Results from the second Scottish national prevalence survey: the changing epidemiology of healthcare-associated infection in Scotland.

BACKGROUND: Healthcare-associated infections (HAIs) are a recognized public health problem worldwide. Point prevalence surveys (PPSs) can be used to measure the burden of all HAI types. AIM: To measure the prevalence of HAI and determine any changes in the epidemiology of HAI since the first Scottish national PPS. METHODS: A national rolling PPS in National Health Service (NHS) acute, NHS non-acute, NHS paediatric and independent hospitals was carried out during September and October 2011 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. The prevalence of HAI and distribution of HAI types were measured and the results compared with the first Scottish national HAI point prevalence survey of 2005/2006. RESULTS: The prevalence of HAI was 4.9%, 2.5%, 6.1% and 1.2% in acute, non-acute, paediatric and independent hospitals respectively. The prevalence of HAI was significantly higher in acute hospitals compared with non-acute hospitals. There were no significant differences between the prevalence in the other hospital types. The prevalence of HAI in acute and non-acute hospitals was lower than the first survey by approximately one-third. The proportion of HAIs that were urinary tract infection, surgical site infection and bloodstream infection was higher and the proportion that were gastrointestinal including Clostridium difficile infection was lower in acute hospitals compared with the previous survey. CONCLUSIONS: The epidemiology of HAI has changed in Scotland since the first national survey in 2005/2006, thus infection prevention and control measures require to be refocused in this regard. The lower prevalence and changing epidemiology of HAI in acute and non-acute care suggest that there may be a temporal relationship with the implementation of the national programme of targeted HAI interventions in the intervening period.

Epidemiology of hospitalization due to alcohol-related harm: evidence from a Scottish cohort study.

OBJECTIVE: To examine a broad range of risk factors and their association with alcohol-related hospital admissions in a Scottish general population. DESIGN: Observational record-linkage study in Scotland from 1998 to 2008 involving 8305 respondents aged 16-74 years who participated in the 1998 Scottish Health Survey. Outcome was defined as first-time hospital admission with at least one alcohol-related diagnosis. METHODS: Cox proportional hazards modelling was applied to estimate the hazard ratio (HR) of first-time hospitalization with an alcohol-related condition associated with a range of behavioural, social and biological risk factors. FINDINGS: In total, 287 (3.4%) respondents experienced at least one alcohol-related hospitalization during the observation period. Moderate to excessive drinking was the strongest predictor of subsequent admission to hospital with an alcohol-related diagnosis, with clear evidence of a dose - response relationship. Moderate and heavy smoking were also significant predictors of subsequent admission to hospital with an alcohol-related problem. Social factors - such as being in receipt of income-related benefits [HR 1.68, 95% confidence interval (CI) 1.25-2.28]; being retired or economically inactive; and being separated, divorced or widowed (HR 2.34, 95% CI 1.70-3.22) - were also significant predictors of alcohol-related hospitalization. CONCLUSIONS: Moderate and higher levels of weekly alcohol consumption, moderate to heavy smoking, economic circumstances and marital status are the main risk factors for alcohol-related hospitalization in the Scottish population. These findings add to the evidence that population-based strategies are needed to limit alcohol-related morbidity.

An analysis of the link between behavioural, biological and social risk factors and subsequent hospital admission in Scotland.

OBJECTIVE: To determine the association between risk factors and hospital admission. METHODS: The 1998 Scottish Health Survey was linked to the Scottish hospital admission database. FINDINGS: Smoking was the most important behavioural risk factor (hazard ratio: 1.90, 95% CI: 1.59-2.27). Other behavioural risk factors yielded small but largely anticipated results. Hazard ratios for biological risks increased predictably but with some exceptions (blood pressure and total cholesterol). The top quintile for C-reactive protein showed almost double the risk of admission compared with the bottom quintile (hazard ratio: 1.93, 95% CI: 1.52-2.46). Elevated body mass index (BMI) increased the risk of serious admission (hazard ratio: 1.23, 95% CI: 1.03-1.47) and raised gamma-GT increased this risk by 20% (hazard ratio: 1.20, 95% CI: 1.04-1.38). Forced expiratory volume was the 'biological' factor with the largest risk (hazard ratio for lowest category: 1.82, 95% CI: 1.49-2.22). All the measures of social position showed variable effects on the risk of hospital admission. Large effects on risk were associated with self assessed health, longstanding illness and previous admission. CONCLUSION: The linkage of national surveys with a prospective hospitalization database will develop into an increasingly powerful tool.

Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'.

OBJECTIVES: To determine the degree to which changing patterns of deprivation in Scotland and the rest of Great Britain between 1981 and 2001 explain Scotland's higher mortality rates over that period. DESIGN: Cross-sectional analyses using population and mortality data from around the 1981, 1991 and 2001 censuses. SETTING: Great Britain (GB). PARTICIPANTS: Populations of Great Britain enumerated in the 1981, 1991 and 2001 censuses. MAIN OUTCOME MEASURES: Carstairs deprivation scores derived for wards (England and Wales) and postcode sectors (Scotland). Mortality rates adjusted for age, sex and deprivation decile. RESULTS: Between 1981 and 2001 Scotland became less deprived relative to the rest of Great Britain. Age and sex standardized all-cause mortality rates decreased by approximately 25% across Great Britain, including Scotland but mortality rates were on average 12% higher in Scotland in 1981 rising to 15% higher in 2001. While over 60% of the excess mortality in 1981 could be explained by differences in deprivation profile, less than half the excess could be explained in 1991 and 2001. After adjusting for age, sex and deprivation, excess mortality in Scotland rose from 4.7% (95% CI: 3.9% to 5.4%) in 1981 to 7.9% (95% CI: 7.2% to 8.7%) in 1991 and 8.2% (95% CI: 7.4% to 9.0%) in 2001. All deprivation deciles showed excess indicating that populations in Scotland living in areas of comparable deprivation to populations in the rest of Great Britain always had higher mortality rates. By 2001 the largest excesses were found in the most deprived areas in Scotland with a 17% higher mortality rate in the most deprived decile compared to similarly deprived areas in England and Wales. Excess mortality in Scotland has increased most among males aged <65 years. CONCLUSIONS: Scotland's relative mortality disadvantage compared to the rest of Great Britain, after allowing for deprivation, is worsening. By 1991 measures of deprivation no longer explained most of the excess mortality in Scotland and the unexplained excess has persisted during the 1990s. More research is required to understand what is causing this 'Scottish effect'.

A proposed mathematical model for sleep patterning.

The simple model of a ramp, intersecting a triangular waveform, yields results which conform with seven generalized observations of sleep patterning; including the progressive lengthening of 'rapid-eye-movement' (REM) sleep periods within near-constant REM/nonREM cycle periods. Predicted values of REM sleep time, and of Stage 3/4 nonREM sleep time, can be computed using the observed values of other parameters. The distributions of the actual REM and Stage 3/4 times relative to the predicted values were closer to normal than the distributions relative to simple 'best line' fits. It was found that sleep onset tends to occur at a particular moment in the individual subject's '90-min cycle' (the use of a solar time-scale masks this effect), which could account for a subject with a naturally short sleep/wake cycle synchronizing to a 24-h rhythm. A combined 'sleep control system' model offers quantitative simulation of the sleep patterning of endogenous depressives and, with a different perturbation, qualitative simulation of the symptoms of narcolepsy.