Can.Med.Assn Journal: OBESITY in CANADA: SPORT

Attack on so-called JUNK FOOD.

When teaching Public Health doctors, Emeritus Prof Nutrition G.BEATON PhD pointed out that there is NO JUNK FOOD. What is meant is CONCENTRATED food. All food has a nutrition value.

George Beaton, Ph.D


Professor Emeritus

Department of Nutritional Sciences

Department of Community Science,

Faculty of Medicine

University of Toronto

FitzGerald Building, Room 322

150 College Street

Toronto ON M5S 3E2 CANADA



Home Office Address (GHB Consulting):

9 Silverview Dr

Willowdale, Ontario M2M 2B2

CANADA

Tel: (416) 221 7409

Fax: (416) 221 8563

E-mail: g.beaton@utoronto.ca

Research

My long term interest relates to the estimation, interpretation and application of human nutrient requirements. A related interest in the assessment and evaluation of nutrient intake, and the error structure of dietary data (and implications for statistical analyses and interpretation of diet-based research). My interests extend into the area of assessment of efficacy and effectiveness of nutritional interventions in developing countries. In recent years I have been involved in two major efficacy studies - one relating to vitamin A and young child mortality and the other relating to comparative efficacy of daily and weekly iron supplementation. Both involved collection and secondary analysis of data from studies conducted in developing countries.

Although now retired I continue my activities and interests in a consultant role, working with UN agencies and national bodies (in Canada and the United States) involved in international nutrition. I no longer accept students but serve on study advisory committees when requested.

Selected Publications

Beaton, G.H., McCabe, G.P. Efficacy of Intermittent Iron Supplementation in the Control of Iron Efficiency Anaemia in Developing Countries: An Analysis of Experience. Micronutrient Initiative, Ottawa, 1999.

Tarasuk, V.S., Beaton, G.H. Women's Dietary Intakes in the Context of Household Food Insecurity. J Nutr 129:672-9, 1999.

Beaton, G.H. Recommended Dietary Intakes: Individuals and populations. Chapter 103 in Modern Nutrition in Health and Disease, 9th Ed. (M.E. Shils, J.A. Olson, M. Shike, A.C. Ross, eds.) Williams and Wilkins, Baltimore, 1999, pp 705-25.

Beaton, G.H. Iron needs during pregnancy: Do we need to rethink out targets? Am. J. Clin. Nutr. 72 (suppl):265S-71S, 2000.

SPORT TAXED in CANADA

Sport equipment and Sport Clubs have no TAX RELIEF. To outfit a AAA Goalie costs $5000 plus $750 TAX. A hockey AAA club can cost $3000/year TAX: $450.

UK DAILY MAIL: GYNESONICS Inc- " VizAblate FAST-EU"

Gynesonics initiates VizAblate FAST-EU study for uterine fibroid treatment


Gynesonics, Inc., a women's healthcare company focused on minimally invasive solutions for symptomatic uterine fibroids, today announced the start of, and initial treatments in, the FAST-EU Trial, a multicenter clinical study to demonstrate the effectiveness of the VizAblate® procedure for the treatment of uterine fibroids associated with heavy menstrual bleeding. The VizAblate® System is the only CE marked system that combines ultrasound image guidance with radiofrequency ablation to treat fibroids transcervically in an outpatient setting. Symptoms from uterine fibroids have been reported to affect as many as 24 million women in the European Union.



“The VizAblate® System represents a new and exciting approach to treating fibroids associated with heavy menstrual bleeding and has the potential to be a very important tool for the gynecologist. We are excited to be a part of this study and to have started treatments at our center.”



Centers in the Netherlands, the United Kingdom, and Mexico are participating in the study. Professor Hans Brölmann MD, PhD, Head - Department of Obstetrics and Gynaecology, Vrije Universiteit Medisch Centrum (FREE UNIVERSITY Medical Centre) in Amsterdam, Netherlands was the first physician to treat a patient in the FAST-EU study in the European Union. "The VizAblate® System represents a new and exciting approach to treating fibroids associated with heavy menstrual bleeding and has the potential to be a very important tool for the gynecologist. We are excited to be a part of this study and to have started treatments at our center."

Ontario College of Physicians & Surgeons (CPSO) reinvents the` medical wheel".

In the USA States, since the 1970s, about 150 hours of Category 1 CME`credits every three years is needed for a med.licence. Covered by two five-day conferences. The CPSO is copying the idea of compulsory CME.

At last the CPSO is facing the problem of patients physically threatening MDs to prescribe opioids. There is also the routine blackmailing of GPs to prescribe opioids with the threat of timewasting complaints to the CPSO. For the past 50 years USA MDs in many States,`have had two licences; one for medicine the other optional licence for prescribing narcotics. Many MDs do not need to prescribe opioids and do not pay for the optional licence.

The CPSO regulaly copies the Mother Country's General Medical Council. The latest fad is Revalidation.
The CPSO wants to check every Ontario MD at 10y intervals: shortened to every 5y. for the Over 70s.
The assessors are charitably less than brilliant. No really good MD has the time to snoop into another practice. A few honest CPSO assessors do admit that they "appropriate"good business ideas.

The biggest mass murderer in Medical history Late UK GP H.SHIPMAN won an award for practice efficiency. A past CPSO President GP. S.BAIN was convicted for not informing a patient and Public Health that a patient cought AIDS from a blood transfusion. CPSO Pres.BAIN was convinced, without actually asking the patient, that there was no physical marital activity. Bain was wrong. Mrs.Pitman sued and won
damages before she died from AIDS. (details on web).

The CPSO is at last going to have a look at shopfront Cosmetic surgery using general anaesthesia. This CPSO activity resulted from GP removing six litres of fat and fluid. GP B.YAZDANFAR who calls herself a Cosmetic surgeon is waiting for the penalty. The CPSO ignored the written warning of an Ontario GP "quackbuster" Terry POLOVOY.

Ontario docs`are expecting the retirement of CPSO CEO past-ER specialist R.V.GERACE.MD(1972)
An Internist with Legal qualifications and MBA woiuld be best.

LONDON,UK: REFRACTION COURSE

The course is for doctors wishing to refine their refraction technique with comprehensive preparation for the Refraction Certificate Examination. Lack of confidence and a haphazard examination under time pressure are the main reasons for failure in an OSCE examination. This course specifically focuses on these aspects so that attendees have an organised routine to achieve success.What is the content of the course?

The course covers, in demonstrations and practical workshops, the following topics:

Objective refraction - non-cycloplegic and cycloplegic retinoscopy

•Subjective refraction - sphere and cylindrical element

•Near addition

•Duochrome/+1 blur test/Binocular balance

•Muscle balance - with Maddox Rod and Prism Cover Test

•Trial frame fitting and Interpupillary Distance (IPD) measurement

•Refraction of a Model Eye

•Focimetry

•Lens neutralisation

•Visual acuity and refraction estimation

•Visual acuity testing in a child

What is the format of the day?

The day is divided into the morning session during which candidates will be shown detailed step-by-step demonstrations on how to successfully perform a refraction based on the RCOphth Refraction Certificate syllabus with vital tips. A course handbook covering how to carry out each practical station, with the relevant theory will be sent to candidates 2 weeks before the course date. The afternoon session consists of practical workshops with a 2:1 ratio of candidate to examiner. Candidates will work through all 16 OSCE stations outlined in the syllabus with subjects and all the necessary equipment provided, under the guidance of the examiner. At the end of the day, a mock Refraction Certificate Examination will be conducted. Candidates will be assessed based on the RCOphth Refraction Certificate Examination mark sheets and these will be made available to candidates with feedback on each station. Where is it?

The course is held at Charing Cross Hospital, Hammersmith. This central London location is easily accessible by public transport or car, with free parking available around the hospital.What is the cost of the course?

The London Refraction Course costs £445 including course handbook, lunch and refreshments. Early booking is advised, as spaces are limited.How many places are available?

To ensure candidates receive the highest possible standard of tuition the number of places available is strictly limited to ten, allocated on a first come first served basis. This will allow us to provide a 2:1 ratio of candidates to examiners.

UK:INDEPENDENT newspaper: ANTIBIOTIC RESISTANCE

Our last line of defence against bacterial infections is fast becoming weakened by a growing number of deadly strains that are resistant to even the strongest antibiotics, according to new figures given to The Independent on Sunday by the Health Protection Agency (HPA).



The disturbing statistics reveal an explosion in cases of super-resistant strains of bacteria such as E.coli and Klebsiella pneumoniae, a cause of pneumonia and urinary tract infections, in less than five years.



Until 2008, there were fewer than five cases a year in the UK of bugs resistant to carbapenem, our most effective intravenous (IV) antibiotic. New statistics reveal how there have been 386 cases already this year, in what the HPA has called a "global public health concern". Doctors are particularly concerned because carbapenems are often the last hope for hospital patients suffering from pneumonia and blood infections that other antibiotics have failed to treat. Such cases were unknown in the UK before 2003.



Years of over-prescribing antibiotics, bought over the counter in some countries, and their intensive use in animals, enabling resistant bacteria to enter the food chain, are among the factors behind the global spread. According to the latest figures from the World Health Organisation, some 25,000 people a year die of antibiotic-resistant infections in the European Union.



In a statement issued during a WHO conference in Baku, Azerbaijan, last week, the organisation warned that doctors and scientists throughout Europe fear the "reckless use of antibiotics" risks a "return to a pre-antibiotic era where simple infections do not respond to treatment, and routine operations and interventions become life-threatening."



More than 50 countries signed up to a European action plan on antibiotic resistance, unveiled at the conference, which includes recommendations for greater surveillance of antibiotic resistance, stricter controls over the use of antibiotics, and improved infection control in hospitals and clinics.



"We know that now is the time to act. Antibiotic resistance is reaching unprecedented levels, and new antibiotics are not going to arrive quickly enough," said Zsuzsanna Jakab, the WHO Regional Director for Europe. "There are now superbugs that do not respond to any drug," she added.



Dr Alan Johnson, a clinical scientist and expert in antibiotic resistance at the HPA, warned delegates at its annual conference last week that the problem is making some infections harder and in some, cases, virtually impossible, to treat.



Speaking to the IoS, he said: "We've had a problem of antibiotic resistance for as long as we've had antibiotics. The big problem at the moment is, for certain types of bacteria, we are seeing problems of resistance emerging and we don't actually have any new antibiotics in the pipeline to deal with them."



The rise is partially due to certain epidemic strains of bacteria that are well adapted to spreading between people, with the added complication that the genes encoding resistance in bacteria can move between different types, explained Dr Johnson.



People are largely unaware of the dangers of taking antibiotics, he added. "There's been a perception among doctors and the public that antibiotics are quite harmless. What we now know is that if, as an individual, you take a course of antibiotics you will almost certainly end up being colonised by antibiotic-resistant bacteria in the gut, because the bacteria mutate so rapidly. Now they may disappear and not be a problem, or they may sit there and next time you get an infection it could be due to the resistance that has persisted."



And one of the country's leading experts warned last night that Britain is very close to seeing the first cases of infections that are resistant to all antibiotics.



Professor Tim Walsh, an expert in antibiotic resistance at Cardiff University, said: "We are very close to having pan-resistant bacteria in this country. The consequence of this is that we are more or less back to the pre-antibiotic days of the 1920s, so these drugs that we've relied on for so long and taken for granted have now become obsolete because we've become complacent."



A rise in deaths will almost certainly result, claimed Professor Walsh, with people that have weakened immune systems among those at greatest risk.



Little is known about the toll on Britons, with the HPA admitting that it does not have "the mortality statistics for this resistance in the UK". It is calling on doctors to exercise caution when using antibiotics, and for hospitals to track cases of antibiotic resistance and stop the spread of the bacteria between patients.

COLUMBIA NY,ADRENAL CENTRE: ADRENAL INCIDENTALOMA

Adrenal Disorders: Incidentalomas

With improvements in the resolution and availability of abdominal scanning (i.e., CT, MRI, and USG), many small tumors are being found in the adrenal glands incidentally—i.e. when the scan is performed during the work-up for another reason. Up to 5% of patients undergoing an abdominal CT scan will have a small adrenal mass.

(of all Incidentalomas)

55% are nonfunctioning, benign adenomas

20% are a metastasis from another primary cancer, such as breast, lung, kidney, melanoma, or lymphoma

5% are a primary adrenal cancer

20% are a hormone producing tumor—i.e., a cortisol producing tumor, an aldosteronoma (CONN SYNDROME), or a pheochromocytoma

A tumor with a mass of 5 cm or larger has a greater likelihood of being malignant.

DiagnosisThe work up of an incidental mass discovered through abdominal imaging begins by evaluating the patient for signs and symptoms of hormone overproduction. The treatment for incidentalomas depends on 2 major factors: 1) whether or not the tumor is making excess hormone and 2) the chance of the tumor being cancer. These two factors are determined by obtaining the screening blood and urine tests previously outlined, as well as a CT or MRI scan. It is vitally important to exclude the possibility of pheochromocytoma prior to operating (on any part of the body for any indication), since surgery on unprepared patients with pheochromocytoma can be fatal.


TreatmentFunctioning adrenal tumors should be surgically removed to eliminate the source of the excess hormone production. Patients with a nonfunctioning adrenal mass that is less than 3 cm should be followed by abdominal imaging every six months. The likelihood of an adrenal tumor being a cancer is heavily dependent on the tumor size. Once a tumor has reached 5 cm, the risk of developing cancer outweighs the risks of surgical removal. Tumors that are 5 cm or greater, or that are rapidly growing should, therefore, be surgically removed. Typically the surgery can be performed laparoscopically, through several very small incisions. Tumors that are between 3 cm and 5 cm may be either removed or observed depending on the patient's overall health and preferences.

UK LONDON Liveryman Worshipful Soc.Apothecaries Dr. John GAYNER

Liveryman Dr.John GAYNER MBBS (Lond. 1970) is joint Hon.Sec of The Livery Companies Golfing Society.

jg@sloanedoc.co.uk

Clinic address:
6 SLOANE SQUARE,
London SW1W 8EE

Special interest : SPORT MEDICINE.