Article

Headaches and the N95 face-mask amongst healthcare providers

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Abstract

During the 2003 severe acute respiratory distress syndrome epidemic, healthcare workers mandatorily wore the protective N95 face-mask. We administered a survey to healthcare workers to determine risk factors associated with development of headaches (frequency, headache subtypes and duration of face-mask wear) and the impact of headaches (sick days, headache frequency and use of abortive/preventive headache medications). In the survey, 212 (47 male, 165 female) healthcare workers of mean age 31 years (range, 21-58) participated. Of the 79 (37.3%) respondents who reported face-mask-associated headaches, 26 (32.9%) reported headache frequency exceeding six times per month. Six (7.6%) had taken sick leave from March 2003 to June 2004 (mean 2 days; range 1-4 days) and 47 (59.5%) required use of abortive analgesics because of headache. Four (2.1%) took preventive medications for headaches during this period. Multivariate logistic regression showed that pre-existing headaches [P = 0.041, OR = 1.97 (95% CI 1.03-3.77)] and continuous use of the N95 face-mask exceeding 4 h [P = 0.053, OR = 1.85 (95% CI 0.99-3.43)] were associated with development of headaches. Healthcare providers may develop headaches following the use of the N95 face-mask. Shorter duration of face-mask wear may reduce the frequency and severity of these headaches.

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... Conclusions: This study indicates that healthcare workers develop headaches due to use of masks during the COVID-19 outbreak. are several studies showing the emergence of a new headaches due to the use of masks in healthcare workers [2][3][4]. The aim of this study is to investigate mask-related headache during the COVID-19 outbreak, and to determine its clinical features. ...
... The number of studies on headache associated with mask use is very limited [2][3][4]. Several studies have described mask-associated de-novo headache [2,3]. ...
... There may be more than one mechanism in the physiopathology of de-novo headache. Several factors may explain its association with the use of filtering masks, including hypoxia, hypercapnia, local compression, and even mask use anxiety [4]. Sleep deprivation, irregular mealtimes, and emotional stress are other sources of headache among healthcare workers during prolonged mask use [2]. ...
Article
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Background: It has been reported that a new type of headache may develop as a result of face mask use during the COVID-19 pandemic. The aim of this study is to investigate the clinical features of face mask-related headache during the COVID-19 pandemic. Methods: This is a cross-sectional study carried out on healthcare workers at the Afyonkarahisar Health Sciences University. The number of workers at our university was established. Sample size was calculated using the G*Power program. A questionnaire consisting of questions relating to pre-existing headache, an aggravation in headache, and de-novo headache was filled out by 3 neurologists with all participants. Results: Data was collected from a total of 375 participants, after the exclusion of 5 individuals who refused to participate. Out of all participants, 26 (6.9%) used a filtering mask, 274 (73.1%) used a surgical mask, 75 (20.0%) participants used a combination of both masks. The number of participants with preexisting headache was 114 (30.4%) had pre-existing headache. Of those with pre-existing headache, 77 (67.5%) healthcare workers had reported an aggravation in their headache after mask use. De-novo headache was observed in 116 (30.9%) of participants. De-novo headache characteristics included throbbing in 17 (14.7%) participants and pressing in 99 (85.3%) participants. In addition, symptoms such as tachypnea, sleep disturbance, and fatigue were found to be significantly higher. Conclusions: This study indicates that healthcare workers develop headaches due to use of masks during the COVID-19 outbreak.
... The personal protective equipment (PPE) include N95 respirators, valved-respirators and powered air purifying respirator (PAPR), in addition to face shields and goggles. Although PPE use is necessary, the side-effects become more noticeable with their prolonged use [8,9]. These perceptions have been associated not only with mask fit but also with carbon dioxide (CO2) rebreathing from the mask [10][11][12]. ...
... These perceptions have been associated not only with mask fit but also with carbon dioxide (CO2) rebreathing from the mask [10][11][12]. Numerous side-effects such as dyspnea, dizziness, reduced cognition and headaches, have been reported with mask use, particularly with the tight-fitting N95 masks and valved respirators [4,8,9]. ...
... Elevated CO2 has been reported to result in hemodynamic changes in the intracranial arteries and considered a contributor towards discomfort, fatigue, dizziness, headache, shortness of breath, generalized weakness, lethargy and drowsiness [10]. Furthermore, these symptoms increased with prolonged use of the face mask [8,19]. Some studies even showed proportional decrease in cognitive abilities with increasing CO2 levels [15][16][17][18]. ...
Article
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Background and purpose: COVID-19 pandemic led to wide-spread use of face-masks, respirators and other personal protective equipment (PPE) by healthcare workers. Various symptoms attributed to the use of PPE are believed to be, at least in part, due to elevated carbon-dioxide (CO2) levels. We evaluated concentrations of CO2 under various PPE. Methods: In a prospective observational study on healthy volunteers, CO2 levels were measured during regular breathing while donning 1) no mask, 2) JustAir® powered air purifying respirator (PAPR), 3) KN95 respirator, and 4) valved-respirator. Serial CO2 measurements were taken with a nasal canula at a frequency of 1-Hz for 15-min for each PPE configuration to evaluate whether National Institute for Occupational Safety and Health (NIOSH) limits were breached. Results: The study included 11 healthy volunteers, median age 32 years (range 16-54) and 6 (55%) men. Percent mean (SD) changes in CO2 values for no mask, JustAir® PAPR, KN95 respirator and valve respirator were 0.26 (0.12), 0.59 (0.097), 2.6 (0.14) and 2.4 (0.59), respectively. Use of face masks (KN95 and valved-respirator) resulted in significant increases in CO2 concentrations, which exceeded the 8-h NIOSH exposure threshold limit value-weighted average (TLV-TWA). However, the increases in CO2 concentrations did not breach short-term (15-min) limits. Importantly, these levels were considerably lower than the long-term (8-h) NIOSH limits during donning JustAir® PAPR. There was a statistically significant difference between all pairs (p < 0.0001, except KN95 and valved-respirator (p = 0.25). However, whether increase in CO2 levels are clinically significant remains debatable. Conclusion: Although, significant increase in CO2 concentrations are noted with routinely used face-masks, the levels still remain within the NIOSH limits for short-term use. Therefore, there should not be a concern in their regular day-to-day use for healthcare providers. The clinical implications of elevated CO2 levels with long-term use of face masks needs further studies. Use of PAPR prevents relative hypercapnoea. However, whether PAPR should be advocated for healthcare workers requiring PPE for extended hours needs to evaluated in further studies.
... Esto puede llegar a ser clínicamente relevante en relación con las mascarillas, especialmente en lo que se refere a la interacción más reducida y a la mayor susceptibilidad a los accidentes de estos pacientes debido al uso de la mascarilla. Para evitar la anestesia involuntaria provocada por el CO 2 [39], según los criterios de los CDC (Centers for Disease Control and Prevention, EE.UU.), lois pac.rntrs feadois y srdadois poig fágmacois, sin posibilidad de monitorización continua, no deben ser enmascarados debido a la posible retención de CO 2 descrita anteriormente, ya que existe un riesgo de aspiración y asfxia si se produce inconsciencia [16,17,20,38,82,83]. ...
... [69]. Cuando se producen estos síntomas, se produce un rstgés adicional durante horas laborales para el usuario de la mascarilla y, por lo tanto, en relación con la sensación de agotamiento, contribuye a un problema de auto-refuerzo de un círculo vicioso a través de una activación simpática vegetativa con un aumento adicional de la frecuencia respiratoria, la frecuencia cardíaca, la presión arterial y una mayor sensación de agotamiento [16,20,35,83]. Otros estudios han demostrado que los efectos psicológicos y físicos de las mascarillas pueden provocar una reducción adicional del rendimiento laboral (medido por la escala de 1 a 5 de Roberge de síntomas subjetivos durante el trabajo/medido por la escala Roberge Subjective Symptoms During Work Scale de 1 a 5) a través de un aumento de la sensación de fatiga, insatisfacción y ansiedad [58,102,103]. ...
... causadas poig rl caloig, así como por la irritación de la piel [29,35,116,129]. Para complicar aún más la situación, existe la acumulación de dióxido de carbono inducida por el espacio muerto (especialmente bajo las mascarillas N95) con la consecuencia de dolores de cabeza descritos [19,27,37,[66][67][68]83]. Además, el aumento de la frecuencia cardíaca, el picor y la sensación de humedad [15,29,30,35,71] hacen que se grduzca la sr/ug.dad ...
Article
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Many countries introduced the requirement to wear masks in public spaces for containing SARS-CoV-2 making it commonplace in 2020. Up until now, there has been no comprehensive investigation as to the adverse health effects masks can cause. The aim was to find, test, evaluate and compile scientifically proven related side effects of wearing masks. For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES). We objectified evaluation evidenced changes in respiratory physiology of mask wearers with significant correlation of O2 drop and fatigue (p < 0.05), a clustered co-occurrence of respiratory impairment and O2 drop (67%), N95 mask and CO2 rise (82%), N95 mask and O2 drop (72%), N95 mask and headache (60%), respiratory impairment and temperature rise (88%), but also temperature rise and moisture (100%) under the masks. Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields.
... The regular use of PPE has resulted in various health-related issues (headaches, dehydration, and contact dermatitis) [6,7]. Studies have shown that when HCW continue to work for >1 h with N-95 masks without a break, the blood CO 2 levels may increase causing various physiological effects such as headache and increased work of breathing among others [8]. ...
... Only 7% attributed this to the use of eye protection devices alone. The possible reasons for this headache could be mechanical compression, hypoxemia, hypercarbia, and stress [8,[12][13][14]. Pressure and/or tractional force from the mask and/ or the eye protection device can cause local tissue damage and irritation of the underlying (superficial) sensory nerve endings [15]. ...
... Most of the respondents agreed that these headaches influenced their work performance. Possible solutions suggested have been to wear the mask for a shorter duration, which may prevent or reduce the severity of the headaches [8]. This may translate into breaks between surgeries. ...
Article
Personnel protective equipment (PPE) are recommended during surgery even in COVID-19 negative patients especially in a high-prevalence region due to its higher false-negative rates. However, the use of PPE has not been universal mainly due to the perception of discomfort and associated stress and fatigue. This study was done to understand the pattern of PPE use by cancer surgeons during the pandemic and the associated discomfort, stress, and fatigue with its use. The survey, consisting of 29 questions, was circulated widely across the country by email and chat groups among cancer surgeons. The study was registered with the Clinical Trials Registry of India (CTRI/2020/08/027050). We received a total of 342 evaluable responses that could be included for analysis. All the respondents used appropriate PPE in different combinations. N-95 mask and the face shield were the two components of the PPE that gave rise to a lot of discomforts. Fogging (of face shields) (p < 0.001,OR 3.61), dryness of mouth (p < 0.001,OR 3.35), and breathing difficulty/feeling of suffocation (p = 0.034,OR 1.68) contributed to the stress, whereas headache (p < 0.001,OR 11.34) and breathing difficulty/feeling of suffocation (p < 0.001,OR 4.24) contributed to the fatigue associated with PPE use the most. PPE was routinely used during cancer surgery in COVID-19 negative patients during the pandemic. However, most surgeons experienced different degrees of discomfort, especially with the N-95 masks and eye protection. Supplementary information: The online version contains supplementary material available at 10.1007/s13193-021-01316-6.
... Studies have shown that wearing PPE for prolonged time periods may lead to symptoms of physical discomfort including headache [6][7][8]. However, there is a lack of literature related to PPE-associated headaches that examines the combined usage of N95 face masks and protective eyewear, specifically goggles. ...
... Studies exploring the effect of PPE on people's health have focused on its association with headaches. For instance, a study of healthcare providers wearing N95 face masks during the 2003 severe acute respiratory distress syndrome (SARS) epidemic in Singapore reported a prevalence rate of 37.3% for face-mask-associated headaches [6]. Another study found that nurses who wore N95 face masks while working in a medical intensive care unit reported headache as one of their main sources of physical discomfort [22]. ...
... One possible reason for the association might be that the prolonged use of N95 causes an increased concentration of Carbon monoxide in the blood, which leads to headache [13]. It is expected that during the pandemic, the frequency of healthcare workers donning full PPE would increase [6], a possible cause to study participants' frequency and intensity of headaches increasing with longer hours of PPE use. ...
... Previous studies confirm that headaches are common among HCWs when the filtering facepiece respirator is used especially for a prolonged period. [46][47][48] It is well known that headaches could arise from the continuous pressure of pericranial soft issues by putting on objects with tight straps around the head, for example, helmets, hats, goggles. [49][50][51] Also, breathing discomfort due to filtering facepiece respirator has also been reported in the literature confirming our finding that dyspnoea is a common adverse event among HCWs due to PPE use. ...
... A scoping review 55 among dental professionals has revealed moderate breathing difficulties due to the use of filtering facepiece respirators, while the prolonged duration of respirators usage was related to headaches. This finding is confirmed by a study 46 that was conducted during the SARS pandemic and found that 37.3% of HCWs who were filtering facepiece respirators developed headaches. This percentage was even higher (81%) in a study 32 that was conducted during the COVID-19 pandemic and found also that the odds of headache were 4.2 times higher in HCWs with pre-existing headache than among those without a preexisting headache. ...
... 31 Seven studies [27][28][29][30]32,38,39 in our review found that the duration of PPE use is an important risk factor for adverse events among HCWs. The literature comes to an agreement with this finding since Lim et al. 46 during the SARS pandemic revealed that the increased duration of filtering facepiece respirator use is related to headaches development, while Shenal et al. 48 found a relation between prolonged wear of respiratory protection and discomfort. ...
Article
Background During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have been obliged to wear personal protective equipment (PPE). We assessed the impact of PPE use on HCWs’ physical health and we examined factors related to a greater risk of adverse events due to PPE use. Methods We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Cochrane criteria. We searched PubMed, Medline, Scopus, ProQuest, CINAHL, and medRxiv from January 1, 2020 to December 27, 2020. Results Our review included 14 studies with 11,746 HCWs. The estimated overall prevalence of adverse events among HCWs was 78% with a range from 42.8% to 95.1% among studies. Among others, the following factors were related to the risk of adverse events among HCWs due to PPE use: obesity, diabetes mellitus, smoking, pre-existing headache, longer duration of shifts wearing PPE, increased consecutive days with PPE, and increased exposure to confirmed or suspected COVID-19 patients. Conclusions The frequency of adverse events among HCWs due to PPE use is very high. Healthcare facilities should take the necessary precautions and change the working conditions during the COVID-19 pandemic to prevent adverse events associated with PPE use and minimize harm to HCWs.
... Studies have shown that wearing PPE for prolonged time periods may lead to symptoms of physical discomfort including headache [6][7][8]. However, there is a lack of literature related to PPE-associated headaches that examines the combined usage of N95 face masks and protective eyewear, specifically goggles. ...
... Studies exploring the effect of PPE on people's health have focused on its association with headaches. For instance, a study of healthcare providers wearing N95 face masks during the 2003 severe acute respiratory distress syndrome (SARS) epidemic in Singapore reported a prevalence rate of 37.3% for face-mask-associated headaches [6]. Another study found that nurses who wore N95 face masks while working in a medical intensive care unit reported headache as one of their main sources of physical discomfort [22]. ...
... One possible reason for the association might be that the prolonged use of N95 causes an increased concentration of Carbon monoxide in the blood, which leads to headache [13]. It is expected that during the pandemic, the frequency of healthcare workers donning full PPE would increase [6], a possible cause to study participants' frequency and intensity of headaches increasing with longer hours of PPE use. ...
Article
Full-text available
It is mandatory that healthcare workers wear personal protective equipment (PPE) while caring for COVID-19 patients. Studies have shown that wearing PPE for a prolonged time may lead to symptoms of physical discomfort including headache. The aim of this study is to assess the prevalence and association between prolonged use of PPE and headaches. This was a cross-sectional study. A convenience sample of healthcare workers who worked with COVID-19 patients in clinical settings was recruited. The data were collected through an electronic survey shared as a link through social media. This study included 1060 participants, 753 (71%) female and 307 (29%) male. Participants were divided into two groups. Group A had 628 (60%) participants who did not have chronic headache before the COVID-19 pandemic, while Group B contained 432 (40%) participants who had a previous chronic headache. Headaches differed significantly between Groups A and B in frequency, type, location, and quality during the COVID-19 period. The analysis found a significant relationship between duration of PPE use and headache occurrence. The significant relationship between the duration of PPE usage and headache occurrence among healthcare workers should be considered when refining policies and procedures regarding prolonged PPE use.
... The deadliest pandemic in human history was in 1918-1919, pandemic influenza appeared nearly simultaneously around the globe and caused extraordinary mortality . 1 Some of the other biggest in the history to fetch the attention of health care workers (HCW) are avian influenza H5N1 Flue in 2009, severe acute respiratory syndrome corona virus (SARS) 2002, and Ebola virus outbreak that lasted from 2013 to 2016 2,3,4 . ...
... Since the first pandemic, the protective equipment's for HCW are constantly evolving .N 95 mask is considered the best of all as it protects against respiratory droplets 3 . Since breathing while wearing the N95 mask is harder, it is not recommended for the elderly, claustrophobics, and individuals suffering from lung diseases as it may exacerbate their pre-existing conditions 3 these masks need to be properly fitted to ensure maximal protection. ...
... This can be difficult to achieve in individuals with facial hair and in children. 3 it can also lead to frequent adjusting the mask, which further increases the risk of transmission 3 . The tight seal, on the other hand, leads to the build-up of heat within the mask causing difficulty in breathing 5 most recently introduced mask are filtering face piece or FFP. ...
Article
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Aim: To assess the compliance and difficulties faced by health care providers with variants of mask, eye protection and face shields. Methodology: This cross sectional study took place from 2 nd April 2020 till 30 th April 2020. All participants meeting inclusion criteria filled online questionnaire regarding type of mask, eye protection and face shields they use in their outpatient clinics, ward rounds and while performing surgical procedures, which is their favorite feature of these, which of the characteristic of particular equipment, how often they readjust the mask and how long do they wear it daily on an average. Results: A total of 196 participants were recruited in the study. The frequency of mask readjustment was most frequent by house officers 35(48.6%). Five (10.4%) of the consultants and 1(1.7%) of the medical students do not wear mask at all. In present study, the highest compliance was with N95 mask with filter 68(33.6%) 31(14.8%) wear goggles, 33(16.3%) wear face shield. The most comfortable characteristic of mask was chosen to be elastic ear loops 72(36.5%) voted by most of the house officers 27(37.5%) in which 40% wear it daily for 8 to 2 hours straight. Goggles leads to troublesome fogging interfering to an extent of limiting their performance and efficacy p <0.001. Luckily, 9(0.4%) came out to be positive in our research (p 0.47). Conclusion: The choice of PPE should be based on the nature of interactions with patients and the modes of transmission but sadly it is seen to be much impacted by the discomfort faced by our front line worriers while wearing it that will adversely affect themselves the most.
... El diagnóstico se basa en la presencia de al menos dos episodios que cumplan con lo siguiente: que la cefalea sea provocada y ocurra dentro de la primera hora de una compresión externa sostenida del cuero cabelludo o la frente, que el dolor sea máximo en el sitio de la compresión, que se resuelva dentro de la primera hora después del retiro de la compresión y que no se describa mejor por algún otro diagnóstico de la ICHD [3]. La bibliograf ía sobre la CCE es escasa y muchas de sus características clínicas se derivan de series de casos [4][5][6]. Además, faltan ensayos clínicos controlados sobre el tratamiento. ...
... Por lo tanto, una mayor incidencia de CCE es esperable, lo cual podría conducir a un empeoramiento sintomático de cefaleas previas y a la aparición de otras formas de cefalea y/o dolor facial asociados con el uso de EPP. Estas nociones se encuentran respaldadas por experiencias similares con el virus SARS [4]. Recientemente, un estudio de Ong et al realizado en Singapur, que incluyó a 158 trabajadores de la salud, ha informado sobre los factores de riesgo asociados con la aparición de cefalea relacionada con el EPP (CREPP) [8]. ...
... Otro aspecto interesante es la prevalencia de cefalea previa en los encuestados con CREPP de novo. Otros estudios han descrito una prevalencia del 29,1-37,3% [4,8]. Observamos una prevalencia ligeramente menor (24,2%; 189/780) y casi la mitad de éstos tenían un diagnóstico de migraña. ...
... It has been suggested that this may be the cause of headache that starts within minutes during mask use (14). On the other hand, it has been stated that the headache might be due to the compression on face skin and the superficial facial nerves by face mask and mask straps, especially in the use of N95 masks for longer durations (14,15). In a previous study in which we examined the effect of long-term mask use on choroidal thickness, we observed a significant increase in choroidal thickness due to prolonged use of masks and related potential hypercapnia (13). ...
... However, there has been no previous study in the literature regarding the clinical significance of this. An increase in subjective visual complaints with long-term use of N95 masks has been reported (15). The complaints of subjective visual impairment and loss of contrast sensitivity have been observed in people wearing masks for extended time. ...
Article
PURPOSE : We aimed to examine the changes in choroidal stroma and vascular system due to long-term use of N95 mask in healthcare workers. METHOD : The healthcare workers included in the study were between the ages of 18-50, with best corrected visual acuity (BCVA) 10/10, spherical and cylindrical refractive errors less than 3 diopters, intraocular pressures (IOP) within normal limits, and axial lengths (AL) less than 25 mm. The choroid was imaged with enhanced depth imaging (EDI) techniques using SD-OCT. The choroidal vascularity index (CVI), total choroidal area (TA), luminal area (LA), and stromal area (SA) were measured in the subfoveal 2 mm area. Measurements were first made after wearing the N95 mask for at least 2 hours without removing it and repeated 1hour after removing, while doing office working. RESULTS : The study included 62 eyes from 62 participants (32 women [%51.61]; 30 men [%48.39]). The mean age of patients was 33.81± 8.88 years (20–50 years). The differences in subfoveal TA, LA, SA between 2 hours of N95 mask use and 1 hour after removal of the mask were statistically significant (p<0.05 for each). However, the difference in CVI between the mask use and removal of the mask was not statically significant (p=0.537) CONCLUSION : Due to CO2 retention and hemodynamıc changes, choroidal vascular flow, the choroidal vascular area, and the choroidal stromal area may be affected by prolonged use of masks.
... [11] However, studies done by Roberge et al. in 2010, indicated that this hypoventilation did not pose a significant risk to healthcare workers over the course of less than one hour of continuous N95 use. [12] When healthcare workers are working for longer hours without a break while continuously wearing an N95 mask, blood CO2 levels may increase past the 1-hour mark, which could have a significant physiological effect on the wearer (Lim et al., 2006). [13] Some of the known physiological effects of increased concentrations of CO2 include: 1. Headache; 2. Increased pressure inside the skull; 3. Nervous system changes (e.g., increased pain threshold, reduction in cognitionaltered judgement, decreased situational awareness, difficulty coordinating sensory or cognitive, abilities and motor activity, decreased visual acuity, widespread activation of the sympathetic nervous system that can oppose the direct effects of CO2 on the heart and blood vessels); 4. Increased breathing frequency; 5. Increased "work of breathing", which is result of breathing through a filter medium; 6. Cardiovascular effects (e.g., diminished cardiac contractility, vasodilation of peripheral blood vessels); 7. Reduced tolerance to lighter workloads. ...
... [12] When healthcare workers are working for longer hours without a break while continuously wearing an N95 mask, blood CO2 levels may increase past the 1-hour mark, which could have a significant physiological effect on the wearer (Lim et al., 2006). [13] Some of the known physiological effects of increased concentrations of CO2 include: 1. Headache; 2. Increased pressure inside the skull; 3. Nervous system changes (e.g., increased pain threshold, reduction in cognitionaltered judgement, decreased situational awareness, difficulty coordinating sensory or cognitive, abilities and motor activity, decreased visual acuity, widespread activation of the sympathetic nervous system that can oppose the direct effects of CO2 on the heart and blood vessels); 4. Increased breathing frequency; 5. Increased "work of breathing", which is result of breathing through a filter medium; 6. Cardiovascular effects (e.g., diminished cardiac contractility, vasodilation of peripheral blood vessels); 7. Reduced tolerance to lighter workloads. ...
Article
Background: Outbreak of novel corona virus has led World Health Organization (WHO) to come up with healthcare guidelines which includes wearing of N95 mask. The aim of this study was to evaluate whether blood oxygen saturation level is affected by wearing of N95 mask for the duration of 4 hours. Materials and Methods: A total of 90 exam going students were included in this study, who were instructed to wear N95 mask. Blood oxygen saturation level (SpO2) was checked both before and after wearing of N95 mask for a period of 4 hours. Results: It was observed that, before wearing N95 mask at 9 am, SpO2 values were 96.64±0.196 while at 1 pm after removing N95 mask, the saturation values were 95.68±0.235 (p=0.000) among all the students. There was a statistically highly significant difference seen for the values between the time intervals (p<0.01) with higher values at 9 am and lesser at 1pm. On comparing the SpO2 levels among males and females, a statistically nonsignificant difference was seen. Thus, reduction in blood oxygen saturation level can be a major parameter to evaluate the respiratory consequences of N95 mask. Conclusion: Various adverse effects of N95 mask were quoted in literature but respiratory consequences due to reduction in blood oxygen saturation level can be harmful. Thus, to avoid such consequences, precautionary measures are advised to be taken. Key words: N95 mask, SpO2, Blood oxygen saturation, COVID-19.
... She usually wore contact lenses, without sensitivity. Her allodynia symptom checklist (ASC12) [3] was scored as 7 (sensitivity to necklace, glasses, tight clothes, ponytail, hair combing and exposure to cold), before March 2020 (Table 1). ...
... A previous study among healthcare providers wearing the N95 face mask during the 2003 severe acute respiratory distress syndrome (SARS) epidemic reported a new onset of face maskassociated headaches with a prevalence rate of 37.3% [3]. The literature about PPE-associated headaches, specifically the combined usage of the N95 face mask and protective eyewear (goggles) is scarce [4,5]. ...
Article
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In this complex context of coronavirus disease 2019 (COVID-19), headache medicine has been completely affected by this new reality, with new types of headaches directly or indirectly related to COVID-19 being detected. Personal protective equipment (PPE) was recommended for workers in many professions that did not previously require wearing masks leading to new headaches, or the exacerbation of past headaches, especially among health workers. A 57-year-old female working in a secondary care hospital had a history of migraine twice/month without aura and allodynia symptom checklist (ASC12) scored as 7 before COVID-19 outbreak. She began to work with PPE (surgical masks, face shield and surgical cap) and migraines became daily (bifrontal, pulsatile, with photophobia, nausea, vomiting and of severe intensity, visual analog scale: 7), starting after 1 h of wearing protective equipment and lasted for at least 6 h during the day. There was no adequate response to treatment. The headache frequency retuned to twice/month after the patient stayed home 45 days due to another condition. It is hypothesized here that people with allodynia symptoms when exposed to PPE are more susceptible to the development of new headaches or to the worsening of existing primary headaches. The relationship between previous allodynia determined with the ASC12 questionnaire and new headaches, or past primary headaches that have become worse during the COVID-19 pandemic in workers using PPE, should be better investigated in order to clarify this hypothesis. Cutaneous allodynia could be related with the sensitivity to PPE and headache progression.
... 1,5 Another previous study measured the impact of headaches associated with prolonged use of N95 masks as a risk factor, with 217 health workers, revealing that 79/217 (37.3%) reported headache associated with the use of N95 mask, 26/217 (32.9%) reported headache frequency more than six times a month, 7.6% requested sick leave due to work disability (ranging from 1 to 4 days, with an average of two days), 47/217 (59.5%) resorted to crisis abortion medication and 4/2,017 used preventive medication during the period of use of the equipment, showing positive statistical significance for the association of pre-existing headaches and continuous use of the N95 face mask. 6 The pressure exerted by the facial protector, depending on the elastic adjustment, can pressure the region of the epicranial muscles 5 , which are areas of hypersensitivity and can reproduce pain symptoms, which can also enhance the headache characteristics. The headaches that occur in professionals who use masks, face shield, and goggles for eye protection may arise due to the pressure of the strap in the neck or the occipital area, on the superficial nerves, which may aggravate an underlying cervical tension and potentiate the headache associated with the use of the three equipment combined simultaneously or alternating. ...
... The headaches that occur in professionals who use masks, face shield, and goggles for eye protection may arise due to the pressure of the strap in the neck or the occipital area, on the superficial nerves, which may aggravate an underlying cervical tension and potentiate the headache associated with the use of the three equipment combined simultaneously or alternating. 6 For those who already suffer from primary headaches such as migraine, the damage can be greater, as the continued use of the accessory by pressing on sensitive areas for an extended period can increase the chance of triggering a crisis. ...
Article
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Personal protective equipment such as a mask, face shield, and glasses for healthcare professionals has never been more widespread during is the occurrence of the Covid-19 pandemic. These devices compress the scalp tissue circumferentially and often leave pressure marks after its removal, as is often observed in the case of the mask. This situation has affected the work environment of professionals who have been at the forefront of combating Covid-19 since December 2019, in units dedicated to the care of infected patients. Therefore, we wonder about the need and importance of exploring the adverse event of prolonged use of personal protective equipment such as mask, face shield, and goggles associated with the triggering of external pressure headaches. The etiology of this type of headache is triggered by external pressure resulting from the sustained compression of the soft tissues of the epicrania, associated with the use of the equipment on the head, which can lead to work disability. For those who already suffer from primary headaches such as migraines, the damage can be greater, as the continued use of the accessory by pressing on sensitive areas for an extended period can increase the chance of triggering a crisis. Based on these notes, it is recommended that greater attention be paid to the care with the improvement of protective equipment as an object of study, in the search for alternatives that can minimize the damage caused.
... [34][35][36] It was reported that healthcare workers suffer headaches ascribed to the use of respirators. 37 Not to mention, various adverse skin reactions can be caused by wearing face masks or respirators. [38][39][40] Indeed, those reports [34][35][36][37] suggested that the burden is rather psychological than physiological. ...
... 37 Not to mention, various adverse skin reactions can be caused by wearing face masks or respirators. [38][39][40] Indeed, those reports [34][35][36][37] suggested that the burden is rather psychological than physiological. However, it is important to avoid a modification that can cause extra discomforts, especially in regard of breathing process. ...
Article
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Use of face masks and respirators are significant in preventing the transmission of coronavirus disease 2019 (COVID-19) via respiratory droplets or aerosols. The development of face masks and respirators have been focused on the modification using nanoparticles (NPs) to obtain biocidal activities. The incorporation of NPs can also increase the hydrophobicity of the material that assists the repelling of virus carrying droplets or aerosols. Nevertheless, the common cost of gaining those benefits is breathability. Previous studies have reported on the discomforts of wearing a face mask or respirator, one of which is stems from breathing difficulty. At the time of pandemic, maintaining the comfort wearing of face masks or respirators is even more crucial. Thus, this review article is important to keep the breathability aspect gaining a spotlight in the development of NPs-modified face masks or respirators. Herein, we discuss the relationship between the addition of NPs with breathability of the material. In the beginning of discussion, types of protective respiratory equipments, and biocidal activities of the modified fabrics are discussed. Strategies in maintaining the air permeability for long duration use and self-cleansing feature are also discussed.
... Despite the significant role that facemasks play during this pandemic due to the beneficial impact on the prevention of the virus SARS-CoV-2 transmission, they had traditionally been associated with discomfort and increased difficulty in certain activities of daily living [15,[26][27][28][29]. The perceived difficulty when wearing a facemask could easily contribute to reduced compliance to the facemask-wearing directive and potentially increase the rate of virus transmission. ...
... According to their outcomes, the most common problem was humidity in the facemask, fogging up of glasses, difficulty in breathing for both genders, and makeup coming off for women. Similarly, Lim et al. [26] and Ong et al. [14] analyzed the impact of PPE such as N95 facemask on the development of headaches of healthcare workers while attending to patients during the 2003 SARS epidemic and COVID-2019 pandemic, respectively. From these surveys, it was concluded that de novo PPE-associated headaches or exacerbation of pre-existing headache disorders are developed in the majority of healthcare workers, which leads to frequent abuse of analgesics. ...
Article
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PurposePrimary objective of this study was to identify potential difficulties and/or discomfort when using a facemask. Moreover, to explore the impact of spectacles, contact lenses and visual acuity on the compliance to the facemask directive.Methods This is a prospective study that was conducted at the Department of Ophthalmology, University Hospital of Alexandroupolis, Greece between June 2020 and August 2020. Greek speaking citizens with permanent residency in Greece above 18 years old were included. A custom questionnaire (DeMask-20) was constructed and validated, which pertained to the perceived difficulty and discomfort when using a facemask. It contained 20 items grouped in 8 subscales (driving, near vision, distance vision, ocular discomfort, role limitation, collaboration, dependency on others, emotional stress). Perceived difficulty and discomfort when using a facemask, compliance and correlations of compliance with DeMask-20 scores, demographics, spectacle and/or contact lens use, and visual acuity were evaluated.ResultsThe number of factors was determined through factor analysis. Cronbach's alpha ranged from 0.716 for the "Role limitation" subscale to 0.938 for "Ocular discomfort" subscale. 1,214 participants (402 men, 812 women, mean age 36.79±12.50 years) completed the DeMask-20 instrument. Mean DeMask-20 score of all study participants was 3.79±0.71. Significant differences in DeMask-20 score were detected in gender (p = 0.009), spectacle use (p = 0.034), contact lens use (p = 0.049), and binocular distance visual acuity (bDVA) (p = 0.001). Mean compliance of all participants was 4.05±0.96. Men, people
... Similar results were reported by Lim and co. [32] in most (healthcare workers 37%) during the (SARS-CoV-1) epidemic in 2003, involving a virus comparable to SARS-CoV-2 that impacts on the upper respiratory tract. Probably, the design of the masks, a tight fit in combination with tight elastic straps, produces pain behind the contact points on the face and the ears. ...
Article
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Background: Safety in medical work requires eye protection, such as glasses, and protective facial masks (PFM) during clinical practice to prevent viral respiratory infections. The use of facial masks and other full personal protective equipment increases air flow resistance, facial skin temperature and physical discomfort. The aim of the present study was to measure surgeons' oxygenation status and discomfort before and after their daily routine activities of oral interventions. Methods: 10 male voluntary dentists, specializing in oral surgery, and 10 male voluntary doctors in dentistry, participating in master's courses in oral surgery in the Department of Oral Surgery of the University of Chieti, with mean age 29 ± 6 (27-35), were enrolled. This study was undertaken to investigate the effects of wearing a PFM on oxygenation status while the oral surgeons were actively working. Disposable sterile one-way surgical paper masks (Surgical Face Mask, Euronda, Italy) and FFP2 (Surgical Face Mask, Euronda, Italy) were used and the mask position covering the nose did not vary during the procedures. The FFP2 was covered by a surgical mask during surgical treatment. A pulse oximeter was used to measure the blood oximetry saturation during the study. Results: In all 20 surgeons wearing FFP2 covered by surgical masks, a reduction in arterial O2 saturation from around 97.5% before surgery to 94% after surgery was recorded with increase of heart rates. A shortness of breath and light-headedness/headaches were also noted. Conclusions: In conclusion, wearing an FFP2 covered by a surgical mask induces a reduction in circulating O2 concentrations without clinical relevance, while an increase of heart frequency and a sensation of shortness of breath, light-headedness/headaches were recorded.
... Moreover, people may pay less attention to other important measures such as social distancing and hand hygiene (24,37). Lastly, face mask use can be associated with discomfort, skin acne, headaches, respiratory distress, difficulties in communication (especially for deaf or hard of hearing persons), as well as less non-verbal communication (24,38,39). ...
Article
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During the current COVID-19 pandemic, the use of face masks has become increasingly recommended and even mandatory in community settings. To evaluate the risk of bacterial cross-contamination, this study analyzed the bacterial bioburden of disposable surgical masks and homemade cotton masks, and surveyed the habits and face mask preferences of the Flemish population. Using culture approaches and 16S rRNA gene amplicon sequencing, we analyzed the microbial community on surgical and/or cotton face masks of 13 healthy volunteers after 4 h of wearing. Cotton and surgical masks contained on average 1.46 × 10 ⁵ CFU/mask and 1.32 × 10 ⁴ CFU/mask, respectively. Bacillus, Staphylococcus , and Acinetobacter spp. were mostly cultured from the masks and 43% of these isolates were resistant to ampicillin or erythromycin. Microbial profiling demonstrated a consistent difference between mask types. Cotton masks mainly contained Roseomonas, Paracoccus , and Enhydrobacter taxa and surgical masks Streptococcus and Staphylococcus . After 4 h of mask wearing, the microbiome of the anterior nares and the cheek showed a trend toward an altered beta-diversity. According to dedicated questions in the large-scale Corona survey of the University of Antwerp with almost 25,000 participants, only 21% of responders reported to clean their cotton face mask daily. Laboratory results indicated that the best mask cleaning methods were boiling at 100°C, washing at 60°C with detergent or ironing with a steam iron. Taken together, this study suggests that a considerable number of bacteria, including pathobionts and antibiotic resistant bacteria, accumulate on surgical and even more on cotton face masks after use. Based on our results, face masks should be properly disposed of or sterilized after intensive use. Clear guidelines for the general population are crucial to reduce the bacteria-related biosafety risk of face masks, and measures such as physical distancing and increased ventilation should not be neglected when promoting face mask use.
... Humans are special beings. No other earth species has hands capable of grabbing, carrying, moving and manipulating objects like human hands, so it is necessary to protect our hands by usage of hand gloves (28). Double mouth masks and doubt hand gloves usage will prevent us from getting contracted from the virus (16,29). ...
... Although experts argue that such extreme symptoms are unlikely for most people, however, in subsets of individuals with underlying cardiovascular and respiratory disease, or with particularly tightly fitted masks and respirators, the side effects may be exacerbated during exercise such as running [6]. In a study of more than 200 paramedics, approximately 30% reported experiencing headaches when they wore face masks or respirators [7]. N95 and surgical masks can produce unsuitable temperature and humidity in a small space and have an additional effect on the respiratory and circulatory systems; this is also one of the causes of discomfort. ...
Article
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Since the first cases of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported at the end of 2019, this infection has spread around the globe, becoming a pandemic. The use of face masks and respirators is an important public health measure to reduce or prevent transmission of SARS-CoV-2. Here we discuss the hypothetical mechanisms by which exercise with face masks or respirators can induce detrimental effects on the cardiovascular system, potentially explaining adverse events such as cardiac arrhythmias and spontaneous pneumothorax. Although sudden death associated with the wearing of a face mask during running is a rare event, the risk is higher especially in those with existing cardiac comorbidities. In such cases, a mask designed specifically for runners with no or few side effects of oxygen deficiency should be considered instead.
... In a survey study conducted with nurses wearing PPE, they detected headache in 50% of the participants wearing N95 masks (Atay and Cura 2020). In another study on the use of N95 during the SARS epidemic, Lim et al. reported headache in 37.3% of participants after N95 use and linked this finding to the increased amount of inhaled CO 2 (Lim et al. 2006). In another study, it has been suggested that the use of filtering facepiece masks may lead to CO 2 retention; these findings were supported with laboratory studies (Roberge et al. 2010;Wu et al. 2011). ...
Article
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Objectives During the COVID-19 pandemic, healthcare professionals are recommended to use PPE to prevent the transmission of disease. Healthcare workers who use N95 FFR, which has an important place, experience complaints such as headache and dizziness. In this study, we plan to find the cause of these complaints and aim to clarify whether they are associated with the use of N95 mask. Method Healthcare workers first put on a surgical mask for at least 1 h and a maximum of 4 h, this process was then repeated on another day with the same workers wearing N95 masks. After removing the mask, capillary blood gases were taken and a questionnaire was given. Results Thirty-four participants over the age of 18 were included in the study; 19 participants were female (56%) and 15 male (44%). The results of the capillary blood gas analysis after the use of surgical mask and N95 mask, respectively: pH: 7.43 ± 0.03; 7.48 ± 0.04 (p < 0.001); pCO2: 37.33 ± 8.81; 28.46 ± 7.77 mmHg (p < 0.001); HCO3: 24.92 ± 2.86; 23.73 ± 3.29 mmol/L (p = 0.131); Base excess (BE): 1.40 (− 3.90–3.10); − 2.68 (− 4.50–1.20) [median (Q1−Q3)] (p = 0.039); lactate: 1.74 ± 0.68; 1.91 ± 0.61 (p = 0314). Headache, attention deficit and difficulty in concentrating were significantly higher after using N95 mask. Conclusion Respiratory alkalosis and hypocarbia were detected after the use of N95. Acute respiratory alkalosis can cause headache, anxiety, tremor, muscle cramps. In this study, it was quantitatively shown that the participants’ symptoms were due to respiratory alkalosis and hypocarbia.
... Use of PPE is not easy as more than 40% of medical staff treating COVID-19 infected patients may experience serious skin injury secondary to use of masks, goggles, face shields, and protective gowns. [2][3][4] Also, it is difficult to operate for long hours using PPE. It is suffocating, it decreases the vision because of fogging, tactile sensations are reduced and also intensive work for long hours put residents at risk of mental stress, and fear of getting infected. ...
Article
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COVID-19 was declared as a public health emergency of international interest on 30 January 2020; and as a pandemic on 11 March 2020.1 In order to minimise the spread and to optimize the health care resources Indian government announced national lock down with suspension of all routine hospital activities (outpatient clinics, routine surgeries) on March 24, 2020. Only emergency services were allowed along with diversion of all available resources to COVID centre.
... Long duration wearing of N95 respirator may induce physiological stress, making regular tasks more challenging, and causes headaches among healthcare providers [18]. These effects might be due to the respiratory microclimate change surrounding the masks. ...
Article
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In order to live safely with an exacerbation of the Coronavirus, a face mask must be made with specifications that prevent infection or transmission among people; which is characterized by high efficiency and low cost, and renewable. Fiberstructure widely used in air filtration industry using electrospinning method, where its field is booming in an exceptionally impressive manner. Using a biopolymer as a olyhydroxyalkanoates (PHAs) to create a facemask will give excellent results because of the solidity and porosity of the polymer in addition to the non-stick feature. During this work, emphasis will be placed on the best method to manufacture the face mask in terms of the solidity and non-stick feature which gives a longer life for facemask. The facemask is quicker and more affordable than delivering a treatment or a counteractant, and furthermore gives the facemask better outcomes against the Coronavirus.
... Long duration wearing of N95 respirator may induce physiological stress, making regular tasks more challenging, and causes headaches among healthcare providers [18]. These effects might be due to the respiratory microclimate change surrounding the masks. ...
Article
Full-text available
In order to live safely with an exacerbation of the Coronavirus, a face mask must be made with specifications that prevent infection or transmission among people; which is characterized by high efficiency and low cost, and renewable. Fiberstructure widely used in air filtration industry using electrospinning method, where its field is booming in an exceptionally impressive manner. Using a biopolymer as a olyhydroxyalkanoates (PHAs) to create a facemask will give excellent results because of the solidity and porosity of the polymer in addition to the non-stick feature. During this work, emphasis will be placed on the best method to manufacture the face mask in terms of the solidity and non-stick feature which gives a longer life for facemask. The facemask is quicker and more affordable than delivering a treatment or a counteractant, and furthermore gives the facemask better outcomes against the Coronavirus.
... An essential component of level D protective clothing is the N95 face mask. A previous study showed that wearing the N95 face mask may lead to headaches and that wearing the N95 masks for shorter durations may reduce the headaches [25]. A situation in which a nurse is in physical pain but cannot take off their protective clothing due to caring for a patient may lead to mental stress. ...
Article
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COVID-19 is an ongoing worldwide infectious disease pandemic. The purpose of this study was to investigate post-traumatic stress and related factors among hospital nurses during the COVID-19 outbreak. The subjects of this study were 300 nurses who worked in three general hospitals that operated National Designated Isolation Unit (NDIU) wards during the COVID-19 outbreak. Self-reporting questionnaires were used to collect data on post-traumatic stress, general characteristics, and work-related information. The average post-traumatic stress score was 20.68 ± 19.5 points and 36.7% of participants were at high risk of post-traumatic stress disorder (PTSD). The odds ratio (OR) for PTSD was higher for nurses who worked in the NDIU ward (OR = 16.31, 95% CI = 3.79–70.32), who responded that nurse staffing was poor (OR = 3.03, 95% CI = 1.01–9.10), and who responded that they experienced COVID-19 symptoms (OR = 3.83, 95% CI = 1.89–7.75). Total 36.7% of nurses were at risk of PTSD and the factors related to PTSD were the work department, nurse staffing, and experiencing COVID-19 symptoms. These results could be used to manage PTSD and provide psychological support of nurses during infectious disease epidemics, such as COVID-19.
... [24, 25••, 26-32, 33•, 34•, 35•, 36•]. In comparison, a study amongst healthcare providers using the N95 face mask during the 2003 severe acute respiratory distress syndrome (SARS) epidemic in Singapore observed that new-onset face mask-associated headaches occurred with an incidence of 37.3% [37]. ...
Article
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Purpose of Review Personal protection equipment (PPE)–associated headache is an unusual secondary headache disorder that predominantly occurs in healthcare workers as a consequence of the donning of protective respirators, face masks and/or eyewear. The appreciation of this entity is important given the significant ramifications upon the occupational health of healthcare workers and could additionally have an impact on persons living with pre-existing headache disorder(s). Recent Findings There has been a renewed interest and recognition of PPE-associated headaches amongst healthcare professionals, largely brought about by the ongoing COVID-19 pandemic which has besieged healthcare systems worldwide. De novo PPE-associated headaches may present with migrainous or tension-type features and can be viewed as a subtype of external compression headache. The prognosis of the disorder is generally favourable, given that most headaches are short-lived without long-term sequalae. Several aetiologies have been postulated to account for the development of these headaches. Notably, these headaches can affect the occupational health and work performance of healthcare workers. Summary In this review, we discuss the epidemiology, clinical characteristics, probable etiopathogenesis, management and prognosis of PPE-associated headaches in the context of the COVID-19 pandemic. Future directions for research and PPE development are proposed.
... It has to be noted that PPE is very uncomfortable in day-today practice and affects psychological interaction between doctors and patients, which isn't negligible in the orthodontic practice. An important component of PPE is face mask and the recommendation for dental AGPs is high-filtration mask (N95/ FFP2), although there are reports of headache of the health care personal during prolonged use of N95 respirators (33,34). A systematic review found no difference between N95 respirator and surgical masks in health care workers exposed to acute viral respiratory infections, with a low or very low evidence due to the heterogeneity research method (35), but there is no research about N95 respirator protection against COVID-19 transmission. ...
Article
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious disease with a major impact on orthodontic practice regarding the risk of control transmission of COVID 19. Due to the particularities of orthodontic treatment which includes return-visits of the patients for a long period of time, the number of patients per day, dental aerosols-generated procedures risk, management considerations should be constant in order to update practice to the scientific evidence. The aim of this critical narrative review of the literature is to highlights the latest scientific data in order to control the transmission of SARS-CoV-2 infection in the orthodontic practice.
... There is reason to believe that this could compromise the user's breathability, since the breathed air would have to pass through both fabrics. A previous study among healthcare providers wearing PPE masks during the 2003 severe acute respiratory distress syndrome (SARS) epidemic in Singapore reported new onset face mask-associated headaches with a prevalence rate of 37.3% [24]. It can be speculated if these findings might be due to a slight hypoxemia. ...
Article
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A significant number of health care professionals subjected to high-risk situations have been infected by Covid-19 due to the lack of adequate protection equipment or the deficient safety margins that these present. The aim of this study was to investigate whether the use of a personal peripheral sealing device (PSD) on surgical face masks (SM) allows them to achieve double mask properties, by providing two-way protection to professionals or users. The proposed device is a thermoplastic resin ring composed of a reusable and biodegradable polylactic acid (PLA) designed to be used in a healthcare setting. Since it is a thermoplastic device, it can be molded and adapted to each individual, becoming personalized and ensuring a correct adjustment to the user's face. First, a qualitative fit test was performed using a saccharin solution (SS) to evaluate respiratory protective equipment in recruited professionals exposed to high-risk situations of infection by Covid-19. Individuals were divided into an intervention group, who used SM with the PSD, and a control group, who used SM without the PSD. In addition, a quantitative inward air leakage fit test was performed using a 2% sodium chloride (NaCl) aerosol in a sealed cabinet with probes sensitive to this substance , in order to validate the SM with the PSD as a Face Filtering Mask (FFP). Only 5% of the individuals who performed the qualitative fit test with the PSD perceived the sweet taste of the SS, while 100% of the individuals who performed the test without the PSD sensed it (p = 0.0001). In the quantitative fit test, the percentage of air leakage of 2% NaCl aerosol into the SM with the PSD was 6.5%, achieving the same range of air leakage as a FFP mask. Thus, the use of a personalized PLA thermoplastic PSD, together with an inexpensive and widely available SM, could have a significant impact in terms of preventive safety by providing bi-directional protection to its user.
... The increased CO 2 concentration in the inhaled air during mask wearing is accompanied by decreased O 2 concentration. The O 2 debt may result in headache and increased sick days [16]. If the inhaled CO 2 concentration is between 7% and 7.5%, severe dyspnea, headache, dizziness, perspiration and even short-time memory loss may occur [17]. ...
Article
Wearing of face masks has been identified as an essential means of reducing COVID-19 infection during the pandemic. However, air leakage into ordinary face masks decreases the protection they provide. Wearing a mask also causes both CO2 and humidity to accumulate inside, imposing breathing difficulty and discomfort. To remedy the above problems, this investigation proposed to ventilate ordinary masks by supplying additional HEPA filtered air. The N95, surgical, and cotton masks available on the market, were modified into ventilated masks. The air inside the masks was extracted for measurement of the PM2.5, CO2, and water vapor concentrations. The protection provided by the masks was evaluated in terms of their effectiveness in shielding wearers from ambient PM2.5. Mask comfort was examined in terms of both CO2 concentration and humidity ratio. In addition, a mathematical model was established to solve for the exchanged air flow rates via different routes. Subjective voting by 20 mask wearers was also conducted. Performance of the ventilated face masks were compared against the non-ventilated ones. It was found that the protection provided by the ordinary non-ventilated masks is much lower than that claimed for the filter materials alone due to significantly total inward leakage. The accumulated CO2 and humidity inside masks resulted in discomfort and complaints. For contrast, the ventilated face masks not only enhanced protection by suppressing the inward leakage of ambient airborne particles, but also significantly improved comfort. The wearers preferred a filtered air flow rate ranging from 18 to 23 L/min.
... So, these skin reactions of N95 masks are due to the healthcare workers having to tie the mask tightly and squeeze the metal clip hard to ensure the tightness of the mask so as to ensure a complete protection against the infection. This in turn leads to the physical problems such as headache, giddiness, weakness, nausea, and vomiting among the nurses due to the hypoxemia and hypercapnia; similar finding was found in a study conducted by Lim et al. 14 The compression of the metal strap at the fixed site for prolonged duration constantly results in the device-related pressure injuries. The excessive binding of the mask is such that edge of the mask is in close contact with the skin for a long period of time; this results in friction between the edge of mask and skin and leads to the formation of erythema, blisters, or ulcers; the moisture created inside the mask during the respiration facilitates the softening of the skin and augments the external injury due to the shear forces of edge of masks on nasal bridge. ...
Article
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Background: In the event of coronavirus disease-2019 (COVID-19) spread worldwide, frontline healthcare workers play a key role in the containment of this devastating pandemic, and to prevent the cross-transmission and gain confidence in battle with the pandemic, they are wearing personal protective equipment (PPE). Aim and objective: To explore the adverse health problems and skin reactions caused by the use of PPEs among the frontline nurses in the ICUs of COVID hospital. Materials and methods: A cross-sectional study was conducted using an online-based questionnaire assessing the physical problems, and adverse skin reactions of PPEs were sent among the 150 frontline nurses in ICUs of COVID hospital. The collected data were analyzed using descriptive statistics. Results: We got 137 valid responses from frontline nurses, and the most common adverse health effects expressed by them were headache (73.4%), extreme sweating (59.6%), and difficulty in breathing (36.7%); 91.7% complained about the fogging of the goggle. Majority of frontline nurses expressed nasal bridge scarring (76.64%) and indentation and pain on the back of the ears (66.42%) as the adverse skin reactions after wearing N95 masks. The common skin problems identified due to double gloving of latex gloves were excessive skin soakage with sweat (70.07%) and skin chapping (19%). The protective clothing caused minimal adverse reactions, and excessive sweating (71.53%) was the most reported. Conclusion: The healthcare workers wearing PPE for a prolonged period show significant adverse effects, so appropriate strategies should be taken to prevent the adverse effects by designing effective PPEs and education of preventive measures among healthcare workers. How to cite this article: Jose S, Cyriac MC, Dhandapani M. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2021;25(2):134-139.
... Increased incidence of adverse skin reactions to the use of PPE among HCWs has been reported. 1 The incidence of headaches with the use of N95 masks has been reported to be around 35%. 2 In the current issue of the IJCCM, Jose et al. 3 attempt to describe the health problems and skin damage related to the use of PPE among ICU nurses in a COVID center in India. This was a cross-sectional study carried out using an online questionnaire developed in-house. ...
Article
The use of personal protection equipment (PPE) is associated with physical and physiological derangements. Healthcare workers are at the forefront of the fight against COVID-19 and are continuously exposed to PPE. This editorial discusses a survey carried out by Jose et al. capturing the physical problems associated with PPE use. How to cite this article: Samavedam S. "Physical" Aspect of COVID Nursing. Indian J Crit Care Med 2021;25(2):109-110.
... This has risen a new question while some controversy is still rising about the chronic use of face masks. In this line, while the SARS outbreak, the prolonged use of face mask by healthcare workers, resulted in headaches [11], and adverse skins reactions such as rashes, acne, and itches [12]. So on, recent research suggest that prolonged use of masks causes a host of physiologic and psychologic burdens and could decrease work efficiency [13].Indeed, authors stated that chronic use of FPII and surgical mask of healthcare workers in the actual pandemic lead to headaches, breathing difficulty, acne, skin breakdown, rashes, interferes with vision, communication, and thermal equilibrium [13]. ...
Article
The aim of the present study was to analyze the impact of surgical mask use in cognitive and psychophysiological response of university students during a lesson. We analyzed 50 volunteers university students (age 20.2±2.9) in two 150 min lessons. i. personal class using a surgical mask and ii. online class with student at home without the mask. Blood oxygen saturation, heart rate and heart rate variability, mental fatigue and reaction time were measured before and immediately after both lectures. We found how both lesson produced an increase in mental fatigue, reaction time and autonomous sympathetic modulation, being heart rate significantly higher (77.7±18.2 vs.89.3±11.2 bpm, mask, not mask respectively) and blood oxygen saturation significantly lower (98.4±0.5 vs. 96.0±1.8%, mask, not mask respectively) using the surgical mask. The use of surgical mask during a 150 min university lesson produced an increased heart rate and a decrease in blood oxygen saturation, not significantly affecting the mental fatigue perception, reaction time and time, frequency and nonlinear hear rate variability domains of students.
... 24 30 In one survey, 79/212 (37%) reported face mask associated headaches, 26 (33%) reported headache frequency Open access exceeding six times/month and 6 had taken sick leave. 30 Another survey of healthcare workers in Singapore found that of the 307 staff who used masks regularly, 60% reported acne, 51% facial itch and 36% rash from N95 mask use. 24 A COVID-19 survey of healthcare workers in Singapore found that 128/158 (81%) developed de novo personal protective equipment (PPE)-associated headaches, increasing with duration of use (>4 hours). ...
Article
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Objective To identify, appraise and synthesise studies evaluating the downsides of wearing face masks in any setting. We also discuss potential strategies to mitigate these downsides. Design Systematic review and meta-analysis. Data sources PubMed, Embase, CENTRAL and EuropePMC were searched (inception–18 May 2020), and clinical registries were searched via CENTRAL. We also did a forward–backward citation search of the included studies. Inclusion criteria We included randomised controlled trials and observational studies comparing face mask use to any active intervention or to control. Data extraction and analysis Two author pairs independently screened articles for inclusion, extracted data and assessed the quality of included studies. The primary outcomes were compliance, discomforts, harms and adverse events of wearing face masks. Results We screened 5471 articles, including 37 (40 references); 11 were meta-analysed. For mask wear adherence, 47% (95% CI 25% to 68%, p<0.0001), more people wore face masks in the face mask group compared with control; adherence was significantly higher (26%, 95% CI 8% to 46%, p<0.01) in the surgical/medical mask group than in N95/P2 group. The largest number of studies reported on the discomfort and irritation outcome (20 studies); fewest reported on the misuse of masks, and none reported on mask contamination or risk compensation behaviour. Risk of bias was generally high for blinding of participants and personnel and low for attrition and reporting biases. Conclusions There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks. New research on face masks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of face mask wearing, particularly the assessment of possible alternatives. Systematic review registration Open Science Framework website https://osf.io/sa6kf/ (timestamp 20-05-2020).
Article
The outbreak of the ongoing coronavirus disease 2019 (COVID-19) pandemic has led to the recommended routine use of face masks to reduce exposure risk. In this study, the increase in work of breathing (WOB) imposed by face masks is theoretically studied for both normals and patients with obstructive and restrictive lung diseases at different levels of activity. The results show a significant increase in WOB due to face masks, which is more severe in higher activity levels. The added WOB is considerable during physical activity and may be intolerable for patients with preexisting lung disease and may contribute to inspiratory muscle fatigue and dyspnea. Moreover, in this study, the effects of the physical properties of a fibrous medium, including thickness, porosity, and fiber diameter, are analyzed on the particle filtration efficiency (PFE) and the added WOB. The relations between the physical properties of the fibrous medium and the added WOB and the PFE are shown on some contour plots as a quick and simple tool to select the desired physical properties for a single layer filter to ensure that the added WOB is comfortable while the PFE is sufficiently high.
Preprint
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General conclusions Our all-purpose assumptions are that the use of face masks to protect against airborne infections - in this case the so-called Covid19 syndrome due to unconfirmed SARS Cov2 - and particularly in healthy people, has behaved with more harm than beneficial. And that this has been more distinctive for women and for health personnel independent of the type of mask, social class, educational level and other variables analyzed. For future epidemics, a more selective risk communication of users should be chosen as a warning and assume if indeed the use of masks for healthy people is objectively valuable to prevent the spread, exposure and contagion of viral germs and not a method of social coercion with unnecessary damages and burdens. Future epidemics will first of all recognize the call for professional teams with experience in field epidemiology and infectious diseases and restrictive decisions to be applied by broad expert consensus to vulnerable and susceptible populations based on health and non-political considerations.
Article
Objectives Compliance and tolerance of facemasks for extended periods are legitimate concerns. The goal of this study was to identify the physiologic and symptomatic effects of extended-use N95 filtering facepiece respirator (N95) compared with medical masks. We hypothesized that hospital personnel wearing medical masks alone would report fewer subjective complaints compared with personnel wearing an N95 with or without overlying medical mask. Methods This was a nonrandomized cohort study of hospital-based healthcare personnel at a single tertiary center wearing a medical mask alone or N95 with or without overlying medical mask during routine clinical activity. Potential subjects were consented and asked to complete a structured survey, including a 10-point Likert scale for subjective symptoms: headache, lightheadedness, breathlessness, facial bruising, facial irritation, mental fatigue, physical fatigue, and yawning. Study investigators also obtained vital signs on the participants. Results between subjects wearing a medical mask and subjects wearing an N95 were compared. A sample of 144 subjects, 72 in each mask cohort, was needed to detect a 20% difference in a composite outcome of headache, shortness of breath, or lightheadedness between groups with an alpha of 0.05 and power of 0.8. Results We enrolled 72 subjects in each group. There were no differences in baseline demographics. Overall 77% of the cohort reported subjective symptoms while donning a mask. There was no difference in the composite outcome, no difference recorded symptoms except facial bruising, and no difference in physiologic measures between groups. Conclusions Most medical mask and N95 users reported symptoms during mask use. However, there was no difference in the symptom proportion or severity in either user.
Article
Introduction. Healthcare practitioners are at increased risk of infection with infectious diseases, including the inhalation route. Healthcare practitioners use respirators of various designs providing different efficiency of protection. The purpose of the study was to improve efficiency of the respiratory protection of the healthcare practitioners in Russian Federation. There were analyzed available NIOSH publications, articles in journals Taylor & Francis, Oxford University Press, published materials of Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor), and western training manuals. Differences in the requirements of the legislation were identified that increase the risk of infection in healthcare practitioners. There are no methods for assessing the risk level, and there are no specific requirements for selecting the respirator’s type that corresponds to the risk level. The employer is not obliged to provide the fit test for all employees. The respirator must be used timely, so it should not negatively affect the worker. But the average carbon dioxide concentration can exceed the STEL by more than two times. The certification requirements for respirators do not correspond to the conditions of their use in the hospitals. Respirators were not certified as means of protection against bioaerosols. Conclusions. Identified shortcomings in the respiratory safety of health care workers show possible ways to improve their protection by harmonizing national legislation with the best of existing Western requirements.
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Background: Covid-19 has been announced as a pandemic by the World Health Organization. To maintain social distancing effectively, the Government of India announced a complete lockdown on March 25th, 2020. As there are no proper transport facilities for patients who need health care services, the Government of Andhra Pradesh started 104 sevakendram as a helpline. Medical services were also provided by this 104 sevakendram through teleconsultation with doctors. The aim and objectives of the study were to study the disease pattern and treatment given to patients attending teleconsultations, to analyze the disease burden among the patients attending teleconsultation, to study the treatment given to the patients attending teleconsultation.Methods: It is a retrospective, observational, and analytical study. After prior IEC clearance and permission from teleconsultation authority, we did the study at Dr.YSR Aarogyasri health care trust, Guntur. Data regarding all calls connected to 104 was collected. Detailed information of the calls related to the Medical officer about the age, gender, disease pattern, and treatment given to the patient was collected. Statistical analysis was done using MS excel software.Results: On average, 104 sevakendram received two hundred valid teleconsultations per day. Most of the calls are related to anxiety and these calls constitute twenty four percent. Treatment given was according to probable diagnosis, mostly symptomatic and continuation of the same treatment.Conclusions: 104 sevakendram has played a vital role in meeting the medical and health requirements of the people suffering from different diseases during the lockdown period.
Article
PURPOSE We aimed to show the changes in choroidal thickness (CT) with spectral domain optical coherence tomography (SD-OCT) after prolonged use of N95 mask. METHOD The healthcare workers who use the N95 face-mask, between 30-50 years of age who have best corrected visual acuity (BCVA) ≥10/10, spherical or cylindrical refraction errors less than 2 diopters, with normal intra ocular pressure (IOP), axial length (AL) between 22-24 mm included in the study. The choroid was imaged with enhanced depth imaging (EDI) techniques using SD-OCT. CT was measured, subfoveal, at 1000 μm nasal and temporal of the center of the fovea. Measurements were first made after wearing the N95 mask for at least 2 hours without removing it and repeated 15 minutes after removing. RESULTS After 2 hours of the N95 mask using without removal, the mean subfoveal CT was 293.56 ± 76.12(min:185, max:479), the mean temporal CT was 253.81 ± 63.48(min:172, max:384), the mean nasal CT was 239.18 ± 53.92(min:139, max:356). Fifteen minutes after removal of the N95 mask, the mean subfoveal CT was 250.56 ± 52.48(min:172, max:397), the mean temporal was 218.40 ± 53.58(min:129, max:354), the mean nasal CT was 210.67 ± 53.31(min:132, max:366). The differences in subfoveal, temporal and nasal CT between 2 hours of N95 mask use and 15 minutes after removal of the mask were statistically significant (p < 0.05 for each). CONCLUSION Hypercapnia due to prolonged use of the N95 mask may cause choroidal hemodynamic changes and transient increased choroidal thickness.
Article
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Covid-19 due to Sars-Cov-2 infection has reached pandemic proportion. Many healthcare workers are involved in managing both COVID-suspected and confirmed cases. It is mandatory for healthcare workers to have droplet and contact precautions by means of Personal protective equipment (PPE), facemask, face shield or eye protection. Prolonged usage of medical mask results in various adverse effects. This study is an attempt to know the common effects of prolonged face mask in healthcare workers and its resultant quality-of-life (QOL). To study the common effects of prolonged face mask and its impact on QOL of healthcare workers during the COVID 19 crisis. This was a prospective cross-sectional study conducted over 6 months among 2750 healthcare workers. A questionnaire requesting demographic details and most common side effects after prolonged usage of face mask was circulated. We also attached a short form-12 (sf-12) questionnaire to assess its impact on QOL. Out of 2750 personnel, 299 were excluded. Male preponderance was noted. Study was conducted on candidates using 3ply mask or above. Age range was between 18 and 65 years with mean age being 37.61 ± 15.23 in mask users < 5 h per day, 32.2 ± 10.02 in 5–10 h group and 30.19 ± 8.15 in 10 h group. 8.48% (n = 174) had comorbidities. QOL impacted. The complaints with face mask use definitely are troublesome with increase in severity with duration of mask usage. This definitely has a proportional impact on the healthcare workers’ QOL.
Article
Résumé Introduction Les masques « antipollution » sont des équipements de protection individuels destinés à assurer une filtration des particules ambiantes. État des connaissances Leur capacité de filtration est, d’après les tests effectués en laboratoire, élevée. L’efficacité filtrante de ces masques en condition réelle d’utilisation, c’est-à-dire lors d’un effort physique, est en règle inférieure à celle établie en laboratoire. L’étude de la protection conférée chez l’homme n’a donné lieu qu’à peu d’études. Ces dernières, rarement pratiquées en aveugle, mettent en évidence, lors de la marche en milieu pollué et port de masque, une réduction des symptômes et une certaine protection cardiaque. La tolérance à court terme est satisfaisante. Perspectives Il y a une place pour une amélioration technique de ces masques pour assurer une meilleure congruence avec le visage, réduire la résistance inspiratoire, l’espace mort et l’accumulation d’humidité sur le masque. Conclusion Les masques « antipollution » ont en théorie un pouvoir de filtration élevé vis-à-vis des particules mais, en vie réelle, leur efficacité est plus limitée. Du fait d’un possible sentiment de fausse sécurité pour celui (celle) qui le porte, l’Agence nationale de sécurité sanitaire n’a pas jugé bon d’en promouvoir l’usage.
Article
Background: . The effect of exposure to particulate matter (PM) on human health is a global public health concern. To develop an effective strategy to reduce PM exposure, we performed detailed questionnaire surveys regarding the type of lifestyle required to avoid PM exposure in patients with chronic obstructive pulmonary disease (COPD). We correlated the data with real-time PM concentration during the winter season. Methods: . We enrolled 104 patients with COPD aged 40 years or older. Detailed questionnaire surveys were conducted among participants, and internet of things-based sensors were installed at their homes to measure the indoor PM2.5 concentration, which was continuously monitored between December 2019 and February 2020. The associations among PM2.5 concentration, patients' lifestyles, and the impact of both concentration and lifestyle on COPD exacerbation were analyzed. Results: . Mean outdoor PM2.5 concentration was higher than mean indoor PM2.5 concentration during the study period (21.28±5.09 μg/m3 vs. 12.75±7.64 μg/m3), with a mean difference of 8.53±7.99 μg/m3. Among the various social factors and practices that aim to avoid exposure to PM, six practices and economic statuses were confirmed to reduce indoor PM2.5 concentration compared to outdoor concentration; Contrarily, these practices created a significant difference between the outdoor and indoor PM2.5 concentrations. The six practice items that showed a significant difference were 1) checking air quality forecast (the difference: -13.31±1.35 μg/m3, p=0.013), 2) indoor air filter operated (-15.43±1.32 μg/m3, p<0.001), 3) ventilating home by opening the windows (-13.14±1.28 μg/m3, p=0.013), 4) checking filters of the air filter (-13.95±1.50 μg/m3, p=0.002), 5) refraining from going out when outside PM is high (-12.52±1.37 μg/m3, p=0.039), 6) wearing a mask when going out (-13.38±1.32 μg/m3, p=0.017). The higher the household income and economic level, the more significant the difference in the PM2.5 concentration. Severe exacerbation was more prevalent among patients with acute exacerbation as the exposure time of PM2.5≥35 μg/m3 or PM2.5≥75 μg/m3. Conclusion: . Lifestyle and economic levels can affect the indoor PM2.5 concentration, which may impact COPD exacerbation.
Article
People use a particulate respirator in order to reduce exposure to ambient fine particulate matter (PM2.5). Acute exposure to PM2.5 is known to increase blood pressure. However, systematic reviews or meta-analyses on blood pressure-related benefits of using a particulate respirator is lacking. Therefore, we reviewed randomized crossover intervention studies on blood pressure-related effects of particulate matter respirator use. We conducted a literature review of articles found on Embase, Medline, and Cochrane library on August 31, 2020. The study outcomes were systolic and diastolic blood pressure and mean arterial pressure. A random-effect model was used in the meta-analysis. Subgroup analyses, based on age (adult < 60 years, elderly ≥ 60 years), personal PM2.5 exposure levels (High: ≥ 25 μg/m³, Low: < 25 μg/m³), and types of monitoring methods (ambulatory and resting blood pressure) were conducted. We identified 297 references, and seven studies were included in our systematic review. None of the studies used a sham respirator as control and complete allocation concealment and blinding were impossible. The use of a particulate respirator was associated with a −1.23 mmHg (95% confidence interval (CI): −2.53, 0.07) change in systolic blood pressure and a −1.57 mmHg (95% CI: −3.85, 0.71) change in mean arterial pressure. There were significant heterogeneities and possibilities for publication bias. The subgroup analyses revealed that studies involving elderly individuals, those conducted in high PM2.5 personal exposure, and those in which resting blood pressure was monitored demonstrated a larger decrease in blood pressure resulting from respirator use. Further intervention studies with a large sample size and subjects with diverse characteristics and different personal PM2.5 levels may add the evidence to current literature.
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The chapter addresses the salient and overlooked key areas regarding the use of face mask, the likely health implications as well as the reported side effects associated with prolonged use of face mask by both health care workers and the general populace at large. It also emphasizes on the need for proper orientation on who, when and how to put on the face mask to ensure adequate prevention against respiratory infection such as covid-19.
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The chapter addresses the salient and overlooked key areas regarding the use of face mask, the likely health implications as well as the reported side effects associated with prolonged use of face mask by both health care workers and the general populace at large. It also emphasizes on the need for proper orientation on who, when and how to put on the face mask to ensure adequate prevention against respiratory infection such as covid-19.
Article
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Face masks and respirators are used to filter inhaled air which may contain airborne droplets and high particulate matter (PM) concentrations. The respirators act as a barrier to the inhaled and exhaled air, which may change the nasal airflow characteristics and airconditioning function of the nose. This study aims to investigate the nasal airflow dynamics during respiration with and without an N95 respirator driven by airflow through the nasal cavity to assess the effect of the respirator on breathing conditions during respiration. To achieve the objective of this study, transient computational fluid dynamics (CFD) simulations have been utilised. The nasal geometry was reconstructed from high-resolution Computed Tomography (CT) scans of a healthy 25-year-old female subject. The species transport method was used to analyze the airflow, temperature, carbon dioxide (CO 2), moisture content (H 2 O), and temperature distribution within the nasal cavity with and without an N95 respirator during eight consecutive respiration cycles with a tidal volume of 500 ml. The results demonstrated that a respirator caused excessive CO 2 inhalation by approximately 7× greater per breath compared with normal breathing. Furthermore, heat and mass transfer in the nasal cavity was reduced, which influences the perception of nasal patency. It is suggested that wearers of high-efficiency masks that have minimal porosity and low air exchange for CO 2 regulation should consider the amount of time they wear the mask.
Article
Objectives To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. Design Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. Data sources Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. Study selection Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. Results We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. Conclusion A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
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Information on the clinical features of the severe acute respiratory syndrome (SARS) will be of value to physicians caring for patients suspected of having this disorder. We abstracted data on the clinical presentation and course of disease in 10 epidemiologically linked Chinese patients (5 men and 5 women 38 to 72 years old) in whom SARS was diagnosed between February 22, 2003, and March 22, 2003, at our hospitals in Hong Kong, China. Exposure between the source patient and subsequent patients ranged from minimal to that between patient and health care provider. The incubation period ranged from 2 to 11 days. All patients presented with fever (temperature, >38 degrees C for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed crackles and percussion dullness. Lymphopenia was observed in nine patients, and most patients had mildly elevated aminotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive air-space disease. Two patients died of progressive respiratory failure; histologic analysis of their lungs showed diffuse alveolar damage. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy a mean (+/-SD) of 9.6+/-5.42 days after the onset of symptoms, and eight were treated earlier with a combination of beta-lactams and macrolide for 4+/-1.9 days, with no clinical or radiologic efficacy. SARS appears to be infectious in origin. Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name. The microbiologic origins of SARS remain unclear.
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Severe acute respiratory syndrome (SARS) is a condition of unknown cause that has recently been recognized in patients in Asia, North America, and Europe. This report summarizes the initial epidemiologic findings, clinical description, and diagnostic findings that followed the identification of SARS in Canada. SARS was first identified in Canada in early March 2003. We collected epidemiologic, clinical, and diagnostic data from each of the first 10 cases prospectively as they were identified. Specimens from all cases were sent to local, provincial, national, and international laboratories for studies to identify an etiologic agent. The patients ranged from 24 to 78 years old; 60 percent were men. Transmission occurred only after close contact. The most common presenting symptoms were fever (in 100 percent of cases) and malaise (in 70 percent), followed by nonproductive cough (in 100 percent) and dyspnea (in 80 percent) associated with infiltrates on chest radiography (in 100 percent). Lymphopenia (in 89 percent of those for whom data were available), elevated lactate dehydrogenase levels (in 80 percent), elevated aspartate aminotransferase levels (in 78 percent), and elevated creatinine kinase levels (in 56 percent) were common. Empirical therapy most commonly included antibiotics, oseltamivir, and intravenous ribavirin. Mechanical ventilation was required in five patients. Three patients died, and five have had clinical improvement. The results of laboratory investigations were negative or not clinically significant except for the amplification of human metapneumovirus from respiratory specimens from five of nine patients and the isolation and amplification of a novel coronavirus from five of nine patients. In four cases both pathogens were isolated. SARS is a condition associated with substantial morbidity and mortality. It appears to be of viral origin, with patterns suggesting droplet or contact transmission. The role of human metapneumovirus, a novel coronavirus, or both requires further investigation.
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Most patients with end-stage renal disease (ERSD) visiting our hospital for hemodialysis treatment during the SARS outbreak wore an N95 mask. Data on the physiological stress imposed by the wearing of N95 masks remains limited. This study investigated the physiological impact of wearing an N95 mask during hemodialysis (HD) on patients with ESRD. ESRD patients who received regular HD at National Taiwan University Hospital between April to June 2003 were enrolled. Each patient wore a new N95 mask (3M Model 8210) during HD (4 hours). Vital signs, clinical symptoms and arterial blood gas measured before and at the end of HD were compared. Thirty nine patients (23 men; mean age, 57.2 years) were recruited for participation in the study. Seventy percent of the patients showed a reduction in partial pressure of oxygen (PaO2), and 19% developed various degrees of hypoxemia. Wearing an N95 mask significantly reduced the PaO2 level (101.7 +/- 12.6 to 92.7 +/- 15.8 mm Hg, p = 0.006), increased the respiratory rate (16.8 +/- 2.8 to 18.8 +/- 2.7/min, p < 0.001), and increased the occurrence of chest discomfort (3 to 11 patients, p = 0.014) and respiratory distress (1 to 17 patients, p < 0.001). Baseline PaO2 level was the only significant predictor of the magnitude of PaO2 reduction (p < 0.001). Wearing an N95 mask for 4 hours during HD significantly reduced PaO2 and increased respiratory adverse effects in ESRD patients.
Article
Cephalalgia has been successful by a number of measures in the last 12 months: our circulation is up particularly through electronic penetration in libraries, our submission rate has risen substantially and our impact factor remains high amongst clinical neuroscience journals. We are entering our fifth and last year of the current publisher’s contract. In the life of the contract we have switched to a very successful on-line submission system, finalized details for a new CDROM containing all issues of Cephalalgia and Headache, and will publish this year the revised International Headache Society classification for headache (1). All of this is excellent progress The journal continues to attract a range of important, interesting and often very thought-provoking submissions. We have benefitted greatly from the broad range of interests of the Associate Editors we are able to recommend and solicit high-quality expert reviews that keep the scientific standards high. In keeping with our general philosophy there is a need for renewal amongst the Associate Editors, and Professor Peer Tfelt-Hansen will be standing down. Peer is widely regarded as one of the most authoritative figures on clinical trial methodology in headache, his wide contributions to the field have appropriately lead to his election as President of the International Headache Society. The journal thanks him for his contributions, and congratulates him on his election. After wide consultation I have invited Professor Nahib Ramadan, University of Chicago, to join the Associate Editors. Professor Ramadan was extensively involved in the journal under the previous Editor-in-Chief, Professor K. Michael Welch, and brings both excellence in academic life and a stint in industry with that important perspective to the Board. I welcome his acceptance of the invitation. From this issue Cephalalgia will become a monthly journal. We have a strong throughput of excellent work and rather than raise the rejection rate, and somewhat arbitrarily dismiss work that readers might be very interested in seeing, we felt it timely to increase to 12 issues a year. We hope this will allow more rapid publication of your accepted work and a greater range of interesting papers for readers in any one year. Let me close by thanking the Editorial Assistant Faye Cheeseman for her sterling efforts at the Blackwell’s Office in keeping the journal ticking over, our referees whose expertise is the key to our success, the Associate Editors who do so much for the journal, and you the reader for your continued support for Cephalalgia.
Article
Most headaches, including the chronic ones, have an organic background. This applies in particular to the unilateral headaches, but also probably to some of the global ones. In spite of this, there seems to be a clear, but variable influence of stress in the various types of headache. This effect may be a dual one. Thus, in migraine the effect of the low-degree, daily, annoying stress may be much worse than that of major stress, which may in fact prevent a headache almost even completely. A distinction should be made between the influence of stress on the headache as such and on the separate attacks. An example of this may be cluster headache: the mechanism underlying the long-term development may be under influences of external stressors, whereas the shortlasting, solitary attacks are scarcely influenced by such factors. The negative influence of stress is probably most apparent in common migraine and the acute form of tension headache. Headaches like the "atypical facial neuralgia" have been thought to have a strong, psychogenic background. Atypical facial neuralgia is one of the unilateral headaches, and bears a great similarity to cervicogenic headache. In the latter headache, attacks may even be precipitated mechanically, so that a psychogenesis or a marked stress-influence seems to be unlikely. In some cases of classic migraine, attacks seem to appear in their own inherent, stereotypical rhythm irrespective of outer events of a possible harmful nature.
Article
Although there are no data demonstrating the effectiveness of personal respiratory protection in the prevention of occupational tuberculosis, there are sound theoretical bases supporting the use of respirators to reduce the risk of inhalational exposure. The major factor that limits the effectiveness of most respirators is the leakage between the face and the mask. There are data suggesting that traditional fit testing of respirators does not adequately predict the degree of protection in actual use, and more research is needed in that area. There is a large range of infectiousness of aerosols of TB, and classes of respirators vary greatly in the degree of protection they offer. I have argued that respirator selection should be based on anticipated exposures. High-risk exposures to TB are often associated with cough-inducing procedures or with aerosolization of infected tissues during autopsies. In my opinion, the most reasonable type of respirator for such high-risk situations in health care settings is a PAPR hood. The concentration of infectious aerosols in well-ventilated respiratory isolation rooms is likely to be very low, and the new N95 respirators offer a reasonable balance of comfort, cost, practicality, and protection. Preliminary data from mathematical modeling studies suggest there may be little additional benefit from more sophisticated personal respiratory protection in such settings. Additional research is needed to more accurately assess exposures to TB, to determine the size and aerodynamic behavior of TB generated by infectious patients, and to more accurately define the role and effectiveness of personal respiratory protection against TB.
Article
The increasing popularity of scuba diving has added a new category to the differential diagnosis of headache. Headache in divers, while uncommon and generally benign, can occasionally signify serious consequences of hyperbaric exposure such as arterial gas embolism, decompression sickness, and otic or paranasal sinus barotrauma. Inadequate ventilation of compressed gases can lead to carbon dioxide accumulation, cerebral vasodilatation, and headache. Other types of headache encountered in divers include exertional headache, cold stimulus headache, migraine, tension-type headache, acute traumatic headache, cervicogenic headache, carbon monoxide poisoning headache, and headache associated with envenomation. Correct diagnosis and appropriate treatment require a careful history and neurologic examination as well as an understanding of the unique physiologic stresses of the subaquatic environment.
Article
Used as an adjunct or alternative to medication treatment, psychologic and behavioral approaches to tension-type headache decrease headache frequency, affective distress, and headache-related disability. These approaches directly address the psychologic and behavioral factors that contribute to the disorder and to the individual headache episodes. There is well-established evidence of efficacy for the three broad approaches: relaxation training, electromyographic biofeedback training, and cognitive-behavioral stress management. Treatment has been difficult to access, with most care provided by behavioral specialists in tertiary care settings using clinic-based or home-based treatment protocols. Recent attempts to make treatment more accessible to a wider range of tension-type headache sufferers include using medical personnel to deliver treatment from physician practices and using existing and emerging technologies to provide care in a purely self-administered format without face-to-face contact with therapists. These attempts are promising, but remain preliminary; therefore, there is a need for further development and testing.
Article
Two women, aged 27 and 45 years, presented to the Dermatology Outpatient Clinic with acne vulgaris. Both had nodular acne in a similar distribution over the cheeks, chin, and perioral areas (Fig. 1). Each had a history of acne vulgaris as a teenager. Both were healthcare assistants working in the Singapore General Hospital throughout the severe acute respiratory syndrome (SARS) crisis, had worn N95 masks continuously for about 3 months whilst on the wards, and had suffered an outbreak of acne of the skin occluded by the mask. They were treated with topical retinoid and systemic antimicrobials, and both responded well. Figure 1. Twenty-seven-year-old woman with acne papules and nodules on the face over the area occluded by the N95 mask Download figure to PowerPoint
Article
The International Headache Society has classified the external compression headache as a kind of cranial neuralgia caused by continued external pressure over the head. This headache has peculiar characteristics and resolves after pressure is relieved. The aim of this study was to analyze the occurrence of this headache type among 82 police officers who reported headache after wearing a helmet. We retrospectively studied 82 patients (79 men, 3 women), age 19-35 years (mean, 26), who presented to an outpatient neurology department in a military police hospital with complaints of headache associated with wearing a helmet on at least 3 occasions. The headache subsided after removal of the helmet. During subsequent follow-up consultations, designed to reevaluate the patients and to renew the authorization releasing helmet use, no patients described recurrence of the head pain. We conclude that headache caused by external compression can be related to wearing a helmet, and headache relief can be obtained simply by not wearing such a helmet.
Article
Before the advent of severe acute respiratory syndrome (SARS), use of the powered air-purifying respirator (PAPR) in the setting of pulmonary tuberculosis has been controversial. Data regarding health care worker (HCW) perceptions and problems encountered with the use of the PAPRs were lacking. A questionnaire-based survey was conducted of HCWs who had used the PAPR in clinical practice during the SARS outbreak, when use of the PAPR was mandatory and widespread. Evaluations of the question of whether HCWs were receptive to the use of the PAPR and their perceptions of common problems that were encountered were made. Perceptions of comfort, ease of use, visual, hearing, breathing and speech impairment, perceived protection against SARS and usage preferences were recorded. Only a minority of respondents found the PAPR uncomfortable, despite some interference with communication. Despite its much higher cost, the majority (84%) preferred to use the PAPR rather than the N-95 respirator when treating suspected SARS patients. However, opinions were equally divided regarding its use when treating patients with pulmonary tuberculosis; with 51% being in favour. With the advent of highly contagious diseases that pose a major occupational hazard to HCWs, the use of the PAPR has become more acceptable in clinical practice.
Article
Severe Acute Respiratory Syndrome (SARS) was responsible for outbreaks in Canada, China, Hong Kong, Vietnam, and Singapore. SARS focused attention on the adequacy of and compliance with infection control practices in preventing airborne and droplet-spread transmission of infectious agents. This paper presents a review of the current scientific knowledge with respect to the efficacy of personal protective equipment in preventing the transmission of respiratory infections. The effectiveness of infection control policies and procedures used in clinical practice is examined. Literature searches were conducted in several databases for articles published in the last 15 years that related to infection control practices, occupational health and safety issues, environmental factors, and other issues of importance in protecting workers against respiratory infections in health care settings. Failure to implement appropriate barrier precautions is responsible for most nosocomial transmissions. However, the possibility of a gradation of infectious particles generated by aerosolizing procedures suggests that traditional droplet transmission prevention measures may be inadequate in some settings. Further research is needed in this area.
Article
Avian flu outbreaks in Thailand and Vietnam, followed by a reported case of human-to-human transmission in Cambodia (http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_02_02/en/) prompted rapid responses by health authorities around the world. The WHO and local health ministries launched investigations into the potential source(s) of the outbreaks, and millions of ducks and other farm poultry were slaughtered (http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/feb0205cambodian.html). The US Centers for Disease Control responded by elevating its previous advice to travellers about avian influenza A (H5N1) in Asia from an Outbreak Notice to a Travel Health Precaution, and increased surveillance for the disease. Some experts predict that the world is on the brink of an avian flu pandemic; others say a pandemic may not be inevitable, but urge caution and ongoing monitoring. The following sites offer background information and the latest news on avian flu.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004;24(Suppl. 1):1-160.