Retooling the health care system

Thérèse Stukel and David Henry, Toronto Star

As Canadians, we take justifiable pride in our health-care system with its long record of equitable coverage for most important services. If you become acutely ill and you live close to a major centre you will receive care that is as good as anywhere in the world.

But how good is our health care overall compared with the rest of the world?

In 2010, the New York-based Commonwealth Fund surveyfound that Canada ranked near the bottom in a seven-country comparison of several measures, including access, safety, equity and efficiency. A recent report in the Lancet compared burden-of-disease statistics in 19 OECD countries. In terms of life expectancy at birth, and years of life lost, Canada slipped from second to seventh and from fourth to 10th position, respectively, between 1990 and 2010, although all measures improved over time.

So what is the cause of Canada’s uncompetitive performance in health and health care and should it make us reconsider the way that we deliver services?

One major challenge is co-ordinating the care of chronic disease. Heart disease, stroke, chronic obstructive pulmonary disease and diabetes are leading causes of death in Canada. They affect more than one in three Canadians, have a major effect on health and quality of life and account for more than half of provincial health-care spending. However, the current structure and payment system, with heavy investment in hospitals, is designed for acute episodic care and copes poorly with the needs of chronic disease patients.

Fragmentation and poor co-ordination result in serious gaps in quality of care. Chronic disease management programs require a multidisciplinary approach designed to encourage adherence to medications and lifestyle changes, and promote patient self-management. Such programs can reduce complications, avoid costly readmissions to the hospital, and improve survival and quality of life.

To read the full article:  http://www.thestar.com/opinion/commentary/2013/05/14/retooling_the_healthcare_system.html

Food Safety – Part Two: Preventing Contamination

By Gail Packwood

Age tends to weaken our immune system, making us more susceptible to infections of all kinds.  Something that would not have likely been a concern to us in our youth, can make us seriously ill in our later years.  Because of this, we need to be extra vigilant and take precautions that we may have considered to be unnecessary or overly cautious in the past.

Food preparation, handling and storage are all areas where we may have cut corners when hurrying to get a meal on the table, but these are all key to preventing the spread of bacteria that can lead to very serious illness.

The most common bacteria found include the following:

E-coli – this bacteria is found in raw or under-cooked meat, sprouts and unpasteurized dairy

Salmonella – this is an infection caused by bacteria in raw and under-cooked chicken, raw eggs and milk

Listeria – is a bacteria that may be found in ready to eat foods (cold cuts, dairy and hot dogs for instance).  Many health care providers recommend that the elderly or those with pre-existing conditions that weaken the immune system avoid eating cold cuts altogether to avoid this risk.

There are simple ways to lower your risk of exposure to these bacteria and infections.

Ensure that all meat and poultry is cooked thoroughly to a safe internal temperature.  It is a good idea to invest in a meat thermometer so you can really be sure that everything is properly cooked all the way through.  You can buy these inexpensively at most kitchen supply and department stores – sometimes they are referred to as turkey thermometers as people often think they only need to use them when cooking a full turkey.  It is recommended that all raw beef, pork, lamb and veal be cooked to an internal temperature of 145F.  For ground beef (or any other ground meat) 160F is recommended.  For all poultry, an internal temperature of 165F is recommended.  Please note, the internal temperature is not a reflection on the temperature of the overall oven.

It is also important to not spread the fluids from the meat packaging onto counter tops, cutting boards and other food preparation areas.  Be very careful when disposing of all wrap and packaging that your food comes in.

Clean all surfaces and utensils thoroughly using hot water and soap or a cleaning agent. And wash your hands thoroughly and often, particularly after handling any raw foods.

Remember to always refrigerate leftovers and to help prevent cross-contamination of foods, separate raw meat and eggs from cooked meat, fruit and vegetables.  Do not store them in the same container.

There are 11 million cases of food poisoning in Canada each year and they range in severity from a slight stomach upset to requiring hospitalization.  Some signs of food poisoning are vomiting, stomach cramps, nausea and diarrhea.  If you have these symptoms please consult with your health care provider.

Age increases our risk of dehydration and can lead to more serious side effects when trying to ward off infection.  For further information, please see the Health Canada website:  www.hc-sc.gc.ca

Food Safety for Older Adults – Part One: Choking

By Gail Packwood

Studies show that after infancy, the highest risk of choking occurs in those aged 65 to 85 years of age.

As we get older, many of us suffer from a reduction in saliva production.  Many medications also cause a condition called “dry mouth”, as they impede saliva and leave you with a constantly dry mouth.  Without saliva it is harder to eat and digest food.  Also, because of this unpleasant condition, many older adults are inclined to suck on hard candies to stimulate saliva.  These candies pose a significant choking hazard.

Other medical conditions including loose teeth and ill-fitting dentures may make it difficult, painful or uncomfortable to chew food.  Improperly chewed food and food swallowed whole may pose a choking risk.

Often we do not take adequate time to eat and rush our meals.  This is equally true in long term care facilities and nursing homes where limited staffing may not allow enough time for each resident to eat at a slower, healthier, pace.  If we do not take the time to cut up our food into smaller pieces and do not chew each piece adequately, we are putting ourselves at risk of choking.

Some food poses a great risk than others.  Here are some key foods to avoid:

• Popcorn
• Hard candy
• Chicken with bones
• White bread (when it gets moist it expands and can block airways)
• Peanut butter
• Crackers and other dry foods
• Hot dogs (the outer skin is a choking hazard)

Interestingly, water can also be a risk because it is such a thin liquid, it can be choked on.  Be sure to take only small sips at a time.

Some basic do’s and don’ts for eating to reduce the risk of choking include:

Do:

• Cut your food into small pieces.
• Eat slowly!  Chew carefully.

Don’t:

• Do not talk while you are eating.
• Do not eat lying down.  Be sure to always be sitting upright, preferably in a chair.
• Do not drink while you are eating.  People think drinking and eating will help “wash” the food down.  This actually increases your choking risk!

Following some basic common sense tips can significantly reduce your risk of choking.  Take the time you need for each meal and enjoy it safely!

For more information, see the Health Canada website www.hc-sc.gc.ca

Heart attacks and strokes not enough to motivate healthy changes, study says

Karissa Donkin, Toronto Star

What does it take to make people live a healthier lifestyle? New research suggests even major medical issues might not be enough.

A study led by Koon Teo, chief of cardiology service at McMaster University Medical Centre, shows that most people who have had a stroke or a coronary heart disease event, such as a heart attack, don’t have a healthy diet.

More than 7,500 people, from 17 countries and various income levels, were surveyed. Each person had a heart attack or stroke about five years before participating. Out of those people, only 39 per cent had a healthy diet.

Even fewer — about 35 per cent — participated in a high level of physical activity, while 18.5 per cent kept smoking after their heart attack or stroke.

The findings didn’t surprise obesity expert Yoni Freedhoff, who helps patients change their lifestyles in his Ottawa weight management clinic. He sees the same behaviour every day.

“They’ll come here because they’ve had a life scare, whether it’s a new diagnosis of diabetes or heart disease. You can see that there’s this initial honeymoon period where they’re really keen.

“(But) people grow accustomed to their diagnoses. What was once really motivating and scary in a fairly short order becomes commonplace.”

Another factor is that directly after the incident, people who’ve just had a heart attack or stroke will also find themselves depressed or anxious after getting a wake-up call about their own mortality.

To read the full article:  http://www.thestar.com/life/health_wellness/diseases_cures/2013/04/23/heart_attacks_and_strokes_not_enough_to_motivate_healthy_changes_study_says.html