Braces for curved spines cut need for surgery

Toni Lopez, who suffers from chronic back pain stemming from scoliosis, receives a back massage from Martha Garcia, at her home in Sacramento, Calif. Bracing significantly decreases progression of high-risk curves in patients with an adolescent form of scioliosis. (Rich Pedroncelli/Associated Press)

Bracing the spine in teens with a curvature is more effective than watching and waiting in preventing the need for surgical correction, Canadian and U.S. surgeons have found.

Scoliosis is a type of spinal curvature that now affects mainly girls beginning in adolescence. If the curvature worsens to more than 50 degrees after maturity it increases the risk of severe deformity and compromising lung function. 

In Thursday's online issue of the New England Journal of Medicine, orthopedic surgeons from the Hospital for Sick Children in Toronto and three U.S. institutions said bracing significantly decreased progression to needing surgery.

"I won't be so much telling kids that I don't know whether it works," said study co-author Dr. James Wright, surgeon in chief at the Hospital for Sick Children. "I'm going to be saying, it does work and I'm afraid you have to wear it."

The researchers concluded that in adolescents with idiopathic scoliosis who were considered to be at high risk for curve progressing that would eventually warrant surgery, bracing was associated with a significantly greater likelihood of reaching skeletal maturity with a curve of less than 50 degrees, compared with watching and waiting.

The findings will have a direct impact on clinical practice in assessing orthopedic patients for bracing, Wright said.

The rate of treatment success in terms of preventing the need for surgery was 72 per cent in the bracing group compared with 48 per cent in the untreated group. In the bracing group, 41 per cent also had a successful outcome even though they spent little time wearing the brace. The braces contained a device that indicated when they were being worn. 

But wearing a brace has financial, emotional and social burdens that need to be considered, Dr. Eugene Carragee of Stanford University School of Medicine in California and Dr. Ronald Lehman of Walter Reed National Military Medical Center in Bethseda, Md., said in a journal commentary published with the study.

"We agree with the authors that the equally important finding of this study is that so many growing children with adolescent idiopathic scoliosis seem to do just fine with no treatment at all; the challenge for the field going forward is to identify children who are most likely to benefit from bracing," the commentators said.

The trial of 242 patients was designed as a randomized trial but 126 ended up choosing their care. The study's authors said they minimized but did not eliminate the potential bias from the nonrandomized patients.

Scoliosis develops in about three per cent of children younger than 16 but less than one per cent have progressive curves that need treatment, previous research suggests.

The study was funded by the U.S.National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Shriners Hospitals for Children, the Canadian Institutes of Health Research, Children's Mercy Hospitals and Clinics, the University of Rochester and SickKids Foundation.

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Dr. Donald Low, public face of Toronto SARS crisis, dies

Dr. Donald Low, a leading Canadian infectious disease expert who rose to prominence while helping Toronto cope with the SARS crisis that killed hundreds worldwide a decade ago, has died at age 68 after being diagnosed with a brain tumour.

Low was the microbiologist in chief at Toronto's Mount Sinai Hospital and a professor at the University of Toronto.

'It's a big loss to all of us in microbiology.'- Allison McGeer, Mount Sinai Hospital

After the 2003 breakout of severe acute respiratory syndrome in Toronto, Low oversaw regular updates to the public about the syndrome, which eventually killed 44 people in Canada and nearly 800 worldwide.

Dr. Allison McGeer, director of infectious disease control at Mount Sinai hospital, worked with Low and knew him for 25 years.

In an interview on CBC Radio's Metro Morning shortly after news of his death broke, McGeer said Low provided a  voice of calm to a city gripped by fear during the SARS outbreak.

"He was the face and a good piece of the brains behind our response to SARS," McGeer told host Matt Galloway. "What many of us in Toronto don't recognize is the loss he leaves behind to microbiology and infectious diseases in Canada, and to all of his research work in emerging diseases around the world. It's a big loss to all of us in microbiology.

"With Don, no problem is ever too large," said McGeer. "You simply lay it out, you put it in its pieces, you figure out how to deal with it and you move on. That may be his biggest legacy."

Dr. Michael Gardam, from the University Health Network, told CBC News that Low's commitment to keeping the public informed during the outbreak was a unique trait. 

"The thought you would have a world renowned expert really seeing it as one of his major jobs … to go directly to the public and actually talk about what's going on … I can't tell you how unusual that is," he said.

Low died Wednesday evening after battling a brain tumour. "As a husband and a father — nobody better," his wife, Maureen Taylor, told CBC News.  "His kids adore him and he was everything to me."

McGeer credits Low for his role in not only studying infectious diseases, but also in teaching other doctors in the field.

"He created the generation of people that we now count on to study antimicrobial resistance and emerging infectious diseases," she said.

Dr. Donald Low, leading Canadian health expert who rose to prominence during the SARS crisis, has died. (Frank Gunn/Canadian Press)

"One of the standing jokes in microbiology at Mount Sinai was that nobody ever leaves. There was no temptation. He was the best boss you could imagine."

According to Mount Sinai's website, Low was a fellow of the Royal College of Physicians and Surgeons of Canada. He completed his undergraduate training and postgraduate training in medicine and infectious diseases at the University of Manitoba and his training in medical microbiology at the University of Toronto. 

Low's primary research interests were in the study of the epidemiology and the mechanisms of antimicrobial resistance in community and hospital pathogens. 

Low published more than 385 papers in peer-reviewed journals and was a reviewer for several organizations including the Medical Research Council, Health Canada, New England Journal of Medicine, Journal of American Medical Association, and the Proceedings of the National Academy of Science, and had been cited some 3600 times.

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Alzheimer's causes half of long-term care cases

David Hilfiker knows what's coming. He was diagnosed with Alzheimer's so early that he's had time to tell his family what he wants to happen once forgetfulness turns incapacitating.

"When it's time to put me in an institution, don't have me at home and destroy your own life," said the retired physician, who is still well enough that he blogs about the insidious progress of the disease. "Watching the Lights Go Out," it's titled.

Nearly half of all seniors who need some form of long-term care -— from help at home to full-time care in a facility — have dementia, the World Alzheimer Report said Thursday. It's a staggering problem as the global population ages, placing enormous strain on families who provide the bulk of that care at least early on, and on national economies alike.

Indeed, cognitive impairment is the strongest predictor of who will move into a care facility within the next two years, 7.5 times more likely than people with cancer, heart disease or other chronic ailments of older adults, the report found.

"It's astonishing," said Marc Wortmann, executive director of Alzheimer's Disease International, which commissioned the report and focused on the problems of caregiving. "What many countries try to do is keep people away from care homes because they say that's cheaper. Yes it's cheaper for the government or the health system, but it's not always the best solution."

And dropping birth rates mean there are fewer children in families to take care of aging parents, too, said Michael Hodin of the Global Coalition on Aging.

"Very shortly there will be more of us over 60 than under 15," he noted.

Today, more than 35 million people worldwide, including 5 million in the U.S., are estimated to have Alzheimer's. Barring a medical breakthrough, those numbers are expected to more than double by 2050.

This week, the U.S. National Institutes of Health announced $45 million in new Alzheimer's research, with most of the money focused on finding ways to prevent or at least delay the devastating disease. The Obama administration had hoped to invest $100 million in new Alzheimer's research this year, a move blocked by the budget cuts known as the sequester. Overall, the nation has been investing about $400 million a year in Alzheimer's research.

But the disease's financial toll is $200 billion a year in the U.S. alone, a tab expected to pass $1 trillion by 2050 in medical and nursing home expenditures — not counting unpaid family caregiving. The world report puts the global cost at $604 billion 

Thursday, families affected by Alzheimer's and aging advocates said it's time for a global push to end the brain disease, just like the world's governments and researchers came together to turn the AIDS virus from a death sentence into a chronic disease. 

"We need a war on Alzheimer's," said Sandy Halperin, 63, of Tallahassee, Fla., who was diagnosed with early-stage Alzheimer's three years ago. He now finds himself stumbling for words, but still visits lawmakers to urge more funding.

Meanwhile, the world report focuses on caregiving, stressing how the needs of people with dementia are so different than those of other ailments of aging, such as cancer and heart disease.

People with dementia begin needing some help to get through the day early on, to make sure they don't leave the stove on or get lost, for example. Eventually, patients lose the ability to do the simplest activities of daily life, and can survive that way for a decade or more. Often family members quit their jobs so they can provide round-the-clock care, and the stress can harm their own health.

The world report said families need early education about what services are available to help before they're in a crisis, plus training in how to handle the behavioural problems of the disease — such as not to argue if their loved one thinks Ronald Reagan is still president, or how to handle the agitation at dusk known as sundowning, or how to react when the patient hits someone.

Two-thirds of the calls that Home Instead Senior Care, which provides in-home personal care services, receives are from families that did no planning until the patient had a crisis, such as wandering or a fall, said its president, Jeff Huber.

Hilfiker, the blogger with early Alzheimer's, takes that education idea a step further. He tells everyone he knows that he has Alzheimer's as a way to break some of the stigma, "so when I make dumb mistakes, I don't need to be embarrassed," he said Thursday.

He urges other patients to plan their end-of-life care early, while they're still cognitively able to participate. He believes that telling his wife no extraordinary care — no feeding tubes, for example — will ease her burden.

Hilfiker's big unanswered question: "If I'm at peace with my disease, does that make it easier to care for me later?

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Man brewed beer in his gut, say researchers

A Texas man who stumbled into an emergency room showing signs of drunkenness has become a medical anomaly – he was diagnosed with auto-brewery syndrome.

The man was found to have a blood alcohol level of .37, five times the legal limit in Texas. Medical staff assumed he was inebriated, but the man insisted he hadn't had one drop of alcohol all day. They were also told he had spent the past five years with bouts of intoxication that didn't involve drinking booze.

Having a beer gut took on a new meaning for a Texas man studied by U.S. researchers, who found that his overgrowth of yeast in his body was making him drunk because he was brewing beer from within. (Rick Rycroft/Associated Press)

In a report published in Scientific Research Publishing, U.S. researchers Barbara Cordell and Dr. Justin McCarthy tested out what they call "gut fermentation syndrome."

Cordell and McCarthy were alerted about the man's condition and a few months after his emergency room visit, hey decided to test out their theory.

The man returned to the hospital and was kept there for 24 hours. During that time, he was only fed a diet of carbohydrate-rich foods. The researchers soon had their answer.

The patient had an infection with Saccharomyces cerevisiae, a common yeast. Whenever he ingested starch — pasta, bread or soda — the yeast fermented along with the sugars, turning into ethanol. 

He was brewing beer in his gut.

"He would get drunk out of the blue — on a Sunday morning after being at church, or really, just any time," Cordell said in an interview with NPR this week.

'It would behoove health care providers to listen more carefully to the intoxicated patient who denies ingesting alcohol.'- Barbara Cordell and Justin McCarthy, researchers

The man's wife eventually bought a Breathalyzer as well.

The researchers say they suspect that antibiotics that the man took after surgery in 2004 may have destroyed his gut bacteria, allowing for the yeast to flourish.

The cure was easy. The man was put on a low-carbohydrate diet and given antifungal medication to purge him of the yeast.

Cordell and McCarthy say the syndrome is rare and say there have only been about five cases in the last 30 years.

In conclusion, they say "this is a rare syndrome but should be recognized because of the social implications such as loss of job, relationship difficulties, stigma, and even possible arrest and incarceration. It would behoove health care providers to listen more carefully to the intoxicated patient who denies ingesting alcohol."

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Mental health care needed by 1 in 6 Canadians

About one in six Canadians said they needed mental health care last year, Statistics Canada reports.

The findings are included in the agency's 2012 Canadian Community Health Survey on mental health that was released Wednesday. The survey results were based on a national sample of more than 25,000 people 15 or older in the 10 provinces.

The need for mental health care was mainly for counselling, the survey suggests. Other mental health care needs were for medication and information.

"An estimated 600,000 had a perceived unmet mental health care need, and more than 1,000,000 had a partially met need," the report's authors said, extrapolating from the sample.

About 17 per cent of the population 15 or older reported having had a mental health care need in the past 12 months, the agency found. Of these:

• 67 per cent said their needs were met.
• 21 per cent said their needs were partially met.
• 12 per cent said their needs were unmet.

"The presence of a mental disorder, higher distress, and chronic physical conditions were positively associated with perceiving a mental health care need, many of which were unmet or only partially met," the report's authors concluded. "As well, higher levels of distress predicted a greater likelihood that needs would be unmet or partially met."

About 75 per cent of those with a mood or anxiety disorder such as depression or bipolar disorder reported a need for mental health care, compared with 25 per cent of those with a substance abuse problem.

Counselling needs were the least likely to be met, with 65 per cent showing it was met, 16 per cent partially and 20 per cent unmet.

Dr. Ian Dawe, physician-in-chief at Ontario Shores Centre for Mental Health Services in Whitby, Ont., said the report misses a large swath of other illnesses such as schizophrenia and panic disorders.

Dawe said that patients often say it's relatively easy to get prescription medications, but needs for counselling go unmet.

"This study really speaks to unmet needs outside of the medication realm, and I think that's very consistent with what we're hearing," he said.

He said barriers include cost for those without workplace or private insurance for therapy outside of a doctor's office.

Arthur Gallant, 23, of Burlington, Ont., was diagnosed with anxiety and depression when he was 13. Gallant said he now can't afford the services of a psychologist. 

"It comes at a cost of about $150," Gallant said, for two sessions a week. "That's my entire income."

Most perceived barriers to receiving mental health care were related to personal circumstances, although almost one in five who reported barriers said they were related to features of the health care system, such as language barriers.

About four in 10 with an unmet or partially met need said they preferred to manage the need on their own. Camille Quenneville, chief executive of the Canadian Mental Health Association's Ontario division, attributed that to the stigma associated with mental health issues.

There is a tremendous need for mental health care services in the community and hospital systems, Quenneville said.

"We know today in Canada, 500,000 people didn't go to work because they're struggling with their mental health," she said. "So I think if employers alone stepped up and wanted to work and help those in their workplace with their mental health issues and recognize the existing need that we know is there, I think we would make tremendous strides."

Gallant said many people are also being rejected by family, friends and employers because of the lack of understanding what mental illness truly is.

In a related report, the agency found higher rates of mood disorders and of generalized anxiety disorder among females, while males had higher rates of substance abuse issues.

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Suicide rate climbs after global economic downturn

Roberto La Rosa, right, filled out a temporary job application in November 2008. There was a clear rise in suicide after the 2008 global economic crisis, researchers say. (Alan Diaz/Associated Press)

Suicide rates in Europe and North America increased after the 2008 global economic crisis, especially among men and in countries with greater increases in unemployment, a new study suggests.

Researchers from Hong Kong and the UK used data from 54 countries to look at changes in suicide rates after 2008, when turmoil in the banking sector led to downturns in stock markets, bankruptcies, and job losses.

"We found a clear rise in suicide after the 2008 global economic crisis, there were about 4,900 excess suicides in the year 2009 alone compared with those expected based on previous trends (2000-07)," David Gunnell of the University of Bristol and his co-authors concluded in Wednesday's issue of the British Medical Journal.

The largest increase in Europe was seen in 15-24 year old men and in 45-64 year old men in the U.S. In Canada, the researchers estimated there were 294 excess suicides among men. There was no change in suicide in European females and a small increase was seen in American females.

The researchers say that their findings likely underestimate the true global impact of the economic crisis on suicide since data were unavailable for countries such as China and India.

Because younger men were most at risk, the researchers suggested that countries with limited resources could target their labour market support at this group. But in many countries, government austerity measures are contributing to further job losses, they said.

"Urgent action is needed to prevent the economic crisis leading to further increases in suicides."

The mortality database sources included the World Health Organization and the U.S. Centers for Disease Control and Prevention.

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Braces for curved spines cut need for surgery

Toni Lopez, who suffers from chronic back pain stemming from scoliosis, receives a back massage from Martha Garcia, at her home in Sacramento, Calif. Bracing significantly decreases progression of high-risk curves in patients with an adolescent form of scioliosis. (Rich Pedroncelli/Associated Press)

Bracing the spine in teens with a degenerative curvature is more effective than watching and waiting to see if it needs to be surgically corrected, Canadian and U.S. surgeons have found.

Scoliosis is a type of spinal curvature that now affects mainly girls beginning in adolescence. If the curvature worsens to more than 50 degrees after maturity it increases the risk for disabling disk and joint problems.

In Thursday's online issue of the New England Journal of Medicine, orthopedic surgeons from the Hospital for Sick Children in Toronto and three U.S. institutions said bracing significantly decreased progression to needing surgery.

"I won't be so much telling kids that I don't know whether it works," said study co-author Dr. James Wright, surgeon in chief at the Hospital for Sick Children. "I'm going to be saying, it does work and I'm afraid you have to wear it."

The researchers concluded that in adolescents with idiopathic scoliosis who were considered to be at high risk for curve progressing that would eventually warrant surgery, bracing was associated with a significantly greater likelihood of reaching skeletal maturity with a curve of less than 50 degrees, compared with watching and waiting.

The findings will have a direct impact on clinical practice in assessing orthopedic patients for bracing, Wright said.

The rate of treatment success in terms of preventing the need for surgery was 72 per cent in the bracing group compared with 48 per cent in the untreated group. In the bracing group, 41 per cent also had a successful outcome even though they spent little time wearing the brace. The braces contained a device that indicated when they were being worn. 

But wearing a brace has financial, emotional and social burdens that need to be considered, Dr. Eugene Carragee of Stanford University School of Medicine in California and Dr. Ronald Lehman of Walter Reed National Military Medical Center in Bethseda, Md., said in a journal commentary published with the study.

"We agree with the authors that the equally important finding of this study is that so many growing children with adolescent idiopathic scoliosis seem to do just fine with no treatment at all; the challenge for the field going forward is to identify children who are most likely to benefit from bracing," the commentators said.

The trial of 242 patients was designed as a randomized trial but 126 ended up choosing their care. The study's authors said they minimized but did not eliminate the potential bias from the nonrandomized patients.

Scoliosis develops in about three per cent of children younger than 16 but less than one per cent have progressive curves that need treatment, previous research suggests.

The study was funded by the U.S.National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Shriners Hospitals for Children, the Canadian Institutes of Health Research, Children's Mercy Hospitals and Clinics, the University of Rochester and SickKids Foundation.

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Dr. Donald Low, public face of Toronto SARS crisis, dies

Dr. Donald Low, a leading Canadian infectious disease expert who rose to prominence while helping Toronto cope with the SARS crisis that killed hundreds worldwide a decade ago, has died at age 68 after being diagnosed with a brain tumour.

Low was the microbiologist in chief at Toronto's Mount Sinai Hospital and a professor at the University of Toronto.

'It's a big loss to all of us in microbiology.'- Allison McGeer, Mount Sinai Hospital, on death of Dr. Donald Low

After the 2003 breakout of severe acute respiratory syndrome in Toronto, Low oversaw regular updates to the public about the syndrome, which eventually killed 44 people in Canada and nearly 800 worldwide.

Dr. Allison McGeer, director of infectious disease control at Mount Sinai hospital, worked with Low and knew him for 25 years.

In an interview on CBC Radio's Metro Morning shortly after news of his death broke, McGeer said Low provided a  voice of calm to a city gripped by fear during the SARS outbreak.

"He was the face and a good piece of the brains behind our response to SARS," McGeer told host Matt Galloway. "What many of us in Toronto don't recognize is the loss he leaves behind to microbiology and infectious diseases in Canada, and to all of his research work in emerging diseases around the world. It's a big loss to all of us in microbiology.

"With Don, no problem is ever too large," said McGeer. "You simply lay it out, you put it in its pieces, you figure out how to deal with it and you move on. That may be his biggest legacy."

McGeer credits Low for his role in not only studying infectious diseases, but also in teaching other doctors in the field.

"He created the generation of people that we now count on to study antimicrobial resistance and emerging infectious diseases," she said.

"One of the standing jokes in microbiology at Mount Sinai was that nobody ever leaves. There was no temptation. He was the best boss you could imagine."

According to Mount Sinai's website, Low was a fellow of the Royal College of Physicians and Surgeons of Canada. He completed his undergraduate training and postgraduate training in medicine and infectious diseases at the University of Manitoba and his training in medical microbiology at the University of Toronto. 

Low's primary research interests were in the study of the epidemiology and the mechanisms of antimicrobial resistance in community and hospital pathogens. 

Low published more than 170 papers in peer-reviewed journals and was a reviewer for several organizations including the Medical Research Council, Health Canada, New England Journal of Medicine, Journal of American Medical Association, and the Proceedings of the National Academy of Science. 

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E. coli cheese outbreak in B.C., Alberta leaves 1 dead, 10 ill

One person has died and 10 have become ill in B.C. and Alberta after eating E. coli tainted products from Gort's Gouda Cheese Farm of Salmon Arm, B.C.

A statement from Health Canada said there were four cases of illness in B.C. and seven in Alberta.

"One of the cases in British Columbia has died, and the cause of death is currently under investigation," said the Health Canada statement.

One person is still recovering in hospital and several cases remain under investigation, said B.C. Centre for Disease Control epidemiologist Dr. Eleni Galanis.

The illnesses began in July, with the majority of infected people displaying symptoms in late August to early September. 

Gort's Gouda has been linked to an outbreak of E. coli in B.C. and Alberta. (Gort's Gouda Farm Cheese)

Recalled cheese

All sizes of the raw milk cheeses listed below are affected by the recall:

• Medium Gouda Cheese Quaso de Prato.
• Aged Quaso de Prato.
• X Aged Quaso de Prato.
• Cumin Quaso de Prato.
• Greek Blend: Onion, Paprika, Parsley, Pepper, Thyme, Oregano Quaso de Prato.
• Gouda Cheese with Jalapeno Peppers Quaso de Prato.
• Smoked Gouda Cheese Quaso de Prato.
• Gouda Cheese with Red Peppers, Ginger, Onions & Garlic Quaso de Prato.
• Peppercorn, Ginger, Paprika, Onion & Garlic Quaso de Prato.
• Parsley, Celery, Onion, Garlic, Dill & Chives Quaso de Prato.
• Maasdammer.
• Beaufort.
• Parmesan.
• Mazouda.

​An alert from the Canadian Food Inspection Agency states the affected products have lot codes 122 to 138 and were sold at the manufacturer's outlet, at retail stores in Alberta and B.C, and through internet sales from May 27 to Sept. 14, 2013, inclusive.

Some product packages may not bear a lot code or indicate that the cheese was made with raw milk, and CFIA advises consumers who are unsure if they have purchased the affected product to contact their retailer.

Farm owner and operator Kathy Wikkerink said she was devastated by the news.

"We feel like we … we have hurt these people and it's totally unintentionally ... we were totally unaware of this bacteria being in any of our products," she said.

"We only have raw milk cheese sales ... people come here for raw milk cheese," adding the farm will only make pasteurized cheese for the time being. 

"Our shelves are bare and we just are trying to hold it together and stay alive," she said.

It is illegal to sell unpasteurized milk, but cheese made from unpasteurized milk is legal for sale in Canada.

E. coli facts

Officials advise that if you have eaten this cheese and feel well, there is no need to do anything further.

But if you have eaten this cheese within the last 10 days and have severe diarrhea or feel very sick, see your health-care provider.

• E. coli is a germ, or bacterium, that infects the digestive tract of animals.
• There are many types of E. coli, and most of them are harmless. But some can cause severe illness, even death.
• E. coli O157:H7 can cause stomach cramps and mild to severe diarrhea that can be bloody.
• Symptoms start two to 10 days after exposure to the bacteria, and usually last between five to 10 days.
• For more information on E. coli and its health risks, visit the BCCDC website.

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Playground equipment involved in rising number of injuries

More than 28,000 children are injured every year on playgrounds across Canada, and the rate of hospitalizations has gone up by eight per cent between 2007 and 2012, CBC News has learned.

Even though playgrounds continue to be upgraded and made safer, experts point to a lack of consistent standards —together with problems maintaining playground surfaces properly — with the continuing rate of injury.

In all jurisdictions in Canada, play structures only need to adhere to the Canadian Safety Association Standards in the year they were built, and no upgrades are mandatory. Some experts think that has to change.

"If equipment does not meet the standard then children should not be allowed on that equipment," said Debbie Friedman, director of trauma at the Montreal Children's Hospital.  

"Because I think we are only setting them up to potentially have a serious injury," she said.

Debbie Friedman of the Montreal Children's Hospital tells CBC News that although there are risks for kids using playgrounds, 'physical activity, being outdoors, is extremely important for a child's motor development, psychological development.' (CBC News)

Pamela Fuselli, of Parachute, a national injury prevention organization, echoed the concern about the lack of mandatory CSA standards and she called for more regulations to prevent injuries.

"There isn't a national body that regulates playgrounds, so while there are CSA standards for playgrounds, they're voluntary," she told CBC News. "Some municipalities have adopted them, or written them into their bylaws and guidelines that structures need to meet these standards,"

"There isn't a body that oversees if that is put into place or not," she said.

Studies show that playground surfaces and equipment that meet the standards and are properly maintained lead to fewer injuries.

According to the Canadian Paediatric Society, "Playgrounds modified to meet the current CSA standard can reduce associated injuries by as much as 49 per cent."

Playgrounds can be made safer

Research also shows that playgrounds can be made safer and that the playground surface is usually the most important factor.

CBC News tested a Winnipeg playground with Keith Thomas, a risk management expert with the Manitoba Association of School Boards.

Thomas operates a tool called the Triax 2000 that measures the impact of a playground fall on a steel ball meant to simulate the weight of a child's head.

The tool is on a tripod that holds a steel ball filled with sensors at the height of a play structure's highest point. When released it measures the force of the fall.

He told CBC News that playgrounds frequently fail the test, which is considered a score 1,000 and over, because of inadequate surfacing.

"What happens in many cases is people only have the bare necessity when it comes to sand or pea gravel," Thomas said. "We're trying to educate them to have 10 inches — frequently there is less than 10 inches."

Maintenance of the surface is another problem that Thomas pointed out. 

As children pound the playground, a cement-like surface results that will not protect them from fractures and other serious injuries.

"That's why maintenance is such a big issue," said Thomas. "If we have good protective surfacing and we can reduce those numbers of falls … it will reduce the overall injuries that children suffer on playgrounds."

The playground CBC News tested came in at 981, but Thomas pointed out that without proper maintenance, that playground surface may fail in the future.

"It looks like concrete but it's actually a hard surface that needs to be broken up," he said. "It definitely points to the need for proper maintenance."

Pamela Fuselli, of the injury prevention group Parachute, recommends avoiding playgrounds with hard surfaces, including dirt and grass. She says playgrounds with soft, deep surfaces reduce the risk of injury. (CBC News)

Fuselli said that the playground surface should be deep and soft, and that could go a long way in preventing injuries.

"Fractures are the most common injury that we see from playgrounds and those are due to falls," she said. "And falls cause not just fractures to arms and legs but the more serious ones like head injuries."

She also emphasized maintenance and said that regular upkeep should be a part of any playground management.

Serious hospitalization rates due to playground injuries across Canada also vary by region.

By province, Saskatchewan has had by far the highest injury rate by population, more than double the rate for both Ontario and Quebec.

Manitoba's rate almost doubled from 2007, at 48 serious hospitalizations, to 77 incidents in 2011.

The data also shows a steady increase in playground-related hospitalizations starting in 2006.

According to numbers provided to CBC News by the Canadian Institute for Health Information, there had been a gradual decrease in all injury-related hospitalizations — including those due to playground injuries — since 1994.

Gone up steadily since 2006

The number of playground hospitalizations, however, has gone up steadily since 2006.

Again, experts cannot say why there has been an increase, but they point to numerous factors including parental supervision, an increase in the number of playgrounds and the prevalence of multi-age structures.

Friedman told CBC News that there has been an increase in play structures geared for different ages being built in the same area, and this can cause big problems.

"The sections for older kids are a lot more enticing to the younger kids, and if they are on it then they clearly need a different level of supervision."

Friedman also believes that parents play a major role in keeping their kids safe.

"Supervision in this type of activity means eyes on the child, being in arm's length and not being halfway across the yard on your cellphone having coffee with a friend," Friedman points out.

Fuselli agreed, but said that risk of serious playground injuries needs to be measured against the benefits of physical exercise.

 "Where are the kids playing if there isn't a playground?" Fuselli asked. "Are they in the street, are they doing more unsafe behaviours or activities?"

"We'd all agree that physical activity, being outdoors, is extremely important for a child's motor development, psychological development. They're developing their social skills, and I think we want to encourage activity," she added.

Friedman advocates for a ban on play structures that are not approved.

 "I think if it doesn't meet the standard then it shouldn't be used. I think we know enough in this day and age that is a straightforward principle," she said. "We are concerned because certainly you don't need to have a hundred of the same injuries to get the idea that there's a problem."

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