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PubMed2003

Pregnancy in a persistent vegetative state: case report, comparison to brain death, and review of the literature.

UNLABELLED: Severe maternal neurologic injury during pregnancy has the potential for fetal demise without advanced critical care support to the mother. Brain death is the unequivocal and irreversible loss of total brain function, whereas patients in a vegetative state, by contrast, have preserved brain stem function but lack cerebral function. They can appear to be awake, have sleep-wake cycles, be capable of swallowing, and have normal respiratory control, but there are no purposeful interactions. These conditions have different maternal prognoses, but both have resulted in near-normal neonatal outcomes with long latencies from maternal injury to delivery in previously published cases. This article compares and contrasts the 11 cases of brain death with 15 cases of persistent vegetative state in pregnancy. We found that the mean latency between maternal brain injury and delivery was significantly shorter in the brain-dead patients as compared with those in a vegetative state (46 days vs. 124 days, P </=.001). Correspondingly, the gestational ages at delivery (29.7 weeks vs. 33.2 weeks, P </=.01) and the birth weights (1380 g vs. 2145 g, P </=.01) were shorter in duration and smaller in size in the brain-dead group. We also present a case of persistent vegetative state in pregnancy at our institution with both maternal and neonatal death in the context of previously published literature with a focus on obstetric and ethical management. We hope this information will help elucidate the issues for providers confronted with these unique and challenging cases. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to state the difference between coma, persistent vegetative state and brain death, to describe the neurologic aspects of a patient in a persistent vegetative state, and to list the fetal effects of maternal brain injury.

Adult↗

PubMed2003

Pesticide residues in canned foods, fruits, and vegetables: the application of Supercritical Fluid Extraction and chromatographic techniques in the analysis.

Multiple pesticide residues have been observed in some samples of canned foods, frozen vegetables, and fruit jam, which put the health of the consumers at risk of adverse effects. It is quite apparent that such a state of affairs calls for the need of more accurate, cost-effective, and rapid analytical techniques capable of detecting the minimum concentrations of the multiple pesticide residues. The aims of this paper were first, to determine the effectiveness of the use of Supercritical Fluid Extraction (SFE) and Supercritical Fluid Chromatography (SFC) techniques in the analysis of the levels of pesticide residues in canned foods, vegetables, and fruits; and second, to contribute to the promotion of consumer safety by excluding pesticide residue contamination from markets. Fifteen different types of imported canned and frozen fruits and vegetables samples obtained from the Houston local food markets were investigated. The major types of pesticides tested were pyrethroids, herbicides, fungicides, and carbamates. By using these techniques, the overall data showed 60.82% of the food samples had no detection of any pesticide residues under this investigation. On the other hand, 39.15% different food samples were contaminated by four different pyrethroid residues +/- RSD% ranging from 0.03 +/- 0.005 to 0.05 +/- 0.03 ppm, of which most of the pyrethroid residues were detected in frozen vegetables and strawberry jam. Herbicide residues in test samples ranged from 0.03 +/- 0.005 to 0.8 +/- 0.01 ppm. Five different fungicides, ranging from 0.05 +/- 0.02 to 0.8 +/- 0.1 ppm, were found in five different frozen vegetable samples. Carbamate residues were not detected in 60% of investigated food samples. It was concluded that SFE and SFC techniques were accurate, reliable, less time consuming, and cost effective in the analysis of imported canned foods, fruits, and vegetables and are recommended for the monitoring of pesticide contaminations.

Carbamates↗

PubMed1997

Western Australian Health Department recommendations for fruit and vegetable consumption--how much is enough?

In 1989 the Nutrition Program of the Health Department of Western Australia determined a minimum recommended daily intake of fruit and vegetables for use in promotion of increased fruit and vegetable consumption. Considerations in the development of this recommendation included: a review of existing recommendations; the protective effects of fruit and vegetables; specification of fruit and vegetables separately or together; classification of fruit and vegetables; definition of a serve; and practical considerations for the implementation of the recommendation. This paper outlines the development of the recommendation to eat at least two average-sized (120-150 g) pieces of fruit and five average-sized (60-90 g) serves of vegetables daily.

Fruit↗

PubMed2004

The tooty fruity vegie project: changing knowledge and attitudes about fruits and vegetables.

OBJECTIVES: The Tooty Fruity Vegie (TFV) project was a multi-strategic, school-based intervention aimed at preventing the large decline in fruit and vegetable intake that typically starts during primary school. METHODS: During 1999 and 2000, TFV was implemented in 10 volunteer primary schools across the Northern Rivers region of New South Wales. Surveys were conducted, in late 2000, with children, parents, teachers and principals across nine intervention and three matched control schools. Intervention schools' management teams also completed strategy implementation indexes indicating how often, how well and with how many people each major strategy was implemented. RESULTS: Completed surveys from 613 parents (59%), 392 older children (65%), 50 teachers (81%) and all 10 intervention principals and school management teams showed the project was well implemented, achieved high reach and was very positively received. The project enhanced the quality, diversity and frequency of classroom fruit and vegetable-promoting activities, substantially increasing children's involvement and enjoyment levels. It significantly improved children's fruit and vegetable knowledge, attitudes, access and preparation skills; parents' knowledge and involvement in fruit and vegetable-promoting activities in schools and beyond; and teachers' perceived support for doing fruit and vegetable promotions. CONCLUSION: Despite some methodological limitations, which may limit confidence in our findings, survey results across all target groups consistently indicated that primary schools can be supported to establish, implement and sustain highly acceptable and effective fruit and vegetable-promoting programs.

Child↗

PubMed2006

Use of repetitive DNA sequences to determine the persistence of enteropathogenic Escherichia coli in vegetables and in soil grown in fields treated with contaminated irrigation water.

AIMS: Fresh fruits and vegetables are increasingly recognized as vectors for food-borne illness. On farm contamination through contaminated irrigation water is considered likely source of the pathogen for several outbreaks. The purpose of this study is to investigate the possible similarity of strains of Escherichia coli isolated from the soil and vegetables irrigated by treated wastewater. METHODS AND RESULTS: Seventy-five strains of enteropathogenic Escherichia coli isolated from vegetables, soil and irrigation water were tested for sensitivity to antibiotics and shown to be sensitive. The result of enterobacterial repetitive intergenic consensus (ERIC)-PCR shows similarities between analysed strains isolated from the three different samples. Moreover strains of E. coli isolated from vegetables over different periods of time have the same ERIC-PCR profile. CONCLUSIONS: The isolated strains of enteropathogenic E. coli can persist in soil and in vegetables growing in fields treated with contaminated irrigation water for an extended period of time. SIGNIFICANCE AND IMPACT OF THE STUDY: Contaminated irrigation water can transport pathogenic bacteria, which persists in the soil for a long period of time and contaminates the vegetables growing in the field irrigated by this contaminated water.

DNA, Bacterial↗

PubMed2004

The effect of fruits and vegetables on urinary stone risk factors.

BACKGROUND: The overall effect of fruit and vegetable intake on urinary stone risk profile is not yet known. METHODS: We studied the effect of a two-week period of fruit and vegetable elimination on urinary stone risk profile in 12 normal adults, and of supplementing the diet with a fair quantity of low-oxalate fruits and vegetables in 26 idiopathic calcium stone formers characterized by hypocitraturia and a very low fruit and vegetable intake in their usual diet. RESULTS: In the normal subjects, the elimination of fruits and vegetables from the diet decreased the urinary excretion of potassium (-62%), magnesium (-26%), citrate (-44%) and oxalate (-31%), and increased that of calcium (+49%) and ammonium (+12%) (P < 0.05 for all). The relative saturation for calcium oxalate and calcium phosphate increased from 6.33 to 8.24 (P = 0.028), and from 0.68 to 1.58 (P = 0.050), respectively. In the hypocitraturic stone formers, the introduction of these foods in the diet increased urinary volume (+64%), pH (from 5.84 to 6.19), excretion of potassium (+68%), magnesium (+23%), and citrate (+68%), while it decreased the excretion of ammonium (-18%) (P < 0.05 for all). The relative saturation for calcium oxalate and uric acid fell from 10.17 to 4.96 (P < 0.001), and from 2.78 to 1.12 (P = 0.003), respectively. CONCLUSION: The total elimination of fruits and vegetables in normal subjects brings about adverse changes in the urinary stone risk profile that are only partially counterbalanced by a reduction in oxalate. In contrast, the addition of these foods to the diet of hypocitraturic stone formers not used to eating them not only significantly increases citrate excretion without affecting oxalate excretion, but also decreases calcium oxalate and uric acid relative saturation.

Adult↗

PubMed1993

Survival and growth of Escherichia coli O157:H7 on salad vegetables.

The influence of modified-atmosphere packaging, storage temperature, and time on survival and growth of Escherichia coli O157:H7 inoculated onto shredded lettuce, sliced cucumber, and shredded carrot was determined. Growth of psychotrophic and mesophilic microorganisms and changes in pH and sensory qualities of vegetables, as judged by subjective evaluation, were also monitored. Packaging under an atmosphere containing 3% oxygen and 97% nitrogen had no apparent effect on populations of E. coli O157:H7, psychotrophs, or mesophiles. Populations of viable E. coli O157:H7 declined on vegetables stored at 5 degrees C and increased on vegetables stored at 12 and 21 degrees C for up to 14 days. The most rapid increases in populations of E. coli O157:H7 occurred on lettuce and cucumbers stored at 21 degrees C. These results suggest that an unknown factor(s) associated with carrots may inhibit the growth of E. coli O157:H7. The reduction in pH of vegetables was correlated with initial increases in populations of E. coli O157:H7 and naturally occurring microfloras. Eventual decreases in E. coli O157:H7 in some samples, e.g., those stored at 21 degrees C, are attributed to the toxic effect of accumulated acids. Changes in visual appearance of vegetables were not influenced substantially by growth of E. coli O157:H7. The ability of E. coli O157:H7 to growth on raw salad vegetables subjected to processing and storage conditions simulating those routinely used in commercial practice has been demonstrated.

Escherichia coli↗

PubMed1996

Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit.

OBJECTIVE: To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics. DESIGN: Retrospective study of the clinical records of the medical, occupational therapy, and clinical psychology departments. SETTING: 20 bed unit specialising in the rehabilitation of patients with profound brain damage, including the vegetative state. SUBJECTS: 40 patients admitted between 1992 and 1995 with a referral diagnosis of vegetative state. OUTCOME MEASURES: Patients who showed an ability to communicate consistently using eye pointing or a touch sensitive single switch buzzer. RESULTS: Of the 40 patients referred as being in the vegetative state, 17 (43%) were considered as having been misdiagnosed; seven of these had been presumed to be vegetative for longer than one year, including three for over four years. Most of the misdiagnosed patients were blind or severely visually impaired. All patients remained severely physically disabled, but nearly all were able to communicate their preference in quality of life issues-some to a high level. CONCLUSIONS: The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment. Accurate diagnosis is possible but requires the skills of a multidisciplinary team experienced in the management of people with complex disabilities. Recognition of awareness is essential if an optimal quality of life is to be achieved and to avoid inappropriate approaches to the courts for a declaration for withdrawal of tube feeding.

Awareness↗

PubMed1997

Randomised controlled trial of effect of fruit and vegetable consumption on plasma concentrations of lipids and antioxidants.

OBJECTIVES: To determine the extent to which plasma antioxidant concentrations in people with habitual low intake of fruit and vegetables respond to increased intakes of these foods. To examine whether advice to increase fruit and vegetables will result in reduction of concentrations of total and low density lipoprotein cholesterol. DESIGN: Randomised controlled trial in which intervention and control groups were followed up for eight weeks. The intervention group was asked to consume eight servings of fruit and vegetables a day. SETTING: Dunedin, New Zealand. SUBJECTS: Eighty seven subjects with normal lipid concentrations who ate three or fewer servings of fruit and vegetables daily. MAIN OUTCOME MEASURES: Plasma concentrations of vitamin C, retinol, alpha and beta carotene, alpha tocopherol, lipids, and lipoproteins. Dietary intake assessed with diet records over four days. RESULTS: The mean plasma vitamin C, alpha carotene, and beta carotene concentrations increased in parallel with increased dietary intake of fruit and vegetables in the intervention group. Concentrations of retinol, alpha tocopherol, lipids, and lipoproteins remained unchanged despite some increase in dietary vitamin E and a small reduction in saturated fat intake. CONCLUSIONS: Following a recommendation to increase fruit and vegetable consumption produces change in plasma concentrations of vitamin C, alpha carotene, and beta carotene likely to reduce incidence of cancer. More specific dietary advice to modify fat intake may be necessary to reduce the risk of cardiovascular disease mediated by lipoprotein and vitamin E.

Adult↗

PubMed1999

The Health Education Authority's health and lifestyle survey 1993: who are the low fruit and vegetable consumers?

STUDY OBJECTIVE: Firstly, to determine the demographic and behavioural characteristics of low fruit and vegetable consumers. Secondly, to investigate whether knowledge and attitudes are barriers to consumption of fruit and vegetables. DESIGN: Cross sectional survey: an interviewer administrated questionnaire was used to assess the demographic, knowledge, attitude, and behavioural characteristics of the respondents. SETTING: England. PARTICIPANTS: Random sample of 5553 men and women aged between 16 and 74 years. Response rate 70%. MAIN RESULTS: The main demographic characteristics of the respondents identified as low consumers of fruit and vegetables (less than daily consumption of either fruit or vegetables) were age, sex, and smoking status. The adjusted odds ratios were 2.59 for those aged 16-24 years compared with those aged 45-74 years, 2.17 for men compared with women, and 1.77 for current smokers compared with never smokers. The most important knowledge and attitude statements after adjusting for the demographic variables were disagreeing with the statement "healthy foods are enjoyable" (odds ratio 1.90) and agreeing with the statement "I don't really care what I eat" (odds ratio 1.76). The impact of knowledge seemed less important than attitudes about a healthy diet in characterising a low fruit and vegetable consumer. CONCLUSIONS: These findings are relevant to future strategies for improving intake of fruit and vegetables, but demonstrate the complexity of interventions required, and the dangers inherent in assuming simplistic relations between psychosocial factors and behaviour.

Adolescent↗

PubMed2005

A randomized trial of an intervention to increase fruit and vegetable intake in curatively treated patients with early-stage head and neck cancer.

The leading cause of death in patients who have had curatively treated early-stage head and neck cancer is a second primary cancer of the upper aerodigestive tract (lung, esophagus, larynx, pharynx, and oral cavity cancers). Low fruit and vegetable intake has been associated with increased risk of primary head and neck cancer and the available data suggest that increasing intake following diagnosis may reduce the risk of a second primary cancer. The goal of this study was to develop and test an easily administered intervention to increase fruit and vegetable intake in these patients following diagnosis and treatment. The 6-month intervention was based on the Stage of Change model. Seventy-five early-stage head and neck cancer patients were randomized to either the intervention group or to the "blinded" control group, with diet change data available on 65 patients. Fruit and vegetable intake, assessed using a food frequency questionnaire, and plasma carotenoid concentrations were measured at baseline and at the end of the study period. The change in self-reported intake of fruit and vegetables (servings per day) over the study period was significantly greater (P = 0.009) in the intervention group (n = 35; +2.1) compared with the control group (n = 30; +0.5). Total plasma carotenoids, a biomarker of fruit and vegetable intake, increased by 70 nmol/L in the intervention group as compared with a reduction of 42 nmol/L in the control group, a relative difference of 12% (nonsignificant). An intervention that can be delivered in a physician's office resulted in a significant increase in intake of fruit and vegetables in early-stage head and neck cancer patients.

Carotenoids↗

PubMed2005

GSTP1 and GSTA1 polymorphisms interact with cruciferous vegetable intake in colorectal adenoma risk.

The possible interplay between cruciferous vegetable consumption, functional genetic variations in glutathione S-transferases (GST) M1, T1, P1, and A1, and colorectal adenomas, was investigated in a Dutch case-control study. The GSTM1 and GSTT1 deletion polymorphisms, and the single nucleotide polymorphisms in GSTP1 (A313G) and in GSTA1 (C-69T) were assessed among 746 cases who developed colorectal adenomas and 698 endoscopy-based controls without any type of colorectal polyps. High and low cruciferous vegetable consumption was defined based on a median split in the control group. High consumption was slightly positively associated with colorectal adenomas [odds ratio (OR) 1.15; 95% confidence interval, 0.92-1.44]. For GSTP1, a positive association with higher cruciferous vegetable intake was only apparent in individuals with the low-activity GSTP1 genotype (GG genotype, OR 1.94; 95% confidence interval, 1.02-3.69). This interaction was more pronounced in men, with higher age and with higher meat intake. The GSTA1 polymorphism may have a modifying role as well: the OR for higher intake compared with lower intake was 1.57 (0.93-2.65) for individuals homozygous for the low expression variant (TT genotype). This seemed to be stronger with younger age and higher red meat intake. Cruciferous vegetable consumption and the combined GSTA1 and GSTP1 genotypes showed a statistically significant interaction (P = 0.034). The GSTM1 and GSTT1 genotypes did not seem to modify the association between cruciferous vegetable intake and colorectal adenomas. In conclusion, GSTP1 and GSTA1 genotypes might modulate the association between cruciferous vegetable intake and colorectal adenomas.

Adenoma↗

PubMed2005

A qualitative exploration of determinants of fruit and vegetable intake among 10- and 11-year-old schoolchildren in the low countries.

BACKGROUND: For the development of fruit and vegetable promotion interventions, insight is needed into determinants of health behaviour. This study presents results of focus group interviews held with 10- to 11-year-old schoolchildren from Ghent (Belgium-Flanders) and Rotterdam (the Netherlands) to explore personal beliefs and motivations and environmental factors related to schoolchildren's fruit and vegetable intake, to inform the Pro Children intervention development. METHODS: Twelve focus groups were held with 92 schoolchildren. The interviews were recorded and transcribed and NVivo was used to analyse the transcripts. RESULTS: Positive health beliefs, taste preferences, lack of knowledge and practical barriers were identified as personal factors related to fruit and vegetable intake. Home and school availability of fruits and vegetables, as well as parenting practices were identified as important environmental factors. CONCLUSION: A fruit and vegetable promotion intervention should aim to increase fruit and vegetable accessibility and should include educational and motivational activities tailored to these personal and environmental factors. These indications should be further evaluated in quantitative research among representative samples.

Belgium↗

PubMed1999

Vegetables, fruits, and related nutrients and risk of breast cancer: a case-control study in Uruguay.

To evaluate whether the protective effect associated with vegetables and fruits in breast cancer could be explained by nutrients and bioactive substances present in these plant foods, we carried out a case-control study in Uruguay including 400 cases and 405 controls. The intake of vegetables, fruits, and related nutrients was estimated with a food frequency questionnaire on 64 food items. This questionnaire allowed the calculation of total energy intake, and nutrients were calorie adjusted by the residuals method. Odds ratios for study variables were estimated by unconditional multiple logistic regression. Total vegetable, total fruit, dietary fiber, vitamin C, vitamin E, lycopene, folate, and total phytosterol intakes were inversely associated with breast cancer risk [4th quartile odds ratio for total vegetable intake = 0.41, 95% confidence interval = 0.26-0.65, p (for trend) = 0.004]. The association with total vegetable intake was not independent of lycopene intake. The results related to vegetable and nutrient intakes are consistent with antioxidant and antiestrogenic effects. This could be mediated, among other nutrients, by dietary fiber and lycopene intake. The role of other unmeasured phytochemicals, correlated with dietary fiber and lycopene intakes, cannot be ruled out.

Ascorbic Acid↗

PubMed2004

Quantity and variety of fruit and vegetable consumption and cancer risk.

The recommendation for fruit and vegetable intake includes eating a certain quantity as well as a variety. The evidence for eating a variety is limited. We examined the association with cancer in a prospective cohort study among 730 Dutch men aged 65-84 yr followed for 10 years, resulting in 138 cancer cases. The quantity of fruits and vegetables was assessed using a dietary history and the variety in intake was based on a food frequency questionnaire. Adherence to the recommended amounts of fruit and vegetables was inversely associated with total cancer risk: The adjusted relative risk (RR) was 0.56 [95% confidence interval (CI) = 0.31-1.00]. Eating the recommended daily 200 g of vegetables was not related to cancer incidence, whereas eating the recommended 200 g of fruit was associated with a 38% lower risk. Variety in vegetable intake was inversely associated with total cancer and non-lung epithelial cancer: The RRs (95% CI) for the highest and lowest tertiles were 0.64 (0.43-0.95) and 0.51 (0.27-0.97), respectively. Only after excluding the first two years of follow-up, variety in fruit intake was associated with reduced cancer risk. In conclusion, adherence to the guidelines for fruit and vegetable intake was associated with lower cancer risk. Besides quantity, variety in intake is also of importance.

Aged↗

PubMedDate not supplied

[Endoparasite prevalence in truck farmers and in the vegetables of Feira do Produtor de Maringá, Paraná].

Few studies have assessed the contamination of vegetables at Brazilian production sites. From April 1996 to December of 1997, the sanitary conditions of raw consumed vegetables sold in the Feira do Produtor de Maringá were investigated. We based the analyses on the contamination of vegetables, of the producers (stool samples and material under the fingernails) and of the water used for irrigation. It was observed that 16.6% of 144 samples of five different types of vegetables were contaminated with intestinal parasites. Forty three of 163 individuals (26%) were infected with one or more parasites. Only three of the 49 samples of material under the fingernails analyzed were positive for intestinal parasites. Analysis of samples of the water used for vegetable irrigation showed that the water did not satisfy bacteriological standards of potability. We conclude that in the investigated area the contamination of vegetables occurred during the production phase and that a sanitary education campaign directed at the producers is needed.

Agricultural Workers' Diseases↗

PubMedDate not supplied

[Detection of transmissible forms of enteroparasites in water and vegetables consumed at schools in Sorocaba, São Paulo state, Brazil].

Water and raw vegetables consumed in ten nursery schools were evaluated for the presence of transmissible forms of enteroparasites. The water was submitted to filtration through membranes. The washed membrane water was submitted to the Faust method. The in natura and washed vegetables were washed and the water analyzed by the sedimentation method. Contamination was not detected in one school; in two schools, all the materials were contaminated; in four schools, two items were contaminated and in three, one material presented contamination. The water presented a contamination index of 0.7% contamination (Hymenolepis diminuta, Strongyloides stercoralis and Ancylostomatidae); the vegetables in natura, 3.9% (Strongyloides stercoralis, Ancylostomatidae, Ascaris lumbricoides and Giardia lamblia) and the washed samples 1.3% (Strongyloides stercoralis, Ascaris lumbricoides and Giardia lamblia). The water and vegetables are enteroparasites vehicles. The larval form predominated. The vegetables in natura presented higher contamination than those that were washed. Elimination of these forms in vegetables was not guaranteed by washing.

Brazil↗

PubMed2006

Fruit and vegetable intake by Brazilian adults, 2003.

This study estimated indicators of fruit and vegetable intake by Brazilian adults and examined the influence of demographic and socioeconomic variables on the consumption of these foods. We used the following indicators: daily fruit intake, daily vegetable intake, and daily consumption of five or more servings of fruits and vegetables per day. Only 41.0% of adults reported daily fruit intake, while 30.0% reported daily vegetable intake. Fruit and vegetable intake was more common in urban as compared to rural areas and increased in both genders with age, schooling, and number of household goods. We conclude that initiatives to promote fruit and vegetable consumption are necessary for the country as a whole, but special attention should be given to younger individuals, males, rural communities, and groups with less schooling and lower income.

Adolescent↗