Changes would ensure the viability of pharmacists and deliver greater transparency

TORONTO - The McGuinty government is proposing changes to its comprehensive drug strategy, including Bill 102, the Transparent Drug System for Patients Act, which will strengthen the legislation, ensure the viability of pharmacists, and secure better access to better drugs for patients, Health and Long-Term Care Minister George Smitherman announced June 6.

"We're on the side of all Ontarians who want and deserve better health care. That's why we're improving access to medications that improve their quality of life," said Smitherman. "These proposed amendments will help us to achieve fundamental objectives of the legislation, which is to provide Ontarians with better access to the drugs they need and ensure that taxpayers get value for their money."

<< The proposed government changes include:

- Narrowing the scope of the legislation to permit pharmacists to receive defined "professional allowances" under a new Code of Conduct, with a cap of 20 per cent of the generic cost in the public system

- Securing volume discount benefits for government on drugs purchased for the public system

- Including the Pharmacy Council and Citizen's Council in the legislation

- Instituting an automatic second review of decisions by the Committee to Evaluate Drugs or the Executive Officer to not list drugs

- Improving transparency by requiring the Executive Officer to prepare an annual report

- A clause in the legislation that specifically prohibits therapeutic substitution

- Establishing a joint working group with industry and the Ministries of Health and Long-Term Care, Research and Innovation, and Economic Development and Trade to promote investment in Ontario. >>

"The purpose of committee hearings on government bills, such as Bill 102, is to explore whether the legislation can be strengthened or enhanced," said Smitherman. "We have listened to the concerns of many groups including pharmacists, and the changes we're proposing address these legitimate concerns."

Today's initiative is part of the McGuinty government's plan for innovation in public health care, building a system that delivers on three priorities - keeping Ontarians healthy, reducing wait times and providing better access to doctors and nurses.

University of Guelph researchers have perfected a technique for injecting cancer cells directly into mouse ovaries, a breakthrough that could ultimately improve diagnosis and treatment of ovarian cancer. Biomedical sciences professor Jim Petrik will discuss this work and other research at Canadian Cancer Society’s Relay for Life June 9 at 9:45 p.m. in the Fergus Community Centre, 550 Bellside Ave. E.

Ovarian cancer is the fifth-highest cause of cancer deaths among Canadian women. “We’re hoping to lead the way to new drugs to effectively choke tumour growth,” said Petrik. “It’s a treatable disease if we can get to it early enough.”

Over the past 18 months, Petrik, Prof. Roger Moorehead and PhD student Jim Greenaway have developed a mouse model for in vivo testing of the disease. Petrik is already working with a pharmaceutical company making anti-angiogenic drugs, compounds that curtail blood vessel growth and effectively cut off a tumour’s supply of oxygen and nutrients.

Clinicians and other researchers are offering positive reviews of the new mouse model for ovarian cancer. Clinical oncologists who see the disease every day in their clinics are particularly interested in this work, said Petrik.

About 1,500 Canadian women die of ovarian cancer each year, and about 2,500 new cases occur annually, according to statistics from the National Ovarian Cancer Association. The disease is usually diagnosed only in later stages, earning it the nickname of the “silent disease.” Its vague symptoms include abdominal pain or swelling, nausea and bloating, all of which may be ascribed to other problems.

Until now, researchers have relied on artificially cultured clumps of cells and immuno-compromised mice that poorly mimic disease progression in normal animals.

In the U of G mouse model, ovarian cancer spontaneously occurs in about two months, allowing the researchers to follow tumour progression, including characteristic development of secondary lesions and fluid buildup. Petrik hopes to hunt down particular genes and proteins involved in that progression as candidate targets for early diagnosis and treatment.

Conceding that the disease and particular genes may not work exactly the same in mice and humans, he said researchers know enough about cancer genetics to suspect that certain biochemical pathways and early “biomarkers” may be common.

Petrik received a $500,000 grant from the Ontario Cancer Research Network to support this work. He and his U of G colleagues have been working with researchers at the University of Western Ontario and Harvard University and are discussing collaborations with an ovarian cancer research group at the University of Toronto.

Outside his Ontario Veterinary College lab, he has spoken about his work to cancer survivor groups and supporters.

“Women are so concerned about other women having to go through this,” he said. “I really try to stay grounded with my research, and I appreciate the opportunity to interact with people who make what I’m doing relevant.”

Along with Moorehead, Petrik is taking part in Friday’s Relay for Life fundraiser. The Relay for Life events and entertainment, beginning at 6:45 p.m. June 9, are open to the media and members of the public.

The 28th annual Guelph Sexuality Conference runs June 10 to 13 at the University of Guelph. Started in 1978, the conference is recognized as Canada’s largest and longest-running annual training and educational forum for sexual health professionals.

Focusing on the theme “Sexual Health for All: Promotion, Prevention, Advocacy,” this year’s conference includes a half-day workshop on intersexuality, the rarely talked about condition where physical sexual anatomy is either mixed or ambiguous at birth. Other topics on the agenda include sexual rights and health of people with disabilities, teen sex and sibling incest. Sessions related to sexually transmitted infections and the relationship between sex and religion are also planned.

“Despite some greater openness and willingness to talk about sexual concerns, there are still many individuals and communities who are denied information, who are marginalized, or are voiceless,” said Richard Barham, chair of the conference planning committee and retired U of G professor in the Department of Family Relations and Applied Nutrition.

“This year’s conference will assist professionals working in the area of sexual health move a little further on the road towards inclusiveness in providing for the health and well-being of an even greater part of our highly diverse community.”

The event will bring together more than 400 educators, nurses, physicians, therapists, social workers, clergy, students and other health professionals.

The conference is open only to registrants and the media. Media passes may be arranged in advance. A media registration desk will be set up on the ground level of the Thornbrough Building. It opens with a two-day sexual attitudes reassessment weekend June 10 and 11 designed to give participants an opportunity to assess their beliefs, attitudes and values regarding aspects of human sexuality, including developmental sexuality, sexual myths, extra-couple relationships, sexual abuse and cybersex.

Program Highlights

Monday, June 12

• “STI Clinical Update,” 9 a.m. to 4:30 p.m. is designed for nurses and physicians that offers leading-edge updates on the treatment and management of sexually transmitted infections.

• “Intersexuality – A Case of Emergency?,” 1:30 to 5 p.m., encourages health-care professionals to move toward a flexible understanding of intersexuality, rather than an “emergency” that needs to be fixed.

Concurrent sessions, 8:30 to 10 a.m.

• “Helping Couples Through the Crisis of Infertility,” focuses on the issues facing couples, techniques for overcoming communication obstacles and the infertility treatments available.

• “How to Conduct Successful Heterosexism and Homophobia Awareness Interventions and Why They Work."

Concurrent sessions, 10:30 a.m. to noon

• “Getting It On…line: The Teen Sex Information Program” explores an innovative program that trains peer volunteers to provide sexual health information to youth by phone, e-mail and instant messaging.

• “Intimacy, Inclusion and Mental Health: Practical Approaches."

Concurrent sessions, 1:30 to 3 p.m.

• “Friend and Lover, Sexuality After Spinal Cord Injury” shares the personal story of a couple who discuss making love and sharing life after a spinal cord injury.

Concurrent sessions, 3:30 to 5 p.m.

• “Exploring Attitudes Toward LGBTQ Individuals: Creating Allies for All — A Research Forum," a series of three research presentations followed by a question-and-answer period.

Opening plenary, 7:30 to 8:45 p.m.

• “Reflections on Sexual Health Education Over the Years."


Tuesday, June 13

Plenary address, 8:45 to 10 a.m.

• “Sexuality in Canada: What's Going on in Research, Education and Therapy?” an overview of the current state of Canadian academic research, sex therapy and youth sexuality education.

Concurrent sessions, 10:30 a.m. to noon

• “Contraception Update” is a session providing information on what’s new and on the horizon in the evolving field of contraception.

• “Supporting Parents as Primary Sexuality Educators Through Parent Education Programs."

Concurrent sessions, 1:45 to 3:15 p.m.

• “Muslim Immigrant Sexuality in Canada” is designed to familiarize participants with the cultural and religious perspectives that influence Canadian Muslims and outreach methods that respect those sensitivities.

Closing plenary, 3:30 to 4:45 p.m.

• “Claiming Our Moral Values: Sexuality, Faith and Spirit," a discussion about core moral values that are surrounded by faith and spirit, how sex educators address ethical and moral issues in their own work.

For more details and a full program of events, contact Lise Smedmor, manager of program development, (519) 824-4120, Ext. 53412. The complete program and registration form are available online.

TORONTO - The Ontario Public Service Employees Union says Ontario hospitals should open any and all new full-time nursing positions to experienced nurses including those now working part-time, not just new graduates.

The provincial government's recent promise that all graduating nurses would have "guaranteed jobs" could mean by-passing experienced RNs and RPNs now working part-time for new full-time positions.

A recent job advertisement in Grey Bruce Health Services (GBHS) was for new graduates (past 12 months) only, at all six hospital sites.

OPSEU Local 260 is filing grievances because GBHS failed to post positions internally and failed to inform the union, says Local President Jill McIllwraith. "Experienced nurses have been told they need not apply for these new full-time positions," she said. "Union members were denied job application forms, and were told by human resources to 'complain to their MP'(sic)."

"This is a slap in the face for nurses, here and across the province, who have worked hard, battled infectious diseases, and put their patients first for years, and now see nothing but disrespect from their employer and the McGuinty government."

OPSEU says the government seems to be making up health care policy as it goes along, without thinking of the consequences.

Companies failing to create detailed crisis management and business continuity plans are likely to find themselves at peril.

The avian flu virus, which has spread rapidly in wild-bird and fowl populations through Asia, Europe and Africa, has killed about half the people who have contracted the virus from birds. While the timing and severity of a worldwide pandemic are difficult to predict, the report warns that “to gamble that it won’t happen or its impact will be minimal could prove catastrophic for businesses.”

Responding to a flu pandemic requires a different kind of business response than natural disasters and other crises. “Unlike most business continuity planning efforts, coping with a pandemic requires a more holistic response,” says Ellen Hexter, Director of The Conference Board Integrated Risk Management Program and author of the report. “Most crisis management and business continuity plans are built on the expectation of loss of infrastructure or data, for example. An avian flu pandemic would be nearly the opposite, impacting the workforce in one’s own company and throughout the supply chain.”

The H5N1 avian flu virus first infected humans in 1997 in Hong Kong. Since then, it has spread via the bird population throughout Asia and into parts of Europe and Africa. Humans have contracted the disease primarily through improper handling of infected birds.

MANAGING A POTENTIAL DISASTER

Pandemic crisis management requires a range of tools, from scenario planning to creating global, company-wide strategies to deal with potential disasters. The creation of crisis management and business continuity planning can help transform risk mitigation strategies into business processes to manage extraordinary events.

The development of risk mitigation plans are transferable to other risk management areas and functions. Because a real pandemic would likely cause high employee absenteeism and damage a company’s ability to produce goods or services, an avian flu pandemic would have a global rather than a single-area impact.

BALANCING HUMAN NEEDS WITH CORPORATE NEEDS

The threat of a severe pandemic has driven many companies to develop detailed crisis management and business continuity plans. While first tending to the human needs of employees, their families and others, companies are now developing plans to deal with periodic and extended business interruptions.

“At the very least, companies ought to consider how to continue when work practices must be altered to reflect the reality of a changed environment,” says Hexter. “Meetings, travel, and even office environments can spread infection through an extensive population. Because of this, companies can play major rules in containing the spread of the virus if they plan adequately.”

For example, in October 2005, the Netherlands-based global bank ABN Amro set up a task force to plan company-wide strategy to deal with a potential flu crisis. It created plans to educate all employees about symptoms and appropriate responses; made the decision to not purchase anti-viral medication as a matter of principle; and emphasized ethical considerations of stockpiling drugs in light of their current scarcity. The group also recommended setting up a task force team in each country where the company operates to monitor the health environment.

After considering human needs, managers must face the challenge of assessing risks to the continued health of their businesses. Identifying key people and processes is necessary to sustain business in the face of a pandemic. Many companies are choosing to run scenarios of how to get work done with 20 percent to 30 percent of their workforce incapacitated—and even greater losses of workers in certain areas.

One global hotel chain is considering closing its properties in locations where the virus has spread. Other companies are considering shutting down non-critical processes or producing only key products. Roche has determined that it will attempt to continue to produce its anti-viral medication along with other life-saving medications.

ENTIRE SUPPLY CHAINS MIGHT BE THREATENED

“The interconnectedness of the global economy suggests that a business slowdown in one sector is likely to have an impact across many sectors,” says Hexter. “If travel comes to a standstill, airlines, hotels, restaurants, and convention businesses will start a ripple effect though local economies. Some companies may be hard pressed to make lease payments to their lenders, and financial institutions could face liquidity problems. Companies must consider the impact not only on their business, but on their entire supply chain.”

A GLOBAL CASH SQUEEZE AND LIQUIDITY CRISIS?

When developing scenarios and possible mitigation plans, companies must think about extra costs, loss of production or service delivery capabilities, and impacts to their cash flow and income. Companies are likely to continue to pay people as long as they are able--even when not producing or selling goods--contributing to a potentially significant cash squeeze and possibly a global liquidity crisis.

“Realistically, companies are unable to mitigate every potential risk because the costs are simply too high,” says Hexter. “But understanding the possible implications is important, and building enough financial flexibility in the form of additional liquid assets or access to increased lines of credit can cushion a temporary disruption of a normal business environment.”

Employee engagement is important when developing action plans. Besides ethical concerns, companies need to consider a vast range of issues, from increased security for IT systems, to supporting those working from home, to designing communications plans and back-up alternatives for employees and their families. Companies also must engage their suppliers and customers to ensure the viability of their supply chains, particularly for critical goods and services.

Human resources functions must remain intact in the event of an avian flu pandemic. Policies for continuing to pay employees, for adequate sick leave, and for when infected employees can return to work all need to be considered.

Establishing teams and plans to develop educational materials and policies for a potential pandemic is a way to help ensure the continuity of a business. The first line of communications may be to point employees looking for information to the World Health Organization’s website. Local emergency management teams should be the communications conduit to employees in specific areas. Protocols for interfacing with local health officials to accurately track infection and offer guidance should be developed.

“This kind of business continuity planning effort will lay the foundation for companies to begin thinking about expanding these policies into enterprise risk management,” concludes Hexter.

For more information on avian flu preparedness visit:
http://www.conference-board.org/knowledge/resources/resource_avianFlu.cfm

OTTAWA - The Canadian Institutes of Health Research's Institute of Population and Public Health (IPPH), the Canadian Public Health Association (CPHA), the Canadian Institute for Health Information's Canadian Population Health Initiative (CPHI) and the Public Health Agency of Canada (PHAC) are pleased to announce the six winners of the annual award program in applied population and public health research for Masters and PhD students enrolled in Canadian academic institutions.

This year's awards will be presented at CPHA's 97th Annual Conference being held from May 28-31, 2006 at The Fairmont Hotel Vancouver, 900 West Georgia Street, Vancouver, BC. Population and public health research aims to improve the health of populations in Canada and globally. These awards are designed to acknowledge excellence in the next generation of population and public health researchers, policy makers and practitioners.

The recipients and their winning research projects include:

Dr. John Hastings CPHA Student Award: -------------------------------------

Chantelle A.M. Richmond, a PhD candidate in the Department of Geography at McGill University, for her abstract "Societal resources and their implications for Aboriginal health in Canada."

PhD Level PPH Student Awards: -----------------------------

Dawn Smith, who has recently completed a PhD in Population Health at the University of Ottawa, for her abstract "Learning from Success: Evaluating Care with Pregnant and Parenting Aboriginal People."

Cat Tuong Nguyen, a PhD Candidate in the Department of Social and Preventive Medicine at the University of Montreal, for her abstract "Depressive disorders among young Canadians: associated factors of its continuity and discontinuity."

Masters Level PPH Student Awards: ---------------------------------

Karen Roberts, a MSc. Candidate in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University for her abstract "Predictors of Nutritional Risk in Community Dwelling Seniors."

Laura Nimmon, a M.A. Candidate in Health Literacy Education at the University of Victoria for her abstract "ESL speaking immigrant and refugee women's responses to creating and using participatory photonovels as a means to comprehend health information."

Marie-Jo Ouimet, MSc. Candidate in the Department of Social and Preventive Medicine at the University of Montreal, for her abstract "Conception de l'équité et performance des mutuelles de santé au Sénégal."

The University of Guelph is hosting an international conference June 4 to 7 on sustainable livelihoods and ecosystem health. The gathering is expected to attract policy-makers, researchers, practitioners and students from Canada, the United States and Europe.

The conference will allow participants to share ideas and experiences about everything from AIDS, climate change and disaster relief to asset-building and human rights, said organizer Prof. Tony Fuller of the School of Environmental Design and Rural Development.

“This is an opportunity to think about the complexity of the issues,” he said. “It’s not about problem-solving but systems thinking, where uncertainty and surprise are normal.”

He added that one of the conference’s goals is ensuring that key players consider the broad implications of policies and strategies for tackling threats to livelihoods and the environment.

Speakers will include Naresh Singh, recently named executive director of a United Nations commission on the legal empowerment of poor people. Formerly director general of governance and social development with the Canadian International Development Agency (CIDA), Singh is the co-author of Sustainable Livelihoods: Building on the Wealth of the Poor and is a former visiting fellow at Guelph’s Ontario Agricultural College.

Also on the roster is Mario Giampietro, director of the Unit of Technological Assessment at the National Institute of Research on Food and Nutrition in Italy. He's the author of Multi-Scale Integrated Analysis of Agroecosystems.

Fuller hopes the conference will foster new links between environmental and social agencies. They’re the kinds of connections he says are needed to cope with, or even anticipate, the effects of an epidemic or environmental disaster, from HIV- AIDS in Africa to a tsunami in Southeast Asia. “You have to mesh the ecological side with the human side,” he said.

The “Sustainable Livelihoods and Ecosystem Health: Informing Policy, Practice and Research” conference culminates two years’ worth of discussions and study under a project headed by Fuller called “Building Institutional Capacity.” That project, funded jointly by the University and CIDA, is intended to support rural development research and policy discussions involving policy-makers and development agencies.

Advance registration is required. For those unable to attend the entire conference, one-event pricing is available for the opening reception and dinner on Sunday, June 4. More information and complete registration details are available online.

"It will take a huge infusion of development aid -- as much as $70 billion annually -- to improve the health of the world's poor by 2015, the World Bank says," reports The Associated Press.

"Countries need the money to meet such health goals as fighting the spread of HIV/AIDS, malaria and other diseases, lowering child death rates and cutting mortality rates for mothers. 'Increased assistance on the order of $25 billion - $70 billion a year will be needed to achieve the millennium development goals for health,' the World Bank said Thursday in a 300-plus page report that examines health care financing worldwide."

The Press Trust of India further notes the World Bank report said "developing countries of the world, including India, must face the challenges of reforming their health financing systems to ensure that all their citizens get access to effective healthcare, while protecting their people against impoverishment due to catastrophic medical expenses . 'Buzzwords, flavors of the day, and magic bullets will not provide effective solutions to the health financing challenges faced by countries at all income levels. At this crucial global health crossroads, the report offers policy choices based on international evidence and economic principles for governments everywhere facing these enormous challenges,' say authors Pablo Gottret and George Schieber in the report 'Health Financing Revisited: A Practitioner's Guide.'"

The Hindu (India) adds that despite an unprecedented global focus on health as a humanitarian and national security issue, and dramatic increases in development aid for health, three million people died of HIV/AIDS last year alone. The average life expectancy in Africa is now 47 years. Without the ravages of HIV/AIDS, it would be 62. Tuberculosis is curable with low-cost drugs, and yet 5,000 people die everyday; the same is also true of malaria which daily takes 3,000 lives, mostly of youngsters.

The Financial Mirror (Cyprus) also notes that according to the report, "global health spending in 2002 was $3.2 trillion, about 10 percent of global GDP, but only some 12 percent of that was spent in low- and middle-income countries, mainly by patients themselves. High-income countries spend about one hundred times more on health per person than low-income countries, while developing countries have 90 percent of the world's disease burden. 'This report shows us how poor people in their developing countries face almost certain financial ruin in coping with catastrophic diseases without the financial protection that effective health systems in OECD countries routinely offer,' says Jean-Louis Sarbib, Senior Vice President for the World Bank's Human Development Network, which produced the new report. 'This inequity has tremendous consequences for the health of the world's poor since it means that falling sick to a major disease, and having to pay for a doctor out of their own pockets, is an automatic recipe for poverty.'"

Reuters meanwhile writes the study found that "demographic changes alone over the next 20 years will mean most low- and middle-income countries will face two to three percent annual increases in health-care spending, it said . Donor aid from governments, multilateral lenders and private foundations has grown to $10 billion in 2003 from $6 billion in the late 1990s, but only half of those funds make their way into national budgets with the rest going to consultants and administration. Rwanda, for example, currently has more than 50 donors in its health sector funding a variety of competing initiatives and hiring away scarce health-care workers from the public sector. Attempts to harmonize aid in education to match individual countries' policy goals is a good example for health donors to follow to maximize the effectiveness of their financing, said Sarbib. 'We need more (money). We need better coordination. We need an outcome focus,' Sarbib said. 'We need better evaluation.'"

Waterloo - Cigafree Incorporated, a Waterloo based stop smoking company will help businesses and their smoking employees cope with the “No Smoking in the Workplace” legislation that takes effect on May 31st.

Cigafree has developed a Workplace Seminar Series that provides a 3 prong support system for companies who want to help their employees cope with quitting smoking on the job.  What is distinctive about the Workplace Seminar Series is that it provides a quitting plan to follow, a certified trainer to coach smokers through the quitting process and effective quitting tools including the successful Ciganot Smokeless Cigarette which helps smokers manage their smoking behaviour . 

Cigafree president, Charlotte Whaley says, “it has been proven that the quitting success rate for any addiction dramatically increases within a peer group dynamic, that’s why providing a program with fellow employees can be extremely effective for the individual and ultimately beneficial to the overall bottom line of the company.”

May 31st is World No Tobacco Day and an incentive for smokers to make a clean break from their smoking habit.  Whaley says, “by providing tools and a program that has already proven to be successful, along with the encouragement of a stop smoking coach and peer group, the decision to live smoke free can become a reality.”

National Health Groups Recognize Benefits of Vitamin D

TORONTO - National health groups announced May 25, key findings from the first North American conference on UV, Vitamin D and Health, which took place in Toronto in March. The groups also identified areas where more research is needed about this topic.

At the conference, clinicians and researchers from the United States, Canada and Australia presented information about the health effects of Vitamin D, methods of obtaining Vitamin D - supplements, diet, and sunlight (sunlight contains both UVA and UVB radiation: UVB radiation promotes Vitamin D production in the skin) - and the health risks of UV radiation exposure.

Following the conference, national health organizations met to start developing consistent health messaging for the public about skin-cancer prevention and Vitamin D. These organizations represented the areas of cancer, dermatology, nutrition, public health, bone health and autoimmune diseases in Canada and the United States. The following key findings reflect this collaborative work. These findings will assist health clinicians, health-care providers and those working in health promotion in developing their own messaging for providing guidance to their patients and the public.

These key messages have been endorsed by the American Cancer Society, American College of Rheumatology, Canadian Cancer Society, Canadian Dermatology Association, Dietitians of Canada, National Council on Skin Cancer Prevention (US), Osteoporosis Canada, and the World Health Organization Collaborative Centre for the Promotion of Sun Protection. The key messages were also developed with technical support in consultation with staff from the US Centers for Disease Control and Prevention.

Key findings

1. There is strong evidence of the harms of exposure to UV radiation from the sun and other sources, including skin cancer, melanoma and some cataracts. Based on expert consensus, sun protection is required when the UV index is 3 (moderate) or higher.

2. There is strong evidence of the benefits of adequate vitamin D status on musculoskeletal health and prevention of fractures in the elderly. There is also a growing body of evidence that vitamin D may have beneficial effects on some types of cancer, in particular colorectal cancer. Experts are concerned that vitamin D status may be too low in the general population to achieve these health benefits.

3. Vitamin D is obtained through skin exposure to UVB radiation, and also through diet (particularly fortified foods) and supplementation. To minimize the health risks associated with UVB radiation exposure while maximizing the potential benefits of optimum Vitamin D status, supplementation and small amounts of sun exposure are the preferred methods of obtaining vitamin D.

The known risks associated with unprotected UVB exposure must be weighed against its benefits as a source of vitamin D. For example, it is possible that just a few minutes a day of unprotected sun exposure will increase vitamin D status, but for some, may also increase the risk of skin damage. Factors such as age, diet, skin pigmentation, geographic location and intensity of the sun will affect the amount of sun exposure needed to produce adequate vitamin D. More research is needed in this area before any more specific recommendations can be made.

4. Groups at risk of not obtaining adequate amounts of vitamin D include:

- the elderly;

- exclusively breast-fed babies;

- individuals with dark skin pigmentation;

- individuals with limited skin exposure to the sun (e.g. housebound, or those who wear clothing covering most of the skin for cultural/religious reasons); and

- those who during the winter are living above 37 degrees latitude (Canada and Northern US).

If you are concerned about adequate vitamin D levels, discuss supplementation with your health care practitioner. For breast-fed babies, vitamin D drops are available on their own (only in Canada), or as part of a multi-vitamin drop, and are recommended as a supplementation source by health authorities both in Canada and the USA. For adults, current recommendations are 200 IU/day up to age 50, 400 IU for 50-70 and 600IU over age 70. These recommendations are now considered too low by many experts for optimal health. The most appropriate supplementation level is likely to be above this but below the safe upper level of 2000 IU/day for adults. More research is needed to determine the optimal amount of vitamin D supplementation required to prevent health problems.

More research is needed to clarify the following issues:

- the optimum level of blood concentration and daily intake of vitamin D needed to maintain health;

- the amount of UVB exposure needed to synthesize optimum vitamin D in the skin; in particular, the appropriate recommendation given skin pigmentation, age and latitude. It appears that recommendations must be individualized based on age, skin pigmentation, geographic location and other factors;

- the long-term risks, if any, of lifetime ingestion of large quantities of vitamin D; and

- the level of vitamin D sufficiency that is clinically relevant, decreasing the risk of health problems, such as cancer.

Buying prewashed lettuce can save you time, but it can also make you sick, as close to two dozen U.S. consumers discovered last year. Now University of Guelph food scientists have found a more effective way of cleaning vegetables that can dramatically reduce the risk of contamination.

“Pathogens can actually get into the internal tissue of the lettuce,” said Prof. Keith Warriner of the Department of Food Science. “You can wash it for as long as you like, but you’re not going to remove all the pathogens because they can hide in cut edges and the pores of the lettuce leaves.”

When lettuce is harvested for bagged salads it’s kept cool in containers of water and then it’s washed again at the processing plant, he said. “If the water is contaminated, which it sometimes is, bacteria will be passed onto the lettuce, and simple washing can’t remove them.”

This could be what happened in October 2005 when 23 people in three states became sick from eating lettuce contaminated with E. coli O157:H7, said Warriner. Most people aren’t aware that, next to ground beef, fresh produce is the most common culprit in food-borne illness, he said.

At least 19 food-borne illness outbreaks have been linked to leafy greens since 1995, resulting in two deaths and 425 people becoming seriously ill, according to the U.S. Food and Drug Administration.

To find a way to eliminate pathogens in vegetables, Warriner, along with researcher Christina Hajdok, decided to apply the same method used to decontaminate food cartons. Like fresh produce, the surface of carton packaging material is full of crevices that can provide protective sites for microbes. Milk, juice and soup cartons are sterilized by being sprayed with hydrogen peroxide at the same time they are illuminated with UV light. The UV light converts the hydrogen peroxide into antimicrobial free radicals that penetrate into the packaging material to inactivate microbes.

To test this method on produce, Warriner artificially contaminated tomatoes, cauliflower, iceberg lettuce, romaine lettuce, Spanish onions and broccoli with Salmonella. After “cleaning” the vegetables using the hydrogen peroxide/UV method, “we managed to achieve 99.999-per-cent inactivation of the Salmonella,” he said.

This inactivation is huge in food-safety terms. “The good thing about hydrogen peroxide and UV is that they make free radicals that can penetrate right into the subsurface of vegetables so we can ensure the pathogens in the lettuce leaf can be inactivated, something that washing cannot do,” said Warriner.

You wouldn’t actually be consuming any hydrogen peroxide by eating vegetables that have been cleaned by this method, said Warriner. Plants contain enzymes called catalase that degrade hydrogen peroxide into water. “These free radicals are so short-lived that within seconds they do their job and are converted to water as the by product.”

Warriner has determined the optimal levels of hydrogen peroxide and exposure time. Next, he will test his decontamination method on produce contaminated with E. coli O157:H7 and viruses to show the true potential of the system. This new way of cleaning produce will not only make food safer to consume, but it should also extend the shelf life of products because vegetables are often spoiled by microbial action, said Warriner.

WATERLOO -- How electronic technologies can advance public health response times in emergencies is one of the topics to be addressed at a special University of Waterloo seminar on May 24.

The Smarter Health Seminar is presented by the Waterloo Institute for Health Informatics Research (WIHIR) and the InfraNET Project, based at UW. Health informatics is the discipline that investigates how information, information management, and information and communications technologies can deliver value in the area of health.

Guest seminar speaker is Dr. George Pasut, executive lead, Public Health System Transformation, Ontario Ministry of Health and Long-Term Care. His talk is titled "Ontario's Public Health E-Health Strategy-Supporting Public Health Renewal."

The public seminar runs Wednesday, May 24 from 3 to 4:30 p.m. in the Davis Centre, Room 1302, on the UW campus. There is no charge for the seminar. However, please register to attend or to view the live web cast at: link The names of people who pre-register are entered in a draw to win a BlackBerry.

The public health system is often described as an invisible component of the health-care system, working in the background to protect and promote health, as well as to prevent disease and injury at a local community and systemic level.

Over the last decade, the importance of a strong public health system has been highlighted by Canada's experience with infectious disease outbreaks, such as the Walkerton Ontario E. coli and North Battleford Saskatchewan cryptosporidium outbreaks, West Nile virus and the SARS outbreak.

Though those recent public health experiences have been largely shaped by infectious disease issues, epidemics of obesity and tobacco-related diseases also underscore the importance of integrated health promotion programs to ensure optimal growth and development and improved health at all ages.

But the public health system, along with much of the health-care system, has lagged other sectors in the development and implementation of e-health solutions.

"The presentation will offer an opportunity to learn about current developments, and exchange ideas on possible future directions," said Shirley Fenton, managing director of WIHIR. "The public health e-Health strategy has evolved along with the changes to the public health system."

The presentation will highlight several key priorities. These include a recently introduced province-wide information system for effective disease control and inter-jurisdictional information sharing for outbreak response, an "Important Health Notice" emergency alerting system, development of two communication portals to support collaborative planning, as well as planning of next generation public health case management information systems.

Pasut's ministry office is responsible for supporting the renewal of public health system, including an update of the public health legislation and program standards, and a response to the Capacity Review Committee recommendations that together frame a strategic direction for public health programs and services in Ontario.

Previously, Pasut was the medical officer of health and chief executive officer for Simcoe County, and following amalgamation, the Simcoe Muskoka District Health Unit. He also worked at the Ministry of Health as a senior medical consultant and physician manager in the Public Health Branch and as acting director of the Health Promotion Branch.