A BEFORE AND AFTER TRIAL OF THE EFFECTIVENESS OF NETWORK ANALYSIS IN HEALTH OPERATIONS MANAGEMENT

An intervention trial using “before-and-after” approach was undertaken to address the question whether network analysis as a health managerial tool of control can favourably affect the delays that occur in planning and executing the antimalaria operations of a Station Health Organization in a large military station. Exposure variable of interest was intervention with a network diagram, by which the potential causes of delay along the various activities were assessed and remedial measures were introduced during the second year. Sample size was calculated using conventional alpha and beta error levels. The study indicated that there was a definite beneficial outcome in that the operations could be started as well as completed in time during the intervention year. There was reduction in time requirement in 5 out of the 9 activities, the exact ‘p’ value being 0.08, by both parametric and non-parametric tests. The use of network analysis in health care management has been recommended.KEY WORDS: Health services research, Health care, Health plan implementation, Malaria, Network analysis, Operations research     

APPLICATION OF HAZARD ANALYSIS CRITICAL CONTROL POINT SYSTEM : ANALYSIS OF A FOOD POISONING OUTBREAK

The World Health Organization as well as several experts have recently recommended the use of hazard analysis critical control point system for prevention of food-borne illnesses. The present study proceeded to identify the hazardous operations and their critical control points by investigating, through a case-control design, an outbreak of food poisoning. The predominant presenting symptoms were watery diarrhoea and abdominal cramps. The cumulative incidence during this episode was 28.6 per cent, with a median incubation of 13 hours. Evaluation of food histories indicated a very high and significant odds ratio for mutton dish (OR = 6.45; p < 0.001), which persisted even after adjusting for the consumption of other food items through stratified analysis using the Mantel-Haenszel procedure. Environmental assessment revealed a strong possibility of contamination of raw mutton at the source with animal excreta and prolonged storage at room temperature of cooked mutton dish. Based on these findings, hazardous operations were identified and critical control points and monitoring criteria for prevention of food poisoning have been suggested.KEY WORDS: Food poisoning, Epidemiologic methods, Hazard analysis critical control point (HACCP)     

The cofactor role of protein S in the acceleration of whole blood clot lysis by activated protein C in vitro

The effect of purified human activated protein C (APC) and protein S on fibrinolysis was studied by using an in vitro blood clot lysis technique. Blood clots were formed from citrated blood (supplemented with 125I-fibrinogen) by adding thrombin and Ca2+-ions; lysis of the clots was achieved by adding tissue-type plasminogen activator. The release of labeled fibrin degradation products from the clots into the supernatant was followed in time. We clearly demonstrated that APC accelerates whole blood clot lysis in vitro. The effect of APC was completely quenched by antiprotein C IgG, pretreatment of APC with diisopropylfluorophosphate, and preincubation of the blood with antiprotein S IgG. This demonstrates that both the active site of APC and the presence of the cofactor, protein S, are essential for the expression of the profibrinolytic properties. At present, the substrate of APC involved in the regulation of fibrinolysis is not yet known. Analysis of the radiolabeled fibrin degradation products demonstrated that APC had no effect on the fibrin cross-linking capacity of factor XIII.     

Tumor necrosis factor alpha induces endothelial galactosyl transferase activity and verocytotoxin receptors. Role of specific tumor necrosis factor receptors and protein kinase C

Infections with verocytotoxin (VT) producing Escherichia coli have been strongly implicated in the epidemic form of hemolytic uremic syndrome (HUS). Endothelial damage plays a central role in the pathogenesis of HUS. In vitro studies have shown that VT can damage endothelial cells after interaction with its cellular receptor globotriaosylceramide (GbOse3cer). Cytokines, such as tumor necrosis factor alpha (TNF alpha) and interleukin-1 (IL-1) can potentiate the toxic effect of VT by inducing a protein-synthesis dependent increase in VT receptors on endothelial cells. In this study, the mechanisms underlying the increase in endothelial VT receptors induced by TNF alpha were studied in more detail. To investigate which proteins were involved in this induction, endothelial cells were incubated with and without TNF alpha in the presence of 14C-galactose or 14C-glucose. Thin-layer chromatography (TLC) analysis of the glycolipid extracts of these cells demonstrated a markedly enhanced incorporation of 14C-galactose in GbOse3cer and other galactose-containing glycolipids, suggesting that TNF alpha enhanced galactosyl-transferase activity. To examine the role of the two recently cloned TNF-receptors (TNFR-p75 and TNFR-p55) in the TNF alpha-induced increase in GbOse3cer in human endothelial cells, cells were incubated with TNF alpha, the TNFR-p55 selective R32W-S86T- TNF alpha-mutant, or the TNFR-p75 selective D143N-A145R-TNF alpha- mutant. The effect of TNF alpha activation, determined by binding- experiments with 125I-VT-1, could be largely, but not completely mimicked by R32W-S86T-TNF alpha. Although incubation of cells with D143N-A145R-TNF alpha did not show an increase in VT-1 binding, the monoclonal antibody utr-1, which prevents binding to TNFR-p75, decreased the TNF alpha-induced VT-1 binding. Activation of protein kinase C (PKC) by phorbol ester increases the expression of VT-1 receptors; this effect was prevented by the PKC inhibitor Ro31-8220 and by homologous desensitization by pretreatment with phorbol ester. In contrast, the presence of the protein kinase inhibitor Ro31-8220 or desensitization of PKC activity reduced the TNF alpha-induced increase in VT-1 receptors maximally by 50% and 24%, respectively. Comparable reductions in overall protein synthesis and the synthesis of E-selectin and plasminogen activator inhibitor-1 (PAI-1) were observed. This suggests an effect on general protein synthesis rather than a specific effect of PKC in the signal transduction pathway, by which TNF alpha induces VT-1 receptors. Our results indicate that TNF alpha can increase the VT-1 receptors on endothelial cells by inducing galactosyl- transferase activity, that this action of TNF alpha mainly occurs via the TNFR-p55; and that PKC activation increases expression of VT-1 receptors by a separate mechanism that acts additively to the TNF alpha- induced increase in VT-1 receptors.     

EPIDEMIOLOGICAL STUDY OF ENTEROPATHOGENIC CARRIER STATE AMONG FOOD HANDLERS OF ARMED FORCES EATING ESTABLISHMENTS

A cross-sectional epidemiological study was undertaken on a randomly selected sample of 308 food handlers working in different eating establishments of Indian Armed Forces in Pune. These included 101 Service personnel and 207 civilians. Stool samples were analysed for enteropathogens and epidemiological assessment of gastrointestinal disease occurrence in the military units of these food handlers was undertaken. The study revealed that 4 of the subjects were carriers of salmonella typhimurium, thus giving the prevalence as 1.3% (95% confidence interval 0.2% to 2.56%). No other enteropathogen except salmonella typhimurium was isolated. The positive carriers showed a typical “spatial - clustering” in that they were working in two geographically contiguous medical units.KEY WORDS: Carriers, Food-handlers, Salmonella typhimurium     

A MATHEMATICAL MODEL FOR PREDICTING THE PERSISTENCE AND EFFICACY OF BACILLUS THURINGIENSIS VAR ISRAELENSIS IN RELATION TO WATER POLLUTION

In a simulated field trial, the bead formulation of Bacillus thuringiensis var israelensis (Bti) was found to be more persistent in moderately polluted as compared to highly polluted water. A mathematical model was built up to study the influence of time (independent variable) on larval reduction (dependent variable) in relation to degree of water pollution. Two predictive models for different grades of water pollution were developed, which estimated that the larval mortality in moderately polluted water was likely to decline by 3.79 as compared to 5.02 on an average, in highly polluted water with each passing day.KEYWORDS: Biocide, Mosquito control, Prediction model     

CROSS SECTIONAL ANALYTIC STUDY OF AWARENESS REGARDING FACTORS RELATED TO CHILD SURVIVAL AMONG MARRIED WOMEN IN A SEMI-URBAN COMMUNITY

A cross sectional analytic study was undertaken on 480 married women living in a semi-urban locality in Pune, with the objective of assessing their awareness regarding factors related to child survival. It was observed that 62.1 per cent of the ladies had adequate knowledge about immunisation. A highly significant trend was evident as regards knowledge about immunisation and formal education and socio-economic status (p<0.01). 93 per cent ladies initiated breast feeding within 24 hours of birth of the new born. Significantly larger proportion of ladies from lower education favoured prolonged breast feeding (p<0.001) and favoured late introduction of top milk (p<0.001). In general, the awareness about growth chart was very poor with only 3.5 per cent ladies having adequate knowledge. Larger family size was significantly associated with declining probability of use of oral rehydration solution (ORS). Certain recommendations for improving the awareness regarding child survival have been submitted accordingly.KEYWORDS: Child survival, Health awareness     

EFFECTIVENESS OF A HEALTH EDUCATIONAL PACKAGE FOR AIDS PREVENTION AMONG ADOLESCENT SCHOOL CHILDREN

A randomised, controlled, community based intervention trial was undertaken to assess the effectiveness of a Health Education Programme (HEP) for HIV infection and AIDS among school children at Pune. Sample size was calculated on the basis of conventional Type I and Type II errors. School children studying in classes 9th to 12th in six different schools (n=1102) formed the study material. Baseline assessment for knowledge for AIDS/HIV was undertaken and used for formulating the Health education Programme Package. Randomisation was done so as to allocate five schools into trial group (n=803) and one school into control group (n=299). Blinding was also ensured to reduce bias. The study revealed that the HEP was very effective in improving the knowledge, the difference being highly significant as compared to control group. The effect was specially well marked for girls in school level (OR=4.76) followed by boys intermediate level (OR=3.11); there was clear evidence of statistical effect modification as regards this ‘sex and educational class’ differential (Woolfs''chi square=11.82, p < 0.0001). The study also revealed that the maximum aceceptability of programme was among girls studying in girls school (Stratum OR =2.25) followed by boys in boys school (OR=1.50) compared to students in co-educational system (linear trend chi square=9.35, p < 0.01). Certain recommendations for health education for HIV/AIDS among school children have been submitted.KEY WORDS: AIDS, Health education, Randomised controlled trial     

Diagnostic and therapeutic percutaneous gallbladder procedures

The authors report their experience with 24 patients who underwent a variety of percutaneous procedures involving the gallbladder. Twenty diagnostic and 13 therapeutic procedures were performed under sonographic, computed tomographic (CT), or fluoroscopic guidance; these procedures included biopsy of the gallbladder, diagnostic cholecystography, diagnostic aspiration of bile, gallstone dissolution and removal, cholecystostomy for drainage, and gallbladder abscess drainage. The indications for percutaneous cholecystostomy (performed in 11 patients) included relief of hydrops and empyema, gallstone dissolution, mechanical gallstone removal, and drainage for malignant obstruction. Each procedure was successful. There was one complicating episode of cholecystitis and four previously described episodes of vagal hypotension. Bile peritonitis did not occur in any of the patients. The authors discuss the various percutaneous gallbladder procedures and specific technical considerations in performing them.