Doctor won't see you now: Few drop patients with anti-vaccine views in U.S.

With California gripped by a measles outbreak, Dr. Charles Goodman posted a clear notice in his waiting room and on Facebook: His practice will no longer see children whose parents won't get them vaccinated.

"Parents who choose not to give measles shots, they're not just putting their kids at risk, but they're also putting other kids at risk — especially kids in my waiting room," the Los Angeles pediatrician said.

It's a sentiment echoed by a small number of doctors who in recent years have "fired" patients who continue to believe debunked research linking vaccines to autism. They hope the strategy will lead parents to change their minds; if that fails, they hope it will at least reduce the risk to other children in the office.

The tough-love approach — which comes amid the second-biggest measles outbreak in the U.S. at least 15 years, with at least 98 cases reported since last month — raises questions about doctors' ethical responsibilities. Most of the measles cases have been traced directly or indirectly to Disneyland in Southern California.

The American Academy of Pediatrics says doctors should bring up the importance of vaccinations during visits but should respect a parent's wishes unless there's a significant risk to the child.

"In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child," according to guidelines issued by the group.

The Canadian Paediatric Society also recommends physicians to "not dismiss children from your practice because parents refuse to immunize."

However, if the relationship between patient and doctor becomes unworkable, the U.S. pediatrics academy says, the doctor may want to encourage the vaccine refuser to go to another physician.

Some mothers who have been dropped by their doctors feel "betrayed and upset," said Dotty Hagmier, founder of the support group Moms in Charge. She said these parents made up their minds about vaccines after "careful research and diligence to understand the risks versus the benefits for their own children's circumstances."

Dropping patients who refuse vaccines has become a hot topic of discussion on SERMO, an online doctor hangout. Some doctors are adamant about not accepting patients who don't believe in vaccinations, with some saying they don't want to be responsible for someone's death from an illness that was preventable.

Dr. Charles Goodman says parents who choose not to give measles put the children in his waiting room at risk. (The Associated Press)

Others warn that refusing treatment to such people will just send them into the arms of quacks.

The measles-mumps-rubella vaccine, or MMR, is 97 per cent effective at preventing measles, according to the U.S. Centers for Disease Control and Prevention.

Measles spreads easily through the air and in enclosed spaces. Symptoms include fever, runny nose, cough and a rash all over the body. In rare cases, particularly among babies, measles can be deadly. Infection can also cause pregnant women to miscarry or give birth prematurely.

All states require children to get certain vaccinations to enrol in school. California is among 20 states that let parents opt out by obtaining personal belief waivers. Some people worry that vaccines cause developmental problems, despite scientific evidence disproving any link. Others object for religious or philosophical reasons.

Nationally, childhood measles vaccination rates have held steady for years at above 90 per cent. But there seem to be growing pockets of unvaccinated people in scattered communities, said Dr. Gregory Wallace of the CDC.

In recent years, nearly all U.S. measles cases have been linked to travellers who caught the virus abroad and spread it in this country among unvaccinated people.

Northern California's Marin County has a high rate of people claiming personal belief exemptions. In 2012, Dr. Nelson Branco and his partners at a Marin County practice started turning away toddlers whose parents refused to make sure they received the measles vaccine.

Branco said 10 to 20 of his practice's 8,000 or so patients left after the change.

Vaccines "can be spooky for parents," Branco said. But "in the end, we have the science. We have the experience that it's the right thing to do."

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Medical marijuana easily 'dispensed' in Vancouver

Marijuana is being openly sold in specialty stores in Vancouver under the guise of a government-approved system meant to limit sales for medical use only, a documentary by the CBC's fifth estate shows. 

Medical marijuana has been legally sold in Canada since 2001 under strict government guidelines and only under authorization from a physician.

But the fifth estate's Mark Kelley found that in Vancouver these days the drug is readily available in medical marijuana dispensaries, where a quick consultation with a nurse or a naturopath gets people a membership and access to as much marijuana as they want.

After a consultation that took just 65 seconds, for example, Kelley was given a membership at one such dispensary where he could buy marijuana as a way to relieve stress.

The dispensaries are illegal, but Vancouver City Police have said they will ignore them unless they sell to minors or create a nuisance.

Medical marijuana has been legally sold in Canada since 2001 under strict government guidelines and only under authorization from a physician. But the fifth estate found that in Vancouver these days the drug is readily available in medical marijuana dispensaries. (CBC)

The dispensary business in Vancouver is booming. There are now nearly 60, more than the number of Tim Hortons in that city. 

Chuck Varabioff, owner of Canada's first marijuana vending machine, says it has grossed more than $1 million since he set it up last May.

The legal medical marijuana market has also grown rapidly since the federal government revamped the rules last year. It has since licensed 15 legal big-box grow ops for the medical marijuana market. Investors have poured tens of millions of dollars into the industry.

The staggering amount of money flowing into the marijuana business has many thinking legalization here in Canada might be a hard train to stop.

Benedikt Fischer, a criminologist and expert in substance use, says for all intents and purposes, marijuana might as well already be legal: "We have in Canada an emerging situation of de-facto cannabis legalization under the veil of medicalization."

Watch the fifth estate's investigation, Pot Fiction.

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Truck-stop health care fills a void for drivers, farmers in U.S.

Robert Day is in rough shape, slumped over in a chair in one of Dr. Rob Marsh's exam rooms.

For nine days, the truck driver from Fort Worth, Texas, has had trouble breathing, and has been delirious and coughing up phlegm.

The pungent odour from his body and the black grime on his hands suggest he hasn't showered in days. He's barely had anything to eat — a few bites of a hamburger and fries — and his two-packs-a-day smoking habit has been put on hold.

"Put me in the hospital, I don't care," Day tells Marsh as the doctor puts a stethoscope to his chest. "Anything to get rid of this."

He thinks he is sick from inhaling fumes from his truck, but he's not sure.

Dr. Rob Marsh examines truck driver Robert Day at Marsh's clinic in Raphine, Va. Day said he used to be healthy. but now smokes two packs of cigarettes a day and doesn't get enough exercise. (Meagan Fitzpatrick/CBC News)

'I want drivers to feel we're here for the long term.'- Dr. Rob Marsh

After the examination and some tests, Marsh indeed sends Day to the closest hospital, about 30 minutes away. He doesn't have insurance and one night's stay would cost him about $1,000 US.

Day, though, is grateful that Marsh was able to see him. This is truck-stop health care in action.

Marsh's medical clinic is part of the Petro truck stop in Raphine, Va., a dot on a map of the Shenandoah Valley, a beautiful area about three hours southwest of Washington, D.C. Interstate 81 carries a steady stream of trucks through the valley, which features little more than farms and places for drivers to eat, rest and fill their vehicles with gas.

Doctor felt 'a calling'

It's tranquil. It's nothing like Somalia and the other dangerous places Marsh was deployed to when he served in the U.S. military with the elite Delta Force unit. He was in Mogadishu in 1993 for the battle that Hollywood dramatized in Black Hawk Down. Marsh was seriously injured by shrapnel from a mortar round that killed the person standing next to him.

The blast to his right hip and the massive bleeding that followed could have killed him, but Marsh made it out alive. After a few more years serving, he retired and returned to his Virginia roots to practise family medicine.

Dr. Rob Marsh's clinic on the grounds of the Petro truck stop in Raphine, Va., has a sign on the door that says walk-ins from truck drivers are welcome. (Meagan Fitzpatrick/CBC News)

"I felt a calling to come back here," he said between bites of fried chicken that had been brought in for lunch for the staff on Tuesday.

He opened his first clinic nearly 20 years ago in Middlebrook, about 20 minutes from Raphine.

The truck-stop clinic, a building on the far side of the sprawling complex, started about a year ago and at the urging of Petro's owner, who wants to provide plenty of services and amenities for drivers.

Other truck stops in the U.S. sometimes have doctors on site, but they mostly set up in a trailer and rotate staff.

"Doc in a box," Marsh calls them, and that's not his style of practising medicine.

"I want drivers to feel we're here for the long term," he added. "I want them to feel like I am going to take responsibility for their health care, if they want me to, just like I do for the local people."

Busy clinic has 'too many patients'

The truck-stop clinic serves both locals and drivers, and fills a void for both populations. Marsh has about 3,500 patients between his two clinics. Then there are the walk-ins.

"Yes sir, we'll work you in," a man with no appointment is told when he inquired about seeing Marsh. The North Carolina resident is working on a construction project at the truck stop and has run out of diabetes medication.

"It's a good problem, but I've got too many patients," Marsh said.

Some of the truckers he treats come in with acute problems, but others get their department of transportation-mandated physicals or their company-required drug tests.

'He is tireless, totally selfless, totally dedicated to what he loves to do.'- Barry Perkins, former military colleague, now physician assistant to Dr. Rob Marsh

There is a big push lately by both government and trucking companies to ensure healthy drivers are on the road, for their own benefit and the safety of other drivers.

Marsh's clinic makes it convenient for tests to be conducted and for truckers to pay some attention to their health.

"It's tough for them," Marsh said, describing the lifestyle of long-haul drivers. Truckers are away from home for long stretches. They are also very independent and self-reliant, they often don't seek help until they feel really, really bad. When they're home after a week or more away, they have other things to take care of and family to see.

The stereotypical truck driver is overweight, eats junk food and never exercises, said Marsh, but that is starting to change thanks in part to the recent focus on truck driver health and safety. Truck centres are starting to build gyms and offer healthier options in their restaurants to encourage better lifestyles, he noted.

But the homemade fudge and fried peach pies, not to mention the Krispy Kreme donuts, offered next to the cashier at the Petro truck stop must still be a challenge for some to resist.

Marsh is committed to taking good care of whoever walks through his door, whether it's a scruffy trucker like Day or the 10-month-old baby he saw right after him. He patiently answers all of the questions the young mother had written on a scrap of paper.

Later in the day, Marsh will be making a house call to check in on a newborn. That's right, a house call. It sounds old-fashioned, and it is. It's rare to find a doctor who does that anymore, but rare is exactly how people describe Marsh.

"He is tireless, totally selfless, totally dedicated to what he loves to do. There are not a lot of people in this world who are like that," according to Barry Perkins, a physician assistant at the clinic who goes way back with Marsh, to their military days at Fort Bragg. "He is very special."

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Rabies: What to know about the virus in Canada

Natural resources officials in Newfoundland and Labrador are on alert after a rabid wolf nearly attacked two families in western Labrador and are asking the public to report any sightings of animals acting strangely.

The provincial department says the incident is the first case of rabies in the region since last summer. Across the country, the virus can be common or not, depending on the province in which you live.

Here's what you need to know about rabies in Canada.

What is rabies?

It's a virus that can infect domestic and wild animals and can be spread to humans. Rabies attacks the central nervous system and eventually makes its way to the brain. The disease occurs throughout the world, except Antarctica and a few island nations.

How common is rabies?

The Canadian Food Inspection Agency reports that in 2014, there were 92 confirmed cases of rabies in animals — bats, skunks, foxes, dogs and other warm-blooded animals — mostly in Saskatchewan and Ontario. Bats in Ontario made up about one-fifth of all animal rabies cases. 

'The risk in people is if you are bitten and you never report it to anybody so no treatment was given.'- Dr. Hugh Whitney

"In Canada, the overall risk of getting rabies from a domestic or wild animal is pretty low," says Dr. Allan Grill, a family physician and assistant professor at the University of Toronto.

Since 1924, 24 people have died across the country, says the Public Health Agency of Canada. More recently, there have been only four cases of human rabies in the past 30 years.

How is rabies spread to humans?

The virus travels through the saliva of infected animals, usually as a result of bites, scratches or licks on broken skin. The vast majority of people who become infected were bitten or scratched by an animal, with the face and upper body being the riskiest areas.

However, there are also some cases of organ or tissue transplants, where the virus was transmitted via the transplant.

The virus spreading among humans is very uncommon.

"Person-to-person transmission is theoretically possible, but rare and not well-documented," according to the Public Health Agency of Canada website.

The agency says the risk for children becoming infected is estimated at four times higher than adults. Boys are also at a highter risk than girls.

Why is rabies dangerous?

Almost all cases of clinical rabies (that is, when symptoms start to show) are fatal, according to the public health agency. But the vaccines are "very effective."

Exposed people who get treated with a post-exposure prophylaxis vaccine right away often do not get sick.

"The risk in people is if you are bitten and you never report it to anybody so no treatment was given," says Dr. Hugh Whitney, chief veterinary officer for the Newfoundland and Labrador government.

"If you start to show the signs of rabies, at that point, it is usually too late to do anything about it and you die."

University of Toronto's Grill says any exposure to a wild animal, or even a strange domestic animal, could pose a risk of contracting rabies.

The virus goes into the nerves — a "very slow movement," says Whitney.

"If [an animal] is bit in the hind leg, you can just imagine that's a fairly long distance to go through the nerves, up the hind leg, along the spine into the brain. And once it hits the brain, that's when you get the change in temperament."

How should you vaccinate against rabies?

"Anybody whose occupation puts them at a higher risk than the general public for rabies, we get vaccinated beforehand," says Whitney.

Veterinarians also get their blood sampled regularly to ensure there are enough antibodies. 

Although the general public isn't at a great risk of rabies, he suggests that people in areas where rabies exists in the animal populations get vaccinated on a regular basis.

If you get exposed to the virus, the public health agency says five doses are needed — the first as soon as possible and then on days three, seven, 14 and 28 after that first dose. About 65 per cent of yearly vaccine doses in Canada are used for post-exposure.

What happens if you get infected?

Firstly, if you've been bitten by an animal and you think you might have been exposed to rabies,the agency says you should immediately wash and flush the wound with soap and water.

Then, Grill says it's "extremely important" to immediately seek medical attention and contact public health officials to get advice on treatment.

"The reason why it's so crucial," says Grill, "is because if the proper treatment is given early before symptoms develop, the disease is entirely preventable."

Symptoms can take 20 to 60 days to appear, depending on a number of different factors such as the severity of the wound, where the wound is in relation to your nerves, the strain of rabies and how much protection was provided by your clothes.

Much like in animals, human rabies is spread through the nerves.

"It is considered to be one of the worst diseases, human diseases, because you go in and out of consciousness and you'll have hallucinations," says Whitney.

"People talk about Ebola as being a very bad virus, which of course it is. But people infected with rabies — if they get sick — have a much higher ... case fatality rate.

"We're just very fortunate that there aren't that many human cases of rabies."

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Truck-stop health care fills a void for drivers, farmers in U.S.

Robert Day is in rough shape, slumped over in a chair in one of Dr. Rob Marsh's exam rooms.

For nine days, the truck driver from Fort Worth, Texas, has had trouble breathing, and has been delirious and coughing up phlegm.

The pungent odour from his body and the black grime on his hands suggest he hasn't showered in days. He's barely had anything to eat — a few bites of a hamburger and fries — and his two-packs-a-day smoking habit has been put on hold.

"Put me in the hospital, I don't care," Day tells Marsh as the doctor puts a stethoscope to his chest. "Anything to get rid of this."

He thinks he is sick from inhaling fumes from his truck, but he's not sure.

Dr. Rob Marsh examines truck driver Robert Day at Marsh's clinic in Raphine, Va. Day said he used to be healthy. but now smokes two packs of cigarettes a day and doesn't get enough exercise. (Meagan Fitzpatrick/CBC News)

'I want drivers to feel we're here for the long term.'- Dr. Rob Marsh

After the examination and some tests, Marsh indeed sends Day to the closest hospital, about 30 minutes away. He doesn't have insurance and one night's stay would cost him about $1,000 US.

Day, though, is grateful that Marsh was able to see him. This is truck-stop health care in action.

Marsh's medical clinic is part of the Petro truck stop in Raphine, Va., a dot on a map of the Shenandoah Valley, a beautiful area about three hours southwest of Washington, D.C. Interstate 81 carries a steady stream of trucks through the valley, which features little more than farms and places for drivers to eat, rest and fill their vehicles with gas.

Doctor felt 'a calling'

It's tranquil. It's nothing like Somalia and the other dangerous places Marsh was deployed to when he served in the U.S. military with the elite Delta Force unit. He was in Mogadishu in 1993 for the battle that Hollywood dramatized in Black Hawk Down. Marsh was seriously injured by shrapnel from a mortar round that killed the person standing next to him.

The blast to his right hip and the massive bleeding that followed could have killed him, but Marsh made it out alive. After a few more years serving, he retired and returned to his Virginia roots to practise family medicine.

Dr. Rob Marsh's clinic on the grounds of the Petro truck stop in Raphine, Va., has a sign on the door that says walk-ins from truck drivers are welcome. (Meagan Fitzpatrick/CBC News)

"I felt a calling to come back here," he said between bites of fried chicken that had been brought in for lunch for the staff on Tuesday.

He opened his first clinic nearly 20 years ago in Middlebrook, about 20 minutes from Raphine.

The truck-stop clinic, a building on the far side of the sprawling complex, started about a year ago and at the urging of Petro's owner, who wants to provide plenty of services and amenities for drivers.

Other truck stops in the U.S. sometimes have doctors on site, but they mostly set up in a trailer and rotate staff.

"Doc in a box," Marsh calls them, and that's not his style of practising medicine.

"I want drivers to feel we're here for the long term," he added. "I want them to feel like I am going to take responsibility for their health care, if they want me to, just like I do for the local people."

Busy clinic has 'too many patients'

The truck-stop clinic serves both locals and drivers, and fills a void for both populations. Marsh has about 3,500 patients between his two clinics. Then there are the walk-ins.

"Yes sir, we'll work you in," a man with no appointment is told when he inquired about seeing Marsh. The North Carolina resident is working on a construction project at the truck stop and has run out of diabetes medication.

"It's a good problem, but I've got too many patients," Marsh said.

Some of the truckers he treats come in with acute problems, but others get their department of transportation-mandated physicals or their company-required drug tests.

'He is tireless, totally selfless, totally dedicated to what he loves to do.'- Barry Perkins, former military colleague, now physician assistant to Dr. Rob Marsh

There is a big push lately by both government and trucking companies to ensure healthy drivers are on the road, for their own benefit and the safety of other drivers.

Marsh's clinic makes it convenient for tests to be conducted and for truckers to pay some attention to their health.

"It's tough for them," Marsh said, describing the lifestyle of long-haul drivers. Truckers are away from home for long stretches. They are also very independent and self-reliant, they often don't seek help until they feel really, really bad. When they're home after a week or more away, they have other things to take care of and family to see.

The stereotypical truck driver is overweight, eats junk food and never exercises, said Marsh, but that is starting to change thanks in part to the recent focus on truck driver health and safety. Truck centres are starting to build gyms and offer healthier options in their restaurants to encourage better lifestyles, he noted.

But the homemade fudge and fried peach pies, not to mention the Krispy Kreme donuts, offered next to the cashier at the Petro truck stop must still be a challenge for some to resist.

Marsh is committed to taking good care of whoever walks through his door, whether it's a scruffy trucker like Day or the 10-month-old baby he saw right after him. He patiently answers all of the questions the young mother had written on a scrap of paper.

Later in the day, Marsh will be making a house call to check in on a newborn. That's right, a house call. It sounds old-fashioned, and it is. It's rare to find a doctor who does that anymore, but rare is exactly how people describe Marsh.

"He is tireless, totally selfless, totally dedicated to what he loves to do. There are not a lot of people in this world who are like that," according to Barry Perkins, a physician assistant at the clinic who goes way back with Marsh, to their military days at Fort Bragg. "He is very special."

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Canadian seniors satisfied with health-care quality, study finds

Older Canadians were more likely to have discussions with their health-care provider about healthy habits like diet and exercise, compared with people in other developed countries.

Canadian seniors wait longer to see a doctor or nurse but are generally pleased with the quality of care when they do, compared with their counterparts in 10 industrialized countries, according to a new report.

The Canadian Institute for Health Information and the Canadian Institutes for Health Research released the report Thursday.

Just over half of survey respondents in Canada, 53 per cent, waited at least two days to see a family doctor or nurse the last time they were sick compared with the international average of 32 per cent.

The other countries were:

• Australia.
• France.
• Germany
• The Netherlands
• New Zealand.
• Norway.
• Sweden.
• Switzerland.
• United Kingdom.
• United States.

A quarter of older Canadians waiting at least two months to see a specialist, compared with the average of 15 per cent elsewhere.

Once people met their doctor or nurse, their experience was generally on par or sometimes better than those of people in other countries.

For example, older Canadians were more likely to get their medications reviewed by a health professional and more likely to have discussions with the provider about treatment goals and healthy habits like diet and exercise.

In Canada, seven per cent of respondents said they didn't fill a prescription or skipped doses because of cost, compared with an average of four per cent elsewhere.

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New Ebola cases fall under 100 for 1st week since June

New weekly cases of Ebola fell below 100 in three hot spots for the first time since last June, but the hardest part of stamping out the outbreak remains, infectious disease experts say.

The World Health Organization says a combined total of 99 confirmed cases were reported from the three countries in the week ending Jan. 25: 30 in Guinea, four in Liberia and 65 in Sierra Leone.

"The response to the EVD [Ebola virus disease] epidemic has now moved to a second phase, as the focus shifts from slowing transmission to ending the epidemic," the WHO said Thursday.

The outbreak has killed 8,810 people out of 22,092 cases, almost all of them in those three countries.

The latest drop in numbers differs from previous declines, WHO communications officer Tarik Jasarevic said.

"Now there is necessary capacity in these countries to fight the virus. Before there was not enough treatment centres, we didn't have enough trained and equipped teams for safe burials. We didn't have enough surveillance teams in communities. We didn't have enough community engagement. Now all of those elements are there," he said in an interview from Geneva.

Elsewhere on Thursday, a second Canadian Forces medical contingent left CFB Trenton in Ontario to start training in the United Kingdom before its deployment in Sierra Leone.

"The admission rates and new infections rates have been dropping dramatically," Col. David Weger, deputy commander for Canadian Forces Health Services, said before boarding.

"We are optimistic that this may be our last two-month rotation of clinical personnel going in," he said. "We are, however, entirely prepared to do a third one if we need to go the full six months of our current mandate."

The situation has definitely improved since December in Sierra Leone, said Maj. Ian Schoonbaert, a physician with Canadian Forces who will deploy as senior medical authority in Kerry Town, Sierra Leone.

"I think it's time that we make sure we kind of consolidate those victories and help to make sure that it continues to go in a positive manner," Schoonbaert said.

Infectious disease experts stress that tracking down everyone who has had close contact with an Ebola patient is key to ending the outbreak.

Microbiologist Dr. Allison McGeer of Mount Sinai Hospital in Toronto returned 10 days ago from two weeks helping health officials in Liberia. In her five-week trip in October streets were quiet during curfew, but now restaurants have re-opened.   

It's major progress to have the number of cases consistently down in all three countries, McGeer said.

"The hardest part of outbreak is the end," McGeer said, especially for one centred in some of the world's poorest countries.

"If we're not there for them, the outbreak will come back."

Last week, researchers from the Institut Pasteur of Dakar and the Institut Pasteur in Paris reported other signs of progress.

They interviewed patients, their families and neighbours in three regions of Guinea—the capital of Conakry, Boffa, and Télimél, They found in March, hospital transmissions made up 35 per cent of all transmissions and funeral transmissions 15 per cent. From April to Aug. 25, the sources of transmission fell to nine per cent and four per cent, respectively.

Currently, in dozens of remote villages in Guinea, angry residents are blocking access for health workers.

The most intense transmission in Guinea is in Forecariah district, close to the border with western Sierra Leone, the worst Ebola hot spot.

"There have recently been reports of high levels of community resistance to EVD response measures in Forecariah, indicating a need to better engage the community in the response," the WHO said.

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Doctor won't see you now: Few drop patients with anti-vaccine views in U.S.

With California gripped by a measles outbreak, Dr. Charles Goodman posted a clear notice in his waiting room and on Facebook: His practice will no longer see children whose parents won't get them vaccinated.

"Parents who choose not to give measles shots, they're not just putting their kids at risk, but they're also putting other kids at risk — especially kids in my waiting room," the Los Angeles pediatrician said.

It's a sentiment echoed by a small number of doctors who in recent years have "fired" patients who continue to believe debunked research linking vaccines to autism. They hope the strategy will lead parents to change their minds; if that fails, they hope it will at least reduce the risk to other children in the office.

The tough-love approach — which comes amid the second-biggest measles outbreak in the U.S. at least 15 years, with at least 98 cases reported since last month — raises questions about doctors' ethical responsibilities. Most of the measles cases have been traced directly or indirectly to Disneyland in Southern California.

The American Academy of Pediatrics says doctors should bring up the importance of vaccinations during visits but should respect a parent's wishes unless there's a significant risk to the child.

"In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child," according to guidelines issued by the group.

The Canadian Paediatric Society also recommends physicians to "not dismiss children from your practice because parents refuse to immunize."

However, if the relationship between patient and doctor becomes unworkable, the U.S. pediatrics academy says, the doctor may want to encourage the vaccine refuser to go to another physician.

Some mothers who have been dropped by their doctors feel "betrayed and upset," said Dotty Hagmier, founder of the support group Moms in Charge. She said these parents made up their minds about vaccines after "careful research and diligence to understand the risks versus the benefits for their own children's circumstances."

Dropping patients who refuse vaccines has become a hot topic of discussion on SERMO, an online doctor hangout. Some doctors are adamant about not accepting patients who don't believe in vaccinations, with some saying they don't want to be responsible for someone's death from an illness that was preventable.

Dr. Charles Goodman says parents who choose not to give measles put the children in his waiting room at risk. (The Associated Press)

Others warn that refusing treatment to such people will just send them into the arms of quacks.

The measles-mumps-rubella vaccine, or MMR, is 97 per cent effective at preventing measles, according to the U.S. Centers for Disease Control and Prevention.

Measles spreads easily through the air and in enclosed spaces. Symptoms include fever, runny nose, cough and a rash all over the body. In rare cases, particularly among babies, measles can be deadly. Infection can also cause pregnant women to miscarry or give birth prematurely.

All states require children to get certain vaccinations to enrol in school. California is among 20 states that let parents opt out by obtaining personal belief waivers. Some people worry that vaccines cause developmental problems, despite scientific evidence disproving any link. Others object for religious or philosophical reasons.

Nationally, childhood measles vaccination rates have held steady for years at above 90 per cent. But there seem to be growing pockets of unvaccinated people in scattered communities, said Dr. Gregory Wallace of the CDC.

In recent years, nearly all U.S. measles cases have been linked to travellers who caught the virus abroad and spread it in this country among unvaccinated people.

Northern California's Marin County has a high rate of people claiming personal belief exemptions. In 2012, Dr. Nelson Branco and his partners at a Marin County practice started turning away toddlers whose parents refused to make sure they received the measles vaccine.

Branco said 10 to 20 of his practice's 8,000 or so patients left after the change.

Vaccines "can be spooky for parents," Branco said. But "in the end, we have the science. We have the experience that it's the right thing to do."

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Psychopathic criminals learn differently from punishment cues

Criminal psychopaths learn to respond differently to punishment cues than others in jail and may need more reward-focused treatments, new research suggests.

Criminals such as Paul Bernardo, Ted Bundy and Clifford Olson, who scored high on psychopathy checklists, were known to be callous and unemotional. Psychopaths derive pleasure from being manipulative and use premeditated aggression to get what they want with no regard for those who are hurt.

The search for what makes them tick has shown some physical differences in their brains such as reductions in grey matter.

Now researchers in London, Montreal and Bethseda, Md., have used functional MRI imaging to assess how the brains of 12 violent criminals with psychopathy, 20 violent criminals with antisocial personality disorder but not psychopathy (such as those with a history of impulsivity and risk-taking), and 18 healthy people who were not criminals responded differently to rewards and punishment.

"In the room with them, there's the sense that the weight of what they've done and the deleterious effect this is having on their lives doesn't really hold for them," said Dr. Nigel Blackwood of King's College London, a senior author of the paper in Wednesday's issue of Lancet Psychiatry.

Criminals such as Paul Bernardo who score highly on psychopathy checklists are known to be callous and derive pleasure from being manipulative. New research shows how behaviour and emotion areas of a psychopath's brain respond to a simple reward-punishment test. (Frank Gunn/Canadian Press)

It's only at the moment in the scanner when the sanction of lost points cues them to change their behaviour that the differences between violent psychopaths and those with antisocial personality disorder appear.

"They're not simply insensitive to punishment," Blackwood said. "There's a very different organization of their reinforcement learning system that shapes their behaviour."

The findings could have implications both for treating incarcerated psychopaths and to prevent children showing callous tendencies from progressing to psychopathy.

In Canada, psychopathy occurs in about one per cent of the population. In federal prisons, it's about 25 per cent, said Michael Woodworth, a psychologist at the University of British Columbia Okanagan, who has worked on research projects with Correctional Service Canada.

Standard cognitive behavioural treatments aren't considered effective in criminals with psychopathy.

"Perhaps at the youth level, if we can start to learn more about some of these underlying motivations and processing of information that we could develop some way to recognize and prevent them from behaving in that manner," Woodworth said.

The goal is to find ways to help those with psychopathic tendencies to fulfil their needs in less criminal ways to prevent harm to others.

Rather than being "doomed from the womb," Woodworth said the brain is particularly plastic early in life. The biological fact offers an opportunity to intervene in children with conduct disorders before the path to psychopathy is set.

For instance, perhaps children with these tendencies would benefit if their parents stressed rewards for good behaviour instead of just sanctions like timeouts, the researchers said.

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New B.C. study shows Type 2 diabetes increasing among 30 and under

A new B.C. study on Type 2 diabetes shows that the disease is increasing among people under the age of 30. 

It's been typically thought of as a disease that affects older populations, but researchers at the Providence Health Care in Vancouver have found that the rate of Type 2 diabetes has surpassed Type 1 diabetes under the age of 30. 

The figures are particularly alarming for youth of South Asian and Chinese descent. 

"South Asians are three to five times more likely to develop Type 2 diabetes than the general population," said Dr. Parmjit Sohal, one of the co-authors.

"This study suggests that this increased risk of Type 2 diabetes may begin as early as age 20."

Of all the diabetics surveyed, the study showed that 87 per cent of Chinese youth had Type 2 diabetes as did 86 per cent of South Asian youth — a significantly higher proportion compared to the 62 per cent of white youth that have the disease. 

The study didn't look at exactly why more young people are getting Type 2 diabetes, but an increase in obesity, poor eating habits and simply not getting enough exercise are certainly factors. 

The good news is that Type 2 diabetes can prevented, or at least delayed, with proper dietary habits and exercise.

"Over the last few decades, lifestyles have changed dramatically. Many now live in urbanized environments where people are generally less active and eat more high-calorie foods," said Dr. Calvin Ke, another co-author. 

"These  changes have led to an astounding increase of young people with diabetes. We need to act urgently to prevent diabetes in young people."

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Liver transplant ethics: Should alcoholics be sober first?

Should alcoholics be required to stop drinking for six months before they are eligible for a liver transplant in Ontario?

The issue has been raised by the widow of Mark Selkirk, a Toronto man well known as the person behind the moose sculptures that once appeared across the city.

Selkirk was also a lifelong alcoholic. In 2010, he was diagnosed with acute alcoholic hepatitis and told by doctors he would die without a liver transplant.

In Ontario, patients who need a new liver must abstain from drinking for six months before they are eligible for a transplant. Selkirk died two weeks after his diagnosis.

His widow, Debra Selkirk, is planning a constitutional challenge of the six-month policy. She intends to use the Charter of Rights and Freedoms to argue that the policy discriminates against patients who suffer from alcoholism and uses a moral judgment to deny patients a life-saving treatment.

"I believe that if doctors have a patient whose life they can save and they have a donor who's willing to give, that they have an obligation [to save their life]," she said in an interview on CBC Radio's  As It Happens.

Selkirk believes Ontario's six-month abstinence policy contravenes the charter and Canadians' right to universal access to health care.

She theorizes that if lifestyle choices were taken into account for all procedures, it would be seen by many as inhumane.

"Perhaps we should have a rating system for every disease and everything that comes into our hospital," she argues.

"If someone comes into the hospital bleeding to death and you're a gang member ... I say to him, OK, I'm going to look at my list ... 'Gang related.' We make them wait three hours [according to our lifestyle policy]. If you bleed to death in the meantime, oh well, you're a bad person.

"That's not what universal health care is. Universal health care is save every life you can."

Dr. Gary Levy, the former director of the Multi-Organ Transplant Program at University Health Network who now heads the living donor liver program there, said the policy is in place mainly because livers are a scarce and finite resource. He is not involved in Selkirk's case.

In an interview on CBC Radio's Metro Morning on Wednesday, Levy said last year more than 100 people died while waiting for a transplant.

"We have a shortage of suitable organs, we don't have enough to meet the need," he said. "We have a responsibility to ensure the organs are used wisely."

Levy said studies have shown that alcoholics awaiting a liver transplant and who are able to abstain from drinking for six months have a very low rate of returning to drinking.

He said if a liver is donated to a patient who damages the new organ by continuing to drink "we don't have one death, we have two deaths."

Levy also denied suggestions that the six-month waiting period is about saving the cost of the transplant surgery.

"We've never denied an individual in our centre because of dollars and cents," he said. "Where a need exists and where people meet the criteria, we move quickly to provide them the service."

Selkirk plans to push ahead with her challenge, saying the current policy treats alcoholism as a "character flaw" instead of a medical condition.

She said the provincial government, which earns revenue from alcohol sales, has a responsibility to make sure everyone gets the medical treatment they need.

"We have an alcohol problem and it's not right to let people die because we don't want to address these problems," she said. "It's not for them to make moral judgment calls."

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New Ebola cases per week fall under 100 for 1st time since June

A burial team member wearing personal protective equipment (PPE), stands for decontamination spray at the U.S.-built cemetery for "safe burials" in Disco Hill, Liberia on Tuesday. (John Moore/Getty Images)

The number of new confirmed Ebola cases totalled 99 in the week to Jan. 25, the first time the weekly total has fallen below 100 since June 2014, the World Health Organization said on Thursday.

"The response to the EVD (Ebola virus disease) epidemic has now moved to a second phase, as the focus shifts from slowing transmission to ending the epidemic," the WHO said.

"To achieve this goal as quickly as possible, efforts have moved from rapidly building infrastructure to ensuring that capacity for case finding, case management, safe burials, and community engagement is used as effectively as possible."

The outbreak has killed 8,810 people out of 22,092 cases, almost all of them in Sierra Leone, Liberia and Guinea.

Cases and deaths have fallen rapidly in Liberia and Sierra Leone in the past few weeks, with 20 deaths recorded in Liberia in the 21 days to Jan. 25 — less than one a day.

But Guinea reported 30 confirmed cases in the latest week, up from 20 in the previous week. The epidemic is also still spreading geographically there, with a first confirmed case in Guinea's Mali prefecture bordering Senegal, which reopened its border with Guinea on Monday.

A resurgence of the virus in Guinea, where the outbreak began, would threaten President Alpha Conde's goal of eradicating Ebola from the country by early March.

Disease experts say that tracking down everyone who has had close contact with an Ebola patient is crucial to ending the outbreak. But in dozens of remote villages in Guinea, angry residents are blocking access for health workers.

The most intense transmission in Guinea is in Forecariah district, close to the border with western Sierra Leone, the worst Ebola hotspot.

"There have recently been reports of high levels of community resistance to EVD response measures in Forecariah, indicating a need to better engage the community in the response," the WHO said.

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Complacency now a concern as Ebola numbers decline

Complacency looms as a big risk in the fight against the Ebola virus, those leading the battle say.

Although West Africa has about 50 new cases (confirmed, probable and suspected) every day, mostly in Sierra Leone, the rate of new cases is on a downward trend. But that has happened before during this epidemic.

In May, for example, the World Health Organization projected that in a matter of days the Ebola outbreak in Liberia "could be declared over."

However, in July, the number of cases in Liberia began to rise rapidly, peaking in August and September, followed by an equally rapid decline.

Three months ago, health workers were identifying about 240 new cases a day in West Africa. Now the WHO talks about new case numbers halving, because in Guinea new case numbers go down by half every 10 days, in Liberia every 14 days and in Sierra Leone every 19 days.

As it released those numbers, the WHO warned, "Complacency is the biggest risk to not getting to zero cases. Continued vigilance is essential."

Doctors Without Borders, which says it has cared for about a quarter of all declared Ebola cases in West Africa, now has just over 50 patients in its Ebola care centres.

The group, known by its French initials MSF, is also worried that "loss of vigilance now would jeopardize the progress made in stemming the epidemic."

Dr. Allison McGeer, who helped lead efforts to halt the SARS outbreak in Toronto in 2003, also worries that the world could become complacent as case numbers drop. McGeer, based at Mount Sinai Hospital in Toronto, began working with the WHO on Ebola last fall, making several trips to West Africa.

How the outbreak was slowed

Several factors were critical in slowing the epidemic.

Three days after his wife died of Ebola in Monrovia, Liberia, James Flomo is in isolation with his children, Jan. 21, because he may have the virus. (James Giahyue/Reuters)

This was the first Ebola outbreak to hit West Africa, so health workers there were slow to recognize it and respond. With weak public health systems, countries lacked sufficient resources to respond, and the rest of the world was also slow to help out at required levels.

McGeer says there has been a huge community education campaign in the three countries about what Ebola does, how people can protect themselves, the importance of changing funeral practices such as washing the body, and the need to report and identify illness.

Quickly identifying ill people and treating them in isolation were also key, she says.

Brice de le Vingne, MSF director of operations, says improved efforts and resources for contact tracing — identifying and tracking everyone who was recently in contact with a new Ebola patient — were also key to slowing the epidemic.

De le Vingne tells CBC News that people not on any Ebola contact list are still getting the disease, indicating the surveillance system is still not good enough.

All those measures sounds simple, McGeer says, but it is an enormous amount of work. Because of the three countries' "very fragile health and public health systems, there has been a need for funding both within those systems and for people to help them."

Virus speculation

There has been speculation that something about the virus has changed, but no one CBC News interviewed for this story says there is evidence of that.

Tom Geisbert, at his biosafety Level 4 lab at the University of Texas Medical Branch in Galveston, works on treatments and and vaccines for Ebola. Time magazine included him among Ebola fighters it named 2014 Person of the Year. (UTMB-Galveston)

Microbiologist Tom Geisbert says research is underway in biosafety Level 4 labs, including his own at the University of Texas Medical Branch in Galveston, on samples of the virus from West Africa.

So far researchers have confirmed the virus is very similar to the Zaire strain of Ebola, which has been responsible for most of the outbreaks in Central Africa. Geisbert says it's too early to tell whether the small genetic differences would have any impact on the effectiveness of a vaccine.

Time magazine included Geisbert as one of the Ebola fighters it named as Person of the Year for 2014, for his work on vaccines and treatments.

McGeer, who is also a microbiologist, says it's not impossible that the virus is losing strength, "just unlikely." If that was happening, she says it's odd that it would be "losing strength differentially in different countries."

While corona viruses like SARS and MERS have changed virulence, she says there is no evidence that Ebola can do this.

Lessons learned

McGeer, Geisbert and de le Vingne stressed vigilance for what the Liberians call "getting to zero" in the Ebola outbreak.

Since last fall, Dr. Allison McGeer, a microbiologist and infectious disease consultant at Mount Sinai Hospital in Toronto, has been working with the World Health Organization. (CBC)

De le Vingne says MSF will stay in an emergency mindset because of the need to track down every case and monitor every contact. Cross-border spread requires a regional response.

He notes the delay in the global response allowed the virus to spread out of control. If there's another Ebola outbreak tomorrow, "we still don't have a functioning organizational system to respond to that kind of epidemic."

But, he adds, "You cannot have a one-size-fits-all system, you need to know very well the people you are working with and interacting with and you need to have a very well qualified staff to do that."

McGeer says it's critical to continue investment and hard work, although it is difficult to keep up the pace. "As soon as you let up, you are likely to have relapses."

All the people she has worked with at the Liberian health ministry have been at it "24/7 for nine months now — no holidays, no days off and one in 20 of their colleagues have died."

Geisbert would like to have stocks of treatments such as ZMapp and TKM-Ebola readily available near potential outbreak zones. He says that although the vaccines have the potential to make a big difference, they are "no substitute, especially in Africa where you have poor public health infrastructure."

Nevertheless, he'd like to see "everything ready for that vaccine, so that when you do have an outbreak, you can move in quickly."

Geisbert, along with Canadian scientists, came up with VSV-EBOV, an experimental vaccine now in trials. Because it is a single-injection, fast-acting vaccine, it holds promise for use as an emergency response.

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'World cannot walk away' from West Africa's Ebola recovery

Incomes in Guinea, Sierra Leone and Liberia have shrunk dramatically since the first Ebola cases were confirmed. (Youssouf Bah/Associated Press)

Rich countries must act swiftly to repair battered health systems and get cash to millions of families in the three countries hit hardest by the world's worst Ebola outbreak, the international development agency Oxfam said Tuesday.

Though the economies of Sierra Leone, Guinea and Liberia were recording strong growth prior to the outbreak, the countries remain some of the world's poorest and incomes have shrunk dramatically since the first Ebola cases were confirmed in Guinea last March.

New cases now appear to be on the wane, but Oxfam said donor countries should commit to a post-Ebola "Marshall Plan" that would address urgent cash shortages and crippling damage to social services like health, education and water and sanitation.

Families in the three countries have "gone through hell," Oxfam GB Chief Executive Mark Goldring said, in no small part because the international community reacted slowly during the early stages of the outbreak.

"The world cannot walk away now that, thankfully, cases of this deadly disease are dropping. Failure to help these countries after surviving Ebola will condemn them to a double-disaster," Goldring said.

Oxfam research from three counties in Liberia, the country with the most Ebola deaths, shows that 73 per cent of families are facing income declines averaging 39 per cent.

The lack of money combined with high food prices mean 60 per cent of people have not had enough to eat in the last seven days, Oxfam said.

Ebola has killed more than 8,600 people in Liberia, Sierra Leone and Guinea, according to the World Health Organization — a total that includes confirmed, suspected and probable deaths.

On Sunday, several dozen of WHO's member countries approved a resolution aimed at strengthening the UN health agency's ability to respond to emergencies after a sluggish performance that experts say cost thousands of lives.

Even as aid agencies look to the recovery effort, Doctors Without Borders warned this week that "critical gaps" in countries' efforts to trace Ebola contacts could lead to new surges in cases.

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Streptococcus: What it is and why chickenpox raises risk

Toronto health officials blamed an infection from "a common bacteria" known as Group A streptococcus (GAS) this week in the death of a three-year-old boy who attended an east-end daycare.

The child was reportedly running a fever on Jan. 13. His parents took him home and he died four days later.

While GAS is often carried on the skin and in the nose and throat in many people, it is generally not regarded as dangerous for most of the population.

Immunologists and microbiology experts explained how the bacteria spreads, who's most at risk, and how chickenpox may be a danger factor.

What is Group A streptococcus?

Streptococci are bacteria that commonly cause infections. Among the most common infections in pediatrics is streptococcus pneumonia or impetigo, a contagious skin infection.

There are eight strains of the bacteria, classified from groups A through H. Different types of streptococci cause different types of infections. A common, mild illness brought on by the human-specific Group A streptococcus is strep throat. GAS can also cause more serious infections such as pneumonia, bloodstream infections and infections to the brain.

"It's also associated with diseases that are part of your immunogenic response to infection, such as rheumatic fever and a condition called glomerulonephritis, or inflammation of the kidneys," said Dr. Allison McGeer, director of infection control at Mount Sinai Hospital.

How common is this bacteria?

Very common, according Dr. Rita Shahin, an associate medical officer of health with Toronto Public Health.

"A lot of people carry it either on their skin or in their throat," Shahin said, noting that it's only in rare cases that it becomes invasive, entering "sterile" body sites such as the bloodstream or the lining of the brain.

"We don't know why in certain people that happens, and we do know that in a small percentage of those people who get invasive disease, they can go on to die of this disease," she said.

McGeer said about one in 10 children carries Group A strep in the throat without symptoms, and in the overall population, about two in every 100,000 people will develop any type of serious infection.

Toronto Public Health estimates there were 150 cases of Group A streptococcus in Toronto last year, occurring more often in the winter than summer. About 15 per cent of people who develop invasive disease will die, she said.

When does it become dangerous?

An invasive streptococcal disease is one that has been isolated from a part of the body that is normally sterile, said Dr. John McCormick, an associate professor of microbiology with Western University.

"So not your throat or skin, but more so a blood sample or a soft-tissue infection, those types of areas," he said.

Bacteria can make its way into deep muscle tissue and the lungs, for example.

When this happens, one common form of invasive GAS disease is necrotizing fasciitis, also known as flesh-eating disease.

Added danger may also come in the form of streptococcal toxic shock syndrome, a disease that arises when the immune system "overreacts," McCormick said.

"A patient's blood pressure really drops, you can get organ failure and other things," he said, adding that the mortality rate in children is about 50 per cent if they develop the condition.

Early treatment with antibiotics can reduce the risk of death in cases of invasive illness.

How are Group A streptococci transmitted?

The bacteria spreads by direct contact, for example skin on skin or respiratory droplets.

Although Toronto Public Health officials have said the Toronto daycare has been disinfected, McGeer said environment is typically not the issue.
 
"It's important for people to remember that it's very uncommon for serious illness to occur in a second child in this setting," she said.

"Generally speaking, if there's not a case in the next two weeks, there's not going to be another one."

Family members living in a close setting or sharing beds could be at higher risk of transmission.

"If somebody in a household gets sick with Group A strep, there's about a 10 per cent chance that another member of the household will have Group A strep – not the infection, just colonization," McGeer said. "The risk they'll get an infection is much, much lower."

Shahin added that if parents of children who attended the Toronto daycare notice symptoms such as sore throat or fever, "or if their children develop symptoms like that beyond a mild cold," they should take them to the doctor, who can conduct a throat swab test.

Who is most at risk?

It's tough to say, according to McGeer.

"People who die from this infection often have perfectly normal immune systems," she said. "We still don't know why an occasional person can develop a catastrophic illness with Group A strep while most other people don't."

Children are more likely to carry a strain of almost any bacteria, McGeer said.

While handwashing is always good practice to prevent the spread of bacteria, McCormick also points to a research paper co-authored by McGeer that found chickenpox to be a factor in invasive Group A strep.

"Any disease that damages your skin and leaves you with open lesions on skin can increase your infection," McGeer said.

For that reason, health officials recommend that children get vaccinated against chickenpox.

For more information, you can visit Toronto Public Health's invasive GAS fact sheet or consult your doctor.

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Winnipeg's 1st citywide boil-water advisory not a 'no-water event'

Winnipeg's first-ever boil-water advisory doesn't mean it should turn into a "no-water event," a city official said a day after the advisory took effect due to an E. coli scare.

While water must be boiled before drinking it or using it for food preparation, tap water is still safe for hand washing, Geoff Patton, of the water and waste department, told media Wednesday morning.

Abnormal test results, including the ones that confirmed the E. coli that prompted the advisory on Tuesday night, are rare for Winnipeg.

Winnipeg's first citywide boil-water advisory is not the same as a "no water event," says the City of Winnipeg. Officials say people can still wash their hands, but should still use bottled water or boil tap water before consuming it.

The boil-water advisory instituted Tuesday marked the first for the entire city, Patton said.

"They just don't add up," Patton said of the test results. "We need to get to the bottom of this." 

He noted that it takes time to grow bacterial samples for testing, and if Wednesday's tests come back negative, there will be a consultation before the boil-water advisory is lifted.

Boil-water advisory affects in healthcare

According to the Winnipeg Regional Health Authority (WRHA), the boil-water advisory will not affect surgeries because they don't require the use of tap water. 

Young patients or those with weakened immune systems in facilities are being given bottled water, because they could be at risk of "bad water," said Helen Clark of the WRHA.

The WRHA has been in contact with a bottled water supplier to ensure sufficient supplies for patients, Clark said.

There have been no reports to the city of anyone getting sick from consuming city water, and the WRHA has not seen any water-related clusters of illness.

But the city is emphasizing that Winnipeggers should keep boiling their water and not panic.

Schools turn off taps

Schools throughout Winnipeg turned off their taps after the boil-water advisory came into effect.

Parents were asked to send their children to school with bottled water, or water that has been properly boiled and cooled at home.

At the University of Winnipeg, plastic wrap covered a water fountain in the soccer complex.

Oliver Thomas was caught off guard when he showed up with an empty bottle before his game.

"There's no water in the bottle — totally nothing.  And I usually bring water from home, but they usually tell us not to, so I usually use the water fountain," he said.

Water fountains and bottle-filling stations have also been turned off at Red River College, where food services are limited as a result of the advisory.

Staff have provided residents with bottled water at the Paterson GlobalFoods Institute, where culinary, hospitality and baking programs are held. A limited breakfast will be offered to those residents on Wednesday morning, and classes won't be affected, according to a college spokesperson.

World of Water, companies work to keep supply available

Bottled water has been scarce in Winnipeg after a run on stores on Tuesday night.

Winnipeggers bought up huge numbers of bottled water from stores across the city Tuesday night after a boil water advisory was issued for Winnipeg. (Sarah Penton/CBC)

Winnipeg's head office for World of Water on Keewatin Street usually closes at 4:30 p.m. but on Tuesday the office stayed open until midnight filling bottles for their outlets around the city. On Wednesday, employees were on the job at 6 a.m., two hours earlier than their regular start time.

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Obesity health strategy in Canada shifts to prevention

Prevention of even a slight weight gain is key to avert heart disease, cancer and other chronic health problems from setting in at middle age, according to new Canadian guidelines.

Expanding waistlines are well recognized. Obesity measurements among adult Canadians has almost doubled from 14 per cent in 1978-1979 to 26 per cent in 2009-2011.  

Karen Ward thinks obesity should be treated as a sign or symptom of other underlying issues. (Paul Borkwood/CBC)

The excess weight is a public health concern since research suggests it increases the risk of cardiovascular disease, cancer, Type 2 diabetes, osteoarthritis and back pain. 

To counter the health problems, the Canadian Task Force on Preventive Health Care released recommendations for family physicians Monday on prevention of weight gain and treatment of overweight and obesity.

"Weight really creeps up on people," task force member Dr. Brett Thombs of Jewish General Hospital in Montreal said in an interview.

That's why Thombs and his colleagues encourage doctors to track their patients. "People don't realize they're putting on a pound a year until it's too late."

The recommendations include:

• Measure height, weight and calculate body mass index (BMI) at primary care visits to monitor weight changes over time.
• Don't offer formal programs to prevent weight gain in healthy adults because there's such scant evidence of success in terms of lower BMI, reduced waist circumference or loss of body fat. 
• Do offer structured programs with such those with diet and exercise to coach behaviour changes in those who are overweight and obese, especially if they are at high risk of developing Type 2 diabetes.
• Don't routinely offer medications for weight loss since trials suggest participants were more likely to experience gastrointestinal side-effects compared with those in a control group. Behavioural options are preferred.

Previously in 2006, the panel supported interventions for adults with Type 2 diabetes and hypertension related to obesity. Panellists pointed to updates in knowledge to explain the change, which they called consistent with other national international guidelines.  

They also suggested practitioners should be aware of barriers to participation in structured weight-loss programs, such as unrealistic expectations, hunger, sociocultural factors and past stigmitizing experiences.

Dr. Raj Padwal of the University of Alberta in Edmonton was an expert reviewer for the report.

"Given the trade off between spending time, between modest weight loss results and getting a person's blood pressure controlled and preventing their stroke, I think the health care provider can only do the latter and that's what I think they should be spending their time doing," Padwal said.

Successful weight loss will mean looking beyond the health-care system, to other aspects such as  buildings conducive to encourage exercise, countering sedentary lifestyles, and curbing calorie-dense foods, Padwal said.

Karen Ward blogs as the Curvy Canadian and has a plus-sized clothing store in Toronto. Ward says nearly all of her clients have dieted and felt badly about themselves at some point.

"I would like to see the conversation framed in such a way that the focus is shifted away from preventing or treating obesity, which I look to be a side-effect or a symptom of maybe something else going on," Ward said.

Ward recalls she started gaining weight around age nine. 

"The best way to manage my health personally was not to necessarily worry about the number on the scale or about the size of my dress, but to make sure I am getting the proper nutrition and proper exercise …but not necessarily to worry about the all the rest of the stuff because it was damaging to my mental health."

The recommendations made by the task force do not apply to pregnant women or individuals with eating disorders.

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H7N9 bird flu confirmed in B.C. resident who travelled to China

The first human case of H7N9 bird flu in North America has been confirmed in a woman from British Columbia who had recently visited China, health officials say.

The woman does not pose a risk to the public, officials said.

"The individual is a resident of British Columbia and was not symptomatic during travel and only became sick after arrival in Canada. The individual did not require hospitalization and is currently recovering from their illness, in self-isolation," the Public Health Agency of Canada said in a statement.

The B.C. resident returned to Canada on Jan. 12 from China and began feeling ill on Jan. 14. 

Dr. Gregory Taylor, Canada's chief public health officer, said there is no evidence of human to human transmission. 

Health officials keep a lookout for high-risk bird flu viruses that easily spread from person to person.

The same strain of avian flu has caused over 500 illnesses in China since 2013, Taylor said. 

Symptoms include fever, cough and shortness of breath. Most of the cases in China developed severe pneumonia and breathing difficulties, some resulting in death, according to the Public Health Agency of Canada.

Dr. Bonnie Henry, B.C.'s deputy provincial health officer, said a second person, a man who travelled with the infected woman, likely had avian flu and remains a suspect case.

Since the two showed symptoms within a day of each other, health officials said both were likely exposed to a common source of infection, such as waste at a live poultry market in China, rather than one person infecting the other. 

The woman in her 50s had been travelling with her partner, said Dr. Reka Gustafson of Vancouver Coastal Health. He became ill first, and a day or two later the woman became sick enough to seek care from a family doctor, she said.

The couple from B.C.'s Lower Mainland were given the antiviral Tamiflu.

Swabs were taken and the specific result was confirmed by the National Microbiology Laboratory in Winnipeg.

Anyone who has travelled to areas of China with H7N9 and gets sick should consult a doctor.

Outside of mainland China, the federal health agency said, travel-related cases have been confirmed in Taiwan, Hong Kong and Malaysia, after exposure to poultry traced to eastern provinces in China.

"There is no indication that international spread has occurred, as contacts of the travellers did not develop illness," the agency said.

Travellers to China should avoid live bird markets and make sure eggs and poultry are cooked properly, health officials recommended. 

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Thalidomide survivors still hope for funding after Ottawa misses deadline

The federal NDP chastised the Conservative government on Monday for missing a deadline to provide funding to 95 thalidomide victims.

The Thalidomide Victims Association of Canada had given the government until Monday to announce a funding package. But Health Minister Rona Ambrose told the group that it will take more time to determine how best to help them.

"Thalidomide survivors just do not have the luxury of time," NDP MP Murray Rankin told the House of Commons during the daily question period.

"They have been suffering from their disabilities for their whole lives. The Canadian government told their mothers that thalidomide was safe. That means we have a moral responsibility to provide them with support now."

Eve Adams, parliamentary secretary to Ambrose, responded that the government "will be able to make an announcement shortly."

Mercedes Benegbi, a thalidomide survivor and executive director of the association, was on Parliament Hill to push for action. NDP leader Tom Mulcair greeted her in the foyer outside the House following the daily question period.

Ambrose's office says senior Health Canada officials have been working around the clock and remain committed to a funding package.

The association says it's still optimistic that Ottawa will come up with a proposal that will fully support thalidomide survivors.

People affected by thalidomide are dealing with missing and malformed limbs, deafness, blindness, disfigurement and other disabilities a half-century after the drug was prescribed to their pregnant mothers.

The Conservatives supported an opposition motion in the Commons late last year that would extend full support to the survivors.

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Daycare issues warning after Toronto boy dies of Streptococcus infection

Health officials are advising parents that a child who attended an east-end Toronto daycare centre has died of a bacteria-related infection.

Dr. Irene Armstrong, an associate medical officer of health with the City of Toronto, wrote a letter to the parents and staff of Woodfield Day Care last Thursday advising that a child had died of an infection caused by the bacteria known as group A streptococcus (GAS).

The letter indicates that GAS is "a common bacteria" that can cause strep throat, skin infections, scarlet fever and tonsillitis.

"On rare occasions, GAS can cause more severe illnesses such as toxic shock and necrotizing fasciitis (flesh-eating disease)," the letter says.

The city has released a fact sheet detailing the symptoms of severe invasive GAS.

The symptoms include:

• Necrotizing fasciitis and myositis — fever, severe pain, swelling and/or redness of part of the body.
• Meningitis — fever, headache, severe neck pain, nausea and/or vomiting.
• Streptococcal toxic shock syndrome — fever, a general feeling of unwellness, dizziness, confusion and/or a flat, red rash on the body.

Officials are advising the daycare staff and parents of the children to seek "prompt medical attention" should they or their children attending the daycare develop an illness with fever or any of these symptoms within 30 days of contact with a person diagnosed with invasive GAS.

Doctors should be instructed that the individual has been in contact with someone diagnosed with invasive GAS disease and developed symptoms.

The letter from the city does not say when the child died or his age.

Eileen Levy, the vice-president of family and neighbourhood services at WoodGreen Community Services, told CBC News that the child was a three-year-old boy.

Levy said the boy was found to be running a fever on Jan. 13, at which time his parents were called and he was picked up. He did not return to the daycare centre and died at home four days later.

According to Levy, approximately 100 children attend Woodfield Day Care. She said the daycare centre has very high standards and the facilities are regularly disinfected.

Woodfield Day Care is located within the Duke of Connaught Public School, in the Coxwell Avenue and Queen Street East area.

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Clinicians told to rethink prescribing morphine for kids after trials halted

Clinicians are being asked to rethink post-operative care for children with sleep apnea, and avoid prescribing morphine, following clinical trials that revealed the drug can cause life-threatening breathing problems. 

Midway through 2014, researchers from Toronto's Hospital for Sick Children and Hamilton's McMaster University halted trials about the adverse effects of morphine as a pain reliever for children who had their tonsils or adenoids (commonly called a nose tonsil) removed after one child needed to be resuscitated because of a lack of oxygen. 

Each hospital's ethics board, as well as Health Canada, was notified as a result. The general findings showed the adverse affects of morphine, and an alternative that managed pain just as effectively. 

Researchers found morphine should not be given to children following sleep apnea operations, except in monitored or extreme cases, and that standard doses of ibuprofen and acetaminophen helped ward off pain in the three weeks of discomfort children tend to have after the operation. 

"It is safer, treats the pain just as well and should be considered the main treatment," Dr. Doron Sommer, clinical professor of surgery at McMaster's Michael G. DeGroote School of Medicine and a surgeon at McMaster Children's Hospital, said of the alternatives.

Sommer and researchers from the Hospital for Sick Children were looking into alternative pain management options for children getting tonsillectomies.

Some 14,000 tonsillectomies are performed in Ontario every year, and according to Sommer, many are to prevent sleep apnea in children.

In 2009 and 2012, major studies revealed codeine caused adverse reactions and even death when used in pediatric post-operative care for sleep apnea patients, suppressing the brain's signalling to breathe while sleeping. It's one part of what causes apnea, along with physical blockages in the breathing pathway.

"It works on the brain directly to decrease the respiratory drive," Sommer said.

Since codeine is metabolized into morphine in the body, Sommer said, researchers looked at removing the metabolic stage to give a more uniform pain management delivery, essentially skipping the middle man. However, similar negative effects were found when morphine was give to children following surgery. 

"The evidence here clearly suggests children with obstructive sleep apnea should not be given morphine for post-operative pain. We already know that they should not get codeine, either," says Dr. Gideon Koren, another author of the study and senior scientist at the Hospital for Sick Children.

"The good news is that we now have evidence that indicates ibuprofen is safe for these kids, and is just as effective in controlling their pain, so there's a good alternative available for clinicians to prescribe."

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Pharmacists say corporate pressure can lead to prescription mistakes

Some Canadian pharmacists are saying they are under intense pressure to meet business quotas, which causes an assembly-line mentality that increases the likelihood of making mistakes.

Several pharmacists are speaking out as part of a months-long investigation by CBC News and Marketplace looking at pharmacy errors across the country.

EarIier this week, Marketplace revealed that many pharmacists may not be conducting important screening required to keep Canadians safe from dangerous drug interactions.

Some pharmacists say the pressure to meet profit targets can compromise the quality of the care and attention they're able to dispense.

CBC agreed to protect the identity of the pharmacists who spoke out and fear industry reprisal.

"You know it comes down to metrics and bottom lines, as margins shrink," one pharmacist told Marketplace co-host Erica Johnson.  

"You keep hearing, 'Doing more with less, doing more with less.' And it's not sparing the health care profession at all," he said. "It's every pharmacist's worst nightmare."

The Marketplace investigation, Dispensing Danger, airs Friday, Jan. 23 at 8 p.m. (8:30 p.m. NT) on CBC Television and online.

'At some point you just reach your limit'

Every year, close to 38,000 pharmacists dispense more than half a billion prescriptions in Canada. There are no statistics on how often errors occur, and little mandatory reporting of mistakes.

Some pharmacists have come forward to say that corporate targets can affect patient care. "It's every pharmacist's worst nightmare," says one pharmacist. (CBC)

Marketplace spoke with several pharmacists who describe a corporate environment where pressure to meet business targets makes errors more likely.

Pharmacists described targets that include corporate quotas for prescriptions filled per day and productivity targets that include labour hours per prescription dispensed.

Pharmacy insiders say they are also under pressure to push services such as flu shots and medical checks, services that can mean increased revenue for pharmacies.

"It comes down to transactions, yet again. 'How many can I get through in an hour?' To do it quickly? You know, you just go, go, go," one pharmacist said.

"As a pharmacist, you just get frustrated."

When they don't achieve those targets, some feel it can invite corporate scrutiny, change staffing levels and ultimately affect their jobs, meaning there's less support behind the pharmacy counter.

"If you're messing around with labour to achieve a financial goal, then you're doing things faster; you're cutting corners," another pharmacist said.

"You might be a great pharmacist at a slower speed and everyone has a breaking point. You keep dialing that up, at some point, you just reach your limit," he said.

He acknowledges that he has made errors, but adds that "you only know about the ones you know about. What scares me more is the ones I don't know about."

The corporate pressure to perform can mean balancing business pressure and professional responsibilities can get "blurred," he says. Because of the pace, he says that he often feels he's operating on "automatic pilot."

Marketplace requested an interview with the Neighbourhood Pharmacy Association of Canada (NPAC), which represents most pharmacies across the country.

The group declined to speak on camera, but issued a statement that said: "Patient health and safety is our top priority. Pharmacy in Canada works hard every day to earn the trust and promote the health and well-being of Canadians."

NPAC didn't address the use of targets or the effect they have on pharmacy practice.

Error stories pour in to CBC

Since news of the Marketplace investigation first aired, stories have been pouring in from Canadians about their experiences with pharmacy errors. Some say they were dispensed the wrong drug or the wrong dose; others complain that they were never made aware of drug interactions.

After hearing about the Marketplace investigation, Debbie McDonald discovered that her son's acne medication, Accutane, had been mixed up with a drug called Accupril. (CBC)

Debbie McDonald from South Surrey, B.C. is alarmed at how a pharmacy error could have affected her family.

Earlier this week, she picked up an acne medication -- Accutane -- for her 18-year-old son, Kevin. After hearing about the Marketplace investigation, Kevin looked up the drug by doing a web search for the number printed on the pills.

While the bottle was labeled correctly, the pills inside were actually Accupril.

McDonald was alarmed. "Thank goodness I know [that] medication is for high blood pressure," she said.  

"If I had been someone else, I might have told him, 'Well, it's probably the same.'"

She doesn't want to think about what would happen if Kevin, who studies aviation at the University of Fraser Valley and often flies solo, had taken the Accupril pills.

Pharmacists also wrote in about their concerns about why errors happen.

"I have worked for independent, grocery and chain pharmacies," one pharmacist wrote. "The bottom line is always the same, regardless of how the employer frames it. Work as fast as you can, do not take meal breaks, forget about being able to relieve your bladder.

"It is a ridiculous situation that we are placed in. If your blood sugar level drops so low that you cannot function, is it any wonder that errors are made?

"We are supposed to be health care providers, but are expected in many workplaces to put our own health and well-being to one side in order to make more money for our employers."

Have you experienced a pharmacy error? Marketplace wants to hear from you. Email marketplace@cbc.ca

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Ottawa 'bubble boy' needs gene therapy treatment in U.S.

An Ottawa family is trying to raise $30,000 for travel costs as they seek life-saving treatment for their infant son, who suffers from Severe Combined Immune Deficiency (SCID) — popularly known as "bubble boy" disorder.

SCID involves a group of rare and potentially fatal conditions in which the immune system either lacks key immune cells called T-lymphocytes or the cells don't work properly. It's also known as bubble boy disorder after David Vetter, a boy from Texas with a type of SCID, lived for 12 years in a plastic, germ-free bubble.

Etienne Blais of Ottawa, now seven months old, has an incredibly weak immune system due to the rare disorder, making him vulnerable to bacteria and viruses. His parents can't take him out of the house without literally putting him in a plastic bubble.

"The shock kind of came in waves. The more we understood about it, the more we realized how serious it was," said Etienne's father, Pierre-Julien Beaulieu-Blais, "I'm working harder than I ever have."

1st baby tested for disorder

The parents must keep their home incredibly clean because a simple cold could kill the baby boy.

Etienne Blais, seen here in his first few months, was born with Severe Combined Immune Deficiency. His parents say the only permanent treatment exists in California. (Photo supplied by the family of Etienne Blais)

​Blais was the first child to be detected with SCID as part of Ontario's new screening program, which started in August 2013, according to Anne Phem-Huy, a pediatrics and disease specialist at the Children's Hospital of Eastern Ontario.

Ontario was the first province in Canada to screen for the disorder, which affects one in every 100,000 newborns.

Blais is currently undergoing treatment but it is only temporary, his father said. The only permanent treatment is called gene therapy, still in its experimental stages.

"It's been around for about 20 years and its definitely been refined over the years, and there have been more promising results in the last couple of years," said Phem-Huy.

Treatment only at UCLA

Blais's parents debated whether gene therapy was necessary, but now they believe it is the only way to go.

The family is set to travel to Los Angeles where therapy exists at the University of California, Los Angeles (UCLA). The university will pay for the expensive treatment, but the family must pay for the trip there plus the stay in L.A.

Beaulieu-Blais said they hope to raise about $30,000, as the therapy could take a couple of years.

To donate to the family's cause, you can visit their website at babyetienne.com.

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Couple pleads for liver donor as dad can only help 1 twin daughter

It's a decision no parent or medical professional would want to make.

An Ontario dad with twins who both need a liver transplant is a match to donate part of his organ, but can only help one of the three-year-old girls. Unless Michael Wagner and his wife Johanne's public campaign for another donor succeeds, doctors may need to choose which of their daughters undergoes the lifesaving operation first.

The Wagners adopted Binh and Phuoc knowing the girls have Alagille syndrome, a genetic disorder that affects liver function.

"We need people to come forward, people who are willing to be assessed to be live liver donors," said Johanne Wagner in an interview with CBC News on Sunday.

"Things could turn around very quickly on us and their condition could get worse."

'We're going to move forward'

The Wagners — who have seven older children — adopted Binh and Phuoc from Vietnam in November 2012 when the girls were 18 months old.

"When we went to Vietnam, before we went, we knew that they were very ill and we knew it was liver-related," said Michael Wagner. "We said, 'All right, we're committed and we're going to move forward with the hope that everything is going to be OK.'"

The girls' conditions worsened over time, however, and now a live liver transplant is the only option to keep them alive for the long term.

Twins Binh, left, and Phuoc Wagner have Alagille syndrome, which affects the function of their livers. Their father, Michael, is set to donate part of his liver to save one girl, but cannot donate to both. (Wagner family/Canadian Press)

"In both the girls, it's quite advanced, and it can't be improved or maintained with medicines or other surgeries, so we've been forced to list them for a liver transplant," said Dr. Binita Kamath, who treats the twins.

Because Michael Wagner can only donate to one of his daughters, doctors will decide which of the girls gets a transplant first based on the severity of each child's symptoms

"I think we will make the decision based on facts and keep it as dispassionate as possible … We feel comfortable making this decision," Kamath said.

Keeping a promise

The family has turned to social media with a Facebook page that lays out the requirements for potential donors. They say they won't stop until both twins have a chance of survival.

"It was what we promised from the beginning when we picked them up from Vietnam. We promised we would do everything in our power to make everything OK, and this is just keeping that promise," said the girls' father.

The couple hopes the first transplant will happen as early as next month, but that both girls can undergo the procedure around the same time.

A potentially suitable donor must fulfil the following criteria:

• Be older than 18 years old but younger than 60.
• Be in good overall health.
• Have a compatible blood type (A or O in this case).
• Have a body mass index (BMI) of less than 35 prior to the operation, and no more than 32 on the day of the procedure.

Donors can expect to spend five to 10 days in hospital. The donor's liver will regenerate within about six to eight weeks, doctors say.

If you might meet the criteria and are willing to undergo testing, contact Toronto General Hospital at 416-340-4800, ext. 6581. 

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Experimental Ebola vaccine reaches Liberia for trials on health-care workers

The first batch of GlaxoSmithKline's experimental Ebola vaccine has been shipped to West Africa and is expected to arrive in Liberia later on Friday, the British drugmaker said.

The shipment, of an initial 300 vials of the vaccine, will be the first to arrive in one of the three main Ebola-affected African countries, GSK said in a statement.

It will be used in the first large-scale vaccine trials in coming weeks, in which health-care workers helping to care for Ebola patients will be among the first to get it.

Researchers hope eventually to enrol up to 30,000 people in the trial, a third of whom would get GSK's candidate vaccine.

The vaccine, co-developed by the National Institutes of Health in the United States and Okairos, a biotechnology firm acquired by GSK in 2013, is currently being tested in five small phase I safety trials in Britain, the United States, Switzerland and Mali involving around 200 healthy volunteers in total.

"The initial phase I data ... are encouraging and give us confidence to progress to the next phases of clinical testing which will involve the vaccination of thousands of volunteers, including front line health-care workers," said Moncef Slaoui, GSK's Global Vaccines chief.

The vaccine uses a type of chimpanzee cold virus to deliver safe genetic material from the Zaire strain of Ebola, the strain responsible for the unprecedented West African epidemic.

Data so far show "an acceptable safety profile" including in a West African population and across a range of dose levels, GSK said, adding it had now selected the most appropriate dosage for the Liberia trial.

The World Health Organization said on Thursday the Ebola outbreak in West Africa appears to be waning but cautioned against complacency in an epidemic that has seen 21,724 cases reported in nine countries since it started in Guinea a year ago. Some 8,641 people have died, according to WHO data.

Slaoui stressed that GSK's shot, like other candidates from a NewLink Genetics and Merck collaboration, and from Johnson & Johnson and Bavarian Nordic, is still in development and can't be deployed unless and until it proves safe and effective.

"Any potential future use in mass vaccination campaigns will depend on whether the WHO, regulators and other stakeholders are satisfied ... and how quickly large quantities ... can be made," he said.

NewLink Genetics and Merck are collaborating on the vaccine which was originally developed at the National Microbiology Lab in Winnipeg. Trials for that vaccine were temporarily halted in December due to a potential side effect, but were eventually resumed.

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Stress of family caregiving red flagged

Carolyn Poirier and her sister Claire have looked after their mother, Jane, centre, at home since she was diagnosed with early onset Alzheimer's disease nearly seven years ago. (Courtesy Carolyn Poirier)

Many people caring for a chronically ill family member say they're very stressed, according to the Mental Health Commission of Canada. It's calling for better access to mental health treatment as a top priority.

Thursday's interim report from the commission red flags the nearly 17 per cent of the 5.5 million Canadian caregivers aged 15 and over as a "substantial proportion" coping with very difficult levels of caregiver stress.

"We need to support caregivers' health," Kimberley McEwan of the Centre for Applied Research and Mental Health, at Simon Fraser University, one of the authors of the report, said in an interview. "We know caregivers who are under a lot of stress will ultimately develop mental health and potentially physical health problems as well."

As the population ages, the number of people with dementia and other chronic illnesses will rise, boosting the need for family care, the authors said.

The group looked at national 13 indicators to see how well the health system responds to mental health needs and what collectively needs to be done.

Commission members said they want mental health prioritized among all health spending so it's given the same calibre as wait times for cancer treatment or hip replacement.

For recovery to happen, the mental health system needs to be sensitive to the needs of the family as whole, said Chris Summerville, CEO of the Schizophrenia Society of Canada.

"Listen to the family member's needs," Summerville urged. "They may have to take time off of work, they have to take money out of the budget to help the one they're caring for, there's fatigue that perhaps comes along with it," Summerville said. 

Carolyn Poirier of Toronto was 19 when her mother, Jane, was diagnosed with early onset Alzheimer's disease. In the seven years since, taking care of her mother, along with her sister and dad, has required a lot of sacrifices.

"I have had to give up a number of career opportunities," and chances to travel," Poirier said. Despite her love for the mother, she said the situation creates anxiety, resentment and sometimes anger.

Proposed solutions included:

• Tax credits for family caregivers.
• Respite care.
• More flexible work hours.
• Better access to support groups.

Other red indicators of "significant concern" in the report were:

• Intentional self-harm among post-secondary students.
• Recovery or self-rated mental health among people with common mental health conditions. About a third of Canadians with mental health conditions reported very positive mental health compared with 72 per cent without a mental disorder.
• In 2011, almost 11 out of every 100,000 people — or 3,728 Canadians — killed themselves. Coupled with the high rate of suicide among Canadian males relative to females (16.3 per 100,000 versus 5.4/100,000) was a cause for concern.​

Men are less likely than women to identify when they have a significant mental health problem and are also less likely to seek treatment.

The commission noted Canada lacks a suicide prevention strategy.  When such programs were started in the UK, their value was proven.

Yellow indicators included stress at work, unmet need for mental health care among people with mental disorders and how Canada Pension Plan disability benefits for mental health reasons has steadily increased. These now represents 30 per cent of claims.

The rise in claims could be seen in both a negative or positive light. Either mental health disorders are increasing or the disorders are more recognized as a legitimate disability. 

Sense of belonging among immigrants was rated green. 

The Mental Health Commission of Canada was formed in 2007 with a 10-year mandate to improve the mental health system and change attitude and behaviours around mental health issues. The organization is funded by Health Canada and operates at arm's length from the government.

Caregivers feeling serious stress: report by TheCanadianPress

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