14% of Afghanistan veterans diagnosed with mental disorder

Nearly 14 per cent of Canadian Forces personnel who were deployed to Afghanistan have been diagnosed with a mental disorder such as post-traumatic stress, a new study suggests.

Since 2001, more than 40,000 Canadian Forces members have been deployed in support of the Afghanistan mission. While research from other countries has found mental health problems among those returning from missions in Southwest Asia such as Iraq, researchers in Ottawa set out to understand the psychological impact among Canadians.

"An important minority of Canadian Forces personnel received a diagnosis of a mental disorder related to deployment in support of the Afghanistan mission," David Boulos and Dr. Mark Zamorski, directorate of mental health, Canadian Forces Health Services Group Headquarters, concluded in Monday's issue of the Canadian Medical Association Journal.

"Deployment to higher-threat locations, service in the army and lower rank were independent risk factors."

In total, 13.5 per cent of those whose medical records were randomly reviewed were found to have a mental disorder.

Post-traumatic stress disorder (PTSD) was the most common mental disorder, found in eight per cent of personnel who served in Afghanistan, followed by depression in 6.3 per cent. Another 5.5 per cent had a mental disorder that was judged by a clinician to be unrelated to the Afghanistan deployment.

With PTSD, people tend to cope with it on their own as best they can initially until symptoms affect their functioning, said Major Paul Sedge, a military psychiatrist who has worked at the operational trauma and stress support centres in Gagetown and Petawawa.

"We constantly have to battle the issue of stigma," said Sedge.

"We need soldiers to come forward as soon as possible to get the comprehensive care that is available to them. The longer they wait, the harder it is to treat the illness," he said in an interview with CBC News.

Deployment to Kandahar was associated with almost six times the risk associated with deployment to the United Arab Emirates or Arabian Gulf, and twice the risk associated with deployment to multiple locations including Kabul, the researchers said.

Other studies also suggested that the strength and intensity of traumatic exposure are the greatest predicators for PTSD, Sedge said.

Overall, 29.6 per cent of the those studied used the military's mental-health services after deployment. The authors noted that the study only included diagnoses made by Canadian Forces mental-health services during the followup period, which was a median of 1,354 days or 3.7 years.

Barriers to seeking treatment

It's also possible that clinicians may have favoured attributing a diagnosis to deployment out of a desire to help patients qualify for later benefits. The probability of an Afghanistan-related mental disorder started to plateau after six or more years of followup.

"Even though our combat mission in Afghanistan is over, we need to be prepared to treat and manage combat-related mental health injuries for the next five to 10 years," Sedge said.

Greg Woolvett, whose son suffers from PTSD linked to two tours in Afghanistan, said he thinks the numbers capture only a small fraction of people affected and that services are lacking.

"There's probably double that amount who have PTSD but who have not come forward," Woolvett said.

Woolvett removed his son, Jon, from Canadian Forces Base Petawawa to find him help for a drinking problem and the pain of seeing many of his friends killed in action. He pointed to a disconnect between the chain of command and the military's medical personnel that he said prevents soldiers from getting the care they need.

The study was funded by the Canadian Forces Surgeon General's Medical Research Program.

With files from The Canadian Press

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Night shift workers face increased breast cancer risk

Working night shifts for 30 years or more could increase breast cancer risk, a Canadian review suggests.

The World Health Organization's International Agency for Research on Cancer (IARC) considers shift work as a probable carcinogen based on limited evidence in humans and stronger associations in animal studies.

Nurse Nglia Buchan says her sleep and eating habits are affected by working night shifts. (CBC)

Previous research on breast cancer risks associated with night shifts were largely based on nurses.

Now Prof. Kristan Aronson of Queen's University in Kingston, Ont., has extended those findings to include prolonged shift work in non-health professions as well.

"Long-term night-shift work in a diverse mix of occupations is associated with increased breast cancer risk," Aronson and her co-authors concluded in the journal Occupational and Environmental Medicine.

The researchers also asked about lifetime occupational histories to capture both rotating and permanent night-shift schedules for more than 1,100 women with breast cancer and more than 1,100 others without the diagnosis who were the same ages and lived in Vancouver or Kingston. Most were in their mid to late 50s.

They also reviewed hospital records for information on cancer diagnoses.

About a third of women in both groups said they had a history of night shift work.

"Our ultimate aim is to prevent breast cancer all together," Aronson said in an interview Tuesday.

"So if this is truly an environmental risk factor for breast cancer, we can develop healthy workplace policy that would reduce the impact of shift work on women."

Sleep and hormone melatonin

The researchers considered other factors that can affect cancer risk, such as reproductive history, body mass index, smoking and alcohol consumption.

In Kingston, the ongoing research is looking at how current shift-work patterns may be related to cancer risk.

One hypothesized mechanism focuses on melatonin, a hormone that is blocked by light and has been suggested to be protective against cancer. Suppression of melatonin is a possible explanation, agreed Russel Reiter, a researcher at the University of Texas Health Science Center in San Antonio, who has also studied the topic.

"The strength of the study is in the number of individuals included," Reiter told HealthDay News.

Sleep disturbances, throwing off the body's internal clock mechanism and low vitamin D levels are other possibilities.

Nglia Buchan has worked night shifts as a nurse in Toronto for 14 years. She averages about five hours of sleep.

"I give up my sleep so that I can be with my children," Buchan said.

"Hoping that as they get a little older then I can try to regain my health again, do some more exercise, eat properly because you eat a lot to stay awake."

Provincial workplace insurance boards and employers are already interested in the findings and ways of reducing the impact of shift work, Aronson said.

In Denmark, 37 women who got breast cancer after working night shifts were compensated following a 2007 decision by the International Agency for Research on Cancer.

"It depends on people's value systems and judgments for at what point they will consider this causal," Aronson said.

The Canadian researchers plan to combine their updated data with groups in Europe to judge the carcinogen relationship of night shifts.

The research was funded by the Canadian Institutes of Health Research.

With files from CBC's Kelly Crowe and Melanie Glanz

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2 men with HIV show no sign of virus after stem cell transplants

Two HIV-positive patients in the United States who underwent bone marrow transplants for cancer have stopped anti-retroviral therapy and still show no detectable sign of HIV, researchers say.

The Harvard University researchers stressed it was too early to say the men have been cured, but said it was an encouraging sign that the virus hasn't rebounded in their blood months after drug treatment ended.

HIV may be hiding in the patients' other organs and could return months later, Timothy Henrich says. (Lai Seng Sin/Associated Press)

The first person reported to be cured of HIV, American Timothy Ray Brown, underwent a stem cell transplant in 2007 to treat his leukemia. He was reported by his German doctors to have been cured of HIV two years later.

Brown's doctors used a donor who had a rare genetic mutation that provides resistance against HIV. So far, no one has observed similar results using ordinary donor cells such as those given to the two patients by the Harvard University researchers.

The researchers, Timothy Henrich and Daniel Kuritzkes of the Harvard-affiliated Brigham and Women's Hospital in Boston, announced last year that blood samples taken from the men — who both had blood cancers — showed no traces of the HIV virus eight months after they received bone marrow transplants to replace cancerous blood cells with healthy donor cells. The men were still on anti-HIV drugs at the time.

The men have both since stopped anti-retroviral therapy — one 15 weeks ago and the other seven weeks ago — and show no signs of the virus, Henrich told an international AIDS conference in Malaysia on Wednesday.

"They are doing very well," Henrich said. "While these results are exciting, they do not yet indicate that the men have been cured. Only time will tell."

The virus may be hiding in other organs such as the liver, spleen or brain and could return months later, he warned.

Further testing of the men's cells, plasma and tissue for at least a year will help give a clearer picture on the full impact of the transplant on HIV persistence, he said.

Kuritzkes said the patients will be put back on the drugs if there is a viral rebound.

A rebound will show that other sites are important reservoirs of infectious virus and new approaches to measuring these reservoirs will be needed in developing a cure, Henrich said.

"These findings clearly provide important new information that might well alter the current thinking about HIV and gene therapy," Kevin Robert Frost, chief executive of The Foundation of AIDS Research, said in a statement.

"While stem cell transplantation is not a viable option for people with HIV on a broad scale because of its costs and complexity, these new cases could lead us to new approaches to treating, and ultimately even eradicating, HIV."

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Bike helmets should address concussion risk, scientists say

While sports medicine has gained a deeper understanding of head injuries in recent years, protective headgear hasn't kept pace, and that is particularly true when it comes to bicycle helmets, experts in the field tell CBC News.

Bike helmets were designed to protect against catastrophic head injuries like skull fractures, lacerations or contusions on the brain, which they do.

However, as the understanding of concussions has advanced significantly in recent years, basic helmet design has not, and the standard that North American helmet manufacturers follow has not changed since 1999.

If a cyclist falls and his head hits the pavement or an automobile, the brain could undergo what scientists call linear acceleration – moving in the direction of the impact. And by moderating that, helmets can reduce the risk of skull fractures, neurosurgeon Charles Tator told CBC News.

Tator is a surgeon at Toronto Western Hospital and a professor of neurosurgery at the University of Toronto. He founded ThinkFirst Canada, an injury prevention group, and is now a board member of its successor organization, Parachute Canada.

However, at impact the brain may also undergo rotational or angular acceleration.

"The evidence from science is that concussion is more related to rotational acceleration, which in laymen's terms is really a jiggle of the brain. It's like the movement of Jell-O in a bowl when you jiggle it," Tator explains. And the result of that jiggle can be cellular damage to the brain, which can affect neurons and their connectors.

He says "it is time that our standards include measures of angular acceleration."

Toronto neurosurgeon Charles Tator tells CBC News that it's time current bike helmet standards measured rotational acceleration, with the goal of reducing the risk of concussion. (CBC)

Current bike helmets, Tator says, "are pretty well useless in attenuating" rotational acceleration.

University of Ottawa kinesiologist Blaine Hoshizaki concurs. He told CBC News, "Bicycle helmets are not really providing a great deal of protection, if at all, in regards to concussions."

Concussions on the rise

When it comes to bike crashes, concussions are on the rise.

For example, U.S. hospital emergency room data shows that the number of cycling-related concussions increased 67 per cent between 1997 and 2011.

A 1996 study found that more than half of U.S. riders who sustained concussions were wearing a helmet.

Different helmet designs aimed at reducing the risk of concussion are in the works.

Randy Swart, director of the all-volunteer Bicycle Helmet Safety Institute in the U.S. says, "It's tricky for a helmet designer to try to design a helmet that will help prevent an injury that isn't completely understood, guarding against a mechanism that isn't completely understood."

But Hoshizaki says the mechanism of a concussion is well enough understood now and he feels a new helmet can be designed.

The key, he says, is a design that reduces rotational acceleration. In his Ottawa lab, his team has introduced systems that substantially decrease rotational acceleration.

However, the lab isn't about helmet design, it "focuses more on reconstruction and understanding the mechanism of injury."

Understanding the mechanism of head injuries in sport is the focus of Hoshizaki's research.

He chairs the ice hockey equipment committee of the International Organization for Standardization and also sits on Canadian, American and European standards committees for sports equipment.

University of Ottawa scientist Blaine Hoshizaki is confident we are on the cusp of helmet designs that will manage concussive injuries. (Courtesy University of Ottawa)

And he also acknowledges that there is little incentive for manufacturers to "develop a different paradigm" when it comes to protective equipment.

The cost of new design likely means a higher price tag and in the bike shops such a helmet would be competing against other helmets, of lower price, that also meet the current safety standards.

So to make a new helmet accessible would mean revising the standard to address rotational acceleration, in the expectation this would reduce the number of cycling-related concussions.

No mandatory standard in Canada

Bike helmets sold in the U.S. must meet the mandatory standard set by the U.S. Consumer Product Safety Commission, and since 1999 there has been no change to the standard.

Canada does not have a mandatory standard. There was one developed by the Canadian Standards Association, but its use by manufacturers has waned because of free trade, so it's the CPSC standard that really matters.

In a detailed look at helmets and concussions in the June 2013 issue of Bicycling magazine, journalist and author Bruce Barcott looked at the difficultly in getting a CPSC standard revised. Even CPSC commissioner Robert Adler described it as "almost impossible," during congressional testimony in 2012.

Nevertheless, according to Barcott, "National Institutes of Health (NIH) scientists warned that 'existing helmets are not protecting the brain adequately' because their design was based on a paradigm that ignored data on rotational forces. Revising the existing standards was deemed an 'urgent task.'"

Hoshizaki says it wouldn't be difficult to develop a test to measure the ability of a helmet to manage rotational acceleration and "it's pretty clear you can develop a standard for [rotational and/or] angular acceleration, no question about it."

New designs claim to address concussion

There are now helmet designs out there that claim to lower the risk of concussion by reducing rotational acceleration of the brain.

One is known as MIPS, an acronym for Multi-directional Impact Protection System.

This Swedish design uses a liner inside the helmet that attaches to it with a pin and on impact allows the rest of the helmet to rotate a bit, thereby absorbing some of the rotational energy. There are now helmets on the market with MIPS.

Hoshizaki, who has visited the MIPS lab in Stockholm, calls the Swedish company's mechanism for measuring rotational acceleration "very narrow," but acknowledges it does have one and "it's valid and other people have replicated it."

The helmet's layers in the angular impact mitigation (AIM) system show the elastically suspended aluminum honeycomb liner that is supposed to absorb both linear and angular acceleration in order to reduce the risk of brain injury. (Courtesy Legacy Biomechanics Laboratory )

Swart, who is also the co-vice chair of the American Society for Testing and Materials' subcommittee on headgear, cautions that he doesn't "think the MIPS technology is proven in the field to really mitigate concussion."

Another design, by the Legacy Biomechanics Laboratory in Portland, Oregon, "employs an elastically suspended aluminum honeycomb liner to absorb linear acceleration in normal impacts as well as angular acceleration in oblique impacts," according to a study.

The study's authors claim their Angular Impact Mitigation (AIM) system reduced peak angular acceleration by 34 per cent, and predict a 27 per cent reduction in the risk of concussion.

Study co-author Michael Bottlang told CBC News that they have recently secured funding to introduce AIM to the market.

"Further research is required," the study states.

Hoshizaki says bike helmets designed to protect against concussions are a priority now.

"It doesn't mean you are going to make the helmet less protective in terms of catastrophic injury, but you have to start opening up the opportunity to encourage the manufacturers to become more innovative in terms of managing concussive injuries and for sure it can be done, we're right on the cusp of this."

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White blood cells help spread cancer, mouse study shows

White blood cells, key defenders in the body's immune system, can activate cancer cells and help them spread, a new study by Montreal and Calgary researchers suggests.

The findings likely explain why infection after surgery among cancer patients is associated with a higher death rate due to the spread of the cancer, the researchers reported in a paper published Monday in the Journal of Clinical Science.

'What's equally exciting is medications already exist that are being used for other non-cancer diseases, which may prevent this mechanism of cancer spread or metastasis.'—Lorenzo Ferri, RI-MUHC

"We are the first to identify this entirely new way that cancer spreads," said Lorenzo Ferri, a co-author of the paper, in a statement.

"What's equally exciting is medications already exist that are being used for other non-cancer diseases, which may prevent this mechanism of cancer spread or metastasis."

Ferri, director of the Division of Thoracic Surgery and the Upper Gastrointestinal Cancer Program at the Research Institute of the McGill University Health Centre, and his colleagues decided to examine the role of white blood cells more closely after noticing that cancer patients who had a severe infection after surgery were more likely to have their cancer return in the form of secondary tumours — tumours that later grow in parts of the body other than the site of the original tumour.

The researchers induced infections in mice by puncturing the cecum, a pouch located where the small and large intestine join. That caused their white blood cells to spring into action. The white blood cells produced web-like networks made of DNA called neutrophils extracellular traps (NETs). The NETs, which typically trap and kill pathogens such as bacteria, were clearly visible using a microscope in mice that had their cecum punctured, but not those who had a "sham" surgery that didn't cause infection.

A fluorescence microscope image taken by the researchers shows cancer cells (red) trapped by the NETS (green), which are produced by white blood cells (blue). (McGill University)

Cancer cells were injected into both sets of mice. Afterward, the mice that had their cecum punctured had an average of 400 secondary tumours in their livers, compared to an average of two in the mice who had the "sham" surgery.

The researchers hypothesized that the NETs produced by the white blood cells trapped the cancer cells, and activated them instead of killing them. They managed to actually see this in experiments conducted on cells under a microscope.

When the mice with their cecums punctured were treated with drugs that prevent the formation of NETs, such as enzymes that break down DNA, they developed far fewer tumours — an average of 234 or 132, depending on the drug.

The researchers wrote that further studies are needed to validate their results, but the findings suggest it may be possible to reduce the spread of tumours among cancer patients who develop infections after surgery. They proposed that drugs targeting NET formation might be a potential new treatment for cancer patients.

The study was co-authored by Ferri's colleagues at McGill University and at the University of Calgary and was funded by the Canadian Cancer Society Research Institute.

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WHO recommends earlier drug treatment for HIV

Doctors could save three million more lives worldwide by 2025 if they offer AIDS drugs to people with HIV much sooner after they test positive for the virus, the World Health Organisation said on Sunday.

While better access to cheap generic AIDS drugs means many more people are now getting treatment, health workers, particularly in poor countries with limited health budgets, currently tend to wait until the infection has progressed.

But in new guidelines aimed at controlling and eventually reducing the global AIDS epidemic, the U.N. health agency said some 26 million HIV-positive people — or around 80 percent of all those with the virus — should be getting drug treatment.

The guidelines, which set a global standard for when people with human immunodeficiency virus (HIV) should start antiretroviral treatment, were drawn up after numerous studies found that treating HIV patients earlier can keep them healthy for many years and also lowers the amount of virus in the blood, significantly cutting their risk of infecting someone else.

"We are raising the bar to 26 million people," said Gottfried Hirnschall, the WHO's HIV/AIDS department director.

"And this is not only about keeping people healthy and alive but also about blocking further transmission of HIV."

Some 34 million people worldwide have the HIV virus that causes AIDS and the vast majority of them live in poor and developing countries. Sub-Saharan Africa is by far the worst affected region.

Deaths falling

But the epidemic — which has killed 25 million people in the 30 years since HIV was first discovered — is showing some signs of being turned around. The United Nations AIDS programme UNAIDS says deaths from the disease fell to 1.7 million in 2011, down from a peak of 2.3 million in 2005 and from 1.8 million in 2010.

Swift progress has also been made in getting more HIV patients into treatment, with 9.7 million people getting life-saving AIDS drugs in 2012, up from just 300,000 people a decade earlier, according to latest WHO data also published on Sunday.

Indian generics companies are leading suppliers of HIV drugs to Africa and to many other poor countries. Major Western HIV drugmakers include Gilead Sciences, Johnson & Johnson and ViiV Healthcare, which is majority-owned by GlaxoSmithKline.

Margaret Chan, the WHO's director general, said the dramatic improvement in access to HIV treatment raised the prospect of the world one day being able to beat the disease.

"With nearly 10 million people now on antiretroviral therapy, we see that such prospects — unthinkable just a few years ago — can now fuel the momentum needed to push the HIV epidemic into irreversible decline," she said in a statement.

Treatment threshold changed

The WHO's guidelines encourage health authorities worldwide to start treatment in adults with HIV as soon as a key test known as a CD4 cell count falls to a measure of 500 cells per cubic millimetre or less.

The previous WHO standard was to offer treatment at a CD4 count of 350 or less, in other words when the virus has already started to damage the patient's immune system.

The guidelines also say all pregnant or breastfeeding women and all children under five with HIV should start treatment immediately, whatever their CD4 count, and that all HIV patients should be regularly monitored to assess their "viral load".

This allows health workers to check whether the medicines are reducing the amount of virus in the blood. It also encourages patients to keep taking their medicine because they can see it having positive results.

"There's no greater motivating factor for people to stick to their HIV treatment than knowing the virus is 'undetectable' in their blood," said Gilles van Cutsem, the medical coordinator in South Africa for the international medical humanitarian organisation Médecins Sans Frontières (MSF).

Money and political will needed, MSF says

MSF welcomed the new guidelines but cautioned that the money and the political will to implement them was also needed.

"Now is not the time to be daunted but to push forward," MSF president Unni Karunakara said in a statement. "So it's critical to mobilize international support... including funding for HIV treatment programmes from donor governments."

The WHO's Hirnschall said getting AIDS drugs to the extra patients brought in by the new guidelines would require another 10 percent on top of the $22 to $24 billion a year currently needed to fund the global fight against HIV and AIDS.

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Woman in a wheelchair feels trapped in seniors’ complex

A 76-year-old Nova Scotia woman with a broken hip says she hasn't been outside in two months because the elevator in the seniors' complex where she lives is broken.

Margie MacDougall says she just wants to get outside. (Norma-Jean MacPhee/CBC)

Margie MacDougall of Inverness broke her hip last year and uses a wheelchair to get around. She feels confined on the second floor.

"When the elevator was up and running I used to take my wheelchair on it and go down and sit in the lobby with the people down there, you know? If it was a good day I'd ask one of them to push me out to the front so I could wheel around out there for a little bit, you know, but right now it's going on two and a half months since I've seen the outside world," she said.

MacDougall said she's made dozens of calls to politicians and housing officials.

"They kept telling me this day and that day and the next day and the other day and last week and this week so at the end of it I just wasn't believing any of it," she said.

"Makes me feel frustrated, very frustrated."

The Department of Community Services, which oversees the building, said they need a specific part to fix the shaft.

The stairs Margie MacDougall has to get down in a wheelchair. (Norma-Jean MacPhee/CBC)

Last week it started staffing people during the day and on-call at night to help the seniors navigate the home's two flights of stairs.

"They're not as happy, they're certainly not as happy and we listen to that, we hear about it," said Ramona Miller, a homecare worker in the building.

"She's standing for the rest of them because there are different members in here that have the same disabilities and can't get out, there's more than one."

MacDougall said she missed a doctor's appointment because of the broken elevator and she refused to let four men carry her down the stairs.

"But I had my pride and I wasn't being carried downstairs to get no doctors' appointment. How was I going to get back up? Drag me up again?"

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U.S. energy drinks tout organic ingredients

U.S. energy drinks are busting out of the convenience store cooler and into the health food aisle.

As energy drink sales soar like a caffeine-fueled rocket, more drinks are promoting organic ingredients, added juices, natural caffeine and so-called "clean" energy. A jolt from Rockstar not your speed? There's the "natural energy drink" Guru, and Steaz Energy, which according to the can is "good for the mind, body and soul." Or there's Runa's energy drink, made from something called Amazonian guayusa leaves.

As energy drink sales soar, more drinks are promoting organic ingredients. (Mike Groll/Associated Press)

Claims of cleaner caffeine boosts come as energy drinks find themselves under increasing scrutiny, particularly for their effects on children and adolescents. The word "organic" in front of "energy drink" might seem as incompatible as yoga pants with a backward tractor cap, but analysts say that as the market for energy drinks grows, it's diversifying too.

"I think we're going to see more beverages that offer energy functionality, but in non-traditional energy drinks," says John Sicher, publisher of Beverage Digest.

Energy drink sales hit $12.6 billion U.S. last year, representing a 14 per cent jump from 2008, according to market research firm Packaged Facts. While Red Bull, Monster and Rockstar still dominate the U.S. market, part of the recent growth comes from new kinds of products, including diet and natural energy drinks. Even the big players are getting into the act. Campbell Soup Co.'s venerable V8 line of drinks now includes a canned V-Fusion + Energy drink made with juice and green tea. And Starbucks sells fruit-flavoured Refreshers made with unroasted coffee beans.

"Because retailers are devoting more shelf space to energy drinks, there's always a battle among the competitors within the sector. So what you're seeing within the energy drink category is an innovation in products," says John Lennon, president of Xyience, which makes Xenergy energy drinks.

But with growth comes greater scrutiny.

Regulators have been increasingly concerned about caffeinated products, particularly energy drinks. The U.S. Food and Drug Administration in April said it would investigate the safety of caffeine added to snacks and gum and its effects on children and adolescents.

The FDA said last year it was investigating reports of deaths linked to energy drinks. At the time, Health Canada said it had received 86 reports of adverse reactions to energy drinks.

Health Canada is moving towards regulating caffeinated energy drinks as foods and requiring strict labelling.

The FDA has said it would take action if it could link the deaths to consumption of the drinks, including forcing the companies to take the products off the market.

And San Francisco's city attorney in May sued Monster Beverage for marketing its energy drinks to children. The lawsuit came after Monster sued City Attorney Dennis Herrera over his demands that the company reduce caffeine levels in its drinks and stop marketing to minors.

'Energy drink of the health club'

At least on face value, some of the natural drinks seem to be aiming for a different audience. Xenergy calls itself the "energy drink of the health club, not the nightclub." The company expanded its line this year to include energy drinks with tea or lemonade.

Ray Jolicoeur, vice-president marketing for Guru, says consumers of his product, which has been available in the United States since 2005, tend to be slightly more mature and educated. The entrepreneurs behind Runa say they are not looking for people who want "head throbbing, punched-in-the face energy" like some other brands.

"Some of them went after adrenaline junkies, others went after NASCAR fans," says Runa co-founder Dan MacCombie. "For us, it's just part of the people who are already ... being careful about what they are putting into their bodies."

Runa's energy drink hit the shelves recently around the country. It boasts its caffeine from the guayusa "super leaf" and supposedly provides as much caffeine as coffee with more anti-oxidants than green tea.

They join non-traditional energy drinks like Guru and Steaz, which share display space with the likes of aloe juice at Dean's Natural Foods in Albany. Owner Dean King said the drinks eliminate "ridiculous stuff" like artificial flavours and colours. The kick still comes from caffeine, but some consumers say it's different.

"You know how most caffeinated products you feel that surge come over you? And then you drop and you feel miserable? This is more of an alertness," says Cheryl Fairweather, a 36-year-old vegan and athlete from the Philadelphia area who drinks a daily can of Steaz at 4 a.m. before she trains.

"It doesn't have that overwhelming effect, like you're on edge," she says.

It's typical for the caffeine in natural energy drinks to come from organic and natural sources. But in the end, as Roland Griffiths, a professor of behavioural biology at Johns Hopkins University, notes, "caffeine is caffeine."

"It doesn't matter whether that compound is synthesized in a laboratory or is synthesized in a plant," he says. "It's going to have identical pharmacological, subjective and behavioural effects."

Guru says one 8.4-ounce can has 125 milligrams of "naturally occurring" caffeine. Steaz says a 12-ounce can of its energy drink contains 100 milligrams of caffeine from sustainably sourced ingredients. Ounce for ounce, that's in the ballpark of mainstream energy drinks, like Rockstar or Monster, which each deliver 160 milligrams of caffeine per 16-ounce can, according to the Center for Science in the Public Interest, a nutrition advocacy group.

The natural products generally do not make explicit health claims, opting instead to tout ingredients such as organic guarana or the lack of artificial colours. But Michael Jacobson, the executive director of the Center for Science in the Public Interest, says words like "natural" and "organic" printed on a can make consumers assume the contents are good for you, even if that's not necessarily so.

"It implies that there's something helpful about them and it's totally vague," he says.

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4 BBQ food safety tips

To barbecue safely and avoid foodborne illnesses takes four key steps.

Watch Marilyn Lee, a professor of food safety at Ryerson University in Toronto, show CBC's Kim Bruhuber how to prepare, cook and serve meat from a backyard BBQ.

They cover:

• Handwashing.
• Using a thermometer.
• Separating utensils for raw and cooked foods.
• When to put leftovers in the fridge.

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Home care agency's priority is non-acute wait time cuts

Provincial government funding to reduce home care wait times in Ontario will primarily go towards slashing wait times for patients with who aren't necessarily in need of acute care, says the head of Waterloo Wellington home care agency.

Patients in hospital who have a high level of need are already being assessed quickly, "within a day, sometimes two", said Gordon Milak, the CEO of the Waterloo Wellington Community Care Access Centre (CCAC), in a panel discussion with Craig Norris on The Morning Edition Friday.

But the Waterloo Wellington CCAC wait times for initial assessments for those with non-acute needs are among the highest in the province.

The provincial government has invested $260 million in its budget for the year to achieve that goal, with $185 million going directly to local CCACs for home care delivery. But there are no specifics on how that money will be allocated.

The government funding comes with the goal of reducing wait times across the board to just five days in CCACs across Ontario.

Milak said his agency's priority "would be addressing those moderate to lower needs clients that we can move them within that five-day period.

"As well as, how can we continue to evolve an effective and safe home approach? Again ultimately getting people into the right care setting is the goal," he added, saying it would apply whether it's long-term care or home-based care."

For lower needs clients, Milak admits that the CCAC has the opportunity to improve on their services and speed up access to care.

For more, listen to the entire panel discussion below.

Featured guests:

- John Hirdes, Ontario home care research chair, professor University of Waterloo.

- Jane Meadus, a lawyer with the Advocacy Center for the Elderly.

- Gordon Milak, the CEO of the Waterloo Wellington CCAC.

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