Does Your Child Consume Too Much Caffeine?

Many of our kids are “hooked” on energy drinks and soft drinks. Do you know the amount of caffeine in some 500 mL energy drink is equal to caffeine in 10 cans of cola? And we allow our children to drink that.

On October 19, an editorial – “Caffeinating” children and youth – in the Canadian Medical Association Journal (CMAJ) says, “Owing to inadequate labelling requirements, a lack of awareness of caffeine’s harmful effects and marketing campaigns that appeal to children and youth, this is precisely what we are unwittingly allowing in Canada and elsewhere.”

The editorial says that the energy drinks are very effective high-concentration caffeine delivery systems. These sugar-loaded syrups typically contain 80 to 140 mg of caffeine per 250 mL – the equivalent caffeine in one cup of coffee or two cans of cola.

Children who are looking for more caffeine go for drinks which have caffeine concentrations as high as 500 mg per can in US products such as Wired X505TM and FixxTM. Caffeine can also be purchased in 100- and 200-mg tablets in Canada and the United States.

“However, even tablets with two and one-half to five times less caffeine have mandatory health warnings guarding against use in children and cautions to limit use because too much caffeine may cause nervousness, irritability, sleeplessness and occasionally, rapid heart rate,” says the CMAJ editorial.

The question is: Caffeine-loaded energy drinks – are they beverages or drugs delivered as tasty syrups?

Health Canada has to do a better job of regulating products heavily loaded with caffeine. The food labels should clearly say how much caffeine is in the product. These labels should be easily understood by the general public – content of caffeine equivalent in terms of cups of coffee.

Can you compare energy drinks marketed towards youth and consumption of coffee by adults? For example, a 16-oz “grande” coffee at Starbucks contains 330 mg of caffeine. That is lot of caffeine. The editorial says, “Children and youth are notorious for making poor health choices. They can hardly be expected to make appropriate decisions about consuming energy drinks when information on caffeine concentration and appropriate safe amounts is not visible on these products.”

Adolescents and college students often mix energy drinks with alcohol. This is dangerous Studies have shown that the high levels of caffeine can mask the perception – but not the consequences – of acute alcohol intoxication.  

In a survey, college students who mixed alcohol with energy drinks were three times more likely to leave a bar highly intoxicated and four times more likely to drive while intoxicated than bar patrons who did not mix alcohol with energy drinks or drank them separately, says the CMAJ article.

A study of 100 US adolescents aged 12 to 18 found that 73 per cent consumed 100 mg or more of caffeine per day, with most consumption in the evening, the time of day most likely to negatively affect sleep. Poor sleep quality and quantity in adolescents has been associated with mood disorders, exacerbation of asthma, obesity, lower sense of well-being and poor school performance.

CMAJ is asking regulatory authorities such as Health Canada to step in. Regulations could include government-mandated restrictions on labelling, sales and marketing, or self-imposed industry-wide standards with clear labelling accompanied by public education.

Until 2008, France did not even allow the sale of Red BullTM, and in Denmark, sale was prohibited as of 2009. At a minimum, all products with caffeine levels exceeding 100 mg should have labels and advertising that carry warnings comparable to those required for caffeine tablets. There should be no advertising targeting children.  We should invest in public education focused on the health consequences of caffeine in children.

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Bloodthirsty Bedbugs Have Returned

“They’re back, and they’re bloodthirsty. Bedbugs, not too long ago little more than a riff in a nursery rhyme, have returned with a vengeance in the United States and around the world,” says an article in the Canadian Medical Association Journal (CMAJ).

And the problem only promises to get worse before it gets better, says the article. An expert on bedbugs from Virginia is quoted as saying, “Our ability to stop the spread is absolutely nonexistent.” No corner of the US has been spared, and the situation is similar in Canada.

The problem in big cities is worse than rural areas. It’s a pandemic – a disease prevalent throughout the entire country, continent or the whole world. It is an epidemic over a large area.

Why are the government policy-makers, local officials, businesses, landlords and private homeowners all struggling to respond to apple-seed-sized insects?

When we had DDT (dichlorodiphenyltrichloroethane) – now banned – bedbugs were largely eradicated. Now the bedbugs have become resistant to most of the insecticides we have in the market. They have demonstrated an extraordinary ability to multiply in spite of everything we have done to get rid of them.

Where would you find the bugs?

As the name implies, you will find them on your beds. You may find them in chairs, sofas, electrical outlets, baseboards and crevices at homes, apartments, hotels, hospitals, college dorms, offices, movie theatres, high-end stores and more, says the CMAJ article. Bedbugs hide during the day and they emerge at night to feed. Only in cases of severe infestation are they found crawling on individuals or in their clothing during the day.

How do they get around?

The common bedbug (Cimex lectularius) is a wingless, red-brown, blood-sucking insect that grows to an adult length of 5 – 6 mm. Bedbugs do not fly. They get around by crawling or hitching a ride on people’s clothing or shoes, bedding, luggage, handbags and furniture.

Are they dangerous?

No, they do not cause or transmit any disease. They feed on human blood with a painless bite, often delivered when people are asleep. The bites can leave itchy, bloody welts. They can cause skin rashes and allergic symptoms, as well as psychological effects like exasperation and irritation. Bedbug bites, however, should be considered a possible cause of chronic blood loss and iron-deficiency anemia in people who have signs of bedbug infestation.

Treatment of the bites typically involves symptomatic use of antihistamines and corticosteroids. Getting rid of bedbugs is hugely difficult. Methods include insecticides, heat, steam, freezing and vacuuming, but can take time and be very costly.

The Environmental Protection Agency held its first “bedbug summit” in 2009 and is participating in a US government task force trying to educate the public and develop better eradication options, says the CMAJ article.

Travellers should take steps like carefully inspecting their hotel room and checking clothing and luggage after a trip. Sleep well. Don’t let the bedbugs bite you.

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Early Seasonal Influenza Vaccinations may Prevent First Heart Attack

Scientists have observed increased incidence of heart attacks (acute myocardial infarction) and stroke during the winter months. The exact reason why this happens is not completely known. But it has been thought that it is due to cold weather or due to metabolic activity in the body or due to infection such as respiratory infection.

It has also been observed that significant increases in acute heart attacks occur during peak winter incidence of pneumonia and influenza, particularly during years dominated by epidemic of influenza A. So it is surmised that this association supports the notion that the increase heart attacks during winter months is caused by influenza rather than cold weather.

 Why? The favoured hypothesis is that infection triggers atherosclerotic (the stuff that clogs the arteries) plaque to rupture and cause heart attack.

A study done in the U.K., using large database of general practice patients, found that heart attacks occurred less frequently in people who had had a recent influenza vaccination than in those who had not. But the same could not be said for pneumococcal vaccination.

If influenza vaccination does have the added benefit of reducing heart attacks, then it may be important to vaccinate early in the season. 

Other studies have shown influenza vaccination within the past year was associated with a 19 per cent reduction in the rate of acute heart attack among patients aged 40 years and over. Influenza vaccination administered within influenza season was also associated with a significant reduction (20 per cent) in the rate of acute heart attack.

Similar findings by other researchers reinforce current recommendations for annual influenza vaccination of target groups, with a potential added benefit for prevention of acute heart attack and stroke in those without established cardiovascular disease. 

So, how are we doing with our annual influenza vaccination programs? Which one is better – targeted high risk groups or universal vaccination program?

In 2007, Statistics Canada said that despite increases in influenza vaccination rates across the country, the rates for high-risk groups are falling short of national targets.

Ontario, which since 2000 has provided free flu shots for residents aged six months and older, led the provinces, with vaccination rates rising from 18 per cent to 42 per cent between 1996/97 and 2005. Newfoundland and Labrador, with a 22 per cent rate in 2005, ranked lowest. Nationally, the rates of influenza immunization increased to 34 per cent in 2005.

In 1993, a national consensus conference on influenza set target vaccination coverage rates of 70 per cent for adults aged 65 or older and for all adults with chronic medical conditions. These targets were raised to 80 per cent in 2005.

An article published in 2003, compared Alberta’s regional coverage rates of influenza vaccination among Alberta seniors during the period April 1, 1999 to March 31, 2001. The rates of immunization in the health regions varied from 30 per cent to 80 per cent (mean 70 per cent).

Their conclusion was that some parts of Alberta can do better. Under-utilization of preventive influenza vaccination in Alberta seniors is associated with increased utilization of health services for community-acquired pneumonia. The per capita vaccination cost (about 10 dollars) was small in relationship to the per capita cost of hospital care for pneumonia (about 100 dollars).

There is no doubt that in the elderly, vaccination against influenza is associated with reductions in the risk of hospitalization for heart disease, cerebrovascular disease and pneumonia or influenza. The vaccination also reduces the risk of death from all causes during influenza seasons. So, get yourself immunized today.

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New CPR Guidelines Make Resuscitation Technique Easy to Save a Life

It has been 50 years since the introduction of closed chest compression and mouth-to-mouth rescue breathing as the techniques of modern cardiopulmonary resuscitation (CPR). The technique is simple and it has saved many lives of victims of cardiac arrest.

As we know, CPR is an emergency procedure involving chest compressions (pressing down on the chest) and artificial respiration (rescue breathing). It has the power to restore blood flow to someone suffering cardiac arrest, keeping them alive until an ambulance arrives.

The guidelines are reviewed every five years and updated only when evidence is clear that changes will improve survival rates. Over the years it has become clear that high quality chest compressions is vital to proper resuscitation technique.

It is also evident that many people are reluctant to provide mouth-to-mouth resuscitation due to hygienic reasons. The Heart and Stroke Foundation of Canada survey finds that only 40 per cent of Canadians trained in CPR would try to revive someone who has had a cardiac arrest. 

So, it was time for change. The Heart and Stroke Foundation of Canada is co-author of the 2010 Guidelines for CPR and Emergency Cardiovascular Care (ECC) in North America. The Foundation is actively involved in resuscitation science, education and training (http://www.heartandstroke.com). 

Experts looked at all the evidence to see if the technique can be simplified so we can save more lives. The 2010 guidelines are based on input from 356 resuscitation experts from 29 countries.

As indicated earlier, most victims of out-of-hospital cardiac arrest do not receive any bystander CPR. Why? There are probably many reasons for this, but one impediment may be the A-B-C (Airway, Breathing, Chest compressions) sequence, which starts with the procedures that rescuers find most difficult, namely, opening the airway and delivering breaths. Starting with chest compressions might encourage more rescuers to begin CPR.

So, the new guideline has changed the sequence from A-B-C to C-A-B (Chest compressions, Airway, Breathing) for adults, children, and infants (excluding the newly born). Here are some important points from the new guidelines (2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science):

-A chest compression rate of at least 100/min (a change from “approximately” 100/min)
-A chest compression depth of at least 2 inches (5 cm) in adults and a compression depth of at least one third of the anterior-posterior diameter of the chest in infants and children.

-Allow for complete chest recoil after each chest compression
-Minimize interruptions in chest compressions
-Avoid excessive ventilation. There is no change in the recommendation for a compression-to-ventilation ratio of 30:2 for single rescuers of adults, children, and infants

If you are the only person to witness a cardiac arrest, at home or on a street, then start with chest compressions and call for help. If there are two or more rescuers around then one rescuer immediately initiates chest compressions while another rescuer gets an automated external defibrillator (AED), if available, and calls for help. A third rescuer opens the airway and provides ventilations.

Once the heart stops pumping, seconds count. For every minute that passes without help, a person’s chance of surviving drops by about 10 per cent. But if you know how to respond to a cardiac arrest, a person’s odds of survival and recovery may increase by 30 per cent or more.

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