Considerations for the design of nutrition-sensitive production programmes in rural South Africa.

BACKGROUND: Very little has been researched about the efficacy, effectiveness, feasibility, sustainability and impact of food-based approaches on the diets and nutritional status of populations at risk of hunger and food insecurity. This study contributes knowledge about the impact of food-based approaches on the diets of populations at risk of hunger and food insecurity in four of the poorest rural communities in South Africa. The study investigated the consumption and production patterns of rural households (278 in summer and 280 in winter) in four sites in the poorest municipalities in South Africa. METHODS: A multistage stratified random sampling technique was applied to identify the communities and sample households for the quantitative survey and qualitative assessments. Qualitative and quantitative data were collected between 2013 and 2015 through focus group discussions (FGDs), key informant interviews and the two-round panel survey to cover both the summer and winter seasons at each site. RESULTS: Home gardening led to a significant positive increase in the consumption of white roots and tubers, dark green leafy vegetables, orange-coloured fruit and other fruit in the 24 h prior to the survey. Participation in a community garden led to significant increases in the consumption of dark green leafy vegetables and other vegetables. School gardening did not demonstrate any statistical relationships with the consumption of foods from the crop-related food groups. Crop production improved dietary diversity. Selling produce and irrigation showed a stronger improvement in dietary diversity. Seasonality affected the availability of fresh fruit and vegetables for home consumption in winter. CONCLUSIONS: Producing beyond that solely for home consumption has greater benefits for dietary diversity and a consumption-smoothing effect during the post-harvest period. Politicians and the scientific community should recognise the role that household and small-scale crop production plays in supporting household consumption and the provision of essential micronutrients despite constraints and disincentives. Production and education programmes should focus on strengthening existing good consumption patterns and promoting the consumption of foods that can improve dietary diversity.

Binding interactions of algal-derived dissolved organic matter with metal ions.

The nature and composition of dissolved organic matter (DOM) strongly influences its binding properties to heavy metals and thus their fate, mobility and toxicity in aquatic environments. Fluorescence spectroscopy with parallel factor analysis (PARAFAC) was used to characterize DOM exuded by the cosmopolitan freshwater green algae Scenedesmus acutus during early exponential growth phase. One protein-like (peak T; C2) and two humic-like components (peaks A+C and A+M, C1 and C3, respectively) were split half validated on 122 emission-excitation matrices (EEMs). Our data show that both humic-like could be associated with biological activities. Unlike Cd, Pb and Zn, Cu strongly binds to algogenic DOM with conditional stability constants (logK) averaging 5.26±0.29 (from 4.85 to 5.36). Significant differences in logK values were found between humic-like PARAFAC components, indicating clear differences in the binding properties of humic-like components with copper.

Cost-minimization analysis of CHOP, fludarabine and rituximab for the treatment of relapsed indolent B-cell non-Hodgkin's lymphoma in the U.K.

The optimal therapy for patients with relapsed indolent B-cell non-Hodgkin's lymphoma is unclear. Combination chemotherapy such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) or purine analogues including fludarabine are frequently used and the anti-CD20 monoclonal antibody rituximab has recently been licensed for use. However, no comparative studies of these therapies have been reported. Since relapsed indolent B-cell NHL is generally regarded as incurable with current therapies, the place of each of these therapies is likely to be determined by their relative efficacy, toxicity and cost. We undertook a literature review and a retrospective analysis of patients receiving combination chemotherapy for relapsed indolent B-cell NHL at our institution to determine the response rates and the duration of response when treated with CHOP or fludarabine. Reported response rates and median response duration for these regimens are similar, and similar to those reported in phase II studies of rituximab. A cost minimization analysis was therefore conducted. The per patient costs for the treatment of drug-related adverse events were pound 5049 for CHOP, pound 2953 for fludarabine and pound 109 for rituximab. When costs of a full course of each treatment were compared, the costs per patient for CHOP, fludarabine and rituximab were pound 7210 (pound 5975-8445), pound 10022 (pound 8917-11126) and pound 6080 (pound 5892-6267) respectively. In this preliminary analysis, rituximab appeared to have a similar efficacy rate to CHOP and fludarabine, but had significantly fewer adverse events and a lower total cost per patient. These data require confirmation in a prospective randomized study with formal assessment of cost-effectiveness.

Dornase alpha and survival of patients with cystic fibrosis.

Dornase alpha can offer substantial clinical benefits to cystic fibrosis patients, but its long-term impact is as yet unknown. This article attempts to model the impact of continuous dornase alpha use on patient survival and its cost implications for the health-care provider.

Burden of illness review of obesity: are the true costs realised?

Obesity can no longer be viewed as merely a cosmetic or social problem, but must be acknowledged as a serious disease, responsible for the premature death and morbidity of millions and for significant expenditure of limited healthcare resources. In addition, there are significant costs to the individual with regard to social status and quality of life. It has been argued that obesity is one of the most important preventable causes of ill health in the UK today. This is especially important when one considers that the incidence of obesity is actually rising, with 13% of men and 16% of women in the UK in 1997 being obese. To begin treating such a disease it is essential to raise awareness of this problem, not only from the associated morbidity and mortality risks that have been well documented, but the socio-economic and psychological costs. This paper reviews the literature available globally, giving some measure of the magnitude of the associated burden of illness.

New patients presenting to their GP with dyspepsia: does Helicobacter pylori eradication minimise the cost of managing these patients?

Fifty-seven patients newly presenting to their GP with dyspepsia agreed to take part in a pharmacist-led clinic which tested and treated for Helicobacter pylori. Of these patients, 63% (36/57) tested positive and received eradication therapy. For 78% (28/36), eradication was successful with the first course of treatment, 89% (25/28) remaining symptom-free over the six-month follow-up. Eradication was successful for a further 17% (6/36) after a second attempt; again, these patients remained free of symptoms over the follow-up period. Thus, of the initial patients, 54% (31/57) were successfully treated, with no further symptoms. Such results had significant consequences on the expected direct cost of management per patient from a GP viewpoint. Using decision analysis it was found that H. pylori eradication for patients presenting with dyspepsia for the first time could result in considerable cost savings per patient in the long term.