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Canada has among the highest rates of inflammatory bowel disease in the world — and no one knows exactly why

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When Dr. David Mack began work at CHEO in 2001, the hospital was treating 90 children and youth with inflammatory bowel disease. Just over 20 years later, that number has jumped to 400 young patients and it continues to grow.

As director of CHEO’s IBD Centre and a professor at the University of Ottawa’s faculty of medicine, Mack is on the frontlines of the alarming rise in inflammatory bowel disease among Canadian children. Like others, he is calling on governments to provide more support for the physical and mental health needs that come with the chronic illness that will follow the patients throughout their lives.

Mack compares IBD to insulin-dependent diabetes. “Crohn’s disease and ulcerative colitis are also incurable and life-long conditions,” he said. “Medical treatments are used to both get them under control and to maintain control of the underlying disease condition.”

Canada has among the highest rates of IBD in the world for reasons that are not fully understood.

A report released by Crohn’s and Colitis Canada this week offers a sobering look at the growth in cases of IBD among all age groups across the country. The organization releases an impact report every five years on IBD, which includes Crohn’s disease and ulcerative colitis.

The report found that the number of people in Canada with IBD is increasing rapidly. There are currently 322,600 people, or 0.8 per cent of the population, up from 270,000 in 2018.

By 2035, the report predicts 470,000 Canadians will have been diagnosed with IBD, 1.1 per cent of the population.

One person in Canada is diagnosed every 48 minutes, according to the report.

Older Canadians, as a group, represent the fastest growth in cases of IBD in Canada as treatments improve and people live longer with the disease.

But the rapid growth in cases among children presents special concerns.

New diagnoses are rising the most rapidly in children under the age of six. Children tend to have more extensive disease and higher rates of acute severe colitis. They are also at risk for growth delay, puberty delay and bone development deficits.

Crucially, children diagnosed with IBD also have significantly higher rates of anxiety and depression, and treatment options are more limited than for adults.

Although there are growing numbers of treatments for IBD approved by Health Canada, most have not been tested on children and must be used off-label by pediatric IBD specialists.

In Ontario, some of those specialists, including CHEO’s Mack, are pressing the province to invest more money in treatment and care of children with IBD.

“In the pediatric field needs are not one-size-fits-all,” he said. “Certain conditions are seeing massive increases and are going to need some special funding over and above a general increase.”

Increased mental health supports are needed for youth being diagnosed and treated for IBD, he added, as children have double the risk of mental health impacts, including anxiety and depression. “It is tough on the patients and their parents. We have to get appropriate resources.”

Dr. Eric Benchimol, the report’s co-chair and a professor of pediatrics and clinical epidemiology at the University of Toronto, said underfunding has meant many children diagnosed with IBD don’t have the mental health care they need.

“The value of having a mental health care provider involved in the care of these kids is massive. It is one of the things that has been lacking.”

CHEO’s clinic has a social worker, he said. SickKids in Toronto, where Benchimol is based, has a psychologist as part of its IBD clinic, but their salary is paid through donor funding.

He said the special needs of children and growing numbers of Canadians with IBD requires new approaches, including more interdisciplinary care for children and the addition of some virtual care for adult patients.

“We can’t keep doing what we are doing. The number of patients is overwhelming gastroenterologists.”

Canada has among the highest rates of IBD in the world and is only second to Norway when it comes to pediatric rates of diagnosis.

Treatment options continue to grow, but there is no cure and no prevention.

Many researchers are focused on looking at risk factors with a view to reducing cases.

“The reality is that the prevalence will continue to increase until we change peoples’ risk,” Benchimol said.

Although the exact cause of IBD remains unknown, genetics, the environment and microbiome are among risk factors.

The autoimmune diseases cause inflammation, ulcers and bleeding in the bowel that can extend to other parts of the body.

 

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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