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Verduyckt I, Chang T, Creagh S, Taleb H. Self-reported voice difficulties in educational professionals during COVID-19 in Quebec: a cross-sectional mixed-methods study. LOGOP PHONIATR VOCO 2024; 49:66-74. [PMID: 36256890 DOI: 10.1080/14015439.2022.2121986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 05/11/2022] [Accepted: 09/02/2022] [Indexed: 10/24/2022]
Abstract
Background: The health measures imposed by COVID-19 on workplaces created adverse communication settings. Our cross-sectional study aimed to document the nature and severity of the vocal difficulties experienced by educational professionals a few weeks after the implementation of health measures in schools and early childhood settings in Quebec, Canada while teaching in class.Methods: To this end, we conducted a self-report survey containing nine close-ended questions and one open-ended question regarding self-reported vocal difficulties and the implementation of health measures. The survey was answered by 194 educational professionals in October 2020.Results: Since the introduction of the health measures, respondents reported often or always: having difficulty making themselves heard (66.5%), needing to strain their voice (68.1%), having throat pain after work (38.1%), and being concerned about their vocal health (25.2%). 35.6% perceived that their voice changed moderately or a lot and 75.3% did not feel equipped to take care of their vocal health. Fisher's exact tests revealed the difficulties overall were more present in women (p < 0.05).Discussion: The qualitative analysis of open-ended question answers shows a circular process at play, where the vocal responses to the COVID-19-induced communication barriers contribute to creating more problematic communication settings, thus increasing the challenges for vocal health. Better equipping the professionals to take care of their vocal health by developing resources in their professional settings to help them face vocal challenges in both every day as well as extreme situations, should be a priority.
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Affiliation(s)
- Ingrid Verduyckt
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain, Montréal, Canada
| | - Tiffany Chang
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain, Montréal, Canada
| | - Sinead Creagh
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain, Montréal, Canada
- Faculty of Education, University of Hong Kong, Hong Kong, Hong Kong
| | - Hanaa Taleb
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Canada
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Hamdan AL, Jabbour C, Ghanem A, Ghanem P. The Impact of Masking Habits on Voice in a Sub-population of Healthcare Workers. J Voice 2024; 38:918-921. [PMID: 34986996 PMCID: PMC8720484 DOI: 10.1016/j.jvoice.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the impact of face masks on voice in a sub-population of healthcare workers, namely residents, medical students, and nurses, during the COVID-19 era. MATERIALS AND METHODS A cross-sectional study was conducted in a large tertiary care center where a 23-items web-based questionnaire was conveyed to sub-population of healthcare professionals, namely residents, medical students, and nurses. The questionnaire included demographic data, type, and duration of mask use. Voice outcome measures included the Voice Handicap Index (VHI)-10 questionnaire and the visual analogue scale for vocal effort and vocal fatigue. RESULTS A total of 178 participants answered the survey. One third had an abnormal score on the VHI-10 questionnaire, one third reported moderate to severe vocal fatigue, and 45% of the participants had moderate to severe vocal effort based on a visual analogue scale score. There was a significant association between the type of mask used and vocal fatigue (P = 0.044). No significant association was seen between the duration of mask used and the different voice outcome measures. CONCLUSION Masking habits during the COVID-19 pandemic were associated with a high prevalence of vocal fatigue, effort and abnormal VHI-10 score among residents, medical students, and nurses.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otorhinolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Christopher Jabbour
- Department of Otorhinolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anthony Ghanem
- Department of Otorhinolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Paola Ghanem
- Department of Medical Oncology, Johns Hopkins University, Baltimore, Maryland
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Altan E, Barmak E, Tatar EÇ, Saylam G, Korkmaz MH. Which Mask, N95 or Surgical Mask, Causes Hoarseness in Healthcare Workers? J Voice 2024:S0892-1997(24)00154-1. [PMID: 38902143 DOI: 10.1016/j.jvoice.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES This study aimed to determine the impact of different types of masks on the voices of healthcare professionals who had to wear masks for an extended amount of time during the pandemic period and had a healthy voice. METHODS Our research included 41 healthcare workers. The participants were separated into two groups: surgical (n = 21) and N95 mask users (n = 20). Healthcare workers evaluated masks before and after wearing them for at least 8 hours throughout the workday. All subjects had a videolaryngoscopic examination; the Voice Handicap Index-10 (VHI-10), GRBAS, acoustic voice analysis (F0, jitter%, shimmer%, noise/harmonic ratio, relative average perturbation [RAP]), aerodynamic measures (maximum phonation time, MPT), and blood oxygen saturation were evaluated. RESULTS Although both groups' VHI-10 scores increased after using the mask, this rise was not statistically significant in our research. According to the GRBAS classification, voice quality deterioration was identified in 9.6% (mild-moderate) of the group using surgical masks and 15% (mild) of the group wearing N95. Only the jitter and RAP values of individuals wearing both surgical and N95 masks were determined to be statistically significant. There was no significant change in MPT following mask wear in either group. Both the surgical and N95 mask-using groups showed a substantial drop in blood oxygen saturation before and after mask usage. CONCLUSION There was no change in voice quality between healthcare workers wearing surgical and N95 masks. It has been noticed that voice perception and quality are affected by the mask's barrier effect rather than the kind of mask.
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Affiliation(s)
- Esma Altan
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Elife Barmak
- Ankara Yıldırım Beyazıt University Department of Speech and Language Therapy, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Private Practice Dr, Etlik City Hospital, Ankara, Turkey
| | - Guleser Saylam
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Lokman Hekim Hospital, Ankara, Turkiye
| | - Mehmet Hakan Korkmaz
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Private Practice Dr, Etlik City Hospital, Ankara, Turkey
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Song Z, Lee PJ. Voice use of nurses working in the intensive care unit during the COVID-19 pandemic. Intensive Crit Care Nurs 2024; 82:103620. [PMID: 38232571 DOI: 10.1016/j.iccn.2023.103620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/12/2023] [Accepted: 12/24/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE This study aimed to investigate the voice use of nurses working in intensive care units (ICUs) and their perception of acoustic environments. SETTING AND SAMPLE The research was conducted in four different hospitals in China during the COVID-19 pandemic. A total of 60 ICU nurses were recruited for their voice use monitoring and 100 nurses participated in the survey. RESEARCH METHODOLOGY Firstly, voice-related parameters such as voice level (SPL, dB), fundamental frequency (F0, Hz), and voicing time percentage (Dt, %) were measured using a vocal monitor. To collect data, a non-invasive accelerometer was attached to the participants' necks during their working hours. Secondly, the perception of the ICU acoustic environment was assessed using semantic differential. RESULTS The results showed that nurses spoke approximately 0.9-4 dB louder to patients and colleagues in ICUs compared to quiet rooms, and their fundamental frequency (F0) significantly increased during work. The voice levels of nurses were influenced by background noise levels, with a significant correlation coefficient of 0.44 (p < 0.01). Furthermore, the background noise levels ranged from 58.1 to 73.9 dBA, exceeding the guideline values set by the World Health Organisation (WHO). The semantic differential analysis identified 'Stress' and 'Irritation' as the two main components, indicating the prevalence of negative experiences within ICUs. IMPLICATIONS FOR CLINICAL PRACTICE This study highlights the potential risk of voice disorders among ICU nurses. The findings also underscore the importance of implementing strategies to reduce noise levels in ICUs to reduce voice disorders among nurses.
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Affiliation(s)
- Ziwei Song
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, UK
| | - Pyoung-Jik Lee
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, UK.
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Shekaraiah S, Suresh K. Effect of Face Mask on Voice Production During COVID-19 Pandemic: A Systematic Review. J Voice 2024; 38:446-457. [PMID: 34802856 PMCID: PMC8502684 DOI: 10.1016/j.jvoice.2021.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Coronavirus Disease 2019 (COVID-19) is an ongoing global pandemic and wearing face mask is recommended across the globe to break the transmission chain of infection. The masks available in the market are of different types and materials and tend to alter the voice characteristics of the speaker. This can therefore impair optimal communication and the present study is a systematic review exploring the effect of various masks on voice production parameters. STUDY DESIGN Systematic review. MATERIALS AND METHODS The titles and abstracts screening was carried out for the inclusion of articles using eight electronic databases spanning the period from 1st January 2020 to 30th April 2021. 10 articles (8 published & 2 in pre-print) that met the inclusion criteria were considered for this systematic review and the pooled age range was 18 -69 years. RESULTS Three primary studies from the USA, 2 each from Australia & Italy, one each from Brazil, China, and Germany were found to have investigated the influence of wearing N95, KN95, surgical and fabric masks on voice related measures. The users significantly reported vocal fatigue, discomfort, and also perceived voice problems. Attenuation of speech sound amplitude was highest for the transparent mask followed by cloth mask, N95, KN95, and surgical mask. CONCLUSION The World Health Organization (WHO) has been repeatedly endorsing the need to use a face mask in the current COVID-19 pandemic. However, for an unintruded voice production, the surgical mask is recommended for everyone, including healthcare professionals when they are not in close contact with patients, and not involved in aerosol-generating procedures. For teachers, doing direct teaching (offline classes), 'surgical mask' can reduce the vocal load of teachers, smoothen the teacher-student interaction and thereby facilitate better learning by the students. Additionally, it would be useful to protect oneself from the risk of developing voice problems by following standard vocal healthcare tips.
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Affiliation(s)
- Sheela Shekaraiah
- Department of Speech and Hearing, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, India.
| | - Kiran Suresh
- A. J. Institute of Speech and Hearing (AJISH), Mangalore, Karnataka, India
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Polo N, Lã FMB. Self-Perceived Voice Handicap During COVID19 Compulsory Facemask Use: A Comparative Study Between Portuguese and Spanish Speakers. J Voice 2024; 38:105-111. [PMID: 34465480 PMCID: PMC8403057 DOI: 10.1016/j.jvoice.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022]
Abstract
This study investigates self-perceptions of voice-related handicap as a function of facemask use in the general working population during the COVID19 outbreak, using the Voice Handicap Index (VHI). Each VHI item was answered twice in a row; the first answer referred to the condition of not wearing a facemask (henceforth, the Without condition) and the second to the condition of using a facemask (henceforth, the With condition). VHI scores were collected via Google Forms (Google, Mountain View, California), targeting 2 groups of speakers of different nationalities, Portuguese (n = 261) and Spanish (n = 297). A Wilcoxon test was carried out to compare VHI scores between With and Without conditions for each group of speakers; a Mann-Whitney U test was used to compare groups within each condition. Results suggested that VHI overall scores and scores for all dimensions were higher for the With condition, for both Portuguese and Spanish speakers. When comparing groups of speakers, Spanish speakers presented higher scores for functional and emotional dimensions, for both With and Without conditions. In addition, the overall score for the Without condition was higher for Spanish speakers. No differences between groups were found for the total VHI score for the With condition. When comparing overall VHIdiff between speakers, that is, the difference in the VHI total score between With and Without conditions, no significant differences could be found. Thus, a multiple regression analysis was carried out between the VHIdiff and the independent variables of interest: age, sex, smoking habits, professional occupation, nationality, facemask type and its hours of use. The resulting model providing the highest association suggested that 2.5% of the variation in overall VHIdiff total score could be associated with sex, smoking habits, and professional level. Female smokers who use their voices during prolonged hours at work (e.g., teachers, lawyers, sales people) presented a higher VHI total score when wearing a mask. Future voice-related health interventions should address preventive strategies towards speaking behaviors leading to vocal fatigue and vocal effort as a consequence of compulsory facemask use, especially with respect to female professional voice users who smoke.
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Affiliation(s)
- Nuria Polo
- Department of Spanish Language and General Linguistics, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.
| | - Filipa M B Lã
- Department of Didactics, School Organization and Special Didactics, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Silva MT, Occhi-Alexandre IGP, Teixeira LC. Association Between Vocal Symptoms, Communication, Work Environment, and Sense of Coherence in Hospital Health Professionals. J Voice 2023:S0892-1997(23)00370-3. [PMID: 38129270 DOI: 10.1016/j.jvoice.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aimed to associate the presence of vocal symptoms with sociodemographic and occupational data, work environment self-perception, oral communication wearing a face mask, and the sense of coherence (SOC). METHOD This cross-sectional analytical observational study included 66 health professionals from a Brazilian hospital. They answered an online questionnaire on sociodemographic aspects, self-perception of the physical work environment, and oral communication at work. The Voice Symptom Scale (VoiSS) and Sense of Coherence Scale (SOC-13) were also applied. The significance level was set at 5% for the statistical analysis. RESULTS The self-perception of vocal symptoms was 62%. Professionals who considered the noise in their work environment unsatisfactory had more vocal symptoms (P = 0.005), especially in the limitation (P = 0.013) and physical (P = 0.028) domains of the VoiSS. Professionals with higher self-perceived vocal symptoms also reported incoordination between breathing, speech, and articulation (P = 0.041) and self-perceived difficulty being heard with a protective mask (P = 0.033). Professionals with a higher self-perceived score in the limitation domain of the VoiSS also had a higher self-perceived effort to speak with a mask (P = 0.035) and a higher self-perception that other people find it difficult to hear them with a face mask (P = 0.050). There was a weak negative correlation between VoiSS and SOC (P < 0.05) and between its domains (P < 0.05). CONCLUSION Self-perception of voice symptoms is high among health professionals in a Brazilian public hospital. The presence of these symptoms is related to the perception of a noisy work environment and communication difficulties due to the use of a face mask. The lower the ability to cope with stressful situations, the larger the presence of voice symptoms among health professionals.
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Affiliation(s)
- Melyssa Tamietti Silva
- School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | | | - Letícia Caldas Teixeira
- School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Grassi J, de Oliveira IB, Chiriboga LF, Maia AA, Attianezi M, Almeida ANP. Effects on communication due to face mask use: an integrative review. Rev Bras Enferm 2023; 76:e20220674. [PMID: 37820148 PMCID: PMC10561930 DOI: 10.1590/0034-7167-2022-0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/20/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES to integrate evidence from studies on auditory perceptual and speech production effects in communication situations with face mask use. METHODS an integrative literature review, in MEDLINE, Cochrane Library and Embase databases. The guiding question was: what effects on communication (perceptual-auditory and speech production) occur with face mask use? RESULTS searches in electronic databases resulted in 1,478 studies and filtering resulted in 29 final studies. CONCLUSIONS mask use has effects on communication, both in perception and speech production, factors that are also related to quality of life, stress and socio-emotional factors. These data can impact on indicators and alerts in favor of adopting strategies to manage mask use, involving speech production and perception when wearing a mask in health services.
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Affiliation(s)
- Jonathan Grassi
- Universidade Federal do Espírito Santo. Vitória, Espírito Santo, Brazil
| | | | | | - Andréa Alves Maia
- Universidade Federal do Espírito Santo. Vitória, Espírito Santo, Brazil
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Song Z, Lee PJ, Jung H. Prevalence of voice handicap among nurses in intensive care units due to occupational noise during pandemic. Front Public Health 2023; 11:1250512. [PMID: 37727611 PMCID: PMC10505665 DOI: 10.3389/fpubh.2023.1250512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
Background Healthcare workers have been identified as being at risk of occupational voice disorders. Among them, nurses working in intensive care units (ICUs) are particularly vulnerable due to the risk factors that are associated with their exposure to high levels of noise. Thus, this study aimed to determine the prevalence of voice disorders among ICU nurses. Methods A questionnaire was administered to 100 ICU nurses from four hospitals in China. The questionnaire assessed vocal-related symptoms, perceived voice handicap, frequently heard noise sources, and the quality of communications. Results Results indicate that the most frequently reported voice symptoms were 'voice tiredness' and 'voiceless'. Nurses working more than 50 h per week experienced voice symptoms more frequently than nurses working for 40-50 h per week. The median value of the perceived voice handicap score (VHI-30) was 23, indicating mild voice handicap, while 24% of the nurses reported severe voice handicap. Longer working hours and working at patient wards were significantly associated with higher VHI-30 scores. The nurses also reported that the quality of verbal communication with patients and colleagues and voice problems worsened during the COVID-19 pandemic. Conclusion More than 20% of nurses reported severe voice handicap, however, voice handicap among ICU nurses did not appear universally to all nurses. Further research is necessary to identify the risk factors associated with voice disorders and the mechanism behind such heterogeneity among ICU nurses.
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Affiliation(s)
- Ziwei Song
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, United Kingdom
| | - Pyoung-Jik Lee
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, United Kingdom
| | - HeeJung Jung
- Department of Management and Entrepreneurship, Imperial College London, London, United Kingdom
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Castillo-Allendes A, Guzmán-Ferrada D, Hunter EJ, Fuentes-López E. Tracking Occupational Voice State with a Visual Analog Scale: Voice Quality, Vocal Fatigue, and Effort. Laryngoscope 2023; 133:1676-1682. [PMID: 36134759 PMCID: PMC10972625 DOI: 10.1002/lary.30398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Due to elevated vocal health risk in industries such as call centers, there is a need to have accessible and quick self-report tools for voice symptoms. This study aimed to determine if the concurrent and construct validity of three visual analog scales (VASs) of voice quality and symptoms could be used as a screening tool in call center agents. METHODS A cross-sectional study was carried out in three call center companies. The Voice Handicap Index-10 (VHI-10) and a vocal hygiene and symptoms survey were administered to 66 call center workers. Further, acoustic parameters including harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPs), L1-L0 slope, and Alpha ratio were collected. Finally, workers completed three VASs capturing self-perception of vocal effort (VAS-1), voice quality (VAS-2), and vocal fatigue (VAS-3). Linear regression models with bootstrapping evaluated the possible relationship between the three VASs measurements, self-perceived vocal symptoms, and acoustic parameters. RESULTS VAS-1 scores were associated with HNR and voice breaks, VAS-2 with voice breaks, and VAS-3 with Alpha ratio. Using the area under a receiver operating characteristic curve (AUC), the highest AUC for detecting an altered VHI-10 questionnaire score was observed for the three VASs. Also, the highest AUC for detecting altered CPPs was reached for the VAS-1. CONCLUSIONS VAS as a self-report instrument of vocal symptoms is related to psychosocial voice impairment and alterations of acoustic voice parameters in call center workers. Such instruments could be easily implemented to identify voice complaints in these populations. LEVEL OF EVIDENCE 2 (Diagnosis research question) Laryngoscope, 133:1676-1682, 2023.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan, USA
| | - Daniel Guzmán-Ferrada
- Escuela de Fonoaudiología, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago, Chile
| | - Eric J. Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan, USA
| | - Eduardo Fuentes-López
- Carrera de Fonoaudiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia, Universidad Católica de Chile, Santiago, Chile
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Kisielinski K, Hirsch O, Wagner S, Wojtasik B, Funken S, Klosterhalfen B, Kanti Manna S, Prescher A, Sukul P, Sönnichsen A. Physio-metabolic and clinical consequences of wearing face masks—Systematic review with meta-analysis and comprehensive evaluation. Front Public Health 2023; 11:1125150. [PMID: 37089476 PMCID: PMC10116418 DOI: 10.3389/fpubh.2023.1125150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/17/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundAs face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.MethodsA systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.ResultsWe found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = −0.24, 95% CI = −0.38 to −0.11, p < 0.001) and minute ventilation (SMD = −0.72, 95% CI = −0.99 to −0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31–0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03–0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03–0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23–1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32–3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01).DiscussionMasks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.ConclusionFace mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.
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Affiliation(s)
- Kai Kisielinski
- Orthopaedic and Trauma Surgery, Clinical Medicine, Private Practice, Düsseldorf, Germany
- *Correspondence: Kai Kisielinski
| | - Oliver Hirsch
- Department of Psychology, Fachhochschule für Oekonomie und Management (FOM) University of Applied Sciences, Siegen, Germany
| | - Susanne Wagner
- Veterinary Medicine, Wagner Medical Science Liason (MSL) Management, Blankenfelde-Mahlow, Germany
| | - Barbara Wojtasik
- Department of Genetics and Biosystematics, Faculty of Biology, University of Gdańsk, Gdansk, Poland
| | - Stefan Funken
- Internal Medicine, Clinical Medicine, Private Practice, Moers, Germany
| | | | - Soumen Kanti Manna
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, Kolkata, India
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), Rhine-Westphalia Technical University of Aachen, Aachen, Germany
| | - Pritam Sukul
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anesthesiology and Intensive Care, University Medicine Rostock, Rostock, Germany
- Pritam Sukul
| | - Andreas Sönnichsen
- Internal Medicine, Clinical Medicine, Private Practice, Gesundheit für Österreich e.V. (Health for Austria), Vienna, Austria
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Tunç-Songur E, Gölaç H, Önen Ç, Duyar TR, Yılmaz M, Kemaloğlu YK. How Does Long Term Use of Surgical Face Mask Affect the Voice in Normophonic Subjects? J Voice 2023:S0892-1997(23)00037-1. [PMID: 36907682 DOI: 10.1016/j.jvoice.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES To assess the effects of the longterm-use of surgical face mask (SFM) on acoustic and auditory-perceptual voice parameters in normophonic subjects without any known risk factor related to voice disorders. MATERIALS AND METHODS Of 73 normophonic subjects who were previously included in a couple of studies before the COVID-19 outbreak, 25 people (18 female and 7 male) who were free of any known risk factor related to voice disorders during the outbreak were re-evaluated to assess the long-term effect of SFM on voice by using acoustic (mean F0, Jitter-local, Shimmer-local, Cepstral Peak Prominence (CPP), Noise to Harmonic Ratio (NHR), maximum phonation time (MPT)) and auditory-perceptual (Consensus Auditory-Perceptual Evaluation of Voice, CAPE-V) parameters and those data found in SFM period were compared with the previous (preSFM) data. MPT and acoustic data were analyzed by PRAAT software. RESULTS It was seen that the mean F0 value presented a significant increase, while Jitter-local and Intensity values revealed a significant decrease in females after 2 years pass with SFM use (average 22.52 ± 0.18 months).In males, only a significant decrease in Jitter-local was detected. CONCLUSIONS This study is the first longitudinal investigation on the effects of SFM use on acoustic and auditory-perceptual measures of voice. The data in this study, revealed that long-term use of SFM would not appear to be negatively affecting the acoustic parameters of the voice in normophonic subjects (particularly females) without any related risk factors such as tobacco use, reflux, and etc.
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Affiliation(s)
- Elif Tunç-Songur
- Department of Speech and Language Therapy, Selcuk University, Konya, Turkey.
| | - Hakan Gölaç
- Department of Speech and Language Therapy, Gazi University, Ankara, Turkey
| | - Çiğdem Önen
- Department of Speech and Language Therapy, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Tugay Rifat Duyar
- School of Psychology, Queen's University Belfast, Belfast, United Kingdom
| | - Metin Yılmaz
- Department of Otolaryngology, Gazi University, Ankara, Turkey
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Koseoglu S, Cakıcı K, Demirtaş M, Gokdogan O, Ucuncu H. ENT symptoms of mask-wearing in the coronavirus disease 2019 era. J Laryngol Otol 2022; 136:645-648. [PMID: 35297364 PMCID: PMC9114751 DOI: 10.1017/s0022215122000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Analysis of the otorhinolaryngological problems caused by mask-wearing in the coronavirus disease 2019 era. METHODS A survey with 26 questions was sent by e-mail to 576 individuals. RESULTS The most frequently worn masks were three-layer surgical ear loop masks (n = 434, 80.1 per cent), followed by N95 or filtering facepiece code 2 masks (n = 58, 10.7 per cent), and cloth masks (n = 50, 9.2 per cent). The most bothersome symptoms caused by mask-wearing were difficulty in nasal breathing (n = 227, 41.8 per cent), nasal itching and pain (n = 93, 17.2 per cent), earache (n = 88, 16.2 per cent), difficulty in expressing oneself (n = 73, 13.5 per cent), difficulty in understanding speech (n = 56, 10.3 per cent), and ear itching (n = 5, 0.9 per cent). CONCLUSION The problems associated with mask-wearing may result in avoidance of wearing them. Thus, there is a need for new methods that will reduce the problems related to mask-wearing, to increase their use in the community.
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Affiliation(s)
- S Koseoglu
- Department of Otorhinolaryngology, School of Medicine, Mugla Sitki Kocman University, Kötekli, Muğla, Turkey
| | - K Cakıcı
- Department of Otorhinolaryngology, School of Medicine, Mugla Sitki Kocman University, Kötekli, Muğla, Turkey
| | - M Demirtaş
- Department of Otorhinolaryngology, School of Medicine, Mugla Sitki Kocman University, Kötekli, Muğla, Turkey
| | - O Gokdogan
- Department of Otorhinolaryngology, School of Medicine, Mugla Sitki Kocman University, Kötekli, Muğla, Turkey
| | - H Ucuncu
- Department of Otorhinolaryngology, School of Medicine, Mugla Sitki Kocman University, Kötekli, Muğla, Turkey
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14
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Medical masks' and respirators' pattern of use, adverse effects and errors among Portuguese health care professionals during the COVID-19 pandemic: A cross-sectional study. Am J Infect Control 2022; 50:618-623. [PMID: 34653529 PMCID: PMC8511873 DOI: 10.1016/j.ajic.2021.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
Background During COVID-19 pandemic, a shortage of surgical masks (Mask) and respirators (Resp) was experienced worldwide. We aimed to assess its pattern of use, adverse effects and user errors by Portuguese health care professionals (HCP). Methods A cross-sectional study was conducted through snowball convenience sample, collected by email/ social media to health care organizations. Participants answered an online anonymous survey in March 2021. Results Mean age of 3052 respondents was 42.1 years old, 83.6% were female and 77.8% provided direct health care to COVID-19 patients. Mean time of use per shift was 6-8 hours in 40.8% of the participants. 28.0% reported never changing it during their shift. Resp use (vs Mask) was more associated with discomfort (58.2% vs 26.8%), affecting task performance (41.5 vs 18.9%) and communication (55.0 vs 40.9%), dyspnea (36.0 vs 14.4%), skin rash (37.5 vs 19.4%) and headache (37.5 vs 19.4%). Frequent user errors included touching the front while in use (70.1% Mask vs 66.3% Resp) and omitting hand hygiene before (61.8% Mask vs 55.0% Resp) or after use (61.3% Mask vs 57.0% Resp). Average number of errors was higher for Mask (4.3), than for Resp (3.2) (all: P < .001). Conclusions Most HCP admitted an extended use of Mask/ Resp. Resp were more prone to adverse effects and Mask more prone to errors. Strategies to reinforce good practices should be considered.
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Schuster M, Deitmerg U, Gantner S. [Vocal tract discomfort and wellbeing of caregivers for the elderly during the pandemic]. Laryngorhinootologie 2022; 101:797-804. [PMID: 35016249 DOI: 10.1055/a-1727-6012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND During the Sars-CoV2-pandemic, people working in healthcare such as caregives for the elderly face additional burden, e.g. by the use of face masks. METHODS In a prospective study, the emotional and physical wellbeing as well as the vocal tract discomfort of caregivers of two municipal homes for the elderly were assessed by questionnaires, the Mini-SCL and the Vocal Tract Discomfort Scale (VTDS), and one on personal data (sex, age, lung disease, previous SARS-CoV2-infection) and on voice symptoms. RESULTS 67% of the questionnaires were answered by 56 women and 11 men aged 45.2 ± 11.5. In the Mini-SCL, increased scores were found in depression in 23.8%, anxiety in 49.3%, somatization in 55.2% and in the global score in 44.7%. 52%. showed increased scores in the VTDS Significant correlations were found in between the subscales of the Mini-SCL and the VTDS as well as to dysphonia symptoms. DISCUSSION Psychological problems, somatization and vocal tract discomfort is more frequently reported by caregivers for the elderly than in the normal population. The VTDS, voice symptoms and the Mini-SCL scales are significantly related. Training on vocal hygiene should be included in workplace health promotion during the pandemic.
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Affiliation(s)
- Maria Schuster
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, Ludwig-Maximiians-Universität München, München, Germany.,Praxis für Hals-Nasen-Ohrenheilkunde, Phoniatrie und Pädaudiologie, Nuremberg, Germany
| | | | - Sophia Gantner
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, Ludwig-Maximiians-Universität München, München, Germany
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16
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El Kik A, Eid H, Aoun Bacha Z. Post-COVID-19 paradoxical vocal cord movement and dysfunctional dysphonia: A clinical case. Respir Med Case Rep 2022; 39:101710. [PMID: 35874177 PMCID: PMC9287584 DOI: 10.1016/j.rmcr.2022.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/19/2022] [Accepted: 07/13/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Post-COVID persistent dyspnea linked to a paradoxical vocal fold movement has rarely been described, and it has never been described as associated with dysfunctional dysphonia. Case study We present a case of a 46-year-old patient with severe COVID-19 history who presented to our hospital for persistent cough, dysphonia, and intermittent episodes of dyspnea, getting worse when speaking. A chest computed tomography (CT) scan done was normal. The patient was treated by empiric bronchodilators with inhaled corticosteroids but without any improvement. A bronchoscopy was done and revealed spontaneous paradoxical vocal fold movement and dysfunctional dysphonia. The patient was referred to a speech therapist, and her problem was resolved. Conclusion Resistant dyspnea to empiric treatment, after COVID-19, should suggest the diagnosis of paradoxical vocal fold movement. Laryngoscopy should be done to confirm the diagnosis, and the patient should be referred to a speech therapist.
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Does the wearing of masks change voice and speech parameters? Eur Arch Otorhinolaryngol 2021; 279:1701-1708. [PMID: 34550454 PMCID: PMC8456395 DOI: 10.1007/s00405-021-07086-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/10/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The authors aim to review available reports on the potential effects of masks on voice and speech parameters. METHODS A literature search was conducted using MEDLINE and Google Scholar databases through July 2021. Several targeted populations, mask scenarios and methodologies were approached. The assessed voice parameters were divided into self-reported, acoustic and aerodynamic. RESULTS It was observed that the wearing of a face mask has been shown to induce several changes in voice parameters: (1) self-reported-significantly increased vocal effort and fatigue, increased vocal tract discomfort and increased values of voice handicap index (VHI) were observed; (2) acoustics-increased voice intensity, altered formants frequency (F2 and F3) with no changes in fundamental frequency, increased harmonics-to-noise ratio (HNR) and increased mean spectral values in high-frequency levels (1000-8000 Hz), especially with KN95 mask; (3) aerodynamics-maximum phonatory time was assessed in only two reports, and showed no alterations. CONCLUSION Despite the different populations, mask-type scenarios and methodologies described by each study, the results of this review outline the significant changes in voice characteristics with the use of face masks. Wearing a mask shows to increase the perception of vocal effort and an alteration of the vocal tract length and speech articulatory movements, leading to spectral sound changes, impaired communication and perception. Studies analyzing the effect of masks on voice aerodynamics are lacking. Further research is required to study the long-term effects of face masks on the potential development of voice pathology.
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18
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Borja-Villanueva CA, Bernuy-Torres LA, Gómez-Carrión CE, Simbrón-Macera AP. [Non-verbal communication during the pandemic due to Coronavirus disease 2019]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e070. [PMID: 38464854 PMCID: PMC10919792 DOI: 10.21142/2523-2754-0903-2021-070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/20/2021] [Indexed: 03/12/2024] Open
Abstract
Aim The present study aimed to explore the characteristics of non-verbal communication during the coronavirus disease pandemic. Materials and Methods An exploratory cross-sectional study was carried out in a population between 18 and 65 years old from Lima. The participants were selected by convenience sampling. A virtual questionnaire of 9 questions was applied on non-verbal communication variable and 3 questions about parentage data. Results A total of 391 individuals were included. The results of the kinesic dimension indicate that the frequency of gestures and facial expressions (51.9%) and the width of the smile (42.7%) did not change during the pandemic. In the proxemic dimension, it was found that the majority considerably decreased the frequency of kissing on the cheek (74.2%), kissing on the lips (56%) and the intensity of kissing (54.5%). For the paralinguistic dimension, the volume of the voice did not change in most individuals (52.4%) and nor did the speed of speech or articulation of words (57.5%). Conclusions The COVID-19 pandemic has produced changes in non-verbal communication, the most important being a reduction in the frequency and intensity of kissing on the lips and cheek, while the volume and speed of the voice did not vary greatly. Neither have gestures, expressions and smiling undergone major changes.
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Affiliation(s)
- César Andrés Borja-Villanueva
- Universidad Católica Los Ángeles de Chimbote. Chimbote, Perú. , Universidad Católica de Los Ángeles de Chimbote Universidad Católica Los Ángeles de Chimbote Chimbote Peru
| | - Luis Alexis Bernuy-Torres
- Universidad Privada Juan Pablo II. Lima, Perú. , Universidad Juan Pablo II Universidad Privada Juan Pablo II Lima Peru
| | - Christian Esteban Gómez-Carrión
- Universidad Privada Norbert Wiener. Lima, Perú. Universidad Privada Norbert Wiener Universidad Privada Norbert Wiener Lima Peru
| | - Adriana Paola Simbrón-Macera
- Universidad Privada Juan Pablo II. Lima, Perú. , Universidad Juan Pablo II Universidad Privada Juan Pablo II Lima Peru
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Kisielinski K, Giboni P, Prescher A, Klosterhalfen B, Graessel D, Funken S, Kempski O, Hirsch O. Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4344. [PMID: 33923935 PMCID: PMC8072811 DOI: 10.3390/ijerph18084344] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
Many countries introduced the requirement to wear masks in public spaces for containing SARS-CoV-2 making it commonplace in 2020. Up until now, there has been no comprehensive investigation as to the adverse health effects masks can cause. The aim was to find, test, evaluate and compile scientifically proven related side effects of wearing masks. For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES). We objectified evaluation evidenced changes in respiratory physiology of mask wearers with significant correlation of O2 drop and fatigue (p < 0.05), a clustered co-occurrence of respiratory impairment and O2 drop (67%), N95 mask and CO2 rise (82%), N95 mask and O2 drop (72%), N95 mask and headache (60%), respiratory impairment and temperature rise (88%), but also temperature rise and moisture (100%) under the masks. Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields.
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Affiliation(s)
| | | | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), Wendlingweg 2, 52074 Aachen, Germany;
| | - Bernd Klosterhalfen
- Institute of Pathology, Dueren Hospital, Roonstrasse 30, 52351 Dueren, Germany;
| | - David Graessel
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, 52425 Jülich, Germany;
| | | | - Oliver Kempski
- Institute of Neurosurgical Pathophysiology, University Medical Centre of the Johannes Gutenberg University of Mainz Langenbeckstr. 1, 55131 Mainz, Germany;
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, 57078 Siegen, Germany
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Unoki T, Sakuramoto H, Sato R, Ouchi A, Kuribara T, Furumaya T, Tatsuno J, Wakabayashi Y, Tado A, Hashimoto N, Inagaki N, Sasaki Y. Adverse Effects of Personal Protective Equipment Among Intensive Care Unit Healthcare Professionals During the COVID-19 Pandemic: A Scoping Review. SAGE Open Nurs 2021; 7:23779608211026164. [PMID: 34212076 PMCID: PMC8216406 DOI: 10.1177/23779608211026164] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/28/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To avoid exposure to SARS-COV-2, healthcare professionals use personal protective equipment (PPE) while treating COVID-19 patients. Prior studies have revealed the adverse effects (AEs) of PPE on healthcare workers (HCWs); however, no review has focused on the AEs of PPE on HCWs in intensive care units (ICUs). This review aimed to identify the AEs of PPE on HCWs working in ICUs during the COVID-19 pandemic. METHODS A scoping review was conducted. MEDLINE, CINAHL, the World Health Organization (WHO) global literature on COVID-19, and Igaku-chuo-zasshi (a Japanese medical database), Google Scholar, medRxiv, and Health Research Board (HRB) open research were searched from January 25-28, 2021. The extracted data included author(s) name, year of publication, country, language, article title, journal name, publication type, study methodology, population, outcome, and key findings. RESULTS The initial search identified 691 articles and abstracts. Twenty-five articles were included in the analysis. The analysis comprised four key topics: studies focusing on PPE-related headache, voice disorders, skin manifestations, and miscellaneous AEs of PPE. The majority of AEs for HCWs in ICUs were induced by prolonged use of masks. CONCLUSION The AEs of PPE among HCWs in ICUs included heat, headaches, skin injuries, chest discomfort, and dyspnea. Studies with a focus on specific diseases were on skin injuries. Moreover, many AEs were induced by prolonged use of masks.
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Affiliation(s)
- Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo City University, Sapporo, Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Ryuhei Sato
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Tomoki Kuribara
- Department of Adult Health Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Tomomi Furumaya
- High Care Unit of Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Junko Tatsuno
- Department of Nursing, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Yuki Wakabayashi
- Department of Nursing, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Asami Tado
- Faculty of Medicine and Health Sciences, Yamaguchi University, Ube, Japan
| | - Naoya Hashimoto
- Department of Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Japan
| | - Noriko Inagaki
- Faculty of Nursing, Setsunan University, Hirakata, Japan
| | - Yoshiko Sasaki
- Department of Disaster and Critical Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - from the Committee and working group of COVID-19 Task Force of the Japan Academy of Critical Care Nursing
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo City University, Sapporo, Japan
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Adult Health Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
- High Care Unit of Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
- Department of Nursing, Kokura Memorial Hospital, Kitakyusyu, Japan
- Department of Nursing, Kobe City Medical Center General Hospital, Kobe, Japan
- Faculty of Medicine and Health Sciences, Yamaguchi University, Ube, Japan
- Department of Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Japan
- Faculty of Nursing, Setsunan University, Hirakata, Japan
- Department of Disaster and Critical Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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