Annual and intra-annual climate variability and change of the Volta Delta, Ghana.

Deltas are geographically and socio-ecologically distinct systems, with a unique climate and contextually high vulnerabilities to climate dynamics. Hence, they require specific climate change adaptation and policy responses, informed by delta-scale analysis. However, available climate knowledge on deltas is based mainly on broad-scale analysis that masks information unique to deltas. This applies to the Volta Delta system of Ghana. This study presents annual and intra-annual climate variability and trend analysis carried out across the Volta Delta, using the coefficient of variation (CV), anomaly, Mann-Kendall and Pettit statistics. There were time and space differences in climate change and variability. Statistically significant (P < 0.05) positive trends were observed for the major wet season and the mean annual rainfall for Ada and highly significant (P < 0.01) positive trends for Akatsi. These contrasted with the observations in Adidome, which experienced a statistically highly significant (P < 0.01) decreasing trend in rainfall. There were significant (P< 0.05) increases in annual minimum, maximum, and mean temperatures over time in both coastal and inland delta stations. The annual rate of change of mean temperature ranged from 0.03 to 0.05. Ada, the more coastal location, has experienced a narrow range of temperature change, most probably due to the buffering capacity of the ocean. Point changes were observed in the climate data series in four (4) localities. We recommend that adaption and policy actions should include, the provision of small-scale irrigation, encouraging adoption of drought-resistant crop varieties and crop diversification, and also be made responsive to the existing spatiotemporal climate variability and change within the Volta Delta.

Patient perception of skin-cancer prevention and risk after liver transplantation.

INTRODUCTION: Sun exposure is a major risk factor for the development of skin cancer. This is particularly relevant in immunosuppressed liver-transplant recipients (LTRs). Preventative strategies may help minimize the skin-cancer risk in this patient group. METHODS: We assessed 670 patients in our post-transplant clinic, using questionnaires. Patient data were collected, and we assessed whether patients had received education (such as formal talks or information from transplant coordinators or from hepatologists) on skin, sun exposure and skin cancer. In a subset of 280 of the LTRs who responded, we recorded their recall of sun-protection advice and assessed the level of patient adherence to such advice. RESULTS: The response rate was 57.5% (349/607), with a mean responder age of 51.1 years (range 19-84) and an average post-transplant time of 7.1 years (range 0-27). In the recall assessment, 37.2% reported that they were given advice about their skin, while 18.1% were seen by a dermatologist, and education on sun exposure and the risks of skin cancer was given to 65.6% and 47.9%, respectively. Over three-quarters (78%; 185/280) of the patients used mechanical sun protection (i.e. hats/clothing), while 66% reported using sunscreen; 31.8% of these used a sunscreen of the recommended sun protection factor (SPF) of > 30. Twelve patients had developed squamous cell carcinoma after a mean of 10.9 years (1-23) post-transplant; half of these had used either no sunscreen or one with an SPF of < 15. CONCLUSIONS: Despite the fact that LTRs are given information on sun-exposure and SC before and after transplantation, recall of such advice and use of sun-protection methods was only moderate, indicating that regular reinforcement of SC education is needed.

An odd lump in the oesophagus - diagnostic and therapeutic approach?

A 60-year-old woman initially presented with a history of mild haematemesis. The patient denied any dysphagia, weight loss, or fever, intake of non-steroidal anti-inflammatory drugs or excessive alcohol consumption. She did not have abdominal pain and had not observed blood in her stools or melaena. At upper endoscopy, a potential source of bleeding could not be detected, but a subepithelial mass in the mid-oesophagus was revealed. The diagnostic and therapeutic approach to subepithelial oesophageal lesions is discussed.

Uncomplicated diverticular disease is not a common cause of colonic symptoms.

BACKGROUND: Colonic diverticular disease is common among older individuals whereas colonic symptoms, such as those of irritable bowel syndrome, are frequent in the general population. AIM: To determine among patients in secondary care, if uncomplicated diverticular disease is a common cause of colonic symptoms. METHODS: Patients aged ≥50 years attending gastroenterology out-patient clinics or scheduled for colonoscopy or barium enema in a secondary care hospital were invited to take part. Those with structural gastrointestinal diseases were excluded. Participants completed a locally validated Rome II questionnaire on colonic symptoms. Patients with diverticular disease were compared with those without. RESULTS: Seven hundred and eighty four patients with no structural pathology other than diverticular disease or benign colonic polyps completed the study. A total of 744 patients underwent colonoscopy, 40 barium enema. Of these, 281 patients had diverticular disease. Among patients with and without diverticular disease, the frequency of abdominal pain, diarrhoea, constipation and irritable bowel syndrome were 123 (44%) and 226 (46%), 44 (16%) and 80 (17%), 38 (14%) and 80 (17%) and 66 (25%) and 119 (25%), respectively (N.S.). CONCLUSION: Uncomplicated colonic diverticular disease is not a common cause of colonic symptoms among patients in secondary care.

Paclitaxel plus doxorubicin in metastatic breast cancer: preliminary analysis of cardiotoxicity.

This ongoing phase II trial was designed to determine the antitumor activity and cardiotoxicity of a combination of doxorubicin (50 mg/m2) and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) (175 to 225 mg/m2 over 3 hours) as first-line chemotherapy for metastatic breast cancer. Of 76 patients entered so far, 57 who had received at least three courses of chemotherapy are assessable for efficacy and cardiac toxicity. A slight majority (57%) of the patients entered had prior adjuvant chemotherapy, including 33% with anthracycline-containing combinations. An objective response was achieved by 70% of patients, with 18% complete responders. The main noncardiac toxicities were alopecia, neutropenia, mucositis, and peripheral neuropathy. Overall, after a median cumulative doxorubicin dose of 350 mg/m2, the evolution of left ventricular ejection fraction (LVEF) values did not significantly decrease from baseline to the sixth course of therapy. However, LVEF values decreased significantly in eight patients (14%). The LVEF decreased by more than 14% over basal values in three patients, although the final determination was still above the lower limits of normal. The remaining five patients had LVEF decreases that fell below the lower limits of normal (33% to 48%). None of the patients developed clinically evident heart failure. Our results indicate that the combination of doxorubicin (50 mg/m2) plus paclitaxel (175 to 225 mg/m2) is effective and does not induce a clinically relevant cardiotoxicity.

The Social Development Summit and the developing countries.

PIP: This article discusses some concerns of the 1996 UN Summit on Social Development. Conference organizers identified the three key conference issues as poverty alleviation, social integration of the marginalized and disadvantaged, and expansion of productive employment. The goal of a "society for all" means dealing with the increasing differences between rich and poor countries, the survival of weaker economies in a competitive market system, wide variations in consumption patterns between countries, attainment of political stability while respecting ethnic identity, the rise in social problems among countries with a high human development index, and increasing joblessness. The Human Development Report for 1994 emphasizes human security. Social development is not the equivalent of human resource development nor a side issue of economic growth. The integration of ethnic groups poses social and political problems. There remains a question about what political system and culture would be best for social integration. Developed countries define poverty as the inability of people and government to provide resources and necessary services for people's productive activity. Poverty in developing countries is blamed on colonialism. Globally, developed countries control 71% of world trade. Sharing resources to meet basic needs throughout the world is not an operational ideal. The highest 20% of income earners receive 83% of the world income. The culture of poverty is the strategy used by the poor to survive. Welfare is not an end in itself but does enable the poor to improve their conditions. Development that focuses on productive employment is uncertain. Developed and developing countries do not share similar perceptions of human rights. There is a question as to who should set the priorities for social development. Sustainable social development is related to preservation of natural resources, control of population growth, and promotion of social security.^ieng

Population growth and social change: a note on rural society.

PIP: Changing social conditons, particularly in rural areas, often create a feeling of normlessness. For such major changes as family limitation to be accepted in rural India, those involved must understand the total social change which will be necessary. In rural areas today the desire for motherhood is a matter of being accepted. A barren woman suffers social ostracism; folk tales tell of even animals refusing to eat a meal prepared by a barren woman. A women with a large family is particularly respected, especially if they are well provided for. The other reasons given for having large numbers of children are family survival, care in old age, increase in family income, to get more share in the property, to follow the community pattern, and to make the home happier. There is a rationale for most of these. High infant and child mortality account for the family survival, The only security the parents have is the children. More children increase the family share in a joint-family land-holding. Raising the age at marriage for girls has often been suggested as a population control measure, but what is the girl to do until 19? Rural parents do not feel their obligations to their daughter have been discharged until she is married and it is the parents who are blamed if no arrangments have been made. The idea of her becoming educated is not socially acceptable and rural boys are reluctant to marry educated girls. India's values pertaining to divorce, widow remarriage, and abortion are already undergoing change. Migration to the cities is bringing about change. Looking to the cities may bring about modernization, but the fact that the young men are the ones moving away is leading a lack of leadership in the villages. To bring about the social conditions favorable to modernization agriculture should be modernized, reducing the need for labor; factories should be built in rural areas to take up this slack in agricultural employment, and perhaps it would become acceptable for girls to work in them; rising expectations should be encouraged; and efforts should be made to encourage better diet, better child care, education, and other factors which would lead to a small family norm. When family planning programs are introduced in the context of total social change, chances of success are greater.^ieng