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Dr. Zach on Sexually Transmitted Infections (STIs)

BT Montreal | posted Wednesday, Nov 7th, 2018

STI’s (sexually transmitted infections) formerly known as STD’s (sexually transmitted diseases)

more info: www.drzach.ca

Rates of sexually transmitted infections are continuing to rise across Canada

In general, all the sexually transmitted infections have been increasing in the last 20 years.

Rates of syphilis, gonorrhea and chlamydia have climbed for the fourth consecutive year in the United States, the Centers for Disease Control and Prevention announced August 28/18 at the National STD Prevention Conference in Washington.

Last year, nearly 2.3 million US cases of these sexually transmitted diseases were diagnosed, according to preliminary data.

That’s the highest number ever reported nationwide, breaking the record set in 2016 by more than 200,000 cases, according to the CDC.

The growth of dating apps is one suspected culprit.  It’s easier to find sex and easier to find anonymous sex than it was before.

More people appear to be having condomless sex, including those in the gay community, who once were at the vanguard of safe-sex campaigns in response to the HIV-AIDS epidemic.

But with HIV treatment being really so effective now that it’s essentially a chronic disease, the concern around contracting HIV has really decreased a lot and that potentially is diving the reduction in condom use.

The majority of cases are diagnosed in the under-30 age group and many of them are diagnosed at university or college sexual health clinics but there has been increasing prevalence in older adults (https://www.aarp.org/health/conditions-treatments/info-2017/std-exposure-rises-older-adults-fd.html)

With young girls and many boys in Canada being vaccinated against human papillomavirus — a major cause of cervical cancer — and changes to guidelines advising that lower-risk women be tested less often for that malignancy than previously recommended, there is likely less screening for gonorrhea and chlamydia. Such STI testing was often performed at the same time as a Pap smear.

Nationally, statistics confirm bacterial STIs are on an upward trajectory in jurisdictions across the country.

In 2015, the latest year for which national figures are available, there were almost 116,500 cases of chlamydia, the most commonly reported STI in Canada, with females accounting for two-thirds of infections, says the Public Health Agency of Canada (PHAC). Between 2010 and 2015, chlamydia rates increased by almost 17 per cent.

Gonorrhea is the second most commonly reported STI in the country. About 19,845 cases were recorded in 2015, a jump of more than 65 per cent from 2010. Males had higher rates than females, with the highest number of cases among those aged 15 to 29, PHAC says.

From 2010 to 2015, the rate of infectious syphilis in Canada increased by almost 86 per cent. In 2015, a total of 3,321 cases were reported, with nearly 94 per cent occurring among males; those aged 20 to 39 had the highest rates and men who have sex with men were among those at most risk.

While the three STIs can be successfully cured with antibiotics, untreated chlamydia and gonorrhea can lead to pelvic inflammatory disease in females, affecting fertility. Untreated, syphilis can cause damage to the brain, nerves, eyes, cardiovascular system, bones and joints. In extreme cases, it can be fatal.

There is a rare strain of gonorrhea that is resistant to standard antibiotics.  There was one case in Quebec last year.

Condom use is among the best ways to protect against infection.

 

Information about condoms: https://www.canada.ca/en/public-health/services/sexual-health/safer-condom-use.html

Information about gonorrhea:

https://www.canada.ca/en/public-health/services/diseases/gonorrhea.html

Information about chlamydia:

https://www.canada.ca/en/public-health/services/diseases/chlamydia.html

Information about syphilis:

https://www.canada.ca/en/public-health/services/diseases/syphilis.html

Information on Lymphogranuloma venereum:

https://www.canada.ca/en/public-health/services/diseases/lymphogranuloma-venereum-lgv.html

Information about genital herpes:

https://www.canada.ca/en/public-health/services/diseases/genital-herpes.html

Information about human papillomavirus:

https://www.canada.ca/en/public-health/services/diseases/human-papillomavirus-hpv.html

Information about HIV-AIDS:

https://www.canada.ca/en/public-health/services/diseases/hiv-aids.html

Hepatitis B virus (HBV) is a virus that causes inflammation of the liver. Most people do not think of hepatitis as a sexually transmitted infection; however, one of the more common modes of the spread of viral hepatitis B is through intimate sexual contact.

Hepatitis B (HBV) is 50 to 100 times easier to transmit sexually than HIV ( the virus that causes AIDS). HBV has been found in vaginal secretions, saliva, and semen. Oral sex and especially anal sex, whether it occurs in a heterosexual or homosexual context, are possible ways of transmitting the virus.

Hepatitis B is a sexually transmitted disease, but it is spread in other ways, too. This is a hardy virus that can exist on almost any surface for up to one month. You can get infected through contact with an infected person’s blood or body fluids.

Hepatitis C (HCV) is spread through contact with an infected person’s blood — which may be present because of genital sores or cuts or menstruation.HCV has been detected with greater-than-average frequency among people who have a history of sexual promiscuity — which can be defined as a history of a sexually transmitted disease, sex with a prostitute, more than five sexual partners per year, or a combination of these. A person who is in a long-term monogamous relationship with an HCV-infected person rarely contracts this virus. Only approximately 2% of sexual partners of HCV-infected people also test positive for HCV.

In Quebec HPV vaccine is offered to grade 4 students free of charge, both girls and boys.  2 doses (need 3 doses after age 18)

Halloween & Sugar, by Dr. Zach, ER Physician

BT Montreal | posted Wednesday, Oct 24th, 2018

more info: www.drzach.ca 

 

  1. Sugar is pleasurable and somewhat addictive.
  2. Sugar is bad for us, specifically refined sugar and especially high fructose corn syrup (glucose-fructose in Canada).
  • Better with fibre.  Juice is not our friend.
  1. Ways sugar harms us.
  2. Recommended amount of sugar intake
  3. Ways to limit sugar
  4. Ways to limit sugar this Halloween

 

The advice used to be cut fat for health

For years the conventional wisdom was that we should cut down on fat and cholesterol in order to lose weight and decrease our risk of heart attack and stroke. Part of the problem, it seems, is that in cutting fat people increased their consumption of sugar.  And there are better (polyunsaturated) and worse (saturated, trans) fats.

Sugar is pleasurable to consume and enhances appetite.

(debatable if addictive — Sugar activates the reward center in our brain much the same way that drugs do, and provokes similar cravings and ??withdrawal symptoms.  (Studies done in rats. Sugar is more psychologically addictive than physical)

But

Sugar, and especially HFCS (high fructose corn syrup), may be as unhealthy as fat and salt, and may be associated with the metabolic syndrome of obesity, diabetes, high blood pressure, and high cholesterol.

High-fructose corn syrup (called glucose-fructose in Canada) is made from corn. After it’s milled, the resulting starch is processed into a syrup. By adding enzymes, the syrup is converted into fructose. Glucose syrup is then added to the mix to make high-fructose corn syrup. The most common form of the syrup contains 45 per cent glucose and 55 per cent fructose.

Corn is abundant in North America, which helps make high-fructose corn syrup a cheaper alternative. It’s sweeter than sugar and helps extend the shelf life of processed foods. It’s also easier to blend and transport because it’s a liquid.

As a mixture, its chemical composition differs from sucrose, and some say that’s critical in its effect on the human body. Critics suggest there’s a link between the increased use of high-fructose corn syrup and a growing North American diabetes and obesity epidemic.

Sucrose comes from sugar cane and sugar beets and is our table sugar.  It consists of glucose and fructose.  Fructose is of concern because it is broken down only by the liver and can cause fatty liver.  It is broken down into components including uric acid, which may be associated with gout and increased blood pressure, and triglycerides, which are a form of bad cholesterol.  There is concern that fructose, and especially high fructose corn syrup, causes weight gain, diabetes, high blood pressure, increased cholesterol, and fatty liver.

While it is true that sugar is found naturally in many foods such as fruits, these also contain fiber, which makes us satiated, so we don’t eat as much, and which slows the absorption of sugar.

In March, 2015 the World Health Organization presented the following new guideline:  “In both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake. A further reduction to below 5% of total energy intake would provide additional health benefits.”  Free sugar refers to sugar that is added to food, as opposed to the natural sugar that exists in fruits and vegetables, which are not as unhealthy.   The WHO says that limiting your sugar intake will decrease your risk of obesity, which is associated with heart attack, stroke, and certain cancers, and dental cavities.

The amount of calories that are recommended per day depend on one’s age and gender (here is a guide — http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/1_1_1-eng.php).  An average adult male should take in about 2500 calories per day, and an average woman about 2000 calories.  10% of 2000 is 200 calories, which is about 50g of sugar/day.  A single can of soda contains about 39g of free sugar, approaching the 10% recommendation for an entire day.

Added sugar is in many foods, juice is not healthy

While most people realize that there is free sugar in soft drinks, candies, cakes, and cookies, many don’t realize that there is added sugar in such foods as bread, pizza, salad dressing, yoghurt, and ketchup.  Also, even though the sugar in fruit is ok, that in fruit juice or punch is not because it is ingested without the benefit of the other components of fruit, especially the fibre. Fibre slows down the absorption of sugar and thereby decreases the unhealthy spikes in our blood glucose levels.  Moderation seems like the best policy at this time, and we should make an effort to consume less artificially sweetened foods such as soft drinks and get more of our sweetness from fruit.

Check the labels of what you are purchasing, and remember to remain physically active, which improves blood sugar levels and helps maintain a healthy weight.  Also choose brown rice bread pasta less shooting up of blood sugar.

In the U.K.and U.S., the amount of added sugar is on food labels.  In Canada the total amount of sugar is listed, which is a combination of naturally occurring and added sugar.

 

Fats are more filling than carbs

Fat contains 9 cals/g

Protein and carbs contains 4 cals/g

As far as wt is concerned a calorie is a calorie

But trans fat increases weight gain dm2 heart dz

 

1 calorie is the amount of energy or heat it takes to raise the temp of 1g of water by 1 degree celcius (=4.184 joules)

For food it’s kilocalories so

Fat is how extra energy is stored

 

Negative effects of too much sugar on the body (this is depressing, literally and otherwise):

 

  • Cavities
  • Obesity — which leads to increased risk for diabetes, heart disease, multiple cancers (endometrial, esophageal, gastric, liver, kidney, multiple myeloma, meningioma, pancreatic, colorectal, gallbladder, breast, ovarian, thyroid)
  • glucose spikes cause inflammation, associated with heart disease
  • possibly depression
  • Skin aging
  • Cell aging
  • Energy crash (after initial spike)
  • Fatty liver
  • Kidney disease
  • Gout

It may negatively effect memory and brain function

Insulin resistance — While eating sugar by itself does not cause insulin resistance, foods with sugar and fat can contribute to weight gain, thereby reducing insulin sensitivity in the body.

Worse memory — Although the brain needs glucose, too much of this energy source can be a bad thing. A 2012 study in animals by researchers at the University of California at Los Angeles indicated a positive relationship between the consumption of fructose, another form of sugar, and the aging of cells, while a 2009 study, also using an animal model, conducted by a team of scientists at the University of Montreal and Boston College, linked excess glucose consumption to memory and cognitive deficiencies.

Too much sugar can lead to obesity, insulin resistance and inflammation, all of which are risk factors for cancer and are linked to an increased risk of dying from heart disease.

A diet rich in added sugar and processed foods may increase depression risk in both men and women.

Sugary foods can increase the production of AGEs , which can accelerate skin aging and wrinkle formation.

Advanced glycation end products (AGEs) are compounds formed by reactions between sugar and protein in your body. They are suspected to play a key role in skin aging

Eating too much sugar can accelerate the shortening of telomeres, which increases cellular aging.

 

High-sugar foods can negatively impact your energy levels by causing a spike in blood sugar followed by a crash.

 

Eating too much sugar may lead to NAFLD (non-alcoholic fatty liver disease), a condition in which excessive fat builds up in the liver.

Eating too much sugar may lead to NAFLD, a condition in which excessive fat builds up in the liver.

 

Having consistently high blood sugar levels can cause damage to the delicate blood vessels in your kidneys. This can lead to an increased risk of kidney disease

Negatively impact dental health: Eating too much sugar can cause cavities. Bacteria in your mouth feed on sugar and release acid byproducts, which cause tooth demineralization.

Increase the risk of developing gout: Gout is an inflammatory condition characterized by pain in the joints. Added sugars raise uric acid levels in the blood, increasing the risk of developing or worsening gout.Accelerate cognitive decline: High-sugar diets can lead to impaired memory and have been linked to an increased risk of dementia.

How to reduce sugar intake in general (overall message is to keep sugar consumption in mind)

Although consuming small amounts now and then is perfectly healthy, you should try to cut back on sugar whenever possible.

Focusing on eating whole, unprocessed foods automatically decreases the amount of sugar in your diet.

Here are some tips on how to reduce your intake of added sugars:

  • Swap sodas, energy drinks, juices and sweetened teas for water or unsweetened
  • Drink your coffee black or use Stevia for a zero-calorie, natural sweetener.
  • Sweeten plain yogurt with fresh or frozen berries instead of buying flavored, sugar-loaded yogurt.
  • Consume whole fruits instead of sugar-sweetened fruit smoothies.
  • Replace candy with a homemade trail mix of fruit, nuts and a few dark chocolate chips.
  • Use olive oil and vinegar in place of sweet salad dressings like honey mustard.
  • Choose marinades, nut butters, ketchup and marinara sauce with zero added sugars.
  • Look for cereals, granolas and granola bars with under 4 grams of sugar per serving.
  • Swap your morning cereal for a bowl of rolled oats topped with nut butter and fresh berries, or an omelet made with fresh greens.
  • Instead of jelly, slice fresh bananas onto your peanut butter sandwich.
  • Use natural nut butters in place of sweet spreads like Nutella.
  • Avoid alcoholic beverages that are sweetened with soda, juice, honey, sugar or agave.
  • Shop the perimeter of the grocery store, focusing on fresh, whole ingredients.

Prepare your own meals

Exercise – it improves glucose metabolism

 

Advice specific to Halloween

  • Eat before you go out
  • Brush after eating the junk
  • Toss some (or give away)
  • Switch with other things
  • Make it invisible (don’t keep it visible)
  • Smaller trick or treating bags
  • Move it (your body)
  • Eating a sugary treat along with foods high in protein or fibre can result in a smaller rise in blood sugar.  So make sure kids eat a healthy meal before trick or treating.
  • If followed by a good teeth brushing, parents can also reduce their child’s risk of cavities.
  • Parents of younger children often find they can toss the majority of treats after a week or two as their children lose interest, or even forget about the stash.
  • Older children may want to weigh their treats and “sell” them back to their parents for a reasonable price per pound.
  • Other parents implement the Switch Witch. This benevolent helper can visit children as they sleep, trading the big bag of candy they have left out for her — for a small prize.
  • Whittle through the candy and get rid of some at the end of trick or treating
  • Store the candy where it’s not visible
  • Trade candy for something else
  • Smaller trick or treating bags
  • Get moving. Get some exercise by making Halloween a fun family activity. Walk instead of driving kids house to house. Set a goal of how many houses or streets you’ll visit, or compete in teams to do as many as you can. Bring a bottle of water and a flashlight, and wear comfortable shoes for walking!

Mental Health Day, by Dr. Zach Levine, ER Physician

BT Montreal | posted Wednesday, Oct 10th, 2018

More info: www.drzach.ca 

 

Institut national de santé publique du québec: annual prevalence of mental disorders is 20%

Fewer than 50% of people with mental disorders see a doctor for these problems

Increasing prevalence in children and adolescents.

 

Mental illness in Canada

  • In any given year, 1 in 5 people in Canada will personally experience a mental health problem or illness.
  • Mental illness affects people of all ages, education, income levels, and cultures.
  • Approximately 8% of adults will experience major depression at some time in their lives.
  • About 1% of Canadians will experience bipolar disorder (or “manic depression”).
  • By age 40, about 50% of the population will have or have had a mental illness.
  • Schizophrenia affects 1% of the Canadian population.
  • Anxiety disorders affect 5% of the household population, causing mild to severe impairment.
  • Suicide accounts for 24% of all deaths among 15-24 year olds and 16% among 25-44 year olds.
  • Suicide is one of the leading causes of death in both men and women from adolescence to middle age.
  • The mortality rate due to suicide among men is four times the rate among women.
  • Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem.
  • Stigma or discrimination attached to mental illnesses presents a serious barrier, not only to diagnosis and treatment but also to acceptance in the community.
  • Mental illnesses can be treated effectively.

 

Depression

Causes

Biological — neurotransmitter imbalance — serotonin, norepinephrine

Psychological — worldview, thoughts

Social — Life events

 

Symptoms:

Emotional Symptoms:

  • Constant sadness, almost every day
  • Feeling of worthlessness, of excessive or inappropriate guilt
  • Dark or suicidal thoughts
  • Loss of interest or pleasure in favourite activities

Physical Symptoms

  • Low energy
  • Aches and pains
  • Insomnia or its opposite, hypersomnia
  • Change in weight

Behavioural Symptoms

  • Change in appetite
  • Impression of restlessness
  • Difficulty making decisions or focusing

Treatment

  • Therapy
  • Exercise
  • Sleep (both a result and a cause of anxiety and mood disorders)
  • Diet (studies on diet and mood are ongoing)
  • Medication

Marijuana Legalization, by Dr. Zach, ER Physician

BT Montreal | posted Wednesday, Sep 26th, 2018

For more info, visit www.drzach.ca

 

1. Patients present to ER because of cannabis “poisoning” (bad trip) or cannabis hyperemesis syndrome.

Cannabis poisoning (aka a “bad trip”) — anxiety, paranoia, numbness, dizziness, hallucinations, confusion, psychosis, hallucinations, slurred speech

High heart rate and BP (or orthostatic hypotension), red eyes, dry mouth

Can cause asthma exacerbation.  Rarely angina or heart attack (risk is increased)

No deaths have been reported

Peak concentration levels by route of administration:

Inhalation — 3-10 minutes (smoke vs vape, no smoke with vape)

Oral — 1-5 hours — patients with oral ingestion may take more because they won’t feel intoxicated immediately

Treatment: Largely symptomatic.  Fluids, relaxants if needed, antivomiting medications

 

Cannabinoid Hyperemesis Syndrome:

Most commonly reported cluster of symptoms that brings regular cannabis users to the ER is cannabinoid hyperemesis syndrome.   (even though cannabis decreases nausea in cancer patients)

It consists of intractable nausea, vomiting, and abdominal pain.

Recurrent relapsing disorder.

Vomiting may last 24-48 hours and may lead to dehydration and weight loss.

Symptoms may respond to showering in very hot water.

Treatment: supportive therapy, cannabis cessation.  IV hydration. Metoclopramide, ondasetron. Haloperidol, capsaicin cream to the abdomen chest or back.

Termination of heavy habitual cannabis use may lead to withdrawal symptoms within 48 hours — irritability, anxiety, nervousness, restlessness, sleep difficulty, seizures, and aggression.

2. Legalization results elsewhere:

In colorado ER visits spiked for 6-12 months after legalization but then leveled off.

Experience in places where pot is legalized — In Washington and Colorado:

Rising rates of pot use by minors

Increasing arrest rates of minors, especially

black and Hispanic children

Higher rates of traffic deaths from driving

while high

More marijuana-related poisonings and

hospitalizations

A persistent black market

 

The public health impact of decriminalization or legalization of recreational cannabis use include:

  • Both decriminalization and legalized recreational use have been associated with increased unintentional pediatric ingestions. As an example, after legalization of recreational marijuana use in Colorado, annual calls to the regional poison control center for pediatric marijuana exposure increased 34 percent on average to 6 cases per 100,000 population, which was almost twice the rate for the rest of the United States.  Exposure to recreational marijuana accounted for about half of cases. Rates of hospital visits at a large regional children’s hospital system also increased significantly during the period of the study, although the total number of presenting patients (81) was small.
  • In regions with medical marijuana availability, diversion of drug from registered users may also encourage adolescent abuse.

3. Driving:  

In QC you’ll get a 90 day license suspension if police find any THC in your system.

Not clear how much time before it’s safe but probably at least 4 hours for inhaled and longer for edibles.

Driving stoned is not safe.  One focuses too much on one thing and is too slow to respond to sudden changes.

No clear level that is safe.

Canadian law Bill C-46 states that if you drive with 2-5 nanograms of THC per ml of blood, you’ll face a maximum fine of $1000.  More than 5 nanograms, or having a mix of booze and THC, gets a minimum $1000 fine. Repeat offenders can face up to 10 years in prison

Drivers using cannabis are two to seven times more likely to be responsible for accidents compared to drivers not using any drugs or alcohol. Furthermore, the probability of causing an accident increases with plasma levels of delta-9-tetrahydrocannabinol.

Cannabis use increases reaction time and impairs attention, concentration, short term memory, and risk assessment.  Lasts 12-24 hours

 

Federally approved roadside police tool is Drager DrugTest 5000 — takes a saliva sample but apparently there are false positives and negatives and there are concerns about keeping swabs at the right temperature in Canada.  Other ones are being tested.

Many police forces have not ordered the devices yet.

In the meantime police will rely on a field sobriety test, which can involve standing on one leg or tracking an object with your eye, to screen for impairment.

 

Testing for cannabis in the body:

Urine drug screens are less helpful in adolescents and adults for the diagnosis of acute intoxication. Although testing is usually positive several hours after acute exposure it can also be positive well after symptoms have resolved. As an example, positive results for delta-9 tetrahydrocannabinol metabolites (urine test) have been reported up to 10 days after weekly use and up to 25 days for after daily use

Saliva swab test positive for 6-12 hrs after use

Blood test shows level, positive for 36 hrs after use

Blood samples, which are legally binding, can only be taken if you fail the roadside test, and only at a police station.

 

4. Cannabis seems to unmask predisposition to certain mental illness, especially if used in youth

 

Public health agency of Canada: “One of the things that the research clearly demonstrates is that early access to cannabis can have detrimental affects for brain development and the brain develops up to age 25.”

Several studies have linked marijuana use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorders. The amount of drug used, the age at first use, and genetic vulnerability have all been shown to influence this relationship. The strongest evidence to date concerns links between marijuana use and substance use disorders and between marijuana use and psychiatric disorders in those with a preexisting genetic or other vulnerability

Teenagers: Prolonged cannabis consumption below age 17 is linked to memory and attention issues later.  Alcohol is not better. Young people struggling with anxiety, depression, or learning problems are more at risk of dependency.

Mental health: people at risk of mental health issues are more likely to suffer adverse effects from cannabis use

Can one get high from second hand marijuana smoke?  No.  Exhaled smoke contains so little THC that you’d have to sit in a room with 16 joints being smoked per hour to show any signs of being high.

Plans for cannabis laws in Canada once legalized:

https://www.canada.ca/en/services/health/campaigns/legalizing-strictly-regulating-cannabis-facts.html

Controlled access

When the Cannabis Act becomes law in October 2018, adults who are 18 years or older would be able to legally:

  • possess up to 30 grams of legal dried cannabis or equivalent in non-dried form
  • share up to 30 grams of legal cannabis with other adults
  • purchase dried or fresh cannabis and cannabis oil from a provincially-licensed retailer
    • In those provinces that have not yet or choose not to put in place a regulated retail framework, individuals would be able to purchase cannabis online from a federally-licensed producer.
  • grow up to 4 cannabis plants per residence for personal use from licensed seed or seedlings
  • make cannabis products, such as food and drinks, at home provided that  organic solvents are not used

The sale of cannabis edible products and concentrates would be authorized no later than 12 months following the coming into force of the proposed legislation.

Strict Regulation

QC law:

Under the new plan, the legal age to buy, possess and consume marijuana in Quebec will be 18 — the same as the drinking age.

Other key points include:

  • No one will be allowed to grow cannabis for personal use. It will also be banned to grow it for commercial use, unless following the laws set out by the government.
  • It must be smoked in the same places as tobacco. Smoking will also be prohibited on university and CEGEP grounds.
  • There will be zero tolerance for drivers — police officers will be able to ask for a saliva sample if they suspect someone is driving while high and will be able to suspend a driver’s licence for 90 days if a sample comes back positive for ANY cannabis.

While saliva testing has yet to be federally regulated, the province says that police officers are being trained to detect signs of marijuana-impaired driving.

 

The Quebec law would set the legal age at 18 and allow individuals to transport up to 30 grams at a time and hold 150 grams at home

 

A government agency, the Société québécoise du cannabis, will have exclusive legal control of recreational use, selling the product through a limited number of storefronts and online. The province will have 15 stores ready by July 1 and up to 150 in two years.

 

Laws re driving high Canada:

Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired driving, while drivers with both alcohol and THC in their system would be considered impaired if they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5 nanograms of THC in their blood.

The government said the other two proposed offences would be similar to the offences for drunk driving. Drivers with more than five nanograms of THC in their blood would be punished with a mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120 days for a third offence.

Laws re driving high Canada:

Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired driving, while drivers with both alcohol and THC in their system would be considered impaired if they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5 nanograms of THC in their blood.

The government said the other two proposed offences would be similar to the offences for drunk driving. Drivers with more than five nanograms of THC in their blood would be punished with a mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120 days for a third offence.

Apple Watch Series 4 review: ‘Guardian on your wrist’ packs a punch

Winston Sih | posted Wednesday, Sep 19th, 2018

At Apple’s annual Sep. event in Cupertino, Calif., the tech giant announced a new Apple Watch that brings hardware and software improvements that doubles down on its commitment to health. With Series 1 only launched three years ago, in just under a week with my review unit of Series 4, you can tell that this is what Series 1 should have been all along.

From a hardware standpoint, Apple Watch Series 4 packs a punch in still a small form factor. It retains its iconic design with some minor updates, featuring 40 and 44mm size options, enabling an over 30 per cent larger display through rounded corners.

watchOS 5 takes advantage of this through enhanced complications on the watch faces, apps have more real estate, and button inputs are easier. This is the first thing you’ll notice when you power it up. While I’m traditionally a silver kind of a guy, I’m a huge fan of the new gold finish, too, aligning with the new iPhone XS offering.

Your bands are still good!

You’ll be relieved to know the bands you’ve spent so much money on are still compatible with Series 4—phew! This was a worry from some tech analysts—that this is a way to force consumers to purchase new bands to be compatible with the new model.

As far as other improvements to the body of Apple Watch itself, a new Digital Crown now has built in haptic feedback. When you scroll through different menu options, subtle vibrations will help guide you through the user interface—a very nice detail.

If you listen to music or interact with Siri on Apple Watch, the speaker is 50 per cent louder—enough to fill a small room with ample feedback. The microphone has been moved to the opposite side of the device to facilitate clearer phone calls.

The ‘guardian on your wrist’

Health is where you see the most improvement, and Apple is very proud of that. Series 3 brought a high heart rhythm alert that became quite popular in notifying users of irregular patterns. Now, Series 4 will do the same with low heart rhythms. 

At launch in the United States, Apple Watch will come with a first-of-its-kind over-the-counter electrocardiogram—or ECG—application, through a new heart sensor built into the back and Digital Crown. This will allow a new way to record information for medical professionals to analyze. However, no word on when this will come to Canada.

Last on the health developments, something that can be great for our aging population (and even clumsy people like me): fall detection. It utilizes the internal gyroscope and accelerometer to detect irregular movements like falls.

In these instances, users will receive a notification to decide whether they want to notify emergency services, and if there’s no response within 60 seconds, Emergency SOS will be activated automatically.  Apple likened these new features as the ‘guardian on your wrist.’

Added cellular support in Canada

New this year is expanded cellular support for Apple Watch in Canada. Rogers has joined the other major wireless carriers to carry the device, meaning active runners can leave their iPhones at home and still be connected to music, podcasts, and loved ones wirelessly.

eSIM technology shares data from your phone plan, while connecting Apple Watch independently to the cellular network. This, combined with the faster dual-core S4 processor and W3 wireless chip brings the future onto your wrist.

How much will this cost, and do I need all this power on my wrist?

Apple Watch Series 4 will start at $519 CAD, with the cellular model starting at $649 CAD. Series 3 will also be available for those who are happy with last year’s model—it is still a great watch. Cellular is good for you if you like to run and be mobile without a phone, however for many (including myself), the standard model suffices. I’m happy to see all three major Canadian carriers—including Rogers—on board with support.

Apple Watch Series 4 is really designed for iPhone users. So if you’re an Android user, you’ll have to look elsewhere.  If you use iPhone and are in the market for a new smart watch, this is a great upgrade. This is the first Apple Watch where I felt it could keep up with my fast fingers.

Rogers Communications is the parent company of Citytv and this website.

7 Days of Fat-Blasting Workouts by Kathleen Trotter

BT Montreal | posted Tuesday, Sep 18th, 2018

 

Intervals are convenient — you can do them anywhere and on any piece of equipment or without equipment — AND they are effective. With intervals, you alternate between bouts of high- and low-intensity training. This places a high metabolic demand on the body, burns lots of calories in a short amount of time, produces a high EPOC (post-workout calorie burn), increases mitochondria growth (mitochondria help to burn fat), and helps to improve one’s fitness level. Plus, they are a fantastic workout regardless of your fitness level; you adapt the interval intensity to fit your current capacity. The intensity of your interval is dependent on your individual fitness level. For some, the “high” interval will be walking quickly. For others, it might be jogging.

Exercise will improve your mood, energy, and overall health, and change your body shape, BUT no amount of fat-blasting workouts will help you shed those extra pounds if you are eating poorly. Be aware of your nutritional choices. Consider journaling — we often overestimate our health choices and underestimate our unhealthy choices.

Always do a proper warm-up and cool-down. The warm-up should be a minimum of 5 minutes; it should promote blood flow and prime your body for motion. Typically, it entails a lower-intensity version of the workout that is to come. For example, jog to warm-up for running or do a low-impact version of high knees before an intense interval of high-impact high knees. The cool-down is 5 or more minutes of stretching, foam rolling, and light cardio that cools the body down.

All exercises can — and should — be progressed or regressed depending on your fitness level. For example, cardio options can be made low or high impact (eg, stepping your feet back into a burpee vs jumping your feet back) and strength exercises can be progressed by adding weight and/or an unstable surface such as a Bosu.

Always listen to your body. Stop if you feel faint, sick, negative pain, etc.

Progress gradually. This week of workouts is an end goal. If you have never worked out before, don’t jump right in. Maybe do 2 of the more intense workouts and on the other days go for a walk. Slowly work your way up. Progress your intensity, choice of exercise, duration, and frequency.

 

Monday Tabata intervals: Cardio based

Tabata is a method of interval training. One cycle of Tabata takes 4 minutes. The 4 minutes is made up of 8 sets of 20 seconds of intense work followed by 10 seconds of complete rest. After 1, 4-minute Tabata set, rest for 1 minute and move on to your next exercise. Literally any exercise can be made into an interval. Both cardio and intense strength exercises can be made into Tabata. For today’s workout, focus on cardio exercises — we will do strength tomorrow! Think mountain climbers, high knees, bum kicks, burpees, or skipping.

Sample Workout

Warm up for 5 minutes by running on the spot or dancing around your living room. Then pick a cardio exercise (such as burpees or jumping jacks). Do the exercise hard for 20 seconds. Rest for 10 seconds. Repeat for 4 minutes. That is 1 Tabata. Do 4 to 6 Tabatas. Cool down.

 

TuesdayAMRAPs

AMRAP stands for “as many rounds as possible.” AMRAP is an example of time-based training. With AMRAP, you aim to fit in as many cycles of a circuit as possible within a set timeframe. The faster you get through the reps of each exercise, the more times you will complete the entire circuit in the given timeframe.

For this workout include strength and cardio exercises — push-ups, squats, and jumping jacks, for example. Beginners should do 2 to 3 sets of a 6-minute round. Intermediate exercisers should aim for 3 sets of 8 minutes. If you’re advanced, 3 sets of 10 minutes. Always warm up and cool down.

Sample Workout

Within your given timeframe (6, 8, or 10 minutes) do as many rounds as you can of 10 push-ups, 10 lunges on each leg, 12 bent-over rows, and 10 jumping jacks. Record how many rounds you get through. Gradually work to increase the number of rounds you can complete in 10 minutes.

 

Wednesday: Extra sleep and recovery day

Both sleep and recovery are KEY for weight and fat loss!!

 

Thursday: Strength and cardio-based minute intervals

With minutes you don’t count reps. You do each exercise as many times as you can within that minute. Pick 4 strength exercises and 2 core exercises. After you warm up, do 1 minute of each exercise, followed by 2 minutes of core and 1 to 3 minutes of intense cardio. Aim to fit in as many good reps as possible for each strength exercise within the 1-minute timeframe. Rest for 1 minute. Beginners repeat the cycle twice. Intermediate exercisers repeat 3 times. Advanced exercisers do 4 sets.

Sample Workout

After you warm up do 1 minute of a “push” exercise such as push-ups, 1 minute of a leg exercise such as squats or lunges, 1 minute of a “pull” exercise such as pull-ups, band reverse flyes, or bent over rows, and finally 1 minute of another leg exercise such as squat pulses, squats jumps, step-ups, or bridges. Then do 2 minutes of core — think planks, V holds, side planks, etc. Finish with 3 minutes of intense cardio such as running, skipping, jumping jacks, stairs, or rowing.

 

Friday: De-stress with yoga and/or pilates!

Stress is the arch nemesis of fat loss — especially abdominal fat. Plus, working your core with Pilates or yoga will help you stand taller. The taller you stand, the better your midsection looks!!

 

Saturday: Cardio-based pyramid intervals

Pick a cardio activity — ie, anything that gets your heart rate up. Any cardio machine, running or walking outside, swimming, dancing, aerobics, etc will all work. Warm-up for 5 minutes with a moderate version of your chosen activity. Then do the following pyramid: 1 minute hard, 1 minute easy, 2 minutes hard, 2 minutes moderate, 3 minutes hard, 3 minutes moderate, 4 minutes hard, 4 minutes moderate, 5 minutes hard, 1 minute easy, and finally 5 minutes hard. Cool down for 5 to 10 minutes.

 

Sunday: Meal prep!

Want to lose weight? EAT BETTER! Instead of exercising on Sunday use the time to rest your body and prep your food for the week!!

 

More info:

What is Tabata?  https://www.flamanfitness.com/blog/stay-fit-this-summer-with-my-do-anywhere-time-efficient-yet-effective-workouts 

What is the Minute Workout? https://www.huffingtonpost.ca/kathleen-trotter/the-minute-workout_b_8296398.html

What is AMRAP?  https://www.huffingtonpost.ca/kathleen-trotter/amrap-training_b_8974816.html

What is Interval Training? (https://www.flamanfitness.com/blog/make-interval-training-your-new-best-friend).

Recovery protocols: https://www.participaction.com/en-ca/blog/lifestyle-culture/4-ways-to-recover-reduce-soreness-and-avoid-injury 

Importance of sleep and how to set up a sleep routine: https://www.theglobeandmail.com/life/health-and-fitness/health/turns-out-sleeping-can-help-you-shed-those-extra-pounds-health/article31415104/

Review: iPhone XS features under-the-hood refinements, but it won’t come cheap

Winston Sih | posted Tuesday, Sep 18th, 2018

Like clockwork, Apple unveiled the latest iteration of their flagship smartphone, iPhone, on Sep. 12 in front of a packed audience at Steve Jobs Theater in Cupertino, Calif. Unlike previous years, however, the tech giant came out with not one, not two, but three smartphones—iPhone XS, iPhone XS Max, and iPhone XR. Tech enthusiasts applauded as CEO Tim Cook and team revealed the tech; but, is it worth the investment?

This review will focus on iPhone XS and iPhone XS Max—the devices Citytv had a chance to review ahead of the Sep. 21 launch in Canada, alongside Apple Watch Series 4. iPhone XR will go on sale later this year.

Hardware

On the exterior, iPhone X and iPhone XS are almost identical. The immersive screen remains at 5.8-inch, no home button, the same top notch you either love or hate, and IP68 water resistance up to two metres for 30 minutes—which Apple is quite proud of boasting through promotional videos. They also come in a new gold finish (in addition to space grey and silver), which I’m quite a fan of. Storage will be available in 64GB, 256GB, and 512GB configurations.

In all three models, you’ll notice Apple has done away with the iconic home button, foreshadowing a slow death of the physical switch. As with iPhone X, there is a slight learning curve, but from personal experience, you get used to the shift in habit.

As for the larger iPhone, it seems the company has nixed the ‘Plus’ naming convention, opting for ‘Max.’ iPhone XS Max comes with a 6.5-inch screen—and it’s gigantic. Both XS and XS Max are great for media consumption, but XS Max is immersive but large for pockets—think watching YouTube videos with the new wide stereo speakers. Or my latest obsession—Ignite TV PVR downloads on the airplane.

Do you need the larger screen? No.  Is it nice to have? Yes.  Can it be a pain to carry in your pocket? Certainly, but having the option is great.

Bionic chip for bionic speeds

When migrating my data from my iPhone X, I could notice speed and power from the get-go. This iPhone houses an A12 Bionic and Neural Engine—what Apple calls ’the smartest and most powerful chip in a smartphone.’ The power is best noticed in resource-intensive applications like video editing, augmented reality, and gaming.

Coupled with iOS 12, it’ll unlock new consumer-friendly functionality, like Memoji and every selfie-taker’s new favourite feature: Smart HDR. Using the two 12-megapixel wide and telephoto lenses, Smart HDR means you can, using a slider, control F-stop or depth-of-field appearance in Portrait mode photos. This puts the power of pro photography in a consumer-grade smartphone—perfect for the ‘gram.

Battery life

In comparison to iPhone X, Apple claims iPhone XS will get you 30 minutes longer than iPhone X. iPhone XS Max will beat iPhone X by 90 minutes, according to Phil Schiller.

In real-life, I got a 12-hour day of consistent use out of iPhone XS Max.

Dual SIM support

New to any iPhone is support for two SIM cards through eSIM technology. It’s reliant on carrier adoption—however, it’s the same technology used for cellular connectivity in Apple Watch Series 4—now on all major carriers in Canada.  Traditional SIM cards will still work, but there is only one slot. The variant to be sold in China which will have two SIM trays.

This means that eventually consumers can still have two phone numbers (say, one for personal use and one for work) and receive calls and texts on one iPhone.

Pricing

In terms of pricing, iPhone XS won’t come cheap. At $1,379 CAD for iPhone XS and $1,519 CAD for the iPhone XS Max variant, these phones aren’t cheap. Carriers will subsidize—for example, Rogers is launching an Ultra tier, where for $10 a month, customers can get up to $250 off the upfront cost of ‘iconic’ devices on a term.

Additionally, later this year, Apple is launching iPhone XR, the third device announced at the Cupertino event. It features a ‘Liquid Retina’ LCD display, 12-megapixel camera, and a wide-array of colours, reminiscent of the iPhone 5C. iPhone XR rings in at just over $1,000.

Bottom line

So why would you want this device? You’re likely using an older iPhone—perhaps a 7—and it’s time for an upgrade. As a former iPhone 7 Plus user, iPhone XS Max is a nice option—albeit the hefty price tag.

If you’re an iPhone X user, there’s plenty to love about it still. iPhone XS brings a lot of new under the hood, but might not be worth $1,379.

Lastly, there’s a lot to be intrigued about iPhone XR, from the colour options to battery life. For the average consumer, it may be worth considering it when it comes out later this year. Let the games begin.

Rogers Communications is the parent company of Citytv and this website.

World Suicide Prevention Day, by Dr. Zach, ER Physician

BT Montreal | posted Monday, Sep 10th, 2018

by Dr. Zach, MUHC (more info: www.drzach.ca)

WHO: Close to 800 000 people die due to suicide every year, which is one person every 40 seconds. Many more attempt suicide. Suicide occurs throughout the lifespan and is the second leading cause of death among 15-29 year olds globally (after unintentional trauma such as car accidents).

Quebec still has the highest suicide rate of any province in Canada, and men and Indigenous people are afflicted disproportionately.  Over 1,000 people die by suicide per year, at an average of just under 100 per month. Indeed,

Men make up around 80 per cent of suicide victims in Quebec. French-Canadian men living in small towns and rural areas have particularly high-rates of suicide.  Risk factors include being unemployed or underemployed, and divorced.

Suicide rates very high in native communities.  Risk  factors including poverty, unemployment and hopelessness, and the long-term impact of assimilationist policy and the residential school system. Many Indigenous people were taught to be ashamed of their culture, and others were sexually or physically abused at residential schools. Such abuse is a strong predictor of suicide and alcohol use.

Quebec has the highest suicide rate of any province in Canada, about 15 per 100,000 (the territories have higher rates, esp Nunavut).

Women make suicide attempts more often than man, and are hospitalized more frequently for them, but men have a higher rate of committing suicide (often they use more violent methods).

The main risk factors for suicide are:

  • A prior suicide attempt
  • Mental health disorders
  • Substance abuse disorder
  • Family history of a mental health or substance abuse disorder
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Being in prison or jail
  • Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
  • Medical illness
  • Being between the ages of 15 and 24 years or over age 60

The behaviors listed below may be signs that someone is thinking about suicide:

  • Talking about wanting to die or wanting to kill themselves
  • Talking about feeling empty, hopeless, or having no reason to live
  • Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
  • Talking about great guilt or shame
  • Talking about feeling trapped or feeling that there are no solutions
  • Feeling unbearable pain, both physical or emotional
  • Talking about being a burden to others
  • Using alcohol or drugs more often
  • Acting anxious or agitated
  • Withdrawing from family and friends
  • Changing eating and/or sleeping habits
  • Showing rage or talking about seeking revenge
  • Taking risks that could lead to death, such as reckless driving
  • Talking or thinking about death often
  • Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
  • Giving away important possessions
  • Saying goodbye to friends and family
  • Putting affairs in order, making a will

Protective factors:

  • Strong connections to family and community support
  • Skills in problem solving, conflict resolution, and non-violent handling of disputes
  • Personal, social, cultural and religious beliefs that discourage suicide and support self preservation
  • Restricted access to means of suicide — gun control
  • Seeking help and easy access to quality care for mental and physical illness

What can we (individuals) do to help prevent suicide:

  • Remove the stigma from mental illness
  • Learn and recognize the signs of warning signs for suicidality
  • Reach out and connect — engage the person, explore their situation
  • Know resources available (there is a list of QC resources here — https://amiquebec.org/suicide/)

 What people who interact with the public need to do:

  • People who interact with the public need to know how to recognize risk factors and address them:  primary healthcare providers, mental healthcare providers, emergency healthcare providers, teachers and school staff, community leaders, police officers and other first responders, social workers, spiritual and religious leaders, traditional healers

What government can do:

  • We need to restrict access to means of self-harm/suicide
  • Government needs to support crisis centres and workers and community programs — mental disorders need to be identified and treated

Suicide rates in Quebec have declined by almost 50 per cent since the year 2000. This may be directly linked to the publication in 1998 of Help for Life: the Quebec Strategy for Preventing Suicide. This strategy was written by the Ministry of Health and Social Services.

References:

https://montrealgazette.com/opinion/opinion-more-can-be-done-to-reduce-suicide-rates-in-quebec

http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

https://iasp.info/wspd2018/

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