Search

Background: Interventions in occupational health often target worksites rather than individuals. The objective of this paper is to describe the (lack of) stability in units of analysis in occupational health and safety intervention projects directed toward worksites.Methods: A case study approach is used to describe naturally occurring organizational changes in four, large, Nordic intervention projects that ran 3-5 years, covered 3-52 worksites, cost 0.25 mill-2.2 mill euro, and involved 3-7 researchers.Results: In all four cases, high rates of closing, merging, moving, downsizing or restructuring was observed, and in all four cases at least one company/worksite experienced two or more re-organizations during the project period. If individual worksites remained, ownership or (for publicly owned) administrative or legal base often shifted. Forthcoming closure led employees and managers to seek employment at other worksites participating in the studies. Key employees involved in the intervention process often changed.Conclusion: Major changes were the rule rather than the exception. Frequent fundamental changes at worksites need to be taken into account when planning intervention studies and raises serious questions concerning design, analyses and interpretation of results. The frequent changes may also have deleterious implications for the potential effectiveness of many real life interventions directed toward worksites. We urge researchers and editors to prioritize this subject in order to improve the quality of future intervention research and preventive action. [ABSTRACT FROM AUTHOR]

Objectives . Parkinson patients often suffer from motor impairments such as tremor and freezing of movement that can be difficult to treat. To unfreeze movement, it has been suggested to provide sensory stimuli. To avoid constant stimulation, episodes with freezing of movement needs to be detected which is a challenge. This can potentially be obtained using a brain-computer interface (BCI) based on movement-related cortical potentials (MRCPs) that are observed in association with the intention to move. The objective in this study was to detect MRCPs from single-trial EEG. Approach . Nine Parkinson patients executed 100 wrist movements and 100 ankle movements while continuous EEG and EMG were recorded. The experiment was repeated in two sessions on separate days. Using temporal, spectral and template matching features, a random forest (RF), linear discriminant analysis, and k-nearest neighbours (kNN) classifier were constructed in offline analysis to discriminate between epochs containing movement-related or idle brain activity to provide an estimation of the performance of a BCI. Three classification scenarios were tested: 1) within-session (using training and testing data from the same session and participant), between-session (using data from the same participant from session one for training and session two for testing), and across-participant (using data from all participants except one for training and testing on the remaining participant). Main results . The within-session classification scenario was associated with the highest classification accuracies which were in the range of 88%-89% with a similar performance across sessions. The performance dropped to 69%-75% and 70%-75% for the between-session and across-participant classification scenario, respectively. The highest classification accuracies were obtained for the RF and kNN classifiers. Significance . The results indicate that it is possible to detect movement intentions in individuals with Parkinson's disease such that they can operate a BCI which may control the delivery of sensory stimuli to unfreeze movement., (Creative Commons Attribution license.)

Purpose: This study investigated the implications of inserting a flexible annuloplasty ring after reconstructing the entire mitral valve in a porcine model using a previously investigated tube graft design made of 2-ply small intestinal submucosa extracellular matrix (CorMatrix®)., Methods: An acute model with eight 80-kg pigs, each acting as its own control, was used. The entire mitral valve was reconstructed with a 2-ply small intestinal submucosa extracellular matrix tube graft (CorMatrix®). Subsequently, a Simulus® flexible ring was inserted. The characterization was based on mitral annular geometry and valvular dynamics with sonomicrometry and echocardiography., Results: After adding the ring annuloplasty, the in-plane annular dynamics were more constant throughout the cardiac cycle compared to the reconstruction alone. However, the commissure-commissure distance was statistically significantly decreased [35.0 ± 3.4 mm vs. 27.4 ± 1.9 mm, P < 0.001, diff =  - 7.6 mm, 95% CI, - 9.8 to (-5.4) mm] after ring insertion, changing the physiological annular D-shape into a circular shape which created folds at the coaptation zone resulting in a central regurgitant jet on color Doppler., Conclusion: We successfully reconstructed the entire mitral valve using 2-ply small intestinal submucosal extracellular matrix (CorMatrix®) combined with a flexible annuloplasty. The annuloplasty reduced the unphysiological systolic widening previously found with this reconstructive technique. However, the Simulus flex ring changed the physiological annular D-shape into a circular shape and hindered a correct unfolding of the leaflets. Thus, we do not recommend a flexible ring in conjunction with this reconstructive technique; further investigations are needed to discover a more suitable remodelling annuloplasty., (© 2024. The Author(s).)

Objectives: Entire mitral valve reconstruction with an extracellular matrix tube graft is a potential candidate to overcome the current limitations of mechanical and bioprosthetic valves. However, clinical data have raised concern with respect to patch failure. The aim of our study was to evaluate the impact of extracellular matrix mitral tube graft implantation on mitral annular and subvalvular regional dynamics in pigs., Methods: A modified tube graft design made of 2-ply extracellular matrix was used (CorMatrix®; Cardiovascular Inc., Alpharetta, GA, USA). The reconstructions were performed in an acute 80-kg porcine model (N = 8), where each pig acted as its own control. Haemodynamics were assessed with Mikro-Tip pressure catheters and mitral annular and subvalvular geometry and dynamics with sonomicrometry., Results: Catheter-based peak left atrial pressure and pressure difference across the mitral and aortic valves in the reconstructions were comparable to the values seen in the native mitral valves. Also comparable were maximum mitral annular area (755 ± 100 mm2), maximum septal-lateral distance (29.7 ± 1.7 mm), maximum commissure-commissure distance (35.0 ± 3.4 mm), end-systolic annular height-to-commissural width ratio (10.2 ± 1.0%) and end-diastolic interpapillary muscle distance (27.7 ± 3.3 mm). Systolic expansion of the mitral annulus was, however, observed after reconstruction., Conclusions: The reconstructed mitral valves were fully functional without regurgitation, obstruction or stenosis. The reconstructed mitral annular and subvalvular geometry and subvalvular dynamics were found in the same range to those in the native mitral valve. A regional annular ballooning effect occurred that might predispose to patch failure. However, the greatest risk was found at the papillary muscle attachments., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Purpose: Patch reconstruction of the posterior mitral leaflet using small intestinal submucosa extracellular matrix has been successfully performed in a porcine study. The patch reconstruction, however, resulted in non-physiological systolic widening of the mitral annulus, suggesting the need for an annuloplasty ring. The objective was to characterize the impact on annular dynamics and leaflet geometry of adding a flexible annuloplasty ring to the posterior mitral leaflet patch reconstruction., Methods: Measurements were performed in an acute 80-kg porcine model, with seven pigs acting as their own controls. The posterior mitral leaflet was reconstructed with a 2-ply small intestinal submucosa extracellular matrix patch (CorMatrix®). Additionally, a Simulus® Flexible Annuloplasty Ring (Medtronic Inc., Minneapolis, MN, USA) was inserted. Mitral annular dynamics were evaluated using sonomicrometry, and leaflet geometry was described using echocardiography., Results: The annuloplasty ring reduced mitral annular dimensions and restricted cyclic changes in mitral annular area (126 ± 19 vs. 30 ± 13 mm 2 , p < 0.001), septal-lateral and commisure-commisure distances. Ring annuloplasty prevented systolic widening in the mitral annulus after posterior mitral leaflet reconstruction. The annular saddle shape and leaflet coaptation length (8.7 ± 2.3 vs. 9.7 ± 1.3 mm, p = 0.221) were comparable before and after ring insertion., Conclusions: The flexible annuloplasty ring resulted in a downsized annulus with restriction of cyclic annular changes in the reconstructed mitral valve. Ring insertion preserved the annular saddle shape and coaptation length. The ring annuloplasty counteracted the non-physiological annular dynamics, and this may improve durability of the posterior mitral leaflet patch reconstruction.

Objective: The objective of our study was to investigate the feasibility of reconstructing the entire mitral valvular and subvalvular apparatus in pigs using a modified tube graft design made of 2-ply small intestinal submucosa extracellular matrix., Methods: The reconstructions were performed in an acute 80-kg porcine model with 8 pigs, each acting as its own control. A modified tube graft was designed from a sheet of 2-ply small intestinal submucosa extracellular matrix. Before and after mitral valve reconstruction, echocardiography was used to assess mitral regurgitation, left ventricular outflow tract obstruction due to systolic anterior motion, mitral stenosis, leaflet mobility, and leaflet geometry., Results: The reconstructed mitral valves were fully functional without any observable echocardiographic signs of regurgitation. We did not observe any left ventricular outflow tract obstruction due to systolic anterior motion nor any mitral valve stenosis, despite a diminished septal-lateral distance after reconstruction. The reconstruction had a reduced tenting area, a reduced coaptation length (9.6 ± 1.7 mm vs 7.9 ± 1.0 mm, P = .010, diff = -1.7 mm, 95% confidence interval, -3.1 to -0.4 mm), and atrial bending of both leaflets., Conclusions: In this acute porcine study, entire mitral valvular and subvalvular apparatus reconstruction using a modified tube graft design made from 2-ply small intestinal submucosal extracellular matrix was feasible. The 2-ply small intestinal submucosa extracellular matrix could withstand the pressure exerted by the left ventricle without any signs of tearing or rupture. These promising results warrant further assessment of both the annular geometry and the long-term durability., (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: A subvalvular annuloplasty is often used for aortic valve repair in patients with isolated aortic regurgitation with aortic annulus dilatation. Our aim was to characterize and compare annulus geometry and dynamics of the Dacron ring and suture annuloplasty and compare it with the native aortic annulus under standardized conditions., Methods: We randomized 29 pigs of 80 kg into a Dacron ring group, a suture annuloplasty group and a native control group. The assessment was performed using sonomicrometry crystals for evaluation of dynamic geometry, and pressure measurements and echocardiography to evaluate valve performance., Results: Aortic annulus area (AAA) was significantly reduced in the Dacron and Suture group compared with the Native group. Expansibility was similar and within normal physiologic limits in all three groups (Native: 12%±7%; Dacron: 11%±3%; Suture: 10%±4%). The largest segmental expansion was observed at the right coronary sinus (RC) in the Native and Dacron group but in the Suture group there was no significant difference between segments. The aortic annulus was primarily oval in systole and became more circular in diastole in the Native and Dacron group, however, in the Suture group, the sphericity remained relatively unchanged throughout the cardiac cycle., Conclusions: This study is the first to describe and compare detailed segmental geometry of the Dacron ring and suture annuloplasty in a standardized porcine model. The two annuloplasties effectively downsized the aortic annulus, while expansibility was maintained. Each annuloplasty had its own geometrical characteristics, but the Dacron ring was more similar to the native aortic annulus than the suture annuloplasty. This study suggests that the Dacron ring offers a more physiological and standardized support by mimicking the geometry and dynamics of the native aortic annulus and thus is a preferable choice over the suture annuloplasty for valve-sparing aortic root procedures., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Objectives: To investigate mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet., Methods: Mitral valve posterior leaflet and subvalvular reconstruction was characterized in an acute 80-kg porcine model with 7 pigs acting as their own controls. The characterization was based on pressure catheter measurements of pressure differences to identify mitral regurgitation, stenosis and systolic anterior motion. Furthermore, echocardiography was used for the evaluation of leaflet mobility and geometry, whereas sonomicrometry was used to describe annular and subvalvular geometry., Results: The reconstructed mitral valve was fully functional without any signs of regurgitation (peak left atrial pressure for baseline and reconstruction 12 ± 2 mmHg vs 11 ± 2 mmHg, P = 0.550), mitral valve stenosis (mean pressure difference across the mitral valve 4.8 ± 2.3 mmHg vs 4.1 ± 2.3 mmHg, P = 0.589) or systolic anterior motion. The echocardiographic characterization revealed septal-lateral downsizing, reduced tenting area, increased coaptation length (6.0 ± 0.6 mm vs 8.7 ± 2.3 mm, P = 0.002) and an atrial bend of the reconstructed posterior leaflet. A ballooning effect of the patch material was present at the posterior annular segment., Conclusions: Mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet as patch material was possible in an acute porcine model. The reconstructed mitral valve was fully functional without signs of mitral valve stenosis, valve regurgitation, stenosis or systolic anterior motion. The ballooning appearance of the patch material might, however, constitute an altered leaflet stress distribution in this area.

The aim of this study was to compare health-related quality of life (HQoL) in adults with dermatomyositis (DM) or polymyositis (PM) with a healthy control group and to assess whether muscle strength was associated with HQoL in patients with DM or PM. A cross-sectional study was performed and included 75 patients with DM or PM and 48 healthy controls. HQoL was assessed by the Short Form 36 questionnaire (SF-36). Muscle strength of the patients was assessed using the Manual Muscle Test-8 (MMT8). Covariables and possible confounding factors were collected by validated tools. Associations were determined in multiple linear regression models. The patients had significantly lower HQoL than the control group in both the physical component summary score (PCS) and the mental component summary score (MCS). Thus, the PCS-difference between groups was 32% (p < 0.001), whereas the MCS-difference was 14% (p < 0.001). Muscle strength was associated with one domain in the patients; Physical Function (β = 1.2; 95% confidence interval 0.37 to 2.1). No statistically significant associations were found between muscle strength and HQoL in the remaining domains. Patients with DM or PM have reduced HQoL compared to healthy controls. Notably, muscle strength was associated with scores of the domain reflecting perceived physical function in patients. These findings corroborate the validity of including selected patient reported outcomes in the evaluation and monitoring of patients with DM or PM.

Introduction: The amount of quality data continues to increase. To help prioritise resources for quality improvement, managers need thorough reviews to help them decide which indicators are most important to improve. The reality is that data is presented in piles of reports and hundreds of tables and graphs that are very time-consuming to go through and that rarely result in a simple comprehensive overview. This paper presents an empirically tested tool to create a simple overview of complex quality data., Methodology: Data comes from a questionnaire-based patient satisfaction survey of 13,129 patients and 1,589 staff members at Ribe County Hospital. A method is described: how to use colour coding in order to present the results for 16 indicators, measured both by patients and three staff member groups, for 28 departments and 46 ambulatories, in one page., Results: Data for mean satisfaction scores on all questions are shown for each department in a core map. Aggregated departmental mean satisfaction scores are then calculated, as are hospital mean scores for each question. The same is done for staff members' evaluation and for outpatient care. Few problems are universal and most of the problematic scores are related to a minority of departments, calling for local activities to improve quality. Diversity seems to be the rule., Conclusions: The SurveillanceMapper-tool proved effective for handling the complexity of quality measures. It is easy to translate hundreds of graphs and tables into the SurveillanceMapper-tool format. The method facilitates easy spotting areas for quality improvements and evaluating the results of intervention.

Research over the last 50 years has repeatedly documented that bus drivers are exposed to several physical and psychological risk factors, which are associated with health problems in the form of heart, musculo-skeletal and stomach disease, and increased coronary mortality. So why has there been little action to improve the situation when it is so obviously indicated by such assessments? This article describes the long and complex process that has made it possible to launch almost 200 interventions among the 3500 municipal bus drivers in Copenhagen. Using a participative action research design, new evidence was gathered by broadening the traditional work environmental scope to lifestyle, health issues and private matters. Comparing this updated needs assessment with a national reference population, it was found that drivers were often still worse off. Again, simply presenting new evidence did not seem to lead to changes and further work is needed to empower the stakeholders so that they can commit to start making effective interventions. It is concluded that every needs assessment has to be supplemented with an evaluation of the action potential.

Background: The aim was to assess the rate at which waste collectors and municipal workers leave their job, to establish the outcome and to identify associated risk factors within work environment, health, lifestyle and marital status., Methods: A questionnaire-based survey among a cohort of 2,918 waste collectors and municipal workers was performed in 1994, with follow-up 2.5 years later., Results: Twenty-five percent had left the job at follow-up. Of these, 31% had changed jobs (associated with low decision authority), 16% were unemployed (associated with low skill discretion, pushing heavy loads and extreme bending of back), 10% received Disability Pension/long-term sick leave (associated with low skill discretion, prevalent diseases, underweight and smoking), and 12% received Early Retirement Pension (associated with extreme bending of back and marital status)., Conclusions: The study suggests a potential for preventing people from leaving physically heavy occupations by improving the physical and psychosocial work environment., (Copyright 2001 Wiley-Liss, Inc.)

Background: Staphylococcus aureus bacteremia (SAB) acquired in hospitals continues to be a frequent and serious complication to hospitalization, and no previous case-control studies dealing with risk factors of this severe disease are available., Methods: Based on a 1-year prospective analysis, the data from all patients with hospital-acquired SAB admitted to 4 hospitals in Copenhagen County, Denmark, from May 1, 1994, through April 30, 1995, were evaluated. Eighty-five patients with hospital-acquired SAB were matched to 85 control patients with a similar primary diagnosis at admission (matched controls). Of these, 62 patients with hospital-acquired SAB were compared with 118 other patients with a similar time of admission, who were randomly selected with no clinical evidence of SAB (unmatched controls)., Results: The incidence of hospital-acquired SAB was 0.71 per 1000 hospital admissions. The presence of a central venous catheter (odds ratio, 6.9; 95% confidence interval [CI], 2.8-17.0), anemia (odds ratio, 3.3; 95% CI, 1.4-7.6), and hyponatremia (odds ratio, 3.3; 95% CI, 1.5-7.0) was significantly associated with hospital-acquired SAB in a conditional and a usual logistic regression analysis. Nasal carriage was not an independent risk factor, but nasal carriers among patients in surgery (odds ratio, 4.0; 95% CI, 1.3-13.0) had a significantly higher risk for hospital-acquired SAB compared with matched and unmatched controls. The presence of hospital-acquired SAB increased the mortality rate 2.4-fold (95% CI, 1.1-5.2)., Conclusions: The presence of a central venous catheter is an important risk factor, and hyponatremia and anemia are associated with the development of hospital-acquired SAB. Furthermore, hospital-acquired SAB in itself increases mortality.

Two consecutive bedside prevalence studies of 455 surgical patients were made by the same infection control nurse in 15 surgical and gynaecological departments in eight Danish hospitals. Four point six percent had a deep and another 4.6% a superficial surgical wound infection (SWI). Two months after the second survey only one third of the infections were correctly recorded by the hospital routine surveillance of surgical wound infections (SWI). Registration systems that are simpler and more valid than the existing ones need to be developed. A follow-up was carried out with self-administered questionnaires in 2976 patients, of whom 1447 (48.6%) responded. A patient-diagnosed SWI was defined as an antibiotic treatment of a wound and/or a wound reopening by a health care professional. A total of 311 patients were treated for a SWI, 42% with antibiotics, 27% with wound reopening and 31% received both these treatments. Post-discharge surveillance cannot be recommended as a routine.

This study examined if surgical wound infections (SWI) result in a severe prognosis regarding general health and increase the consumption of social resources. A group of 1301 patients were interviewed by self-administered questionnaires during 1993-1994, while operated during hospitalization in seven Danish hospitals. These patients were followed up at least once by similar questionnaires at a median time of 5.5 and 10.0 months postoperatively. The consequences of surgically diagnosed SWI were analyzed in a hospital cohort of 58 infected patients and 648 controls. Postdischarge infections were analyzed in a patient cohort of 263 cases and 767 controls. Changes in health was measured by the General Health Questionnaire, Activities of Daily Living index, and self-assessed health. Consumption of resources were estimated by reliance on assistance from family and friends, use of home services, and contacts to doctors. It was found that the long-term prognosis of general health was unaffected by SWIs. However significantly increased social dependence was found for patients with SWIs compared to uninfected patients. Almost one-fourth of the operations were complicated by an SWI. Most of the infections were recognized only after discharge and were thought to be of minor importance, which may explain why no chronic impairment of the health was found for patients with an SWI. A bias toward no-effect may have been introduced if patients with severe SWIs abstained from participation. The societal cost of care for patients with minor infections seems to be large. The causal relation between outcome and SWI needs to be further investigated.

There is still a solid foundation for a further reduction of surgical wound infections. Every twentieth surgical bed is occupied by a patient with this complication. Though three out of four wards register the infections, serious problems with the methods have been established. Thus, it would not be justifiable to use the current registrations for monitoring for clinical and administrative purposes. Death or serious health consequences are to many patients the reality after a wound infection; the social and economical costs are also important. Better systems for surveillance of infections or complications must be developed specifically for the Danish hospitals. The hygienic expertise must be strengthened. Increased resources based on long-term planning are required to prevent more wound infections. Hospital hygiene will be a suitable subject for quality improvement. The surgical specialties should be encouraged to settle standards for specific procedures as to acceptable levels of infection.

Two consecutive bedside prevalence studies of 455 surgical patients were made by the same infection control nurse in 15 surgical and gynaecological departments in eight Danish hospitals. There was a high degree of diagnostic agreement between the prevalence survey and the clinical data. Four point six percent had a deep, and another 4.6%, a superficial surgical wound infection (SWI). Two months after the second survey only one third of these patients had their infection correctly recorded by the routine hospital surveillance of SWI. Better routines need to be developed to secure a valid, reliable and simple registration of relevant infectious wound complications. A follow-up was carried out with self-administered questionnaires in 2976 patients, of whom 1447 (48.6%) responded. This post-discharge survey showed that 15.7% had been treated with antibiotics, because of pus in the wound, 12.4% had to have the wound reopened and 6.6% experienced both these treatments.

The aim of this study was to see if introduction of continuous monitoring of the incidence of surgical wound infections would result in a reduction in the cumulated infection rates. Data from a Danish sentinel system, including more than 65,000 operations, are shown to be sufficiently representative to be used as the basis of a national surveillance system for surgical wound infections. The overall infection rates increased with age and with contamination of the wound. Antibiotic prophylaxis was used in 36% of the operations, with a higher fraction among elderly patients, and in contaminated or major operations. The length of stay was significantly and equally extended for patients with superficial or deep infections, compared to patients without wound infections. The results from 13 departments could be followed at least two years from the beginning of the registration. No general preventive effects of the continuous monitoring were found in these surgical units.

The compliance of practice to national guidelines on urethral catheter care has been examined. Questionnaires on the practices used with patients under their care were sent to 1350 nursing staff. Replies were received from 1153 individuals, 692 from hospitals, 345 from nursing homes and 116 from home care. While national guidelines stress the importance of maintaining a closed urine drainage system, the results revealed that 25.4% of respondents opened the drainage system to collect samples of urine for analysis, 57.9% to perform bladder washouts and 76% to change urine bags. 26% of respondents reported that they collected urine samples for routine bacteriological surveillance, a procedure considered unnecessary in the guidelines. 83% of staff reported that they washed their hands after emptying urine bags. Staff awareness of written guidelines for various aspects of catheter care ranged from 25-68% in hospitals, 27-45% in nursing homes and 7-17% in home care. A marginal costs analysis was performed to estimate the economic consequences of non-compliance to the national guidelines.

A cohort of 4515 surgical patients was selected from ten different surgical intervention groups, and 291 of 317 with a postoperative wound infection were matched 1:1 with controls with regard to intervention, sex and age. The mortality rate was investigated from the time of operation, with a follow-up period from 4 years 4 months to 8 years 4 months. Eighty-seven patients with a deep infection had a significantly increased mortality rate, with a risk ratio of 1.7. Without a distinction between superficial and deep infection the former might mask the higher mortality rate associated with the latter.

A cohort of 4515 surgical patients in ten selected intervention groups was followed. Three hundred and seventeen developed postoperative wound infections, and 291 of these cases were matched 1:1 to controls by operation, sex and age. In comparison to the controls the cases stayed longer in hospital after the intervention and had more contact after discharge with the social security system. Using data from a national sentinel reference database of the incidence of postoperative wound infections, and using national activity data, we established an empirical cost model based on the estimated marginal costs of hospital resources and social sick pay. It showed that the hospital resources spent on the ten groups, which represent half of the postoperative wound infections in Denmark, amounted to approximately 0.5% of the annual national hospital budget. This stratified model creates a better basis for selecting groups of operations which need priority in terms of preventive measures.

Purpose: To evaluate the state of the surveillance of surgical infections in Denmark. To investigate whether a negative attitude to infection registration on the part of the chief surgeon is correlated to departments with no plans of recording their infections., Design: Questionnaire sent to all surgical and gynaecological departments in Denmark., Place: The National Centre for Hospital Hygiene, Statens Seruminstitut, Copenhagen, Spring 1991., Material: 73 general, 34 orthopaedic, eight thoracic and vascular surgical departments, seven reconstructive, five neurosurgical, and 31 gynaecological departments., Variables: Kind of specialty, attitudes to infection registration, do register, plan to register, no plans to register, type of program, year of start of registration, satisfaction, problems and suggestive improvements., Results: Out of 170 possible units, 65 were already recording their infection rates, 59 had plans to start registration, 34 had no plans to start, five did not state whether they had any plans to start, and seven units did not respond. The units which were recording their infections had a more positive attitude towards surveillance systems., Conclusions: We found that the Danish public health service had a high degree of concern about infection surveillance without any legislative or other regulative pressures, and the process of implementing surveillance is still ongoing. The adoption of a common minimal data set is recommended in order to make a national and international comparison of infection surveillance data possible. Enlarging the infection control team may result in a better wound infection surveillance in hospitalised patients. More intensive studies are needed to examine how effectively surveillance prevents postoperative infections.

This review describes health problems in persons primarily exposed to grain dust. The main epidemiological investigations from the nineteen seventies and eighties are reviewed. The commonest complaints were mucus membrane irritation. In the majority of investigations, an excess incidence of chronic bronchitis was encountered and it cannot be disproved that asthma developed in a number of the employees. Influenza-like symptoms compatible with the organic dust syndrome have been described in several investigations from silos but allergic alveolitis has not been described in this branch. The latter condition has been encountered in farm workers working with mouldy grain. With dust concentrations of about the Danish threshold limit value, many health problems still occur. The following prophylactic measures are recommended: Effective drying of corn before storage, effective ventilation and cleaning and covering of dusty working procedures. Epidemiological investigations are proposed in the Danish raw material sector to illustrate health problems related to grain dust. These investigations should be combined with qualitative and quantitative occupational hygienic measurements of dust.