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

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

Nurse-led heart failure follow-up in primary care in Sweden

Background: Little or no knowledge is available about which service is offered to patients with heart failure in primary care. Aims: To describe nurse-led follow-up of patients with heart failure in primary care in Sweden. Methods and results: A questionnaire was sent to all primary health care centres in Sweden and 6 10 of 939 centres returned the questionnaire. Special nurses had designated time for follow-up of heart failure patients at 18% (n = 111) of the centres, compared to 93% and 78% for diabetes and obstructive lung disease. Centres with nurse-led follow-up of heart failure patients more frequently provided heart failure information (p<0.001), had more doctors interested in heart failure (p<0.001), more often had special care programmes (P<0.001) and had more co-operation with the hospitals around patients with heart failure (p<0.01), compared to centres without such follow-up (n = 499). Conclusion: In primary care in Sweden, nurse-led follow-up is uncommon for patients with heart failure, despite being common for patients with diabetes and obstructive pulmonary disease. To improve this situation in primary care, an increased number of specially trained nurses is needed, together with further research to ensure a high quality follow-up in primary care. (C) 2008 European Society of Cardiology. Published by Elsevier B.V. All rights reserved

The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study

Abstract Background There is still a considerable delay between the onset of symptoms and arrival at a stroke unit for most patients with acute stroke. The aim of the study was to describe the feasibility of a pre-hospital diagnosis of stroke by an emergency medical service (EMS) nurse in terms of diagnostic accuracy and delay from dialing 112 until arrival at a stroke unit. Methods Between September 2008 and November 2009, a subset of patients with presumed acute stroke in the pre-hospital setting were admitted by EMS staff directly to a stroke unit, bypassing the emergency department. A control group, matched for a number of background variables, was created. Results In all, there were 53 patients in the direct admission group, and 49 patients in the control group. The median delay from calling for an ambulance until arrival at a stroke unit was 54 minutes in the direct admission group and 289 minutes in the control group (p  In a comparison between the direct admission group and the control group, a final diagnosis of stroke, transient ischemic attack (TIA) or the sequelae of prior stroke was found in 85% versus 90% (NS). Among stroke patients who lived at home prior to the event, the percentage of patients that were living at home after 3 months was 71% and 62% respectively (NS). Conclusions In a pilot study, the concept of a pre-hospital diagnosis of stroke by an EMS nurse was associated with relatively high diagnostic accuracy in terms of stroke-related diagnoses and a short delay to arrival at a stroke unit. These data need to be confirmed in larger studies, with a concomitant evaluation of the clinical consequences and, if possible, the level of patient satisfaction as well.</p

Low serum testosterone and high serum estradiol associate with lower extremity peripheral arterial disease in elderly men - The MrOS study in Sweden

Objectives This study sought to determine whether serum levels of testosterone and estradiol associate with lower extremity peripheral arterial disease (PAD) in a large population-based cohort of elderly men. Background Few studies have explored the relationship between serum sex steroids and lower extremity PAD in men. Methods The Swedish arm of the MrOS (Osteoporotic Fractures in Men) study (n = 3,014; average age 75.4 years) assessed ankle-brachial index (ABI) and defined lower extremity PAD as ABI < 0.90. Radioimmunoassay measured serum levels of total testosterone, estradiol, and sex hormone-binding globulin, and we calculated free testosterone and free estradiol levels from the mass action equations. Results A linear regression model including age, current smoking, previous smoking, diabetes, hypertension, body mass index, free testosterone, and free estradiol showed that free testosterone independently and positively associates with ABI (p < 0.001), whereas free estradiol independently and negatively associates with ABI (p < 0.001). Logistic regression analyses showed that free testosterone in the lowest quartile (vs. quartiles 2 to 4; odds ratio [OR] 1.65, 95% confidence interval [Cl] 1.22 to 2.23, p = 0.001) and free estradiol in the highest quartile (vs. quartiles 1 to 3; OR 1.45, 95% Cl 1.09 to 1.94, p = 0.012) independently associate with lower extremity PAD. Conclusions This cross-sectional study shows for the first time that low serum testosterone and high serum estradiol levels associate with lower extremity PAD in elderly men. Future prospective and interventional studies are needed to establish possible causal relationships between sex steroids and the development of lower extremity PAD in men