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PubMed1976

A quantitative comparison of the formation of synapses in the rat superior cervical sympathetic ganglion by its own and by foreign nerve fibres.

The rat superior cervical sympathetic ganglion (SCG) has about 36,000 neurones in a volume of about 1 cu.mm. There are about 8.8 X 10(6) synapses, and 6000-9000 preganglionic axons. Section of the preganglionic chain causes a loss of 93% of the synapses. In the denervated SCG there are 0.6 X 10(6) remaining ('intrinsic') synapses, and a proportion of the synaptic sites are identifiable as vacated synaptic thickenings (3 X 10(6) per SCG, as compared with 0.5 X 10(6) in the normal intact SCG). After deducting the intrinsic synapses, this indicates that each preganglionic axon forms about 1100 (900-1400) synapses. After freezing the preganglionic chain, subsequent axonal regeneration restores synapse numbers to 85% of normal (7.5 X 10(6) synapses per SCG). After anastomotic repair by suture of the cut ends of the preganglionic chain (a necessary control for the foreign nerve anastomoses), the SCG contains only 60% of the normal complement of synapses (5.2 X 10(6) synapses per SCG). The results of this anastomosis are very variable. However, in individual ganglia the numbers of synapses are directly correlated with the numbers of axons which reach the SCG. After deducting the intrinsic synapses it can be calculated that each axon forms about 700 synapses. This is probably an underestimation of the numbers which would be achieved at longer survival times. After anastomosis of the vagal nerve into the denervated SCG there are about 4.4 X 10(6) synapses per SCG. Morphologically the majority have axon terminals with large dense cored vesicles, and it is likely that these belong to the axons of the parasympathetic preganglionic neurones in the dorsal motor nucleus of the vagus. A smaller population of axon terminals are devoid of large dense cored vesicles; their origin is unknown. The dorsal motor nucleus of the vagus has between 1000 and 2000 neurones. After deducting the intrinsic synapses, this indicates that each axon may form up to 1900-3800 synapses. To the extent that other, unidentified vagal fibres also contribute to the synapses found after this anastomosis, this figure is an overestimate. After anastomosis of the hypoglossal nerve into the denervated SCG, there are 1.5 X 10(6) synapses per SCG. A morphologically distinctive type of axon terminal is found, and it is argued that this may belong to a special category of skeletomotor neurones located in the caudoventral part of the hypoglossal nucleus and distinguished by pseudocholinesterase staining. There are about 600 of these neurones, which would indicate that they form about 1500 synapses per axon (after deducting the numbers of intrinsic synapses). The majority of the hypoglossal neurones do not form intraganglionic synapses; this suggests that although the possession of a cholinergic mechanism may be necessary for axons to be able to form ganglionic synapses, it is not in itself sufficient. For each of the types of anastomosis, the numbers of vacated thickenings are inversely proportional to the numbers of synapses...

Acetyltransferases↗
PubMed1983

Sister chromatid exchange in response to variations in occupational lead exposure.

Sister chromatid exchange (SCE) rates in 10 long-term lead-exposed men increased significantly with increasing zinc protoporphyrin concentration in blood. SCE rates were also related to blood lead levels, but this correlation was not statistically significant. These results were obtained before the summer vacation. Six men were examined again shortly after the vacation; both SCE rates and lead-exposure parameters had decreased significantly. An increase was seen in one worker; however, this result could be related to a serious disease for which he was undergoing treatment. Continued examinations showed a tendency of increasing SCE rates and exposure parameters, but the follow-up was too incomplete to allow a statistical analysis. Further studies of 18 newly employed workers failed to show any increase in SCE during the first 4 months of employment despite some increases in both zinc protoporphyrin and lead levels in the blood. The results obtained suggest that a genotoxic effect due to inorganic lead may occur in long-term lead-exposed workers.

Crossing Over, Genetic↗
PubMed1985

Modifying the snack food consumption patterns of inner city high school students: the Great Sensations Study.

The Great Sensations Program is a nutrition-education project developed for high school students. It was designed to (a) decrease students' consumption of salty snacks and (b) increase students' consumption of fresh fruit snacks. The overall programs were designed following principles of social learning: informative instruction, participatory classroom activities, personal goal setting, feedback, and reinforcement. The program was delivered in six lessons during regular health-education classes. A parental involvement program consisted of mailers and telephone calls to parents to teach them to encourage changes in student snacking habits. A schoolwide program was designed to provide out-of-class peer support for student modifications in salty snack foods. The program was evaluated in one high school using a 2 X 2 design. A second high school served as a no-treatment control. Program assessments were made at both schools before and after the classes, at the end of the school year, and the following fall the next school year following summer vacation. The schoolwide media program was effective in decreasing consumption of salty snack foods and in increasing consumption of target snack foods. However, only those students receiving classroom instruction maintained those changes until the end of the school year. No changes were maintained across summer vacation. These outcomes suggest that school programs developed using principles of social learning may be effective in facilitating important behavior changes at home and at school.

Adolescent↗
PubMed1995

Reinnervation of frog sympathetic ganglia with somatic nerve fibres.

The formation of synapses in the last two ganglia of the sympathetic chain of the frog Rana esculenta was investigated after anastomosing the 6th spinal nerve to the denervated ganglia in order to evaluate the reinnervation of deafferented sympathetic neurons with somatic cholinergic axons. The same ganglia were examined both electrophysiologically and morphologically from 25 to 280 days after the operation. In response to electrical stimulations of the anastomosed spinal nerve, synaptic transmission was analysed with intracellular microelectrodes placed into B or C sympathetic neurons. Synaptic density was quantified using electron microscopy by a synaptic index defined as the ratio of the number of synapses encountered to the number of perykarya examined. After ganglionic deafferentation, post-synaptic membrane differentiations persisted without any pre-synaptic element and an index of the 'vacated' post-synaptic differentiations was calculated. Although somatic axons were growing into all ganglia studied, no sign of neuronal reinnervation was detected in ganglia of 8 of the 31 frogs (26%) taken from 29 to 210 days after the anastomosis. Moreover, in 18 out of 31 frogs (58%) analysed at different times after the operation, the ganglia were reinnervated with regenerating preganglionic axons in spite of care taken to avoid it. However, even after 3 months, certain neurons of these ganglia were not reinnervated and the synaptic index approximated the value of normal ganglia only in the 8th ganglion. In addition, post-synaptic membrane differentiations could still persist and coexist with normal synapses. It was only beyond three months after the anastomosis that the ganglia of 5 of the 31 frogs (16%) were reinnervated with regenerating somatic axons. Reinnervated B and C neurons were polyinnervated. But in 3 out of these 5 frogs the ganglia were also reinnervated with preganglionic axons and several B and C neurons received a double reinnervation. The synaptic indices were far from the value of normal ganglia except for the 8th ganglion of one frog reinnervated by both types of axons and the indices of vacated differentiations were close to that of ganglia with no reinnervated neurons. Contrary to mammals, frog somatic axons are, therefore, relatively ineffective at reinnervating sympathetic neurons, probably because in amphibian ganglia, synapses between the pre- and post-synaptic elements require higher specificity.

Adrenergic Fibers↗
PubMed1987

The response of the associational afferents to the dentate gyrus to simultaneous or sequential elimination of the commissural and entorhinal afferents.

Previous studies have shown that following the removal of the commissural afferents to the dentate gyrus, the ipsilateral association afferents, which are normally distributed within the same region of the molecular layer, sprout new collateral branches and in time occupy essentially all the vacated synaptic sites. It is also known that when the entorhinal afferents to the dentate gyrus are interrupted the associational and commissural fibers can both undergo a similar phase of reactive synaptogenesis and give rise to new collaterals which extend for some distance into the denervated zone. Since the associational fibers can sprout after the removal of either the commissural or entorhinal afferents experiments were designed to determine their capacity for sprouting in newborn and young adult rats when both groups of afferents were eliminated either simultaneously or sequentially (i.e., after an interval of 8 weeks). The resulting changes in the terminal field of the associational afferents were assessed, two months after the last deafferentation, by measuring in autoradiographs the width of the zone occupied by the associational afferents labeled with [3H]proline, and by estimating the volume of this region in Timm-stained sections. The results indicate that under these conditions the associational afferents are capable of expanding their terminal field not only to occupy essentially all of the synaptic sites made available by the elimination of commissural fibers, but also to occupy a significant proportion of the space vacated by the removal of the entorhinal afferents. This suggests that the capacity of the associational afferents for reactive synaptogenesis is greater than that expressed after either commissural of entorhinal lesions alone.

Animals↗
PubMed2006

The September epidemic of asthma hospitalization: school children as disease vectors.

BACKGROUND: Viral infections are associated with the majority of asthma exacerbations in children and adults. Increased asthma hospitalization rates of children and adults, particularly in the early fall, have been observed to follow school vacations. OBJECTIVE: We sought to determine the sequence of timing of September asthma hospitalization epidemics in children and adults and to determine whether school-age children are the primary source of transmission of agents that cause them. METHODS: By using Canadian asthma hospital admission data from 1990 to 2002, we examined geographic variation in the timing of fall asthma epidemics and applied mathematical modeling to estimate their exact timing and magnitude in school-age children, preschool children, and adults, and relation to school return. RESULTS: The September asthma hospitalization epidemic peak occurred in school-age children each year on average 17.7 (95% CI, 16.8-18.5) days after Labor Day. Similar epidemics of lesser magnitude were observed in preschool children peaking 1.7 (95% CI, 0.9-2.5; P<.001) days later, and in adults 6.3 (95% CI, 4.7-7.9; P<.001) days later than in school-age children. The epidemics peaked 4.2 (95% CI, 1.2-7.1; P<.001) days earlier in school-age children in northernmost compared with southernmost latitudes. CONCLUSION: September epidemics of asthma hospitalizations in Canada have a precise relationship to school return after the summer vacation. It may be speculated that school-age children transmit the agents responsible for the epidemic to adults. Measures to improve asthma control and reduce transmission of infections should be directed at children with asthma before school return.

Adolescent↗
PubMed2004

Risk factors for malignant melanoma in an Icelandic population sample.

OBJECTIVES: To describe the constitutional risk factors for malignant melanoma and exposure to sunlight in a population sample in Iceland. METHODS: Information on various risk factors for malignant melanoma was collected through mailed questionnaires sent to a random sample of the Icelandic population. The information collected was the first phase of a prospective study on malignant melanoma among aircrew members as compared to a population sample. RESULTS: The overall participation rate was about 50%. Seven percent of women and six percent of men had red hair color. Blue or green eye color was reported among 89% of women and 87% of men. Sixteen percent of women aged 20 to 39 had used sun beds more than 100 times during their lifetime, while the corresponding figure was 12% for men of the same age. Younger age groups had more sunny vacations than the older age groups. The frequency of sunburn differed in the groups with reported different skin types according to Fitzpatrick classification. CONCLUSION: The high prevalence of sun bed usage among young women is concurrent with the increased incidence of malignant melanoma among young women registered in the nationwide cancer registry. Young people have more often used sun beds and taken sunny vacation than the older, indicating a changed behavior in the population.

Adult↗
PubMed2004

Attitudes, subjective norms and perception of behavioural control as predictors of sun-related behaviour in Swedish adults.

BACKGROUND: Exposure to ultraviolet (UV) radiation is the major preventable cause of skin cancer. The aim of this study was to investigate the explanatory value of attitudes, subjective norms and perceived behavioural control on behaviours related to UV exposure. METHOD: A random population-based sample (n = 1752, 18-37 years of age) in the Stockholm County, Sweden, answered a questionnaire with items on sun related behaviours and beliefs. The items concerned issues influenced by the Theory of Planned Behaviour, that is, attitudes, subjective norms and perceived behavioural control. Logistic regression analysis was used to examine the associations between behaviours and beliefs. RESULTS: Positive attitudes towards being tanned and being in the sun were both strongly associated with time spent in the sun, intentional tanning, sunbed use, going on vacation to a sunny resort, intention to decrease sunbathing and use of protection against the sun. Perceiving sunbathing as risky was associated with using different ways to protect and intending to reduce sun exposure. Having people around oneself who frequently sunbathe was related to intentional tanning and vacations to sunny resorts. Finally, perceived behavioural control was associated with use of sunscreen and use of other ways to protect from the sun among women. CONCLUSION: The study identified factors on which primary preventive interventions towards decreasing sun exposure should be focused.

Adolescent↗
PubMed1999

Intraindividual variations of DNA adduct levels in humans.

Reports on intraindividual changes of DNA adduct levels in humans are rare. Most of the data available in the literature are from polycyclic aromatic hydrocarbons (PAHs) and are measured in white blood cells with 32P-postlabeling or immunochemical assays. Surprisingly, environmental exposure can have a larger effect on PAH adduct levels than occupational exposure, food or smoking. Highest (13-fold) summer/winter increments, due to indoor heating were observed in Gliwice, Poland. Further studies of environmental PAH exposure confirm the environmental influence on intraindividual changes in PAHs-DNA adduct levels: studies of the Teplice program, (Czech Republic) and studies with US soldiers, stationed in Germany who went for a 8-week period of duty to Kuwait. Variations in occupational exposure, e.g., changing of anode material in aluminium plants (elevation factor 3.94), layoffs, reduced working hours in iron foundries or vacation also led to intraindividual changes in PAH adduct levels. Increase in PAH adduct levels after consumption of charcoal broiled meat evidently depends on individual susceptibility, e.g., polymorphism. In one person a 7.4-fold increment was observed. PAH adduct levels were not significantly influenced by smoking cessation whereas sister chromatid exchanges significantly decreased. Changes in occupational exposure to styrene in lamination plants, e.g., due to vacation, did not significantly influence styrene-O6-dG adduct levels in lymphocytes and granulocytes as determined by 32P-postlabeling. Increase of N7-methylguanine and O6-methylguanine levels were followed in white blood cells during treatment of cancer patients with dacarbazine and allowed insights into pharmacokinetic properties. According to a rough estimation the high increment in the PAHs-DNA adduct level of about 13 observed in Gliwice (see above) would result in a tentative increase in cancer risk from about 1 death/107 inhabitants to approximately 10 deaths/107 inhabitants which, in general, is considered as acceptable.

Adult↗
PubMed1998

What to expect from a residency program: answers from a directory of residency programs in obstetrics and gynecology.

OBJECTIVE: To answer questions about obstetric-gynecologic resident salary, night call, vacation, outside employment, gender mix, and training experiences using data from a national directory of residency programs in obstetrics and gynecology. METHODS: The 259 US civilian residency programs were analyzed, using information from the 1996 directory database. We compared programs by size (four or fewer residents per year versus more than four residents per year) and geographic region for each of the questions. We used parametric and nonparametric statistical tests to determine statistical significance. RESULTS: First-year residents earn an average of $31,414 annually and receive a 5% increase each year, although salary varies significantly by region. Residents are on call an average of every 3rd night (twice a week) in the 1st year and every 4th or 5th night in the chief year. Residents in small programs take more night call than those in large programs. A separate night call rotation was more common in large programs. Vacation time varied by year of training and region. Male-to-female ratios in training differed significantly by year in training, program size, and region. The median number of training experiences was identified in each of the categories required by the Residency Review Committee in obstetrics and gynecology. Training experiences varied significantly by program size in three of the 15 categories. CONCLUSION: Program size and geographic region should be considered when comparing programs with regard to pay, work, time off, outside employment, gender mix, and training experiences. Program advisors and potential applicants are encouraged to use this information in comparing programs.

Female↗
PubMed2004

Chronomic community screening reveals about 31% depression, elevated blood pressure and infradian vascular rhythm alteration.

Depression, which is a risk factor for cardiac morbidity and mortality, is not an unusual occurrence among individuals with coronary heart disease (CHD), but evidence concerning its role in the pathogenesis of this condition is less clear. Ambulatory blood pressure monitoring (ABPM) has become an important tool in the diagnosis and management of hypertension. Several previous studies have indicated that various kinds of target organ damage and cardiovascular morbidity are more strongly associated with a diagnosis by ABPM than through spot-checks in a clinical setting. This study investigated whether depressive mood was associated with changes in the about-weekly (circaseptan) and half-weekly (circasemiseptan) variations in blood pressure (BP) and heart rate (HR), including a BP surge on Mondays, in community-dwelling subjects monitored chronomically for the time structure (chronome) of their BP and HR variabilities. From April 2001 to April 2003, 217 subjects (85 men and 132 women; mean age: 56.8 +/- 11.3 yr) from U town, Hokkaido (latitude: 43.45 degrees N, longitude: 141.85 degrees E), self-monitored their BP and HR for 7 days starting around 11 a.m. on Thursday, and took readings at 30-minute intervals between 7 a.m. and 10 p.m., then at 60-minute intervals between 10 p.m. and 7 a.m. The data were retrieved and analyzed on a PC with appropriate commercial software (TM-2430-15; A&D Co., Japan). Subjects were asked about 15 items on a depression rating scale through a self-administered questionnaire. When the score amounted to 5 or higher, subjects were considered to be depressive. Student's t-test, a one-way analysis of variance (ANOVA), and cosinor methods with parametric tests were also used. A p-value below 0.05 was considered to indicate statistical significance (below 0.10: borderline statistical significance). Depression rating scales were obtained for 192 out of the 217 subjects enrolled in this study. Depression scores were (>) 5 in 72 subjects. The average values of systolic (S) and diastolic (D) BP were statistically significantly higher in depressed subjects (SBP: 129.2 vs 124.5 mmHg; p = 0.034; DBP: 79.0 vs 76.5 mmHg; p = 0.041). The 7-day average for HR did not differ between subjects with depression scores of < 5 or > 5. DBP dipping was less in the depressed subjects (16.30 vs 18.22%; p = 0.048). The dipping ratios of SBP and HR showed no statistically significant difference. In the group with depression scores of < 5, HR variability (estimated by the SD of HR and HR dip) was higher during vacations and lower on Mondays. The 24-h BP measures showed a novelty effect and a surge on Mondays. In the depressed group, a prominent circaseptan rhythm appeared to replace the novelty effect, vacation dip, and Monday surge. The results of this investigation indicate the clinical importance of the monitoring of depressed subjects. Fewer than 7 days of monitoring means a greater risk of false diagnosis, and thus a therapeutic decision including potentially unnecessary or inappropriate long-term treatment. Records shorter than 7 days would not have detected circaseptan BP dysrhythmia associated with a depressive state. Prominent circaseptans can provide new indications on the mechanisms underlying the strong relation between depression and adverse cardiac events. Future studies should aim at determining whether the treatment of depression, especially from the standpoint of a chronodiagnosis and chronotherapy, can reduce the incidence of adverse cardiac events, and whether this depends upon restoring normal BP and HR variability, i.e. anormal BP and HR chronome.

Blood Pressure Monitoring, Ambulatory↗
PubMed2003

Determination of cortisol in human saliva using liquid chromatography-electrospray tandem mass spectrometry.

The aim of this work was to develop a method for determination of cortisol in saliva by liquid chromatography-tandem mass spectrometry (LC-MS-MS). Saliva was sampled on Salivette tubes. These were centrifuged, deuterium-labeled cortisol was added as internal standard and the proteins precipitated by acetonitrile. The supernatant was evaporated, dissolved in methanol acidified with acetic acid and analyzed by LC-MS-MS. The with-in run precision, tested by pooling saliva samples from volunteers and then analyzing these in a single run, was found to be 7% at 0.7 microgram l(-1). The between-run precision was tested by analysis of the same samples at different days and found to be 11% at 2.5 microgram l(-1). The limit of quantification was 0.5 microgram l(-1). The method was applied for analysis of saliva samples from three volunteers during their last week before vacation and the first and second week on vacation. In addition, the method was compared to analysis by an immunological method. The values from the immunological method were 2.7 times higher than the LC-MS-MS results.

Chromatography, Liquid↗
PubMedDate not supplied

Cost effectiveness of use of frozen blood to alleviate blood shortages.

Human blood shortages are a perennial problem because of the relatively short life span (21 days) of stored blood and the traditional shortage periods during summer vacation months and other vacation periods. This study evaluates the use of frozen blood during these traditional shortage periods. An empirically-based simulation model is used. During periods of excess supply surplus blood is frozen and during shortage periods frozen blood is thawed and used as a substitute for stored blood. The results of the study indicate that the use of frozen blood during shortage periods alleviates shortages but at a high cost. Improved blood collection scheduling management and promotion will attain the same results at a lower cost.

Blood Banks↗
PubMed2003

Casual sex among Australian schoolies.

This study of the casual sexual partnering of 570 male and 776 female Australian high school students on a schoolies week vacation expands on earlier research on factors that influence the sexual activity of vacationing youth. Over 60% of the men and nearly 40% of the women who engaged in sexual intercourse during schoolies week did so with a casual partner. We used logistic regression to test an expanded version of Triandis Theory of Interpersonal Behavior (TIB) in explaining casual sexual partnering. Situational experiences (similar to what others have called situational disinhibition), prior sexual experiences and intentions (similar to what others have called spillover) influenced casual sexual partnering. Different causal pathways were demonstrated for men and women.

Adolescent↗
PubMed2002

Fungal spores as such do not cause nasal inflammation in mold exposure.

The increased frequency of respiratory symptoms and diseases among sawmill workers has been linked to occupational exposure to airborne contaminants, especially to different fungi. Similar adverse health effects, together with elevated levels of inflammatory mediators in the nasal lavage (NAL) fluid, have been detected in people working in mold-damaged buildings. However, the indoor fungal spore concentrations in moldy houses are much lower than those in sawmills. To study the effect of fungal spores as such on the inflammatory markers in the NAL fluid, we conducted a similar study in sawmill workers who had an intense exposure to fungal spores. NAL was performed in 11 sawmill workers both during high occupational microbial exposure and during their vacation. Concentrations of nitric oxide (NO), tumor necrosis factor-alpha (TNFalpha), interleukin (IL)-4, IL-5, and IL-6 in NAL fluid were analyzed, and occupational exposure to inhalable dust, fungal spores, endotoxins and terpenes was confirmed by personal monitoring during the day of sampling. In addition, health data were collected with a questionnaire. Personal exposures to fungal spores varied from 2 x 10(5) spores/m(3) to 1.5 x 10(6) spores/m(3) (mean 7 x 10(5) spores/m(3)). Concentrations of inhalable dust, endotoxins, and terpenes were relatively low. There were no differences between work and vacation in the concentrations of NO and proinflammatory cytokines in NAL fluid or in the reporting of symptoms, and the levels were lower than in workers at a moldy school building. However, the concentration of TNFalpha in the NAL fluid was positively correlated with the concentration of terpenes in the working environment (r =.768; p =.006). These results show that microbial exposure as such does not invariably result in inflammatory changes detectable with the NAL method. We suggest that the type of microbial flora or microbial products in the occupational environment determines the proinflammatory potency of microbial exposure.

Adult↗
PubMed2002

Nitric oxide alone is an insufficient biomarker of exposure to microbes in a moisture-damaged building.

Several epidemiological studies have revealed a large variety of adverse health effects related to exposure to microbes in moisture damaged buildings. Recently some evidence has been reported for a biochemical linkage between microbial exposure and the respiratory symptoms suffered by the occupants. The objective of the current study was to evaluate the value of nitric oxide (NO) measurements in determining the inflammatory status of airways in inhabitants of problem buildings. NO was measured by a chemiluminescence analyzer from the exhaled air. In addition, NO was determined as its metabolite nitrite from nasal lavage (NL) and induced sputum (IS) samples and also via the expression of inducible nitric oxide synthase (iNOS) in the cells. Occupants of moisture-damaged and reference schools were studied. The sampling was performed at the end of the spring term, at the end of the summer vacation, during the winter term, and after a 1-wk winter holiday. No statistically significant differences in NO levels were detected between the studied groups or between exposure and vacation periods. iNOS was not detected from IS or NL samples of the exposed occupants. These results suggest that NO measurements alone are not sufficient to quantify airway inflammation when evaluating subjects exposed to microbes present in moisture-damaged buildings.

Air Pollution, Indoor↗
PubMed1994

Persistence of O6-guanine DNA adducts in styrene-exposed lamination workers determined by 32P-postlabelling.

A modified 32P-postlabelling method was used for the detection of styrene-specific DNA adducts in lamination workers. The persistence of O6-styrene DNA adducts was studied in DNA from lymphocytes and granulocytes of an exposed and a control group. We compared O6-adduct levels obtained from a sampling prior to vacation, after 2 weeks of vacation and after an additional 1 month of work. In granulocytes, there was no significant difference in adduct levels between the control and the exposed groups in any individual samplings. In lymphocytes of laminators the detected adduct levels were significantly higher (5.4 adducts/10(8) nucleotides) than those in the controls (1.0 adduct/10(8) nucleotides). The 2 week interruption of exposure did not influence the total O6-adduct level (4.9 adducts/10(8) nucleotides in the first sampling versus 5.1 adducts/10(8) nucleotides in the second), indicating very slow removal of the specific O6-styrene adducts from DNA.

Adult↗
PubMed1998

Multivariate time series analysis in nosocomial infection surveillance: a case study.

BACKGROUND: The present study describes the use of time series analysis in the evaluation of the incidence of nosocomial infection. The main hypothesis analysed was that monthly occurrence of nosocomial infection in a hospital may be related to work-related factors such as the control and training of personnel imposed by a surveillance system, strikes supported by medical personnel and movement of personnel. Time series analysis was used to quantify, model and statistically evaluate these interventions. METHODS: The data employed (March 1982-December 1990) were supplied by the nosocomial infection surveillance system of a primary-care general hospital. The monthly time series incidence of nosocomial infections (measured as percentage cumulative incidence) was analysed by curve fitting, autoregressive, integrated and moving average (ARIMA) modelling (Box-Jenkins) and intervention and dynamic regression analysis. RESULTS: The imposed control and training of personnel by the surveillance system was associated with a 3.63% decrease in the accumulated monthly incidence of nosocomial infection from 7.82% to a baseline level of 4.19%. There was a strong indication that an increase of infection incidence of 4.34% corresponded to a medical strike. This increase was maintained over the following months raising the baseline level to 4.84%. An increase of 0.18% was associated with each new nursing contract. Evidence was obtained for the possible relationship between incidence of nosocomial infection and vacation periods. CONCLUSIONS: The results suggest the need for strict control of the activities of hospital personnel and for the adoption of certain preventative measures during vacation periods to avoid an undesirable increase in the incidence of nosocomial infections.

Case-Control Studies↗