A University of Guelph chemist is helping to determine how a dangerous mould that forms on wheat and oats causes kidney cancer, which could have an impact on the allowable levels of the substance in Canadian food sources.

Prof. Richard Manderville is studying a type of mycotoxin – a naturally occurring toxin produced from fungi that often attach to grain crops – called ochratoxin A, to see why it causes cancer in animals.

A recent study by Health Canada found that the toxin is present in 50 per cent of Canadian breakfast cereals and many grain products.

“Mycotoxins should be a big, hot item in Canada because ochratoxin A thrives in northern wet climates and is the most potent kidney carcinogen that’s ever been tested by the National Toxicology Program in the United States,” said Manderville.

The problem is, this mould is naturally occurring in grain products and is difficult to prevent, said Manderville. “You can’t see it with the naked eye. The mycotoxins can be detected only because our analytical techniques are so good today. They’ve probably always been in our cereal; we just couldn’t detect them until recently.”

When wheat is processed into cereal or bread, a lot of the mycotoxins are eliminated, but not enough to meet international standards. They resist high temperatures, so cooking also doesn’t destroy them. “Canada produces great wheat, but if we’re not being stringent enough with our allowable levels of mycotoxins, the implications could be huge,” said Manderville.

Scientists currently don’t know how ochratoxin A causes cancer, but he suspects it acts as a genotoxin (something that damages DNA) and, after it’s metabolized, attaches to DNA, initiating a mutation that causes cancer.

Manderville and his research group are the first scientists in the world to assess the nature of DNA damage caused by this toxin. They have found that once ochratoxin A is oxidized, it tends to target the G-base of DNA to form an ochratoxin A DNA adduct. They are now chemically reproducing the adduct to incorporate into DNA using a DNA synthesizer in Manderville’s lab in U of G’s new science complex. He will structurally characterize the modified DNA and, in turn, study repair of the lesion and mutagenicity.

“We’re looking at how this modification alters DNA structure, such as stability of the duplex, and we’re going to determine if it’s mutagenic,” he said. His team is determining if affected DNA gets repaired naturally and, if not, the kinds of mutations that ochratoxin A causes. “Once we know the answers to those questions, that will provide the key for finding out how this molecule causes cancer.”

Currently, the allowable levels of ochratoxin A in food for humans is governed by its toxic properties in pigs. “If we establish that ochratoxin A is a genotoxin, the allowable levels of ochratoxin A in food will be decreased,” said Manderville. “This will be problematic for the food industry because it’s a natural product and they don’t know how to get rid of it.”

He notes that European scientists are working on procedures to prevent the mould from growing on their crops, and European health officials have set stringent regulations on the limits of the toxins in foods.

The University of Guelph researchers who earlier this month found a dangerous bacterium in food animals now have evidence that Clostridium difficile is in ground and processed meats sold in Canada.

Preliminary findings are being presented today in France at the World Buiatrics Congress by Alex Rodriguez-Palacios, a clinical studies D.V.Sc. student at Guelph’s Ontario Veterinary College.

But Guelph clinical studies professor Scott Weese, one of the study’s authors, is once again cautioning people against drawing premature conclusions.

“I want to reiterate that it’s too soon to conclude that the presence of the bacterium in meat automatically means people can become infected and develop C. difficile-associated disease through eating meat,” he said. “Finding this bacterium in meat is an important step in trying to determine whether C. difficile is a food-borne pathogen, but much more work is required to see whether there is any real risk.”

About 18 per cent of meat tested in Ontario contained the bacterium. A separate independent study by researchers at the University of Arizona found C. difficile in about 30 per cent of meat they tested. Similar research is also being done by the U.S. Food and Drug Administration, Food Safety and Inspection Services and National Institutes of Health.

Although the U.S. researchers found the human epidemic strain, it was not found in Ontario samples. But the majority of strains found in Ontario meat samples can cause disease in people.

C. difficile is recognized as the major cause of colitis (inflammation of the colon) and diarrhea. The bacterium is primarily acquired in hospitals and chronic-care facilities following antibiotic therapy covering a wide variety of bacteria, and is the most frequent cause of outbreaks of diarrhea in hospitalized patients. It has caused severe hospital outbreaks in Quebec and Great Britain, and in the United States alone, it causes about three million cases a year.

Earlier this month, Weese, who specializes in diseases that pass between animals and humans, his OVC colleague Henry Staempfli and Rodriguez-Palacios found the bacterium in the feces of about 11 per cent of dairy calves they tested in Ontario.

They found that the cattle strains were “indistinguishable” from those that have infected humans. Weese said there could be several explanations for this. The strains may be evolving in parallel in different species, for example, or there may be regular movement of various types of the bacterium among different species. "Further study is needed to evaluate these possibilities,” he said. Their study will be published in an upcoming issue of the journal Emerging Infectious Diseases.

Their follow-up research looked at ground beef and ground veal that was purchased randomly from grocery stores in Guelph and tested over a period of several months. Rodriguez-Palacios is presenting preliminary findings today in France, and the full study is expected to be published in upcoming months. Weese said they plan to expand the study to include other provinces.

WATERLOO - A University of Waterloo expert in rhetoric heads a study into links between language and how health-care professionals conduct themselves in their dealings with patients and other professionals.

Catherine Schryer, a professor of English language and literature, is researching the impacts of health-care communications, asking if something vital gets lost when a doctor explains an illness to a patient.

Schryer said the research project, Crossing Borders: Sites of Discursive Negotiation in Healthcare Practice, consists of three case studies, each investigating the role that a genre or a distinctive pattern plays in facilitating or not communication between different health-care professionals.

As a rhetorician (a specialist in the study into how we use language), Schryer does not confine her academic activities to the works of the great poets, dramatists and novelists. Rather, she has extended the field of English studies to include among other things, research into how language is applied.

Schryer, who is also director of UW's teaching resources office, is the principal investigator of the project, sponsored by the Social Sciences and Humanities Research Council of Canada. Project co-investigators are Dr. Lorelei Lingard, of the University of Toronto's faculty of medicine, and Dr. Marlee Spafford, of UW's school of optometry.

The project's first case study explores the production and reception of referral letters between optometrists and ophthalmologists.

The second one investigates the production of reports by pediatricians in a child abuse prevention clinic and the reception of those reports by social workers, police, lawyers and judges. The third studies the role that electronic medical records play in team communication situations in a cancer care clinic.

"Our program of study aims to connect research in health professions education to recent research in the role of language practices in the professional workplace," Schryer said. "What we are finding is that when the members of these professions transfer information from their patients or clients to other professionals, they rearrange it."

She said that doctors, for instance, ask patients to describe their problems and then restate that information in professional terms as they pass it on to consulting specialists, such as internists, oncologists and cardiac specialists.

Medical practitioners have special ways of relaying information about their observations, results of lab tests and diagnoses, to other practitioners, along with outlining the plans they have formulated for patients, including drug prescriptions, fitness programs, dietary changes and surgical procedures.

For example, a patient tells the doctor about an illness. The doctor immediately translates what the patient says into language that would be more meaningful to a medical professional, including a specialist to whom the patient may subsequently be referred. Such case reports differ considerably from the way in which a patient first gives information to his or her doctor.

"They almost never present cases in the order in which the patients have reported on their health or injury problems," Schryer said, adding that medical professionals only deal with details that have clear relevance to the case.

"The entire process has become something of a genre -- a distinctive pattern," she said. "The advantage of the translation done by the doctor is that it enables him or her to transmit information rapidly and accurately to other doctors."

But something always gets lost in the translation, including sometimes the ability to explain to the patient in their own terms the nature of their illness or injury.

Schryer wonders about some of the consequences such as: Is something lost, at times, when the patient's story is reconstructed? Or, might there be problems later on because the patient fails to understand what the doctor is telling him or her to do?

When her research team looked at the way language is used in doctors' case reports, they noticed language that seemed to turn the patient into a kind of object.

"Doctors do need to keep some distance between themselves and their patients," Schryer said. "However, the case presentation system may tend to objectify patients. The medical professional may refer to patients not as the 'people in such-and-such ward' but as the 'cystic fibroses in such-and-such ward' or refer to child patients' mothers collectively as 'the moms'."

Schryer sees her role as that of a rhetorician who can step back and ask questions, including What is language all about? How do we use it now? And how can we make better use of it in the future?

She adds that this could lead to more effective ways of using language and to a better appreciation of the significance of language in all aspects of our lives.

TORONTO - Minister of Health and Long-Term Care George Smitherman today provided the Grand River Hospital with notice of his intention to recommend to Cabinet that a supervisor be appointed for the hospital.

"The McGuinty government is committed to ensuring that residents of Waterloo Region have confidence in their emergency services," Smitherman said. "While I am pleased that the Grand River Hospital's emergency department will not close, we have more work to do. There are serious ongoing and outstanding operational issues at the hospital that must be addressed. I believe the appointment of a supervisor would be in the public interest."

The supervisor's initial mandate would be to work with the board of the Grand River Hospital to resolve the staffing issues at the hospital's emergency department and ensure the effective management of the department in the future.

Under legislation, the health minister must notify the board of a hospital at least 14 days before recommending to Cabinet that a supervisor be appointed. On the minister's recommendation, Cabinet may appoint a supervisor if it considers that it is in the public's best interest.

<< The minister also announced that:

- A team led by Ken Deane, President and CEO of St. Joseph's Health Centre in Toronto, has been appointed to review the management of emergency services at the Grand River Hospital and assist the hospital in resolving the operating issues in the emergency department as identified by the hospital's medical staff. Deane will be assisted by Dr. Marco Duic, medical program director of emergency ambulatory and access services at Toronto's St. Joseph's Health Centre. Other team members will be appointed shortly. The team will begin its work at Grand River Hospital on Monday morning.

- He will recommend to Cabinet that an investigator be appointed under the Public Hospitals Act to review the delivery of emergency services at hospitals across Waterloo Region and provide recommendations to the government.

- The government will continue to work with its partners in the health care sector to develop long-term solutions to stabilize physician coverage at emergency departments across the province. >>

"The McGuinty government will continue to work with hospitals and health care providers to develop a long-term solution to the emergency services staffing issue in Waterloo Region," Smitherman said.

"The people of Waterloo Region deserve access to the best emergency services," said MPP John Milloy. "We are working hard to stabilize the situation and ensure patient safety. The strategy the minister announced today will ensure this happens."

Family Health Teams: Kitchener-Waterloo now has 2 Family Health Teams, which are already providing primary care services to more than 1,500 former “orphan patients” in Kitchener-Waterloo. These teams include doctors, nurses, nurse practitioners and other health care professionals working together to provide comprehensive care day and night, extending into weekends. By working in a team atmosphere, supported by other health care professionals, it has been shown that doctors can treat up to 52% more patients than in solo practice.

Internationally-Trained Medical Graduates: The McGuinty government has more than doubled the number of training and assessments positions from 90 to 200 for internationally trained medical graduates. Since 2003, 750 new IMGs have begun practicing in Ontario Communities and another 470 are currently enrolled in training and assessment programs.

TORONTO - Toronto welcomes the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation, today until September 20 at the Metro Toronto Convention Centre for its 2006 Annual Meeting and OTO EXPO. The 8,000-delegate event is expected to generate more than $13 million in economic visitor spending throughout the Toronto region.

"We're honoured that the American Academy of Otolaryngology - Head and Neck Surgery Foundation selected Toronto for its first international annual meeting," said Bruce MacMillan, President and CEO of Tourism Toronto. "It has been a strong year for medical meetings, having already hosted global medical leaders in AIDS, psychiatry and osteoporosis."

<< The AAO-HNS by the numbers:

- 8,000-delegates
- $13 million in visitor spending throughout the Toronto region.
- 12 hotels across the Greater Toronto Area hosting delegates >>

About the IAFF

The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) is the world's largest organization representing specialists who treat the ear, nose, throat, and related structures of the head and neck. The AAO-HNS Foundation works to advance the art, science and ethical practice of otolaryngology--head and neck surgery through education, research, and lifelong learning.

Wash lunch bags and thermoses after each use. Seams and corners can harbour bacteria if not thoroughly cleaned.

Keep surfaces used to prepared lunches such as countertops, cutting boards and utensils, clean and sanitized.

Cook meats and poultry thoroughly. Cool them quickly and keep them refrigerated until the sandwich or salad is made.

Store perishable foods such as sandwiches or salads made with eggs, cooked meats or poultry, at 4ºC/40ºF or colder in the refrigerator. If a refrigerator is not available, be sure to use an insulated lunch box and reusable ice packs. Freezing juice or a water bottle that is packed with the lunch will also help keep the food cool.

Keep food items such as soups, stews and chili at 60ºC/140ºF or warmer. Keep them hot in a clean thermal container with a tight fitting lid.

When keeping hot foods hot and cold foods cold is not possible, consider foods that are safe to eat at room temperature. Bacteria do not grow in foods that are high in acid or low in moisture. The following foods are safe at room temperature: crackers, bread, cereal, peanut butter, whole fruits, dried fruits, canned foods, juice boxes, nuts and seeds.

By following these recommendations, you can protect yourself and your family from food poisoning and ensure that lunch is safely packed all year long. Have a safe and nutritious lunch!

If you have any questions about food safety, or would like information on the food safety training course, please call us at Region of Waterloo Public Health, Food Safety Program, 519-883-2008, or check out our website, at www.region.waterloo.on.ca/ph.

-expand services used in support of the cancer centre which includes the new HDR (brachytherapy) service for cancer patients

-provide improved infection control measures and update important safety infrastructure provide mechanical and electrical upgrades (including fan replacement and some engineering master plan (EMP))

The government is also providing $850,000 for the purchase of new equipment, including a treatment planning system.

“Upgrading and modernizing our hospital is essential to our government’s goal of providing a health care system that will help keep Ontarians healthy and get them good care when they are sick,” said Health and Long-Term Care Minister George Smitherman.

“This expansion means improved access to health care for our cancer patients,” said Dennis Egan, President & CEO, Grand River Hospital. “We’re dedicated to providing patients with the best cancer care and expanding our oncology services will strengthen our ability to continue doing so.”

This is just the latest example of how the McGuinty government is on the side of Ontario families when it comes to providing quality hospital care. Other initiatives include:

Increasing operating grant funding to hospitals to $12.9 billion in 2006/07, $13.4 billion in 2007/08, and $14 billion in 2008/09

Reducing wait times for five key health care services (hip and knee joint replacement, cataract surgeries, MRI exams, cancer surgeries and cardiac procedures) with a recent investment of $222.5 million

Issuing Requests for Proposals for 11 new hospital projects in 2006/07 worth $2 billion

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.

Investing in 2,091 New Procedures to Reduce Wait Times

WATERLOO REGION – The McGuinty government is continuing to reduce wait times in three key areas ¾ hip and knee joint replacements, cataract surgery and MRI/CT exams – with a total investment of $1,913,000 for St. Mary’s, Grand River and Cambridge Memorial Hospitals, John Milloy, MPP for Kitchener Centre announced September 12 on behalf of Health and Long-Term Care Minister George Smitherman.

“We’re making real progress when it comes to ensuring families in Waterloo Region have faster access to health care in their communities,” said Milloy. “This investment will provide people with faster access to better health services, to reduce their pain and suffering and keep them healthier.”

The $1,913,000 investment will result in 2,091 more procedures in Waterloo Region, including:

162 more total hip and knee joint replacements
850 additional cataract surgeries
450 more MRI operating exams
629 additional CT exams

Today’s announcement is part of the government’s province-wide investment of $50 million to provide a total of 127,200 additional medical procedures (hip and knee joint replacements, cataract surgery and MRI/CT exams).

To support patients and health care professionals, the government is also providing $58 million for additional services and programs. This includes supporting more rehabilitation programs, improving Ontario’s wait times information system and providing additional funding in areas of high need.

“Ontario is building an innovative system of health care delivery, where procedures are coordinated across the province to ensure patients get the timely care they need,” Smitherman said. “We’re developing unique new ways of tackling wait times, which will ensure that hospital resources are used as effectively as possible.”

Since 2004, the government has funded about 657,000 additional medical procedures. These investments have helped speed access to procedures in five key areas. As a result, people are getting the care they need more quickly in their communities. Patients are getting cataract surgery 61 days quicker than before, hip replacements 63 days sooner, knee replacements 52 days earlier and 28 days faster for MRI exams.

Lowering wait times for key medical procedures is just one of the ways the McGuinty government is working for families who want the best health care. Other initiatives include:

Creating 150 Family Health Teams to help improve access to doctors, nurses and other health care professionals for more than 2.5 million Ontarians

Increasing medical school enrolment by 23 per cent

Launching a $45-million HealthForceOntario strategy to attract more health care professionals to the province.

This 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.

Statscan released a 15 year old study that said Canadians born with a disability are likely to be happier than individuals who experienced a disability later in life, according to a new study that explores the determinants of subjective well-being among people with disabilities.

The study found that well-being, measured as self-reported levels of happiness, is independent of the type of physical disability. However, people with mental disabilities have lower levels of well-being than those with physical disabilities. Also, people with more severe disabilities are less happy than those with less severe disabilities.

Overall, about 21% of people with disabilities reported being "very happy", 65% "pretty happy", and the remaining 14% "not too happy".

This study, published recently in the journal Social Science & Medicine, was based on data from the 1991 Health and Activity Limitation Survey. It focused on individuals with disabilities who were not living in an institution.

The sample consisted of individuals whose everyday activities were limited because of a physical or mental condition. These conditions included mobility, seeing, hearing, speaking, agility and mental disabilities.

This study was unique in that it used national data, considered various types of disabilities, and controlled for a broad range of socio-demographic factors related to happiness. Psychologists, sociologists and, more recently, economists, have studied subjective well-being in detail.

However, almost all the studies focused on the general population. A handful of studies focused on individuals with disabilities, but they were limited in that they were not population-based, and their focus was people with specific types of disabilities.

Approximately one-sixth of the Canadian population reported some type of disability in 1991. This proportion will rise in the future because the number of seniors is increasing sharply, and aging is associated with higher rates of disability.

TORONTO - The Fraser Institute today launched the Hospital Report Card: Ontario 2006, a new report and interactive web site that assesses 50 measures of patient safety and quality of care for every acute care hospital in Ontario. The Hospital Report Card can be found at : www.hospitalreportcards.ca.

"The goal of this new Hospital Report Card is to contribute to the improvement of hospital care by providing quality of care information directly to patients and the general public. This will help people make informed choices about their health care and improve hospital performance through enhanced transparency and accountability," said Mark Mullins, co-author and executive director of The Fraser Institute.

Information is shown for all of the 136 acute care hospitals in Ontario from fiscal year 1997 to 2005, comprising more than 8.5 million patient records. The report also calculates the 50 indicators for all of the 138 municipalities in Ontario, based on patient location. Forty-three hospitals agreed to have their institutions identified by name in this Hospital Report Card. Other hospitals are anonymously shown in the report by number. "This constitutes the most comprehensive measure of acute care hospital performance and accountability in Canada available at the present time," said Mullins.

Among the 50 measures are death rates, adverse events, volumes and usage rates in three categories: hospital procedures, medical conditions and those related to child birth. A Hospital Mortality Index is calculated as a summary measure of mortality rates in the larger hospitals (where adequate data are available).

The Hospital Mortality Index assessment reveals that William Osler Health Centre in Brampton is the third top-ranked hospital over the past three years, while two anonymous hospitals are ranked first and second. Interestingly, all of the ten bottom-ranked hospitals over the past three years are anonymous. Stratford General Hospital, Ottawa Hospital (General Site), and Timmons and District General Hospital have all had consistently strong Hospital Mortality Index scores over the study period from 1997 to 2005.

The three top-ranked municipalities over the past three years (based on patient location information) are Arnprior, Maple and Stratford. Of the five largest municipalities in Ontario, Hamilton is the highest ranked at 22nd out of 105 municipalities over the past three years, and Toronto is the lowest ranked at 39th out of 105 municipalities.

"For the first time in Ontario and in Canada, patients and the general public will be able to assess the quality of care delivered by their local hospital in a detailed manner," said Mullins. "This is a momentous occasion. Therefore, we congratulate the forty-three hospitals that opted to participate in the study and look forward to a more informed discussion on the state of hospital care in this country."

Important Note on Methodology

The report uses a state-of-the-art indicator methodology, developed by the U.S. Agency for Healthcare Research and Quality (AHRQ) in conjunction with Stanford University, that has been shown to reflect quality of care inside hospitals.

These indicators are presently in use in a dozen U.S. states, including New York, Texas, Florida and California. In Canada, the Manitoba Center for Health Policy released a report in June 2006 using the AHRQ patient safety indicators. In addition, the OECD recommends this approach by noting that "this set of measures represents an exciting development and their use should be tested in a variety of countries."

The report is based on anonymous patient-level data purchased from the Canadian Institute for Health Information (CIHI). These data are used to produce various CIHI reports and indicators, including annual reports on the performance of the health care system and seven of the health indicators adopted by the federal, provincial and territorial governments. The Ontario Hospital Association, in affiliation with CIHI and the Government of Ontario, uses the same patient information that underlies the Fraser Institute's Hospital Report Card in its acute care hospital report.

It is important to note that the 50 indicators and the Hospital Mortality Index are applicable only to acute care conditions and procedures for inpatient care. The results cannot be generalized to assessing the overall performance of any given hospital. It is also not recommended to choose a hospital based solely on statistics and descriptions such as those given in this report.