Prevalence of antibodies for Peste des petits des ruminants virus and Brucella and related risk factors in goat herds in urban and peri-urban agriculture in Kampala, Uganda

The world’s population reached more than 6.9 billion people in July 2011. It is expected that the population growth during the next 40 years will take place mostly in low-income countries and the population increase will be 2.3 billion people during 2011-2050. A rapid urbanization is also expected to result in 57.7 per cent of Africa’s population living in urban areas in 2050. The rapid growth of urban areas is driven by for example economic growth, unemployment, lack of educational opportunities, natural disasters, food insecurity and social instability. In the rapidly growing urban and peri-urban areas, the demand for food is increasing. To satisfy these needs urban and peri-urban agriculture is in many ways essential for food security. Urban and peri-urban agriculture give poor people access to food by providing for self-consumption and can thereby contribute to poverty alleviation and prevent famine. There are also risks related to urban and peri-urban agriculture such as environmental hazards and transmission of for instance zoonotic diseases. Agriculture is the most important source of income for about 66 per cent of the population (34 million) in Uganda. Twenty-five per cent of Uganda’s population is considered poor and most farming is small scale providing for self-consumption. It has been shown that urban agriculture in Kampala, the capital of Uganda, has positive effects on nutrition status and food security. Health risks have though been reported and the most important zoonotic diseases in urban and peri-urban Kampala are food-borne gastroenteritis, bovine tuberculosis, brucellosis and cysticercosis. In low-income countries, like Uganda, goats are important for poor people providing a source of income, meat, manure, milk and an insurance against emergencies. Goats are essential for poverty alleviation in developing countries. The aim of this study was to gain knowledge about urban and peri-urban agriculture in Kampala, Uganda and to investigate the prevalence of antibodies for Peste des petits ruminants virus (PPRV) and brucella and related risk factors in goat herds. Brucellosis is considered one of the most important zoonotic diseases in urban and peri-urban Kampala. Peste des petits ruminants (PPR) is a highly infectious disease primarily affecting small ruminants. It is a disease of high socioeconomic significance in low-income countries due to the high mortality and morbidity. Fifty-five farms in urban and peri-urban Kampala, Uganda, were visited during our study. A maximum of 5 blood samples were taken on each farm and farmers were interviewed regarding for example their animal’s health, animal movements and bio-security measures. One-hundred and ninety blood samples were taken in total and analyzed using competitive ELISA. The seroprevalence at herd level was 16.4 per cent for brucellosis and 1.8 per cent for PPRV, respectively. No statistically significant risk factors associated with seropositivity for PPRV were found in our study. Seropositive herd status for brucellosis was associated with having a farm in the division of Greater Kampala. Because of the fact that seropositive goats were found in our study it may be possible that transmission of brucella bacteria between goats and humans may occur in urban and peri-urban Kampala. Furthermore, seropositivity for PPRV may indicate that the virus has to some extent spread from the northern parts of Uganda to more central parts. In order to ascertain whether this is true or not I think further studies need to be carried out.I juli 2011 var befolkningen i världen 6.9 miljarder. Befolkningstillväxten de närmaste 40 åren kommer troligen att ske i utvecklingsländer och resultera i en ökning av jordens befolkning med 2,3 miljarder under tidsperioden 2011-2050. Samtidigt kommer även en urbanisering ske vilket kommer att resultera i att 57,7 procent av befolkningen i Afrika kommer att bo i urbana områden år 2050. Denna urbana tillväxt drivs av ekonomisk tillväxt, arbetslöshet, utbildningsmöjligheter, naturkatastrofer, tillgång på mat och social instabilitet. Efterfrågan på mat ökar i takt med tillväxten av urbana och periurbana området vilket gör urbana och periurbana jordbruk otroligt viktiga för livsmedelsförsörjning. En stor fördel med urbana och periurbana jordbruk är att de ger fattiga konsumenter möjligheten till självförsörjning och kan därmed bidra till bekämpning av fattigdom och hungersnöd. Det finns dock även risker med urbana och periurbana jordbruk såsom miljöpåverkan och risk för överföring av sjukdomar t.ex zoonoser. I Uganda är jordbruk den viktigaste inkomstkällan för 66 procent av den 34 miljoner stora befolkningen. Tjugofem procent av befolkningen räknas som fattiga och de flesta jordbruken är småskaliga och producerar för självförsörjning. Man har sett att urbana jordbruk i huvudstaden Kampala har en positiv effekt på nutritionstatus och tillgång på mat. Hälsorisker har dock också rapporterats och de viktigaste zoonotiska sjukdomarna i urbana och periurbana områden i Kampala är gastroenterit, bovin tuberkulos, brucellos och cysticerkos. Det är i Uganda vanligt att man i ett hushåll har getter som inkomstkälla, säkerhet i krissituationer samt för tillgång till kött, mjölk och gödsel. Getter är essentiella för fattigdomsbekämpningen i utvecklingsländer. Syftet med denna studie var att samla information om urbana och periurbana jordbruk i Kampala, Uganda och även undersöka seroprevalens och relaterade riskfaktorer för Peste des petits ruminants virus (PPRV) samt brucella hos getter. Brucellos är beskriven som en av de viktigaste zoonotiska sjukdomarna i urbana och periurbana områden i Kampala och är enligt WHO av betydelse för folkhälsan. Peste des petits ruminants (PPR) är en sjukdom som framförallt drabbar små idisslare. På grund av att PPRV ofta orsakar utbrott med hög mortalitet och morbiditet så är detta en sjukdom av stor socioekonomisk betydelse i utvecklingsländer. Femtiofem gårdar i urbana och periurbana Kampala, Uganda, besöktes under studiens gång. Vid besöken togs blodprov från max 5 getter per gård och djurägarna intervjuades med frågor om t.ex djurhälsa, djurhandel och biosäkerhet på gården. De 190 blodprover som togs analyserades sedan med kompetetiv ELISA teknik. Seroprevalensen på gårdsnivå var 16,4 procent för brucella och 1,8 procent för PPRV. Inga riskfaktorer för seropositivitet för PPRV hittades i denna studie men seropositiv status för brucella på gårdsnivå var statistiskt signifikant associerad med att ha sina getter i området Greater Kampala. Eftersom seropositiva getter hittades i denna studie så kan det innebära att det eventuellt finns risk för överföring av brucella bakterier mellan getter och människor i urbana och periurbana områden i Kampala. Dessutom kan seropositivitet för PPRV tala för att detta agens kan ha spridits från norra Uganda till mer sydliga delar av landet. För att ta reda om så är fallet tycker jag att vidare undersökningar behöver göras

Withdrawal of antihypertensive medication: a systematic review

Although antihypertensive medication is usually continued indefinitely, observations during wash-out phases in hypertension trials have shown that withdrawal of antihypertensive medication might be well tolerated to do in a considerable proportion of people. A systematic review was completed to determine the proportion of people remaining normotensive for 6 months or longer after cessation of antihypertensive therapy and to investigate the safety of withdrawal. The mean proportion adjusted for sample size of people remaining below each study's threshold for hypertension treatment was 0.38 at 6 months [95% confidence interval (CI) 0.37–0.49; 912 participants], 0.40 at 1 year (95% CI 0.40–0.40; 2640 participants) and 0.26 at 2 years or longer (95% CI 0.26–0.27; 1262 participants). Monotherapy, lower blood pressure before withdrawal and body weight were reported as predictors for successful withdrawal. Adverse events were more common in those who withdrew but were minor and included headache, joint pain, palpitations, oedema and a general feeling of being unwell. Prescribers should consider offering patients with well controlled hypertension a trial of withdrawal of antihypertensive treatment with subsequent regular blood pressure monitoring

Underrepresentation of Elderly People in Randomised Controlled Trials. The Example of Trials of 4 Widely Prescribed Drugs

BACKGROUND: We aimed to determine the representation of elderly people in published reports of randomized controlled trials (RCTs). We focused on trials of 4 medications--pioglitazone, rosuvastatin, risedronate, and valsartan-frequently used by elderly patients with chronic medical conditions. METHODS AND FINDINGS: We selected all reports of RCTs indexed in PubMed from 1966 to April 2008 evaluating one of the 4 medications of interest. Estimates of the community-based "on-treatment" population were from a national health insurance database (SNIIR-AM) covering approximately 86% of the population in France. From this database, we evaluated data claims from January 2006 to December 2007 for 1,958,716 patients who received one of the medications of interest for more than 6 months. Of the 155 RCT reports selected, only 3 studies were exclusively of elderly patients (2 assessing valsartan; 1 risedronate). In only 4 of 37 reports (10.8%) for pioglitazone, 4 of 22 (18.2%) for risedronate, 3 of 29 (10.3%) for rosuvastatine and 9 of 67 (13.4%) for valsartan, the proportion of patients aged 65 or older was within or above that treated in clinical practice. In 62.2% of the reports for pioglitazone, 40.9% for risedronate, 37.9% for rosuvastatine, and 70.2% for valsartan, the proportion of patients aged 65 or older was lower than half that in the treated population. The representation of elderly people did not differ by publication date or sample size. CONCLUSIONS: Elderly patients are poorly represented in RCTs of drugs they are likely to receive

Atrial fibrillation in the elderly general population: a 30-year follow-up from 70 to 100 years of age

Objectives. There is limited knowledge of atrial fibrillation (AF) incidence among the very old. Data from longitudinal cohort studies may give us a better insight. The aim of the study was to investigate the incidence rate and prevalence of AF, as well as the impact of AF on mortality, in the general population, from 70 to 100 years of age. Design. This was a population-based prospective cohort study where three representative samples of 70-year-old men and women (n = 2,629) from the Gerontological and Geriatric Populations Studies in Gothenburg (H-70) were included between 1971 and 1982. The participants were examined at age 70 years and were re-examined repeatedly until 100 years of age. AF was diagnosed according to a 12-lead electrocardiogram (ECG) recording at baseline and follow-up examinations, from the Swedish National Patient Register (NPR), or from the Cause of Death Register. Results. The cumulative incidence of AF from 70 to 100 years of age was 65.6% for men and 52.8% for women. Mortality was significantly higher in participants with AF compared with those without, rate ratio (RR) 1.92 (95% CI 1.73-2.14). In a subgroup analysis comprising only participants with AF diagnosed by ECG at screening, the RR for death was 1.29 (95% C.I: 1.03-1.63). Conclusions. Among persons surviving to age 70, the cumulative incidence of AF was over 50% during follow-up. Mortality rate was twice as high in participants with AF compared to participants without AF. Among participants with AF first recorded at a screening examination, the increased risk was only 29%

Changes in drug treatment in the elderly between 1971 and 2000

OBJECTIVE: To investigate changes in drug treatment among elderly men and women over a 29-year period between 1971 and 2000. METHODS: Drug consumption was investigated in five representative population samples of 70-year-olds born in 1901-1902 (n=973), 1906-1907 (n=1036), 1911-1912 (n=619), 1922 (n=449) and 1930 (n=506) and in three representative samples of 79- to 80-year-olds born in 1901-1902 (n=537), 1906-1907 (n=538) and 1915 (n=212). RESULTS: The proportion of 70-year-olds who used drugs increased from 60% to 79% in men and from 76% to 88% in women from 1972 to 2000. Among 80-year-olds, 21% of the men and 11% of the women were without drug treatment in 1980, compared with 7% in 1995. The average number of drugs among 70-year-olds on treatment increased during the observation period from 2.8 to 3.5 in men and from 2.8 to 4.0 in women. At age 79-80 years, the mean number of drugs was 3.3 in men and 4.0 in women in 1980 and 4.0 in men and 4.7 in women in 1995. The most common drugs were cardiovascular drugs, analgesics and drugs for diseases in the central nervous system. The most pronounced changes in the consumption of specific drugs were found for anti-ulcerative drugs (increased), digitalis (decreased), diuretics (decreased in women), anti-thrombotic drugs (increased), calcium/vitamin D (increased), insulin (increased in men aged 70 years), analgesics (increased), levaxin (increased in women), anti-depressants (increased in women aged 70 years) and oestrogen in women (increased). The treatment patterns for cardiovascular diseases changed during the observation period and the use of calcium antagonists, angiotensin converting enzyme inhibitors, beta-blockers and lipid-lowering drugs increased. CONCLUSION: The proportion of the population with drug treatment at ages 70 years and 79-80 years increased as did the average number of drugs among treated subjects between 1971 and 2000. Important differences in the treatment patterns for different diseases were observed

Cholesterol and triglyceride levels in midlife and risk of heart failure in women, a longitudinal study: the prospective population study of women in Gothenburg

ObjectiveTo examine the association between triglycerides and cholesterol serum values and risk of developing heart failure in women.DesignLongitudinal observational study of four cohorts 50-year-old women examined in 1968–1969, 1980–1981, 1992–1993 and 2004–2005, and followed until 2012. S-triglycerides and s-cholesterol were measured at baseline and heart failure morbidity and mortality data collected from 1980 to 2012.SettingProspective population study Gothenburg, Sweden. Primary care.Participants1143 women 50 year old without history of heart failure or myocardial infarction.Main outcome measureAssociation among s-triglycerides, s-cholesterol and heart failure expressed as HR for heart failure, adjusted for smoking, body mass index (BMI), physical activity and age.ResultsFor 50-year-old women examined in 1968–1969, there was an independent association between level of s-triglycerides and heart failure and a significantly higher risk of developing heart failure (HR 1.8; CI 1.16 to 2.80, for each increment of 1.0 mmol/L in s-triglycerides), adjusted for smoking, BMI, physical activity and age. There was no significant association between s-cholesterol and risk of heart failure (HR 0.9; CI 0.77 to 1.15). In the cohorts of 50-year-old women examined in 1980 and 1992, there were no significant associations between neither s-triglycerides or s-cholesterol and the risk of heart failure. In the pooled analyses of the cohorts examined in 1968, 1980 and 1992, a significantly increased risk of heart failure was found (HR 1.49; CI 1.10 to 2.03) for s-triglycerides independently, but not for s-cholesterol. None of the 50-year-old women examined in 2004–2005 developed heart failure by 2012 and were excluded from further analyses.ConclusionsHigh levels of s-triglycerides but not s-cholesterol may be a risk marker for later development of heart failure in 50-year-old women.</jats:sec