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Kaur J, Sharma A, Passi G, Dey P, Khajuria A, Alajangi HK, Jaiswal PK, Barnwal RP, Singh G. Nanomedicine at the Pulmonary Frontier: Immune-Centric Approaches for Respiratory Disease Treatment. Immunol Invest 2024; 53:295-347. [PMID: 38206610 DOI: 10.1080/08820139.2023.2298398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Respiratory diseases (RD) are a group of common ailments with a rapidly increasing global prevalence, posing a significant threat to humanity, especially the elderly population, and imposing a substantial burden on society and the economy. RD represents an unmet medical need that requires the development of viable pharmacotherapies. While various promising strategies have been devised to advance potential treatments for RD, their implementation has been hindered by difficulties in drug delivery, particularly in critically ill patients. Nanotechnology offers innovative solutions for delivering medications to the inflamed organ sites, such as the lungs. Although this approach is enticing, delivering nanomedicine to the lungs presents complex challenges that require sophisticated techniques. In this context, we review the potential of novel nanomedicine-based immunomodulatory strategies that could offer therapeutic benefits in managing this pressing health condition.
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Affiliation(s)
- Jatinder Kaur
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Akanksha Sharma
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Gautam Passi
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Piyush Dey
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Akhil Khajuria
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Hema Kumari Alajangi
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Pradeep Kumar Jaiswal
- Department of Biochemistry and Biophysics, Texas A & M University, College Station, Texas, USA
| | | | - Gurpal Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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2
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Moussa OZ, Takeuchi K. Does searching online for vaccination information affect vaccination coverage? Evidence from Sub-Saharan African countries. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101181. [PMID: 36116175 DOI: 10.1016/j.ehb.2022.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
The Internet is reshaping the way people access health information. Over the past decades, an increasing number of people have been using the Internet to access vaccine-related information. Many studies suggest that the Internet can help improve people's understanding of health issues but at the same time facilitate the rapid spread of misinformation. This study explores the impact that searching the Internet for immunization information has on vaccination coverage. Using Google trends data, we found that access to online vaccination information has impacted vaccine uptake from 2004 to 2017, in Sub-Saharan African countries. The results indicate an overall positive impact on vaccine uptake. We also found that the effects are heterogeneous among vaccines. The effect is statistically significant for the vaccine related to high-risk disease, but not significant for the controversial vaccine and the vaccine related to low-risk disease.
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Affiliation(s)
- Ouattara Zieh Moussa
- Graduate School of Economics, Kobe University, 2-1 Rokkodai-cho, Nada-ku, Kobe, Hyogo Prefecture 657-8501, Japan.
| | - Kenji Takeuchi
- Graduate School of Economics, Kobe University, 2-1 Rokkodai-cho, Nada-ku, Kobe, Hyogo Prefecture 657-8501, Japan
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3
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Vollmer BL, Solowey J, Chen X, Chang BP, Williams O, Kulick ER, Elkind MS, Boehme AK. Individual and Joint Effects of Influenza-Like Illness and Vaccinations on Stroke in the Young: A Case-Control Study. Stroke 2022; 53:2585-2593. [PMID: 35861760 PMCID: PMC9329193 DOI: 10.1161/strokeaha.121.038403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Influenza-like illness (ILI) is an acute trigger for stroke, although joint effects of vaccinations and ILI have not yet been explored.
METHODS:
Data for our case-control study was obtained from MarketScan Commercial Claims and Encounters between 2008 and 2014. Patients 18 to 65 years old who experienced a stroke were matched on age and admission date to a control, defined as patients with head trauma or ankle sprain at an inpatient or emergency department visit. Exposures were ILI in the prior 30 days, and any type of vaccination during the year prior. Our outcome was ischemic and intracerebral hemorrhagic strokes identified using
International Classification of Diseases, Ninth Revision (ICD-9
) codes. Logistic regression models estimated adjusted odds ratios (aORs) controlling for preventive care visits, diabetes, valvular heart disease, smoking, alcohol abuse, obesity, and hypertension.
RESULTS:
We identified and matched 24 103 cases 18 to 44 years old and 141 811 45 to 65 years old. Those aged 18 to 44 years had increased stroke risk 30 days after ILI (aOR, 1.68 [95% CI, 1.51–1.86]) and reduced risk with any vaccination in the year prior (aOR, 0.92 [95% CI, 0.87–0.99]). Joint effects indicate that ILI was associated with increased stroke risk among those with (aOR, 1.41 [95% CI, 1.08–1.85]) and without (aOR, 1.73 [95% CI, 1.55–1.94]) vaccinations in the prior year (
P
interaction
=0.16). Among those aged 45 to 65 years, adjusted analyses indicate increased stroke risk for those with ILI (aOR, 1.32 [95% CI, 1.26–1.38]), although there was no effect of vaccinations (aOR, 1.00 [95% CI, 0.97–1.02]). Joint effects indicate that ILI was not associated with stroke among those with any vaccination (aOR, 1.07 [95% CI, 0.96–1.18]) but was associated with increased risk among those without vaccinations ([aOR, 1.39 [95% CI, 1.32–1.47];
P
interaction
<0.001).
CONCLUSIONS:
ILI was associated with increased stroke risk in the young and middle-aged, while vaccinations of any type were associated with decreased risk among the young. Joint effects of ILI and vaccinations indicate vaccinations can reduce the effect of ILI on stroke.
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Affiliation(s)
- Brandi L. Vollmer
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City (B.L.V., J.S., O.W., M.S.V.E., A.K.B.)
- Department of Epidemiology, Columbia University Irving Medical Center, New York. (B.L.V., M.S.V.E., A.K.B.)
| | - Julia Solowey
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City (B.L.V., J.S., O.W., M.S.V.E., A.K.B.)
| | - Xing Chen
- Department of Biostatistics, Columbia University Irving Medical Center, New York. (X.C.)
| | - Bernard P. Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York. (B.P.C.)
| | - Olajide Williams
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City (B.L.V., J.S., O.W., M.S.V.E., A.K.B.)
| | - Erin R. Kulick
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Temple University, Philadelphia, PA (E.R.K.)
| | - Mitchell S.V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City (B.L.V., J.S., O.W., M.S.V.E., A.K.B.)
- Department of Epidemiology, Columbia University Irving Medical Center, New York. (B.L.V., M.S.V.E., A.K.B.)
| | - Amelia K. Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City (B.L.V., J.S., O.W., M.S.V.E., A.K.B.)
- Department of Epidemiology, Columbia University Irving Medical Center, New York. (B.L.V., M.S.V.E., A.K.B.)
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4
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Ali MA, Balcha ES, Woldesemayat AA, Tirore LD. Combined assessment of tuberculosis case notification rate and infection control at health facilities of Dale districts, Sidama Zone, Southern Ethiopia. PLoS One 2021; 16:e0242446. [PMID: 34637447 PMCID: PMC8509858 DOI: 10.1371/journal.pone.0242446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mycobacterium tuberculosis (TB) is the deadliest disease that claims millions of deaths globally. Ethiopia is among the countries heavily hit by the disaster. Despite the effective directly observed treatment and TB infection control (TBIC) measures provided by the world health organization (WHO), the rate of new cases increased daily throughout the country. Healthcare workers (HCWs) are at highest risk serving without having the necessary facility in place while overcrowding of patients exacerbated TB transmission. The study aimed to assess TBIC implementation and analyze case notification rate (CNR) of smear-positive pulmonary TB in the selected health facilities at Dale district, Sidama Zone, Southern Ethiopia. Methods Seven health care facilities have been visited in the study area and smear-positive pulmonary TB notification rate was determined retrospectively during the years 2012 to 2014. Data on smear positive test results and demographic characteristics were collected from the TB unit registries. A structured questionnaire, facility survey, and observation checklists were used to assess the presence of TBIC plans at the health care facilities. Results The overall case notification rate of smear-positive pulmonary tuberculosis was 5.3% among all 7696 TB suspected patients. The odds of being diagnosed with smear-positive TB were 24% more in males than in females (adj OR = 1.24, 95% CI: (1.22, 1.55). Moreover, in the study area, only 28% of the facilities have been practiced TB infection control and 71% of the facilities assigned a focal person for the TBIC plan. The implementation of environmental control measures in the facilities was ranged between 16–83%. N95 particulate respirators were found only in 14% of the facilities. Conclusion TB CNR in Dale district was low. Moreover, implementations of TBIC in Dale district health facilities were poor when the survey was done. Hence, urgent measures should be taken to reverse the burden of TB.
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Affiliation(s)
- Makka Adam Ali
- Department of Oncology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Cellular and Molecular Biology, Faculty of Sciences, Addis Ababa University Addis Ababa, Ethiopia
- Department of Microbiology, Faculty of Medicine, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Ermias Sissay Balcha
- School of Medical Laboratory Science, College of Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Adugna Abdi Woldesemayat
- Department of Biotechnology, College of Biological and Chemical Engineering, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Lopisso Dessalegn Tirore
- Department of Microbiology, Faculty of Medicine, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
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5
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Cabral CZ, Guaragna JBDA, Amantéa FC, Lopes PGM, Pasqualotto AC, Rhoden CR, Amantéa SL. Distribution of airborne respiratory pathogens in pediatric emergency department waiting room. Pediatr Pulmonol 2021; 56:2724-2728. [PMID: 34185972 DOI: 10.1002/ppul.25469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the presence of genetic material from potentially infectious airborne respiratory virus pathogens in a pediatric emergency department (PED) waiting room. METHODS A cross-sectional study in the waiting room area of PED at Santo Antonio Children's Hospital, Porto Alegre, in southern Brazil. The room air samples were collected with a portable cyclone sampler (Coriolis®), twice a day (8 a.m. and 8 p.m.), during 5 consecutive weekdays, during two seasons, fall and spring (20 samples), in 2016. Reverse transcription polymerase chain reaction was used to detect influenza A, influenza B, parainfluenza 2, parainfluenza 3, human metapneumovirus, respiratory syncytial virus, human adenovirus, human bocavirus, and Bordetella pertussis. The PED provides care to an average of 6000 patients per month and the age of patients ranges from 1 month to 17 years old. It is waiting area has 645 ft square. RESULTS Genetic material from pathogens was detected in 12 out of 20 samples (60%). In 5 samples, more than one pathogen of respiratory virus was identified. Human adenovirus was the most frequent pathogen (n = 9/52%), followed by Bordetella pertussis (n = 4/24%), respiratory syncytial virus (n = 2/12%) and human bocavirus (n = 2/12%). Season and number of people in the waiting room were not associated with the presence of genetic material from pathogens. CONCLUSIONS Genetic material from pathogens potentially associated with severe respiratory diseases was found in the room air of a pediatric ED waiting room.
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Affiliation(s)
- Catiane Zanin Cabral
- Department of Postgraduate Program in Pediatrics, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Fernanda Chaves Amantéa
- Department of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo Guilherme Markus Lopes
- Department of Pollution and Oxidative Stress Laboratory, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alessandro Cumaru Pasqualotto
- Department of Postgraduate, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Claudia Ramos Rhoden
- Department of Postgraduate Program in Pediatrics, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Pollution and Oxidative Stress Laboratory, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Postgraduate, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sérgio Luís Amantéa
- Department of Postgraduate Program in Pediatrics, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Pediatric Emergency, Santo Antônio Children's Hospital, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Pollution and Oxidative Stress Laboratory, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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6
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Kulick ER, Alvord T, Canning M, Elkind MSV, Chang BP, Boehme AK. Risk of stroke and myocardial infarction after influenza-like illness in New York State. BMC Public Health 2021; 21:864. [PMID: 33952233 PMCID: PMC8097921 DOI: 10.1186/s12889-021-10916-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Influenza may be associated with increased stroke and myocardial infarction (MI) risk. We hypothesized that risk of stroke and MI after influenza-like illness (ILI) would be higher in patients in New York State. We additionally assessed whether this relationship differed across a series of sociodemographic factors. Methods A case-crossover analysis of the 2012–2014 New York Statewide Planning and Research Cooperative System (SPARCS) was used to estimate odds of ischemic stroke and MI after ILI. Each patient’s case window (the time period preceding event) was compared to their control windows (same dates from the previous 2 years) in conditional logistic regression models used to estimate odds ratios and 95% confidence intervals (OR, 95% CI). We varied the case windows from 15 to 365 days preceding event as compared to control windows constructed using the same dates from the previous 2 years. Analyses were stratified by sex, race, and urban-rural status based on residential zip code. Results A total of 33,742 patients were identified as having ischemic stroke and 53,094 had MI. ILI events in the 15 days prior were associated with a 39% increase in odds of ischemic stroke (95% CI 1.09–1.77), increasing to an almost 70% increase in odds when looking at ILI events over the last year (95% CI 1.56, 1.83). In contrast, the effect of ILI hospitalization on MI was strongest in the 15 days prior (OR = 1.24, 95% CI 1.06–1.44). The risk of ischemic stroke after ILI was higher among individuals living in rural areas in the 90 days prior to stroke and among men in the year prior to event. In contrast, the association between ILI and MI varied only across race with whites having significantly higher ILI associated MI. Conclusion This study highlights risk period differences for acute cardiovascular events after ILI, indicating possible differences in mechanism behind the risk of stroke after ILI compared to the risk of MI. High risk populations for stroke after ILI include men and people living in rural areas, while whites are at high risk for MI after ILI. Future studies are needed to identify ways to mitigate these risks.
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Affiliation(s)
- Erin R Kulick
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 904, Philadelphia, PA, 19122, USA. .,Department of Epidemiology, Brown University, Providence, RI, USA.
| | - Trevor Alvord
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michelle Canning
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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7
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Kulick ER, Canning M, Parikh NS, Elkind MSV, Boehme AK. Seasonality of Influenza-Like-Illness and Acute Cardiovascular Events Are Related Regardless of Vaccine Effectiveness. J Am Heart Assoc 2020; 9:e016213. [PMID: 33028143 PMCID: PMC7763381 DOI: 10.1161/jaha.120.016213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Influenza has been identified as a trigger for stroke and myocardial infarction (MI) with prior studies demonstrating that influenza vaccination may decrease risk of stroke and MI. Methods and Results We used data from the New York Department of Health Statewide Planning and Research Cooperative System to evaluate whether annual variability in influenza vaccination effectiveness (VE) would be associated with cardiovascular events. Daily and monthly counts of outpatient and inpatient visits for influenza‐like illness (ILI), stroke, and MI were identified using International Classification of Diseases, Ninth Revision (ICD‐9) codes; VE data for each year are publicly available. We identified pertinent lags between ILI, stroke, and MI using prewhitening cross‐correlation functions and applied them to autoregressive integrated moving average time series regression models. Time series forecasting systems assessed correlations among ILI, stroke, and MI, and the effect of VE on these relationships. Cross‐correlation functions indicated stroke events increased 1 month after increases in ILI rates; MIs increased immediately. Accounting for seasonality and lag, peaks in ILI rates were significantly related to peaks in stroke (P=0.04) and MI (P=0.01). Time forecasting analyses indicated no relationship between VE and cardiovascular events. Conclusions We identified that seasonality of cardiovascular events may be associated with seasonality in ILI, though VE did not modify this relationship.
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Affiliation(s)
- Erin R Kulick
- Department of Epidemiology and Biostatistics Temple University College of Public Health Philadelphia PA.,Department of Epidemiology Brown University Providence RI
| | - Michelle Canning
- Department of Epidemiology Mailman School of Public Health Columbia University New York NY
| | - Neal S Parikh
- Department of Neurology Cornell University New York NY
| | - Mitchell S V Elkind
- Department of Epidemiology Mailman School of Public Health Columbia University New York NY.,Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York NY
| | - Amelia K Boehme
- Department of Epidemiology Mailman School of Public Health Columbia University New York NY.,Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York NY
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8
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Yan Y, Li X, Ito K. Numerical investigation of indoor particulate contaminant transport using the Eulerian-Eulerian and Eulerian-Lagrangian two-phase flow models. ACTA ACUST UNITED AC 2019; 2:31-40. [PMID: 32289121 PMCID: PMC7111533 DOI: 10.1007/s42757-019-0016-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Abstract
Transport of micron particles in a displacement ventilated room was simulated using both the Eulerian-Eulerian model and the Eulerian-Lagrangian model. The same inter-phase action mechanisms were included in both models. The models were compared against each other in the aspects of air velocity, particle concentration, and particle-wall interactions. It was found that the two models have similar accuracy in predicting the airflow field while each of them has its own advantage and drawback in modelling particle concentration and particle-wall interactions. The E-E model is capable of providing a mechanistic description of the inter-phase interactions, whilst the E-L model has obvious advantage in modelling particle-wall interactions. Advices were given for choosing an appropriate model for modelling particulate contaminant transport in indoor environments.
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Affiliation(s)
- Yihuan Yan
- 1School of Engineering, RMIT University, PO Box 71, Bundoora, VIC 3083 Australia
| | - Xiangdong Li
- 1School of Engineering, RMIT University, PO Box 71, Bundoora, VIC 3083 Australia
| | - Kazuhide Ito
- 1School of Engineering, RMIT University, PO Box 71, Bundoora, VIC 3083 Australia.,2Faculty of Engineering Sciences, Kyushu University, Fukuoka, Japan
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9
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Min JY, Kim HJ, Yoon C, Lee K, Yeo M, Min KB. Tuberculosis infection via the emergency department among inpatients in South Korea: a propensity score matched analysis of the National Inpatient Sample. J Hosp Infect 2018; 100:92-98. [PMID: 29608938 PMCID: PMC7114590 DOI: 10.1016/j.jhin.2018.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/26/2018] [Indexed: 12/02/2022]
Abstract
BACKGROUND Emergency departments (EDs) carry a high risk of infectious disease transmission and have also been implicated in tuberculosis (TB) outbreaks. AIM To determine if patients who visit EDs have an increased risk of TB infection. Using South Korean inpatient sample data (2012), the risk of TB occurrence during 90 days after hospitalization for patients admitted via EDs was compared with that for patients admitted via outpatient clinics. METHODS The data of the 2012 Health Insurance Review and Assessment Service - National Inpatient Sample were used. TB diagnosis was based on International Classification of Diseases Version 10 [all TB (A15-A19), pulmonary TB (A15-A16) and extrapulmonary TB (A17-A18)]. FINDINGS After propensity score matching using the demographic and clinical characteristics of the patients, 191,997 patients (64,017 patients admitted via EDs and 127,908 patients admitted via outpatient clinics) were included in this study. There was no significant difference in baseline patient characteristics between the two groups. The percentage of patients with TB admitted via EDs was higher than that of patients admitted via outpatient clinics. The likelihood of active TB occurrence was 30% higher for all TB [hazard ratio (HR) 1.30; 95% confidence interval (CI) 1.12-1.52] and pulmonary TB (HR 1.30; 95% CI 1.10-1.53) in patients admitted via EDs compared with patients admitted via outpatient clinics; this difference was significant. However, no difference in the occurrence of extrapulmonary TB was observed between the two groups. CONCLUSIONS The likelihood of TB infection was greater in patients admitted via EDs than in patients admitted via outpatient clinics.
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Affiliation(s)
- J-Y Min
- Institute of Health and Environment, Seoul National University, Graduate School of Public Health, Seoul, Republic of Korea
| | - H-J Kim
- Institute of Health and Environment, Seoul National University, Graduate School of Public Health, Seoul, Republic of Korea
| | - C Yoon
- Institute of Health and Environment, Seoul National University, Graduate School of Public Health, Seoul, Republic of Korea; Department of Environmental Health Sciences, Seoul National University, Graduate School of Public Health, Seoul, Republic of Korea
| | - K Lee
- Institute of Health and Environment, Seoul National University, Graduate School of Public Health, Seoul, Republic of Korea; Department of Environmental Health Sciences, Seoul National University, Graduate School of Public Health, Seoul, Republic of Korea
| | - M Yeo
- Department of Architecture and Architectural Engineering, College of Engineering, Seoul National University, Seoul, Republic of Korea
| | - K-B Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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10
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Abstract
Nanostructures have been widely involved in changes in the drug delivery system. Nanoparticles have unique physicochemical properties, e.g., ultrasmall size, large surface area, and the ability to target specific actions. Various nanomaterials, like Ag, ZnO, Cu/CuO, and Al2O3, have antimicrobial activity. Basically, six mechanisms are involved in the production of antimicrobial activity, i.e., (1) destruction of the peptidoglycan layer, (2) release of toxic metal ions, (3) alteration of cellular pH via proton efflux pumps, (4) generation of reactive oxygen species, (5) damage of nuclear materials, and (6) loss of ATP production. Nanomedicine contributes to various pharmaceutical applications, like diagnosis and treatment of various ailments including microbial diseases. Furthermore, nanostructured antimicrobial agents are also involved in the treatment of the neuroinfections associated with neurodegenerative disorders. This chapter focuses on the nanostructure and nanomedicine of antimicrobial agents and their prospects for the possible management of infections associated with neurodegenerative disorders.
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11
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Yen YL, Chen IC, Wu CH, Li WC, Wang CH, Tsai TC. Factors associated with delayed recognition of pulmonary tuberculosis in emergency departments in Taiwan. Heart Lung 2015; 44:353-9. [PMID: 25929441 DOI: 10.1016/j.hrtlng.2015.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 03/19/2015] [Accepted: 03/22/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify and evaluate factors associated with delayed recognition of pulmonary tuberculosis (TB) in the emergency department (ED). BACKGROUND Delayed recognition of pulmonary TB in ED may precipitate mortality and morbidity. METHODS Medical records of newly diagnosed TB patients admitted to four hospitals in Taiwan were retrospectively reviewed. Patients were divided into two groups based on ED physicians' recognition or not of TB and statistically compared to identify differences in their characteristics. RESULTS 310 newly diagnosed TB patients were identified; 150 were unrecognized in the ED. Cough, chest tightness, general malaise, and body weight loss were more common for those with recognized TB. Older age (≥65 yrs, P = 0.035) and chronic renal insufficiency (P = 0.005) were associated with delayed TB recognition. CONCLUSION Older age and chronic renal insufficiency are risk factors for delayed TB while in the ED. Typical symptoms should heighten alertness for recognizing TB.
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Affiliation(s)
- Yung-Lin Yen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung County, Taiwan
| | - I-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan; Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Chien-Hung Wu
- Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City 833, Taiwan
| | - Wen-Cheng Li
- Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan; Department of Occupation Medicine, Chang-Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan
| | - Cheng-Hsien Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan; Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Tsung-Cheng Tsai
- Chang Gung University College of Medicine, No.5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City 833, Taiwan.
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Silva DR, Müller AM, Tomasini KDS, Dalcin PDTR, Golub JE, Conde MB. Active case finding of tuberculosis (TB) in an emergency room in a region with high prevalence of TB in Brazil. PLoS One 2014; 9:e107576. [PMID: 25211158 PMCID: PMC4161448 DOI: 10.1371/journal.pone.0107576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/18/2014] [Indexed: 11/18/2022] Open
Abstract
SETTING Public hospital emergency room (ER) in Porto Alegre, Brazil, a setting with high prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. OBJECTIVE To determine the prevalence of PTB, using a symptom based active case finding (ACF) strategy in the ER of a public hospital in an area with high prevalence of TB and HIV, as well as variables associated with pulmonary TB diagnosis. METHODS Cross sectional study. All patients ≥ 18 years seeking care at the ER were screened for respiratory symptoms and those with cough ≥ 2 weeks were invited to provide a chest radiograph and two unsupervised samples of sputum for acid-fast bacilli smear and culture. RESULTS Among 31,267 admissions, 6,273 (20.1%) reported respiratory symptoms; 197 reported cough ≥ 2 weeks, of which pulmonary TB was diagnosed in 30. In multivariate analysis, the variables associated with a pulmonary tuberculosis diagnosis were: age (OR 0.94, 95% CI: 0.92-0.97; p<0.0001), sputum production (OR 0.18, 95% CI 0.06-0.56; p = 0.003), and radiographic findings typical of TB (OR 12.11, 95% CI 4.45-32.93; p<0.0001). CONCLUSIONS This study identified a high prevalence of pulmonary TB among patients who sought care at the emergency department of a tertiary hospital, emphasizing the importance of regular screening of all comers for active TB in this setting.
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Affiliation(s)
- Denise Rossato Silva
- Pulmonology Department, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul – Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- * E-mail:
| | - Alice Mânica Müller
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karina da Silva Tomasini
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo de Tarso Roth Dalcin
- Pulmonology Department, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul – Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jonathan E. Golub
- Epidemiology Department, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Marcus Barreto Conde
- Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Silva DR, Viana VP, Müller AM, Livi FP, Dalcin PDTR. Respiratory viral infections and effects of meteorological parameters and air pollution in adults with respiratory symptoms admitted to the emergency room. Influenza Other Respir Viruses 2013; 8:42-52. [PMID: 24034701 PMCID: PMC4177797 DOI: 10.1111/irv.12158] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/28/2022] Open
Abstract
Background Respiratory viral infections (RVIs) are the most common causes of respiratory infections. The prevalence of respiratory viruses in adults is underestimated. Meteorological variations and air pollution are likely to play a role in these infections. Objectives The objectives of this study were to determine the number of emergency visits for influenza-like illness (ILI) and severe acute respiratory infection (SARI) and to evaluate the association between ILI/SARI, RVI prevalence, and meteorological factors/air pollution, in the city of Porto Alegre, Brazil, from November 2008 to October 2010. Methods Eleven thousand nine hundred and fifty-three hospitalizations (adults and children) for respiratory symptoms were correlated with meteorological parameters and air pollutants. In a subset of adults, nasopharyngeal aspirates were collected and analyzed through IFI test. The data were analyzed using time-series analysis. Results Influenza-like illness and SARI were diagnosed in 3698 (30·9%) and 2063 (17·7%) patients, respectively. Thirty-seven (9·0%) samples were positive by IFI and 93 of 410 (22·7%) were IFI and/or PCR positive. In a multivariate logistic regression model, IFI positivity was statistically associated with absolute humidity, use of air conditioning, and presence of mold in home. Sunshine duration was significantly associated with the frequency of ILI cases. For SARI cases, the variables mean temperature, sunshine duration, relative humidity, and mean concentration of pollutants were singnificant. Conclusions At least 22% of infections in adult patients admitted to ER with respiratory complaints were caused by RVI. The correlations among meteorological variables, air pollution, ILI/SARI cases, and respiratory viruses demonstrated the relevance of climate factors as significant underlying contributors to the prevalence of RVI.
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Affiliation(s)
- Denise R Silva
- Pulmonology Department, School of Medicine, Graduate Program in Pulmonology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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14
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Abstract
OBJECTIVES Infrared thermal detection systems (ITDSs) have been used with limited success outside the United States to screen for fever during recent outbreaks of novel infectious diseases. Although ITDSs are fairly accurate in detecting fever in adults, there is little information about their utility in children. METHODS In a pediatric emergency department, we compared temperatures of children (<18 years old) measured using 3 ITDSs (OptoTherm Thermoscreen, FLIR ThermoVision 360, and Thermofocus 0800H3) to standard, age-appropriate temperature measurements (confirmed fever defined as ≥38.0°C [oral or rectal], ≥37.0°C [axillary]). Measured temperatures were compared with parental reports of fever using descriptive, multivariate, and receiver operating characteristic analyses. RESULTS Of 855 patients, 400 (46.8%) had parent-reported fever, and 306 (35.8%) had confirmed fever. At optimal fever thresholds, OptoTherm and FLIR had sensitivity (83.0% and 83.7%, respectively) approximately equal to parental report (83.9%) and greater than Thermofocus (76.8%), and specificity (86.3% and 85.7%) greater than parental report (70.8%) and Thermofocus (79.4%). Correlation coefficients between traditional thermometry and ITDSs were 0.78 (OptoTherm), 0.75 (FLIR), and 0.66 (Thermofocus). CONCLUSIONS Compared with traditional thermometry, FLIR and OptoTherm were reasonably accurate in detecting fever in children and better predictors of fever than parental report. These findings suggest that ITDSs could be a useful noninvasive screening tool for fever in the pediatric age group.
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Hsieh YH, Kelen GD, Dugas AF, Chen KF, Rothman RE. Emergency Physicians' Adherence to Center for Disease Control and Prevention Guidance During the 2009 Influenza A H1N1 Pandemic. West J Emerg Med 2013; 14:191-9. [PMID: 23599869 PMCID: PMC3628481 DOI: 10.5811/westjem.2012.11.12246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 09/14/2012] [Accepted: 11/21/2012] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Little is known regarding compliance with management guidelines for epidemic influenza in adult emergency department (ED) settings during the 2009 novel influenza A (H1N1) epidemic, especially in relation to the Centers for Disease Control and Prevention (CDC) guidance. METHODS We investigated all patients with a clinical diagnosis of influenza at an inner-city tertiary academic adult ED with an annual census of approximately 60,000 visits from May 2008 to December 2009. We aimed to determine patterns of presentation and management for adult patients with an ED diagnosis of influenza during the H1N1 pandemic, using seasonal influenza (pre-H1N1) as reference and to determine the ED provider's adherence to American College of Emergency Physicians and CDC guidance during the 2009 H1N1 influenza pandemic. Adherence to key elements of CDC 2009 H1N1 guidance was defined as (1) the proportion of admitted patients who were recommended to receive testing or treatment who actually received testing for influenza or treatment with antivirals; and (2) the proportion of high-risk patients who were supposed to be treated who actually were treated with antivirals. RESULTS Among 339 patients with clinically diagnosed influenza, 88% occurred during the H1N1 pandemic. Patients were similarly managed during both phases. Median length of visit (pre-H1N1: 385 min, H1N1: 355 min, P > 0.05) and admission rates (pre-H1N1: 8%, H1N1: 11%, P > 0.05) were similar between the 2 groups. 28% of patients in the pre-H1N1 group and 16% of patients in the H1N1 group were prescribed antibiotics during their ED visits (P > 0.05). There were 34 admitted patients during the pandemic;, 30 (88%) of them received influenza testing in the ED, and 22 (65%) were prescribed antivirals in the ED. Noticeably, 19 (56%) of the 34 admitted patients, including 6 with a positive influenza test, received antibiotic treatment during their ED stay. CONCLUSION During the recent H1N1 pandemic, most admitted patients received ED diagnostic testing corresponding to the current recommended guidance. Antibiotic treatment for ED patients admitted with suspected influenza is not uncommon. However, less than 70% of admitted patients and less than 50% of high-risk patients were treated with antivirals during their ED visit, indicating a specific call for closer adherence to guidelines in future influenza pandemics.
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Affiliation(s)
- Yu-Hsiang Hsieh
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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16
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Martel J, Bui-Xuan EF, Carreau AM, Carrier JD, Larkin É, Vlachos-Mayer H, Dumas ME. Respiratory hygiene in emergency departments: compliance, beliefs, and perceptions. Am J Infect Control 2013; 41:14-8. [PMID: 22503134 PMCID: PMC7115267 DOI: 10.1016/j.ajic.2011.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 12/22/2011] [Accepted: 12/23/2011] [Indexed: 11/21/2022]
Abstract
Background Low respiratory hygiene compliance among health care workers of emergency departments has become a major concern in the spread of respiratory infections. Our objective was to determine the compliance with respiratory hygiene of triage nurses at 2 university hospital centers and to identify factors influencing compliance to the respiratory hygiene principles of emergency health care workers. Methods A 2-part, cross-sectional, descriptive study was conducted at 2 training centers. An anonymous observation of compliance with respiratory hygiene by triage emergency nurses was performed. A self-administered, voluntary questionnaire on attitudes, perceptions, and knowledge of respiratory hygiene guidelines was distributed to the health care workers at the emergency department of the 2 hospital sites. Results Median objective compliance with respiratory hygiene measures of triage nurses was 22% (interquartile range [IQR], 11%-33%). Median perceived compliance of the health care workers was 68% (IQR, 61%-79%). Median actual knowledge score was 75% (IQR, 75%-100%). Overall, 91.9% of respondents believed that the mask was an effective preventive measure. The main obstacles toward mask wearing by the health care worker were “tendency to forget” (37.8%) and “discomfort” (35.1%). Conclusion The compliance rate at our institution is very low. We identified a few factors affecting adherence to respiratory hygiene measures that are of potential use in targeting groups and formulating recommendations.
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Koh Y, Hegney D, Drury V. Nurses' perceptions of risk from emerging respiratory infectious diseases: a Singapore study. Int J Nurs Pract 2012; 18:195-204. [PMID: 22435984 PMCID: PMC7165875 DOI: 10.1111/j.1440-172x.2012.02018.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The recent emergence of virulent respiratory infectious diseases such as Severe Acute Respiratory Syndrome (SARS) and Influenza A/H1N1 viruses predisposes nurses to occupational risks. This qualitative study investigated how Chinese Singaporean nurses perceived the risks of exposure to these infectious diseases and the factors that influenced this risk perception. Data were collected through face-to-face interviews and were analyzed using Braun and Clarke's process of thematic analysis. Three themes emerged: living with risk; the experience of SARS; and acceptance of risk. The nature of nursing work was perceived to place participants at risk of infection. Another significant finding of this study is that the government's, organizations' and nurses' perceptions of new emerging respiratory infectious diseases were influenced by their previous experience with SARS. Similar to previous studies, nurses working at the 'front line' believed that infection from these diseases was an unavoidable occupational hazard.
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Affiliation(s)
- Yiwen Koh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Maltezou HC, Mougkou K, Asimaki H, Koniaraki K, Katerelos P, Giannaki M, Theodoridou M. Extremely low risk for acquisition of a respiratory viral infection in the emergency room of a large pediatric hospital during the winter season. Influenza Other Respir Viruses 2012; 7:14-7. [PMID: 22429730 PMCID: PMC5780729 DOI: 10.1111/j.1750-2659.2012.00355.x] [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] [Indexed: 12/01/2022] Open
Abstract
Please cite this paper as: Maltezou et al. (2012). Extremely low risk for acquisition of a respiratory viral infection in the emergency room of a large pediatric hospital during the winter season. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00355.x. The aim of this study was to investigate the rate of transmission of respiratory viral infections to children visiting the emergency room of a large pediatric hospital during winter. A total of 615 children were prospectively studied. Twenty‐two (3·6%) children developed at least one symptom compatible with a respiratory viral infection within 1–7 days after the visit, including cough (12 children), fever (8), rhinorrhea (7), and/or respiratory distress (1). Three children (0·49%) developed an influenza‐like illness. These findings indicate that transmission of respiratory viral infections to children visiting an emergency room during the winter season is extremely low.
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Affiliation(s)
- Helena C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Diseases Control and Prevention, Athens, Greece
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Nguyen AV, Cohen NJ, Lipman H, Brown CM, Molinari NA, Jackson WL, Kirking H, Szymanowski P, Wilson TW, Salhi BA, Roberts RR, Stryker DW, Fishbein DB. Comparison of 3 infrared thermal detection systems and self-report for mass fever screening. Emerg Infect Dis 2011; 16:1710-7. [PMID: 21029528 PMCID: PMC3294528 DOI: 10.3201/eid1611.100703] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In a hospital setting, the systems had reasonable utility for fever detection. Despite limited evidence regarding their utility, infrared thermal detection systems (ITDS) are increasingly being used for mass fever detection. We compared temperature measurements for 3 ITDS (FLIR ThermoVision A20M [FLIR Systems Inc., Boston, MA, USA], OptoTherm Thermoscreen [OptoTherm Thermal Imaging Systems and Infrared Cameras Inc., Sewickley, PA, USA], and Wahl Fever Alert Imager HSI2000S [Wahl Instruments Inc., Asheville, NC, USA]) with oral temperatures (>100°F = confirmed fever) and self-reported fever. Of 2,873 patients enrolled, 476 (16.6%) reported a fever, and 64 (2.2%) had a confirmed fever. Self-reported fever had a sensitivity of 75.0%, specificity 84.7%, and positive predictive value 10.1%. At optimal cutoff values for detecting fever, temperature measurements by OptoTherm and FLIR had greater sensitivity (91.0% and 90.0%, respectively) and specificity (86.0% and 80.0%, respectively) than did self-reports. Correlations between ITDS and oral temperatures were similar for OptoTherm (ρ = 0.43) and FLIR (ρ = 0.42) but significantly lower for Wahl (ρ = 0.14; p<0.001). When compared with oral temperatures, 2 systems (OptoTherm and FLIR) were reasonably accurate for detecting fever and predicted fever better than self-reports.
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Affiliation(s)
- An V Nguyen
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Conde MB, Melo FAFD, Marques AMC, Cardoso NC, Pinheiro VGF, Dalcin PDTR, Machado Junior A, Lemos ACM, Netto AR, Durovni B, Sant'Anna CC, Lima D, Capone D, Barreira D, Matos ED, Mello FCDQ, David FC, Marsico G, Afiune JB, Silva JRLE, Jamal LF, Telles MADS, Hirata MH, Dalcolmo MP, Rabahi MF, Cailleaux-Cesar M, Palaci M, Morrone N, Guerra RL, Dietze R, Miranda SSD, Cavalcante SC, Nogueira SA, Nonato TSG, Martire T, Galesi VMN, Dettoni VDV. III Brazilian Thoracic Association Guidelines on tuberculosis. J Bras Pneumol 2010; 35:1018-48. [PMID: 19918635 DOI: 10.1590/s1806-37132009001000011] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 08/25/2009] [Indexed: 11/21/2022] Open
Abstract
New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.
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Hsieh MJ, Liang HW, Chiang PC, Hsiung TC, Huang CC, Chen NH, Hu HC, Tsai YH. Delayed suspicion, treatment and isolation of tuberculosis patients in pulmonology/infectious diseases and non-pulmonology/infectious diseases wards. J Formos Med Assoc 2009; 108:202-9. [PMID: 19293035 PMCID: PMC7135255 DOI: 10.1016/s0929-6646(09)60053-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 09/15/2008] [Accepted: 09/26/2008] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/PURPOSE Delayed diagnosis and isolation increases the risk of nosocomial transmission of tuberculosis (TB). To assess the risk of delayed management of TB, we analyzed the risk factors of prolonged delay in isolation of smear-positive TB patients in pulmonology/infectious diseases and other wards in a tertiary teaching hospital. METHODS We enrolled smear-positive TB patients aged > 16 years with delayed respiratory isolation following hospitalization. Medical records were reviewed retrospectively. Time intervals between admission, order of sputum acid-fast staining, initiation of anti-tuberculous treatment and isolation were compared between pulmonology/infectious diseases wards (PIWs) and other wards. Risk factors were analyzed in patients with prolonged isolation delay of > 7 days in individual groups. RESULTS Isolation was delayed in 191 (73.7%) of 259 hospitalized smear-positive TB patients. Median suspicion, treatment and isolation delays were 0, 3 and 4 days in PIWs and 1, 5 and 7 days in other wards. For patients admitted to non-PIWs, atypical chest radiographs, symptoms without dyspnea or not being admitted from the emergency department (ED) were risk factors for prolonged isolation delay exceeding 7 days. The only risk factor for delayed isolation in patients admitted to PIWs was age >or= 70 years. CONCLUSION Delays in suspicion, treatment and isolation of TB patients were longer in non-PIWs. Clinicians should be alert to those admitted to non-PIWs with atypical chest radiographs, atypical symptoms, or not admitted from the ED.
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Affiliation(s)
- Meng-Jer Hsieh
- Division of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Linkou, Taipei
- Department of Respiratory Care, Chang-Gung University, Taiwan
| | - Huey-Wen Liang
- Division of Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei
| | - Ping-Chern Chiang
- Division of Infectious Diseases, Chang-Gung Memorial Hospital, Linkou, Taipei
- Division of Committee for Infection Control, Chang-Gung Memorial Hospital, Linkou, Taipei
| | - Te-Chih Hsiung
- Division of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Linkou, Taipei
| | - Chung-Chi Huang
- Division of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Linkou, Taipei
- Department of Respiratory Care, Chang-Gung University, Taiwan
| | - Ning-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Linkou, Taipei
- Department of Respiratory Care, Chang-Gung University, Taiwan
| | - Han-Chung Hu
- Division of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Linkou, Taipei
- Department of Respiratory Care, Chang-Gung University, Taiwan
| | - Ying-Huang Tsai
- Division of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Linkou, Taipei
- Department of Respiratory Care, Chang-Gung University, Taiwan
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Dumais N, Hasni A. High school intervention for influenza biology and epidemics/pandemics: impact on conceptual understanding among adolescents. CBE LIFE SCIENCES EDUCATION 2009; 8:62-71. [PMID: 19255137 PMCID: PMC2649650 DOI: 10.1187/cbe.08-08-0048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 10/27/2008] [Accepted: 11/06/2008] [Indexed: 05/27/2023]
Abstract
Understanding real-life issues such as influenza epidemiology may be of particular interest to the development of scientific knowledge and initiation of conceptual changes about viruses and their life cycles for high school students. The goal of this research project was to foster the development of adolescents' conceptual understanding of viruses and influenza biology. Thus, the project included two components: 1) pre- and posttests to determine students' conceptions about influenza biology, epidemics/pandemics, and vaccination; and 2) design an intervention that supports conceptual change to promote improvements in influenza knowledge based on these primary conceptions. Thirty-five female students from a high school biology class participated in a series of instructional activities and pre- and posttest assessments. Results from the pretest indicated that high school students exhibit a limited understanding of concepts related to viruses. Six weeks after an intervention that promoted active learning, results from a posttest showed that conceptions about influenza are more accurately related to the provided scientific knowledge. Although adolescents have nonscientific models to explain influenza biology, we showed that a carefully designed intervention can affect students' knowledge as well as influence the implementation of health education programs in secondary schools.
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Affiliation(s)
- Nancy Dumais
- Département de Biologie, Faculté des Sciences, Université de Sherbrooke, Sherbrooke, QC J1K2R1, Canada.
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Pazin-Filho A, Soares CS, Ferrais ADSN, Oliveira e Castro PDT, Bellissimo-Rodrigues F, Nogueira JDA, Passos ADC. Tuberculosis among health care workers in a Brazilian tertiary hospital emergency unit. Am J Emerg Med 2008; 26:796-8. [PMID: 18774046 DOI: 10.1016/j.ajem.2007.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Revised: 09/24/2007] [Accepted: 10/23/2007] [Indexed: 11/18/2022] Open
Abstract
The Brazilian emergency system is being reorganized as a hierarchy in the region of Ribeirão Preto, state of São Paulo. We found increased occupational risk for tuberculosis in this region tertiary reference center--a nurse technician (Incidence rate [IR] 526.3/100,000 inhabitants) had a risk of tuberculosis 12.6 (95% confidence interval [CI], 2.57-37.23) greater than the city population (41.8/100,000 inhabitants). The system reorganization will have to make the centers adequate to deal with this problem.
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Affiliation(s)
- Antonio Pazin-Filho
- Department of Internal Medicine, Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil.
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Chiang WC, Wang HC, Chen SY, Chen LM, Yao YC, Wu GHM, Ko PCI, Yang CW, Tsai MT, Hsai CC, Su CP, Chen SC, Ma MHM. Lack of compliance with basic infection control measures during cardiopulmonary resuscitation--are we ready for another epidemic? Resuscitation 2008; 77:356-62. [PMID: 18343557 PMCID: PMC7116997 DOI: 10.1016/j.resuscitation.2007.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 11/07/2007] [Accepted: 12/22/2007] [Indexed: 11/30/2022]
Abstract
Objective Healthcare workers in the emergency department are particularly vulnerable to communicable disease. This study aimed to evaluate compliance with standard precautions by analysis of the incidence and systems sources of such contaminations and by quantifying the use of personal protective equipment. Method A prospective observational study from 1 November 2005 to 30 April 2006, using analysis of video segments. Videotapes were recorded in two rooms designed for cardiopulmonary resuscitation of out-of-hospital cardiac arrests, and compliance with basic infection control measures by all emergency department crews was monitored. Results A total of 44 consecutive performances of cardiopulmonary resuscitation were recorded for time-motion analysis. The percentages of staff wearing personal protective equipment were 90%, 50%, 20% and 75% for masks, eye protection, gowns and gloves, respectively. Compliance ranking scored doctors as high, trainees as moderate and nursing staff as low. Overall contamination rate was 16.9 × 10−2 events/person-min. The two leading systems sources for contamination were lack of specific task assignments among rescuers (44%) and inadequate preparation for procedures (42%). Conclusions Among healthcare workers in the emergency setting, the study disclosed suboptimal compliance with basic infection control measures, including use of personal protective equipment and avoiding contamination. By further time-motion analysis of resuscitation sessions, major systems sources and strategies for improvement could be identified.
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Affiliation(s)
- Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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