Calendar rhythm and menstrual cycle range.
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Adolescent↗
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Seasonal variation in plasma L-tryptophan availability in healthy volunteers. Relationships to violent suicide occurrence.
OBJECTIVE: To investigate the seasonal variation in levels of plasma L-tryptophan and competing amino acids (CAAs) in healthy humans in relation to climatic variables, total serum protein levels, and violent suicide occurrence. METHODS: Twenty-six healthy volunteers (13 men and 13 women; mean [+/- SD] age, 38.7 +/- 13.4 years) had monthly blood samplings for assays of L-tryptophan, valine, leucine, isoleucine, tyrosine, and phenylalanine during 1 calendar year. RESULTS: Significant annual rhythms were detected in L-tryptophan, the L-tryptophan/CAA ratio, phenylalanine, valine, and leucine, and semiannual rhythms in L-tryptophan values and in L-tryptophan/CAA ratios. Plasma L-tryptophan and the L-tryptophan/CAA ratio were significantly lower in the spring than in the other seasons. The peak-trough differences in the yearly variation expressed as a percentage of the mean were 17.1% and 16.1% for L-tryptophan values and L-tryptophan/CAA ratios, respectively. The amplitude of the yearly variation in all CAAs was low, ie, less than 7%. An important part of the variance in L-tryptophan availability (ie, 12% to 14%) could be explained by the composite effects of present and past climatic factors; higher ambient temperature and relative humidity in the face of lower air pressure are the most important predictors of low L-tryptophan availability. Important and positive time relationships were noted between total serum protein level and all amino acid concentrations, and a significant time relationship was also noted between the seasonal variation in L-tryptophan availability and the occurrence of violent suicide in Belgium. CONCLUSION: Our results show a bimodal seasonal pattern in the availability of plasma L-tryptophan that matches seasonal patterns in the prevalence of violent suicide in the local population and depression in other studies.
Adult↗
Predictability of monthly and yearly rhythms of breast cancer features.
In order to evaluate if breast cancer biological characteristics undergo significant menstrual and seasonal variations, we analysed in a consecutive series of 905 breast cancer patients, steroid receptor level (ER and PgR by DCC assay), proliferative activity (3H-Thymidine Labeling Index, 3H-TLI) and size of primary tumour in relation to calendar date and day of menstrual cycle at the time of the surgical procedure. For data analysis, the method of time series construction and classical spectral analyses with Bartlett Kolmogorov-Smirnov test for white noise (BKS test) was utilised. For what concerns menstrual variations, 3H-TLI showed a significant periodicity (t = 0.3146, p < 0.01 by BKS test) with peaks at day 12nd and day 18th; ER showed a significant periodicity (t = 0.3605, p < 0.01 by BKS test) with more evident peak at day 27th; PgR, a significant periodicity (t = 0.160, p = 0.05 by BKS test) with peaks at day 15th and day 24th, similar to that observed for tumour size (t = 0.19, p < 0.05 by BKS test). With respect to yearly fluctuations, 3H-TLI showed only a trend for a significant rhythm (t = 0.16, p = 0.06 by BKS test) with peaks in May and November; ER a significant periodicity (t = 0.2099, p < 0.05 by BKS test) with two evident peaks in January and April; also for PgR a significant periodicity (t = 0.3161, p < 0.05 by BKS test) was demonstrated with a peak in July; finally, tumour size showed a significant rhythm (t = 0.335, p < 0.01) paralleling 3H-TLI behaviour. Finally, the analysis of variance with interaction of menstrual and seasonal timings showed that only the seasonal timing was able to independently influence the 3H-TLI variations (3H-TLI higher in spring). We confirmed that breast biology has significant menstrual and seasonal variations and that the seasonality is probably the timing factor more relevant in periodicity determination.
Breast Neoplasms↗
Toward chronobiologic pattern discrimination of the risk of developing breast cancer and other diseases.
With a view of the prevention as well as treatment of cancer and other diseases, it is important to quantify health positively and on an individual basis by chronobiologic methods. These include the assessment of the characteristics of certain circadian, circannual and other endocrine rhythms and trends, for the recognition of risk (prior to the occurrence of a given disease) by an alteration of the same rhythm characteristics and even by a time-specified single sample. With this aim in mind, a small number of selected (rather than randomly picked) women of 3 age groups was extensively sampled for 12 plasma hormones around the clock and the calendar, in 2 geographic locations. Such data revealed correlations of the familial risk of developing breast cancer with the circannual amplitudes of circulating prolactin and TSH. The risk of several other conditions was also correlated with hormonal rhythm characteristics; for example, the risk of developing diseases associated with a high blood pressure was correlated with the circannual amplitude of plasma aldosterone. The mapping of circannual characteristics, however, is time-consuming and costly and may not be warranted as a first step, for example when a physician is not in a position to wait for a year to make a diagnosis. With the possibility in mind that sampling requirements may be reduced to one or at most two samples, a chronobiologic pattern discrimination analysis was undertaken on the original data from young adults. The results are presented to indicate the method and to suggest the singling-out of certain variables for further testing on a larger, properly stratified and randomized sample, rather than as definitive results. Different classifiers and different corresponding reference values from variables that undergo circadian and circannual rhythms may perhaps withstand the test (and, with Vergil, the tooth) of time. If so, reference values that are time-specified may well prove to be a sine qua non in the assessment of certain neuroendocrine aspects of developing certain diseases, including breast cancer.
Adolescent↗
In humans, the seasonal variation in poly-unsaturated fatty acids is related to the seasonal variation in violent suicide and serotonergic markers of violent suicide.
BACKGROUND: Depression is accompanied by a depletion of n-3 poly-unsaturated fatty acids (PUFAs). There is also a negative correlation between suicide and fish-oil intake (rich in n-3 PUFAs) across different countries. Both depression and suicide show a seasonal variation and are related to disorders in the serotonergic system. AIMS: The present study was carried out to determine if there is a seasonal variation in the PUFA fractions in serum phospholipids and whether there are significant relationships between lowered n-3 PUFA status and the seasonal variation in the number of suicide deaths and serotonergic markers of suicide. METHODS: We took monthly blood samples during 1 calendar year from 23 healthy volunteers and analyzed the PUFA composition in serum phospholipids and related those data to the annual variation in the mean weekly number of suicides for Belgium and the Bmax [3H]-paroxetine binding to platelets in the same 23 subjects. RESULTS: Significant annual rhythms were detected in the long-chain PUFAs only, i.e. arachidonic acid (C20: 4n-6; AA), eicosapentaenoic acid (C20: 5n-3; EPA), and docosahexaenoic acid (C22: 6n-3; DHA). There was a significant correlation between the changes over the last 2 weeks in AA and EPA and the mean weekly number of violent, but not nonviolent, suicide deaths in Belgium. There was a significant correlation between the PUFAs, AA and DHA, and the Bmax [3H]-paroxetine binding to platelets. CONCLUSIONS: Our results show that there is a true seasonality in long-chain PUFAs, such as AA, EPA and DHA. The results suggest that the seasonality in PUFAs may be related to the incidence of violent suicide and the expression of the serotonin transporter complex.
Arachidonic Acid↗
How many people with heart failure are appropriate for biventricular resynchronization?
AIMS: Increasing evidence exists suggesting that biventricular pacing improves outcome and symptoms in severe heart failure if various selection criteria are fulfilled. It is unsure how many people might benefit from this therapy. Our aim was to provide such data. METHODS AND RESULTS: Over one calendar year all patients admitted to a large U.K. District General Hospital, that were classified with a diagnosis of heart failure, were audited. The selection criteria were; (1) severe heart failure (NYHA class III or IV), (2) heart failure due to a dilated cardiomyopathy, (3) QRS duration greater than 120 ms or (4) the presence of a bundle branch block pattern. Subjects were divided into those in sinus rhythm to determine those who would be suitable for atrially synchronized biventricular pacing and those with an abnormally long PR interval (>210 ms) who might additionally benefit from improved atrioventricular synchrony. 1042 patients were coded with heart failure. 721 fulfilled diagnostic criteria and were studied. 202 (28%) had severe heart failure, 178 (25%) had a QRS of at least 120 ms, 437 (61%) had an ischaemic cardiomyopathy, 176 (24%) an idiopathic cardiomyopathy and 433 (60%) were in sinus rhythm. Overall mortality at the time of census was 29%. 43 patients were suitable for biventricular pacing with a further 29 atrial patients fibrillation who might benefit from biventricular pacing alone. CONCLUSION: Using our criteria, approximately 10% of an unselected group of heart failure admitted to a typical U.K. district general hospital over a calendar year would be appropriate for biventricular pacing. This represents a large number of patients who might derive benefit from this new therapy.
Aged↗
[Live birth distribution by time and place from 1981 to 1998 in Japan].
OBJECTIVES: To investigate the diurnal rhythm of live births labored spontaneously, and the effects of obstetric intervention on birth time distributions. METHODS: The data of live births tabulated by time (one-hour intervals), date and birthplace throughout Japan between 1981 and 1998 were obtained with permission from the former Ministry of Health and Welfare. Together with an investigation of hourly birth numbers by place in each year, an annual transition of hourly birth rates in medical institutions and the diurnal rhythm of birth numbers in maternity homes and at home were analyzed using regression analysis. RESULTS: In every calendar year studied the hourly live birth numbers at hospitals showed a single-peak distribution pattern with maximum values at 13:00-15:00. The annual transition of hourly birth rates showed a 10% (birth numbers base) decrease in the 11:00-13:00 period in 1998 as compared with that in 1981, while there was a corresponding increase of 8% in the 13:00-15:00 period. Hourly birth numbers at clinics showed a double-peak distribution pattern with maximum values during the 11:00-12:00 and 14:00-15:00 periods in early 1980, while a single-peak distribution with a maximum value during the 13:00-15:00 period appeared in 1989 and has remained thereafter. Hourly birth rates (birth numbers base) increased by over 6% in the 13:00-15:00 and 17:00-20:00 periods over the past 18 years, while they decreased by 10% in the 9:00-13:00 period. The results at maternity homes were clearly different from those at hospitals and clinics. The live birth numbers totaled for the 18 years showed a double-phase distribution with a maximum value in the 6:00-7:00 period and a minimum value in the 19:00-20:00 period. The best-fit regression model for the obtained data was a sine curve with a maximum value at 6:00 (coefficient of determination 0.97). Hourly distributions of live births at home also fitted best to a since curve with the maximum value again at 6:00 (coefficient of determination 0.95). CONCLUSIONS: The results suggested that the timing of spontaneous live births follows a circadian rhythm and that obstetric intervention affects time distributions of live births by shifting over 10% of births during the night and early morning to a working day service time (9:00-17:00).
Birth Rate↗
Secular and seasonal cycling of IA2-ab autoantibody in Slovak diabetic children.
The concept of seasonal and secular cycling of initial autoantibody plasma levels in children with diabetes mellitus 1 is not common, despite the known fluctuations in one of the triggering factors, i.e., various enteroviral infections. The aim of this study was therefore to assess the trends and cycles in the time series of IA2-autoantibody (ab) blood plasma levels measured in each patient at the moment of diagnosis of the disease, before the first injection of insulin. In a retrospective study, the IA2-ab data, with each item related to a calendar day, were analyzed from 83 male and 108 female patients aged up to 14 years, with the date of disease menifestation between January 1993 and December 1999. The data source was the Slovak National Register of Childhood Diabetes. The plasma levels of the autoantibody against pancreatic tyrosine phosphatase (IA2-ab) were measured by radioimmunoassay. The chronogram of the daily observed values, modified by moving averages, from three successive data items per patient, was processed by Halberg's cosinor method to test the presence of seven-year sinusoids and one-year rhythms. One seven-year sinusoid, peaking in February 1998 (boys) and in October 1996 (girls), and a seasonal rhythm culminating in May/June each year were significant. There are some similarities to the cycling of other variables such as the incidence of diabetes, the birth of future diabetics, Coxsackie virus epidemics and pancreatic glutamic acid decarboxylase (GAD 65) autoantibody. Moreover, some cosmo-geophysical periods also seem to be cycling in a parallel manner. The novelty of this contribution is that it examines the seasonal cycling of the autoantibody, connected with the pathogenesis of diabetes and directed against IA2-ab.
Adolescent↗
Chronobiological aspects of acute cerebrovascular diseases.
The study was aimed at further investigating the circadian and circannual patterns of stroke onset. Study design and type of participants: 977 strokes (475 in men and 502 in women) concerning 926 subjects (457 men and 469 women) admitted to Ferrara Hospital in two calendar years (1990-1991), were prospectively investigated. The strokes were classified as based on cerebral infarction (CI), transient ischemic attack (TIA) and cerebral hemorrhage (CH: subarachnoid and intracerebral hemorrhage). Two statistical models of analysis were used. The assessment of circadian and circannual periodicity was performed utilizing the single cosinor method. A separate analysis was performed after distribution of events into 6-hour intervals, and chi-square test for fit was applied to the number of observed versus expected cases. The majority of strokes occurred in the morning between 7 a.m. and noon (35% of cases) and the hypothesis of a uniform distribution of the time onset was rejected on the basis of the chi-square for all subtypes of stroke. A circadian rhythm was found for CI and TIA with acrophase at the 11.56 and 12.41 respectively. Also a circannual periodicity was found for CI with a prevalent peak in October. The spectral analysis detected a circadian cycle for CH having a period of 4 h, and a circannual cycle for TIA with a period of 4 months. This study confirms that stroke is a high-chrono-risk disease, with specific circadian and circannual rhythms. This is very important for a better understanding and control of the underlying factors and in terms of prevention.
Acute Disease↗
Going Dutch in nocturnal enuresis.
Based on several intervention programmes, a strategy for the treatment of nocturnal enuresis has recently been developed by an expert committee in the Netherlands. It consists of three parts. First, two structured interviews are given: one to differentiate between enuresis and incontinence and one to detect associated problems such as diurnal enuresis, constipation or behavioural problems. Secondly, a medical examination is made, confined to the inspection of the external genitalia and lower back, palpation of the abdomen and urine examination. Thirdly, the following guidelines for treatment at different age levels are applied: up to the age of 6 years no intervention is needed; between the ages of 6 and 8 years, lifting out of bed and/or the calendar method; between the ages of 8 and 12 years, enuresis alarm (if not successful, medication with desmopressin is prescribed for a restricted period of time), and ambulatory dry-bed training in a group setting may follow; over 13 years of age, clinical dry-bed training according to the Messer/Azrin method is advised. According to the expert committee, these guidelines offer sufficient possibilities to deal with the problem of nocturnal enuresis.
Adolescent↗
Pseudogout: timing of attacks and the cosmogeophysical environment.
OBJECTIVE: To search for a time parallelism between lunar and solar rotation cycles and calendar dates of attacks of pseudogout--chondrocalcinosis articularis (pyrophosphate arthropathy). METHODS: Seventy-four documented attacks with known calendar dates of onset recorded in 16 patients of one family cluster between 1955 and 1995 were examined in this study. Their daily frequencies during the given time span (chronogram) were transformed into frequencies pertaining to separate days of the corresponding cycle (plexogram). The latter data were processed by the cosinor analysis to test the presence of a priori supposed periodicities. RESULTS: The most pronounced time parallelism was found with the Bartels solar rotation cycle, covering a period of 27 days. The cosinor regression explained 95% of the total variance in the data. The plexogram of the attacks displayed 4 clear peaks and 4 troughs. Besides the 27-day cycling, its 2nd, 3rd, 4th and 5th harmonics, i.e. approximately 14-, 9-, 7- and 5 day rhythms were also statistically significant. Some periodic changes were also found during lunar cycles. The maximum frequency was encountered shortly after the full moon and after the moon perigee. CONCLUSION: A causal connection between fluctuations of the geomagnetic field, such as that during solar rotation and perhaps also lunar cycles, and the occurrence of pseudogout attacks could exist and should be studied more extensively.
Chondrocalcinosis↗
Arginine vasotocin (AVT) and isotocin (IT) in fish brain: diurnal and seasonal variations.
An HPLC assay with solid-phase extraction and fluorescence derivatization was developed for measurement of arginine vasotocin (AVT) and isotocin (IT) in the neural tissues of fish. The efficiency and usefulness of the method have been verified in experiments by examination of peptides concentrations in brains of three fish species. The day-night changes in neuropeptides levels have been studied in brains of adult sea bream (Sparus aurata) and juvenile Atlantic salmon (Salmo salar). Seasonal fluctuations have been investigated in brains of three-spined sticklebacks (Gasterosteus aculeatus). The AVT and IT biosynthesis in brain seems to be controlled independently and probably each neuropeptide plays a different role in a circadian time-keeping system and an endocrine calendar in fish.
Animals↗
Relationships of climatic data to immune and hematologic variables in normal human.
OBJECTIVES: The purpose of this study was to examine the relationships between climatic and immune or hematologic variables in the peripheral blood of normal human. METHODS: Twenty-six normal volunteers gave blood samples monthly during one calendar year for flow cytometric assays of peripheral blood mononuclear cells (PBMC) and assays of red blood cell (RBC)- and platelet-related variables. Time relationships between the weather and immune or hematologic variables were investigated by means of multiple regression and bivariate cosinor analyses. RESULTS: Highly significant relationships were found among number and percentage of neutrophils, lymphocytes, CD4+, CD8+, CD25+ (interleukin-2-receptor bearing lymphocytes), CD20+ B lymphocytes, number of platelets and RBC, hemoglobin (Hb), mean corpuscular (MC) volume, MC Hb, MC Hb concentration, mean platelet volume or plasma fibrinogen levels and ambient temperature, sunlight duration, air pressure, wind speed, relative humidity, and rainfall duration/day. An important part of the variability in the immune and hematologic variables could be explained by the composite effects of contemporaneous and lagged climatic variables. Common seasonal rhythms were detected in the time series of the above immune/hematologic and sun insolation variables, such as ambient temperature. CONCLUSIONS: The results suggest that i) short-term fluctuations in atmospheric activity modulate immune and hematologic features in the peripheral blood of normal human; and ii) the seasonal rhythms observed in immune/hematologic variables may be entrained by the seasonal rhythms in ambient temperature.
Journal Article↗
Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study.
OBJECTIVES: This study was designed to investigate the potential of circumferential pulmonary vein (PV) ablation for atrial fibrillation (AF) to maintain sinus rhythm (SR) over time, thus reducing mortality and morbidity while enhancing quality of life (QoL). BACKGROUND: Circumferential PV ablation is safe and effective, but the long-term outcomes and its impact on QoL have not been assessed or compared with those for medical therapy. METHODS: We examined the clinical course of 1,171 consecutive patients with symptomatic AF who were referred to us between January 1998 and March 2001. The 589 ablated patients were compared with the 582 who received antiarrhythmic medications for SR control. The QoL of 109 ablated and 102 medically treated patients was measured with the SF-36 survey. RESULTS: Median follow-up was 900 days (range 161 to 1,508 days). Kaplan-Meier analysis showed observed survival for ablated patients was longer than among patients treated medically (p < 0.001), and not different from that expected for healthy persons of the same gender and calendar year of birth (p = 0.55). Cox proportional-hazards model revealed in the ablation group hazard ratios of 0.46 (95% confidence interval [CI], 0.31 to 0.68; p < 0.001) for all-cause mortality, of 0.45 (95% CI, 0.31 to 0.64; p < 0.001) for morbidities mainly due to heart failure and ischemic cerebrovascular events, and of 0.30 (95% CI, 0.24 to 0.37; p < 0.001) for AF recurrence. Ablated patients' QoL, different from patients treated medically, reached normative levels at six months and remained unchanged at one year. CONCLUSIONS: Pulmonary vein ablation improves mortality, morbidity, and QoL as compared with medical therapy. Our findings pave the way for randomized trials to prospect a wider application of ablation therapy for AF.
Aged↗
Seasonal variations in socially and legally unacceptable sexual behaviour.
The calendar dates, over the 15-year span 1966-1980, of committed rapes by eight male recidivists and offences of sexually indecent or immoral behaviour by eight other male recidivists were gathered from the files of the Préfecture de Police, Paris, France. Each offender of the first group had committed from two to six rapes, while each offender of the second had committed from two to 16 incidences of indecent behaviour. Although the reported rapes took place during several calendar years, almost all, 18 out of 22 offences, were committed by the eight rape-recidivists during the 4-month span of July-October. Single cosinor analysis of these data revealed a circannual rhythmicity (P less than 0.03) with luminal diameter being 10 August +/- 34 days (the 95% CL). The peak time of indecent sexual behaviour, exclusive of rape, against females occurred during September with secondary peaks in February and June; such offences directed against males peaked in October. 'Bootstrap' and 'Jackknife' methods confirmed seasonality within all data sets, except for the offences of indecent behaviour.
Adolescent↗
Assessment of the risk of mesor-hypertension.
A small number of selected (rather than randomly picked) women of three age groups was extensively sampled in two geographic locations. Data on twelve of the plasma hormones in addition to those on some systemic variables, including blood pressure (BP), determined around the clock and along the calendar were here analyzed further. The risk of developing certain diseases was assessed by epidemiologically designed questionnaires. The risk of cerebro-, reno-, cardiovascular disease was here approached by focus upon the risk of developing a high rhythm-adjusted mean (mesor) of BP. The risk of mesor-hypertension (RMH) for a selected group of young adult women was inversely correlated with the circannual amplitude (a measure of the extent of predictable since rhythmic change along the scale of a year) and the circannual mesor of plasma aldosterone. These indices are costly in several ways since it takes at least a year and quite a few samples to estimate them reliably. In the attempt to reduce sampling requirements to one or at most two plasma samples, a chronobiologic pattern discrimination analysis was undertaken on the original data from the subgroup of young adult women. Data were normalized by the sample standard deviation of each variable and processed according to proximity (so-called nearest neighbor) rules, for dimension reduction and classification. For each variable, each subject's samples were classified by reference to those of all others. The results objectively identify certain variables for further testing on larger, properly stratified and randomized cohorts followed preferably for a life-time and also illustrate the computer method of pattern discrimination used. Pattern discrimination not only singles out plasma aldosterone as the primary classifier for RMH, but shows further the circannual- and circadian-stage dependence of the classification. The clock-hour for optimal classification of RMH by aldosterone and by hormonal co-classifiers changes with the season. Furthermore, the relation between the circadian mesor of aldosterone concentration and RMH is an inverse one in summer, fall and winter, but a direct one in spring. A validated inverse relation to RMH of the circannual amplitude and mesor as well as any added differences in acrophase or waveform of aldosterone as a function of circannual stage all contribute to the change in sign of the relationship between aldosterone and RMH observed in spring. The latter change renders mandatory the specification as to clock-hour and season of any spot-check for risk assessment, whether it is based upon single or multiple samples.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Are duodenal ulcer seasonal fluctuations paralleled by seasonal changes in 24-hour gastric acidity and Helicobacter pylori infection?
The occurrence of duodenal ulcer is characterized by seasonal variation, for poorly understood reasons. No previous study has assessed whether 24-h intragastric acidity and Helicobacter pylori infection have similar seasonal fluctuations in patients with this disorder. For this reason, we evaluated retrospectively the circadian gastric pH in 319 new patients (226 men and 93 women, mean age 45.2 years) with endoscopically proven duodenal ulcer, who agreed to undergo this examination during the years 1987-1992 in our center. The month-by-month occurrence of the disease over the global 6-year period was assessed, and the mean pH values were calculated for each patient during three time intervals of interest: 24 h, daytime (08:00-19:59 h), and nighttime (20:00-07:59 h). The mean pH values of these three time periods were then calculated month by month throughout the annual cycle. H. pylori infection was sought by histology in 171 patients examined in the period from 1990 to 1992. The percentage of H. pylori-positive duodenal ulcer patients was then calculated for each season. The calendar fluctuation of duodenal ulcer occurrence showed an evident increase (p < 0.001) in fall (October-December) and in winter (January-March) compared with spring (April-June) and summer (July-September). Both 24-h and nighttime gastric acidity showed no significant variation by month, whereas daytime gastric pH varied significantly (p < 0.05) with two evident decreases, meaning higher acidity, in April and August. H. pylori infection was detected in 152 of 171 patients (89%), and the percentage of H. pylori-positive duodenal ulcers did not differ from season to season. We conclude that there was no parallel circannual fluctuation of duodenal ulcer, gastric acidity, and H. pylori infection in the restricted sample of patients we studied. This reduces the apparent relevance of acid in inducing ulcer seasonal fluctuation. Also, the responsibility of H. pylori in this phenomenon can be excluded until a reliable diagnostic method capable of distinguishing recent from old infection is found.
Adult↗
Long term effect of a medical emergency team on cardiac arrests in a teaching hospital.
INTRODUCTION: It is unknown whether the reported short-term reduction in cardiac arrests associated with the introduction of the medical emergency team (MET) system can be sustained. METHOD: We conducted a prospective, controlled before-and-after examination of the effect of a MET system on the long-term incidence of cardiac arrests. We included consecutive patients admitted during three study periods: before the introduction of the MET; during the education phase preceding the implementation of the MET; and a period of four years from the implementation of the MET system. Cardiac arrests were identified from a log book of cardiac arrest calls and cross-referenced with case report forms and the intensive care unit admissions database. We measured the number of hospital admissions and MET reviews during each period, performed multivariate logistic regression analysis to identify predictors of mortality following cardiac arrest and studied the correlation between the rate of MET calls with the rate of cardiac arrests. RESULTS: Before the introduction of the MET system there were 66 cardiac arrests and 16,246 admissions (4.06 cardiac arrests per 1,000 admissions). During the education period, the incidence of cardiac arrests decreased to 2.45 per 1,000 admissions (odds ratio (OR) for cardiac arrest 0.60; 95% confidence interval (CI) 0.43-0.86; p = 0.004). After the implementation of the MET system, the incidence of cardiac arrests further decreased to 1.90 per 1,000 admissions (OR for cardiac arrest 0.47; 95% CI 0.35-0.62; p < 0.0001). There was an inverse correlation between the number of MET calls in each calendar year and the number of cardiac arrests for the same year (r2 = 0.84; p = 0.01), with 17 MET calls being associated with one less cardiac arrest. Male gender (OR 2.88; 95% CI 1.34-6.19) and an initial rhythm of either asystole (OR 7.58; 95% CI 3.15-18.25; p < 0.0001) or pulseless electrical activity (OR 4.09; 95% CI 1.59-10.51; p = 0.003) predicted an increased risk of death. CONCLUSION: Introduction of a MET system into a teaching hospital was associated with a sustained and progressive reduction in cardiac arrests over a four year period. Our findings show sustainability and suggest that, for every 17 MET calls, one cardiac arrest might be prevented.
Aged↗