Ontario public health officials are trying to contact 27 people who have been exposed to tuberculosis from a passenger on a bus traveling from Toronto to Windsor this past August. The passengers are being publicly urged to contact their local health units in order to be tested for TB as a safeguard. As the TB bacteria cannot be detected for at least 3 weeks following exposure, people may not be aware that they could potentially become ill. The risk that other passengers may have been exposed is low, but it is still necessary to be tested to determine if anyone else has caught the disease.

Approximately 1600 new cases of TB are reported in Canada every year, so the risk of developing the disease is relatively low. However, it can have serious health risks, so it is important for Canadians to recognize the symptoms as well as minimize the risk of becoming infected. TB is transmitted by frequent exposure to someone that has active tuberculosis; the bacterium is spread via sneezing, singing, coughing, etc. It is not as contagious as other diseases such as influenza or the chicken pox.

Most people can be exposed to TB bacteria and not develop the disease. It is possible for the immune system to effectively kill the germs. If this doesn't happen the bacteria can remain alive in the body which is called TB infection. Someone with TB infection will show no symptoms and not fall ill; they are also at no risk of spreading the disease. TB infection occurs when the immune system cannot stop the bacteria from growing; this risk is highest within 2 years of becoming infected. Approximately 10% of people will become infected with tuberculosis within their lifetime.

The symptoms of tuberculosis in the lungs are:

• bad cough that lasts longer than 3 weeks
• pain in the chest
• feeling very weak and/or tired
• coughing up blood and/or sputum
• loss of appetite
• fever and/or night sweats

A simple skin test can determine whether or not a person has a TB infection. This is accomplished by a very small amount of non-infectious TB protein being injected under the surface of the skin; a hard swelling will develop within 48-72 hours if the person is infected. At this point the health care provider will probably recommend antibiotic treatment in order to prevent the infection from developing into TB disease. Additional tests as well as chest x-rays may be needed in order to determine whether or not TB disease is present.

For those people who have TB disease it is extremely important to be treated as soon as the disease has been determined. A course of antibiotics for a minimum of 6 months is needed in order to kill all of the TB bacteria. Finishing the course of treatment is vital in order to prevent the risk of developing a strain of the disease that will be drug resistant, which is harder as well as more expensive to treat. As well, people who do not finish the treatment also pose a risk of spreading TB to others.

People with a weakened immune system are more at risk of developing TB infection and/or disease. People who have HIV/AIDS are 50-170 times more likely to develop TB disease; therefore this population group should always be tested for TB. Conversely, people who test positive for TB infection and/or disease should also get tested for HIV in order to help the physician determine the best course of treatment. Other populations that have an increased risk for TB infection are anyone:

• who has come into close contact with someone who has or is suspected to have active TB
• with a history of active TB and/or has had an x-ray suggesting that they had TB in the past but did not receive treatment
• who is living in an Aboriginal community that has a high rate of TB infection and/or disease
•  who is living or working at a long-term care facility, correctional facility
• who has had an organ transplant and is being treated with immunity-suppressing drugs
• who has a lung disease known as silicosis
• who has chronic lung failure and requires dialysis
• who has cancer of the head and/or neck
•  who has been infected with the TB bacteria within the past 2 years
•  who has had a chest x-ray that shows signs of old TB
• who is being treated with glucocorticoids
• who is receiving treatment with tumor necrosis factor alpha inhibitors (for auto-immune disorders such as rheumatoid arthritis)
• who has any type of diabetes
• who is underweight with a body mass index of under 20
• who smokes one pack of cigarettes or more per day
• who is under five years old when first infected with the bacteria

If you suspect that you have been exposed to someone that has tuberculosis, make an appointment with your health care provider for testing. You can also visit The Lung Association website for more information regarding tuberculosis.

Age-related macular degeneration (AMD) has long been the leading cause of severe vision loss in Canadians. As age is one of the predominant risk factors for developing this condition, all Canadians over 50 years of age are strongly encouraged to learn more about the warning signs, as well as having an understanding of what this condition entails.

AMD gradually takes away central vision by the slow degeneration of the macula (a small area located in the very centre of the retina). Due to the slow and painless progress of this condition, AMD can remain undetected until it reaches the more advanced stage; routine eye exams however can detect it in its earlier stages. Therefore it is highly recommended that all people over 50 have their eyes regularly examined. In rare cases AMD can progress incredibly fast, i.e. weeks and/or months, resulting in permanent central vision blindness. It is imperative that AMD be caught as quickly as possible as earlier treatment usually results in less vision loss.

AMD is characterized by either 'dry' or 'wet'. Dry AMD occurs first; all people who have wet AMD have had the dry form of the condition. For 85-90% of people however, AMD will stay at the dry level and not progress to the advanced wet AMD. Dry AMD happens when light sensitive cells in the macula begin to break down; this causes gradual blurring of the central vision. As it progresses some individuals may see a blurry spot in the center of their vision. This loss of central vision increases as less of the macula can function. This can happen to either one eye or both; it is possible that both eyes may be affected at different times as well. For those who have AMD in one eye there is an increased likelihood that AMD will develop in the other eye. It is also possible to have AMD in both eyes and have the eyes progress to wet AMD at different interval.

A common early sign of dry AMD is drusen, which are yellow deposits located under the retina. Scientists are uncertain about the connection between drusen and AMD; what is known is that an increase in size and/or number of drusen raises the likelihood of developing into advanced dry AMD or wet AMD. Drusen alone does not cause vision loss, and many people can have a few small drusen in their eyes and not progress into AMD. However, people who have drusen should be regularly tested by their eye care professional in order to monitor this condition.

Wet AMD (also known as advanced AMD), occurs when abnormal blood vessels start to grow under the macula. These blood vessels are usually quite fragile and often leak blood and fluids, which raise the macula from its normal location at the back of the eye. This damage occurs rapidly, resulting in a greater loss of central vision. Wet AMD tends to be quite unpredictable and can appear very suddenly. There is no set schedule of when dry AMD changes into wet AMD; one of the early symptoms of wet AMD is the appearance of straight lines that are suddenly wavy. This, as well as any other vision change, should be reported immediately to your eye care professional as a comprehensive dilated eye exam is necessary.

There is currently no known cure for either dry or wet AMD. However, there are different treatments, depending on which type of AMD you have that can halt the progress of the condition. People who have the dry form of AMD can slow the progression and/or reduce vision loss by using specific high dose ocular vitamin therapy. As well, lifestyle changes such as quitting smoking and/or and improved diet can have a positive impact on reducing the chance/speed of progression of the disease. As well, vision should be monitored on a regular basis in order to track the progression.

Currently effective treatment is not available for all forms of wet AMD. Research is progressing, but at this date only 3 treatments for wet AMD have been approved by Health Canada. Although these treatments will not cure the condition, they can be very effective in halting the progression of wet AMD. They are:

Laser Photocoagulation (LPC): This method uses a high energy beam of light (laser) to destroy the fragile, leaky blood vessels. However, this method poses a risk of damaging surrounding healthy tissue as well as some vision. As well, there is a high risk of developing new blood vessels after this treatment; repeated treatments are usually necessary. Laser surgery is only used to treat a very small percentage of people who have wet AMD; it is usually most effective on those whose leaky blood vessels have developed away from the fovea (central part of the macula).

Photodynamic Therapy: This method involves injecting the drug verteporfin into an arm, which then travels throughout the body. This drug will 'stick' to the surface of new blood vessels; when a light is shined on the eye for 90 seconds the light will activate the drug, destroying the new blood vessels. It does not destroy the surrounding healthy tissues, but those who are being treated with this method must avoid any bright lights (indoor and outdoor) for five days after the treatment. It is a painless course of treatment that can be done in a doctor's office and usually takes 20 minutes. This treatment may need to be repeated as the results are often temporary.

Injections: This is the latest method to treat wet AMD and involves injecting drugs directly into the affected eye. Also known as anti-VEGF therapy, the injections work by blocking the growth of new abnormal blood vessels that tend to grow at an abnormally high level in eyes with wet AMD. Injections may need to be done as often as monthly. Successful injection treatments can help slow down vision loss; in some cases it can also improve vision. Injections may need to be done as often as on a monthly basis depending on the rate that the wet AMD is progressing. It is done in a doctor's office; the eye is numbed before injection and afterwards the eye will be monitored.

Research shows that AMD occurs more in people of white origin than those of African American descent. As well, women appear to be at greater risk for this disease than men. Having a family history of AMD can also increase the odds of having the condition. However, there are lifestyle choices that can either lessen the risk, and/or slow down AMD. Smoking has been linked to the increased risk of AMD; obesity has also been linked to the progression of early and intermediate stages of AMD to advanced AMD. Eating a healthy diet of fish and leafy green vegetables can reduce your risk of developing AMD; it is also important to maintain a healthy weight, exercise and maintain a normal blood pressure.

More information can be found about Age-related macular degeneration at AMD Canada, as well as the Canadian National Institute for the Blind.

So far, 15 Canadian deaths have been linked to the listeria outbreak that has now spread throughout most of Canada. Nine deaths in Ontario, one in Alberta and one in British Columbia have been attributed to listeria, either as a contributing factor or the direct cause. 4 deaths in Ontario as well as one death in Quebec and another in Saskatchewan are currently being investigated to determine whether listeria was a contributing factor. As well, the number of listeriosis cases has now reached 33, from the original 17 that had been diagnosed. Another 25 illnesses are being investigated as well to determine whether listeriosis was the cause, as well as 6 more deaths.

The outbreak has been definitively linked to a north Toronto plant of Maple Leaf Foods Inc. The plant has since been closed for mass sterilization. Maple Leaf Foods has recalled almost all products that were produced at this plant; so far over 20 different meat products totaling over 500 000 kilograms, have been recalled. Supermarket chains Loblaw Co. and Sobeys Inc. have recalled close to 50 ready-to-eat sandwiches and other deli products that contain meat that could be contaminated as it originated from the affected Toronto plant. This is due to the uncertainty of what lines have been contaminated in the food plant. Currently, the only meat products that have tested positive for listeria were manufactured in July, but all products that were manufactured from June 2 and forward are being recalled as a preventative measure. King Bean Wholesalers is also recalling 4 different varieties of roast beef sandwiches from stores that are located throughout British Columbia.

Maple Leaf Foods Inc. has taken full responsibility for the listeria outbreak. They have released television commercials as well as full page newspaper ads apologizing to the Canadian public and vowing to do to everything in their power to rectify the situation. The spokesperson for Maple Leaf has stated that the company is in no way is blaming Canada's current food inspection laws and guidelines. Health Canada and the Canadian Food Inspection Agency are supervising and monitoring the food recall at the Toronto plant.  Maple Leaf Foods and the Canadian Food Inspection Agency have set up toll-free phone lines that consumers can call with any questions or concerns. These phone numbers are 1-800-568-5801 and 1-800-442-2342.

Public health officials are warning that the current amount of Canadians that have become ill, or may become ill, from listeriosis will likely increase. Every illness and/or death must be investigated in order to determine whether or not the strain of listeria that has been linked to the tainted meat is actually responsible. They are currently locating and interviewing people in order to establish whether they have been ill with listeria, and to determine the likely source of the contaminated food.

To see the list of all recalled products visit the CFIA website. Remember that there is the possibility of more products that will be recalled. Although this outbreak was initially thought to be in Ontario, other provinces are reporting cases that may be linked to Maple Leaf products. Check with your local health agency to see whether or not these products may have been sold in your region. You may want to check every few days in order to be aware of any new recalls.

The Health Minister of Canada has announced that Canada will be increasing protection for Canadians who suffer from food allergies. This will be done through new labeling requirements for food allergens, gluten sources and added sulphites contained in prepackaged foods. Health Canada has also announced that they will also launch several studies related to allergies, including a large national study of food allergy prevalence. They will also conduct 2 studies on the dietary habits and coping skills of people who have celiac disease and are on a gluten-free diet.

Currently, the Food and Drug Regulations requires that ingredients of food products be declared on the labels of most prepackaged foods; however components of certain ingredients are exempted from this declaration. The Canadian Food Inspection Agency does have the ability to recall foods that are currently exempted from the labeling requirements if a health risk is identified; however the tougher labeling regulations will provide manufacturers with clear rules establishing procedures to be followed in a consistent and systematic fashion, thereby reducing the number of food recalls and/or preventable allergic reactions. The improved regulations would require that manufacturers now declare all food allergens, gluten sources as well as added sulphites on prepackaged food labels. The new regulations would detail exactly how these are to be listed on the food labels.

Some Canadians may be unaware between the differences of food allergies and intolerances. You are not necessarily allergic to a particular type of food just because it does not agree well with you. Although certain foods may make you sick, food allergies are much more serious and can be fatal if untreated quickly.

• Food intolerance: is a food sensitivity that does not involve the immune system. Unlike food allergies, or chemical sensitivities, where a small amount of food can cause a reaction, it usually requires a more normal portion of food to produce symptoms of food intolerance. Although these are commonly mistaken for a food allergy, intolerance is more likely to originate in the gastrointestinal system and caused by an inability to digest and/or absorb certain foods, or food components. One of the most common forms of food intolerance is lactose intolerance. This occurs in people who lack an enzyme called lactase, which is needed by the body to digest lactose (a sugar in milk). Symptoms of lactose intolerance may include abdominal pain, bloating, flatulence and/or diarrhea.
• Chemical sensitivities: This occurs when a person experiences an adverse reaction to chemicals that naturally occur in, or are added to foods. This may be the caffeine found in coffee, tyramine in aged cheeses, and flavor enhancer MSG.
• Celiac disease: This is an inherited intolerance to gluten. The main sources of gluten are cereal grains; the only current treatment for celiac disease is a strict diet that is completely gluten free.
• Food allergies: are sensitivities caused by a reaction of the immune system to specific proteins in a food. Currently, it is estimated that food allergies affect as many as 6% of young children and 3-4% of adults. In allergic individuals, a food protein is mistakenly identified as harmful by the immune system. The first time the body is exposed to such a protein the immune system responds by creating antibodies called immunoglobulin E (IgE). When the individual is exposed again to the same food protein, Ige antibodies and chemicals such as histamine are then released. Histamine is a powerful chemical that causes a reaction in the respiratory system, gastrointestinal track, skin and/or cardiovascular system.

It is also a wise choice to carefully read all labels of prepackaged foods that you are buying. Make sure you also understand what the labels mean, and what the ingredients are. Some people can become confused with the long, confusing names of products; some research of your own will give you a better understanding of what you are buying, as well as what the nutrition value of that product is.

Summer can be an ideal time to take part and/or all of your accrued vacation days from work, especially for those who wish to have a family holiday. Taking time off from your work environment is essential in order to maintain mental and physical health. This time is also valuable in terms of maintaining your relationships with your family and friends. Not taking time off from work often leads to higher levels of stress, which negatively impact health. For those who already have health issues such as cardiovascular problems, acute stress can be quite dangerous.

A study which started in 1948 had women filling out questionnaires over a 20 year period that tracked their vacation time, as well as health status. Back then the study showed that women who took a vacation only once every 6 years were almost 8 times more likely to develop health issues such as coronary disease and/or heart attacks than those women who took a minimum of 2 vacations a year. The published study in 1992 also factored in health issues such as obesity, diabetes, smoking and the amount of income; once again those at a higher risk level were those that did not take regular vacation time.

Another study was conducted in 2000 which studied 12,000 men who were considered high risk for coronary disease over a 9 year period. The results showed that those men who did not take a yearly vacation had a 21% higher risk of death from all causes and 32% more likely to have a fatal heart attack.

A study has shown that 23% of Canadians have canceled and/or postponed their vacation plans due to their obligations at work. Canadians also "give back" an average of 3 days of their vacation time that though they are entitled to, do not take due to work. This is in part due to the fact that most Canadians are conditioned to value employment productivity sometimes more than their work-life balance. To maintain work-life balance, it's also important not only to take your vacation days, but to take them properly. 42% of Canadians seem to use all their time at once, taking a 2-3 week vacation from work, while the rest seem use their days here and there. Taking 2 weeks off seems to be the ideal amount of time; it allows the body and mind the chance to properly unwind and become rejuvenated. However, breaking up your vacation time into a series of long weekends does not seem to give you enough

Every company will have their own policies regarding when to submit your vacation days in order to get them approved. This does require sometimes making plans a few (or more) months in advance. You will need to be proactive as your vacation time approaches, in order to let all the other staff know exactly when you are leaving, and for how long. If someone is temporarily filling in for you, you should make sure they are aware of what their responsibilities will be, and what realistically you expect them to accomplish. Due to this advance planning, you may find that when your vacation finally comes, you are swamped with work, i.e. in the middle of a project. This may require you to be in contact with your office while you are on vacation. If this is happening to you, designate with your office a certain time of day that you will be available to them. Try and deal with your work within that window of time, so you can actually relax and enjoy your vacation the rest of the time. Make sure that all people involved are aware of this schedule, as well as that your cell phone/blackberry/laptop etc will be turned off until the next appointed time.

Remember that by not taking time off you are reducing your productivity as well as optimum health status. Whether jetting out of the country, or simply staying home, all Canadians need to take time to unwind and relax in order to be at their peak performance for work.