Advances in patient positioning.

New technologies and processes have allowed for advances in patient positioning. Indexed immobilization allows clinicians to enhance treatment effectiveness and maximize clinical efficiency. When the same patient positioning system and couch are used in simulation and in the treatment room it is feasible to ensure identical patient setups between simulation and treatment. The emergence of 3-D conformal therapy and IMRT have lead the radiotherapy community to place increased importance and need for accurate patient positioning. As a result, radiotherapy vendors, as well as many radiation oncology departments, have developed their own immobilization devices to reduce patient setup time and ensure exact repeat positioning. Indexed immobilization is intended to facilitate precise repeatable patient positioning both in moving from simulation to treatment and in standardizing day-to-day set-ups. In addition to precise patient positioning, indexed immobilization can significantly reduce the length of treatment sessions by reducing patient movement and by standardizing the placement and set-up of immobilization devices. Coupled with the use of 3D treatment planning capability, precise positioning can facilitate treatments for flat or wedged conformal therapy and Intensity Modulated Radiation Therapy (IMRT). This article summarizes the features and operational benefits of indexed immobilization and then outlines the implications for clinical and departmental processes. The most significant benefits come when the user's processes are modified to take advantage of the enabling technology.

[Dramatic decline in the incidence of gonorrhea and syphilis in Greenland--result of an intervention strategy?]. / Dramatisk fald i forekomsten af gonoré og syfilis i Grønland--resultatet af en interventionsstrategi?

During this century the incidence of gonorrhoea in Greenland has increased continuously and since the late 1960's syphilis has been reported with two epidemic peaks in 1976 and 1987. In 1986 a systematic intervention strategy was initiated consisting of 1) information and education, 2) enhancement of the attention of the medical profession to STD 3) critical evaluation of methods of examination and treatment 4) carefully performed partner notification and the use of epi-treatment of contacts in selected cases and finally 5) continued public information about the result of these efforts and the prevention of spread of HIV-infection. Education was established in schools. Instructions for examination and treatment were renewed, special training was offered to health care personnel, and in 1988 a venereologist was employed by the Health Service. An almost constant decline in the incidences of both gonorrhoea and syphilis has now been demonstrated, which may easily be attributed to the above measures. However, it is uncertain whether the reduction is due to the improved treatment or a real change in sexual behaviour. Studies of knowledge and behaviour indicate that it is still necessary to influence attitudes to sexual behaviour, and to teach "safer sex" in order to further reduce the incidence of STD and to impede the spread of HIV.

Changes in knowledge of HIV/AIDS, sexual behaviour and practice among STD patients in Greenland 1990-1992. Monitoring the Stop-AIDS campaign in Greenland.

Due to a high incidence of STDs Greenland is considered to be a high risk area for an AIDS epidemic, and a close monitoring system has been set up to monitor the spread of HIV and changes in knowledge and sexual norms. This is the second report from surveys of knowledge, sexual behaviour and practice and STD patients i Greenland. Data were collected by means of self administered questionnaires in 1990 to 1992 in Nuuk, Sisimiut and Angmagssalik. The results from Nuuk in 1992 are compared with results from a similar survey from 1990.

[Botulism in Ammassalik]. / Botulisme i Ammassalik.

Botulism is a rare and serious form of food poisoning and was diagnosed for the first time in the East Coast of Greenland. Historical reports suggest that outbreaks of this condition have occurred previously in this region. In 1990, however, the presence of Clostridium botulinum type E could be confirmed with certainty. Eight individuals partook of a meal which consisted of raw seal meat and raw seal intestines. Four of these developed symptoms of botulism and two of these required assisted ventilation. On the basis of this experience, the medical officers of health in Greenland recommend that all hospitals in Greenland should maintain a supply of antitoxin.

[Dog bites in the sledge-dog districts of Greenland]. / Hundebidslaesioner i slaedehundedistrikterne i Grønland.

Serious attacks on humans by dogs occur every year in Greenland. As prophylactic measures, cutting of dogs canine teeth and chaining of sledge dogs have been compulsory for many years. The significance of cutting of canine teeth and municipal regulations concerning keeping the sledge dogs in Greenland was evaluated in a retrospective study of the death certificates and the nosocomial reports. A total of twenty-two dog bite-related fatalities from 1967 through 1989 and 23 hospitalized patients following dog attacks from 1986 through 1988 in a population of 15,000 inhabitants and 29,000 dogs was studied. In only two of the killed and four of the hospitalized persons, reports of intact canine teeth as demonstrated by the typical lesions were available. However, the severe cut-out wounds in 14 survivors and twenty fatalities with great loss of tissue indicated intact canine teeth of the dogs. Unchained dogs were most frequently involved, but at least four fatalities and one severely injured person were caused by chained dogs. 87% (39/45) of the victims were under ten years of age, so future intervention should primarily involve this group despite a declining mortality rate since the mid-seventies. Small children should be escorted by adults out-of-doors and first aid education of laymen ought to have a higher priority because half of the killed children were still alive, on arrival in hospital. Infants and toddlers should be carried in an amaat, a special rucksack well known in the Eskimo culture and still used in Eskimo Canada, or alternatively rucksacks mounted on a tubular frame of aluminium.

An update on knowledge and sexual behaviour among students in Greenland. Monitoring of the stop-AIDS campaign.

Greenland is a considered high risk area for a self-sustained heterosexual HIV-epidemic due to rather relaxed sexual norms in larger segments of the population and a high incidence of sexual transmitted diseases. However, the prevalence of HIV-positives is still low. As part of a monitoring programme longitudinal studies of young peoples' knowledge and sexual behaviour has been established. This paper presents results from the second survey among all students in vocational training and all 10th grade students in the public schools. Previous studies were performed in 1988 and 1989. The present study which took place in April 1991 involved a total of 1201 students, or about 85% of all students in the target groups (95% among students present on the day of surveying). Data collection was based upon standardized self-administered questionnaires. The study showed better knowledge than previously but no marked change in sexual habits. The age of sexual début even appeared to be decreasing. More than half reported a sexual début before the age of 15. More than 20% reported 10 sexual partners or more within the last year. HIV has still not reached the young population in Greenland but when it happens the present sexual behaviour carries a high risk of a self-sustained epidemic.

PIP: Alarming proportions of teenagers in Greenland start to have sex early in life, sleep with multiple partners, and do not use condoms regularly. There is a rather relaxed attitude toward casual sex among the general population in Greenland. There exists a commensurately high incidence of gonorrhea, syphilis, cervical cancer, and other sexually transmitted diseases. 8000 new cases of gonorrhea were diagnosed in 1987, but only 2000 new cases have been diagnosed annually since 1990. This latter incidence is still high for the total population of 55,000 which resides in scattered settlements along the west coast of the protectorate. Greenland is at high risk for a heterosexual HIV epidemic. Thus far, Greenland has benefited by a late introduction of HIV to the society, lack of drug abuse, few opportunities for homosexual contacts, good communication and information systems, good schools, and good health care. As of September 1991, 32 HIV-seropositives had been identified from a serosampled population of 18,000; 11 of the positives were female. Studies of youth's knowledge and sexual behavior were conducted in 1988 and 1989. This repeat study surveyed all students in vocational training and all 10th graders in public schools in April 1991 through self-administered questionnaires. The group of 1201 student respondents represents 85% of all individuals in the target groups. It should be pointed out that 10th grade is the last mandatory year of the elementary school system in Greenland and that 461 respondents were under age 18 and 740 were 18 years or older. 83% had had their sexual debut. Among the sexually experienced, 54% reported first having sex before the age of 15 years. 17% of males and 11% of females reported having more than 10 sex partners in the previous year. 26% of males and 42% of females reported more than 15 intercourses per month. Consistent or most of the time use of condoms was, however, reported by only 29% of males and 24% of females. Compared to earlier surveys, the age of sexual initiation declined and respondents reported both a greater number of sex partners and a higher frequency of sexual intercourse. Denmark, yet residing in Greenland. These findings indicate that while 5 years of intensive education and prevention campaigns have succeeded in improving health personnel, teacher, and student knowledge about AIDS, no marked change has taken place in the sexual habits of the young. It is, therefore, concluded that an AIDS prevention campaign must not be based exclusively upon the promotion of condom use, but should aim to stop the decline in age of sexual debut, reduce the degree of excessive sexual promiscuity, and address alcohol abuse. These steps must be taken now to had off a self-sustained HIV epidemic as the prevalence of HIV grows in this population.

Infant mortality in Greenland: secular trend and regional variation.

Infant mortality and stillbirths were studied in the Inuit population of Greenland. Infant mortality rate decreased from 110 per 1000 live births in 1951 to 50 in 1970 and 20 in 1989. Statistically significant decrease was in particular seen for acute respiratory infections and certain perinatal conditions. Both perinatal and postperinatal mortality rates increased significantly with remoteness from the capital and were higher in settlements than in towns. The overall trend in Greenland is similar to the Danish pattern 30 years earlier, but there was pronounced regional variation. In towns, the infant mortality rate decreased continuously while in settlements an initial decrease was followed by a substantial increase during 1980-87 when the mortality rate doubled. The greater part of this increase could be attributed to an increased number of deaths in the postperinatal period countrywide during 1981-84 and an increased number of perinatal deaths in the settlements of one particular municipality during 1983-86.

[The incidence of gonorrhea as an indicator for prevention of AIDS in Greenland]. / Gonoréincidensen som mål for AIDS-forebyggelsen i Grønland.

The first case of HIV infection in Greenland was demonstrated towards the end of 1985 and, since then, a general informative campaign was instituted and teaching material about AIDS and HIV infection were prepared for use in schools. This activity was particularly great in 1987 and 1988. The main messages were 1) use of condoms and 2) reduction in the number of sexual partners. The incidence of gonorrhoea has been very high for many years in Greenland and the incidence of gonorrhoea was employed as indicator for the effect of the prophylactic campaign. Investigation revealed a decrease of 67% during the period 1985-1988. The decrease was particularly great in 1988 (58%). There appears to be a direct connection between this observation and the two main messages of the campaign as the employment of condoms increased tenfold during the period 1986-1988 end contact investigations revealed a decrease in the number of unknown sexual partners. On the other hand, no definite decrease in the total number of sexual partners was reported by patients attending the clinic for Venereal Diseases in Godthåb. It is emphasized that the incidence of gonorrhoea has decreased markedly but it is still considerably higher than the incidence in Denmark. Continued and active prophylactic efforts are still required.

[The sexual habits of young Greenlanders and their knowledge of AIDS. A study done among students in vocational schools in Greenland in 1989]. / Unge grønlaenderes seksualvaner og viden om AIDS. En undersøgelse blandt elever i grønlandske erhvervsskoler i 1989.

A questionnaire investigation was undertaken among young Greenlanders in vocational training about their knowledge of AIDS and their sexual habits as a link in monitoring of the course of AIDS prophylaxis in Greenland. The investigation was anonymous and was carried out in the vocational colleges with assistance of a contact person in the college. All of the students who were present on the day of investigation (264 out of 326 students) participated. The investigation revealed that 3/4 had basic knowledge about AIDS but their knowledge about the routes of infection was less certain. The average age for commencement of sexual activity was 18.9 years for men and 17.3 years for women. Although the investigation revealed that a number of the participants had sexual habits which scarcely differed from those in other countries, the average number of partners within the past year was stated to be 7.5 for men and 4.4 for women. Information which can provide young people with better knowledge about AIDS should be given via colleges and health service institutions to a greater extent. It is also recommended that materials should be developed which are directed particularly to high-risk groups.