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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... Prior to this study, there have only been two local studies analysing headaches its association with PPE use. The first study was conducted in March 2006, based off the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, [10] and the other being the HAPPE study performed in March 2020 in the midst of the current COVID-19 pandemic [12]. These studies were conducted on healthcare workers in inpatient wards and the emergency department. ...
... In our study, participants with a history of pre-existing headache disorder were more likely to experience headaches with N95 mask usage. Our findings are similar to those found in published studies [10] [12] [14]. The rationale for this correlation is still poorly understood and could be due to a multitude of reasons such as peripheral sensitization from the pre-existing headache disorder, the hypoxemia or hypercarbia incurred from N95 mask usage acting as a trigger for the pre-existing headaches, and the associated stress, inadequate hydration and irregular meal times that arose from the pandemic [17] [18] [19]. ...
... Moreover, alterations in respiratory physiology from N95 mask usage can lead to changes in ce-Open Journal of Anesthesiology rebral blood flow and subsequently development of headaches [24]. That being said, our findings are not in keeping with those made by published local studies [10] [12]. A possible explanation could be the temporal relationship between the period users started to wear N95 masks and the period the studies began. ...
... In this respect, the importance of hand hygiene and the use of the personal protective equipment (PPE) in health institutions to protect against COVID-19 have increased. A number of problems have emerged in healthcare workers with long-term PPE use, such as hunger, difficulty in breathing, itching on the skin, facial redness, headaches, ear pain due to the use of N95 masks [5][6][7]. ...
... In a study, it has been revealed that as the duration of PPE usage increases, serious damage is caused to the face, ears and back of the ears [19]. The studies in the literature indicated that healthcare workers had headache complaints due to the use of N95 masks [6,7,22]. The use of tight masks/glasses puts pressure on the face and cervical nerves and as a result, headache develops [6]. ...
... The studies in the literature indicated that healthcare workers had headache complaints due to the use of N95 masks [6,7,22]. The use of tight masks/glasses puts pressure on the face and cervical nerves and as a result, headache develops [6]. In addition, long-term use of masks caused irregular meal times, hydration and headaches due to stress [7]. ...
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Background: In order for nurses to provide the desired/expected care during the COVID-19 pandemic, the personal protective equipment (PPE) they use should not cause additional damage. Objective: The current study examined the effect of nurses' use of PPE on their vital signs during the COVID-19 pandemic. Methods: The present study was executed in a public hospital located in Turkey between October 2020 and December 2020 with a total of 112 nurses, 54 of them were serving in COVID-19 clinics, and 58 of them were working in other clinics. The data of the study was collected by using the introductory information form, the vital signs measurement, and the Visual Analogue Scale. The numbers, percentages, means, standard deviation, Chi-square, ANOVA, Mann-Whitney U and Wilcoxon tests were used to analyze the data. Results: The mean scores of SpO2, respiratory rate, body temperature, heart rate and blood pressure measurements of the nurses in the experimental group were compared before and after putting on the PPE. It was found that the difference between the two averages was statistically significant (p < 0.05). Conclusion: It was found that the use of PPE for a long time causes a decrease in SpO2, increase in respiratory rate, pulse and blood pressure, as well as the aches in face, ear, nose and head.
... In study on HCWs who used the N95 mask during the SARS epidemic, Lim et al. (43) reported that the prevalence of face mask-associated headaches was 37.3% (43), which is lower than in the present study. Given that the COVID-19 disease is a pandemic and has affected HCWs for a long time, this difference in the prevalence of headache among HCWs can be justified. ...
... In study on HCWs who used the N95 mask during the SARS epidemic, Lim et al. (43) reported that the prevalence of face mask-associated headaches was 37.3% (43), which is lower than in the present study. Given that the COVID-19 disease is a pandemic and has affected HCWs for a long time, this difference in the prevalence of headache among HCWs can be justified. ...
... However, it is remarkable that PPE-associated headaches are also associated with psychological stress, depression, and sleep disorders, which increased during COVID-19 outbreak among HCWs, as headache is also the most common COVID-19-related neurological symptom (43). Because the aggravation of headaches can have a great impact on the wellbeing and occupational performance of HCWs. ...
Article
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Introduction: Health Care Workers (HCWs) use Personal Protective Equipment (PPE) during the COVID-19 pandemic to protect themselves and prevent the transmission of the disease. The use of PPE, especially respiratory masks, has adverse consequences, including headaches, which have been secondary and unusual. The aim of the present systematic review and meta-analysis study was to investigate the prevalence of PPE-associated headaches in HCWs during COVID-19 pandemic. Methods: The present review study was performed based on the PRISMA guideline. The protocol of the present study was registered in PROSPERO with the code CRD42022304437. Valid data resources such as Scopus, PubMed, Web of Science, Science Direct, Google Scholar, Embase were used to identify and extract relevant studies. The searches were conducted between the beginning of 2020 and the end of January 2022. A random eects model was used for meta-analysis and I2 index was used to investigate between-study heterogeneity. Data were analyzed using STATA ver. 14. Results: A total of 539 articles were first identified through initial search and finally 26 final studies were selected to undergo the meta-analysis phase. According to the results of meta-analysis, the prevalence of headache after and before the use of PPE was 48.27% (95% CI: 40.20–56.34, I2 = 99.3%, p = 0 < 001) and 30.47% (95% CI: 20.47–40.47, I2 = 97.3%, p = 0 < 001), respectively. Conclusion: The results of the present study showed that the prevalence of PPE-associated headache in HCWs was relatively high, so, the use of PPE during COVID-19 pandemic can be considered as one of the causes of headache. Therefore, management strategies such as regular screening of HCWs for headaches and regular rest periods without the use of PPE can be eective in reducing the prevalence of headaches.
... While the scientific community acknowledges the benefit of PPE to prevent the viral infection, some concern has been raised regarding the adverse effects of PPE [3,4]. Most of the recent studies revealed that intensive usage of facemasks, which is the most used PPE, greatly exacerbated preexisting headaches and even triggered de novo headaches [5][6][7][8][9][10][11], even before the COVID-19 pandemic [5,11]. ...
... While the scientific community acknowledges the benefit of PPE to prevent the viral infection, some concern has been raised regarding the adverse effects of PPE [3,4]. Most of the recent studies revealed that intensive usage of facemasks, which is the most used PPE, greatly exacerbated preexisting headaches and even triggered de novo headaches [5][6][7][8][9][10][11], even before the COVID-19 pandemic [5,11]. ...
... Due to the pandemic caused by COVID-19, mask use has become part of everyday life [1,24,25]. In the literature, there are studies that have investigated the relationship between the use of facemasks and the presence of acne, skin lesions [26], and headaches [5][6][7]. However, there is no work that has investigated the presence of neuropathic pain: a disabling condition that impacts on daily activities and on quality of life [16,27,28]. ...
Article
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The SARS-CoV-2 pandemic made the use of facemasks mandatory to prevent contact with the virus. Recent studies have revealed that intensive use of facemasks significantly exacerbated pre-existing headaches and triggered de novo headaches. In our experience, some subjects also complain of symptoms of neuropathic pain in the head/facial regions. Until now, the relationship between neuropathic pain and facemasks has not been documented. The aim of the study is to investigate the occurrence of neuropathic pain related to facemask use. It is a cross-sectional survey using a questionnaire, developed following a commonly accepted outcome research methodology. Participants, both health care and non-health care workers, responded to items included in the questionnaire about the type of facemasks, time and manner of wearing them, side effects such as skin lesions, symptoms of neuropathic pain, etc.
... There are few studies in the literature that have looked at the relationship between PPE and headaches. A study conducted during the SARS epidemic in Singapore concluded that 37.3% of healthcare workers reported headaches associated with N95 facemask (Lim et al. 2006). Around 22% of ICU nurses reported that discomfort Bioscience Research, 2022 volume 19(1): 778-783 779 was the main cause of mask removal (suboptimal compliance). ...
... Within those who developed a new onset of headaches, 62.07% used acute analgesics medication, which coincides with another study where 59% required acute analgesics (Lim et al. 2006). However, this considered higher in comparison to 30% from a previous study (Ong et al. 2020). ...
Article
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Wearing proper personal protective equipment (PPE) such as N95 mask and goggles is mandatory for healthcare workers who deal with suspected or infected patients. Since the recent COVID19 pandemic, these measures have become mandatory practiced. We aimed to investigate the association between exposure to PPE and the occurrence of new-onset headaches, and its impact on pre-existing headaches. Cross-sectional study was done among healthcare workers who worked in some hospitals in Saudi Arabia during the COVID-19 outbreak.378 healthcare workers participated in the survey. Around 79% of them were aged between 21-30 years old. 47.9% of them were residents, followed by family physicians (14.8%) and nurses (14.3%). Approximately, 24% of the participants had pre-existing headaches, with migraine being the most common (54.5%). N95 face mask was used by 31.7% of the participants an while 43.7% used goggles. Nurses had a higher mean daily exposure time of 9.78±3.07 compared others (p-value < 0.001). Around 16% of our respondents developed a new onset headache, longer duration of exposure was significantly associated with this type of headache (p-value <0.001), and it occurred more frequently in residents (43.1%). Of those who had prior headaches, 43.2% reported an increase in the frequency, and 36.4% attributed this change to the use of the face mask. 37.5% had an increased need for acute analgesic medication. PPE is associated with the occurrence of new-onset headaches and exacerbation of pre-existing headaches in healthcare workers. Shorter duration of exposure may reduce incidence and severity.
... In all these studies found in the literature [1,2,[11][12][13][14][34][35][36][37][38][39][40], ethylene from the human respiration of the participants wearing surgical face masks was not among the investigated parameters. The originality of our research is also due to the assessment of ethylene from healthy participant's respiration, after wearing a surgical mask, using a modified photoacoustic spectroscopy gas detection system. ...
... They do, however, increase both the carbon dioxide and ethylene concentrations behind them, as evidenced by this study. Although the results show that gases concentrations from the participant's respiration increases after wearing a surgical mask for an hour, they remain below short-term National Institute for Occupational Safety and Health limits [1,2,[11][12][13][14][34][35][36][37][38][39][40]. ...
Article
Full-text available
Wearing surgical face masks is among the measures taken to mitigate coronavirus disease (COVID-19) transmission and deaths. Lately, concern was expressed about the possibility that gases from respiration could build up in the mask over time, causing medical issues related to the respiratory system. In this research study, the carbon dioxide concentration and ethylene in the breathing zone were measured before and immediately after wearing surgical face masks using the photoacoustic spectroscopy method. From the determinations of this study, the C2H4 was established to be increased by 1.5% after one hour of wearing the surgical face mask, while CO2 was established to be at a higher concentration of 1.2% after one hour of wearing the surgical face mask, when the values were correlated with the baseline (control).
... N95 maskelerinin uzun süre kullanılmasıyla ortaya çıkan subjektif semptomlar incelendiğinde, baş ağrısı, sersemlik, görme güçlüğü, nefes alma güçlüğü, çarpıntı, kafa karışıklığı ve zor iletişim gibi çeşitli şikayetlerin önemli ölçüde arttığı yapılan çeşitli çalışmalarda gösterilmiştir. 4,7,17,23 Başka bir çalışmada N95 maskesi takanlarda cerrahi maske takanlara göre; kaşıntı, soluk almada zorluk, yorgunluk, maske içinde sıcaklık ve nemin anlamlı derecede arttığı bildirilmiştir. 9 Ong ve ark. ...
... Lim ve ark. 17 yapmış oldukları çalışmada 4 saatten fazla N95 solunum maskesi kullanımının baş ağrılarına sebep olabileceği bildirilmiş ve daha kısa süreli kullanımların bu ağrıların görülme sıklığını ve şiddetini azaltabileceğini bildirmiştir. Yapılan başka bir çalışmada ise N95 maskelerin kullanıcılar için kullanım konforunu azaltan yönleri incelenmiştir. ...
Article
Amaç: Bu çalışmanın amacı, COVID-19 pandemisi boyunca yapılan dental işlemlerde uzun süre N95 maske kullanımının, diş hekimlerinin oksijen satürasyon değerleri ve nabız atım hızları üzerindeki etkisini değerlendirmek ve kullanım boyunca oluşan subjektif şikayetleri belirlemekti. Gereç ve Yöntem: Çalışmaya N95 maskesi kullanan 21-65 yaş (ortalama 31.43±9.44) arası toplam 60 (24 erkek ve 36 kadın) gönüllü diş hekimi dahil edildi. Satürasyon ve nabız kayıtları, N95 maskesi kullanılmadan önce ve 6 saat sürekli kullanımdan sonra parmak tipi puls oksimetre kullanılarak kaydedildi. Katılımcılara mide bulantısı, baş ağrısı, baş dönmesi, görme bozukluğu, nefes darlığı, çarpıntı, bilinç bulanıklığı, iletişim zorluğu, yorgunluk, nefes kokusu, maske-nem, sıcaklık ve kaşıntı ile ilgili soruları içeren subjektif semptomları 1-10 arasında puanlandırdıkları ölçme testi yapıldı. Bulgular: Kullanım öncesi ve 6 saat boyunca N95 takılması sonrasında, başlangıç ve sonuç oksijen satürasyon değerleri arasında istatistiksel olarak anlamlı bir değişiklik görüldü (1. gün: p=0.012 ve 3. gün: p=0.02). Ancak bu farklılık klinik olarak anlamlı değildi. Katılımcıların N95 kullanımı sonrasında nabız değerlerine bakıldı ve istatistiksel olarak anlamlı farklılık görülmedi (p=0.455, p=0.479, p=0.053). Erkeklerde maske içinde oluşan nem, sıcaklık ve karşılıklı iletişim zorluğu şikayetleri, kadınlarda ise nem, sıcaklık ve kaşıntı şikayetleri nispeten yüksek skorlar aldı. Kadın grubunun mide bulantısı, görme bozukluğu, sıcaklık ve kaşıntı skorları erkeklere göre istatistiksel olarak anlamlı şekilde yüksekti (p=0.001). Sonuç: N95 maskesinin 6 saat sürekli kullanımı diş hekimlerinin oksijen satürasyon ve nabız atım değerlerinde klinik olarak anlamlı bir etki göstermedi. Kadınlarda mide bulantısı, görme bozukluğu, sıcaklık ve kaşıntı şikayeti değerleri erkeklere göre daha yüksek görüldü.
... In the years after the SARS epidemic, researchers investigated the long-term effects of mask use. Lim et al. (2006) examined how masks might induce headaches, while Foo et al. (2006) investigated how masks can cause skin issues such as rashes, acne, and itching. Basile et al. (2020) state that when caring for patients with highly infectious illnesses such as TB, SARS, and COVID-19, the CDC and WHO recommend using N95 masks. ...
... Long-term mask usage may produce headaches due to the mask's movement, the amount of carbon dioxide in the air, and the lack of oxygen. Straps and pressure on the face and cervical nerves near the skin might produce headaches (Lim et al., 2006). Health care professionals who wear masks for extended periods may get headaches due to neck strain from masks, lack of sleep, eating at odd hours, and mental stress (Ong et al., 2020). ...
Article
Full-text available
Lim et al. (2006) examined how masks might induce headaches, while Foo et al. (2006) investigated how masks can cause skin issues such as rashes, acne, and itching. Basile et al. (2020) state that when caring for patients with highly infectious illnesses such as TB, SARS, and COVID-19, the CDC and WHO recommend using N95 masks. The N in N95 represents the National Institute for Occupational Safety and Health in the United States, abbreviated as NIOSH. The 95 indicates the efficiency of particle filtration. So, an N95 mask eliminates 95% of all airborne particles, even the tiniest ones (Bałazy, 2006). In contrast, surgical masks may prevent big particles from entering the lungs, but they are ineffective against tiny particles. When a person breathes in, the mask does not prevent edge leaks. Therefore, surgical masks (Center for Disease Control and Prevention, 2020) are ineffective and inadequate protection while directly caring for COVID-19 patients.
... [2][3][4] The use of N-95 masks led to acneiform eruptions and folliculitis in our study, whereas other studies reported acne, nasal bridge scarring, rash, and facial headache. [2,5] Lastly, PPE kits led to erythema, furunculosis, miliaria, and aggravation of tinea cruris, whereas other studies reported only minor. This again can be attributed to the high humidity and rising temperatures in our country. ...
... Specific health issues, including hypoxemia and hypercapnia, have been reported as consequences of prolonged use of face masks (Elisheva, 2020;Lim et al., 2006). Tight-fitting masks and their straps cause accumulation of exhaled carbon dioxide and inadequate ventilation, termed hypercapnia . ...
Chapter
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Viral infections are inevitable, and since ancient times, there are an increasing number of records of such outbreaks affecting a million lives (Bauerfeind, von Graevenitz, Kimmig, et al., 2016). In 1918–20, the deadly viral outbreak (Spanish Flu) in human history affected two-third of the human population with a high mortality rate. In the 21st century, there has been a subsequent viral outbreak, including SARS in 2002 in China, MERS in the Middle East, NiPAH in India (2009), Ebola, and H1N1 (also new variants). The rise in such viral outbreaks affected human lives and posed challenges to the existing health-care system (Morens & Taubenberger, 2018; Tong, 2006). In the last two decades of the 21st century, more than ten viral outbreaks have been reported worldwide. More than 2.5 million deaths in the case of novel SARS-CoV-2 have been reported; however, the pandemic is not over yet. New strains of the novel SARS-CoV-2 are cautiously emerging in different geographical areas with varying infection and fatality rates (Junejo, Ozaslan, Safdar, et al., 2020). The coronavirus is most common viral infection to humans after H1N1 and its novel variants. All these viruses primarily target the lower and upper respiratory tract causing acute respiratory distress syndrome. The novel SARS-CoV-2 is the prime causative agent for the deadly COVID-19. Based on the recurrent viral outbreaks in the last two decades, it has been hypothesized that human-animal interaction is the prime cause for viral transmission from wild animals to humans (Rabaan et al., 2020).
... Wearing the N95 mask during severe acute respiratory distress syndrome )SARS( epidemic in Singapore )2003( resulted in the occurrence of novel onset face-mask-associated headaches with a prevalence of 37.3%. 4 Similarly, amongst medical professionals using the N-95-mask and protective eyewear for an average of 5.7 hours/day, 81% reported de-novo PPE induced headaches and 91% stated aggravation in their pre-existing headaches. However, certain trigger factors, such as sleep deprivation )60.9%(, physical stress )29.3%(, emotional stress )13.0%(, irregular mealtimes )15.2%(, and inadequate hydration )39.1%( contributed too. 5 Of the primary headaches, migraine is highly prevalent and is the second leading cause of years-lost-to-disability worldwide. ...
... With the use of masks, people are interested in its safety. Many researchers have reported that health care providers wearing a mask may experience headaches and nasal pressure, 12,13 and N95 respirators can reduce PaO 2 in patients with end-stage renal disease. 14 In healthy subjects, wearing masks during short-term moderate-intensity aerobic exercise is associated with an increase in end-tidal carbon dioxide (EtCO 2 ). ...
Article
Objective: This study assessed oxygen saturation variation and comfort in adult surgical patients wearing masks in PACU during the COVID-19 epidemic. Design: Retrospective observation was applied in this study. Methods: One hundred thirty-seven patients wearing no medical masks (Group A, aged from 20 to 87) and 136 patients wearing medical masks (Group B, aged from 18 to 91) were selected in this retrospective study after extubation in PACU. After extubation their pulse oxygen saturation, noninvasive mean blood pressure and heart rate were recorded at two different time points (treated with 40% O2 oxygen therapy for 10 minutes and breathing room air for 10 minutes). The comfort, arterial blood gas data, complications and duration of patients were also reviewed in PACU. Findings: There were no significant differences in the pulse oxygen saturation between the two groups after inhaling 40% O2 or air. Compared with Group A, patients in Group B have lower comfort (6 [4-7] vs 7 [6-8]; P < .001), with shortened duration after extubation in PACU (50 [45-55] vs 56 [48-60]; P < .001). No significant differences were found in heart rate, noninvasive mean blood pressure, arterial blood gas data and complications. And no hypoxemia and respiratory adverse events happened in two groups. Conclusions: Wearing medical masks does not reduce oxygen saturation in adult surgical patients during recovery from general anesthesia. The discomfort caused by masks is the concern in PACU.
... Physicians are mandated to wear personal protective equipment (PPE) for a long time. Previous reports show that there was relative high prevalence of headaches with the use of the PPE especially N95 face-mask amongst healthcare providers working in high-risk areas [4]. This may be related to mechanical factors (external compression), hypoxemia, hypercapnia or the stress associated with its use [5]. ...
Article
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Background Headache is considered a common health problem affecting physicians during Coronavirus disease-19 (COVID-19) pandemic and has direct impact on their productivity. Wearing personal protective equipment (PPE), stress and lack of sleep are common factors affecting their headache. Results Out of 165 participants, 38(23%) experienced new onset headache. Participants using Combined Face and eye PPE usage were at higher risk of developing headache compared to single PPE users, Participants wearing face shield were at higher risk of developing headache compared to eyewear non users. Conclusion COVID-19 hospital’s physicians may experience new-onset headache or change in their previously existing headache, mostly disposed by PPE eyewear and combined face and eye PPE.
... Anschließend folgt eine kurze Beschreibung der Klinik und der möglichen Ursachen. [5], da bereits frühere Studien den Einfluss von Atemschutzmasken auf Kopfschmerzsymptome bei Gesundheitsberufen zeigen konnten [9]. Getragen wurden in der aktuellen Studie überwiegend chirurgische Masken (74,2 %), N95-Masken (dem europäischen FFP2-Standard entsprechend) nur zu 25 %. ...
Article
Newly induced headaches, as well as intensified pre-existing primary headaches following the use of personal protection equipment, has drawn significant attention with the wide use of facemasks in the general population during the coronavirus disease 2019 (COVID‑19) pandemic. Therefore, we present the current state of knowledge regarding facemask-related headache based on three clinical studies, which provides insights to the clinical features and course of this emerging headache entity. Moreover, we summarize preventive and therapeutic recommendations.
... Specific health issues, including hypoxemia and hypercapnia, have been reported as consequences of prolonged use of face masks (Elisheva, 2020;Lim et al., 2006). Tight-fitting masks and their straps cause accumulation of exhaled carbon dioxide and inadequate ventilation, termed hypercapnia . ...
Chapter
Full-text available
Materials at nanometric dimensions offer novel abilities with different properties which cannot be observed with the same material in bulk form. Nanoscience typically refers to the study of nanomaterials, their properties, and related phenomena (Mulvaney, 2015). Nanotechnology refers to the moderation, advancement, and application of atomic or molecular structures at the base of one dimension in the nanoscale range (1–1000nm) to produce devices and products. These particles offer varying shapes, morphologies, compositions, dimensions, or surface characteristics (Fig. 1) (Li, Xiao, Chen, & Huang, 2021; Singh, Misra, Mohanty, & Sahoo, 2020). A diverse range of nanosized particles of both biological and abiological origin includes lipid nanoparticles, nanoemulsions, biodegradable polymers, dendrimers, carbon nanoparticles, exosomes, and viral coats for the potential protected delivery of vaccine components (Chintagunta, Krishna, & Nalluru, 2021; Nasrollahzadeh, Sajjadi, Soufi, Iravani, & Varma, 2020). Nanotechnology involved the manipulation of these materials and emerged as a powerful tool in multiple ways to support the fight against various emerging infections (Chintagunta et al., 2021). In the context of the current pandemic setoff by SARS COV-2, population immunization on a large scale is regarded as a foremost priority for the public health concern.
... Medical staff spend longer time in the ward, wear protective equipment for a long time and as well as more times a day. Studies have shown that wearing protective equipment for a long time might lead to increased mental stress on medical staff [60,61]. Long working hours, high work pressure, irregular diets gradually broke down the health of medical staff, which increased the risk of post-traumatic stress disorder. ...
Article
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Background PTSD (Post-traumatic stress disorder, PTSD) had a great impact on health care workers during the COVID-19 (Corona Virus Disease 2019, COVID-19). Better knowledge of the prevalence of PTSD and its risk factors is a major public health problem. This study was conducted to assess the prevalence and important risk factors of PTSD among medical staff during the COVID-19. Methods The databases were searched for studies published during the COVID-19, and a PRISMA (preferred reporting items for systematic review and meta-analysis) compliant systematic review (PROSPERO-CRD 42021278970) was carried out to identify articles from multiple databases reporting the prevalence of PTSD outcomes among medical staff. Proportion random effect analysis, I² statistic, quality assessment, subgroup analysis, and sensitivity analysis were carried out. Results A total of 28 cross-sectional studies, and the PTSD results of doctors and nurses were summarized from 14 and 27 studies: the prevalences were 31% (95% CI [confidence interval, CI]: 21%-40%) and 38% (95% CI: 30%-45%) in doctors and nurses, respectively. The results also showed 7 risks (P<0.05): long working hours, isolation wards, COVID-19 symptoms, nurses, women, fear of infection, and pre-existing mental illness. Two factors were of borderline significance: higher professional titles and married. Conclusion Health care workers have a higher prevalence of PTSD during COVID-19. Health departments should provide targeted preventive measures for medical staff away from PTSD.
... Exhaled CO 2 builds up between the mask and face, and increased levels of CO 2 cause confusion, impaired cognition and disorientation (3,5). A previous study among healthcare providers wearing the N95 face mask during the 2003 SARS epidemic in Singapore reported new onset face-mask-associated headaches with a prevalence rate of 37.3% (6,7). Another study among nurses working in a medical intensive care unit reported headache as one of the main factors accounting for suboptimal N95 face mask compliance (6,8). ...
Article
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Severe acute respiratory distress syndrome (SARS)-CoV-2, the cause of Coronavirus disease 2019 (COVID-19), has caused a global pandemic with worldwide morbidity, mortality and disruptions to society. Undoubtedly, the global spread of the COVID-19 pandemic had warranted universal precautions to slow the rate of infection. Hand hygiene, social distancing, regular disinfection of surfaces and avoidance of touching one’s face are some of the measures which have been used in an attempt to decrease exponential disease spread. The epidemiology of SARS-CoV-2 had indicated that most infections were spread by respiratory droplets, through exposure to an infected individual at close range. For this reason, healthcare professionals are mandated to wear personal protective equipment (PPE) for a prolonged period of time when caring for COVID-19 patients. On the other hand, the COVID-19 pandemic has led to an increased use of face protection such as surgical masks and eye protection not only amongst healthcare workers but also now the general public. Prolonged use of N95 and surgical masks by healthcare professionals during COVID-19 has caused adverse effects such as headaches, rash, acne, skin breakdown and impaired cognition. This review delves into various adverse effects of prolonged mask use and provides recommendations to ease the burden on healthcare professionals. The magnitude of this condition is clinically significant and might worsen if the current outbreak further continues to spread widely and stays for a longer time, affecting the work performance of healthcare workers. Perhaps better strategies are needed for designing various PPE and reducing the duration for which healthcare workers are required to use them.
... The effectiveness of the use of protective masks has been the subject of many publications, mainly concerning health care [25][26][27][28]. Recent studies show that wearing masks should not adversely affect health [29,30], even in people with diseases [31]. The results of studies in [32] show that wearing the N95 mask during low-intensity work (MET 3) may increase metabolism, which reduces exhaled oxygen and increases the concentration of exhaled CO 2 . ...
Article
Masks are the primary tool used to prevent the spread of COVID-19 in the current pandemic. The use of masks may result in some discomfort, which may be caused by the accumulation of carbon dioxide in the inner space of the mask. This paper presents tests of carbon dioxide concentration in the inner space of the mask during work at a computer, for various flat and convex masks. Five different masks were used in the tests. Convex masks showed a greater accumulation of carbon dioxide than flat masks. The concentration of carbon dioxide was also higher for masks made of more layers. The dependence of the average values of carbon dioxide concentrations under the masks for selected people depending on the BMI and the type of mask was determined, as well as the measurements of carbon dioxide concentrations without the mask. An increase in carbon dioxide concentration was observed with increasing BMI. The development of effective self-defense tools against the virus, including masks, is essential to contain the spread of COVID-19.
... A previous study in 2003, during the SARS epidemic in Singapore, reported the prevalence of face mask-associated ECH was 37.3%. 8 Recently, research on the prevalence and risk factors of PPE-associated ECH was conducted in Singapore. In this study, the prevalence of ECH was 81.0%. 3 The secondhighest prevalence was 51.6% in a study conducted in Spain by Ramirez-Moreno et al. 9 Another study in Morocco reported that PPE-associated ECH was found in 32.9% of healthcare workers. ...
Article
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Personal protective equipment (PPE) in the COVID-19 pandemic era is essential for healthcare workers to decrease the risk of infection. The PPE, such as N95 masks and goggles, can trigger external-compression headache (ECH). This study aimed to determine the factors associated with the prevalence of ECH attributed to PPE usage. It was an analytic-observational study with a cross-sectional design conducted at Dr. M. Djamil Hospital Padang in May 2020. The subjects were healthcare workers (doctors and nurses) who used level 3 PPE for a minimum of 4 hours. The diagnosis of ECH was determined by the International Classification of Headache Disorders (ICHD) 3rd edition criteria. The Headache Screening Questionnaire (HSQ) determined the pre-existing primary headaches. The association between variables was analyzed using chi-square and Kruskal-Wallis tests. P-value<0.05 was considered statistically significant. A total of 113 healthcare workers participated in this study, consisting of 46 (40.7%) males and 67 (59.3%) females. The median age was 30 (23–46) years. ECH occurred in 102 (90.3%) respondents. Pre-existing primary headaches were present in 79 (69.9%) respondents, including migraine in 28 (23.6%) and tension-type headaches (TTH) in 46 (40.7%) respondents. The frontalis (69%) and temporalis (50.4%) were the most affected muscles. In this study, the significant factor associated with ECH was pre-existing primary headache (p=0.001, OR=7.795). There was a significant association between the pre-existing TTH (p=0.022) and ECH. There was a non-significant association between pre-existing migraine and ECH (p=0.284). In conclusion, the pre-existing primary headache was associated with the prevalence of ECH attributed to PPE usage.
... Besides, PPE-associated headache developed in 81% of healthcare providers based at pandemic outpatient clinics [36]. Another study likewise revealed that long-time wearing of N95 respirators was closely associated with headache complaints [37]. A recent study established that relatively long exposure time to N95 respirators (more than 6 h) also doubled (95%CI 1.35-3.01, ...
Article
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Background: Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. Aims: The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. Methods: The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. Results: Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). Conclusion: Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation.
... However, the higher the filtration efficiency of the mask, the greater the respiratory resistance, which may cause the amplification of respiratory fatigue due to the increase in respiratory resistance, and a decrease in the physical-work ability. In addition, the prolonged and continuous use of the mask can cause lung injury [17][18][19][20][21]. For this reason, it is important to wear personal protective equipment, but it is also important to reduce the concentration of oil mist in the workplace. ...
Article
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Oil mist adversely affects the health of workplace workers, and for this reason, regulations on the limitation of the oil-mist exposure of workers are becoming stricter. In order to reduce the amount of the exposure of workers to oil mist, it is important to effectively remove oil mist from machine tools. In this study, the collection efficiency according to the geometry of the oil-mist-collection cyclone consisting of several disks and the output power and rotation speed of the motor were evaluated. Most of the generated oil mists were less than 10 μm, and the mist removal was assessed using an optical particle counter. The cyclone airflow rate increased linearly with the rotational speed, and the rate was affected more by the cyclone geometry than by the power consumption. The mist-removal performance was significantly enhanced when plate- and cone-type disks were added to the rotating blades. The removal efficiencies of PM10 and PM2.5 under the maximum operational conditions of 5000 rpm and a flow rate of 3.73 m3/min were 93.4% and 78.4%, respectively. The removal capacity was more affected by the cyclone geometry than the rotational speed. The experimental results were similar to those predicted by the modified Lapple theory when an appropriate slope parameter (β) was used.
... [10][11][12] The use of N-95 masks led to pressure sores, abrasions, acneiform eruptions and folliculitis in our study whereas other studies reported acne, nasal bridge scarring, rash and facial headache. 8,13 In N-95, N stands for "National Institute of Occupational Safety and Health, and "95" indicates its filtering efficiency. The main mode of spread of has been found to be droplet infection thus masks need to be worn for prolonged hours increasing the risk of adverse effects. ...
Article
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The outbreak of a mysterious pneumonia, reported from a sea food wet market of Wuhan, Hubei, China in 2019 has now taken the shape of a pandemic with successive waves sweeping across nations and creating havoc. Moreover, the transmission speed is much more than earlier severe acute respiratory syndrome coronavirus (SARS) and Middle East respiratory syndrome coronavirus (MERS) making it imperative for the use of protective gears like masks, gloves and personal protective equipment(PPE) kits but ironically they in itself lead to a range of cutaneous complications making it difficult to continuously wear them. : The purpose of this study was to assess the various adverse dermatological manifestation among general population in view of the various precautions taken against COVID-19. This was a descriptive questionnaire based study and a total of ­105 patients were taken up for the study who came to the dermatology outpatient department(opd) with dermatological manifestations following covid 19 protection measures who met the inclusion criterias . All those who didn’t give consent for the study were excluded from the study. : A total of 105 questionnaires were collected. The males outnumbered the females with 71 males and 34 females. The most common reason implicated was wearing masks, goggles in 42(36.19%) patients followed by use of hand sanitizers and frequent hand washing seen in 36(12.4%) patients. In 20(19%) patients, use of gloves resulted in adverse dermatological manifestations followed by the use of PPE kits in 7(6.6%). : The prevalence of Covid -19 precaution taking measures is of utmost importance specially among the health care workers and office going people who have to adorn it for prolonged hours thus leading to adverse effects. Prompt diagnosis and this data can offer valuable insights to help modify the adverse effects.
... Side effects with respirators [53][54][55][56] include concentration problems, reduced working capacity [56], respiratory difficulties [48,[56][57][58], fogging glasses, difficulty with facial recognition and psychiatric symptoms. Headache was reported after prolonged use. ...
Article
In the past, the use of face masks in western countries was essentially limited to occupational health. Now, because of the COVID-19 pandemic, mask-wearing has been recommended as a public health intervention. As potential side effects and some contraindications are emerging, we reviewed the literature to assess the impact of them in daily life on patient safety and to provide appropriate guidelines and recommendations. We performed a systematic review of studies investigating physiological impact, safety, and risk of masks in predefined categories of patients, which have been published in peer-reviewed journals with no time and language restrictions. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. Wearing a N95 respirator is more associated with worse side effects than wearing a surgical mask with the following complications: breathing difficulties (reduced FiO2, SpO2, PaO2 increased ETCO2, PaCO2), psychiatric symptoms (panic attacks, anxiety) and skin reactions. These complications are related to the duration of use and/or disease severity. Difficulties in communication is another issue to be considered especially with young children, older person and people with hearing impairments. Even if benefits of wearing face masks exceed the discomfort, it is recommended to take an “air break” after 1–2 h consecutively of mask-wearing. However, well-designed prospective studies are needed. The COVID-19 pandemic could represent a unique opportunity for collecting large amount of real-world data.
... Among the health hazards, dyspnea is the most concerning, which might be due to increasing resistance during inhalation, the addition of 50-100 ml dead space (the mask area), and re-breathing of a small volume of exhaled gas within that space [32]. Furthermore, wearing the mask can increase end-tidal CO 2 levels [12,33,34]. Filtering masks usually offer more resistance than surgical masks [32], and doctors using filtering masks reported more respiratory distress than others in this study. ...
Article
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Background Wearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors. Methods This cross-sectional survey was conducted in Dhaka Medical College from March 01–May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies. Findings The mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period. Conclusions Healthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks.
... HWs conventionally use P2/N95 particulate respirators as protection against airborne infections, such as pulmonary tuberculosis, measles or chickenpox and for aerosol-generating procedures in patients with other respiratory diseases [5]. During the pandemic, prolonged use of P2/N95 respirators, which requires a tight seal on the face, has caused significant discomfort and facial skin damage [6][7][8]. A PAPR is an alternative respirator, previously reserved for managing high consequence infectious diseases (HCID), such as Ebola virus disease. ...
Article
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Background With the advent of COVID-19, many healthcare workers (HWs) in Australia requested access to powered air purifying respirators (PAPR) for improved respiratory protection, comfort and visibility. The urgency of the response at our hospital required rapid deployment of innovative training to ensure the safe use of PAPRs, in particular, a video-feedback training option to prepare HWs for PAPR competency. Aim To explore the feasibility, acceptability, and utility of video-feedback in PAPR training and competency assessment. Methods Semi-structured interviews were conducted with 12 HWs, including clinicians from Intensive Care, Anaesthetics and Respiratory Medicine, at a large teaching hospital in Australia. Findings Participants believed that the use of video-feedback in PAPR training was feasible, acceptable and useful. They described a variety of benefits to learning and retention, from a variety of ways in which they engaged with the personal video-feedback. Participants also described the impact of reviewing personalised practice footage, compared to generic footage of an ideal performance. Conclusion By conceptualising video-feedback using a pedagogical approach, this study contributes to knowledge around optimising methods for training HWs in PPE use, particularly when introducing a new and complex PPE device during an infectious disease outbreak.
... Wearing face masks for long durations have been associated with an increased incidence of headaches in HCPs. A short duration of wearing face masks should be preferred to reduce the severity of headaches [62]. It is well-known that prolonged use of face masks leads to breathlessness and often leads to hypoxic symptoms [63]. ...
Article
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Since December 2019, the global outbreak of coronavirus disease had a significant impact on humanity. Because of the large number of casualties worldwide, the WHO (World Health Organization) declared the coronavirus disease caused by SARS-CoV-2 a pandemic. Since the start of the pandemic, facial masks have become essential as well as mandatory to protect ourselves from COVID-19. As a result of the pandemic, healthcare professionals (HCPs) have been required to wear personal protective equipment (PPE) for extended periods. Wearing face masks for an extended period has been shown to have several negative effects on HCPs. Additionally, face masks have hampered the use of digital techniques for facial identification. This paper examines the effects of wearing face masks for an extended period, as well as the effect of wearing face masks on facial identification technology. The Web of Science, PubMed, and Scopus databases were searched and screened for relevant studies. According to the current review, prolonged use of masks was found to be associated with adverse effects on the face and skin, including acne, redness, rashes, and itching. The use of masks also resulted in headaches, hypoxic conditions, and changes in voice and speech parameters. This communication in no way intends to advocate the discontinuation of wearing masks, on the contrary, the primary goal of this article is to spread awareness about the adverse effects associated with prolonged use of facial masks (N95, KF94, or surgical). This will help in increasing compliance with mask mandates by helping to develop preventive solutions to the problems that tend to deter the general public. This also demonstrates how the use of masks has become a challenge for facial recognition technologies.
... Headache is one of the most prominent complaints among those who wear masks for more than 4 h together. [20,22] Several factors have been associated with headaches in face mask wearers. Some of them can be tight mask straps, dehydration, and altered eating patterns. ...
Article
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e pandemic has forced the health-care system to adopt newer approach toward patient care. With the changing scenario of health-care delivery, ophthalmologists had to bring about several changes in the way, the patients are seen and operated on. Contact procedures were entirely restricted to emergencies while modifications were introduced to minimize the exposure of the surgeon. However, these modifications were introduced just keeping in mind the spread of infection. e probability that these modifications could affect the optics in ophthalmology is high and cannot be ruled out. e aim of the study was to highlight the effects of modifications introduced in ophthalmic equipment during the pandemic over the visibility for the surgeon and discuss its impact on patient care in ophthalmology. orough search of the literature on PubMed using keywords, visibility and personal protective equipment (PPE), fogging and PPE, face mask and fogging, aberrations and PPE, and surgeries and PPE were done. We found 35 articles which highlighted the effects on visibility with PPE and effects on eyes with prolonged wearing of masks. Several factors have contributed to reduction in visibility for the surgeon. ese factors have, in turn, affected the overall quality of examination and surgical outcome in ophthalmology. e use of PPE during the pandemic could have been a contributory factor for missing relevant findings during examination of patients. For ophthalmologists in particular, the visibility and optics play a crucial role in the management of the patient and have been invariable affected by introduction of modifications at the instrument and surgeon level.
... The prolonged use of a respirator may cause fatigue, increased CO2 levels, and decreased O2 levels, resulting in hypercapnia or hypoxaemia, which can lead to headaches [41]. Likewise, hypoxaemia was observed with N95 masks, especially with greater respiratory rate and increased incidence of discomfort in the chest during a four-hour use [42], which was similar to our findings. High-resistance breathing resulted in respiratory exhaustion in muscles and physical pain. ...
Article
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This study explored the ideal period for wearing masks to prevent the physiological and psychological problems associated with long-term face mask use during respiratory infections by healthcare workers. Breathing simulators, surgical masks (SM) and medical respirators (PM) were prepared for two to eight hours. Changes in the comfort of masks (facial skin temperature, breathing resistance, and moisture permeability) and protection (filtration efficiency, resistance to blood penetration, and colony count) were assessed. The results demonstrated that the masks offered efficient liquid-particle filtering even after eight hours of use. However, the number of bacterial colonies using PM and SM grew significantly after two and four hours, respectively. Concerning comfort, the inspiratory resistance of masks rose dramatically after two hours, whereas the moisture permeability declined considerably after four hours. In addition, skin temperature had a significant increase within two hours, which may result in facial discomfort. When conditions permitted, the hospital staff was instructed to replace their masks every two hours.
... Accordingly, headache, light-headedness, pain behind the ear or other contact points, skin damage, including acne, sore nasal bridges, itchy face, rash/irritation, discomfort related to skin temperature, difficulty in breathing, and discomfort when speaking had been reported in various studies before the emergence of the COVID-19 pandemic. [47][48][49][50][51][52][53] In line with the findings, Chughtai et al. 54 identified common problems associated with using various types of PPE, such as breathing problems, feelings of suffocation, heat stresses, hearing problems, inconveniences, and foggy glasses. ...
Article
Background: It is widely believed that using personal protective equipment (PPE) provides high levels of protection for healthcare workers (HCWs) in the fight against coronavirus disease (COVID-19). However, the long-term use of PPE is inconvenient for HCWs and may cause physical discomfort. These factors could result in poor compliance and disrupt the health and safety of HCWs, which may negatively affect the patient's safety. Objective: This study aimed to investigate the literature for the purpose of collecting convincing evidence of HCWs' physical problems associated with PPE use during the COVID-19 pandemic. Methods: This scoping review was conducted using PubMed, Embase, ProQuest, Science Direct, Springer, Biomed Central, and Google Scholar to identify the related literature. Results: HCWs have experienced various physical disorders including skin, respiratory, musculoskeletal, nervous, urinary, and circulatory system problems that are associated with PPE in various body systems. Among these, skin problems were the most frequent physical problems. Conclusions: The literature demonstrated the adverse impacts of using PPE on HCWs. Therefore, healthcare policymakers should take the appropriate measures to improve the work environment during the COVID-19 pandemic, which could consequently prevent and mitigate the adverse effects of using PPE.
Research
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The study examines the prolonged use of personal protection equipment (PPE) among nurses in Qatar during the height of the COVID-19 pandemic utilizing a qualitative, phenomenological research approach. Qatar is the specific locale of the study, where thirty nurse frontliners, selected through convenient purposive sampling, participated in key informant interviews and focus group discussions via face-to-face and zoom meetings. An interpretative phenomenological analysis (IPA) was employed to dissect and distill key thematic categories and insights related to the nurses' experience, and validation of thematic results was done through focus group discussions for triangulation. The analysis indicated positive and negative impressions and insights; positive impressions were categorized as opportunities and negative impressions as challenges. There were two major thematic categories under opportunities: the feeling of safety and security (82.86%) and confidence to perform the task (17.
Article
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Several concerns regarding the safety of face masks use have been propounded in public opinion. The objective of this review is to examine if these concerns find support in the literature by providing a comprehensive overview of physiological responses to the use of face masks. We have performed a systematic review, pairwise and network meta-analyses to investigate physiological responses to the use of face masks. The study has been registered with PROSPERO (C RD42020224791). Obtained results were screened using our exclusion and inclusion criteria. Meta-analyses were performed using the GeMTC and meta R packages. We have identified 26 studies meeting our inclusion and exclusion criteria, encompassing 751 participants. The use of face masks was not associated with significant changes in pulsoxymetrically measured oxygen saturation, even during maximal-effort exercises. The only significant physiological responses to the use of face masks during low-intensity activities were a slight increase in heart rate, mildly elevated partial pressure of carbon dioxide (not meeting criteria for hypercarbia), increased temperature of facial skin covered by the mask, and subsequent increase of the score in the rating of heat perception, with N95 filtering facepiece respirators having a greater effect than surgical masks. In high-intensity conditions, the use of face masks was associated with decreased oxygen uptake, ventilation, and RR. Face masks are safe to use and do not cause significant alterations in human physiology. The increase in heart rate stems most likely from increased respiratory work required to overcome breathing resistance. The increase in carbon dioxide is too small to be clinically relevant. An increased rating of heat perception when using face masks results from higher temperature of facial skin covered by the mask.
Article
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Introduction: The use of personal protective equipment during the COVID-19 pandemic has affected the majority of the global population. The use of face masks has been proven to reduce the incidence of COVID-19 by 53 % and to be an effective means of prevention, both separately and in combination with other non-pharmaceutical measures. Wearing of face masks and gloves was mandated in different regions of the Russian Federation depending on the epidemiological situation, and it is still required in certain areas and workplaces at high risk of this severe infectious disease. Our literature review has shown that the prolonged mask and gloves use has adverse health effects including headaches, difficulty breathing, and various skin reactions. Objective: To analyze chemicals contained in commercially available face masks and protective gloves as one of the stages of hygienic assessment of personal protective equipment and to assess whether the established chemical composition can pose a risk of adverse health outcomes. Materials and methods: In 2021, four types of commercial face masks and protective gloves were analyzed in an accredited testing laboratory center to establish concentrations of chemicals after modeling their release into the aquatic and air environment. Results: We established that, in all types of masks, the levels of detected chemicals did not exceed their appropriate permissible values. Formaldehyde was found in cotton and latex coated cotton gloves in concentrations exceeding the permissible ones by 1.48 and 1.16 times, respectively. A 1.17-fold excess of the acceptable limit was also registered for zinc in latex coated cotton gloves. Conclusions: Increased levels of formaldehyde and zinc were found in cotton and latex coated cotton gloves. Formaldehyde can induce adverse skin reactions. Stricter control over production of respiratory and dermal protective equipment and a comprehensive hygienic assessment of PPE are required.
Article
The orthopedic environment exposes surgeons and staff to infection, surgical smoke, and high levels of noise. It is helpful to understand how exposure increases risk for adverse health consequences. Protective equipment, safety protocols, and instrument modification can reduce exposure to hazards. When modifications to practice are made, they must be evaluated to ensure they do not introduce new hazards or impede the use of instruments. Despite evidence of risk, protective measures are seldom employed in orthopedic practice. Wider implementation of protection for clinicians may not occur unless the same hazards are shown to impact patient outcomes.
Article
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Background: Coronavirus disease 2019 (COVID-19) began in 2019 with several unknown factors. The World Health Organization (WHO) subsequently developed COVID-19 occupational safety and health (OSH) guidelines to reduce occupational COVID-19 transmission. Many countries also developed their own COVID-19 OSH guidelines, but whether these guidelines included WHO's guidelines and whether including WHO's guidelines in countries' COVID-19 OSH guidelines reduced COVID-19 transmission is unknown. Objectives: The objectives of our study were to (1) compare the COVID-19 OSH guidelines of several countries to WHO's OSH guidelines, (2) estimate associations between characteristics of countries and their OSH guidelines and the number of WHO's OSH guidelines included in countries' OSH guidelines, and (3) estimate associations between WHO's OSH guidelines included in countries' OSH guidelines and COVID-19 risk, death risk, and case-fatality proportion. Methods: This study represents international, ecological research of 36 countries from all six world health regions. Countries' COVID-19 OSH guidelines were compared with WHO's OSH guidelines. Linear regression models adjusted for potential confounders were used to estimate associations of interest. Results: The median number of WHO's 15 COVID-19 OSH guidelines included in countries' COVID-19 OSH guidelines was eight. Countries' COVID-19 OSH guidelines focused on workers included significantly more of WHO's COVID-19 OSH guidelines than countries' COVID-19 OSH guidelines focused on general populations. Including "provide personal protective equipment for workers" and "create workplace policy for wearing personal protective equipment" in countries' COVID-19 OSH guidelines were significantly related to decreased COVID-19 risk, death risk, and/or case-fatality proportion. Conclusions: Countries' COVID-19 OSH guidelines should include WHO's guidelines, focus on workers, and include "provide personal protective equipment for workers" and "create workplace policy for wearing personal protective equipment."
Article
Personal protective equipment (PPE) compliance in healthcare settings has continued to be an issue before and during the pandemic. The purpose of this study was to understand the overall experience of healthcare workers with PPE, including types and uses of PPE, their duties, satisfaction, and dissatisfaction with PPE. By examining the PPE design characteristics and requirements of healthcare workers, the ultimate goal is to redesign PPE to increase comfort and work efficiency. As a pilot study, one-to-one online interviews were conducted with three healthcare workers who had experience wearing PPE while working in a hospital. The transcripts were analyzed using NVivo software, and a total of 5 subgroups were created based on the 69 unique codes by grouping them into semantic units: environmental situation and characteristics, satisfaction, improvement and suggestion, issues and problems, and PPE wearing experience. Masks (N95 and surgical), eye protections (goggle and face shield), gowns, and gloves were investigated, and high risk of infection, discomfort and distrust about reusing PPE, low degree of protection, low usability, and low work efficiency were observed.
Article
Introduction The use of personal protective equipment increased rapidly during the COVID-19 pandemic that began in 2019. The purpose of this study was to examine the effects of uninterrupted 4-hour use of internationally certified nonvalved filtering facepiece respirators on venous blood gas in health care workers during the COVID-19 pandemic. Methods A before-after design included venous blood gas analyses collected at the beginning of shifts before nonvalved filtering facepiece respirator had been put on and after 4-hour uninterrupted use of nonvalved filtering facepiece respirator. Results In this study, 33 volunteer health care workers took part. In terms of blood gas values, mean pCO2 values were 47.63 (SD = 5.16) before and 47.01 (SD = 5.07) after nonvalved filtering facepiece respirator use, mean HCO3 values were 23.68 (SD = 1.10) in first blood gas analysis and 24.06 (SD = 1.31) in second blood gas analysis, and no significant difference was observed between before and after the use of nonvalved filtering facepiece respirator (t = 0.67, P = .50, t = −2.0, P = .054, respectively). The only significant difference in parameters investigated between the groups was in pH levels, at pH = 7.35 (SD = 0.29) before and pH = 7.36 (SD = 0.20) after nonvalved filtering facepiece respirator use (t = −2.26, P = .03). Conclusion Continuous nonvalved filtering facepiece respirator use for 4 hours was not associated with clinician impairment in blood gas and peripheral SpO2 levels during nonexertional clinical ED work.
Article
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Background and aim Headaches related to the use of personal protective equipment (PPE) could affect performance at work in healthcare personnel. Our aim was to describe the prevalence and risk factors for headaches related to PPE, in the personnel of a specialized coronavirus disease 2019 (COVID-19) tertiary hospital. Methods In this cross-sectional survey study, we invited healthcare workers from COVID-19 referral center in Mexico (May 22–June 19, 2020) to answer a standardized structure questionnaire on characteristics of new-onset PPE-related headache or exacerbation of primary headache disorder. Participants were invited regardless of whether they had a current headache to avoid selection bias. This is the primary analysis of these data. Results Two hundred and sixty-eight subjects were analyzed, 181/268 (67.5%) women, 177/268 (66%) nurses, mean age 28 years. The prevalence of PPE-related headache was 210/268 (78.4%). Independent risk factors were occupation other than physician (OR 1.59, 95% CI 1.20–2.10), age > 30 years (OR 2.54, 95% CI 1.25–5.14), and female sex (OR 3.58, 95% CI 1.86–6.87). In the 6-month follow-up, 13.1% of subjects evolve to chronic headache, with stress as predictive risk factor. Conclusion The frequency of PPE-associated headache is high, and a subgroup could evolve to chronic headache. More studies are necessary to improve the knowledge about this condition.
Article
Since the outbreak of COVID-19, wearing personal protective equipment (PPE) has become increasingly common, especially for healthcare workers performing nucleic acid sample collection. A field experiment and questionnaire survey were conducted in a semi-open transition space of a university building in Guangzhou, southern China. Thirty-two subjects wore PPE to simulate nucleic acid sample collection, during which thermal parameters were recorded and subjective questionnaires were completed. The relationship between thermal sensation and thermal index was analyzed to determine the neutral temperature and comfort temperature zones. Subjects had higher requirements for thermal environment parameters when wearing PPE than when not wearing PPE, and were found to have statistically significant differences in thermal perception when wearing and not wearing PPE. Wearing PPE significantly raised the subjects' thermal and humidity sensations and restricted their airflow. Wearing PPE resulted in thermal discomfort for the subjects and a high unacceptability rate for environmental thermal parameters. The subjects wore PPE for an acceptable duration of approximately 1.5 hours. The neutral operative temperatures were significantly lower when wearing PPE than when not wearing PPE, and the deviation from the neutral temperature was 9.7 °C. The neutral operative temperature was 19.5 °C and the comfort temperature zone was 17.4–21.5 °C when subjects wore PPE, demonstrating that subjects who wore PPE preferred lower temperatures. These results suggest that people who wear PPE for work, especially outdoors, should receive more attention to ensure thermal comfort and safety.
Chapter
The outbreak of COVID-19 has raised a worldwide need for effective measures to break the transmission chain of the virus and limit its R number to prevent the spread. Various preventive measures include vaccination, face masks, sanitizers and disinfectants, social distancing, and lockdown. However, face masks are the most critical public health preventive measure to combat various viruses and pathogens due to their airborne nature. Touted as a game-changing technology, nanotechnology has shown immense potential in research and development related to face masks. The inclusion of nanomaterials in the mask has addressed various problems related to bulk materials based on conventional masks, including the efficiency of filtering virus and pathogens, retaining of viruses over the mask surface, breathing and other respiratory issues, facial skin problems, and disposal-related issues. This chapter illustrates the use of various nanotechnology-based materials, including graphene, nanoparticles, nanofibers, nano-membranes, and nanocomposites, to fabricate nano-masks. It also focuses on the advantages of nano-masks over conventional masks based on bulk materials. Further, prospects and suggestions for limiting nano-waste due to nanomaterials in textiles have also been proposed.
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Background: Since the emergence of COVID-19, mandatory facemask wearing has been implemented around the world to prevent viral transmission, however, the impact of wearing facemasks on patients with COPD was unclear. Methods: The current study undertakes a systematic review and meta-analysis of a comprehensive literature retrieval from six databases, based on the pre- determined eligibility criteria, irrespective of language. The risk of bias was assessed using an established instrument. We primarily focused on analyzing ETCO2, SpO2, and heart and respiratory rates, and also considered the impacts on physiological and exercise performance. A descriptive summary of the data and possible meta-analysis was performed. Forest plots were generated to pool estimates based on each of the study outcomes. Results: Of the 3,751 publications considered, six publications were selected for a systematic review and two publications were included for meta-analysis, however, the quality of these six studies was relatively low overall. In the case of inactivity, the facemask wearing COPD cohort had higher respiratory rates than that of the non-facemask wearing cohort (MD = 1.00 and 95% CI 0.47–1.53, P < 0.05). There was no significant di􀀀erence in ETCO2 (MD = 0.10 and 95% CI −1.57–1.78, P > 0.05) and heart rate (MD = 0.40 and 95% CI −3.59–4.39, P > 0.05) nor SpO2 (MD = −0.40 and 95% CI −0.84–0.04, P > 0.05) between the COPD patients with and without facemasks. Furthermore, it was observed that the only significant difference between the COPD patients with and without facemasks undertaking difference activities were FEV1 (%) (MD = 3.84 and 95% CI 0.14–7.54, P < 0.05), FEV1/FVC (%) (MD = 3.25 and 95% CI 0.71–5.79, P <0.05), and blood lactate (MD = −0.90 and 95% CI −1.73 to −0.07, P < 0.05). Conclusion: Wearing facemasks decreased the exercise performance of patients with COPD, however, it had minimal impact on physiological indexes.Further investigations will be performed on the high-quality data from randomized control studies.
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Background Wearing protective face masks has been one of the indispensable measures to prevent droplets and aerosol particles transmission during the SARS-CoV-2 pandemic. This observational cross-sectional survey investigated the different types and modalities of protective mask wearing and the possible association with referred temporomandibular disorders by respondents. Methods An online-questionnaire was developed, calibrated and administered anonymously to subjects with an age of ≥ 18 years. It consisted of different sections: demographics, type and wearing modalities of the protective masks, pain in the preauricular area, noise at the temporomandibular joints and headache. Statistical analysis was performed with R software. Results The questionnaire received 665 replies mainly from participants aged 18–30 years (315 males, 350 females). 37% of participants were healthcare professionals, 21.2% of them were dentists. 334 subjects (50.3%) mostly used the Filtering Facepiece 2/ Filtering Facepiece 3 (FFP2/FFP3) mask, and 578 (87%) wore the mask with two elastics behind the ears. 400 participants referred pain while wearing the mask, and 36.8% of them referred pain with a consecutive use of more than 4 hours (p = 0.042). 92.2% of participants did not report any TMJ noise. 57.7% of subjects referred headaches associated with the FFP2/FFP3 (p = 0.033). Conclusions This survey highlighted the increased referred presence of orofacial pain in the preauricular area and temporal headache associated with a prolonged use of protective face masks for more than 4 hours during the SARS-CoV-2 pandemic.
Article
Background Owing to the highly contagious nature of SARS-CoV-2, the use of personal protective equipment (PPE) among the healthcare workers (HCWs) is mandatory. However, PPE associated adverse effects are also there. Objective To study the adverse effects associated with PPE and their preventive measures amongst the HCWs. Material and Methods A descriptive study was conducted among 200 HCWs working in a Covid center of a tertiary care center. The participants were sent the questionnaires online. Some of them not having smart phones were interviewed telephonically. Their information profile, the various adverse effects associated with PPE, and the preventive measures being practiced by them were noted. Data was analyzed using descriptive and inferential statistics. Results Total 97% HCWs reported adverse effects with hazmat suit; 96% with N 95 mask; 92% with goggle and 78% with gloves. The adverse effects associated with the prolonged use of the mask were erythema; erosions and scar at the nasal bridge; ear pain; difficulty in breathing; and headache. Sixty-seven percent of the participants had sweating with the use of gloves, which led to cutaneous exfoliation such as dry hands (55%) and skin itching (43%). Moisturizers and natural oils were used to prevent the dryness of hands. For the pressure related injury over the nasal bridge due to N95 mask, participants used to apply Band-Aid (adhesive bandage) and cotton dressing. Conclusion Adverse skin reactions related to PPE are common among HCWs. Comprehensive assessment of the skin condition and awareness on adverse skin reactions should be advocated.
Article
Introduction: The World Health Organisation (WHO) recommends that N95 masks should be used by healthcare workers and patients. Given the shortage, extended use and reuse of masks, it becomes imperative to test the filtration efficacy. Surgical masks and cloth covers should also be assessed for their protection factor, since their use is more prevalent among the general population, and these masks are not certified by National Institute for Occupational Safety and Health (NIOSH). Occupational Safety and Health Administration (OSHA) is the authority for the standard testing and certification of Filtering Face Pieces (FFPs) in the USA; its equivalent in India is the Bureau of Indian Standards (BIS). The BIS recently relaxed the certification guidelines for both N95 and Surgical Masks; thus, even certified masks may prove to be inefficient. Aim: To assess different face masks using povidone-iodine in comparison to standard saccharin method. Materials and Methods: A cross-sectional study was carried out in a tertiary care hospital in western India from August 2021 to October 2021. A novel, qualitative (and semi-quantitative) function test using an aerosol of iodine solution and detector strips of starch-iodide paper was studied to prove for efficacy of masks by 15 volunteers and various masks of different types (surgical, N95, cloth) over three months. This method provides a rapid, simple and cost-effective assessment of respirator efficacy. Results: Thirty five masks (N95, Surgical, Cloth and Silver nanoparticle) were tested, of which N95 - 90% pass the test. A 2 out of 5 trials of the double layered cloth mask + surgical mask combination passed both the iodine and saccharin tests. The sensitivity and specificity of proposed iodine test in comparison to standard saccharin test were (10/10, 100%) and (22/25, 88%). Conclusion: Povidone-iodine method is a qualitative assessment which is a crude indicator of mask function as the masks that fail both tests will provide some degree of protection from airborne particles, and concentrations of many respiratory organisms. The N95 masks along with the double masks (surgical and cloth) passed the tests proving their efficacy.
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Motorbikes are by far the dominant mode of transportation in Ho Chi Minh City (HCMC). They solve mobility problems but represent a health risk since riders are directly exposed to noxious exhaust fumes. Hence, face masks emerge as a solution to reduce exposure to harmful particles. The manufacturers of these masks report that they can significantly reduce particle exposure on roads with vehicular traffic. Such reports are usually based on laboratory assessments, with limited data from field experiments. To evaluate the performance of the masks commonly worn by HCMC commuters under quasi-real exposure conditions, we tested the total inward leakage of particles (i.e., including penetration through the filter media, and leaks from the face seal and exhalation valve if the mask is equipped with one) of six representative masks mounted on manikins at the curbside of two busy roads during high traffic time periods. Several particle metrics, including mass and number concentrations, active surface area, and abundances of equivalent black carbon and particle-bound polycyclic aromatic hydrocarbons were measured to determine the protection level provided by masks against distinct types of particles. As part of this study, through a set of measurements using the same instrumentation we found that commuters are exposed to a mix of freshly emitted particles and aged particles, including contributions from sources other than motorbike exhaust, such as trash burning and street food stalls. Ultrafine particles, especially those in the nucleation mode (< 50 nm), turned out to be the dominant fraction in terms of number concentration. This study focused its evaluation on these particles. We found that no mask can completely remove all particles under practical conditions. It is largely due to inappropriate mask fitting. Performance efficiency of 60-80% was achieved by an N95 respirator, a reusable valved filtering mask, and a locally manufactured carbon-layer sandwiched mask. Surgical and cloth masks achieved efficiencies of 25-60%. The results show that any face mask provides some level of protection. Efforts should be made to provide end users with practical information on the effectiveness of masks under real conditions, and informing on how to best fit each mask to increase effectiveness.
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Face masks have been used as the most effective and economically viable preventive tool, which also creates a sense of social solidarity in collectively combatting the airborne health hazards. In spite of enormous research literature, massive production, and a competitive market, the use of modern age face masks-respirators (FMR) is restricted for specific purposes or during public health emergencies. It is attributed to lack of awareness, prominent myths, architect and manufacturing limitations, health concerns, and probable solid waste management. However, enormous efforts have been dedicated to address these issues through using modern age materials and textiles such as nanomaterials during mask fabrication. Conventional FMRs possess bottlenecks of breathing issues, skin problems, single use, fungal infections, communication barrier for differently abled, inefficiency to filter minute contaminants, sourcing secondary contamination and issue of solid-waste management upon usage. Contrary, FMR engineered with functional nanomaterials owing to the high specific surface area, unique physicochemical properties, and enriched surface chemistries address these challenges due to smart features like self-cleaning ability, biocompatibility, transparency, multiple usages, anti-contaminant, good breathability, excellent filtration capacity, and pathogen detecting and scavenging capabilities. This review highlights the state-of-the-art smart FMR engineered with different dimensional nanomaterials and nanocomposites to combat airborne health hazards, especially due to infectious outbreaks and air contamination. Besides, the myths and facts about smart FMR, associated challenges, potential sustainable solutions, and prospects for "point-of-action" intelligent operation of
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Background: The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados. Methods: A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms. Results: Most of the respondents used PPE for consecutive days (77.9%), 1–6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions. Conclusion: The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse events.
Article
Purpose : This study aimed to identify post-traumatic stress disorder (PTSD) and burnout experienced by healthcare providers who cared for patients with Coronavirus Disease 2019 (COVID-19) and their influencing factors.Methods : Data were collected from 135 healthcare providers who cared for patients with COVID-19 in a tertiary general hospital from June 8 to September 2, 2021, using a questionnaire. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, t-test, ANOVA and Scheffe’s test, Pearson’s correlation coefficients, and multiple regression were used for analysis using SPSS/WIN 27.0.Results : Participants’ average PTSD score was 9.31 ± 11.80, and 8.9% were in the high-risk group. Participants’ average burnout score was 51.77±21.28, and 62.2% were at high risk. PTSD scores differed significantly according to participants’ age, education, job, position, and current workplace. Burnout scores differed significantly according to their age, gender, marital status, parental status, and education. There was positive correlation between participants’ PTSD and burnout. The factors influencing participants’ PTSD were term of self-isolation and age (R<sup>2</sup>=.09). There were no significant influencing factors on participants’ burnout.Conclusion : This study reconfirmed that healthcare providers who cared for patients with COVID-19 experienced both PTSD and burnout, suggesting that interventions are needed such as regular pre-training or simulation training and establishing a support system.
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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.
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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.