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Category "Health"

26Jul

Daphne Bramham: Recovery homes’ dilemma: Trying to comply with regulations that have yet to be written

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After three years of operating two registered recovery houses, in January 2016 Cole Izsak found what he believed — and still believes — is the perfect place.

But before taking possession, the owner and executive-director of Back on Track Recovery applied to the provincial health ministry to essentially grandfather his operation and transfer the registration of one of his houses to the new site.

Because Back on Track has never had any substantiated complaints, he didn’t expect any problems and, a month later, shut the registered house and opened a four-plex now called The Fortress.

The next month, Izsak closed one of the two houses that were registered by the provincial government and moved to the new compound with internal, off-street parking at 9889-140th Street in Surrey.

He still wasn’t concerned when in May, the ministry said it was putting a hold on his application while both the province and Surrey were formulating new regulations.

Since then, it is rare that any of the 40 beds — two per bedroom in each of the five-bedroom houses — are empty.

While Back on Track continues to operate the one registered house, The Fortress remains unregistered, with only two of four business licenses that it needs.

For the last 2½ years, Surrey’s bylaw inspectors have been telling Izsak that unless all four houses at The Fortress get their provincial registry, the city can’t license the houses until the registration from the health ministry comes through, certifying that services offered meet its standards of care.

In mid-May, Back on Track and its residents were told that the licenses were being revoked and the four houses would have to close at the end of July. It has since been given a reprieve, pending a decision from the provincial registrar.

“If Mr. Izsak’s registration comes through, we’ll be prepared to do our own inspections for renewal or issuance of the licenses,” bylaw services manager Kim Marosevich said this week.

In late May, after Maggie Plett first spoke publicly about her son Zachary’s death at another Surrey recovery house called Step by Step, Addictions Minister Judy Darcy told News 1130, “We’re trying to make up for lost time over the past many, many years since the scandal started to break.

“But I would expect that we will have new, stronger regulations and enforcement in place by the end of the year.”

Throughout all of this, the government has paid Back on Track the $30.90 per diem that covers the cost of room, board and recovery services for each welfare recipient living there — a rate that has remained unchanged for 16 years.

Izsak doesn’t know why the ministry has yet to make a decision on his application. The mental health and addictions ministry has not yet responded to my questions about it.

On Tuesday, Izsak gave me a tour of the four neatly kept houses. He showed me the well-supplied pantry where residents are free to take whatever food they want and as much as they want. There is also an open-air gym and smoking lounge. Every room has a naloxone kit in case of an opioid overdose, and every few weeks, residents are given training on how to use them.

The half-dozen residents that I spoke to privately — including one who said he had been in at least 20 such facilities — said The Fortress is the best. They talked about feeling safe, well-cared for, and even loved.

Izsak makes no apology for not having more set programming in the houses.

“People who are coming off the street or out of prison are not going to surrender to eight hours of programs per day,” he said. “But what they will surrender to is coming to a place like this where they are fed well, have a clean bed, a TV, and programming from 9 a.m. until noon.”

He acknowledged that there are no certified counsellors or therapists working there. He devised a recovery program called MECCA based on his own experiences in recovery that is delivered by others who are in recovery.

Izsak also said he cannot afford to hire certified addictions counsellors and specialized therapists, as they do at recovery houses where monthly rates are anywhere from $3,000 to $9,000 a month.

Right now, registered facilities don’t require that, according to the registry’s website.

What’s required is that all staff and volunteers “must have the necessary knowledge, skills, abilities and training to perform their tasks and meet the health and safety of residents.”

Far from bridling at more regulations, Izsak has a long list of his own that he would like the province to enact to weed out bad operators.

It includes random site inspections, manager-on-duty logbooks documenting what happens every two hours from 10 a.m. until 10 p.m., and a requirement that all operators provide their expense receipts.

After three recent deaths in recovery houses, Izsak is now a man on a mission.

“I want to close operations that are bad so that I’m not treated almost like a criminal because they acted unscrupulously.”

Of course, he first needs to save his own.

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Twitter: @bramham_daphne


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18Jul

Ian Mulgrew: Medicare expert, lawyer spar to end landmark trial

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The B.C. Government’s defence in the landmark three-year-old Medicare constitutional trial in B. C. Supreme Court is ending not with a bang but a testy, two-day courtroom sparring match involving one of its experts.

Dr. Gordon Guyatt gave as good as he got, repulsing a prolonged assault on his objectivity and left the stand Thursday having provided some last-minute fireworks but seemingly little insight on the key issue — wait-lists and the effects of constraints on access to private care in the provincial Medicare Protection Act.

“My perception is that there’s been a fluctuation of concerns with waiting lists and that governments have, to an extent, addressed things,” he said.

“Things can always get better … you have tensions — constant tensions — in every health care system in the world, and problems will never be solved.”

A specialist in internal medicine and, for almost 35 years, a health researcher at McMaster University, the argumentative Guyatt was assailed as more of an ideological warrior than a disinterested expert.

Robert Grant, lawyer for the two clinics and handful of patients behind the legal challenge over barriers to access to private care, portrayed Guyatt as a virulent opponent of the private clinics and Dr. Brian Day, the driving force behind the decade-old litigation.

Noting he had a duty to be impartial, Guyatt bristled at the broadsides aimed at impeaching his credibility.

“Given my, given that commitment, I do not see personally as relevant further pursuit of my opinions about issues beyond the issues that I’ve been asked to comment on in my deposition,” he complained.

“Thank you for that,” Justice John Steeves said. “In the meantime, just answer his questions.”

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Government lawyers vainly tried to halt the brutal cross-examination that battered Guyatt’s neutrality.

A self-described left winger who ran repeatedly as an NDP candidate, Guyatt has been a social activist for 40 years.

In 1979 he co-founded the Ontario-based Medical Reform Group, which disbanded in 2014 and was replaced by the Canadian Doctors for Medicare, which he joined.

He was also a director of the Ontario Health Coalition, an activist network, that along with its sister group the B.C. Health Coalition, is a member of the Canadian Health Coalition.

Doctors for Medicare and the B.C. coalition, under the banner of B.C. Friends of Medicare Society, have intervened in the challenge to support the government case.

Grant accused the groups of wrongly asserting Day seeks “U.S.-style health care for Canada, where people go bankrupt, lose their homes and life savings, or worse, because they can’t afford treatment when they need it.”

The B.C. coalition, he said, incorrectly claimed Day wanted a system where “international private insurance corporations run the show and patients foot the bill.”

Grant said the groups were fearmongering.

“It is an overstatement that this case could bring down single-tier Medicare,” Guyatt agreed, adding he also did not endorse the portrayal of Day and his supporters as “greedy, awful people.”

He maintained he was too busy to keep up with everything the groups did,  and distanced himself from the inflammatory rhetoric.

“The way I would put it is that we were advocates for equitable high-quality health care accessible to people without financial obstacles,” he said.

“So, specifically, as I have said previously, I believe that it is more appropriate to base care on the need — the medical need than on ability to pay — and I would like to work, continue to work, in a system where the patients I treat are treated on the basis of need rather than ability to pay.
”

“I understand,” Grant replied.

“But the point (of the trial) isn’t about what you want to do in your own practice; it’s whether or not increased private health care, and specifically private-pay surgeries, will be permitted or not. And you are opposed to increased private-pay surgeries. Isn’t that right?
”

“Yes,” Guyatt confirmed.

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Grant insisted Guyatt was a vocal opponent of Day within the Canadian Medical Association, seeing him as a “tragic choice” and “a complete disaster” as the organization’s president.

“I don’t recall active involvement in that matter,” Guyatt said, but again added such comments would be “hyperbolic.”

The Ontario specialist attacked the concept of using “benchmarks” to measure surgical waiting times — saying “not much” research has been conducted to establish what is acceptable and he suggested they were undependable tools set by “good old boys sitting around the table.”

But Guyatt has long minimized waiting lists and their ill effects — calling them “a problem that may be much smaller than we imagine” in 2004.

And he acknowledged he was not familiar with the circumstances in B.C.

“Certainly not in detail …. I do not know the details of the extent of waiting lists currently. I am sure that waiting lists remain a problem. … and that they’re not optimal … I do not know well enough to know whether it would be appropriate to characterize them as a serious problem or not.
”

The final witness John Frank, an expert on social determinants of health, took the stand later on July 18 and was to finish July 19 — day 179 of the proceedings.

“When this trial began I thought it would last up to 18 weeks (three times longer than the similar Chaoulli case in Que.),” said Day, founder of the private Cambie Surgery Centre.

“I am happy that — almost 3 years later — the witness phase is over. I am confident that the justice system will eventually grant all Canadians the same rights to protect their health that the Supreme Court of Canada granted to citizens of Que., and that the citizens of every other country in the world enjoy.”

Justice Steeves plans to hear final arguments this fall and begin deliberations in December.

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[email protected]

twitter.com/ianmulgrew

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17Jul

572 British Columbians died by suicide in 2017, including 22 youth

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The BC Coroner has released its updated suicide report from 2007 to 2017. The report shows 572 people took their own life in 2017. Of those 22 were under 19.


The B.C. Coroners Service has released its updated report on suicides in the province between 2007 and 2017.

The report shows that 572 British Columbians took their own life in 2017, down slightly from 603 in 2016, 615 in 2015, and 644 in 2014.

Most were men and more than half were aged 30 to 59. Twenty-two youths under 19 years old died by suicide in 2017, up from 20 the year previous.

The coroner report shows the highest age-specific suicide death rate was among 40 to 49 year olds in 2017, and the three most common means of suicide were by hanging, followed by poisoning, firearms and falls. The number of SkyTrain suicides went up to four from three in 2016, while railway suicides in 2017 fell to four from six the year before. The number of CO poisonings also fell to 13 from 20 the year before, while the cause of 42 suicides was still under investigation.

The Fraser and Interior Health Authority had the highest number of suicides in 2017, with 157 and 130 deaths, respectively. The Northern Health Authority had the highest rate of suicide deaths at 18 deaths per 100,000 individuals.

Overall, the rate of suicide deaths in B.C. was 12 deaths per 100,000 individuals.

Suicide rates are highest in Northeast, Kootenay Boundary, Thompson Cariboo, East Kootenay, and Northern Interior Health Services Delivery Areas, according to the report.

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11Jul

Illicit drug deaths down this year in B.C., says coroner

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28Jun

Smoky summers: Health experts extend their warnings to pregnant women

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When wildfire smoke enveloped Metro Vancouver last summer, Nikki Rogers noticed soot collecting on the walls of her White Rock condo and closed her windows to keep the bad air out.

“I tried to stay inside because I did not enjoy being outside,” recalled Rogers, who works in a hair salon. “I would never do any kind of exercising or jogging or walking outside because anything that promotes heavy breathing outdoors would be terrible.”

This summer she will take even greater precautions because she is pregnant. And this is the first year that Vancouver Coastal Health and Metro Vancouver have included pregnant women on their list of people especially vulnerable to wildfire smoke, along with asthmatics, the elderly, and people with chronic heart and lung conditions.

Rogers said she will research the best way to keep herself and her baby safe, but laments that wildfire smoke is one more thing expectant mothers will likely need to worry about this July and August.

“We shouldn’t have months of just smoke in the air. That’s just awful,” she said. “Every year it gets worse and worse. It is just getting out of hand.”


Nikki Rogers, who is pregnant, will keep the windows of her White Rock condo closed this summer to keep any wildfire smoke out.

Experts believe British Columbians are about to experience another hot, smoke-filled summer, basing their prediction on the higher-than-average temperatures and drought so far in 2019 — a trend that is expected to continue.

“We expect increased wildfire and smoke risk, and that includes in the southwest where we are,” said a Metro Vancouver air-quality engineer, Francis Ries.

Just in the last week, a stubborn wildfire on steep terrain near Lions Bay snarled traffic on the busy Sea to Sky Highway for days, and a fire broke out Monday near Pender Harbour on the Sechelt Peninsula.


A helicopter dumps sea water on June 23 on a wildfire near Lions Bay.

NICK PROCAYLO /

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Fires started earlier in 2019

Hotter, drier conditions contributed to fires in early spring, far sooner than in other years. Since April 1, the B.C. Wildfire Service has recorded 377 fires that have burned more than 110 square kilometres.

The summers of 2017 and 2018 were the worst on record for smoky skies — a provincial state of emergency was declared both years over wildfires — and much of the haze in Metro Vancouver drifted in from big fires in other parts of B.C.

The smoke led officials to issue a record number of air-quality advisories, and give extensive advice on how residents should try to remain healthy.

This year, local health and municipal agencies added pregnant women to the list of those most vulnerable to the smoke after lobbying by Sarah Henderson, an environmental health scientist at the B.C. Centre for Disease Control.

She advocated the change based on an “evidence review” and academic research that showed mothers exposed to extreme wildfire smoke give birth to smaller babies.

A University of California, Berkeley study found that pregnant women breathing in wildfire smoke during their second trimester in 2003, a terrible fire season in Southern California, had babies that were about 10 grams lighter than women not exposed to smoke. The results were small but “significant,” researchers found, because they showed “climate change can affect health.”

Ten grams would be enough to “push some babies into a low-birth-weight category,” added Henderson, noting undersized infants can face challenges.

Based on pregnancy and population statistics, Henderson predicts a repeat of last summer’s smoky skies could lead to 20 babies in B.C. being born a bit smaller. It’s not a big number, but one that could hurt 20 families.

“And that is kind of the tip of the iceberg in some ways because nobody has looked at preterm birth or malformations, if that smoke exposure happens to pregnant women,” added Henderson, who is also an associate professor in the UBC school of population and public health.

She has applied for funding to do her own study of the outcome of women who were pregnant in B.C.’s Interior, where the smoke was the thickest during the last two summers.


Sarah Henderson of the B.C. Centre for Disease Control.

Wildfire smoke is a toxic, chemical soup

Wildfire smoke contains many pollutants, but the most dangerous to human health is fine particulate matter, a mixture of solid particles and liquid droplets that are generally 2.5 micrometers or less in size — about one-30th the diameter on a strand of hair.

“The very small particles can be inhaled deeply into your lungs and then get into your blood stream, and irritate and lead to inflammation,” said Emily Peterson, a Vancouver Coastal Health environmental health scientist.

A typical summer day in Metro Vancouver would feature 10 or 15 micrograms a cubic metre of these fine particulates, but during the height of last summer’s smoky skies the quantity jumped tenfold.

Smoky air makes it harder for lungs to get oxygen into the blood stream, and it can irritate the respiratory system and cause inflammation in other parts of the body. Common symptoms include eye irritation, sore throat, coughing, wheezy breathing and headaches, and there is an increased risk of infections for some, such as pneumonia in older people and ear infections in children.

At-risk people — including those with chronic lung or heart conditions and now pregnant women — should “pay attention to the smoke much earlier” this summer, said the VCH medical health officer, Dr. James Lu.

“We do start with the vulnerable population, but if the smoke (concentration) is high enough we do encourage people who are normally healthy to take precautions as well,” Lu added.

Among the precautions backed by medical experts: Stay inside places with filtered air, such as most community centres, libraries or malls; drive with the windows up, the air conditioning on, and the recirculate-air button activated to reduce the amount of smoke getting into your car; and drink lots of water.

One expert calculated that people doing exercise or working outside during the height of the wildfire smoke could inhale the equivalent of two packages of cigarettes a day.

Because most people typically spend 90 per cent of their days indoors, Henderson highly recommends buying a portable air cleaner, which plugs into a wall socket and can be moved from room to room. These purifiers remove 40 to 80 per cent of the fine particles found in smoke, but people with respiratory conditions are encouraged to buy higher-performing HEPA (High Efficiency Particulate Air) filters, the Centre for Disease Control says.

If people are outside and want to wear a mask, Henderson said the best option is a well-fitted N95 respirator. A surgical mask can offer limited protection. A cloth mask is close to useless at keeping out the fine particles in smoke.

Doctors’ visits, asthma prescriptions skyrocket

Most people can manage irritations from smoke without medical attention, but those with severe symptoms should see a doctor.

Wildfire smoke caused a slight rise last summer in the number of people visiting Vancouver Coastal Health emergency rooms, although the increase wasn’t even across all communities: North Vancouver and Richmond had more hospital visits, while other cities did not, said Lu.

“What we did see were increased visits with respiratory symptoms, asthma and people short of breath,” the medical health officer told Postmedia.


Dr. James Lu of Vancouver Coastal Health.

The B.C. Health Ministry could not provide information about higher traffic in emergency rooms in other health regions, saying its data does not let it differentiate between treatment specifically for wildfire smoke and other respiratory issues.

However, Centre for Disease Control statistics suggest medical services across B.C. were harder hit when wildfire smoke was heavy. In the summers of 2017 and 2018, 45,000 extra doses of asthma medication were dispensed and there were 10,000 extra visits to doctors for asthma-related conditions in B.C., Henderson said.

“It does stack up, the impact is quite extreme,” she said. “On a very smoky day in Metro Vancouver, there were 350 extra doctor visits.”

The Centre for Disease Control tabulates this information daily in the B.C. Asthma Prediction System, which was launched after previous severe wildfire seasons. The surveillance system tracks asthma-related doctor visits and the prescriptions filled for lung conditions, and is used to warn health officials about the anticipated effects of wildfire smoke.

This summer is also expected to experience a boost in asthma treatments, given what happened in May after a significant wildfire near Fort St. John. “We had this one day of smoke in Fort St John, and the asthma visits skyrocketed,” Henderson said.

During the past few years, Vancouver Costal Health has sent reminders to family physicians to help their patients get ready for smoke expected in July and August — such as ensuring medications for patients with chronic heart or lung disease are up to date.

“I think what we are hoping for is to perhaps educate the public and primary-care physicians in helping people to be prepared so that they don’t really need to come to the emergency,” Lu said.

More than 3,000 ‘smoky skies’ bulletins issued

The provincial Environment Ministry issues “smoky skies” warning bulletins when wildfire smoke gets bad in all areas of the province except Metro Vancouver, which releases its own air quality advisories.

In 2017, 1,646 air-quality advisories were issued across B.C., and that jumped to 1,742 in 2018. There have been 69 warnings so far this year, but that number will likely increase as the majority of 2018 bulletins were issued between late July and late August.

The province monitors 63 regions, and six of those have had 100 or more smoky skies bulletins since 2017 due to bad fires nearby, including Quesnel, Penticton, Prince George, Williams Lake and Kamloops. Other communities in B.C.’s Interior and the Cariboo region have also been hard hit, with just under 100 bulletins issued in the last two years in Vernon, Kelowna, Cranbrook and 100 Mile House.


A wildfire near Fraser Lake in May.

Submitted /

B.C. Wildfire Service

Only Haida Gwaii, off B.C.’s northwest coast, has had no smoke-related air quality warnings since 2017.

The Environment Ministry was unable to provide information about how many advisories it issued in years with far fewer forest fires than 2017 and 2018. But statistics from Metro Vancouver indicate those two years were off the charts.

There were 22 days in Metro Vancouver last summer with poor air quality due to forest fires, mainly between late July and late August. In 2017, it was 19 days of unhealthy amounts of smoke.

The region’s figures, dating back to 1996, showed no other years with near that number of hazy days, the closest being 10 days in 2009 and 2015, when there were also some forest fires. In several years, including 2011, 2013 and 2016, there were no days with poor air quality.

Metro Vancouver’s advisories show much of the air pollution came from forest fires in other parts of the province, but the air was also affected by some local blazes, such as a bog fire in Richmond and a barge blaze in Surrey.

No air quality advisories have been issued so far in 2019; Metro Vancouver said the smoke residents smelled earlier this week from the Lions Bay fire was “below advisory thresholds.”

Ozone pollution rises due to wildfires

Metro Vancouver’s summer 2019 outlook warns of the potential for increased ozone due to higher temperatures and wildfires. Ozone is described as “good up high; bad nearby” — ozone in the atmosphere protects from UV radiation, but when lower to the ground it damages lungs and destroys ecosystems according to a Colorado State University academic paper, Ozone Levels Elevated in Presence of Wildfire Smoke.

“We’ve seen high ozone levels at monitoring stations which we never, under normal circumstances, expect to have high ozone,” said Metro Vancouver’s Ries. “We almost never have high ozone in the western part of the valley, downtown Vancouver and through into Burnaby,” he said, except in 2017 and 2018 when “the highest ozone levels we received were in that part of the region.”

Ries said more studies, including ones that focus on B.C., are making a strong link between climate change and the exacerbation of wildfire seasons.


Francis Ries, Metro Vancouver air quality engineer, and Roger Quan, Metro’s director of air quality and climate change.

In 2017, 65,000 British Columbians were evacuated and 509 buildings burned during wildfires that scorched 12,000 square km of land. The 2018 forest fires were even more destructive, consuming 13,500 sq. km — although fewer people were evacuated (6,000) and fewer structures lost (158).

Over the last two summers, the provincial government grossly outspent its wildfire budgets — by 10 times in 2017, when it cost more than $650 million to fight the fires. This year, the NDP is trying to be better prepared for the unknown by nearly doubling its wildfire budget, boosting it from $64 million in 2018 to $101 million.

Smoky summers in Vancouver may become “the new normal,” if not every year then at least every other year, VCH’s Lu predicted.

“We do not expect this to go away. This is going to be a way of life, unfortunately,” he said. “So I think the need to include that in your consideration of how to stay healthy is important.”

[email protected]

Twitter: @loriculbert




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22Jun

10 tips for a healthy holiday

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Plan ahead to ensure that you stay safe and healthy while travelling this summer.


Getty Images

It wasn’t until monkeys started swarming our tuk tuk that I started to think about a rabies vaccine.

Fortunately the boldest topped short of landing on my lap, opting instead to plunder a bag of fruit left on the seat. The incident, while we were touring Siem Reap in Cambodia, underscores the scouts’ motto, ‘be prepared.’

With summer holidays upon us, it’s time to plan ahead. With help from Dr. Suni Boraston,  travel clinic director for Vancouver Coastal Health and Sara Holland, senior communications director for the BCAA, here are 10 tips for a healthy holiday.


Dr. Suni Boraston is the medical director at the Travel Clinic, Vancouver Coastal Health.

Handout

1. Travel Health Clinics

If you’ll need vaccinations for travel it’s best to visit a travel health clinic six weeks before you leave, but Boraston says even if you’ve left it to the last day, it’s better to get vaccinated then than not at all. Travel clinics’ services and products extend beyond vaccinations; they’re a good place to start regardless of where you’re travelling.

2. Vaccinations

Online sources can give you recommendations on vaccinations and other medicines based on the area you are travelling in and the length of your stay but check with your travel clinic. Anyone born after 1970 who doesn’t have a documented second dose of measles vaccine should get one, said Boraston. Babies don’t get their first measles vaccine until age one, but Boraston said they can safely get the vaccine from six to 12 months, and she recommends that no matter where you’re travelling with a baby. Another must-have for every traveller is a Hepatitis A vaccine. Hep A is spread by food and water and it’s a global issue. Expect to pay for travel vaccinations, although some, like a tetanus booster, are free in British Columbia and others may be covered by extended benefits plans. It can add up: A rabies vaccination, for example, is $200 per dose and there are three doses, probably why I opted not to get that but useful if you’re spending an extended time in areas where rabies is still prevalent. Boraston said E. coli is the most common ailment for travellers. She suggests packing antibiotics prescribed by your doctor, only to be used if you have “think you’re going to die diarrhea”.


Monkeys swarming around our tuk tuk looking for food on a tour around Siem Reap, Cambodia, a country known to still have rabies. Rabies in Cambodia are mainly transmitted by dogs but travellers are advised not to avoid scratches or bites from monkeys as well as dogs, cats and other mammals. Left untreated, rabies is fatal.

Gillian Shaw

3. Insurance

When shopping around for insurance, make sure you know what you need and what your policy covers. Holland recommends travel insurance that covers medical and/or hospital expenses, prescription drugs, ambulance service, emergency dental care and pre-existing conditions. Some extended benefits plans include travel so you don’t have to buy extra insurance or you can just top it up; check with your provider and check for age limitations. Read the fine print on travel coverage you may have through your credit card. Holland also reminds us that travel insurance isn’t just for travelling outside the country. Some medical expenses aren’t covered by the B.C. medical plan when you’re in other provinces.

4. Questions to ask before you buy travel health insurance

  • Does the insurance provider protect spouses or children? If not, can they be added?
  • Does it cover trips of any length? Some policies have a limit on trip length
  • What’s the limit on coverage for medical expenses?
  • What is the policy around pre-existing conditions? Are they covered and to what degree?
  • Did the travel have to be purchased on the credit card in order to be eligible for coverage?

5. Packing a first aid kit

When it comes to packing your first aid kit, your destination will help determine what’s on the list. Here is a list of basics that you can adapt depending on where you’re going.

  • Over-the-counter medication for pain and fever
  • Gravol, Boraston points out as well as being good for nausea it can serve as a sleeping pill.
  • Hand sanitizer
  • Imodium and if you’re travelling in developing countries, an antibiotic to treat diarrhea.
  • Antibacterial cream
  • Bandaids
  • An antihistamine
  • Pads or moleskin for blisters are useful if you’re going to be doing a lot of walking
  • Sunscreen
  • Consider compression socks for long flights

6. Prescriptions and other medication

Don’t pack just enough of your prescription medicine to cover your expected time away, carry extra in case you’re delayed. Make sure your medications are in your carry-on bag and take a copy of your prescription, including the generic name, in case your bag gets stolen or lost.

Spare cheater drugstore specs may be enough to get by if your glasses are lost or broken but if you’re totally dependent on you’re glasses to see, take spare prescription glasses or contacts and your prescription. Take a copy of your health insurance documents.

7. Area-specific additions for your packing list

  • Depending on where you are travelling, you may need extras such as antimalarial medication, or Diamox for altitude sickness
  • Carry repellent when you’re travelling where there are ticks and mosquitos, even in malaria-free countries. If you’re backpacking or sleeping in the open air, consider adding mosquito netting to your packing list.
  • Water purification tablets

8. Reduce your travel footprint

Boraston recommends taking your own water bottle when you travel and refilling it from taps. In developing countries or where you are unsure about water quality, use water purification tablets and leave the water for 30 minutes to kill organisms. Carry a reusable cup and avoid using plastic straws, another source of plastic waste, by carrying a reusable stainless steel straw.

9. What not to take

The legalization of cannabis in Canada doesn’t mean you can take it across the border. The Canadian government warns on its website that: “Taking cannabis or any product containing cannabis – even for medical use – across the Canadian border is illegal.” Plus cannabis is still illegal in most countries. Even if you’re travelling to a state in the United States where cannabis is legal, it is illegal under United States federal laws and it is illegal to cross the border with it.

10. Online sources

Check out health-related travel advice at:

Government of Canada Travel Health and Safety: A comprehensive site that offers advice on everything from finding your nearest travel clinic to a mobile Travel Smart app for Apple and Android devices.

Centers for Disease Control and Prevention: It has a lot of useful information and resources, including  advice for travelers and clinicians that can be customized to your destination and type of travel. Along with recommended vaccinations and health advice, it has packing lists tailored to your travels.

[email protected]

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22Jun

Changing health care one app at a time

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When Mari-Lynn Cordahi was diagnosed with multiple sclerosis 21 years ago, she would have welcomed someone to talk to who knew from experience what she was going through.

Today, she fills that role for others newly diagnosed with MS, thanks to her role as a peer mentor on Curatio. Dubbed a ‘social health prescription,’ Vancouver-based Curatio is the brainchild of co-founder and CEO Lynda Brown-Ganzert.


Mari-Lynn Cordahi is a peer mentor on Curatio.

Handout

“I’ve connected with people through the Curatio app,” said Cordahi. “One person in the UK, I connected with her within days of her being diagnosed.

“If I put myself back 21 years ago, I know what she is going through. I sure would have appreciated it if something like this had been available then.”

Using a combination of artificial intelligence and private social networks, Curatio’s mobile app fills a gap in our healthcare system, creating personalized support networks for patients and caregivers who are newly diagnosed or navigating their way through an illness or chronic condition.

The idea came to Brown-Ganzert when she was undergoing fertility issues and complications in pregnancy.


Using a combination of artificial intelligence and private social networks, Curatio’s mobile app fills a gap in our healthcare system, creating personalized support networks for patients and caregivers who are newly diagnosed or navigating their way through an illness or chronic condition.

“It was when we were having our second child and there were some complications and issues around that,” she said.  “I became  a patient and found, ‘oh my goodness, there are some really broken pieces here.’

“Being an entrepreneur you’re always thinking how you could fix it. The genesis of Curatio came from that – looking at the isolation, the difficulty patients have navigating, the lack of curated information you can trust that is personalized to you, connecting with others who are similar to you or have gone through the same thing.”

Brown-Ganzert, whose background is in digital media, had spent the previous 10 years building private mobile social networks. Her experience with the healthcare system convinced her that the idea of private social networks could be applied in the healthcare field.

“A good friend of mine had a heart attack and became our first use case,” she said. “With him and together with Alireza (Davoodi), my co-founder, we built a prototype in 40 days, went on to win a global challenge and our first customer and we were off.”

That was five years ago. Today Curatio is used in more than 85 countries and in four languages.

“Where I started from was recognizing social was a missing piece in healthcare transformation. When you start to connect patients, and we have clinical evidence to show this, you have improved outcomes,” said Brown-Ganzert.

When you sign onto the system, an AI agent helps you navigate to find what you need. There are currently three active communities: in heart, multiple sclerosis and thalassemia, an online community ThaliMe, plus you can sign onto the general Curatio network, or as a caregiver.

Along with the social support, the app provides everything from medication reminders to self-assessment, helping patients manage their disease or chronic condition.

Brown-Ganzert  took the concept to the Dragon’s Den, winning over three dragons from the television show who are among investors who so far have put US$1.6 million into the company. Curatio counts a number of non-profit patient advocacy organizations as clients, delivering a means to reach patients that complies with privacy and regulatory requirements. The platform is also being used in research, providing a social plugin that helps research teams connect to participants in their community.

For Beverly Sudbury, of Charlottetown, PEI, Curatio creates connections to a global community of people who share a diagnosis of MS.

“For me I like connecting with people and I like finding new sources of information or bouncing ideas off people,” she said.


For Beverly Sudbury, of Charlottetown, PEI, Curatio creates connections to a global community of people who share a diagnosis of MS.

Handout

Sudbury, who is also a peer supporter on the network, said she checks daily to see what’s new.

“It’s building an online community of people you can get support from when you’re having a crappy day,” she said. “They’ll say ‘keep going,’ or they’ll help out with a different perspective.”

Users create their own profile on the app, but they don’t have to use their real name and can choose what information is publicly displayed.

There is also a private chat function.

“For me the chat functionality is fantastic,” said Sudbury.

Unlike friends and family who can’t really understand some of the issues facing people with MS because they haven’t lived with the disease, Sudbury said other patients will know exactly what she is talking about.

“I’ll say ‘I’m tired,” and a friend will say, ‘I know what you mean, I was up really late last night,’” she said. “But it’s not the same.”

Cordahi, who was an elementary school teacher before MS forced her to stop teaching 15 years ago, likes to volunteer since she can’t work and Curatio provides that opportunity to engage.

“When you talk to someone who has gone through this journey, there is definitely a sense of comfort and trust that they understand and are going through something similar – even when it’s difficult subjects or personal things,” she said.

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22Jun

Using artificial intelligence to combat acne

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While artificial intelligence won’t replace your dermatologist it shows promise as a diagnostic tool, in everything from acne to skin cancer.


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Nobody wants to be called in to see the doctor and find a robot wearing a white coat.

You may not have to worry your GP will be replaced by a droid anytime soon, but artificial intelligence is playing a growing role in health care, diagnostics and the delivery of services.

Skin care and cosmetics brand La Roche-Posay is among companies turning to AI as a diagnostic tool.

La Roche-Posay, a L’Oréal brand that specializes in products for sensitive skin, recently introduced the Effaclar Spotscan – a scanning tool that uses artificial intelligence to diagnose acne. It’s the latest in data-driven skin care that uses AI to develop personalized solutions for skin health. AI won’t take the place of your dermatologist, but  it shows promise as a diagnostic tool, in everything from acne to skin cancer.

Othman Bennis, head of marketing for La Roche-Posay said a need for early intervention among acne patients was identified by dermatologists. That was the catalyst for a product that could help patients identify early on the level of their acne, measured on a scale from zero to 4+.

“They were telling us one of the main pain points they have in the management of acne patients was that most of the time acne patients were not going soon enough to see a dermatologist and when they were coming, many times it was too late,” said Bennis.  “Even if they had the right treatment at that time, they would still have marks and scars because they hadn’t gone earlier.”

Dermatologists wanted a way for patients to get an early screening to diagnose the severity of their acne. They also wanted patients with moderate to high acne levels to be directed to a dermatologist for treatment.

That led to research into a digital tool that could provide an early and accurate diagnosis of acne, ranking it on the same scale used by dermatologists seeing patients in person.

It started with data collection, with some 6,000 photos, three for each patient, with varying degrees of acne. Photos had to be taken on both an iPhone and Android phones since the calibration of pictures isn’t the same across the different operating systems.

La Roche-Posay, a L’Oréal brand that specializes in products for sensitive skin, recently introduced the Effaclar Spotscan.The photos had to encompass skins types from all over the world. Dermatologists provided the photos and each photo was graded by three different dermatologists.

In the case of a disagreement on the numbers, something that’s not unusual in real life practice, the majority determined the deciding grade. So, for example, if two dermatologists said an acne was a grade three and one said it was a grade two, it would be counted as grade three.

The photo analysis focuses on pimples, blackheads and acne marks, like pigmentation of the skin.

Once that data collection and analysis was complete, the AI process began with the data fed into supercomputers. Machine learning resulted in a system that could define and grade acne with an accuracy on par with having two dermatologists deliver a diagnosis.

“Basically it is as precise as seeing a dermatologist face to face,” said Bennis.

Response to Spotscan, which launched three months ago, exceeded expectations, said Bennis. It is now available in 50 countries and two million people have used the online tool to evaluate their skin.


La Roche-Posay, a L’Oréal brand that specializes in products for sensitive skin, recently introduced the Effaclar Spotscan.

Handout

There is a professional version of the online tool as well as a consumer version.

Eighty per cent of people under the age of 25 have had acne at least once and 40 per cent of adult women have issues with acne.

“Acne is huge,” said Bennis. “It is a very widespread problem.”

The online tool has a number of functions, not all related to promoting La Roche-Posay skincare products. For ratings of zero to two, users are offered a skincare analysis with both generic suggestions and La Roche-Posay product suggestions for a skincare regime. At higher levels, it recommends a visit to a dermatologist.

Bennis said users don’t have to be La Roche-Posay customers to benefit from the online tool. Another function is a timeline simulation for people who have low to mild acne to show the effect of following a recommended skincare regime for eight weeks. For severe acne there is no such simulation because users are advised to see a dermatologist.

A second function is useful to all — the ability to track progress though a digital diary that compares early results to later ones as treatment is followed.

AI is also being used to screen for skin cancer and some research results are promising. Research published in Nature, the International Journal of Science, demonstrated artificial intelligence could be trained to achieve an accuracy in classifying skin lesions that was on par with board-certified dermatologists. There are consumer screening apps but some of the more popular ones, like SkinVision, haven’t yet been approved for availability in North America.

In recent research published in the Lancet machine-learning algorithms were more accurate in diagnosing skin lesions than a group of human viewers, which included board-certified dermatologists, dermatology residents and general practitioners.

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21Jun

City of Vancouver makes plans for a smoky summer

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The City of Vancouver is preparing for a smoky summer, making plans to create “respite areas” at several communities centres, libraries and non-market-housing units.

The public spaces could act as clean air havens for people who have health concerns and lack access to an air-conditioned space during air quality advisories. The rooms would be equipped with portable HEPA filters and some would also serve as cooling centres, according to a statement from the City of Vancouver.

Experts are warning that it’s likely to be another hot, smoke-filled summer in B.C. this year. B.C. Wildfire Service information shows the province has seen increased drought and higher-than-average temperatures in 2019, with the trend expected to continue.

“Obviously, we expect increased wildfire and smoke risk, and that includes in the southwest … And increased temperatures are likely to drive higher ozone formation, and so we expect there may be more potential for that this summer as well,” Metro Vancouver air-quality engineer Francis Ries told Postmedia on Tuesday.

Ozone, a pollutant that when mixed with fine particulate matter creates smog, often irritates the eyes, nose and throat, and over time can cause permanent lung damage.

Ries said more studies, including ones that focus on B.C., are making a strong link between climate change and the exacerbation of wildfire seasons.

“As we continue to see further warming, we expect that the patterns we are seeing now are likely to continue or perhaps even get more extreme,” he said.

The summers of 2017 and 2018 were the worst on record for smoky skies across B.C.

In Metro Vancouver, there were 22 days last July and August under air-quality advisories, three more than in the summer of 2017.

The last two summers have far exceeded the number of advisories issued in any other year since 1996, the first year for which data is available. Several years, including 2016, had zero air-quality advisories.

University of B.C. public health professor Dr. Michael Brauer said many public buildings are already equipped with air conditioning and filters that provide effective relief on smoky days. Simply closing windows can significantly improve air quality, while even a small filter can remove particulate matter. Higher-quality filters may require more energy, but buildings could swap them in on days when the air quality is poor.

Brauer said the long-term health impacts of one or two weeks of smoky skies each summer are likely very small, but if that time stretches into one or two months — as it is threatening to do in some parts of the B.C. Interior — it would be “concerning.”

“We know that day-in-day-out exposure (to pollution) can be life-shortening,” he said, alluding to studies in other countries where pollution is a significant problem. “It can causes diseases to get worse, and accelerates the progression of disease.”

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With files by Lori Culbert

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20Jun

Reschedule Vancouver fireworks if air quality poor? Not so fast

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Team U.K. puts on a show at the 2017 Honda Celebration of Light in Vancouver.


Francis Georgian / PNG files

When wildfire smoke settles over English Bay this summer, as experts predict it will, there’s not much Vancouver can do about it.

But the city shouldn’t be adding any more ingredients to the “toxic soup,” says Kitsilano resident Judith Maxie, who wants council to reschedule fireworks events if the air quality is poor.

“You don’t have to be a scientist to see that tossing all those fireworks into the soup isn’t a good thing,” she said Thursday. “This is something we can actually change.”

Maxie doesn’t want to ban fireworks altogether — “over the years we’ve loved attending them,” she said — but wants the city to hold events like the Honda Celebration of Light at a different time of year, or put a contingency plan in place in case it’s smoky during the annual Canada Day fireworks.

Dr. Christopher Carlsten said he considers fireworks pollution “a significant issue,” particularly for people who are sensitive to poor air quality. A number of case reports have shown an increase in asthma attacks and irritation in people with lung disease during fireworks events.

“There’s not a lot of good defences for them in a health sense,” said the Vancouver physician. “If we’re just talking about health, I’d say don’t do it.” But the University of B.C. professor and head of respiratory medicine admitted that argument doesn’t factor in the “cultural equation” or the enjoyment derived from the spectacle.

Carlsten, who holds the Canada research chair in occupational and environmental lung disease, said much of the research on fireworks pollution has been done in countries where festivals last for days and fine particulate pollution accumulates at ground level.

“It’s quite clear that fireworks do affect air quality, but in Canada the events do tend to be short,” he said.


Vancouver’s Honda Celebration of Light show. ‘It’s quite clear that fireworks do affect air quality, but in Canada the events do tend to be short,’ says Dr. Christopher Carlsten, a UBC professor and head of respiratory medicine.

Francis Georgian /

PNG files

University of B.C. public health professor Dr. Michael Brauer said Vancouver’s fireworks shows happen high above the ground, which can help the particulate dissipate sooner, especially if wind conditions are favourable.

“It’s a transient increase,” he said of the rise in fine particulate pollutants associated with fireworks. “For most people, it shouldn’t be a concern, but for those with asthma or heart and lung concerns, it would be best to minimize exposure.”

Metro Vancouver air quality advisor Geoff Doerksen said pollution from fireworks is “short-lived and dissipates quickly,” and most years it doesn’t reach the ground. Any localized impacts to air quality tend to return to normal levels within a few hours.

Doerksen advised people who are concerned to avoid viewing areas and close their windows if they live in the area.

In a statement, the City of Vancouver said it did not receive any complaints about air quality during last year’s fireworks events and “is not considering cancelling or rescheduling fireworks that occur on Canada Day or at the Celebration of Lights.”

The summers of 2017 and 2018 were the worst on record for smoky skies across B.C.


Dr. Christopher Carlsten.

In Metro Vancouver, there were 22 days last July and August under air-quality advisories, three more than in the summer of 2017.

The last two summers have far exceeded the number of advisories issued in any other year since 1996, the first year for which data is available. Several years, including 2016, had zero air-quality advisories.

In 2015, a U.S. study published in Atmospheric Environment found that levels of fine particulate matter are elevated in urban areas by an average of 42 per cent during the 24-hour period starting with a fireworks event.

“That was a national average across 315 monitoring sites; it actually varies from place to place and year to year,” lead author Dian Seidel, a senior scientist at the National Oceanic and Atmospheric Administration, told Postmedia at the time.

One monitoring station located near the site of a display registered a 370-per-cent increase in fine particles.

Meanwhile, a study led by researchers from the University of Montreal took recorded PM2.5 concentrations as much as 1,000 times normal on single readings within the smoke plume.

Readings from monitoring stations set up at “breathing level” near the ground showed PM2.5 concentrations about 50 times normal levels during the display. Elevated concentrations of fine particles were detected as far away as 14 kilometres, suggesting the particles remain in the atmosphere for “a long period of time,” probably days.

With Postmedia files

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