#1 Assiduité (92.1%), #1 Lowest % ER visits (1.7%) in CIUSSS Centre-Ouest de L'île-de-Montreal (2023-2024)

ZIKA – 10 things you should know:

mosquito
1. Pregnant women and those planning a pregnancy should avoid travel to countries or areas in the United States (including South Florida and Texas) with reported mosquito-borne Zika virus.

2. All travellers should protect themselves from mosquito bites. Zika virus infection is caused by a virus which is primarily spread by the bite of an infected mosquito.

3. It can be transmitted from an infected pregnant woman to her developing fetus

4. Zika virus can be sexually transmitted, and the virus can persist for an extended period of time in the semen of infected males. Cases of sexual transmission from an infected male to his partner have been reported. Only one case of sexual transmission has been reported from an infected female to her partner.

5. Symptoms of Zika virus can include fever, headache, conjunctivitis (pink eye) and skin rash, along with joint and muscle pain. The illness is typically mild and lasts only a few days and the majority of those infected do not have symptoms.

6. Experts agree that Zika virus infection causes microcephaly (abnormally small head) in a developing fetus during pregnancy and Guillain-Barré Syndrome (a neurological disorder).

7. Zika virus has been reported in Canada in returned travellers from countries with ongoing Zika virus outbreaks.

8. For women planning a pregnancy, it is strongly recommended that you wait at least 2 months before trying to conceive if you just returned from a country with reported mosquito-borne Zika virus.

9. For male travelers, it is strongly recommended that you wait at least 6 months before trying to conceive if you just returned from a country with reported mosquito-borne Zika virus. If your partner is pregnant, it is strongly recommended that men consider using condoms or avoid having sex for the duration of the pregnancy.

10. It is strongly recommended that men consider using condoms or avoid having sex with any partner for 6 months if you just returned from a country with reported mosquito-borne Zika virus.

https://www.cdc.gov/zika/
https://travel.gc.ca/travelling/health-safety/travel-health-notices/152

map1

map2

Le Quinoa, option santé à essayer

Plante herbacée dans la famille des betteraves et des épinards, le quinoa
est riche en fer et en protéines, sans gluten et faible en matières grasses. Essayez-le dans vos salades comme choix santé pour relever vos repas pique-niques cet été!
Voici quelques recettes pour vous inspirer!

http://recettes-de-chefs.ca/genevieve-filion/salade-de-quinoa/

http://www.recettes.qc.ca/recette/salade-de-quinoa-avec-amandes-feta-et-legumes-d-ete-164691

https://www.ricardocuisine.com/recettes/6030-salade-de-quinoa-de-ricotta-d-epinards-et-d-oignons-rouges

http://www.troisfoisparjour.com/fr/web/trois-fois-par-jour/recettes/lunchs-salades/salade-de-quinoa-poulet-pois-chiches-brocoli-et-sauce-au-cari

The Next Frontier

With Grand Prix behind us, there is lots to look forward to in Montreal this summer. In honor of the upcoming Comiccon convention from July 08 to 10, 2016, it’s time to look forward to some exceptional .medical innovations on the not-so-distant horizon.

Qualcomm Tricorder XPrize moving forward

Winner of $10 million contest expected to be named in early 2017

By Mike Freeman | May 26, 2016 |

Tatiana Rypinski, a Johns Hopkins student, heads Team Aezon, which is one of seven contestants remaining in the $10 million Qualcomm Tricorder XPrize competition.

Now in its fifth year, the $10 million Qualcomm Tricorder XPrize competition — which aims to create a portable medical device akin to the fictional tricorder of Star Trek fame — is moving toward naming a winner in early 2017.

The ambitious milestones for teams trying to develop the tricorder have been eased a bit. Instead of being capable of diagnosing 16 conditions without the help of a physician as originally proposed, the tricorders now must diagnose 13 ailments.

And the number of remaining teams has dropped from 10 to seven. One team dropped out and two merged.

Now teams are refining and testing their tricorders in preparation for a preliminary evaluation slated at UC San Diego late this summer.

“What we are attempting to do is require teams to demonstrate to us a certain level of performance on their devices so that we can qualify them to come back at UCSD and enter the final phase,” said Grant Campany, senior director of the Tricorder XPrize.

The final evaluations — including tests with real patients and doctors — are expected to begin in September and continue into early next year. San Diegans who wish to volunteer can email xprize-ctri@ucsd.edu or call (858) 230-4339.

When it officially kicked off in early 2012, the Tricorder XPrize expected to name a winner early this year. But building a hand-held medical device that can continuously read five vital signs, diagnose conditions ranging from pneumonia to diabetes to urinary tract infection and still be easy to use for the layman has proven difficult.

“As with most XPrizes, we set the bar relatively high,” said Campany. “We like to say it is audacious yet achievable. We are trying to create a high hurdle because we want to see breakthroughs occur.”

UC San Diego built a regulatory/approval framework to pave the way for consumer testing of these experimental tricorders. That framework has been used by teams to conduct initial tests in their hometowns in preparation for this summer’s preliminary cut.

Team Final Frontier, for example, includes emergency room physician Basil Harris, who is getting feedback on the team’s device with patients in Pennsylvania, said Campany.

Team DMI of Boston, headed by physician Eugene Chan, has posters up at public transit stations to recruit volunteers, he added.

“I think we are all going to be pleasantly surprised at the improvements that these teams have made in their operating systems and how these devices operate without the interaction of a health care provider,” he said.

The Tricorder XPrize aims to push wireless medical technology into the mainstream. San Diego-based Qualcomm pledged the prize money. The company has long viewed mobile technology as key to cutting health care costs and improving results.

“When you look at the developing world, which has a shortage of doctors, how do you allow technology to step in and extend the reach of health care providers through these types of devices?” said Campany. “That is really what this is all about.”

In addition to Final Frontier and DMI, others teams are: Aezon, which is made up of undergraduate students from Johns Hopkins; CloudDX of Canada; Danvantri of India; Dynamical Biomarkers Group of Taiwan; and Scanadu/Intelesens from the U.S.

 

Further Cuts to Important Services

Please read this powerful article published on CBCNews Montreal about more vital services being cut in our neighborhood…

The Douglas Hospital has suspended a successful program to treat teenagers with serious mental health problems, saying it’s exploring more “cost-effective” options over the next year.

The treatment, called dialectical behavior therapy (DBT), helps patients cope with severe depression, suicidal thoughts, eating disorders and self-harming.

It also includes group therapy and invites parents in to learn how to support and talk to their child.

‘The years from hell’

Andrea, whose last name CBC has agreed to conceal to protect her child’s privacy, said her 16-year-old daughter was part of the last group to go through the program.

She’s devastated other families no longer have access to DBT at the Douglas, which she calls a “miracle” program that “gave us our daughter back.”

“How can the government do this?” asked Andrea. “How can you let these kids just flounder like that?”

Andrea describes 2013 to 2015 as “the years from hell.”

Andrea says the first signs of her daughter’s mental health struggles began in Grade 7, when she became moody and withdrawn, often difficult to coax out of her room. (CBC)

When her daughter Jessica started Grade 7, she became increasingly withdrawn – no longer spending time with her friends and losing interest in everything.

“She just wasn’t her,” said Andrea. “There was no spark in her.”

Jessica had always been a strong student, but her grades started to slip.

A mediocre mark on a test or a critical remark from a teacher could easily send her into a tailspin.

After one of a series of visits to the emergency room at the Montreal Children’s Hospital for suicidal thoughts in May, 2015, Jessica refused to go home.

“I didn’t think I’d be safe if I was at home,” said Jessica. “I did not feel I was strong enough to take care of myself in a way that I should.”

Jessica’s therapist suggested the dialectical behavior therapy program at the Douglas Hospital.

For the first six weeks, Jessica did one-on-one sessions, followed by 20 weeks of group therapy.

“You were in a room, surrounded by people who had things going on that were similar to you, who were feeling ways that you felt and would believe you if you said something,” said Jessica.

“They all understood.”

How DBT works

Together, the teens learn how to identify their triggers and break down potentially stressful situations into smaller steps.

Parents also attend the group sessions to learn new skills which they had to practise at home.

“They really teach you how to talk together again,” said Andrea. “So the bond that was kind of lost has been re-established. I feel we can talk to each other about everything and anything again.”

According to the regional health agency that now administers the Douglas Hospital, the DBT program has helped around 225 teens since 2001.

The Montreal West Island Integrated University Health and Social Services Centre (known by its French acronym CIUSSS de l’Ouest-de-l’Île-de-Montréal) says a decision was made early this year by the DBT team to “temporarily pause” the program for one year, starting last April.

This step was taken in order to “examine new emerging best practices and enhance services provided to the clientele.”

A spokesperson for the CIUSSS de l’Ouest-de-l’Île-de-Montréal refused an interview but said in an email that some DBT services are still available on an individual and family basis.

However, the group portion is “very costly and time intensive” and is no longer being offered. Doctors who usually referred patients to the program were told to hold off this year.

‘We see very significant changes’

One of those doctors, Dr. Lila Amirali, the chief of child psychiatry at the Montreal Children’s Hospital, said she believes the DBT program at the Douglas is the only one of its kind for English-speaking teenagers with severe mood disorders.

Amirali said the combination of individual, group and family therapy is powerful.

“We see very significant changes,” said Amirali.

She said many of the adolescents in the program can go through intense mood swings in the space of a day.

She said some may be the life of the party, then something will happen that will cause them to become very suicidal. The program helps them to learn to use their judgement to make calmer, more sound decisions when they are feeling upset, she said.

“They learn how to adapt better,” said Amirali.

The chief of psychiatry said she wasn’t given any reason for the program’s suspension, but she’s hopeful it will be reinstated next year.

She acknowledges that every hospital is carefully scrutinizing how it uses its resources nowadays.

‘We have her back’

Until the fall, Jessica is still being followed individually by a therapist from the program.

Next month, she’s heading to Philadelphia for a month-long arts program – something that was unthinkable a year ago.

“This year, I am so excited. All I can think about is, just a few more weeks, and I’ll be there,” said Jessica.

Andrea and her husband did pay for private therapy prior to Jessica being admitted to the DBT program, but say the program made a huge difference.

“We have her back,” said Andrea, who no longer worries about what’s happening behind her daughter’s closed door.

Andrea contacted her MNA to raise her concerns about the DBT program’s suspension but was told the same thing: The program is just being put on hold temporarily.

“When people say they put something on pause, it’s never really on pause,” said a skeptical Jessica.

“Chances are, now that this program isn’t happening anymore, it won’t happen again for a long time, which is just terrible because there’s going to be people struggling because of this.”

She and her mother feel they have a responsibility to try and get the program back for other teens who need it right now.

Andrea pleads with the government to reassess its priorities.

“Step up and help these kids,” she said.

http://www.cbc.ca/news/canada/montreal/douglas-dialectical-behaviour-therapy-suspended-1.3623104

Check-ups matter!

Inline image 1

Check-ups matter!

My 15 year old daughter is a skillful debater. We have lively discussions about politics, religion, school, and the Marvel Cinematic Universe. But when she wants to win the debate, she conjures up an obscure reference in a fictitious journal to prove her point – definitively. After all, who can dispute a prestigious scientific publication?

This week, the healthy check-up in Quebec fell victim to a “meta-analysis.“ Experts confidently announced that “medical science no longer recommends these types of exams.“ Even the Minister of Health challenged “What does an annual visit prevent? Nothing.”

Specifically, these experts were citing a 2012 analysis by Lasse T Krogsbøll of the Cochrane Collaboration. His analysis of sixteen randomized studies concluded that “general health checks are unlikely to be beneficial.”

Further words of reassurance were imported from the Maritimes where a media relations advisor for the Nova Scotia Department of Health and Wellness added ““We’re not aware of any concerns or issues since this change (eliminating the health annual check-up) took effect.“

And to allay any final concerns, the experts assured the public that when they “go to (the) doctors at any time for other reasons like an ankle injury or a bad chest infection, …a good doctor will use that opportunity to ask how things are going otherwise.“

With all this seemingly overwhelming scientific evidence condemning the relevance of the health check-up, why are we sad to see it go? Simply – because it shouldn`t.
We increasingly live in a world where human contact for the delivery of services is endangered – and it bothers us. Mail home delivery is threatened, bank branches are not profitable, established brick-and-mortar retail stores are restructuring. Seeing your doctor seemed immune – or at least it felt that it should be. Where else could a person go after accumulating a long “list“ of health problems full of fears, questions and concerns. Dr. Oz? Google? Just like the Crawleys in Downton Abbey, we all want a Dr. Carson to look out for and to look after us and our families. Someone who knows us, listens and cares.

The problem with scientific studies is that they are often misquoted and rarely read. The “definitive“ Cochrane review questioned whether general health checks in adults reduce morbidity and mortality from disease. It did not include geriatric trials. It did not study the value of the doctor-patient relationship. Most of the studies were not conducted in Canada, and according to the authors, “most of the trials were old, which makes the results less applicable to today`s settings because the treatments used for conditions and risk factors have changed.“

To be exact, nine of the fourteen studies included were conducted over thirty-five years ago. The most recent study was initiated twenty-five years ago. That`s like current Habs General Manager Marc Bergevin conducting the 2016 draft based on scouting reports from Sam Pollock and Irving Grundman in the 1970s and 1980s.

The Cochrane Review further qualifies its findings, commenting that “because the majority of the included studies were unblinded with considerable loss to follow-up, analysis of outcomes other than death and hospitalization may be subject to bias.“
Even the Canadian Task Force on the Periodic Health Examination from 1979, purportedly anti- check-up, recommended “ a specific strategy comprising a lifetime health care plan based on a set of age- and sex-related health protection packages.“ Maybe not annually, but more selectively.

Scientific meta-analyses are only as good as the data that is entered. There is lots of talk about the importance of Corsi scores in hockey, but as far as I can tell, neither the Pittsburgh Penguins nor the San Jose Sharks lead the NHL informatics race. Nevertheless, one of these two teams will be raise the Stanley Cup.

Interestingly, if experts are going to quote the merits of the Maritime experience, in which journal has this well-designed experiment been published?

In the end, we are quoting weak medical data from a generation ago, in another jurisdiction, with poor follow-up. None of these studies examine the essence of why general check-ups really matter. Seeing your family doctor on a routine basis fosters a trusting, lasting relationship. It does not exist to order tests; its existence provides comfort and security, knowledge and understanding. Health promotion is not a brochure or a pep-talk: it is a collaborative effort to live better. It is not a sprint, but a marathon.

Honestly, do “experts“ really expect family doctors to do a prostate exam because the patient conveniently limped in with an ankle sprain? Or discuss colorectal screening while the patient is febrile with a bad chest infection?

Air Canada (hopefully) does not wait for the airplane to make funny noises before checking it out. They don`t wait for one wing to fall off before checking the other. Routine maintenance is neither a luxury nor superfluous – it is common sense. Let`s not embrace a crisis-initiated medical model – but improve our efforts towards health promotion. Let`s design a system that rewards doctors for keeping healthy people healthy.

In the end, all the analysis to devalue the annual check-up simply cannot compete with the primal benefit of nurturing a meaningful, trusting, patient-physician relationship. Studies, even “scientific“ ones, need to be understood and properly applied.

Consider the 2003 systemic review of parachute use to prevent death and major trauma related to gravitational challenge published in the prestigious British Medical Journal. Despite a rigorous review, the authors “were unable to identify any randomised controlled trials of parachute intervention.“ As such, they concluded, “the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.”

Please use a parachute – and please continue to see your family physician for general check-ups.

The Case FOR the Annual Check-Up

Blink and it will be gone. Make no mistake about it: the “Annual Check-up,“ once the pillar of our preventative health care system, is on the verge of becoming obsolete – or `medically “insignificant“.

Already, the Annual Health Exam has been de-listed in several provinces:
British Columbia, Nova Scotia, New Brunswick, and Newfoundland and Labrador no longer cover annual physicals in patients without symptoms of illness. Ontario offers “personalized health reviews” in which the doctor focuses on the health risks specific to the patient and the patient’s age.
If you live in Alberta, Manitoba, Saskatchewan, Quebec, Prince Edward Island, and the Northwest Territories – appreciate the Check-up while it lasts.
Calls to eliminate the annual physical examination are not new. In 1979, the Canadian Task Force on the Periodic Health Examination recommended “that the annual checkup, as practiced almost ritualistically for several decades in North America, be abandoned.”
In 2013, the Choosing Wisely campaign (see poster below) recommended against annual preventive examinations in asymptomatic patients.
Despite these calls, many people still want an annual physical. Not surprisingly, surveys show that the majority of both patients and physicians remain strong proponents of the annual check-up.
Ironically, while experts are divided on whether there is a benefit to getting an annual exam, the federal Affordable Care Act (ie. Obamacare in the United States) requires insurers to cover annual physicals free of charge.
So, what exactly is the controversy? Simply, some research has demonstrated that regular physicals do not reduce rates of illness or mortality. At best, the researchers suggest that these exams are an egregious waste of health-care resources, and at worse, they are dangerous by promoting “superfluous,“ expensive testing.
The research most frequently cited against the annual physical is a 2012 analysis of 16 trials by the Cochrane Collaboration. This study concluded that “physicals“ do not reduce mortality or illness. Critics point out that the trials excluded elderly patients and were predominantly performed in Europe, where most patients were already regularly seeing doctors. In other words, do these results really reflect our reality in Canada?
In more detail, the Cochrane review included 16 trials and 182,880 participants. While the authors concluded that they did not find an effect on clinical events or other measures of morbidity, one trial found an increased occurrence of hypertension and hypercholesterolemia with screening and another trial found an increased occurrence of self-reported chronic disease. One trial found a 20% increase in the total number of new diagnoses per participant over six years compared to the control group. Two trials found an increased number of people using antihypertensive drugs, and another two trials found small beneficial effects on self-reported health. The authors also comment, “we did not find an effect on admission to hospital, disability, worry, additional visits to the physician, or absence from work, but most of these outcomes were poorly studied.“ Of note, two additional studies were excluded from the analysis.
In the end, the author`s concluded, “General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased. Important harmful outcomes, such as the number of follow-up diagnostic procedures or short term psychological effects, were often not studied or reported and many trials had methodological problems. With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial.“
Why did the author`s conclude that the General Health Check, or Annual Check-up, were “unlikely to be beneficial?“
The authors suggest:
1. “One reason for the apparent lack of effect may be that primary care physicians already identify and intervene when they suspect a patient to be at high risk of developing disease when they see them for other reasons.
2. Also, those at high risk of developing disease may not attend general health checks when invited.
3. Most of the trials were old, which makes the results less applicable to today’s settings because the treatments used for conditions and risk factors have changed.“

I have included a few clippings from news organizations on this heated topic (see below). But I was amused by the “observations“ of the following physician to the Wall Street Journal article:
Observations as a physician:
1. Nothing ultimately improves mortality since everybody dies. Unfortunate fact overlooked in medical trials.
2. Ironic that presumed liberals (Ivy League affiliated) want universal healthcare but don’t want patients to be seen.
3. If they don’t come in yearly, how else will I be able to nag them every year to quit smoking and tell them that they’re too fat?
4. Hypertension: the “silent” killer because often there are no symptoms until a stroke or heart attack. But don’t see me unless you have symptoms.

In the end, I am reminded of Malcolm Gladwell`s brilliant bestseller “Blink.“ Sometimes we simply overthink the obvious. We become all-consumed with the analysis that we ignore the simplicity in front of us. Annual check-ups, like everything, need to evolve. Preventative medicine should be personalized – but it needs to be planned. Air Canada (hopefully) does not wait for the airplane to make funny noises before checking it out. Routine maintenance is neither a luxury nor superfluous – it is common sense.
We cannot and should not base care or conclusions on old studies that are “less applicable to today`s settings.“ We should make recommendations on well-designed, up-to-date studies that reflect our current health care needs.
Why do the majority of patients and physicians remain strong proponents of the annual check-up? Because it feels right. All the analysis to devalue the annual check-up simply cannot compete with the primal benefit of nurturing a meaningful, trusting, patient-physician relationship. For my part, I certainly hope the annual check-up lives on.