Canadian taste test: Do we like it salty or sweet?

What tastes and flavours are particularly appealing to Canadians, that could set us apart from other nationalities? 

Let's start with salt, and Canadians' reputation for loving salty food.

Canadians do eat a great deal of salt — too much, as health experts keep telling us.

Too much sodium in the diet causes high blood pressure, the leading risk for death in the world, because it increases the risk for heart disease and stroke, according to the Heart and Stroke Foundation.

"Canada is addicted to sodium," says Sylvain Charlebois, professor of food distribution and policy at the University of Guelph.

He notes that when Campbell Soup Co. brought out lower-sodium versions of its famous canned soup, the new products had sluggish sales. Now Campbell's, which had "positioned themselves as a responsible company trying to provide what's good for Canadians," is dropping the low-salt soup line. Charlebois calls that Campbell's campaign "ineffective."

Consuming too much salt won't set Canada apart from too many countries, research from the group World Action on Salt and Health (WASH) suggests.

Comparing salt content

Burger King bacon double cheeseburgers sold in Canada have more salt than the burger does in any other country, a 2014 survey found. But Burger King onion rings have more salt in the U.S. than in Canada. (Matt Cardy/Getty Images)

In 2014, the group compared the salt content of a basket of iconic food brands like Kellogg's breakfast cereals and foods from global restaurant chains like McDonald's, Burger King and KFC.

CBC News reviewed the study data and found some of these Canadian foods ranked high in salt, while others were low. Some foods sold in Canada had more salt than the same product sold in the U.S. but just as often, the U.S. version had more.

Canada did stand out in another WASH survey, on pizza, also for 2014. Of 184 takeout pizzas from six countries, Canadian pizzas had the lowest salt portion in five topping categories.

Those five pizzas all come from Pizza Hut. Interestingly, Pizza Hut also had the highest salt numbers in six topping categories, with five of those pizzas from the U.S. and one from Australia. Take Pizza Hut out of the mix and Canada looks about average on salt content in both takeout and frozen pizza.

For Clare Farrand, WASH's international program lead, the inconsistent international pattern suggests global taste preferences shouldn't be blamed for these differences, and it could lend support to WASH's argument that food processors or restaurants could easily lower salt levels.

While our taste for salt may be innate, scientists should be cautious about cause and effect. If we grow up eating soup high in salt, for example, then we will probably expect soup to taste salty. And if the yogurt we ate had added sugar, then we learned yogurt should taste sweet.

Ketchup high in sugar, salt

Take Heinz ketchup, for example, with four grams of sugar in a tablespoon. Does it have that much sugar because consumers like their ketchup that sweet, or did they learn that's how sweet ketchup should taste from eating it that way? 

Heinz Ketchup in Canada has less salt than Heinz ketchup in the U.S. The view that processed food sold in Canada has more salt than in the U.S. does not stand up to the data. (Dwight Friesen/CBC)

Heinz, which originates in Great Britain, has 100 mg of salt per tablespoon of ketchup there, 140 mg in Canada and 160 mg in the U.S., but the same amount of sugar in the three countries.

While Canadians do seem to like salt, the view that processed and restaurant food in Canada has more salt than in the U.S. does not stand up to the data.

Last year, Heinz left Leamington, Ont. where it had produced ketchup and other foods for more than a century. About 50 nearby farmers had grown tomatoes for Heinz, Charlebois says, but now the ketchup sold in Canada will be produced in the U.S. and will taste different, because different soil imparts a different taste.

Even the taste and texture of pasta depends on where the wheat is grown. In Parma, Italy, during a recent visit to the Barilla pasta operation, Charlebois was told Barilla favours wheat grown in North Texas and California because of the taste.

Sylvain Charlebois, a food industry expert from the University of Guelph, says Canada has lost 146 food manufacturing plants since 2006, while the industry claims it increasingly customizes tastes for local markets. (CBC)

Charlebois sees two contradictory trends for Canadian tastes. Including Heinz, Canada has lost 146 food manufacturing plants since 2006. Meanwhile, the companies tell him that they increasingly customize tastes for local market segments because, "even though brands are global, tastes remain localized."

He argues that those foreign-owned companies closing their Canadian plants and then producing their product overseas are engaged in "anything but customization; it has nothing to do with recognizing local tastes, it's the reverse."

On the other hand, Charlebois notes that trend creates a real market opportunity for independent food companies to sell locally.

Comparing Canada, U.S. flavour preferences

Technomic, a food industry consulting and research company based in Chicago, studies flavour preference trends in Canada and the U.S. Its data shows consumer preferences in the two countries are more similar than different on a range of flavour trends and that age and gender appear to matter more than nationality.

Food industry consultant Howard Moskowitz says food manufacturers would do better making several versions of their products for different groups of consumers in each country, rather than different versions for different countries. (CBC)

For example, while Americans have slightly more interest than Canadians in trying new flavours and so-called ethnic flavours, that interest rates much higher among 18-to-34 year-olds in both countries than older groups.

Surveys conducted in 2013 asking consumers how much they like some basic flavours found the only significant difference was that Americans like sweet and tangy, and the two flavours combined, slightly more than Canadians. "American consumers especially, really, really like sweet flavours," say Kelly Weikel, Technomic's director of consumer insights.

In both countries, 29  per cent said they like salty. Savoury was the most liked flavour in both countries.

Hot and spicy is a growing flavour trend in both Canada and the U.S., according to Technomic.

'Biology transcends learning'

Psychobiologist Julie Mennella says any taste differences between countries start early, as children learn how a food should taste. (Peter Olson/Monell Center)

Psychobiologist and taste expert Julie Mennella says for taste, there are "more similarities among people than difference, and the biology helps you understand that." She says any differences between countries start early, as children learn how a food should taste. 

But "biology transcends learning," says Mennella, who's with the Monell Chemical Senses Center in Philadelphia. And biology can help us understand our differences in flavours and tastes, she adds, by showing how culture acts on these sensory systems to produce those differences.

Howard Moskowitz has spent a lifetime studying consumer preferences and designing processed foods to meet them. Authors Malcolm Gladwell (What the Dog Saw) and Michael Moss (Salt Sugar Fat) helped make Moskowitz a food industry legend.

Moskowitz has found that, when it comes to food, we're not homogenous in the U.S. or in Canada. He finds that a population breaks down into several groups in their product preferences, and that "the countries have different proportions of these basic groups."

When asked whether it's possible to come up with a Canadian flavour profile, he says it could be done, but the food industry hasn't "done it yet because they haven't systematically understood what to do."

And does he think that would be useful for the food industry?

"Not at all."

22.45 | 0 komentar | Read More

Parents of children with Type 1 diabetes allege discrimination by B.C. government

The families of two children with Type 1 diabetes have filed a human rights complaint against the B.C. government and Fraser Health Authority, alleging a policy for standardized care is putting their kids at risk.

One of the parents, Guilly Milburn, said she has been fighting for months to get her seven-year-old daughter Scarlette the care she needs at school in New Westminster. 

In the complaint filed yesterday, she alleges the government policy amounts to discrimination, because Scarlette is not getting personalized diabetes care for her physical disability. 

The grade one student has Type 1 Diabetes, which means her body makes little or no insulin that regulate her blood sugar levels. 

Scarlette's blood sugar can drop at any time, so Milburn said she was concerned her daughter's blood sugar was only being tested at certain, standardized times throughout the school day. 

Within two days of being on the standardized plan, their daughter had a serious hypoglycemic episode at her school. 

When she asked that her daughter be tested outside those set times, Milburn said she was denied diabetes care in school outside of the standardized plan. 

As a result, Milburn said had to personally go to her daughter's school to provide for the child's diabetes care. 

"Every person is different," said Milburn. "Right now I'm getting her to be tested more often."

After some media attention, Milburn said she was finally able to get an individual plan for her daughter in January.

The Ministry of Health said in a statement that "[parents] cannot direct school staff on a day-to-day or hour-to-hour basis to deliver care differently from what is in the care plan, as the clinical evidence shows that this increases the risk for children in a school setting where the child may not be monitored as closely as they are at home."

But that's not good enough for Milburn, who wants the government to change its policy so that it's more flexible, and has filed the human rights complaint.

"Human Rights' law requires individual accommodation for people with disabilities ... a one-size-fits-all approach will rarely work for people," said Laura Johnston, an articling student at Community Legal Assistance Society that is representing Milburn and another Surrey family in their human rights complaint. 

"If the government doesn't take it seriously, if Fraser health and medical experts don't take it seriously, who's going to take it seriously?" Milburn said. 

22.45 | 0 komentar | Read More

Obamacare faces another Supreme Court test Wednesday

The U.S. Supreme Court is hearing arguments in a major test of President Barack Obama's health overhaul that threatens insurance coverage for millions of people.

The case being argued Wednesday is just the latest challenge to the law that was Obama's attempt to bring universal health care to the United States.

In King v. Burwell, the Court will decide whether the Affordable Care Act permits government subsidies for citizens of at least 34 states which use the federal HealthCare.gov marketplace to buy health insurance. It will hear oral arguments on Wednesday.

If the justices rule that only residents of states running their own exchanges are eligible for subsidies, some 9.3 million people will have to pay their full monthly premium or lose coverage, estimates the nonpartisan Urban Institute. Anywhere from six to eight million are expected to be unable to afford it.

Three years ago, opponents of the act failed to kill the law in an epic, election-year Supreme Court case in 2012. Chief Justice John Roberts joined with the court's liberal justices and provided the crucial vote to uphold the law in the midst of Obama's re-election campaign.

The chief justice could again hold the pivotal vote in the current case.

"This case is no less important to the future of the Affordable Care Act" than the court's decision in 2012, said Erwin Chemerinsky, dean of the University of California at Irvine law school.

Parties to get out their message

A ruling that limits where subsidies are available would have dramatic consequences because roughly three dozen states, many run by Republican governors, opted against creating their own marketplace, or exchange. Instead, residents of these states rely on the U.S. Health and Human Services Department's healthcare.gov. exchange to get coverage if they don't get insurance through their jobs or the government.

House Rules Committee Chairman Pete Sessions, R-Texas, has been among the ardent Republican critics of the Patient Protection and Affordable Care Act, often called Obamacare. (J. Scott Applewhite/The Associated Press)

While Democrats dread losing the case, there's a risk for Republicans too: millions of voters in Republican-governed states would lose their subsidies. Many of those states have Republican senators up for re-election in 2016.

Republicans claim the law infringes on individual liberties by requiring almost everyone to have insurance and results in Americans paying more and getting shoddy care.

The new case, part of a long-running political and legal fight to get rid of the law also known as "Obamacare," focuses on four words — "established by the state" — in a law that runs more than 900 pages. The challengers say those words are clear and conclusive evidence that Congress wanted to limit subsidies only to people in states that set up their own exchanges. Those words cannot refer to exchanges established by the federal government, the opponents argued.

The Obama administration, congressional Democrats and 22 states argue that it's absurd to suggest they would have constructed the law the way its opponents suggest — which would undermine their own program. They say the full law makes clear there is no such distinction between federal and state exchanges. But with Republicans controlling Congress, Democrats have little hope of tweaking the law's language.

The idea behind the law's structure was to decrease the number of uninsured. The law prevents insurers from denying coverage because of "pre-existing" health conditions. It requires almost everyone to be insured, so that healthy people can offset the costs of the sick, and provides financial help to consumers who otherwise would spend too much of their paycheck on their premiums.

Both sides in the case argue that the law unambiguously supports only its position. So far, lower courts have been split on the issue. The court is expected to rule by late June.

Democrats and Republicans plan to use an array of tools - from social media and radio interviews to newspaper opinion pieces, news conferences and Senate and House of Representatives floor speeches - to bolster the opposing legal arguments being laid out before the high court and to rally public opinion.

On Twitter, for example, at #acaworks, Senate Democrats brim with upbeat assessments of how Obamacare has slashed the numbers of uninsured while also saving on seniors' drug costs.

One tweet features an Obama quote: "While affordable health care might still be a threat to freedom on Fox News ... it's working pretty well in the real world."

Senator John Barrasso of Wyoming, a member of the Republican leadership, is spearheading his party's efforts in the Senate to land a deadly blow to Obamacare, which is opposed by 53.5 per cent of Americans, according to a recent Reuters/Ipsos poll.

Physicians thinking about Plan B

Interviews conducted by Reuters with doctors reached through professional groups show that they are preparing for a successful court challenge just in case, lining up free clinics to care for patients with chronic illnesses, asking pharmaceutical companies to provide discounted drugs, and moving up preventive-care appointments and complicated procedures.

"We have to be able to navigate this on behalf of our patients if it comes about," said Dr. Jeff Huebner, a family physician in Madison, Wisconsin, one of the affected states.

Parkland Hospital financial councilor Ricky Spain, right, answers questions for Gregory Jackson and his wife Tameka Jackson as they waited in to sign up for health care insurance in March 2014. (LM Otero/The Associated Press)

Last weekend, leaders of the National Physicians Alliance, which supports the Affordable Care Act and works to improve access to medical care, met in Washington to discuss how to work with community organizations to arrange health care for people who might become uninsured, said Huebner, who chairs the group's policy committee.

"The ideas include finding organizations that make referrals to free clinics, encouraging patients to check if they qualify for Medicaid or other state programs, and if they can't get insurance then find a regular source of care that accepts payment on a sliding scale" based on ability to pay, Huebner said.

"I would advise patients in this boat to schedule a visit with their primary care provider as soon as they can" to set up "transition plans," he added.

Dr. Robert Wergin, a primary care physician in Milford, Nebraska, is scrambling to locate labs and imaging centres that offer the lowest prices for blood tests, X-rays and MRIs.

"Around here, people feel responsible for their bills and I'm not sure they would come in if they lost insurance and couldn't pay," Wergin said.

22.45 | 0 komentar | Read More

Sugar intake should be reduced to 5-10% of calories, WHO says

The World Health Organization said sugar "hidden" in processed foods not usually seen as sweets include the about a teaspoon of free sugar in one tablespoon of ketchup. (Aileen Devlin/The Daily Reflector/Associated Press)

People worldwide should cut their free sugar intake to between five and 10 per cent of their overall calories, the World Health Organization advises. 

Free sugars refer to table sugar added to foods and drinks by the cook or consumer and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. Excluded as non-free sugars are those contained in fruit and milk.

"We have solid evidence that keeping intake of free sugars to less than 10 per cent of total energy intake reduces the risk of overweight, obesity and tooth decay," Dr. Francesco Branca, director of WHO's Department of Nutrition for Health and Development, said in a statement Wednesday.

The previous UN public health agency's guideline called for free sugar intake to be less than 10 per cent of energy intake. The update reduces the level to "less than five per cent of total energy intake if possible."

The "strong" recommendation for a 10 per cent limit can be adopted immediately as policy, such as in dietary guidelines in each country, WHO said.

In contrast, the "conditional" recommendation for the five per cent level is desirable, but "dialogue and consultations are needed before the recommendation is implemented as policy."

Five per cent of sugar intake daily is about 25 grams of sugar/day for an adult, or about six to seven teaspoons.

Some countries have taken public health measures to reduce free sugar intake, such as nutrition labelling, restricting marketing of food and non-alcoholic sugary drinks to children, fiscal policy and dialogue with food manufacturers to reduce levels in processed foods.

The 10 per cent target may be more realistic, said Tom Sanders, a professor of nutrition and dietetics at King's College London who wasn't part of the WHO guidelines.. 

He suggested limits on sugary drinks, cereals, beer, cookies and candy. 
 
"I don't want to say that you can't even have jam on your toast, but it is possible to do this with some effort," Sanders said. "Cake is lovely, but it's a treat." 

WHO is also drawing attention to sugars "hidden" in processed foods. For example, one tablespoon of ketchup has about four grams (1 teaspoon) of sugar. 

The draft guidelines were released in March 2014 for public comment.
 

22.45 | 0 komentar | Read More

Alcohol-abuse risks need much more attention, researchers say

Health care providers could spot individuals who drink at levels that are harmful before such patients would consider cutting back or seeking treatment. (Associated Press)

Do you drink beer, wine, coolers or other alcoholic beverages?

That's a question Canadians could hear more often as doctors try to get us to think about the risks of drinking.

Alcohol-related causes are responsible for seven per cent of all deaths in Canada and substantial disability, according to researchers. The consequences include fractures and other injuries from falls, vehicle collisions and accidents and injuries from violence or alcohol-induced suicides.

Recognizing that 15 per cent to 20 per cent of Canadians do meet the criteria for alcohol disorders, Dr. Anne Moyer of  Stony Brook University in New York and Dr. John Finney of the VA Palo Alto Health Care System in Menlo Park, Calif., conducted a review of alcohol misuse. It was published in Monday's issue of the Canadian Medical Association Journal.

Moyer said health care providers such as family physicians and nurse practitioners can spot individuals who drink at levels that are harmful before such patients would consider cutting back or seeking treatment.

Current Canadian guidelines for low-risk drinking recommend:

• No more than 10 drinks a week for women (with no more than 2 drinks a day on most days).
• A maximum of 15 drinks a week for men (with no more than 3 drinks a day on most days).
• Abstinence for pregnant women.

A standard drink is defined as: 

• 341 mL or 12 ounces of beer with five per cent alcohol.
• 142 mL or 5 ounces of wine with 10 to 12 per cent alcohol.
• 85 mL or 3 ounces of fortified wine  with 16 to 18 per cent alcohol.
• 43 mL or 1.5 ounces of liquor with 40 per cent alcohol.

The authors of the review suggest health care professionals ask patients if they consume alcohol and if so, how many days a week and how many drinks per day.

If risky behaviour is identified, then counselling and feedback can be offered in five to 15 minutes with or without follow-up to help people cut back. If drinking habits worsen, then patients can be referred to specialized treatment.

"Screening and brief intervention may reduce the toll of risky or harmful drinking," the pair conclude.

Canada's national alcohol strategy, published in 2007, also calls for widespread screening and brief interventions, which some doctors already do.

But a commentary published with the review calls the Canadian health care system's current approach to at-risk drinking a "systematic failure."

Dr. Sheryl Spithoff, a family physician at Women's College Hospital, and Dr. Suzanne Turner from St. Michael's Hospital, both in Toronto, agree with the authors of the review that family doctors can be well suited to provide addiction care compared with the high no-show rates at specialized clinics.

"The milder group, they tend to have stabler lives, they have jobs, relationships, they tend to be binge drinkers, so they're not drinking heavily every day," Spithoff said. "They are drinking intermittently, once a week, once a month. They tend not to experience significant harm from their drinking pattern at present, but they are at risk of harm."

Their recommended policy changes include:

• Add training on alcohol misuse to medical education for medical students and residents.
• Implement screening at hospitals and primary care clinics and create pathways to connect those with more severe alcohol-use disorders to treatment for addiction.
•  Provinces and territories should fund medications for alcohol use disorders (naltrexone and acamprosate) and make them widely accessible.

They also suggest resources for physicians to use.  

"For some reason, this information just isn't permeating," Spithoff said, noting physicians may feel uncomfortable asking the questions and may not be aware of how effective the interventions are. 

22.45 | 0 komentar | Read More

'Am I normal?': Study reveals average penis size

Marble statues of Venus and Mars in Rome's Chigi Premier's Palace. A new review provides insights on what's considered normal for penis length and circumference in men. (Andrew Medichini/Associated Press)

The question of what's a normal sized penis now has a well-informed answer.

Doctors searched through 17 published studies on more than 15,000 men who had their penis size measured by a health professional and graphed the averages in Tuesday's issue of BJU International, formerly the British Journal of Urology.

The graphs will help doctors reassure the large majority of men that their penis size is in the normal range, said study author Dr. David Veale, of King's College London.

For men with small penis anxiety, education and counselling may be helpful, Veale and his team said.

"It is a hidden problem," Veale said in an email. "Men are more likely to seek solutions on the internet with lotions potions, extenders or surgery."

Some men who are preoccupied and severely distressed with the size or shape of their penis may be diagnosed with body dysmorphic disorder, one of Veale's specialities.

The researchers say measuring penis size is important in assessing men who complain of a small penis and to investigate the relationship between condom failure and penile dimensions.

The average measurements were:

• Flaccid length 9.16 cm (3.61 in.). 
• Flaccid stretched length 13.24 cm (5.21 in.).
• Erect length 13.12 cm (5.17 in.).
• Flaccid girth or circumference 9.31 cm (3.67 in.).
• Erect circumference 11.66 cm (4.59 in.).

Stretched flaccid length looks to be an excellent estimate of erect penile length, they said.

The reviewers recommended taking the measurements in a private, air-conditioned consulting room using a disposable tape measure.

Flaccid circumference is measured mid-shaft, length is skin to tip and bone to tip.  

One of the limitations is relatively few erect measurements have been clinically done. Study volunteers may also have been more confident in their penis size than the general male population.

In 2006, the reviewers noted a large internet survey of heterosexual men and women suggested 85 per cent of women were satisfied with their partner's penis size and 55 per cent of men were satisfied with their own size. The preferences may differ in the homosexual community, the researchers said.

22.45 | 0 komentar | Read More

Virginia lawmakers say bake sale ban takes the cake

Some Virginia lawmakers recently became so fed up – so to speak – with school nutrition rules preventing the sale of sugary, fatty treats that they embarked on what turned out to be a controversial mission: bringing back bake sales.

The effort prompted debate in the state's legislature about childhood obesity, its causes and how to combat it — as well as government overreach and parental responsibility.

Federal regulations brought in under President Barack Obama in 2010 and championed by his wife, Michelle, prohibit the sale on school grounds of foods that don't comply with breakfast and lunch program nutrition standards. That's made it difficult to sell cookies and cupcakes to raise money for school clubs, activities and events.

Bake sales have been essentially banned, unless they are held after school hours, on weekends or off school grounds.

If held during school hours, the goods have to meet the "Smart Snack" standards. But granola bars and fruit cups just don't rake in the same kind of cash as brownies and apple pie, and it has motivated some lawmakers – not just in Virginia – to try and change the rules.

Childhood obesity a concern

Schools can get around the federal regulations if the state's board of education steps in and gives permission for certain foods to be sold. Some states across the U.S. have done that, including Georgia, Oklahoma and South Carolina – but not Virginia.

In the absence of action from Virginia's board, a few representatives in the state legislature decided they would take up the cause.

"The effective prohibition [of bake sales] is an egregious example of federal overreach and the board's decision to not proactively allow these school fundraisers simply doesn't make sense," Speaker of the House of Delegates William J. Howell said in a statement.

A bill introduced at Howell's request that would give schools more freedom to sell whatever goodies they want to raise funds made it through the House of Delegates with little trouble, but once it got to the Senate, it was met with resistance.

Federal school nutrition rules have made it harder to hold bake sales and other food fundraisers which has prompted lawmakers in some states, most recently in Virginia, to work around the regulations. (Mario Anzuoni/Reuters)

"I would ask the body to vote No rather than tell schools how many days they have to sell Ho-Hos," one senator said. Another who was against it said it would "turn the clock back" on progress made in fighting childhood obesity.

If parents are OK with their kids eating cupcakes and donuts, they can put them in their lunchbox, but the school itself should not be selling them, another senator argued. 

There are other ways to raise funds for extracurricular activities and school events, opponents said, and one senator spoke of the challenges teaches face when students are on a "sugar high."

Some in favour of the bill said regulations have gone way too far.

"We don't trust children any more, we don't trust them to eat the right foods, we don't trust the parents, so we now regulate it," Senator William Stanley said.

School food tastes 'terrible'

Others argued that the funds derived from bake sales are much-needed, and, come on, we had these treats when we were growing up – our kids should have them, too.

Stanley added that the cafeteria food offered through schools tastes "terrible," and dared his colleagues to go to a school and try one of the meals.

"Let them have this," he said of the bake sales. "They need it financially and gosh darn it, it probably tastes better," Stanley said.

The bill, allowing schools to hold up to 30 junk food fundraisers a year, passed and will now go to Governor Terry McAuliffe.

But it's not a sure thing that he will sign it. His wife, Dorothy, has made child nutrition a focus of her work as first lady of the state.

"He will evaluate that bill carefully when it reaches his desk," a spokesman for the governor said in an email.

Those looking to bring back bake sales are hoping to get a passing grade from McAuliffe, but those against it say it's clear why he should reject it.

"For the life of me," said Senator Richard Saslaw, "I can't see why you would want to vote for this bill unless you believe, quite frankly, that America's just not fat enough."

22.45 | 0 komentar | Read More

Hospital suicide: So many obstacles to prevention

CBC Radio Metro Morning's Matt Galloway spoke with Dr. Jennifer Brasch, a psychiatrist and former medical director of psychiatric emergency services at Joseph's Healthcare in Hamilton, about the challenges health care providers face with patients who attempt or contemplate suicide.

According to data collected by the CTV's W5, 300 people have died in psychiatric units across the country in the past 10 years.

Here is an edited and abridged transcript of Galloway's interview with Dr. Brausch. You can listen to the full interview by clicking the audio link on this page.

MG: Are you surprised by the number of people who have died while in psychiatric unit care?

JB: I don't think so. People are hospitalized in psychiatric wards because their are mentally ill and because they are at risk of harming themselves or others.

MG: How do you determine whether someone is at a real risk of attempting suicide?

JB: Suicide risk assessment is a very complex task. It involves a very careful assessment, a consideration of risk factors as well as an interview in which one explores with a person what are their thoughts on ending their life, if they are having those thoughts and what those thoughts are like — the intensity and frequency of them, how specific and detailed they are.

CBC Radio's Matt Galloway, host of Metro Morning, spoke with psychiatrist Jennifer Brausch about hospital suicides on Friday February 27, 2015.

MG: Does that speak to the difficulty of insuring they are safe when in psychiatric care?

The person's suicidal thoughts or urges can shift frequently or in response to a number of difficult to quantify things including changes in medication to changes in one's mental illness to events in a person's life or circumstances.

MG: How do hospitals go about protecting those patients?

All hospitals are required to have policies and procedures in place for assessing all mental health patients about their risk for suicide and for monitoring and determining changes in their level of risk. There are a number of interventions that are implemented when a person is deemed to be at risk of suicide. Those include monitoring and insuring the person's environment includes as few risks as possible and engagement nursing which is working with the person to explore and understand their thoughts of suicide as well as treatment with medication, of course.

MG: How much does the stigma around mental health care play into the difficulty health care providers have in that initial care?

I would like to think people working in mental health recognize the importance of identifying risk of suicide and that stigma is not a factor in determining risk. It's important to talk openly with the person about your thoughts of suicide. You won't give them ideas. It makes it easier to cope.

MG: It's been argued, by lawyers, doctors and others, that these suicide cases are preventable. Do you agree with that?

I know that at St. Joe's when there is critical incident there is a death review to examine the circumstances to prevent further instances. I'm certain all hospitals across Canada do this. St. Joe's built a new facility. The furnishings were chosen to minimize risk to patients who might be at risk of suicide.

Why do you think there's a reluctance to talk about patient suicide, whether in-hospital, or after the patient has been discharged?

As a psychiatrist, if a tragedy were to happen to one of my patients I would feel like a failure. I think psychiatrists are uncomfortable to admit that. Some of them will have malignant illness and will want to end their lives despite our best efforts.

MG: Is that something you have gone through?

I am aware of people who I had assessed who took their lives after being released from the hospital... People are very complex. We like to think patients want help. Sometimes the stress becomes so overwhelming they are desperate for an escape and do whatever they feel is necessary. Many organizations are working so people can find reasons to go on living.

22.45 | 0 komentar | Read More

Don't be fooled by big fat surprises, fat is still bad for you

Christopher Labos is a cardiologist and epidemiologist at the McGill University Health Centre. He is currently a fellow in global journalism at the Munk School of Global Affairs at the University of Toronto.

---

New doctors are often told that five years after medical school half of what they learned will be proven wrong.

Problem is, nobody knows which half. That seems to be what's going on with the current debate over fatty foods like bacon, butter and cheese.

For years, doctors said, fat was bad for your health and your waistline. But fat is back and it's even touted as being good for you.

A slew of editorials and news reports are claiming that scientists had it all wrong. And a new book called The Big Fat Surprise by journalist Nina Teicholz has popularized the controversial message to eat more fat.

While many people might be puzzling over this new theory and rethinking their eating habits, most experts do not think of the book as controversial. They just think its advice is flat-out wrong.

The connection between fat and heart disease goes back to the 1960s. A series of epidemiologic studies, most notably the Seven Countries Study run by American physiologist Ansel Keys, established links between dietary fat, cholesterol and heart disease.

It's this research that informed how the medical establishment thought about fat for years, and that Teicholz takes down in her new book, claiming that more recent data invalidates it.

Nina Teicholz is the author of The Big Fat Surprise: Why butter, meat & cheese belong in a healthy diet. (Nina Teicholz)

She claims that the low-fat diet that this research inspired has led to the growing obesity epidemic around the world, as sugars and carbs took the place of dietary fats.

But obesity experts are not so sure that claim is valid.

"We over simplify the message of fat, just like we oversimplify the message around calories," says Dr. Yoni Freedhoff, director of the Bariatric Medical Institute and assistant professor in the faculty of medicine at the University of Ottawa.

He says the real reason that obesity rates have risen is because large numbers of people are consuming more calories and larger portion sizes than they used to.

He points to a 2009 Cornell study that looked at how the popular cookbook, The Joy of Cooking, has evolved over 70 years.

It turns out that in 14 of the 18 recipes published in every edition, the number of calories jumped by 43.7 per cent over 70 years. Since 1996, portion sizes have risen by 33.2 per cent.

"There are a million reasons why we're eating more," says Freedhoff, "but the bottom line is we're eating more."

The notion that we should be eating more meat, butter and fat doesn't strike him as particularly sensible. "I don't think we should be eating more of anything," he says. He recommends eating less.

The problem with focusing on fat, or on any one nutrient, as a diet strategy is that it distracts us from what is really important, says Dr. David Katz, director of the Yale University Prevention Research Centre and president of the American College of Lifestyle Medicine.

He says that when Keys and others initially recommended a low-fat diet, what they meant was eat less fatty food and more fruits, vegetables, whole grains, beans and lentils.

These are all nutritious foods that also happen to be low in fat. But that was not what happened.

A 2009 study of the Joy of Cooking cookbook found that calories and portion sizes have increased noticeably over its then 70-year existence. (Joy of Cooking website / CBC)

"We just invented low-fat junk food," Katz told me.

As consumers sought out low-fat alternatives to their favorite snacks, companies simply took out the fat and added more sugar. Thus they were able to preserve the taste while still being able to label their food fat-free, which was a brilliant marketing strategy.

The public ate it up — literally — and never ate those healthy fruits and vegetables.

Consequently, the low-fat diet, as it was being practised in North America, was not associated with any health benefits.

That doesn't surprise Katz. He says that if you invent new ways to eat badly, your health won't improve.

The new movement to redeem fat was fuelled by a 2014 study in the Annals of Internal Medicine.

This review of 32 studies is often cited as proof that saturated fats are good for you.

However, that is not what the study actually showed, says Katz.

The study found no difference between high-fat and high-sugar diets when it came to cardiovascular disease.  

But that does not mean that saturated fat is good for you, says Katz. "Whether it was low-sugar, high-fat or high-sugar, low-fat, the rates of heart disease were basically the same and really high. Everybody lost."

You can cut the fat and eat badly, just like you can cut carbs and eat badly.

"There's a simple shortcut that's even better," Katz says. That's eating wholesome foods — things like fruits, vegetables, nuts, seeds, lentils and fish — in sensible combinations.

If your diet is mainly made up of good stuff, Katz says, you can't get it wrong, because then there is no room for the bad stuff.

And junk food like low-fat potato chips, just like low-carb brownies, are the bad stuff.

22.45 | 0 komentar | Read More

Patients' 'lives ruined' as hip surgery waits grow

Two osteoarthritis patients struggling with constant pain are speaking out in frustration about increasingly long waits to get hip replacement surgery.

"It's been absolutely horrific," said Julie Bennett, 55, a mother of four and home-care worker from Kamloops, B.C.

"I am in constant pain every day. And my life is slowing slipping away."

"It's not tolerable," said Vancouver resident Chiara Borello, 85. "It's not living…that I stay like this - waiting. It's terrible."

Government statistics and physician surveys suggest wait times for joint replacements have increased or stayed the same in most Canadian provinces in the last five years - despite countless government promises to address the problem.

Julie Bennett fears she will end up in a wheelchair if her hip isn't fixed soon. She's been told she won't get in for surgery until 2016. (CBC)

"I'm very angry. I don't understand what's going on here. I really don't. It's not like this is a new problem," said Bennett, who is among more than 3,000 people in B.C. currently waiting for new hips. "There are lives ruined."

"My mom is not suffering because there is nothing we can do," said Borello's daughter Renata, "This is the type of suffering that could be resolved right now."

Demand up, waits grow

Among larger provinces, statistics show B.C.'s increasing wait times are the longest – twice as long as in Ontario, where earlier wait-time improvements have also slipped.  Demand is up everywhere.

Among all provinces, only Saskatchewan showed significant, consistent reductions in wait times since 2009.  

Bennett was referred for surgery on her right hip in November of 2013 and said she's been told she won't get in until early in 2016. She said her joint has deteriorated so much she is unable to work or even function without strong narcotic painkillers.

"I am losing income. Eventually I won't be able to work at all. I never dreamt that I'd be in this position."

Her local hospital, Royal Inland, has the longest waits in the province, significantly higher than average.

Wheelchair next, patient fears

Overall, B.C.'s wait times vary wildly, depending on the surgeon. The government figures indicate most hip patients wait from six months to a year and a half - and that doesn't include the initial waits to get in to see a surgeon.

"I am eventually going to end up in a wheelchair, if I don't start getting these things addressed," said Bennett who added her other hip is also deteriorating.

Chiara Borello was told she needed a new hip in January, but her first appointment with an orthopedic surgeon in Vancouver isn't until next month.

Renata Borello said she can't just stand by quietly and watch her mother suffer. (CBC)

Her daughter said she was only able to get that booked after she was taken to hospital by ambulance, in unbearable pain.

"Watching her suffer just makes me cry," said Renata Borello.

Hospitalized for pain

She said her mom was put in a dementia ward in Vancouver General Hospital for two weeks even though she has no cognitive impairments. 

"They just kept trying new drugs. It was always about pain management. Not about pain resolution. Or removing the cause of it," said Renata. 

The elderly woman said she would rather die than spend several more months taking incapacitating painkillers.

"If I drop dead, that's fine. But I won't take any more of that poison. That's too much poison," said Chiara.

Chiara Borello's daughter points to the cocktail of drugs her 85-year-old mother is expected to take while she waits. (CBC)

The Fraser Institute is the only Canadian organization that has tracked national wait times over two decades.

Public complacency cited

The author of its annual report said he believes public complacency – acceptance of the unacceptable - is a big reason why most provinces have allowed wait lists to languish.

"We are starting to accept that it's OK to wait a really long time. We are starting to accept that it's OK for your situation to deteriorate, because that is just the price of a universal health care system. It's not. There are several universal health care systems that do not have these long wait times," said Bacchus Barua.

Bacchus Barua of the Fraser Institute said wait times for joint replacement surgery have been steadily getting worse for two decades, despite government promises to fix the problem. (CBC)

He said Saskatchewan's improvements are the likely result of recent changes there.

"One is a pool referral system - where they connect patients with the doctors that have the lowest wait times," said Barua. "Also, they are starting to contract with third-party private providers inside the public system."

B.C.'s minister of health said not enough co-ordinated OR time, nursing staff and anesthesiologists to meet the demand is the main problem there.

Consultations delay action

"I have asked our provincial surgical advisory committee to look at this situation because I think we can do better and that's a matter of co-ordinating services between physicians between specialists and the hospitals and health authorities," said Terry Lake.

The province recently put out a policy paper that, ironically, said B.C. has an oversupply of orthopedic surgeons. It calls for consultation, which will take more time.

"Stop making excuses and get on with addressing the issues," said Bennett. "We have to start speaking up and saying this situation is just not acceptable anymore."

"I cannot have my mother suffer indefinitely waiting for some magical moment on some fictitious wait list for her to be attended to," said Renata Borello.

Source: Fraser Institute. Note: Data for small provinces, such as PEI, is less reliable due to small sample sizes.

---

Submit your story ideas:

(CBC)

Go Public is an investigative news segment on CBC-TV, radio and the web.

We tell your stories and hold the powers that be accountable.

We want to hear from people across the country with stories they want to make public.

Submit your story ideas to Kathy Tomlinson at Go Public

Follow @CBCGoPublic on Twitter

22.45 | 0 komentar | Read More