Discounts on fruit and vegetables combined with a space management intervention increased sales in supermarkets.

BACKGROUND/OBJECTIVES: To examine the effects of two interventions on consumer purchases of fruits and vegetables (F&V) on the Danish island of Bornholm: a 20% discount on F&V combined with improved shelf-space allocation, and improved shelf-space allocation alone. SUBJECTS/METHODS: A space management intervention to promote F&V sales was performed in two large discount supermarkets on Bornholm in Denmark for 3 months (September-November 2012). In addition, a 20% discount on F&V was introduced for 3 months in one of the supermarkets ('space + price'). The effect was evaluated using sales data from the two intervention supermarkets and three control supermarkets from the same supermarket chain but in Odsherred, Denmark (control area). Both the effect on sales of fresh F&V and potential unhealthy substitution effects were evaluated using multi-level regression analyses. RESULTS: During the price intervention period, the index number for sales of fresh vegetables increased by 22.2% (P=0.001) in the 'space + price' intervention supermarket compared with the control supermarkets. Furthermore, the index number for the sale of organic fresh fruit and vegetables increased by 12.1% (P=0.04) and the sale of the total amount of fruit and vegetables (fresh, frozen, dried and canned) increased by 15.3% (P=0.01) compared with the control supermarkets. In the 'space only' intervention supermarket no significant increase in the sale of fruit and vegetables was found. No unhealthy substitution effects were found. CONCLUSIONS: In conclusion, a 20% price reduction on F&V significantly increased sales of F&V. The effect was most pronounced on vegetables and no negative/unhealthy substitution effects were found.

Updated Swiss guidelines for the treatment and follow-up of cutaneous melanoma.

Melanoma is the most common lethal cutaneous neoplasm. In order to harmonize treatment and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland have been inaugurated in 2001. These have been approved by all Swiss medical societies involved in the care of melanoma patients. New data necessitated changes concerning the safety margins (reduction to maximally 2 cm) and modifications of the recommendations of follow-up.

Distribution of human Oesophagostomum bifurcum, hookworm and Strongyloides stercoralis infections in northern Ghana.

A cross-sectional study was carried out in 216 randomly selected, representative rural villages in the northeastern part of Ghana from March 1995 to May 1998. Inhabitants of randomly selected households, stratified by age and gender, were included. The geographical position of villages was recorded with a global positioning system (GPS). The prevalence of Oesophagostomum, hookworm and Strongyloides stercoralis infections in a study population of 20250 people was determined by microscopic examination of larvae in stool cultures. The overall prevalence was 10.2, 50.6 and 11.6% for the three nematodes, respectively. Hookworm infections were seen in all but one (99.5%) and S. stercoralis in 88.4% of the 216 villages, while Oesophagostomum infections were found to be common in a limited area with prevalences varying from 0 to 75%. An association was found between Oesophagostomum and hookworm infection, both at the individual and at the village level. Spatial analysis of the prevalence data indicated that the endemic area is relatively clearly demarcated to the south of the study area.

Lymphatic filariasis-specific immune responses in relation to lymphoedema grade and infection status. I. Cellular responses.

The filariasis-specific cellular responsiveness was assessed in 109 adult individuals from a Wuchereria bancrofti-endemic area in north-east Tanzania. There were 9 study groups. Five groups of individuals were negative for microfilariae (mf) and specific circulating filarial antigen (CFA) and had leg lymphoedema of varying severity ranging from early to more advanced grades (pathology groups 1-5). Another group comprised individuals with mixed grades of lymphoedema and positive for mf and/or CFA (mixed pathology group). Three asymptomatic groups consisted of individuals without leg pathology but with different infection status: (i) CFA- and mf-negative individuals, (ii) CFA-positive but mf-negative individuals, and (iii) CFA- and mf-positive individuals. Peripheral blood mononuclear cells were collected and proliferative responsiveness and secretion of interleukin (IL)-4, IL-10 and gamma interferon (IFN gamma) were measured upon stimulation with a Brugia pahangi antigen. No distinct differences in responses were observed between the 5 uninfected pathology groups. Instead, responses were associated with infection status, with generally higher proliferative activity and higher levels of IL-4 and IFN gamma in uninfected as compared to infected individuals. High levels of IL-10 were observed in asymptomatic individuals without infection and in asymptomatic CFA-positive but mf-negative individuals. Asymptomatic individuals with mf had relatively low IL-10 levels. Groups presenting with chronic pathology generally had low levels of IL-10 independently of infection status. The findings thus give no immediate indication that the measured immunological parameters are related to progression of leg pathology. However, alternative interpretations are presented which suggest a possible role of immunological reactions in development of pathology in lymphatic filariasis.

Lymphatic filariasis-specific immune responses in relation to lymphoedema grade and infection status. II. Humoral responses.

The filarial-specific humoral responses (IgG1, IgG2, IgG3, IgG4 and IgE) to a Brugia pahangi antigen was assessed in 9 groups of adult individuals from a Wuchereria bancrofti-endemic area in north-east Tanzania. In 5 of the groups, individuals were negative for microfilariae (mf) and circulating filarial antigen (CFA) and had leg lymphoedema of varying severity ranging from early to more advanced grades. A 6th group had mixed grades of lymphoedema and were actively infected with mf and/or CFA. Three groups of asymptomatic individuals with different infection status (mf+CFA+; mf-CFA+; mf-CFA-) were also included. No differences in the antibody levels were observed between the 5 uninfected pathology groups. However, groups with advanced lymphoedema had a significantly higher level of IgG3 as compared to groups with early lymphoedema. A decline in the IgG4/IgE ratios were observed when moving from groups with early to groups with more advanced lymphoedema, which could indicate that increasing levels of IgE relatively to IgG4 are associated with progression of pathology. When all study groups were compared, higher IgG4/IgE ratios were observed in infected groups than in uninfected groups. This could suggest that high levels of IgG4 relative to IgE protect the parasite, whereas the opposite may play a role in parasite killing. When relating IgG4/IgE ratios to levels of gamma interferon (IFN gamma), a clear inverse relationship was observed. Thus, high levels of IFN gamma were found in groups with low IgG4/IgE ratios (uninfected groups) and low levels of IFN gamma were found in groups with high IgG4/IgE ratios (infected groups). The relationship between cellular (IFN gamma) and humoral (IgG4/IgE ratios) responses and their possible role in parasite protection and killing, and in development of early lymphoedema, are discussed.

Prevention campaign against skin cancer.

BACKGROUND: The melanoma incidence has increased over recent decades. Educational campaigns aim to encourage protection from the sun and early detection of melanoma. METHODS: During a campaign in Switzerland, information on risk factors, sun protection and melanoma prevention was distributed. 10987 people completed a questionnaire regarding risk factors, and 2746 people were examined by a dermatologist. RESULTS: Men had a higher risk as assessed by skin type, ultraviolet exposure, family history, number of moles and sunburns during childhood. Changes in moles were reported significantly more often by people with: (1). a positive family history (p < 0.0001); (2). multiple moles (p < 0.0001), and (3). sunburns during childhood (p < 0.0001). A precancerous or cancerous condition was suspected in 16% of individuals examined. CONCLUSION: Early detection of melanoma can be achieved by this type of campaign. Primary prevention is a long-term approach and educational efforts targeting risk groups must be continued.

Lymphatic filariasis in Lower Shire, southern Malawi.

Surveys for lymphatic filariasis were carried out for the first time in Lower Shire (Nsanje and Chikawawa Districts) of southern Malawi, in April-June 2000. There were 3 phases. In phase I, questionnaire surveys in 48 randomly selected villages indicated that chronic manifestations of lymphatic filariasis ('swollen scrotum' and 'swollen legs') were common and widespread in the area. In phase II, volunteers from 10 of the villages reporting frequent manifestations of filariasis in phase I were examined with the ICT whole-blood test for Wuchereria bancrofti-specific circulating filarial antigen (CFA). The observed prevalence of CFA positivity was very high (range, 38.8-79.1% for the villages). In phase III, a more detailed parasitological, CFA and clinical investigation was carried out in 2 of the high CFA prevalence villages identified in phase II (1 in each district). Overall, 18.1% and 22.2% were positive for microfilariae, and 62.3% and 64.6% were positive for CFA in the 2 villages. Among those aged > or = 15 years, 3.7% and 1.3% had leg elephantiasis, and 17.9% and 13.0% (of males only) had hydrocoele. In both phase II and III, CFA prevalences were unexpectedly high, especially in children. This was probably related to a recent increase in transmission of filariasis as a result of extensive flooding in the area prior to the study. The study indicated that lymphatic filariasis is highly endemic in the Lower Shire area of Malawi, and calls for action towards its control.

Perforation of the ileum due to foreign body treated laparoscopically.

Laparoscopy has gained widespread acceptance in the setting of acute abdominal pain. We report the case of a patient with acute abdominal pain in the right lower quadrant that proved to be due to a fish bone perforation of the ileum at laparoscopy. The fish bone was retrieved and the perforation closed laparoscopically. Laparoscopy is a powerful diagnostic and therapeutic tool and should be used routinely in patients with acute abdominal affections.

Swiss guidelines for the treatment and follow-up of cutaneous melanoma.

Melanoma is the most common lethal cutaneous neoplasm. There is major controversy over the best management of this malignancy. In order to harmonize treatment and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland have been inaugurated. They have been approved by all Swiss medical societies involved in the care of melanoma patients.

Bulinus nyassanus is an intermediate host for Schistosoma haematobium in Lake Malawi.

At Cape Maclear on the Nankumba Peninsula, close to the southern end of Lake Malawi, Schistosoma haematobium is highly prevalent in the local people and many tourists become infected with this parasite each year. A 'Bilharzia Control Programme' was initiated in this area in August 1998, as a development collaboration between the Government of Malawi, the Danish Agency for Development Assistance (Danida), and the Danish Bilharziasis Laboratory. Although Bulinus globosus is a known host for S. haematobium, B. nyassanus has not previously been incriminated as an intermediate host. However, schistosome-infected B. nyassanus were discovered in surveys to identify transmission sites on the peninsula. Experimental infections of wild-caught B. nyassanus with S. haematobium proved successful and S. haematobium eggs were found in hamsters experimentally exposed to cercariae retrieved from schistosome-infected, field-collected B. nyassanus. These are remarkable observations since, although there are very few reports of diploid members of this species group being experimentally infected with S. haematobium, B. nyassanus is a diploid member (2n = 36) of the truncatus/tropicus group. Bulinus nyassanus is probably responsible for transmission in Lake Malawi, along rather exposed shorelines, devoid of aquatic macrophytes, with a substrate of sand or gravel.

Doses near the surface during total-body irradiation with 15 MV X-rays.

An extended source-surface distance (SSD) is often employed in total-body irradiation (TBI) to obtain fields sufficiently large to encompass the total body. It is clinically desirable to administer a uniform dose to all tissues, including the surface, especially to counteract the skin-sparing of high-energy X-rays. The electrons generated from the air contribute more to the dose near the surface at extended distances than at regular SSDs. However, if further increase of the dose at shallow depths is desired a spoiler can be employed. Monte Carlo simulations were used to study these effects for the electron component of the beam and the parameters needed for the pencil-beam dose calculation of this component. Measurements were performed to confirm these studies. The energy spectrum of electrons generated in air is independent of SSD. All the electrons in the beam, however, originate from the spoiler when one is used. The spectrum of these electrons is nearly independent of the SSD. The pencil-beam dose kernels were calculated using the derived electron spectra. To calculate doses in the buildup region with and without a spoiler, we use one pencil-beam kernel for the electrons generated in air and one for the electrons generated from the spoiler. Measured depth-dose data agreed with the calculation results.

Beam spoilers versus bolus for 6 MV photon treatment of head and neck cancers.

When parallel opposed 6-MV x-ray beams are used for treatment of head and neck tumors, superficial tissues and lymphatics at shallow depths of < or =4 to 6 mm may be at cancer risk but receive less than full radiation dose. In these cases, the use of either a beam spoiler or bolus material can increase dose to superficial tissues. The potential benefit of a beam spoiler relative to bolus is preservation of skin-sparing characteristics for cases in which the skin surface does not require full dose. In this study, we evaluate the application of a beam spoiler and compare it to bolus for standard treatments of head and neck tumors. Measurements of both depth dose in-water and in-air profiles were made with a beam spoiler for a 6-MV photon beam. The measurements were combined with Monte Carlo calculations to obtain the energy spectrum of the spoiler-generated electrons. An in-house pencil beam treatment-planning algorithm was used to calculate the dose distribution with spoiler. The dose distribution in the buildup region was then studied with and without the spoiler for a typical head and neck treatment with parallel-opposed beams. Dose distributions and partial-volume dose histograms (PVDH) demonstrate the benefits provided by spoilers for the head and neck treatments and the limitations of their use. The beam spoiler is useful in treating the superficial lymphatics in the buildup region near head and neck tumors. Guidelines for use of beam spoiler versus bolus are discussed.

Prevalence and distribution of gastro-intestinal helminths and haemoparasites in young scavenging chickens in upper eastern region of Ghana, West Africa.

We conducted a cross-sectional study to determine the prevalence and species of gastro-intestinal helminths and haemoparasites in 100 chickens kept under extensive management systems in Ghana, West Africa. All the examined chickens (100%) were infected with gastro-intestinal helminths; a total of 18 species were detected. The species and their prevalences were: Acuaria hamulosa (25%), Allodapa suctoria (20%), Ascaridia galli (24%), Capillaria spp. (60%), Choanotaenia infundibulum (13%), Gongylonema ingluvicola (62%), Heterakis gallinarum (31%), H. isolonche (16%), Hymenolepis spp. (66%), Raillietina cesticillus (12%), R. echinobothrida (81%), R. tetragona (59%), Strongyloides avium (2%), Subulura strongylina (10%), Tetrameres fissispina (58%), Trichostronygylus tenuis (2%), and finally one unidentified acanthocephalan (1%) and one unidentified trematode (1%). Thirty-five per cent of the chickens were infected with the haemoparasites Aegyptinella pullorum and Plasmodium juxtanucleare (prevalences 9% and 27%, respectively). Association between chicken sex and prevalences was not significant. An over-dispersed distribution was seen for most of the helminth species.

Steal syndrome complicating hemodialysis access procedures: can it be predicted?

The development of steal syndrome distal to an arteriovenous fistula (AVF) created for hemodialysis access remains a significant clinical problem. This study was undertaken to determine the role of intraoperative noninvasive testing in the prediction and management of steal syndrome following arteriovenous fistula creation. First, in order to determine a threshold digital/brachial index (DBI) for patients at risk for steal syndrome, we performed a retrospective review of patients who had had the DBI measured and who developed symptoms (steal syndrome) following AVF creation. This was followed by a prospective evaluation of the ability of the DBI to predict which patients undergoing AVF surgery would develop steal syndrome. A DBI of <0.6 identifies a patient at risk for steal syndrome. Intraoperative DBI cannot be used to predict which patient will develop steal syndrome; however, if revision is indicated, the DBI should be increased to >0.6. Failure to accomplish this puts the patient at risk for continued steal syndrome.

Determining clinical photon beam spectra from measured depth dose with the Cimmino algorithm.

A method to determine the spectrum of a clinical photon beam from measured depth-dose data is described. At shallow depths, where the range of Compton-generated electrons increases rapidly with photon energy, the depth dose provides the information to discriminate the spectral contributions. To minimize the influence of contaminating electrons, small (6 x 6 cm2) fields were used. The measured depth dose is represented as a linear combination of basis functions, namely the depth doses of monoenergetic photon beams derived by Monte Carlo simulations. The weights of the basis functions were obtained with the Cimmino feasibility algorithm, which examines in each iteration the discrepancy between predicted and measured depth dose. For 6 and 15 MV photon beams of a clinical accelerator, the depth dose obtained from the derived spectral weights was within about 1% of the measured depth dose at all depths. Because the problem is ill conditioned, solutions for the spectrum can fluctuate with energy. Physically realistic smooth spectra for these photon beams appeared when a small margin (about +/- 1%) was attributed to the measured depth dose. The maximum energy of both derived spectra agreed with the measured energy of the electrons striking the target to within 1 MeV. The use of a feasibility method on minimally relaxed constraints provides realistic spectra quickly and interactively.

Human serum albumin and immunoglobulin on Dracunculus medinensis.

Dracunculus medinensis recovered from infected humans were examined for the occurrence and localization of human serum albumin and immunoglobulins. Immunoelectrophoretic examination of homogenates prepared from adult female worms (ADGW) and first stage larvae (LVGW) showed that anti-human albumin antibodies reacted to both stages of the parasite. By direct fluorescence antibody technique, antigens resembling human albumin and human immunoglobulins (isotype IgG) were identified on the surface of adult female worms. The occurrence of host-like compounds on the parasites may be an adaptation for survival of the parasites. A possible interference of these compounds should be considered in attempts to develop methods for immunological diagnosis of D. medinensis infections.

Determination of scatter factor parameters and electron disequilibrium for monoenergetic photon beams.

The tissue-phantom-ratio (TPR) is expressed as the product of the phantom scatter factor (SF), an electron disequilibrium factor, and an attenuation factor, equal to the zero-area TPR. The scatter factor, as a function of depth d and field size s, has been described by two parameters a and w, SF(d,s) = 1 + asd/(ws + d). We have determined the parameters a and w for 20 monoenergetic photon beams between 1 and 20 MeV. Pencil-beam energy-deposition kernels were obtained using Monte Carlo simulations. The kernels were used to calculate broad-beam depth-dose data, which were converted to TPR and fitted to the equation above using an iterative search over a-w space. The parameter a is nearly equal to the attenuation coefficient for all energies while the parameter w increases with energy. The resulting a and w compare favorably to values determined for clinical photon beams, as a function of the measured attenuation coefficient. With the scatter factor determined, we isolated the electron disequilibrium factor for each monoenergetic beam. It can be characterized as a quadratic function of the depth. The coefficients of the quadratic function can be related to the range of the most energetic secondary electron produced.

A dosimetric comparison of conventional vs conformal external beam irradiation of a stented coronary artery utilizing a new fluoroscopic imaging detector system.

UNLABELLED: Purpose. To determine whether conformal external photon beam irradiation may prevent or reduce the rate of restenosis of a stented coronary artery following percutaneous transluminal coronary angioplasty (PTCA). Optimal conformal external beam irradiation with limited cardiac dose requires adequate visualization of the stented vascular segment. With existing image intensifiers, identification of a coronary stent is poorly localized. We propose using an amorphous silicon panel detector to observe the movement of the stent during the cardiac cycle. BACKGROUND: Long-term radiation-induced coronary complications can be minimized by: (a) reducing the radiation field sizes, (b) fractionating the total dose over several days, and (c) applying multiple treatment beams. Localization of the movement of the stent during the cardiac cycle may allow for the design of radiation fields that conform to the stented vessel segment. This scheme may permit gating the radiation beam on or off relative to movement of the stent within or outside the radiation fields, respectively. METHODS: Using a new solid-state amorphous silicon planar detector, with a dynamic range of 12 bits, fluoroscopic images of a Palmaz-Schatz coronary stent were obtained. The stent was centered in a polystyrene phantom 20 cm thick and imaged using a 90-kVp, 3.5-ma, source-detector and source stent distances of 114 and 100 cm, respectively. With the solid-state silicon detector, the stent was identified in a single video frame (1/30 s). This fast image acquisition should allow for mapping the motion of the stent during the cardiac cycle. The stent movement during the cardiac cycle may then be correlated with the QRS complex in the electrocardiogram. CONCLUSIONS: The localization of a coronary stent during the cardiac cycle under fluoroscopy permits delivery of small conformal external radiation fields to treat stented coronary arteries, while minimizing radiation dose to surrounding normal cardiac tissue and vasculature. The best selection of treatment beam angles will be provided by high resolution fluoroscopic images of the stented region obtained from different beam directions. The three-dimensional movement of the stent, indexed in time with the QRS complex, will provide an important measure for gating radiation beams for conformal treatment delivery.

Parasites in cross-bred pigs in the Upper East region of Ghana.

A cross-sectional study was carried out in the Upper East Region (UER) of Ghana in order to estimate the prevalence of parasitic infections in local cross-bred pigs. Out of 60 villages with a human population of 200-1000 inhabitants, 10 villages were randomly selected for the study. The number of pigs varied from 50 to 200 pigs per village. In total 259 faecal samples from growers were collected and examined. Ninety-one percent of the animals excreted parasite eggs. Among these the prevalence of Eimeria spp. was 77.2%, Isospora suis (27%) and Balantidium coli (19.3%).The following helminth eggs were identified: Metastrongylus salmi (19.3%); Physocephalus sexalatus (17.4%); Oesophagostomum spp./Hyostrongylus rubidus (60.6%); Trichuris suis (4.6%); Ascaris suum (12.7%); Ascarops strongylina (8.1%); Brachylaemus suis (1.9%); Paragonimus suis (0.8%); Globocephalus urosubulatus (2.7%); and Schistosoma suis (0.4%). Furthermore, six growers were selected from each village for clinical and postmortem examinations, i.e. 60 in total. The clinical examinations revealed ectoparasites on 98.3% of the animals. The ectoparasites were: Haematopinus suis (66.7%); Boophilus spp. (58.3%); Amblyomma spp (45.0%); Sarcoptes suis (38.3%); and Rhipicephalus spp. (8.3%). All pigs were examined for the presence of haemoparasites. It was found that 23.3% of the animals had haemoparasites. These were: Babesia perroncitoi (23.3%); Babesia trautmanni (13.3%); and Eperytrozoon suis (1.7%). Based on postmortem examinations the following adult worms were identified: Metastrongylus salmi (83.3%); Oesophagostomum dentatum (63.3%); Oesophagostomum quadrispinulatum (38.3%); Hyostrongylus rubidus (23.3%); Ascarops strongylina (76.7%); Globocephalus urosubulatus (20.0%); Strongyloides spp. (1.7%); and Physocephalus sexalatus (65.0%). Cysts of the human tapeworm Taenia solium, Cysticercus cellulosae, were present in 11.7% of the animals. Small pieces of the diaphragm were examined for the presence of Sarcocystis spp.. The prevalence was 28.3%, but no larvae of Trichinella spp. were found. Furthermore, four of the animals (6.7%) had Taenia hydatigena cysts.