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Biomedical subjects

E Kristensen

Publications and source records attributed to E Kristensen.

At least 19 recordsLinked to original sources

Within- and across-person uniformity of body condition scoring in Danish Holstein cattle.

Body condition scores (BCS) are very useful for dairy herd management and breeding programs, but the consistency and quality of recordings made by consultants in the field are unknown. The objectives of this study were 1) to estimate the agreement in BCS within and among practicing dairy veterinarians and 2) to provide an indication of the effects of training and the value of calibration, and of what efforts need to be made to obtain a validity and precision in BCS adequate for management purposes. A total of 2,230 scores were recorded by 51 practicing dairy veterinarians and 6 highly trained instructors. The 6 instructors were cross-trained to validate calibration consistency in assigning BCS. Each individual scored approximately 20 cows twice, with the second scoring occurring approximately 2.5 h after the first. Between the 2 recordings, the respective instructors conducted a training session for the practicing veterinarians using other cows. A weighted kappa coefficient was used to assess agreement among and within classifiers. Excellent agreement (kappa > or = 0.86) was documented between repeated BCS recorded for the same cows by the highly trained instructors. In addition, the BCS provided by multiple classifiers from the instructor team appeared to be comparable across herds and classifiers. This legitimizes the use of BCS for benchmarking at both the cow and the herd level. The within-classifier and between-classifier kappa values were in the ranges of 0.22 to 0.75 and 0.17 to 0.78, respectively, in the group of practicing dairy veterinarians. Many of the veterinarians provided estimates of average BCS that differed considerably from the BCS recorded by the instructors. Between-classifier comparisons of herd BCS are not warranted unless a validation has been performed. If scores are collected by multiple classifiers with varying experience, a valid but imprecise estimate of the true population mean of BCS may be obtained if classifiers are inexperienced. The limited training effort used in this study seemed to have brought about substantial improvement in the validity and precision of the BCS determined by practicing veterinarians, compared with the BCS recorded on the same cows by highly trained classifiers.

Animals↗

Impact of polychaetes (Nereis spp. and Arenicola marina) on carbon biogeochemistry in coastal marine sediments.

Known effects of bioturbation by common polychaetes (Nereis spp. and Arenicola marina) in Northern European coastal waters on sediment carbon diagenesis is summarized and assessed. The physical impact of irrigation and reworking activity of the involved polychaete species is evaluated and related to their basic biology. Based on past and present experimental work, it is concluded that effects of bioturbation on carbon diagenesis from manipulated laboratory experiments cannot be directly extrapolated to in situ conditions. The 45-260% flux (e.g., CO2 release) enhancement found in the laboratory is much higher than usually observed in the field (10-25%). Thus, the faunal induced enhancement of microbial carbon oxidation in natural sediments instead causes a reduction of the organic matter inventory rather than an increased release of CO2 across the sediment/water interface. The relative decrease in organic inventory (Gb/Gu) is inversely related to the relative increase in microbial capacity for organic matter decay (kb/ku). The equilibrium is controlled by the balance between organic input (deposition of organic matter at the sediment surface) and the intensity of bioturbation. Introduction of oxygen to subsurface sediment and removal of metabolites are considered the two most important underlying mechanisms for the stimulation of carbon oxidation by burrowing fauna. Introduction of oxygen to deep sediment layers of low microbial activity, either by downward irrigation transport of overlying oxic water or by upward reworking transport of sediment to the oxic water column will increase carbon oxidation of anaerobically refractory organic matter. It appears that the irrigation effect is larger than and to a higher degree dependent on animal density than the reworking effect. Enhancement of anaerobic carbon oxidation by removal of metabolites (reduced diffusion scale) may cause a significant increase in total sediment metabolism. This is caused by three possible mechanisms: (i) combined mineralization and biological uptake; (ii) combined mineralization and abiogenic precipitation; and (iii) alleviation of metabolite inhibition. Finally, some suggestions for future work on bioturbation effects are presented, including: (i) experimental verification of metabolite inhibition in bioturbated sediments; (ii) mapping and quantification of the role of metals as electron acceptors in bioturbated sediments; and (iii) identification of microbial community composition by the use of new molecular biological techniques. These three topics are not intended to cover all unresolved aspects of bioturbation, but should rather be considered a list of obvious gaps in our knowledge and present new and appealing approaches.

Journal Article↗

Using programme budgeting and marginal analysis to assist population based strategic planning for coronary heart disease.

OBJECTIVES: the objective of this project was to use programme budgeting and marginal analysis (PBMA), to inform the planning process of the South Western Sydney Area Health Service (SWSAHS) in respect of coronary heart disease (CHD). METHODS: a working party was established to carry out the project. The group set the parameters of the project and identified the programme, and associated the activity and resource use. Three sub-groups were established to undertake the marginal analysis. RESULTS: each sub-group (representing prevention, treatment, and rehabilitation for CHD) developed a list of potential strategies and provided estimates of resource use and consequences. These were prioritised and presented as recommendations to the SWSAHS. Some recommendations required enhancement funding for the SWSAHS. CONCLUSIOSN: while the use of PBMA presented some challenges, there were also some important outcomes. A comprehensive and detailed picture of resource use enabled the participants to form a view on how additional or reduced resources for CHD should be dealt with at the area level. The ultimate recommendations represent involvement by key stakeholders in the SWSAHS planning process, not just in identifying the 'vision' of CHD services, but also, how service delivery would be organised to achieve the overall objectives of reducing CHD morbidity and mortality.

Australia↗

Evaluation of the first strategic plan for Aboriginal health in south western Sydney, 1993-98.

The 1993-98 Aboriginal Health Strategic Plan for South Western Sydney represented the first partnership of its kind between an Area Health Service, local Aboriginal Health Workers and the local Aboriginal Community Controlled Health Service in Australia. During 1998, an evaluation of the plan was undertaken as part of the preparation for the second Aboriginal Health Plan. Of the 45 strategies in the first plan, 38% had been fully implemented, 42% had been partly implemented, and 20% were not implemented at all. This paper discusses the importance of data collection and monitoring systems, the integration of Aboriginal health into mainstream services, the further development of Aboriginal health infrastructure, and continued leadership by senior managers.

Child↗

[Emergency admissions to a general hospital. Why emergency admission? Is there an alternative?].

A study was conducted where the GPs in a district answered a questionnaire on reasons for hospital admission, divided into the categories: needed hospital investigation, hospital treatment, or needed care and nursing. They judged whether the admission could have been prevented. Finally, a multidisciplinary panel discussed ways to obtain better courses of admission. Of 266 admissions, 40 (15%) were due to a need for care and nursing. Ninety-seven (37%) of the admissions could be replaced by a short one-day stay, and 52 (20%) could have been postponed until the next day if that was possible. The panel discussion showed that municipalities can do more to strengthen the local professional support. It is concluded that the interface between primary care and the hospital should offer better opportunities for one-day admissions or sub-acute admissions, and that municipalities must be more aware of their responsibility for the care of fragile and ill people.

Adult↗

Outcome of lithium prophylaxis: a prospective follow-up of affective disorder patients assigned to high and low serum lithium levels.

The purpose of the study was to examine the outcome of long-term lithium treatment in consecutively admitted affective disorder patients assigned to high and low serum lithium levels. A total of 91 patients were diagnosed according to DSM-III criteria and randomly allocated to two open treatment groups in which prophylactic lithium was administered in high (serum lithium 0.8-1.0 mmol L-1) and low (serum lithium 0.5-0.8 mmol L-1) doses, respectively. The patients were followed for 2 years or until discontinuation of lithium treatment or readmission to hospital for recurrence of affective illness. The main outcome of the treatment groups was compared with Kaplan-Meier survival curves and by Cox regression analysis. A total of 31 patients (34%) completed 24 months of prophylactic lithium treatment without recurrence and readmission to hospital. In total, 18 patients (20%) suffered a recurrence on lithium, and 42 patients (46%) discontinued lithium or were lost to follow-up. No effect of treatment group was seen, either for the total patient group or for the large subgroup of bipolar patients when analysed separately. A number of patients did not maintain their original assignment to the high serum lithium levels group. The results were analysed both according to assignment and according to actual serum lithium levels. Abuse of alcohol or medication was associated with a poor outcome. Only one third of the patients completed 2 years of lithium prophylaxis successfully. No difference in the protection against recurrences was observed between patients maintained on high and low serum lithium levels.

Adult↗

[Communication between primary and secondary sector and its significance for patient care. Evaluation based on admission records and discharge letters of patients admitted acutely to a department of internal medicine].

The aim of this study was to evaluate the informative content of referrals and discharge summary letters concerning patients admitted acutely to the Department of Internal Medicine in a Danish district hospital, and to estimate the delivery time for discharge summary letters. A total of 132 patients were consecutively enrolled from May 2nd to May 30th 1995. The receiving doctor in the hospital on the day of admission as well as the general practitioner who received the discharge summary letter were asked to complete a specific designed questionnaire. The referrals were often insufficient regarding patient history (in particular data on psychosocial aspects and prescribed medicine) and physical examination. Every fifth referral was never received by the hospital. The delivery time for discharge summary letters was 13 days (0-87 days). In every fifth case the information was needed earlier. The discharge summary letters often lacked information concerning what the patients had been told, prognosis and suggestions concerning social medicine. This study indicates that the collaboration between general practitioners and doctors in hospital can be improved by of enhancing the informative content of referrals and discharge summary letters and the expedition time of discharge summary letters.

Adult↗

Serum protein electrophoresis: potential test for use in geriatric companion animal health programmes.

The electrophoretic patterns of 117 serum samples from 37 clinically healthy old dogs (age: 10.0 +/- 2.5 years, mean +/- SD) 47 old dogs (age: 9.7 +/- 2.0 years) with different diseases, 18 clinically healthy young dogs (age: 2.9 +/- 1.6 years) and 15 young dogs (age: 2.0 +/- 1.0 years) with different diseases were evaluated using agarose as a supporting matrix. Three major electrophoretic patterns were identified after densitometric scanning. The first pattern was a predominant pattern for the young healthy dogs (found in 67% of dogs in that group) and was considered normal for healthy dogs. The second pattern had relatively higher proportions of beta and gamma globulins (polyclonal immunoglobulinaemia) and was a predominant pattern among the old healthy dogs (found in 51% of dogs in that group). The findings regarding the second pattern appear to suggest that they had been exposed to antigens during their lives and that they had a well developed and responsive humoral immune response. The third pattern was characterized by high levels of alpha globulins, it was the most common pattern in the old diseased dogs (found in 70% of the dogs in that group). The third pattern was considered to indicate an inflammatory response among old dogs when compared to young dogs (P < 0.01). These patterns appear to suggest that because of aging and/or accumulated injury geriatric dogs will have high levels of polyclonal gamma-globulinaemia or acute phase reactants. The observed patterns, especially the one showing high levels of alpha-globulins, could be a valuable parameter in the search for individuals requiring special attention and thus for the establishment of health programmes for geriatric dogs. With further effort, serum protein electrophoresis might prove to be a useful test for the evaluation of geriatric companion animals for diagnostic, prognostic and therapeutic reasons.

Aged↗

Cholinergic dysfunction of heart, pupil, salivary glands, and urinary bladder in healthy volunteers during long-term treatment with clomipramine.

Cholinergic functions were studied in ten non-depressed healthy volunteers who were treated with 50 mg clomipramine daily for 3 weeks and subsequently with 100 mg daily for a further 3 weeks. Impairments in heart rate variation (HRV) at rest and standing, of the pupillary light response and of salivation were related to serum levels of clomipramine. Since reduction of HRV is closely related to dose (r = -0.83, P less than 10(-2] and is a better predictor of serum levels than the other measures examined, it is suggested that the easy obtainable function test of HRV at standing can be used as an estimate of over-all cholinergic dysfunction during treatment with tricyclic antidepressants.

Adult↗

Sexual function in lithium-treated manic-depressive patients.

Sexual function in 24 patients with major affective disorders who were given prophylactic lithium treatment was compared with that of a control group of surgical outpatients with no known psychiatric disease. Changes in sexual function during lithium treatment were also recorded retrospectively. Sexual dysfunctions were described by about one-fourth of both female patients and controls. About one-third of the male patients and controls reported sexual dysfunctions. We cannot exclude tha lithium in combination with other psychotropic drugs may increase the frequency of sexual dysfunction. Changes in sexual function during lithium treatment were reported by one-fourth of the patients. Of these, four reported a positive influence of the treatment and five a negative influence. Statistically, significantly more patients than controls were dissatisfied with their present sex life.

Adolescent↗

Familial giant hypertrophic gastritis (Ménétrier's disease).

Familial giant hypertrophic gastritis involving three generations is reported. A review of the literature, where approximately 200 cases are described, showed only few cases of familial occurrence of this disease, and only in siblings. Our findings suggest dominant heredity, but considering the sparsity of familial occurrence reported earlier, heredity seems to be of only minor pathogenetic significance.

Adolescent↗

Lymphocyte subpopulations, lymphoblast transformation activity, and concanavalin A-induced suppressor activity in patients with ulcerative colitis and Crohn's disease.

The following immunologic in vitro tests were applied on peripheral blood mononuclear cells (PBMC) from patients with chronic inflammatory bowel disease (IBD): concanavalin A (Con A)-induced suppressor test, Con A-activated lymphoblast transformation test, and spontaneous lymphoblast transformation test. Concomitant phenotypic characterization of subsets of PBMC was performed with monoclonal antibodies. Patients with ulcerative colitis and a control group with rheumatoid arthritis showed significantly reduced activity in the Con A-activated lymphoblast transformation test compared with healthy controls and patients with Crohn's disease. The distribution of PBMC subsets and the results of the other in vitro tests were similar for patients with IBD and healthy controls. Thus the decrease in Con A-activated lymphoblast activity was not due to an increased suppressor function as measured either by functional Con A-induced suppressor test or indirectly by T8 phenotype.

Adult↗

A prospective, blind investigation of immunological reactions in chronic inflammatory bowel disease. Suppressor activity and immune capacity.

In a paired, blind and prospective study including 36 patients with chronic inflammatory bowel disease, i.e. ulcerative colitis (UC) and Crohn's disease (CD), and 36 healthy volunteers, the immune capacity has been examined by three different test systems using peripheral blood mononuclear cells: spontaneous mitotic activity (SMA), concanavalin A (con A) activated lymphoblast transformation test (LTT) and autologous mixed lymphocyte reaction (AMLR). The same patients and controls were examined simultaneously for their suppressor activity by a con A induced suppressor activity (CAISA) test. SMA was similar in UC patients and controls. The lymphoblast transformation (LT) in UC patients was significantly reduced with submaximal concentrations of con A (1 and 2 micrograms), whereas AMLR was only non-significantly decreased. However, the results registered by these two test systems revealed a significantly positive correlation. CAISA in UC patients was significantly enhanced, but this finding showed no correlation to the reduced LTT and AMLR, indicating a primary defect in the mitotic capacity independent of the observed increment in CAISA. SMA, con A activated LT, AMLR and CAISA were similar in CD patients and controls.

Adolescent↗

Concanavalin A induction of suppressor activity in the T-helper subset defined by monoclonal antibodies.

Human monocyte-depleted peripheral blood mononuclear cells were separated in T4+ and T8+ populations by a panning technique. Petri dishes coated with goat anti-mouse antibodies were plated by peripheral blood mononuclear cells coated by monoclonal antibodies, either T4 or T8. The cell populations were separated into adherent and non-adherent populations based on binding to the goat anti-mouse-coated plastic dishes. The purity of the adherent populations was 96%. T4+ and T8+ populations were used as effector cells in the concanavalin A-induced suppressor test. The T4+ population revealed a pronounced suppressor activity similar to that exhibited by the T8+ population. This finding was independent of two different sources of monoclonal antibodies, T4/T8 and OKT4/OKT8. The registered suppressor activity in the monoclonal antibody-defined helper population could not be explained either by a switch of the membrane phenotype from T4+ to T8+ cells or by an increased interleukin 2 consumption of the concanavalin A-treated cells.

Antibodies, Monoclonal↗