The former head of the Canadian Forces health group had to fight tooth and nail last spring to prevent the service from being carved up by “profound” cuts in the Harper government’s deficit reduction drive, newly released documents show.

A series of internal emails, obtained by The Canadian Press under access to information laws, show Commodore Hans Jung was so alarmed by the planned reductions that he went around his immediate superior and appealed directly to the vice chief of defence staff to reconsider eliminating a series of jobs and programs.

“Sir, when we spoke previously, you asked that I communicate to you directly if I felt that (Deficit Reduction Action Plan) cuts would have a profound impact on the military care health care system,” Jung wrote in an April 4, 2012 note to Vice-Admiral Bruce Donaldson, who is in day-to-day charge of the military budget.

Defence Minister Peter MacKay announced increased spending on mental health care services for the Canadian Forces last month. (Andrew Vaughan/Canadian Press)

“I just received the (work force adjustment) list for (Canadian Forces Health Services). It includes the full list of our 10 per cent (budget reduction) submission. Before we take action as per direction, I want to be sure that you … fully understand the implications, as with all of the submissions that you had to deal with, the details may have been less than visible.”

Over 10 days later, Jung requested an “urgent” meeting with Donaldson to “describe fully the implications and provide details of what I believe we can deliver in terms of cuts.”

On the chopping block were mental health research jobs, dental hygenists, researchers who conduct quality assurance and long-term military health planning, a program that accredits military doctors, as well as the popular program that sees Forces physicians liaise and supports civilian hospitals.

They were described as “key strategic enablers” whose loss would “impact care delivery and system performance measure.”

Impact of cuts ‘still under consideration’

The cuts have apparently been put on hold and officials are looking elsewhere within the health system for “efficiencies.”

Jung retired shortly after the budget battle.

A spokeswoman for National Defence insisted in an email Tuesday that no health care providers would be impacted, pointing to the government’s recent injection of $11.4 million into the mental health system to augment preventative care.

“The impact (of) the 2012 federal budget and the associated Deficit Reduction Action Plan on the military health care system is still under consideration, as Canadian Forces Health Services (CFHS) is expected to contribute to defence department targets,” wrote Capt. Joanna Labonte.

“Once changes to the military health care system are known, they will be communicated to all CF personnel. The CFHS remains committed to ensuring the operational readiness of the CF by providing the highest quality care possible to members, wherever they serve.”

“Given the concern about the health and welfare of soldiers, particularly the military’s ability to deal with the problems they’re encountering, (health services) should be left out of cuts,” Harris said.

And if National Defence is struggling with something as essential as health care, Harris said he wondered what must be going across the Forces as it confronts a combined budget wallop of $2.5 billion by 2014-15.

Leslie report disregarded?

In being ordered to make cuts, the health section was told not to touch clinical services; in keeping with Lt.-Gen. Andrew Leslie’s report about transforming the Canadian military, it was told to ensure the reductions were Ottawa-centric.

The health branch was given four days last winter to decide what to cut, but Jung’s email messages show it was an order and the areas under scrutiny had been deemed worthy of keeping during the government’s earlier strategic review process.

“We were directed to provide our ‘allotment’ of cuts (censored),” Jung wrote to Donaldson on April 16, 2012. “We were able to prove that what we were providing was efficient and effective. For (Deficit Reduction Action Plan), we were directed to make submissions with repeated assurances that the impact statements would be carefully reviewed.

“In the end, I had no choice but put in these items to meet my ‘allotment.”‘

Harris said Leslie’s report provided a clear road map on where to cut, but aside from the amalgamation of three headquarters units, he’s seen little evidence that report is being followed.

Instead, the Conservatives have chosen to take a bottom line approach and force a 10 per cent cut across the board, he added.

“If you’re doing 10 per cent across the board, you might get 10 per cent, but maybe you’re not finding the real source of savings,” he said.

A guiding principle of working with people with brain injuries is helping them find “somewhere to live, someone to love and something to do.” UBC alumna Alison McLean, BSc (OT)’89, MSc’10, aspires to help her clients achieve all three during their recovery and rehabilitation. She has witnessed how it can be incredibly challenging to live a fulfilled life when one of those aspects is missing. McLean finds personal and professional meaning in working together with clients towards their goals and seeing them become involved in activities and roles important to them in their lives.

Back in high school, the description of the Occupational Therapy (OT) degree program in the UBC course calendar immediately peaked McLean’s interest. Her interest was confirmed through volunteer work with Sunny Hill Health Centre for Children, the Disabled Skiers Association of BC and at a summer camp for teens with disabilities. She felt pursuing a degree in OT at UBC was a good fit for her because it would allow her to contribute to individuals’ physical, social and psychological well-being. OT is the practice of enabling individuals to participate in the occupations of everyday life self-care, leisure and productivity.

After graduation, McLean found work in a brain injury rehabilitation program at the George Pearson Centre, and she continues to work in brain injury rehabilitation today.  Currently with the Acquired Brain Injury Program’s Outreach Team at the GF Strong Rehab Centre, she works with individuals living in the community who may be a few months or many years post brain injury.  She has also worked in medico-legal assessment with OT Consulting/Treatment Services Ltd. since 1995. McLean joined UBC’s clinical faculty in 2001 and began teaching clinical reasoning, evidence-based practice and neurological rehabilitation with a special focus on cognitive rehabilitation.

As a clinician and instructor, McLean found it necessary to keep up-to-date with clinical research evidence. After working as a clinician for nearly two decades, she felt it was time for a new challenge and direction in her career. She wanted to boost more than just her practical skills and knowledge—she wanted to bring something new to the table. Pursuing a Master of Science degree seemed like the perfect fit. It was never a question where she would go for her Master’s. With her life firmly rooted in Vancouver and a high regard for the OT program at UBC, her choice was simple—an MSc in Rehabilitation Sciences at UBC. Her thesis focused on exploring social participation and subjective well-being for individuals attending brain injury drop-in centres.

After graduate studies, McLean found her strongest interest lay with knowledge translation—taking new research evidence and integrating it into clinical practice.  She has returned to full-time clinical practice, but has increased her involvement in research, teaching and knowledge translation projects. Currently, McLean is working with a research team at the GF Strong Rehab Centre examining the use of a number of cognitive assessments. As part of a Vancouver Coastal Health regional working group, she is also assisting clinicians to enhance best practice in the area of cognitive assessment and rehabilitation. Now a Clinical Assistant Professor, McLean continues to teach within the Department of Occupational Science and Occupational Therapy, and she has co-developed and co-instructed a two-day workshop for OTs in assessment and intervention of executive dysfunction.

McLean also spearheaded a project to develop a decision-making tool (clinical algorithm) to guide OTs in their clinical reasoning and decision-making during the process of cognitive assessment. Her goal was to develop a tool that could be used for both OT students and clinicians. Finalized in 2011, the algorithm has practical uses across client populations, from acute to long-term care. It has become the basis of an OT clinical practice guideline in Vancouver Coastal Health. The cognitive assessment algorithm has also been shared at conferences nationally and internationally. Bridging the gap between research and clinical evidence to create a tool that enhances clinical practice has enabled McLean to merge her passions in clinical work, teaching and research and give back to a profession that has given her so much over the years.

–Written by: Anne McCulloch

By Nick Collins, The Daily Telegraph May 31, 2012

Paralyzed patients have been given new hope after scientists restored the ability to walk, run and even climb stairs to rats with severe spinal injuries.

Researchers witnessed “100 per cent recuperation” weeks after a treatment which forced the rodents to grow new nerve connections that bypassed their injuries.

A similar approach could be used on human patients with spinal injuries, with a clinical trial possible within one to two years, the scientists said.

It is the first study to demonstrate that a severely damaged spinal cord can adapt and recover sufficiently to allow the brain to regain control of the legs.

The researchers built on previous work in which chemicals and electrodes implanted in the spine below the site of the injury had been able to stimulate nerves, causing involuntary movement in rats’ legs.

In the new study they placed the rats in a harness to hold them upright, tricking their brains into thinking their spines were uninjured. They then put a piece of chocolate a short distance away.

Attempting to walk towards the treat encouraged their bodies to grow new nerve connections around the injured section of spine to the artificially aided nerves. Within two to three weeks the animals were able to walk on their hind legs while supported by the harness. Within five to six weeks they could run, climb stairs and move around obstacles while in the harness, a sure sign that their movement was now being controlled by their brains, the scientists said.

The team, from the Ecole Polytechnique Federale de Lausanne in Switzerland, said they were hopeful the same method could be applied to human patients with similar injuries and that the first clinical trials could begin soon.

Gregoire Courtine, lead author of the paper, published in the journal Science, said: “Our rats have become athletes when just weeks before they were completely paralyzed. I am talking about 100 per cent recuperation of voluntary movement.

“With this vertical support the rats are on their hind legs so the only way to walk forward is to force the brain to be active? . . . the brain develops a completely new way to orchestrate the movement [of the legs].”

Dr Elizabeth Bradbury, an expert in spinal injuries at King’s College London, said: “This is groundbreaking research and offers great hope for the future of restoring function to spinal injured patients. However, some questions remain before we know how useful this approach may be in humans.”

She said the “Holy Grail” was still to find a way to let the damaged spinal cord regrow in its entirety.

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Too much sleep — either all at once or including naps during the day — may be just as bad as too little sleep

By Pamela Fayerman, Vancouver Sun July 17, 2012 10:15 AM

VANCOUVER — Seven hours — not more and not less — appears to be the magic number when it comes to how much sleep we need to keep our brains sharp and possibly avoid mental decline or even Alzheimer’s disease, according to the researchers of new studies presented in Vancouver Monday.

The preliminary (unpublished) research was discussed at the Alzheimer’s Association International Conference, being held here this week for about 4,000 researchers and Alzheimer’s experts.

Too much sleep — either all at once or including naps during the day — may be just as bad as too little; both are associated with mental decline. People who have disrupted sleep because of snoring and sleep apnea, or daytime sleepiness, are also more likely to experience mild cognitive impairment or dementia.

But whether sleep problems are a cause of mental decline, an effect, or both, is still open for more study, debate and proof.

“Is it a chicken or egg scenario? The truth is, we don’t yet know, and at this point, my guess is it’s bi-directional,” said researcher Elizabeth Devore, conceding that sleep problems aren’t exactly uncommon in people over 65. Indeed, more than half of those over that age have sleep disturbances that are also associated with many other health conditions like depression, stroke and cardiovascular disease — also risk factors for dementia.

However, Devore, of Brigham and Women’s Hospital in Boston, and other researchers, said that in all their studies, they took into account those confounding factors, and they still came up with results showing sleep and cognitive decline are linked.

“What we can say is that extreme sleep durations [too little or too much] may contribute to cognitive loss,” she said.

The research conducted by Devore and colleagues was based on data from more than 120,000 nurses who were aged 30 to 55 when they enrolled in the Nurses’ Health Study. They have answered questionnaires every few years and queries about sleep were added in 1986 and 2000. Cognitive testing was also done between 1995 and 2001, when the nurses were all at least age 70.

The researchers found that nurses who slept five hours a day or less had lower average memory and cognition scores than those who slept seven hours a day.

Those who slept at least nine hours a day also had lower cognition scores than those who slept seven hours.

An analysis of the results revealed that women whose sleep changed by at least two hours a day had worse mental function than those with no change in sleep time.

Dr. Kristine Yaffe of the University of California (San Francisco) said that in other studies on more than 1,300 women over age 75, those with sleep apnea or some other disordered breathing had more than twice the odds of developing cognitive impairment or dementia over a five-year study period, compared to those with no such breathing problems.

Women who had greater nighttime wakefulness, or insomnia, were more likely to get worse scores on cognition and verbal fluency tests. Sleep apnea (suspension of breathing during sleep) and snoring — which a third of the elderly experience — both decrease oxygen levels in the blood, causing a state called hypoxia.

Yaffe said she thinks hypoxia deserves far more study in the context of dementia. Referring to an unrelated study, she noted that in resuscitated cardiac arrest patients, there was a rise of blood amyloid levels immediately afterwards. Amyloid is a protein that accumulates in the brains of Alzheimer’s patients, causing sticky plaques. There may be a connection, then, between oxygen deprivation from something as banal as snoring, and dementia.

In light of the new findings, Devore said doctors should be assessing patients for sleep problems and referring them to sleep specialists who may be able to prescribe treatment to perhaps delay or prevent dementia. Machines called CPAPs have been shown in some small studies to improve cognition, she noted.

Presenting results from a continuing eight-year three-city study done on nearly 5,000 people in France, Dr. Claudine Berr told delegates that excessive daytime sleepiness, often necessitating napping, was an independent risk factor for cognitive decline.

By contrast, difficulty staying asleep was not associated with cognitive decline; in fact it appeared to have a protective effect, according to data from the National Institutes of Health and Medical Research study.

“It may be that excessive sleepiness, which was shown in our study to be associated with a 30-per-cent increased risk of cognitive decline, may be due to early stage brain lesions in areas [of the brain] associated with circadian rhythm abnormalities,” she said.

During the question and answer session with delegates, an American neurologist noted that some patients who are prescribed a hormone supplement called melatonin experience vastly improved sleep patterns. So instead of prescribing sleeping pills, doctors should think about recommending melatonin because of its safer profile.

There was general agreement that studies on melatonin and dementia prevention should be done and that doctors also need some standard prescribing guidelines for melatonin, which some people use for jet lag and insomnia.

Sun Health Issues Reporter

pfayerman@vancouversun.com

Triggers neuron growth, potential to regenerate brain cells: study

By Sheryl Ubelacker, THE CANADIAN PRESS July 6, 2012

TORONTO — A drug commonly used to control Type 2 diabetes can help trigger stem cells to produce new brain cells, providing hope of a potential means to treat brain injuries and even neurodegenerative diseases like Alzheimer’s, researchers say.

A study by scientists at Toronto’s Hospital for Sick Children found the drug metformin helps activate the mechanism that signals stem cells to generate neurons and other brain cells.

“If you could take stem cells that normally reside in our brains and somehow use drugs to recruit them into becoming appropriate neural cell types, then you may be able to promote repair and recovery in at least some of the many brain disorders and injuries for which we currently have no treatment,” said principal investigator Freda Miller.

“This work is happening against a background of a lot of excitement in the stem cell field about the idea that since we now know that we have stem cells in many of our adult tissues, then perhaps if we could figure out how to pharmacologically tweak those stem cells, then perhaps we could help to promote tissue repair,” added Miller, a senior scientist at SickKids.

The research, published online Thursday in the journal Cell Stem Cell, involved lab-dish experiments using both mouse and human brain stem cells, as well as learning and memory tests performed on live mice given the drug.

Researchers started by adding metformin to stem cells from the brains of mice, then repeated the experiment with human brain stem cells generated in the lab. In both cases, the stem cells gave rise to new brain cells.

They then tested the drug in lab mice and found that those given daily doses of metformin for two or three weeks had increased brain cell growth and outperformed rodents not given the drug in learning and memory tasks.

One standard test involves a water maze in which the mice must swim around until they locate a hidden platform.

“And the remarkable thing is the mice that got the metformin, what they showed was increased flexibility in terms of the way they learned the location of things,” said Miller, explaining that the drug-treated mice had a greater ability to learn and remember.

“If you then, for example, moved the platform some place completely different, the metformin-treated animals were remarkably good at just saying, ‘OK, things have changed’ and learning the new thing and (were) much better than the controls (untreated mice).”

Miller said it was serendipity that led the team to conduct the study. About 18 months ago, they found a pathway known as PKC-CBP that signalled embryonic neural stem cells to make brain cells. At about the same time, some U.S. collaborators at Johns Hopkins University found the same pathway was activated by metformin in liver cells — the means by which the drug controls glucose levels that go awry in diabetes.

Based on those findings, Miller’s team thought metformin might activate the same pathway in neural stem cells.

“I love this story because it’s a classic example of how very basic research into how things work has led to a potential therapeutic endpoint,” she enthused.

One big bonus for researchers is that metformin has been well-tested and long prescribed for a number of diseases, including metabolic disorders in children. The drug also has been shown to have anti-cancer properties.

“The advantage again is that because metformin has been in people from seven until 107, we have lots of safety data on it, we know exactly what kinds of doses, et cetera, et cetera,” she said. “So that’s a really huge plus with moving forward.”

When it comes to progressive neurodegenerative diseases such as Alzheimer’s, Miller said there is a lot of excitement among scientists about finding a drug that could recruit stem cells to produce healthy neurons, “at least to give people just a bit longer healthier cognition, if you will.”

Metformin might be such a drug, but the difficulty is that stem cells age and diminish as people get older, so it’s unclear whether there would be adequate numbers of healthy brain stem cells to produce new neurons that would have a therapeutic benefit.

Still, it’s a possible and worthwhile line of investigation, she said.

Miller’s team is already in discussions with clinical colleagues about launching a pilot study to test metformin in young patients with acquired brain damage, either as result of treating a childhood brain tumour or from a traumatic head injury.

Such a study would try to determine if the drug could increase brain cell mass — using a functional MRI scan, for instance — and measuring any improvement in cognition and behaviour.

If approved, Miller said a pilot study could begin within the next year or so.

 

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