US schools adopt healthier policies: More schools in the United States are promoting healthy food and requiring more physical activity than just 12 years ago, according to the US Centers for Disease Control and Prevention’s School Health Policies and Practices Study. The study is the most comprehensive survey to assess school health policies in the US. More districts now require elementary schools to teach physical education, up from 82.6% in 2000 to 93.6% in 2012. In 2000, 35.3% of districts gave families nutrition information. In 2012, this figure rose to 52.7%. In addition, almost half of schools now prohibit junk food in vending machines on grounds. Districts have also made gains in prohibiting smoking by students, staff and visitors during school-related activities, teaching violence prevention and improving air quality through measures such as prohibiting school buses from idling. — Catherine Cross, CMAJ
Birth control recall: Two lots of the birth control pill Freya-28 are being recalled after a pharmacy reported finding a placebo pill in the place of an active pill. The pill’s distributor, Mylan Pharmaceuticals, issued a voluntary recall through Health Canada Aug. 27. Each pack should contain three rows of seven active (white) pills and one row of seven placebo (green) pills. The recall is reminiscent of a much larger one in April, when distributor Apotex Inc. recalled 12 lots of the birth control pill Alysena 28 because some had two rows of placebo pills instead of one. — Catherine Cross, CMAJ
Quebec girls to get one less shot: Beginning this fall, Quebec girls who received two doses of the human papillomavirus (HPV) vaccine when age 9 or 10 will no longer receive the manufacturer-recommended third dose. As evidence, the Quebec government cited a multicentre Canadian study published in the Journal of the American Medical Association. However, that study actually calls for more data on the duration of protection before recommending reduced-dose schedules. The government also cited research conducted in Quebec indicating that two doses are sufficient when administered to girls before they reach puberty. Quebec’s new policy applies only to girls who got their first two doses in Grade 4. The province will continue to give older teens and young women the three-dose regimen. Quebec vaccinates against HPV earlier than other provinces and territories. According to the committee who recommended this change, dropping the third dose will save the province $3 million annually. “Studies are being conducted around the world to evaluate long-term protection, Quebec’s government states on its website. “If necessary, a booster dose will be given later to prolong protection.” — Catherine Cross, CMAJ
Medication errors in Ontario hospitals: Thirty-six patients in Ontario hospitals experienced severe health problems due to medication errors between October 2011 and December 2012. Of these 36 patients, 10 died, reports the Institute for Safe Medication Practices Canada, a nonprofit organization promoting medication safety, in a report for the Ontario government. The remaining 26 patients had severe adverse events leading to longer hospital stays and, for some, disability. Beginning in October 2011, Ontario’s Ministry of Health and Long-Term Care requires that hospitals report any serious incidents involving medications or intravenous fluids to the Canadian Institute for Health Information. In most of the reported incidents, patients received too much of a drug, received a drug too frequently or received the wrong drug altogether. Opioids, heparin, norepinephrine and oxytocin were the most common medications contributing to severe harm or death. The report lists miscommunication, drug product confusion and distractions or frequent interruptions as the top three factors contributing to the medication errors. — Catherine Cross, CMAJ
Canadian doctor jailed in Egypt: Egyptian authorities held a Thursday Aug. 29, hearing for two Canadians, emergency department physician Dr. Tarek Loubani and filmmaker John Greyson, imprisoned in the country. Family and friends of the men, who were arrested Aug. 16, when visiting a Cairo police station to ask for directions, say lawyers are “optimistic” about their case. Egyptian officials have given no clear reason for the arrest. Cairo district prosecution recently stated that nine foreigners, including Loubani and Greyson, are being detained for 15 days pending investigations. Under Egyptian legal procedures, that detention period may also be renewed before charges are laid. More than 76 000 people have signed a petition asking Canadian officials to “urgently assist in securing the immediate safety and release” of Loubani and Greyson. Some 60 individuals and organizations, including the Canadian Medical Association and World Medical Association, have also issued statements urging action. Canada’s Ministry of Foreign Affairs called on Egyptian authorities to release all evidence against Loubani and Greyson, but family and friends say they believe “it will take ongoing public outcry in order to force the Canadian and Egyptian Governments to find a resolution.” Canadian consular staff, a doctor and lawyer were able to meet for 30 minutes with Loubani and Greyson, and report they are “in good health and good spirits.” However, the prison where the Canadians are being held is “heavily overcrowded,” and the two have been kept inside during their incarceration “due to safety concerns with the instability in Cairo.” Loubani and Greyson were en route to work on an academic and medical collaboration between Western University in London, Ontario, and Gaza’s al-Shifa hospital. — Lauren Vogel, CMAJ
Lyme disease underreported: Lyme disease cases may be far more common in the United States than previously reported, the Centers for Disease Control and Prevention (CDC) report. The tick-borne disease likely affects some 300 000 Americans annually, 10 times the number of cases documented each year, the agency stated. The new estimate supports the findings of studies published in the 1990s and indicates that the actual number of cases is 3–12 times higher than the number reported. Most reported cases of Lyme disease are concentrated in the Northeast and upper Midwest of the US; 96% of cases occurred in 13 states. Symptoms include fever, headache, fatigue and a characteristic skin rash called erythema migrans. If left untreated, infection can affect joints, the heart and nervous system. “This new preliminary estimate confirms that Lyme disease is a tremendous public health problem in the United States, and clearly highlights the urgent need for prevention,” Dr. Paul Mead, chief of epidemiology and surveillance for CDC’s Lyme disease program, said in a news release. The CDC recommends that individuals prevent Lyme disease by wearing repellent, checking for ticks daily and showering after being outdoors. The agency is also calling for a broader, community approach to tick reduction, suggesting that individual measures may not be sufficient to combat the problem. — Lauren Vogel, CMAJ
Obesity rates stable: Adult obesity rates in the United States remained stable last year after three decades of increases, according to a report by the Trust for America’s Health and the Robert Wood Johnson Foundation. This may indicate that prevention efforts are starting to yield results, the report states. The rate of increase in obesity across the country has been slowing since 2005; that year obesity rates went up in every state but one. In 2008, 37 states reported increases, but by 2011 that was down to 16. Despite the progress, obesity rates remain “extremely high,” Jeffrey Levi, the trust’s executive director, said in the release. “Even if the nation holds steady at the current rates, baby boomers — who are aging into obesity related illnesses — and the rapidly rising numbers of extremely obese Americans are already translating into a cost crisis for the health care system.” Thirteen states now have adult obesity rates above 30%, and all have rates above 20%, according to the report. In 1980, no state had a rate above 15%. Obesity rates varied significantly by age, education, income and region, with baby boomers, high school dropouts and people earning less than $25 000 a year, and those living in the South or Midwest experiencing disproportionately high rates. The report recommends several obesity-reduction strategies, including providing only healthy food in schools, limiting food and beverage marketing to children and improving urban planning to encourage walking and biking. — Lauren Vogel, CMAJ
Satellite images can predict cholera outbreaks: Scientists can use satellite images of water to predict the severity of seasonal cholera outbreaks, according to researchers from Tufts University School of Engineering in Massachusetts. Most cholera epidemics originate in coastal areas, where cholera bacteria attach to phytoplankton and zooplankton. The researchers used satellite images of water in the Bengal delta, and wavelength measurements of the water’s colour to estimate the presence of organic matter in the water. Blue water indicates low levels of impurities, while green water contains lots of plankton. The scientists then correlated this information with cholera incidence in the area. They found that this technique can predict the severity of a cholera outbreak months ahead of the actual outbreak, which allows time for early interventions. At present, scientists use an algorithm that measures chlorophyll levels as a proxy for plankton. The researchers suggest that their method is more accurate because it measures a broader range of organic matter in the water. — Catherine Cross, CMAJ