TORONTO – Ontarians are boozing more, exercising less, eating fewer fruits and vegetables and, not surprisingly, getting heavier.

“Unfortunately we’re going in the wrong direction,” Dr. Arlene King, the province’s Chief Medical Officer of Health, said Thursday following the release of her annual report, Health, Not Health Care — Changing the Conversation.

While tobacco use has flat-lined, and there are indications that fewer young people are lighting up, one-fifth of the province’s population still smokes, she said.

Her report says it’s time for an all-out battle against the risk factors that lead to cancer, Type 2 diabetes and other chronic illnesses that shorten life and drive up health care costs.

“This report isn’t just about the state of public health in Ontario,” she said. “It’s a call to action.”

Much of what needs to be done — including more exercise and sensible eating — is outside the traditional boundaries of the health care system, she said.

It’s important to fund doctors and hospitals and health care clinics but making sure kids get a good start in life and creating a sound economy that produces well-paying jobs can help ensure people don’t get sick in the first place, King said.

As an example, Ontario’s anti-smoking and road safety legislation is saving lives, she said.

King recommends viewing all provincial programs and policy through a “health lens,” setting goals and targets for improved health, measuring health indicators like infant mortality rates and focusing more health care system resources on prevention.

Her report notes Ontarians with diabetes account for 32% of heart attacks, 30% of strokes and 70% of amputations in the province.

Health officials say a good diet, regular exercise and eliminating tobacco would prevent up to 90% of Type 2 diabetes cases and 80% of coronary heart disease.

Feeding babies fish before they are nine months old cuts their risk of childhood wheezing in half and could even prevent asthma, a new study shows.

The study looked at responses from more than 4,100 randomly selected families who answered questions about their child’s eating habits and health at six months, 12 months and four and a half years.

By the time they were 4.5 years old, one in five kids had experienced at least one episode of childhood wheezing and one in 20 had experienced recurring wheezing. Of those, more than half were diagnosed with asthma.

But the kids who’d eaten fish before nine months — usually white fish, salmon or flat fish — were half as likely to report wheezing.

The findings, to be published in the December issue of the Acta Paediatrica journal, are the latest in a body of Swedish research lauding the protective effects of fish for children.

A 2009 study by the same authors connected an early introduction to fish with a lower likelihood of developing eczema.

Another study in 2009 out of Linkoping University found that babies whose mothers consumed fish oil during pregnancy were 16% less likely to develop eczema and a 13% less likely to develop food allergies.

There’s no consensus on why fish boosts positive effects on babies’ development, but many researchers point to the prevalence of omega-3 fatty acids, which can counteract the effects of omega-6 fatty acids that attack immune pathways.

The latest research also found that kids who were treated with antibiotics in the first week of life, as well as children whose mothers took the pain reliever paracetamol during pregnancy, were more likely to experience wheezing.

Tanya Sheerin is looking forward to sleeping once her baby is born.

During the latter stages of her pregnancy, she figures she’s averaging only about five hours of sleep a night. “I guess it trains you for when the baby comes home – or that’s my theory,” chuckles the Toronto mom and TV producer.

In these, the last few weeks of her pregnancy, she finds herself waking up at 3 a.m. and not falling back to sleep.

“Sleeping is not comfortable,” she says, adding in the last few months she’s also experienced restless leg syndrome a couple of hours before bed. “It drives me nuts,” she complains of the compulsive need to stretch her limbs.

Plus, she began to snore – sometimes so loud she wakes herself up, forcing her husband to go to another floor for a bit of shut-eye.

Sheerin is the kind of mom-to-be Dr. Robyn Stremler is looking for. The assistant professor in the faculty of nursing at the University of Toronto is conducting one of the first studies to take a comprehensive look at the effects of sleep disturbance on women during and post-pregnancy.

“I have always worked with pregnant and post-partum women in various maternal-newborn settings and I have always been struck by how the effects of lack of sleep accumulate in those stages,” says Stremler whose Sleep TYME study is supported by the Canadian Institutes of Health Research.

“When I started to look for advice that I could give to the women with whom I work, I found there wasn’t much out there. Hence, the research project.”

Sleep TYME stands for Sleep Throughout Your Motherhood Experience and the study, explains Stremler, will help sleep specialists learn how common sleep problems are and what factors make them more likely to occur in pregnancy.

“In pregnancy there are a lot of physical changes going on and those tend to interfere with sleep,” she says. “In the beginning, it may be due to having to get up to go to the bathroom that disrupts sleep. Then, as pregnancy progresses and you get more unwieldy, it’s difficult to find a comfortable position.

“Also pregnancy is an exciting time, but it’s also a life changer,” Stremler says. “Some women report they wake up more frequently and have trouble getting back to sleep. They end up reading, or making lists, and there may be increased anxiety as labour approaches – particularly a first labour.”

Stremler adds there is also a hormonal side that affects sleep: “Progesterone goes way up in pregnancy and makes you feel sleepy which is why many women feel sleepier during the day.”

Some women develop sleep apnea during late pregnancy and snoring is not uncommon. “Some women have trouble breathing, partly because of added weight which you need, plus the extra blood volume that’s created means that your circulation just has to work harder to get that extra fluid out of the way,” she says. “Some women even get nasal congestion which also interferes with sleep.”

Getting a good night’s sleep may be difficult before and after the baby comes, but sleep is critically important not only for women but for their families. Sleep, or lack of it, affects everything from how you parent to how you relate to your partner.

This study will provide needed insight into the impact of sleep disturbance on women, both during and following pregnancy; its purpose is to develop ways to find, prevent and treat sleep problems in order to improve the health of moms and babies.

The Sleep TYME study is recruiting 600 women. To be in the study you have to be having your first baby, and be less than five months pregnant. Participation in the study involves four telephone interviews, and participants receive a $25 gift card for their involvement.

More importantly, they get to contribute to important research on how sleep influences childbearing and overall health for Canadian families. For more information, visit www.stremlerresearch.com.

Are your legs restless?

Restless leg syndrome, or RLS, is a neurological condition in which symptoms include unpleasant feelings in the legs, sometimes described as creepy, tingly or achy. Common in pregnancy, RLS is thought to be related to the amount of iron in the blood which tends to decrease because of the baby’s additional needs.

Beddy-bye blues

According to the National Sleep Foundation, sleep problems during pregnancy include frequent waking due to pressure on the bladder, increased daytime sleepiness, discomfort, leg cramps, sinus congestion and heartburn.

Sleep better

Everything from extra pillows to drinking warm milk is worth a try to bring on a good night’s sleep. Also worth looking into: Relaxation techniques, deep breathing, yoga, massage and stretching. If you can’t sleep, no need to lie there to toss and turn, says sleep researcher Dr. Robyn Stremler: “Better to get up and do a bit of a reset.”

Children with autism appear to have too many cells in a key area of the brain needed for communication and emotional development, helping to explain why young children with autism often develop brains that are larger than normal, U.S. researchers said Tuesday.

Their study suggests the condition starts in the womb because brain cells in this area known as the prefrontal cortex typically develop during the second trimester of pregnancy.

The findings could help narrow the search for a cause of autism, which affects one in every 150 children born today in the United States, or about 1 percent of the population.

“We found a really remarkable 67 percent increase in the total number of brain cells in the prefrontal cortex,” said Dr. Eric Courchesne of the University of California San Diego Autism Center of Excellence, whose study appears in the Journal of the American Medical Association.

Courchesne and colleagues carefully counted the number of brain cells in tissue from seven boys with autism who had died and six boys who did not have autism at the the time of their deaths.

They focused on the prefrontal cortex, a part of the brain which is thought to grow too large and too fast in children with autism.

“It’s a part of the brain that’s important for social, emotional and communication functions, and it composes about 25 to 30 percent of the cerebral cortex,” Courchesne said in a telephone interview.

His team was first in 2003 to link rapid growth in head circumference in the first year of birth with autism.

He said the finding of excess brain cells in the prefrontal cortex explains brain overgrowth in autism, and hints at why brain function in this area is disrupted.

“This isn’t just a simple increase in neurons. It means a huge increase in potential connections and, therefore, a potential for miswiring which would lead to abnormal function,” Courchesne said.

Autism is a spectrum of disorders ranging from a profound inability to communicate and mental retardation to relatively mild symptoms such as with Asperger’s syndrome.

FINALLY, SOMETHING SOLID

Scientists have found dozens of genes that may raise the risk of autism. But genetic causes only explain 10 percent to 20 percent of cases, and recent studies have pointed to environmental factors, possibly in the womb, as a potential trigger.

“For years, it’s been a big puzzle from the standpoint of evidence. Where is the evidence that autism has a prenatal origin?” Courchesne said.

“For the first time, we have something really solid,” he said.

The team found excess brain cells in each child with autism they studied, Courchesne said. And the brains of the autistic children also weighed more than those of typically developing children of the same age.

Lizabeth Romanski of the University of Rochester Medical Center said the findings show that the origins of autism occur very early.

“The generation of new neurons, what we call proliferation, occurs prenatally during the second trimester,” said Romanski, who was not involved in the study. “That is when these neurons are being born.”

She said the finding of a large number of these neurons in children with autism suggests something occurred during this period to change the way the brain develops.

The researchers acknowledge that their study is small.

Courchesne said it is difficult to find brain samples from young people with autism, and his study included some from very young children, ranging from ages 2 to 16.

“This really says prenatal life is a very important time to study and mechanisms there will eventually lead to our understanding of how autism comes about,” he said.

Like many Canadians I make sure I get my annual flu shot. But this year I got both my flu shot and the flu.

This happened before I read about the recent report published in The Lancet that noted current flu vaccines might not be as effective as once believed.

The report called for the future development of “more highly effective and cross-protective vaccines.” In the meantime, flu experts responded to the report with reassurances: Some protection is better than none, they said. And I totally agree. Every year, between 2,000 and 8,000 Canadians die of the flu and its complications. So roll up your sleeve and get the vaccine.

Nonetheless, my getting sick and the recent report have taught me that I shouldn’t depend entirely on the flu shot. The vaccine is but one tool to fight the flu. Yet, if you’re like me, you may have thought the flu shot would protect you even as your co-workers cough in your face and sneeze on your reports. It won’t.

If you work in a large setting, travel in crowded subways and planes or have contact with kids who have runny noses, you will run into zillions of cold and flu viruses from now through to March – our typical flu season. So along with getting your flu shot, protect yourself further:

- Boost your immune system. Windsor, Ont., naturopath Sara Henderson, also a consultant to vitamin manufacturer Jamieson Laboratories, has recommended a daily anti-flu supplement regime to clients who want to build extra protection. Posted on www.jamiesonvitamins.com, it includes a high potency vitamin C, a probiotic, 1,000 IU of vitamin D, plus an anti-flu product (popular ones are Echinacea, Cold-FX and FluShield.)

- Clean like a maniac. A recent British study for Lysol disinfectant noted good hygiene habits are the best defence against spreading infectious diseases. The study, which included people from 12 countries, said people with more neurotic behaviour were more likely to be better at hygiene. Viruses can live on surfaces for up to 48 hours. So scrub your kitchen counters, spray your phones and wipe off your desk. “Regular disinfection of hygiene hotspots is crucial for reducing the spread of bacteria in the home,” says Dr. Donald Low, microbiologist-in-chief at Toronto’s Mount Sinai Hospital, who commented on the study. Germ hotspots in the home also include TV remotes, door handles, light switches – and, well, practically anything you and others might touch.

- Sick? Stay home instead of spreading it around. Researchers at Queen’s University found 83% of participants in one survey on work and illness said they continued to attend work or school while experiencing symptoms of the flu. One-fifth of Canadians ignore symptoms altogether. In their report, entitled Why the Common Cold and Flu Matter, researchers noted it costs employers twice as much in productivity losses for employees who come to work sick than for those who stay home.

- Don’t touch. Avoid close contact with people who are sick, and when you’re sick keep your distance from others (also think of wearing a face mask.) More good advice from the Centers for Disease Control and Prevention: Avoid touching your eyes, nose or mouth. Think about it: A virus has landed on a door knob, you turn the handle, then rub your eyes. My ear, nose and throat doctor puts it another way when it comes to protecting your ears from viruses: Never put anything smaller than your elbow in your ear.

- Wash your hands — often. A great list on flu prevention can be found at www.tylenol.ca. Washing your hands is the simplest and most effective way of protecting yourself. Use warm water and soap; briskly rub your hands together for a count of 20, washing in between your fingers, around your nails and the back of your hands. Wipe them dry with a paper towel or hand dryer; if possible, use the towel to turn off the tap. Hand sanitizers? Probably the best thing since sliced bread.

Got the Flu?

According to www.mayoclinic.com, the flu may initially seem like a common cold. But colds develop slowly, whereas the flu tends to come on suddenly. Common flu symptoms: Fever over 38C, aching muscles, chills and sweats, headache, dry cough, fatigue, nasal congestion.

When to Wash?

Wash your hands before eating; before, during and after preparing food; after contact with blood or body fluids; after changing a diaper; after going to the bathroom; after touching something such as a trashcan that could be contaminated; before inserting contact lenses. For more, visit www.cdc.gov/cleanhands.

Flu Facts

Find out about everything from kids’ vaccines to tracking the flu at the following websites:

www.cdc.gov/flu

www.caringforkids.cps.ca

www.jamiesonvitamins.com

www.tylenol.ca

www.lysol.ca

www.cold-fx.ca

Flu Myths

Top five flu myths as reported by Harvard Medical School (none of them are true):

- You can catch the flu from a flu shot

- Getting the flu shot is all you need to protect yourself

- You don’t need a flu shot every year

- Healthy people don’t need to be vaccinated

- You can catch the flu from getting a draft or going out in cold weather without a coat

Mothers who breastfeed for the recommended period of time, at least six months exclusively, may have a somewhat lower risk of developing high blood pressure later on, a U.S. study of more than 50,000 women said.

The findings, published in the American Journal of Epidemiology, add to evidence that breastfeeding might have benefits for mothers as well as babies, although it does not prove that breastfeeding is the direct cause of the healthier blood pressure, researchers said.

Breastfeeding is thought to help protect babies against common ills, such as diarrhea and middle-ear infections, and previous studies have found that women who breastfeed have lower risks of diabetes, high cholesterol and heart disease later in life.

“Women who never breastfed were more likely to develop hypertension than women who exclusively breastfed their first child for six months or more,” wrote lead researcher Alison Stuebe at the University of North Carolina, Chapel Hill.

In general, experts recommend that babies be breastfed exclusively for their first six months, then continue getting breast milk along with solid food until they are a year old.

For the study, Stuebe and her team looked at the correlation between breastfeeding and later risk of high blood pressure among some 56,000 U.S. women taking part in the long-running Nurses’ Health Study II. All had had at least one baby.

Overall, the study found women who had breastfed for at least six months were less likely to develop high blood pressure over 14 years than those who had only bottle-fed.

Nearly 8,900 women overall were eventually diagnosed with high blood pressure. But those odds were 22% higher for women who did not breastfeed their first child, versus women who’d exclusively breastfed for six months.

Similarly, women who had either never breastfed or done so for three months or less were almost one-quarter more likely to develop high blood pressure than women who’d breastfed for at least a year.

That was with factors such as diet, exercise and smoking habits taken into account.

Stuebe said that none of the findings proves that breastfeeding itself gives long-term protection against high blood pressure, and that it’s possible some other factor both hindered women from breastfeeding as well as contributed to their high blood pressure — such as a stressful work environment, for example.

But it’s also plausible that breastfeeding has direct benefits, she added. Animal research has found that the hormone oxytocin, which is involved in breastfeeding, has lasting effects on blood pressure.

It’s also known that women tend to have a short-term blood pressure decrease immediately after breastfeeding.

If breastfeeding is in fact protective, Stuebe’s team estimates that 12% of high blood pressure cases among women with children could be linked to “suboptimal“ breastfeeding.

“If this is a causal relationship, then taking away barriers to breastfeeding could make a difference in women’s health later on,” she said.

(Reporting from New York by Amy Norton at Reuters Health; Editing by Elaine Lies and Sanjeev Miglani)

A baby’s fetal heart rate patterns may not be a good way to tell if a mother needs a C-section, a new U.S. study has found.

Relying on the heart rate as an indicator can lead to unnecessary interventions and higher costs, doctors at Intermountain Medical Center in Salt Lake City, Col., said in research published in the October issue of Obstetrics and Gynecology.

“For years we’ve used the fetal heart rate to try to identify problems, but it’s not a very good map because we have so many babies in an ‘indeterminate’ category,” Dr. Marc Jackson said in a release about the study.

Jackson and colleagues studied fetal heart rate patterns from more than 48,000 labour and delivery cases at 10 hospitals over a 28-month period. Heart rates were then placed into one of three categories, the first being normal, the second for when doctors were uncertain about the significance of the heart rate and how it was affecting the baby, while the third was for clearly abnormal heart rates.

Researchers found the second category of fetal heart rate patterns showed up most often, occurring in 84% of all labours. They also found that the amount of time spent in that category increased in the two hours before delivery and led to lower Apgar scores, a scoring system used to determine a newborn’s health.

“Our next step, obviously, is to sort out those patterns in category two to determine which ones are more predictive of a baby that’s sick and one that’s healthy,” Jackson said. “When we know that, we will be able to make better decisions for both the mother and her baby.”

Exposure in the womb to bisphenol A (BPA) – a common chemical found in plastics – is associated with behaviour and emotional problems in young girls, according to a new study.

BPA is a controversial chemical that is believed to interfere with the body’s hormone functions, and has been linked to everything from infertility and sexual dysfunction to certain cancers and cardiovascular disease. Many experts say it causes abnormal or premature sexual development in girls.

It’s used in hundreds of consumer goods, such as plastic food storage containers, water and baby bottles and the linings of food and beverage cans.

Researchers from Vancouver’s Simon Fraser University, Harvard School of Public Health (HSPH) and Cincinnati Children’s Hospital and Medical Center examined data from 244 mothers and their children from the time they were in utero to the age of three.

They found that higher concentrations of BPA during pregnancy were associated with more hyperactive, aggressive, anxious and depressed behaviour and poorer emotional control and inhibition in the girls. This relationship was not seen in the boys.

Lead author Joe Braun, of HSPH, believes this is the first study to show that BPA exposure in the womb may be more detrimental than exposure during childhood.

“Gestational, but not childhood BPA exposures, may impact neurobehavioural function, and girls appear to be more sensitive to BPA than boys,” he said.

Canada became the first country to declare BPA toxic, in 2010, and banned the chemical from being used in baby bottles, as did the European Union.

Although the government declared that Canadians’ exposure to BPA does not pose a health risk, it acknowledged that “the combination of the slow breakdown of bisphenol A and its wide use in Canada means that over time this chemical could build up in our waters and harm fish and other organisms.”

BOSTON – Putting babies to sleep on their backs on a firm crib mattress in the same room with their parents is on a list of safe sleep guidelines for infants released Tuesday by U.S. pediatricians.

The American Academy of Pediatrics (AAP), an organization of 60,000 pediatricians, first said in 1992 that infants should be placed in a non-prone position for sleeping to avoid sudden infant death syndrome.

A new report, which was released at the group’s national conference in Boston, recommends infants sleep wholly on their back for every sleep and notes that side-sleeping is unsafe. Some supervised awake-time spent on the tummy is recommended.

A series of 18 recommendations from the AAP are intended to help guide parents, healthcare providers and others who care for infants following an increase in sleep-related deaths over the last few years.

The expanded recommendations focus broadly on creating a safe sleep environment that can reduce the risk of sudden infant death syndrome, suffocation, entrapment and asphyxia, the report said.

The guidelines also recommend that soft objects and loose bedding, such as quilts, pillows and even bumper pads not be kept in cribs.

Infants should not regularly have routine sleep time in sitting devices, such as car seats and strollers, and should not sleep in a bed where they might suffocate, according to the guidelines.

The recommendations, geared to infants up to one year of age, emphasize the importance of regular prenatal care for pregnant women and encourage smoke-free environments for pregnant women and children.

For more information on the guidelines, see www.healthychildren.org/safesleep.

(Reporting by Lauren Keiper; Editing by Greg McCune)

New research out of Yale University suggests a deadly pregnancy disease stems from a battle in the womb between a father’s biological goal to make the biggest, healthiest baby possible, and the mother’s need to survive giving birth.

Preeclampsia, the most common killer of pregnant women worldwide, is a disease that only occurs during pregnancy or the postpartum period. It’s characterized by a spike in blood pressure.

At its most mild, it will leave a woman bedridden with swollen ankles.

“When it gets out of control it can go into seizures and kill a woman,” said Dr. Harvey J. Kliman, lead author of the study.

A new study, published in the journal Reproductive Sciences, posits an explanation for preeclampsia, and could lead to earlier detection and possible treatment.

Kliman found preeclampsia is caused by the conflicting goals of producing a baby big enough to thrive, but small enough to pass through the birth canal.

The fight is between the mother’s uterus and the placenta, which is made up of cells called trophoblasts from the father.

During a regular pregnancy, trophoblasts invade the mother’s tissues and destroy the walls of her blood vessels in order to get more blood flowing to the placenta, which results in a bigger baby.

But, the study notes, the mother has “soldiers” of her own, in the form of lymphocytes, which seek out and kill the invading trophoblasts.

Scientists already knew this much. What they didn’t know is how the trophoblasts manage to get the job done despite being a foreign invader in the woman’s body.

“If you and I were going to rob a bank, for example, we might blow up a grocery store two blocks away,” said Kliman. “The police are in the grocery store and while they’re busy in the grocery store, you’re going to rob the bank. That’s what’s called a diversion.”

The trophoblasts create a diversion by secreting a protein called PP13 into the mother’s blood. Her immune system reacts, creating a mass of inflammation and dead cells called necrosis, which distracts the lymphocytes long enough for the trophoblasts to get blood to the placenta.

This finding surprised Kliman.

“In a normal pregnancy, there are whole big areas of dead maternal cells. I mean, that’s crazy,” he said. “What was it Sherlock Holmes said? When every explanation is already gone, you have to go to absurd ones? Well the absurd explanation is in a normal pregnancy there are massive areas of destruction.”

When, for whatever reason, the mother’s body doesn’t fall for the diversion, preeclampsia can occur.

“We realized that these zones of necrosis are likely occupying the mother’s soldiers while the invasive trophoblasts sneak into her arteries, leading to more blood flow to the placenta and a bigger baby,” said Kliman. “We believe that maintaining this balance could be the key to a healthy pregnancy free from preeclampsia.”

The findings mean doctors can detect women who are at risk of developing preeclampsia very early in the pregnancy. If PP13 levels are low at seven to eight weeks, a woman is likely to develop the disease at 23 weeks.

From there, doctors can keep a close eye on at-risk patients and help them with techniques to lower blood pressure and get blood flowing to the placenta.

“I don’t know about you, but I think that’s pretty magical.”