Medical residents' long shifts questioned

Some medical residents at the University of Calgary are saying goodbye to the 24-hour shift, a move aimed at making doctors healthier and patients safer.

In Alberta, residents' shifts can run 24 hours, with some working up to 100 hours a week. It's a hectic, busy life for medical residents like Dr. David Ward, who says it can also be stressful.

"Often it's hard to find time to eat, to drink, maybe even sometimes to remember go even to the bathroom."

That's not ideal, according to residents' association president Dr. Gillian Shiau.

"You want to help people and you can't necessarily do that when you're tired, or you can't do that necessarily as well."

A recent University of Calgary study replaced the 24-hour shift with shorter rotating shifts for some residents, who reported they were less prone to make errors and they were better able to learn, among other advantages.

The shorter shifts have now been adopted by some U of C medicine departments and others are looking at changes as well.

"Many of our departments are looking at the hours and trying to modify how residents work in order to allow better patient safety, better resident wellness and physician wellness," said Dr. Maureen Topps, associate dean for post-graduate medical education.

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Quitting smoking pays off fully for heart in 20 years

Daily smokers who give up the habit can expect to wait 20 years before their risk of heart disease is lowered to the same level as that of non-smokers, according to a new Canadian report.

Statistics Canada researchers measured the association between daily smoking and the risk of heart disease for more than 10,000 men and women using 16 years of data up to 2011, says an article in Wednesday's issue of the federal agency's journal Health Reports.

Former female smokers tended to light up fewer cigarettes than current smokers. (Jim Mone/Associated Press)

"Smoking cessation reduced the risk of heart disease, but the full benefits were realized only after 20 years of sustained cessation," Didier Garriguet, senior analyst, and his co-authors concluded.

"Among individuals who continue to smoke, cutting down the number of cigarettes smoked also reduced risk."

Current daily smokers were 60 per cent more likely to have been diagnosed with, or to have died from, heart disease than were people who had never smoked daily.

The rate of heart disease decreased for former smokers who abstained the longest.

Garriguet said the finding of 20 years of continuous cessation to return to the same risk levels of those who never smoked is in line with the U.S. surgeon general's finding of 15 years, although Canadians tended to smoke fewer cigarettes than in other studies.

The earlier you quit, the better

When the study began in 1994, men were more likely than women to be current daily smokers (31 per cent versus 25 per cent) or former daily smokers (39 per cent versus 28 per cent).

Among former smokers, about one-quarter of both men and women said they had quit 20 or more years earlier.

Female former smokers reported lower intensity levels — such as number of cigarettes — than did current smokers, regardless of the number of years since quitting.

Among those who said they smoked when the study began, more than half quit during followup.

A related study released by the agency found that the sooner people quit smoking, the better the chances of eventually gaining the same health quality of life as non-smokers.

People with a high health-related quality of life are free of impairments in vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain.

It took about 20 years for former smokers' quality of life to return to that of those who had never smoked daily, a similarity to the first study that Garriguet said was not simply a coincidence.

Last month, Canadian, American and British researchers concluded that people who quit smoking by age 30 are close to never-smoker death rates, after considering their risks of heart attack, stroke and lung and other cancers.

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Antioxidants may not help prevent stroke and dementia

A diet rich in antioxidants may not reduce the risk of stroke or dementia as hoped, a new study suggests.

It's thought that antioxidants may help protect against stroke by neutralizing damaging molecules called free radicals that are linked to heart disease and stroke.

Most of the difference in antioxidant levels in the studywas from differences in how much coffee and tea people drank. (David Gray/Reuters)

A previous analysis of the Rotterdam Study of aging of nearly 5,400 participants aged 55 and older when the study began suggested that higher intakes of vitamin C might be related to lower risk of stroke and vitamin E may be associated with reduced risk of dementia.

In Wednesday's issue of the journal Neurology, Elizabeth Devore of Harvard Medical School in Boston and her co-authors confirmed those vitamin results but no benefits or risks were found for total dietary antioxidants.

"Overall, we found little association between total antioxidant capacity in the diet, measured by FRAP, and major neurologic diseases of the elderly," they concluded.

FRAP or ferric-reducing antioxidant power evaluates antioxidants in the diet including flavonoids missed by other measurements, although the researchers said it doesn't include as much information as individual antioxidants assessments.

Over the study's average follow-up of 13.8 years, 599 cases of dementia were identified as were 601 cases of stroke.

The statistical model controlled for factors such as age, education, total calorie intake, smoking, body mass index and use of supplements.

About 90 per cent of the difference in antioxidant levels in the study was from differences in how much coffee and tea people drank. The beverages are high in flavanoids.

Participants filled in a meal-based checklist of foods and then a detailed food questionnaire during a clinical exam.

The researchers said their findings were consistent with the findings of the Nurses' Health Study in the U.S.

Another study of Italians with an average age of 50 found higher antioxidants levels in the diet were associated with reduced risk of ischemic stroke, although those in the Italian study got relatively more antioxidants from alcoholic beverages, fruits and vegetables rather than coffee and tea. "Growing epidemiologic evidence does suggest that higher consumption of fruits, vegetables and alcohol may be associated with reduced risk of stroke," Devore's team said. The study was funded by the Netherlands Organization for Scientific Research and the U.S. National Institutes of Health.

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Ontario has no plans to fund in vitro fertilization

Ontario's newly re-appointed health minister Deb Matthews says she has no plans for routine funding of in vitro fertilization treatments, though some medical experts have said funding the treatment could save the province in the long run.

As more women try to have children later in life, when fertility levels drop, alternative ways to conceive like in vitro fertilization have become more popular.

But while in vitro fertilization — performed in cases of blocked fallopian tubes, advanced reproductive age, low sperm counts and unexplained infertility — has a high success rate, it is the most expensive of fertility treatments and out of reach for many.

Only Quebec's health care plan funds the treatment.

In 2007 an expert panel appointed by the Ontario Liberal government recommended that OHIP cover fertility treatments.

Among the panel's reasons was that the province could save hundreds of millions of dollars in long-term health care expenses.

But the provincial government balked at implementing the panel's recommendation, sparking a large demonstration outside of Queens Park in Toronto.

Ontario considered covering fertility treatment

Doctor Arthur Leader of the Ottawa Fertility Clinic was on that panel and said the cost issue arises from couples gambling on success in the current user-pay scenario.

"Because many treatments, whether they be artificial insemination ... or in vitro fertilization, when you're spending a third of your disposable income you don't want to do it very often," said Leader. "So given the choice, people will put in two embryos and will take the chance with multiples."

Multiple pregnancies can often result in risky preterm births and other complications, including physical or mental disabilities, said Leader, which can in turn burden an already overwhelmed health care system.

After being sworn in again as Health Minister, Matthews reiterated the issue was not a priority for the government.

"Quebec has gone ahead with funding in vitro fertilization, so that's something we're following very closely," said Matthews. "Whether this is something we can do right now is another question."

The Canadian Taxpayers' Federation, citing rising costs of reproduction technology, is opposed to publicly funding the treatment.

"Health care is already the largest expenditure in the province," said Candice Malcolm, the federation's Ontario spokesperson. "I think it's important to have a national or an Ontario-wide discussion over what we think should be covered by universal health care and what might be better covered in a private insurance system."

Time for a public discussion

Some women aren't waiting for the Ontario government to act and have moved to Quebec to take advantage of its public funding of in vitro.

Ottawa resident Natasha Derouchie said she thinks the Ontario government should recognize infertility as a real health issue.

"Infertility is an illness like anything else," she said. "And the fact that it's not recognized or talked about or taken care of is crazy."

Desrouchie said she was able to afford in vitro fertilization only after winning the treatments for free as part of a radio contest promotion.

She and her husband were one of five couples who won the contest. Today Derouchie said she is enjoying every minute of being a mother to three-month-old Knox.

"Our treatment was around $15,000 to be able to have him so there's no way we would've been able to afford (it)," Derouchie said. "So if we wouldn't have won the radio station contest, as crazy as that sounds, he wouldn't be here."

Do you think Ontario should fund in vitro fertilization treatment?

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Stillbirth rates higher in Quebec Inuit and First Nations

Stillbirth rates in First Nations and Inuit populations in Quebec are higher than in the general population, especially at term when most stillbirths are potentially preventable, researchers say.

Little is known about the timing and causes behind the higher rates of stillbirth among Inuit and First Nations populations compared with Canada's non-aboriginal populations. In Tuesday's issue of the Canadian Medical Association Journal, researchers in Quebec analyzed data on stillbirths and live births to try to find answers.

Improvements in pregnancy and obstetric care may be needed to close the gap in stillbirth rates. (Joshua Lott/Reuters)

"The gap widened at later gestational ages, and was largest at term, a period when most stillbirths are potentially preventable," Dr. Nathalie Auger of University of Montreal and her co-authors concluded.

In Inuit women, stillbirths were more likely to be caused by poor fetal growth, short gestation, and placental and related disorders, as well as birth defects that the researchers said may be linked to smoking.

For First Nations women, diabetes and complications of hypertension were considered the most important causes.

"Prevention may require improvements in pregnancy and obstetric care," the researchers said, suggesting anti-smoking and weight-reduction programs for women of reproductive age.

Rates of stillbirth were 6.8 per 1,000 total births for the Inuit women and 5.7 per 1,000 births for the First Nations women, compared with 3.6 per 1,000 for non-aboriginal women in Quebec.

During the study period of 1981 to 2009, 45 Inuit, 159 First Nations and 7,135 non-aboriginal stillbirths occurred at 24 or more weeks of gestation. The average human gestation is 40 weeks while before 37 weeks is considered pre-term.

Provincial stillbirth rates have fallen for Inuit and non-aboriginal populations but haven't improved for First Nations people. In Quebec, stillbirths need to be registered within eight days of delivery.

The researchers called for more efforts to record stillbirths at low gestational ages more completely.

The research was funded by Quebec's health research foundation.

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New coronavirus tested in human lung cells

The new coronavirus can easily infect the cells of the airways of the human lung and in fact is as adept at doing so as a common cold virus, a new study reports.

The authors say the findings suggest this new virus is already well-adapted to being a human pathogen.

There are six confirmed deaths from a new coronavirus infection. (Beth Fischer/Canadian Press)

The new research finding was published in the journal mBio on Tuesday, the same day British health officials announced that the new coronavirus had taken another life. The unidentified man's death brings to six the number of people confirmed to have died from the new infection.

The man, who had another illness that may have made him more susceptible to infection, is believed to have been infected by a relative, a British resident who became ill while travelling recently in Pakistan and Saudi Arabia. The father remains in serious condition in hospital.

A third member of the same family has also been confirmed to have been infected, but is reported to be suffering from minor symptoms only.

The cluster of cases is not the first in which person-to-person spread is suspected, but in two previous clusters questions remain about whether the virus spread from person to person, or from a source in nature to each.

In the British cluster, the likelihood of person-to-person spread is strong, Britain's Health Protection Agency acknowledged. Neither the second nor the third case in the cluster had recently travelled outside the United Kingdom.

"The three recent cases in the U.K. represent an important opportunity to obtain more information about the characteristics of this infection in humans and risk factors for its acquisition, particularly in the light of the first ever recorded instance of apparently lower severity of illness in one of the cases," John Watson, head of the respiratory diseases department at the agency, said in a statement announcing the death.

Lung experiments

In the new study, Volker Thiel and colleagues tested the new virus in human bronchial cells in a system that mimics the environment of the lining of the airways of the upper lung.

They compared the new EMC virus, as it is called, with the virus that caused SARS and one called 229E that causes colds in people.

All three are members of the coronavirus family.

The cells were as susceptible to the EMC virus as to the other two and in fact, the new virus multiplied at a faster rate than the SARS virus did in the human cells.

Thiel is with the Institute of Immunobiology is at the Kantonal Hospital in St. Gallen, Switzerland. He also teaches at the University of Zurich. Other scientists on this project are with the University of Bonn Medical Centre, the Helmholtz Center for Infection Research in Braunschweig, Germany and Erasmus Medical Centre in Rotterdam, the Netherlands.

Thiel said the team was not surprised that the new virus could infect the airway cells — called epithelial cells — because it has already infected people. But the degree of susceptibility of the cells to the new virus was unexpected.

"We were a bit surprised that it can so easily infect those cells," he said in a telephone interview.

"Usually you think that there is a so-called species barrier when an animal virus gets into a human population. But at least on the epithelium layer, we don't see that."

The new virus was first spotted last June, when a Saudi Arabian man died from an initially unidentified respiratory infection. Since then, cases have emerged sporadically — some singly, others in small groups. As well, testing on stored samples revealed two people who died in a mysterious respiratory outbreak in Jordan last April were infected with the EMC virus.

Unanswerable questions

All of the infections appear to have a link to the Middle East, with Saudi Arabia, Jordan and Qatar being the three countries from which most cases have arisen.

Of the 12 confirmed cases, six have died and several more remain gravely ill in hospital. In addition to the confirmed cases, the World Health Organization considers a number of other people as probable cases, including nine more people who were ill in the April 2012 outbreak in Jordan.

The source of the new virus is still unknown. As such, there are many unanswered — and currently unanswerable — questions about how much of a risk the virus poses to people. No one can say at this point whether it will fade away, continue to trigger the occasional infection or start to spread easily from person to person.

But the question of whether the virus would need to evolve more to gain the power to infect human lungs does seem to have been answered.

"If an animal virus gets into the human population, one assumes that some adaptation is needed," Thiel said.

"As we have seen for instance for SARS, there was a phase of adaptation to the human cells, to the receptor. And obviously that is not needed for this new coronavirus."

Still, he cautioned that just because the virus can easily infect human lung cells doesn't mean it has all the tools it would need to take off and spread widely among people.

"We have shown that the airway cells can easily be infected. But this does not mean that the virus can easily be transmitted," Thiel said. "I think this distinction is important."

The study also found that all three coronaviruses seem to be able to slip past the immune system because they don't trigger much of an innate immune response. The innate immune system is the so-called first line of defence.

The researchers found, though, that if they treated the cells with interferons — signalling proteins that cells release to warn surrounding cells of the presence of an attacker — the number of infected cells was significantly reduced.

That finding opens up the possibility that interferons, which are currently used in the treatment of some viral diseases, could be used to treat infection with the EMC virus, Thiel said.

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Canada Safeway recalls burgers over E. coli concerns

Some frozen beef burgers sold by Canada Safeway Ltd. are being recalled because they may be contaminated with E. coli bacteria

The recall includes the Gourmet Meat Shoppe Big & Juicy Burger and the Gourmet Meat Shoppe Prime Rib Burger with a best before date of Aug. 14.

Also affected are Butcher's Cut Pure Beef Patties sold in packages of 10, 20 and 40, and also bearing a best before date of Aug. 14.

The Canadian Food Inspection Agency and Canada Safeway say the products were distributed in Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and the Northwest Territories.

The CFIA says the recall is the result of E. coli O157:H7 testing related to an ongoing food safety investigation at the facility which produces the meat. Testing will be continued to see if any other products may be affected.

Food contaminated with E. coli O157:H7 may not look or smell spoiled, but it is potentially deadly. Health officials say it can cause bloody diarrhea, dehydration and, in the most severe cases, kidney failure.

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Quitting smoking pays off fully for heart in 20 years

Daily smokers who give up the habit can expect to wait 20 years before their risk of heart disease is lowered to the same level as that of non-smokers, according to a new Canadian report.

Statistics Canada researchers measured the association between daily smoking and the risk of heart disease for men and women using 16 years of data up to 2011, says an article in Wednesday's issue of the federal agency's peer-reviewed journal Health Reports.

Former female smokers tended to light up fewer cigarettes than current smokers. (Sakchai Lalit/Associated Press)

"Smoking cessation reduced the risk of heart disease, but the full benefits were realized only after 20 years of sustained cessation," the report's authors concluded.

"Among individuals who continue to smoke, cutting down the number of cigarettes smoked also reduced risk."

Current daily smokers were 60 per cent more likely to have been diagnosed with, or to have died from, heart disease than were people who had never smoked daily.

The rate of heart disease decreased for former smokers who abstained the longest.

The earlier you quit, the better

When the study began in 1994, men were more likely than women to be current daily smokers (31 per cent versus 25 per cent) or former daily smokers (39 per cent versus 28 per cent).

Among former smokers, about one-quarter of both men and women said they had quit 20 or more years earlier.

A related study released by the agency found that the sooner people quit smoking, the better the chances of eventually gaining the same health quality of life as non-smokers.

People with a high health-related quality of life are free of impairments in vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain.

Last month, Canadian, American and British researchers concluded that people who quit smoking by age 30 are close to never-smoker death rates, after considering their risks of heart attack, stroke and lung and other cancers.

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Artificial sweeteners tied to obesity, Type 2 diabetes

Diet pop and other artificially sweetened products may cause us to eat and drink even more calories and increase our risk for obesity and Type 2 diabetes, researchers are learning.

Former McGill University researcher Dana Small specializes in the neuropsychology of flavour and feeding at Yale University in New Haven, Conn. Small said there's mounting evidence that artificial sweeteners have a couple of problematic effects. Sugar substitutes such as sucralose and aspartame are more intensely sweet than sugar and may rewire taste receptors so less sweet, healthier foods aren't as enjoyable, shifting preferences to higher calorie, sweeter foods, she said.

Exposure to high-intensity sweeteners could change the way that sweet tastes are processed. (Justin Sullivan/Getty )

Small and some other researchers believe artificial sweeteners interfere with brain chemistry and hormones that regulate appetite and satiety. For millennia, sweet taste signalled the arrival of calories. But that's no longer the case with artificial sweeteners.

"The sweet taste is no longer signalling energy and so the body adapts," Small said in an interview with CBC News. "It's no longer going to release insulin when it senses sweet because sweet now is not such a good predictor of the arrival of energy."

Susan Swithers, a psychology professor at Purdue University in West Lafayette, Ind., studies behavioural neuroscience. "Exposure to high-intensity sweeteners could change the way that sweet tastes are processed," she says.

"A number of epidemiological studies show that people who do consume high intensity sweeteners show differences in metabolic responses, have an increased risk for things like Type 2 diabetes and also have an increased risk for overweight and obesity."

This week, researchers in France who followed the drinking habits of 66,000 women for 14 years reported that both regular and diet pop increase the risk of developing Type 2 diabetes, but the risk was higher among diet drinkers — 15 per cent higher for consumption of as little as 500 ml per week and 59 per cent higher for those having 1.5 litres per week.

Writing in the American Journal of Clinical Nutrition, the researchers said the women's age and body size were taken into account but eating habits may have changed over time and factors besides consumption of artificially sweetened drinks couldn't be ruled out.

Scientists in the U.S. have also found this association.

More difficult to manage weight

No longer being able to rely on the body's built-in and subconscious process for regulating eating makes it more difficult for people to manage their own weights, Small and Swithers agreed.

"They might actually have to read labels, pay attention to how many calories are in things because they've lost this easy process," Swithers said.

Last month, Nicola Kettlitz, president of Coca-Cola Canada, told CBC News that artificial sweeteners are safe and approved by Health Canada, adding aspartame has been used for 30 years.

"If you have to pick an evil, I'd pick the diet pop over the regular pop," said Dr. Yoni Freedhoff, director of the Bariatric Medical Institute in Ottawa. "But ideally it shouldn't be either."

Small said she tells everyone she knows not to use artificial sweeteners. "It's better to use a small amount of regular sugar than it is to use artificial sweeteners in your foods."

At a food court in Toronto, patrons recognized that diet drinks aren't ideal.

"It's good for people who are watching their weight," said Withya Ganeshalingam, who was sipping a diet Sprite, which she considers a "free drink" because of the zero calories.

"I feel like it kind of goes back and forth, this one's bad, this one is better for you," said Jason Costa. "Regular is what I do if I am going to drink it."

With files from CBC's Kelly Crowe and Pauline Dakin

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TV habits of children can affect mental health, researchers say

Changing the channel on what TV children watch could improve their behaviour, but watching too much regular programming may have harmful long-term consequences, new research suggests.

In Monday's issue of the journal Pediatrics, researchers reported that preschoolers spent less time watching violent programming when they were randomly assigned to participate in a program that encouraged aggression-filled shows to be replaced with educational or empathy-building viewing compared with a control group.

Muppets Bert, left, and Ernie, from the children's program Sesame Street, were created to teach preschoolers that people can be good friends with those who are very different from themselves, which builds empathy. (Beth A. Keiser/Associated Press)

"We demonstrated that an intervention to modify the viewing habits of preschool-aged children can significantly enhance their overall social and emotional competence and that low-income boys may derive the greatest benefit," Dr. Dimitri Christakis of Seattle Children's Research Institute and his co-authors concluded.

"Although television is frequently implicated as a cause of many problems in children, our research indicates that it may also be part of the solution."

There was no difference in total viewing time between the 820 families involved in the study.

The educational or "prosocial" programs included Sesame Street, Dora the Explorer and Super Why. A second category of shows also promoted co-operative problem-solving and non-violent conflict resolution — but inconsistently, as on Mickey Mouse Clubhouse, for example.

Programs included in the media diaries were coded for ratings, content and pacing, such as fantasy violence or gratuitous violence.

Parents were also encouraged to watch with their children.

Offer more nuanced message

At six months, the children in the intervention group demonstrated significantly less aggression and more positive behaviour compared to the control group, and the effect lasted for 12 months.

The American Academy of Pediatrics recommends that children watch TV one to two hours or less a day but surveys show the message isn't getting through, particularly as screens become a bigger part of our lives, said Dr. Claire McCarthy, a pediatrician at Boston Children's Hospital.

Instead of repeating the simple message of turning the TV off, McCarthy argues in a journal commentary accompanying the research that it's time to take the more nuanced approach in the study: educate parents and children about how watching violent programming can cause aggressive behaviour and give practical ways to shift their viewing.

McCarthy suggests that parents:

• Get informed.
• Watch what their children and teens are viewing in all forms — TV, video, games and online — and talk about it together in a nonjudgmental way.
• Teach media literacy starting at a young age and check that what children are viewing is age-appropriate, including what's on in the background.

Doctors can also play a role through outreach with the entertainment industry, said McCarthy, who is also a professor of pediatrics at Harvard Medical School.

Another study in the same issue looked at TV viewing among children and teens in New Zealand who were followed into adulthood.

Young adults who'd spent more time watching TV were likely to have a non-violent criminal conviction, diagnosis of antisocial personality disorder and aggressive personality traits in early adulthood, Dr. Robert Hancox of the University of Otago and his team found.

"To our knowledge, this is the first longitudinal study to demonstrate long-term associations between television viewing and a broad range of antisocial behaviour," they said.

While the study can't prove that watching TV causes antisocial behaviour, the long-term study adds to the evidence suggesting it could be a factor, said Caroline Fitzpatrick, a postdoctoral researcher at New York University who has studied how early TV viewing influences development in Quebec.

Christakis and Hancox's research was funded by the U.S. National Institutes of Health and New Zealand Health Research Council.

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