Serosurvey of Coxiella burnetii (Q fever) in Dromedary Camels (Camelus dromedarius) in Laikipia County, Kenya.

Dromedary camels (Camelus dromedarius) are an important protein source for people in semi-arid and arid regions of Africa. In Kenya, camel populations have grown dramatically in the past few decades resulting in the potential for increased disease transmission between humans and camels. An estimated four million Kenyans drink unpasteurized camel milk, which poses a disease risk. We evaluated the seroprevalence of a significant zoonotic pathogen, Coxiella burnetii (Q fever), among 334 camels from nine herds in Laikipia County, Kenya. Serum testing revealed 18.6% positive seroprevalence of Coxiella burnetii (n = 344). Increasing camel age was positively associated with C. burnetii seroprevalence (OR = 5.36). Our study confirmed that camels living in Laikipia County, Kenya, have been exposed to the zoonotic pathogen, C. burnetii. Further research to evaluate the role of camels in disease transmission to other livestock, wildlife and humans in Kenya should be conducted.

Treatment of 5413 hypertensive patients: a cross-sectional study.

BACKGROUND: Most hypertensive patients are managed in primary care in Denmark, but previous studies have shown that only 21-43% of hypertensive patients achieve optimal blood pressure (BP) control. Antihypertensive drug treatment, risk factors and cardiovascular disease (CVD) are some of the important factors to consider when optimizing the individual treatment strategy in hypertensive patients. OBJECTIVE: To examine treatment of BP according to Danish guidelines (BP < 140/90 mmHg generally and <130/80 mmHg for diabetics) in a population from general practice in relation to risk factors, CVD and diagnosis of diabetes. METHODS: A cross-sectional study comprising 184 practices and 5413 hypertensive patients was carried out in Denmark. The general practitioners filled in information on each patient's risk factors, CVD and antihypertensive drug treatment. Patients filled in a questionnaire on risk factors. The outcome measures were optimal BP control according to Danish guidelines and antihypertensive drug treatment. RESULTS: Mean patient age was 65.9 years [95% confidence interval (CI): 65.6-66.1]. Optimal BP control was achieved in 29.1% (95% CI: 27.9-30.3) of the study population. Among 842 diabetics with or without CVD, optimal BP control was achieved in 10.9% (95% CI: 8.8-10.3), while 38.7% (35.5-41.9) of patients with CVD achieved optimal BP control. The majority of all patients were treated with 1 (32.5%, 95% CI: 32.5 (31.3-33.8)) or two antihypertensive drugs (39.0%, 95% CI: 38.2-40.8). In hypertensive diabetics, 17.7% were not treated with an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker. CONCLUSION: In general practice, the proportion of hypertensive patients achieving optimal BP control is inadequate. The majority of hypertensive patients are treated with only one or two antihypertensive drugs.

Effect of oral ketamine on secondary hyperalgesia, thermal and mechanical pain thresholds, and sedation in humans.

BACKGROUND AND OBJECTIVES: Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist, and has been proven effective in alleviating secondary hyperalgesia in human subjects when injected intravenously. After oral ingestion, ketamine is metabolized into norketamine, which in vitro possesses NMDA receptor antagonistic effect. The aim of this study was to investigate the effects of oral administration of ketamine on secondary hyperalgesia evoked by standardized tissue injury. METHODS: Twenty-four male volunteers were included in the study. Each volunteer received the following treatment regimen, in randomized, double-blind, 3-way cross-over fashion: (A) placebo; (B) ketamine, 0.5 mg/kg; and (C) ketamine, 1.0 mg/kg. Standardized tissue injury was induced after study medication by heating the right calf with a rectangular thermode. The temperature was 47 degrees C, and heating time was 7 minutes. The following parameters were investigated: Pain during induction of the burn injury; heat-pain detection thresholds in the injured area and a corresponding noninjured area; secondary hyperalgesia surrounding the injured area on the calf; secondary hyperalgesia induced by heating an area on the thigh with 45 degrees C in 3 minutes; pressure-pain detection thresholds measured on the middle phalanx of the 4th left finger; pain during a 60-second thermal stimulation of 46 degrees C on undamaged skin on the left thigh; and side effects. RESULTS: Some degree of sedation was observed after oral administration of ketamine. No effects on any of the other investigated parameters were observed. CONCLUSION: Oral ketamine 0.5 or 1.0 mg/kg has no effect on secondary hyperalgesia or thermal or mechanical pain thresholds in human volunteers.

[Duration of breast feeding--which factors are significant?]. / Ammeperiodens laengde--hvilke faktorer har betydning.

Duration of breast-feeding (BF) was studied in 249 randomly chosen healthy, term infants of Danish origin of which 81% participated. BF was initiated by 99.5% of the mothers. At three, six, and nine months, 71%, 52%, and 33%, respectively, were still BF. Only one infant (0.5%) was exclusively BF beyond the age of seven months. In a Cox multiple regression analysis of factors influencing duration of BF, we found a positive association with maternal education (p < 0.001), and age (p = 0.02), and a negative association with the amount of formula given at the maternity ward (p < 0.001). Six months after delivery 79% of the mothers with higher school education (> or = 12 years) were still BF, compared to 29% with a low school education (< or = 9 years). There is still a need for an increased effort to support mothers in BF to be focused on younger mothers with short school education. Formula supplements during the first days of life, given to 73% of the infants, were associated with shorter duration of BF and should be discouraged.

The Copenhagen cohort study on infant nutrition and growth: duration of breast feeding and influencing factors.

Duration of breast feeding was studied in 249 randomly chosen, healthy, term infants of Danish origin of which 80.7% participated. Breast feeding was initiated by 99.5% of the mothers. At 3, 6 and 9 months, 71%, 52% and 33%, respectively, were still breast feeding. Only 1 infant (0.5%) was exclusively breast fed beyond 7 months of age. In a Cox multiple regression analysis of factors influencing duration of breast feeding, we found a positive association with maternal education (p < 0.001) and age (p = 0.02) and a negative association with the amount of formula given at the maternity ward (p < 0.001). Six months after delivery, 79% of the mothers with higher school education (> or = 12 years) were still breast feeding, compared to 29% with a low school education (< or = 9 years). There is still a need for an increased effort to support mothers in breast feeding, focusing particularly on younger mothers with short school education. Formula supplements during the first days of life, given to 73% of the infants, were associated with a shorter duration of breast feeding and should be discouraged.

The Copenhagen Cohort Study on Infant Nutrition and Growth: breast-milk intake, human milk macronutrient content, and influencing factors.

In 91 healthy term infants breast-milk intake was measured at 2, 4, and 9 mo by test weighing and human milk macronutrient content by infrared analysis every 2-4 wk. In infants exclusively breast-fed, mean milk intake was 781 and 855 mL/24 h at 2 and 4 mo, respectively, and correlated positively with the current weight of the infant and negatively with the amount of formula supplement given at the maternity ward. Median daily energy intake was considerably below current recommendations (423 and 381 kJ/kg body wt at 2 and 4 mo, respectively). Protein concentration in the milk was approximately 8% higher in primipara. Median daily protein intake was 1.3 and 1.0 g/kg body wt at 2 and 4 mo, respectively. Median fat concentration was 39.2 g/L and was positively associated with pregnancy weight gain. This supports the hypothesis that maternal fat stores laid down during pregnancy are easier to mobilize during lactation than are other fat stores and, if low, may limit milk fat when exhausted.

[Effects of reducing the number of general practitioners on call on the pattern of the use of ambulances and emergency services]. / Storvagtkredses indflydelse på ambulanceudrykningsmønsteret i Ringkøbing Amt.

The aim of the study was to evaluate the effect of a reduction of the number of general practitioners on call on the use of ambulance emergency service. A prospective registration of all ambulance emergency activity in the county of Ringkøbing over an eight week period was made before and after the reduction of the number of general practitioners on call, together with a 4 + 4 week prospective registration of persons who claimed that contact to the general practitioners service was impossible, therefore resulting in a contact to the emergency central or the accident and emergency department. The numbers of emergency calls and emergency ambulance services in the population were unchanged, but there was a significant reduction from 78.9% to 69.3% in the relative number of ambulance services resulting in an admission to hospital of the patient. The number of patients, who claimed that contact to the general practitioner service was impossible was unchanged. We conclude that a reduction of the number of general practitioners on call has resulted in a reduction in the relative number of ambulance services resulting in hospital admission of the patient, which suggests a decline in the threshold of the population for calling an ambulance.

Principles and problems of human energy exchange.

The principles and laws that determine the relations between observed quantities in experiments on human energy exchange are described in terms of classical thermodynamics applied to an open system. It is suggested that adherence to such a description will help avoid ambiguities and imprecision in analysis of the data. The description suggests a framework within which the control aspects of the system can be profitably analyzed.

Ovarian and placental hormones during prolactin suppression and stimulation in early human pregnancy.

Twenty-seven healthy females referred for legal abortion between the sixth and ninth week of pregnancy were treated for 1 week with either bromocriptine, metoclopramide or placebo. Serum prolactin was significantly (P < 0.01) elevated by metoclopramide and suppressed by bromocriptine. Despite a more than tenfold difference in circulating prolactin levels among these two groups, no significant difference was found in serum levels of progesterone, oestradiol, human chorionic gonadotrophin (hCG) human placental lactogen (hPL) or pregnancy specific B1-glycoprotein (SP1). These data suggest that circulating levels of prolactin below 150 ng/ml are without effect on either luteal or placental hormone secretion during early human pregnancy.