Public Health 2014 health spending smallest in 17 years: report The cost of health care in Canada will go up this year, but the increase is expected to be the smallest in 17 years, a new report suggested. The report on healthcare spending in Canada estimates that total health expenditures will rise by only 2.1 per cent, or $61 more per person compared to last year’s health costs. Spending on drugs has flattened out, and concerns about the health cost of an aging population aren’t currently driving costs up in a significant way, said the report from the Canadian Institute for Health Information. At this point, population aging is only increasing costs by just under one per cent per year. The trend is expected to change incrementally over the next two decades. “While concerns regarding demographics are understandable – Canadians over the age of 65 account for less than 15 per cent of the population but consume more than 45 per cent of provinces’ and territories’ health-care dollars – the share of public-sector health dollars spent on Canadian seniors has not changed significantly over the past decade,” Brent Diverty, CIHI’s vice-president for programs, said in a press release. In 2012, per person spending for seniors ranged broadly, from $6,368 for those aged 65 to 69 to $21,054 per year for those 80 or older. The low end of that scale isn’t far off what the report said Canada will pay per person in general in 2014 – $6,045. Canada is expected to spend just under $215 billion this year on health care, which equates to 11 per cent of the country’s gross domestic product. The public purse picks up about 70 per cent of health-care costs in Canada. The remaining 30 per cent comes from out-ofpocket payments by individuals and private health insurance. That 70-30 cost breakdown has been relatively constant for the past 20 years, said the report. Hospitals make up about 30 per cent of healthcare spending – $63.5 billion. Drugs and doctors come next, at 16 and 15 per cent respectively, or $33.9 billion and $33.3 billion. Drug costs, once a major driver of expenditure increases, have stabilized, growing by only 0.8 per cent in 2014. - Helen Branswell, The Canadian Press CLINICAL Chiropractic group lauds campaign on opioid overdose prevention The Foundation for Chiropractic Progress (F4CP), a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, calls attention to information published online by the U.S. Centers for Disease Control and Prevention (CDC), highlighting the lethal epidemic of opioid painkiller prescribing and the importance of appropriate preventive action by federal and state bodies. Included in the CDC online information are several methods to prevent overprescribing and increase patients’ accessibility to effective, drug-free treatment options, such as chiropractic care, for pain relief. “Higher rates of prescribing mean more drug-related fatalities,” said Dr. Gerard Clum, spokesperson for F4CP. “In 2012, U.S. medical providers approved 259 million painkiller prescriptions, translating into 46 deaths per day. As alarming as these numbers are, they will continue to climb until our nation stops turning to prescription painkillers as the first choice for pain relief.” Municipalities across the U. S. are taking notice of the latest risk reports related to prescription drugs and positioning themselves on the opposite side of the epidemic, the F4CP said in a statement. Recently, two counties in California sued five of the world’s largest narcotics manufacturers with accusations of creating the nation’s drug crisis through a “campaign of deception” aimed at boosting sales of potent painkillers, such as OxyContin. “The pro-active actions of California counties and the CDC symbolize a step in the right direction,” said Clum. “However, to spark real change, more influencers need to take similar measures toward ending this toxic epidemic and igniting universal acceptance of conservative methods, such as chiropractic, as a first choice for pain relief.” Chiropractic care is an evidence-based, drug-free approach for common health concerns and pain relief. Evidence confirms that the care provided by a doctor of chiropractic is often linked with better clinical outcomes, greater patient satisfaction and noteworthy cost savings, said the F4CP. A plethora of reports, including, “Never Only Opioids: The Imperative for Early Integration of Non-Pharmacological Approaches and Practitioners in the Treatment of Patients with Pain,” support the early use of drug-free care for pain relief. “Protecting ourselves against this ill-fated epidemic needs to be a primary focus,” said Clum. “The first step is increased awareness about treatment risks and better, drug-free options, and the second step is action: using drug-free options, such as chiropractic care, first. I expect the transition away from prescription drugs will be tough, but the lives saved along the way will make it worthwhile.” According to the CDC, deaths from drug overdose have been rising steadily in the U.S. over the last two decades. In 2012 alone, more than 16,000 drug overdose related deaths involved prescription painkillers. Based on the CDC’s 2012 drug overdose data, men were 59 per cent more likely than women to die of drug overdose. RESEARCH Human body microbes produce antibiotics, study finds New research, recently published in the journal Cell, suggests some of the bacteria that share the human body manufacture antibiotics and these substances may be capable of fighting infection. The human microbiome consists of beneficial and harmful microbes that include bacteria, viruses, fungi and others. In this study, researchers purified and solved the structure of a thiopeptide antibiotic (lactocillin) produced by Lactobacillus bacteria that make up part of the vaginal microbial community. The researchers also determined that lactocillin had an activity profile similar to that of other thiopeptides (which are active against Gram-positive, but not Gramnegative, bacteria), with activity against Staphylococcus aureus, Enterococcus faecalis and Corynebacterium aurimucosum, all of which can cause illness, but not against Escherichia coli. Lactocillin was inactive against other Lactobacillus species, suggesting that over time these bacteria had become resistant to the compound. Using the algorithm ClusterFinder, researchers identified 3,118 distinct bacterial gene clusters from various parts of the body. These represent the DNA blueprint for producing microbial natural products and provide a template for future experiments to discover biologically active small molecules from the microbiome. These molecules are a starting point for studying microbe-host interactions at the level of molecular mechanisms and a potentially rich source of therapeutics. POLICY Research aims to identify gender differences in injury and health risks A Toronto scientist has launched a five-year research program on gender- related factors that affect differences in work injury risks, return-to-work and illnesses between male and female workers. Peter Smith, a scientist at the Institute for Work and Health, will focus on issues such as: why men and women face different injury risks, whether they face different challenges in returning to work post-injury, and how work stress and chronic disease affect men and women differently. “This new research knowledge will help shape the development of genderand sex-sensitive policies and practices to improve the health of all working Canadians,” Smith said, stressing that although the terms, gender and sex, are typically interchanged, there is a difference between them. “Gender” refers to socially constructed roles, relationships, behaviours and other traits attributed as “male-like” or “female- like,” while “sex” pertains to the biological and physical characteristics such as hormones, genes, physiology and anatomy. It is important to distinguish between these two dimensions, he said. “They represent different pathways through which differences between men and women are created. In addition, the policy intervention responses to male and female differences will differ depending on whether the differences are ‘gender’ based or ‘sex’ based.” Smith’s research will also aid health-care providers in understanding where differences may exist between genders with respect to care recommendations. Smith said the area of gender difference with respect to the interaction between health-care providers and injured workers is currently not well investigated. “We do know from studies focusing on general conditions, such as back pain and knee osteoarthritis, which are not specifically work-related, that men and women receive different recommendations even when they have the same condition,” Smith said. He cited a study in Ontario on physical recommendations for two patients – one male and one female – with moderate knee osteoarthritis which found that physicians were twice as likely to recommend surgery to the male patient. This could potentially be attributed to unconscious or conscious stereotyping among doctors about gender/ sex differences in who is more likely to benefit from surgery or will be supported in their recovery, he said. “These differences might also be due to the way men and women describe their symptoms; previous studies have suggested women use a more narrative style and men use a more direct and factual style.” Over the next five years, Smith’s research will examine the factors that mediate the relationship between gender/sex and return-towork outcomes, and identify situations where gender/ sex moderates the relationship between variables and return-to-work outcomes. INJURY PREVENTION Ontario’s work-related MSDs declining: study Work-related musculoskeletal disorders are dropping in Ontario along with other more traumatic job-related injuries, a study by the Institute for Work & Health (IWH) revealed. The report, “Time trends in musculoskeletal disorders attributed to work exposures in Ontario using three independent data sources, 2004-2011,” was published online by Occupational and Environmental Medicine. Led by IWH president Cameron Mustard, the study tracks the incidence of work-related non-traumatic musculoskeletal disorders (MSDs) and other work injuries in Ontario between 2004 and 2011 using three independent sources of information. All three sources show a decline in both work-related MSDs and traumatic work injuries over the eight-year period. Workers’ compensation losttime claim records show a 48.2 per cent decline in non-traumatic, work-related MSDs and a 39.4 per cent decline in traumatic work-related injuries. Emergency department treatment records show a 16. 3 per cent decline in MSDs and a 30.2 per cent decline in other work injuries. And a Statistics Canada national health survey shows a 40.7 per cent decline in MSDs and 45.1 per cent decline in other work injuries. “The study focuses on MSDs separately from other work injuries because they represent the largest disability burden among working adults in developed economies,” said Mustard. MSDs include sprains and strains of the neck, back, shoulders, elbows, wrists, knees and other joints and connective tissue of the musculoskeletal system as a result of awkward, forceful and/or repetitive movements and postures. Over the past 10 years in Ontario, sprains and strains have consistently been the leading type of work injury, representing 40 per cent of all lost-time claims in 2013, according to the Workplace Safety and Insurance Board 2013 statistical report. The study cannot say if declining injury rates can be attributed to deliberate efforts by workplaces and health and safety system partners (e.g. governments, health and safety associations) to reduce injury risk. However, “the study does suggest that efforts to prevent MSDs are proving to be as effective as efforts to prevent traumatic work-related injuries,” said Mustard. “The constant change and renewal in workplace equipment and machinery might have played a role by reducing the amount of lifting, pulling and reaching at work.” PROFESSIONAL GROWTH Wickes outlines priorities as new CMCC president The new president of the Canadian Memorial Chiropractic College (CMCC) will focus on pursuing three main agenda for the college: education, research and patient care. At his official inauguration last November, Dr. David Wickes outlined many of his priorities as president to continue the evolution of the CMCC as a leader in chiropractic education, research and the provision of health care. “As an educator, I revel in watching students explore, discover and learn,” said Wickes. “We will emp l oy optimal e v i - dence-based learning methods and technologies to augment the classroom experience. We will provide a superior technology infrastructure to better enable students and faculty to use mobile devices and facilitate anytime-anywhere learning and inactivity.” Wickes noted previous CMCC president Dr. Jean Moss has set a very high bar for the school and he will continue to build on the successes of the college. He declared, “I promise to leave CMCC in an even better position for the future president of CMCC – many, many years from now.” Wickes relocated to Toronto from Bridgeport, CT, last summer to join CMCC and assumed the role of president on July 1, 2014. He has a strong foundation in academic administration. His many accomplishments include the design and implementation of master’s degree programs, the implementation of new organizational structures, development of articulation agreements with other institutions, implementation of distance learning, management of new building projects, curriculum development, fundraising and the development of student assessment programs. Addressing another priority of his presidency, Wickes said CMCC’s outstanding reputation is in part due to the school’s long commitment to research. CMCC allocates close to 12 per cent of its annual budget to graduate education and research. “It is critical to the chiropractic profession that the premier research on spinal manipulation and the chiropractic adjustment be the product of our chiropractic institutions, our adjunct faculty holding research positions in various universities, and our funded research chairs. “We cannot and will not relinquish the responsibility of exploring and validating the basic and clinical concepts of manipulation to the other health professions,” Wickes said. Wickes also stressed the need to provide its students an “amazing clinical experience” through sophisticated clinical examination tools and state-of-the-art treatment facilities. Wickes said CMCC will continue to expand its clinical quality assurance system to provide information used to enhance patient care, improve operational efficiency and help drive curricular improvement. “We will continue to expand our clinical offerings so that we can ensure that our students are immersed in an experience rich in diversity of patients, breadth of complexity and mix of health-care providers,” he said. At the official inauguration the new CMCC president received well wishes and greetings from several personalities in the chiropractic and education community, including: David O’Bryon, president of the Association of Chiropractic Colleges; Ellen Vogel, president of the Canadian Association of Health Sciences Deans; Dr. Robert David, president of the Canadian Chiropractic Association; Dr. Kristina Peterson, president of the Ontario Chiropractic Association; Dr. Ron Brady, president of the CMCC Governors’ Club; Dr. David Starmer, chair of the CMCC Faculty Council; Alfredo Petrone, president, CMCC Students’ Council; and Dr. James Lunney, Member of Parliament. In his remarks, Lunney noted CMCC’s “predominant role” in the development of the chiropractic profession in Canada. “From my view on the Hill, chiropractic has what we need to achieve sustainable health care,” he said. “Canada must embrace innovation, effectiveness and cost-effectiveness or we will lose our competitiveness internationally… This is an area where chiropractic has much to offer.” - Mari-Len De Guzman CLINICAL Smoking linked to chronic back pain: study A new study from Chicago’s Northwestern University showed cigarette smoking can be bad for the back. “We found that (smoking) affects the way the brain responds to back pain and seems to make individuals less resilient to an episode of pain,” said the study’s lead author, Bogdan Petre, in an article posted on Northwestern University’s website. The study was published online in the journal Human Brain Mapping. According to Northwestern University, this study is the first evidence linking smoking and chronic pain with the part of the brain associated with addiction and reward. The study involved a longitudinal observational study of 160 adults with new cases of back pain. At five different times throughout the course of a year they were given MRI brain scans and were asked to rate the intensity of their back pain and fill out a questionnaire asking about smoking status and other health issues. Thirty-five healthy control participants and 32 participants with chronic back pain were similarly monitored. MRI activity between two brain areas (nucleus accumbens and medial prefrontal cortex, Nac-mPFC) was analyzed. These brain areas are involved in addictive behaviour and motivated learning. This is critical in development of chronic pain, the scientists found. These two regions of the brain “talk” to one another and scientists discovered that the strength of that connection helps determine who will become a chronic pain patient, the Northwestern University article stated. By showing how a part of the brain involved in motivated learning allows tobacco addiction to interface with pain chronification, the findings hint at a potentially more general link between addiction and pain. “That circuit was very strong and active in the brains of smokers,” Petre said. “But we saw a dramatic drop in this circuit’s activity in smokers who – of their own will – quit smoking during the study, so when they stopped smoking, their vulnerabality to chronic pain also decreased.” Medication, like anti-inflammatory drugs, did help participants manage pain, but didn’t change the activity of the brain circuitry. In the future, behavioural interventions, such as smoking cessation programs, could be used to manipulate brain mechanisms as an effective strategy for chronic pain prevention and relief, the report said.