic fever has a fatality rate of up to 90 per cent. (Isaac Kasamani/AFP/Getty Images)

"You die of shock from bleeding, but it's more than that," he says. The victim gets a viremia, which is when a virus enters the bloodstream and as a result, gains access to the rest of the body.

"You start to get a breakdown of body function,: Dr. Keystone says. "The kidneys fail, you may get secondary pneumonia. But in this case, it's an overwhelming infection which causes a breakdown of tissue, release of what we call antigens, and then essentially you get a total body failure."

Can it be cured?

There are no known cures or vaccines, according to WHO.

Patients are typically hospitalized and kept in intensive care, and may receive medications and intravenous fluids to cope with shock, as well as transfusions of fresh blood.

How is the current strain in Guinea different from the ones we saw in the 1990s and early 2000s?

The current strain is "more virulent," says Dr. Keystone. Even so, he points out that Ebola's reputation overshadows the actual threat.

What terrifies the public is "the thought that 90 per cent of people die," and that "it kills you within a matter of a few days," he says.

But Ebola, which has killed about 2,000 people since the late-'70s, is inferior, in terms of efficiency, to a virus such as the human immunodeficiency virus (HIV), which "spreads quietly, silently, and millions get infected."

With Ebola, "all the people who get it die," he says, which prevents those hosts from infecting more people.

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Sick man in Saskatoon tests negative for Ebola

A man in hospital in Saskatchewan has tested negative for Ebola and other hemorrhagic fevers, a World Health Organization spokesman says.

On Monday, provincial health officials said a man who had recently travelled in West Africa was in critical condition in hospital in Saskatoon.

They said the patient had visited Liberia and was being examined for a suspected case of viral hemorrhagic fever.

However, a WHO official said Tuesday on his Twitter account that hemorrhagic fevers have been ruled out.

Gregory Hartl, WHO's head of public relations, said Ebola, Marburg, Lassa and two other diseases have been ruled out.

He said testing continues, but the patient may have malaria.

The Public Health Agency of Canada said Winnipeg lab tests confirmed the man does not have Ebola, Lassa, Marburg or Crimean Congo virus.

Testing continues to identify the illness, but the risk to Canadians is very low, the agency said.

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When is a person declared dead? Doctors divided over rules

The standards for defining death in Canada vary so much that the hospital where a dying person ends up may affect when they are declared dead - and that has some Canadian doctors concerned about the implications for organ donation, CBC's the fifth estate has learned.

There are about 2,000 organs transplanted in Canada every year, but hundreds of people die while on a waiting list because of a critical shortage of life-saving organs.

Across the country, physicians involved in organ donation must adhere to what's known as the "dead donor rule." It seems simple — organs cannot be procured until after the donor has died.

'The challenge is that death is a process, and when it's a process, taking it to one specific time is very difficult.'- Dr. David Zygun, University of Alberta director of critical care

The problem is how to pinpoint the exact time of death, says the University of Alberta's director of critical care, Dr. David Zygun.

"The challenge is that death is a process, and when it's a process, taking it to one specific time is very difficult," he told the fifth estate's Bob McKeown.

The result is that the length of time before a person can be officially declared dead in Canada and around the world may depend less on medical science than where the hospital is located.

Health lawyer Jacqueline Shaw in Halifax calls it "postal code death."

"That doesn't line up with what most people think death is — they think, well, it's the same standard everywhere," she said.

The national guidelines for pronouncing cardiac death for organ donation require doctors to wait at least five minutes after the heart stops beating.

That is the policy in place at Toronto's Sunnybrook Hospital and the Toronto General Hospital.  But across the city at St. Michael's hospital, the wait is at least 10 minutes.

Defining death

The fifth estate's Bob McKeown examines how we define death in Canada, and what it means for organ donation. 'Dead Enough' airs on CBC Television on Friday March 21 at 9 p.m. EDT, 9:30 p.m. in Newfoundland. 

In some parts of the United States, the amount of time before death can be declared is much shorter. In Pittsburgh, Pennsylvania, it is two minutes, while in Denver, Colorado, the wait is just 75 seconds.  

In Italy, it takes longer — doctors must wait a minimum of 20 minutes after the heart stops to declare death.

There is another layer of complication: at least three Canadian provinces — Manitoba, New Brunswick and Saskatchewan — do not accept cardiac death as a standard; they rely only on brain death.  

Even if a province has adopted a certain standard, individual hospitals can make their own decisions. In Alberta, the Foothills hospital in Calgary accepts only brain death, while the University of Alberta Hospital in Edmonton recognizes both brain and cardiac death.

Why so much variation?

In Canada, organ donor rates lag behind the United States and Europe. Here, more than 4,000 people are on transplant waiting lists, and each year about 300 people die waiting.

Dr. Sam Shemie of McGill University is an intensive care specialist who was influential in pushing for the new "donation after cardiac death" standard used to determine when someone is clinically dead. DCD is credited with saving hundreds of Canadians' lives by increasing the pool of viable transplants. (CBC)

For years, the standard measurement of death in Canada was brain death: people were not declared deceased until after the brain stopped functioning.

In 2005, the guidelines for declaring death were changed, so that more organs could be donated and procured. Now the national standard also includes "donation after cardiac death," or DCD. Some provinces and hospitals chose to adopt the DCD guideline to wait at least five minutes after the heart stops beating, while others still use brain death as their only standard.

Dr. Sam Shemie of McGill University, an intensive care specialist at the Montreal Children's hospital, was influential in pushing for this new definition to save Canadians' lives with more transplants.

"DCD has accounted for over 1,000 transplants in this country that otherwise would never have occurred," he told McKeown.

Intense debate

Despite that success, the change to DCD has prompted an intense but largely behind-the-scenes debate in medical circles about the consequences for organ donation.

"Some physicians, including myself, believe there is genuine debate about whether organ donors are already dead," said Dr. Ari Joffe, who works in the intensive care unit at the Stollery Children's hospital in Edmonton.  

"I don't want to be misinterpreted because I do definitely support organ donation, but I have concerns about the process involved in DCD," he told McKeown.

Dr. Ari Joffe, who works in the intensive care unit at the Stollery Children's hospital in Edmonton, questions whether the standard five-minute wait after the heart stops beating is long enough to be certain that cardiac death is irreversible. He points out that medical interventions like CPR often bring patients back after five minutes without a pulse. (CBC)

Dr. Joffe questions whether a five-minute wait after the heart stops beating is long enough to be certain that cardiac death is irreversible. He points out that medical interventions like CPR often bring patients back after five minutes without a pulse.

He argues that it would take at least 20 or 30 minutes to be sure death is irreversible, but at that point, Dr. Joffe says the quality of the donated organs may no longer be adequate. Doctors need to harvest organs within two hours after the heart stops or they may deteriorate beyond use.

For some doctors, DCD also raises ethical concerns. Intensive care unit physicians are trying to prolong the patient's life, while the transplant team is focused on saving lives of organ donation recipients.  

Dr. Shemie said the national guidelines indicate there must be strict separation between those two teams, to ensure the transplant team has no role in determining when death occurs.  

"The first sacrosanct rule in organ donation in this country — it's a moral rule and it's a law — is that there needs to be strict separation of teams," Dr. Shemie told McKeown.  

But Dr. Joffe says some critical care specialists may still feel pressure.  

"Although we're not the surgeons taking the organs, we're still part of the transplant team. My concern is, I don't think we can separate those processes as clearly as has been stated."

Life and death decisions

The families of potential donors can also feel pressure to make critical life and death decisions.  

In its documentary Dead Enough, the fifth estate has the stories of two families who both faced difficult decisions about organ donation, because their loved ones were not expected to survive severe brain injuries.

When her daughter was critically injured and paralyzed in a car crash, for example, Sharon Thompson was at her bedside in a Calgary hospital around the clock.

Thompson says she was approached to consent to organ donation, and asked to consider taking her daughter off life support.    

"When people are in an emotional state, I don't think that's the time to be asking those questions. Because the emotional roller-coaster we were on for, I would say, at least three of those six weeks … that's not a great time to be having to make that decision too, because you're not thinking," she told McKeown.

Thompson chose not to take her daughter off life support, and Brandice Thompson made a remarkable recovery.

More public debate  

What happened to the Thompson family reflects the complexity of the life and death decisions at stake in the DCD debate.  

So far, the debate over defining death has mostly been conducted in the medical community, out of public view.

'I think that we're not doing ourselves justice by not providing frank information about death and about the procedures that go on in organ donation to patients.'- Jacqueline Shaw, health lawyer

Health lawyer Shaw says that may explain why one national survey suggests almost a quarter of Canadians feared physicians might declare death prematurely in order to expedite the procurement of organs.

"That's a serious amount of concern in the population, and it could certainly be affecting donation rates. I think that we're not doing ourselves justice by not providing frank information about death and about the procedures that go on in organ donation to patients," she told McKeown.

In Montreal, Dr. Shemie says what the Canadian public needs to know most of all is that there is a system that works to both save lives through transplants — and to protect dying patients who could become donors.

"We know that organ donation saves lives, and we know that we have standards in this country that protect patients at the end of life to make sure that all efforts are provided to those patients. But when that can't happen and that patient's going to die, then we're able to provide the chance to donate, okay," he told McKeown.

"So, standards are in place so that public trust is maintained. I can assure the public that we do a great and very credible job in doing that."

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