1
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Agius R. COVID-19 in Workplace Settings: Lessons Learned for Occupational Medicine in the UK. LA MEDICINA DEL LAVORO 2023; 114:e2023055. [PMID: 38060204 PMCID: PMC10731572 DOI: 10.23749/mdl.v114i6.15461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
This paper addresses lessons learned from the COVID-19 pandemic from a UK Occupational Medicine perspective to permit comparison with other national accounts. In spite of good prior research and statute, the necessary resources to protect workers' health were seriously lacking when the pandemic struck. Weak public health guidance, which did not recognise dominant airborne transmission, was applied to workplaces, leaving workers and others unprotected, especially in respect to Respiratory Protective Equipment (RPE). The Health and Safety Executive (HSE) as regulator was lacking, for example, in not producing guidance to protect HealthCare Workers (HCW) who were amongst the most at risk. The UK COVID-19 Public Inquiry should address shortcomings such as these, but recommendations must be accompanied by robust means to ensure appropriate implementation. These should range from substantial measures to improve indoor air quality, to a permanent pandemic management organization with adequate resources. The enforcing authority has to be obliged to publish more specific workplace guidance than the public health authorities. Occupational medicine as a discipline needs to be better prepared, and hence to assert its responsibility towards high standards of workers' health protection. Future research has to include investigating the best means of mitigation against airborne infection and the management of post-acute covid sequelae.
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Affiliation(s)
- Raymond Agius
- Professor Emeritus of Occupational and Environmental Medicine, The University of Manchester, UK.
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2
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Tang F, Wen X, Zhang X, Qi S, Tang X, Huang J, Zhu C, Shang G, Xu Y, Cai J, Wang R. Ultrafine particles exposure is associated with specific operative procedures in a multi-chair dental clinic. Heliyon 2022; 8:e11127. [PMID: 36276750 PMCID: PMC9574865 DOI: 10.1016/j.heliyon.2022.e11127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/12/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Air quality in dental clinics is critical, especially in light of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, given that dental professionals and patients are at risk of regular exposure to aerosols and bioaerosols in dental clinics. High levels of ultrafine particles (UFP) may be produced by dental procedures. This study aimed to quantify ultrafine particles (UFP) concentrations in a real multi-chair dental clinic and compare the levels of UFP produced by different dental procedures. The efficiency of a high-volume evacuator (HVE) in reducing the UFP concentrations during dental procedures was also assessed. UFP concentrations were measured both inside and outside of a dental clinic in Shanghai, China during a 12-day period from July to September 2020. Dental activities were recorded during working hours. The mean (±standard deviation) concentrations of indoor and outdoor UFP during the sampling period were 8,209 (±4,407) counts/cm3 and 15,984 (±7,977) counts/cm3, respectively. The indoor UFP concentration was much higher during working hours (10,057 ± 5,725 counts/cm3) than during non-working hours (7,163 ± 2,972 counts/cm3). The UFP concentrations increased significantly during laser periodontal treatment, root canal filling, tooth drilling, and grinding, and were slightly elevated during ultrasonic scaling or tooth extraction by piezo-surgery. The highest UFP concentration (241,136 counts/cm3) was observed during laser periodontal treatment, followed by root canal filling (75,034 counts/cm3), which showed the second highest level. The use of an HVE resulted in lower number concentration of UFP when drilling and grinding teeth with high-speed handpieces, but did not significantly reduce UFP measured during laser periodontal therapy. we found that many dental procedures can generate high concentration of UFP in dental clinics, which may have a great health impact on the dental workers. The use of an HVE may help reduce the exposure to UFP during the use of high-speed handpieces.
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Affiliation(s)
- Fengqin Tang
- Department of Stomatology, Clinical Medical College of Shanghai Tenth Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xueyun Wen
- Department of Stomatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Xu Zhang
- Department of Stomatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Shengcai Qi
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, PR China,Department of Prosthodontics, Shanghai Stomatology Hospital, Fudan University, Shanghai, PR China
| | - Xiaoshan Tang
- Department of Stomatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Jieying Huang
- Department of Stomatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Chenjie Zhu
- Department of Stomatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Guangwei Shang
- Department of Stomatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Yuanzhi Xu
- Department of Stomatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, PR China,Corresponding author.
| | - Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, PR China,Corresponding author.
| | - Raorao Wang
- Department of Stomatology, Clinical Medical College of Shanghai Tenth Hospital of Nanjing Medical University, Nanjing, PR China,Department of Stomatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, PR China,Corresponding author.
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3
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Ravindra K, Singh T, Vardhan S, Shrivastava A, Singh S, Kumar P, Mor S. COVID-19 pandemic: What can we learn for better air quality and human health? J Infect Public Health 2022; 15:187-198. [PMID: 34979337 PMCID: PMC8642828 DOI: 10.1016/j.jiph.2021.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/15/2021] [Accepted: 12/01/2021] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 lockdown resulted in improved air quality in many cities across the world. With the objective of what could be the new learning from the COVID-19 pandemic and subsequent lockdowns for better air quality and human health, a critical synthesis of the available evidence concerning air pollution reduction, the population at risk and natural versus anthropogenic emissions was conducted. Can the new societal norms adopted during pandemics, such as the use of face cover, awareness regarding respiratory hand hygiene, and physical distancing, help in reducing disease burden in the future? The use of masks will be more socially acceptable during the high air pollution episodes in lower and middle-income countries, which could help to reduce air pollution exposure. Although post-pandemic, some air pollution reduction strategies may be affected, such as car-pooling and the use of mass transit systems for commuting to avoid exposure to airborne infections like coronavirus. However, promoting non-motorized modes of transportation such as cycling and walking within cities as currently being enabled in Europe and other countries could overshadow such losses. This demand focus on increasing walkability in a town for all ages and populations, including for a differently-abled community. The study highlighted that for better health and sustainability there. is also a need to promote other measures such as work-from-home, technological infrastructure, the extension of smart cities, and the use of information technology.
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Affiliation(s)
- Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Tanbir Singh
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India
| | - Shikha Vardhan
- Centre for Environmental & Occupational Health, Climate Change & Health, National Centre for Disease Control, Delhi, 110054, India
| | - Aakash Shrivastava
- Centre for Environmental & Occupational Health, Climate Change & Health, National Centre for Disease Control, Delhi, 110054, India
| | - Sujeet Singh
- Centre for Environmental & Occupational Health, Climate Change & Health, National Centre for Disease Control, Delhi, 110054, India
| | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Suman Mor
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India.
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4
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Cherrie JW, Cherrie MPC, Smith A, Holmes D, Semple S, Steinle S, Macdonald E, Moore G, Loh M. Contamination of Air and Surfaces in Workplaces with SARS-CoV-2 Virus: A Systematic Review. Ann Work Expo Health 2021; 65:879-892. [PMID: 34329379 PMCID: PMC8385829 DOI: 10.1093/annweh/wxab026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/09/2021] [Accepted: 03/24/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This systematic review aimed to evaluate the evidence for air and surface contamination of workplace environments with SARS-CoV-2 RNA and the quality of the methods used to identify actions necessary to improve the quality of the data. METHODS We searched Web of Science and Google Scholar until 24 December 2020 for relevant articles and extracted data on methodology and results. RESULTS The vast majority of data come from healthcare settings, with typically around 6% of samples having detectable concentrations of SARS-CoV-2 RNA and almost none of the samples collected had viable virus. There were a wide variety of methods used to measure airborne virus, although surface sampling was generally undertaken using nylon flocked swabs. Overall, the quality of the measurements was poor. Only a small number of studies reported the airborne concentration of SARS-CoV-2 virus RNA, mostly just reporting the detectable concentration values without reference to the detection limit. Imputing the geometric mean air concentration assuming the limit of detection was the lowest reported value, suggests typical concentrations in healthcare settings may be around 0.01 SARS-CoV-2 virus RNA copies m-3. Data on surface virus loading per unit area were mostly unavailable. CONCLUSIONS The reliability of the reported data is uncertain. The methods used for measuring SARS-CoV-2 and other respiratory viruses in work environments should be standardized to facilitate more consistent interpretation of contamination and to help reliably estimate worker exposure.
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Affiliation(s)
- John W Cherrie
- Institute of Occupational Medicine, Research Avenue North, Edinburgh, UK
- Heriot Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Riccarton, Edinburgh, UK
| | - Mark P C Cherrie
- Institute of Occupational Medicine, Research Avenue North, Edinburgh, UK
- University of Edinburgh, School of Geosciences, Edinburgh, UK
| | - Alice Smith
- Institute of Occupational Medicine, Research Avenue North, Edinburgh, UK
| | - David Holmes
- Institute of Occupational Medicine, Research Avenue North, Edinburgh, UK
| | - Sean Semple
- University of Stirling, Institute for Social Marketing and Health, Stirling, UK
| | - Susanne Steinle
- Institute of Occupational Medicine, Research Avenue North, Edinburgh, UK
| | - Ewan Macdonald
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, UK
| | - Ginny Moore
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Miranda Loh
- Institute of Occupational Medicine, Research Avenue North, Edinburgh, UK
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5
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Nicholson PJ, Sen D. Healthcare workers and protection against inhalable SARS-CoV-2 aerosols. Occup Med (Lond) 2021; 71:118-120. [PMID: 33733273 PMCID: PMC7989185 DOI: 10.1093/occmed/kqab033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Dil Sen
- Occupational Physician, Milestones, Hightown, UK
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6
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Williams K, Cherrie JW, Dobbie J, Agius RM. The Development of a Covid-19 Control Measures Risk Matrix for Occupational Hygiene Protective Measures. Ann Work Expo Health 2021; 66:269-275. [PMID: 34278429 PMCID: PMC8344429 DOI: 10.1093/annweh/wxab050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/19/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022] Open
Abstract
The British Occupational Hygiene Society (BOHS) Covid-19 Working Group developed a control banding matrix to provide guidance for employers and others to help assess the risks of Covid-19 infection during the pandemic. The matrix was based on occupational hygiene principles and the judgement of the occupational health practitioners involved; since objective data on workers’ exposure were unavailable. Users of the matrix identify one of five exposure categories based on generic job descriptions and example occupations, and these categories are linked to generic guidance on interventions at source, on the exposure pathway and for individual workers. The risk matrix was published on the BOHS website and the guidance has been downloaded more than 2000 times. The matrix has had limited evaluation for reliability, but the data suggest that the highest exposure ranked jobs were associated with higher age-standardized mortality in Britain during the pandemic. However, there was considerable variability in exposure assignments between assessors, which underlines the need for the control guidance to be precautionary. The BOHS calls on academic researchers to undertake further work to validate the reliability of the tool.
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Affiliation(s)
| | - John W Cherrie
- Institute of Occupational Medicine, Edinburgh, UK.,Heriot Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Riccarton, Edinburgh, UK
| | | | - Raymond M Agius
- The University of Manchester, Centre for Occupational and Environmental Health, Manchester, UK
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Cacco T, Fragale M, Sampieri C, Castello E, Risso C, Piras MT, Durando P, Montecucco A, Pariscenti GL, Peretti G. Modified full-face snorkeling mask for thoracic surgery and otolaryngology surgical use: comfort and usability assessment during the COVID-19 pandemic. LA MEDICINA DEL LAVORO 2021; 112:107-114. [PMID: 33881004 PMCID: PMC8095329 DOI: 10.23749/mdl.v112i2.10032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022]
Abstract
Background: A worldwide personal protection equipment (PPE) shortage has emerged during COVID-19 pandemic, contributing to the high incidence of SARS-CoV-2 infection among health care providers. To address this lack of PEE, new solutions have been researched. Among those, full-face snorkeling masks demonstrated to be an interesting option. Among surgical specialties otolaryngologists and thoracic surgeons are at high risk of infection, due to the close contact with airway secretions. Objectives: We tested the comfort and usability of a modified full-face snorkeling mask (Ocean Reef Mask Aria QR+) as a protective device for otolaryngologic and thoracic surgeries. Methods: The mask was customized with a 3D-printed adaptor supporting many industrial filter types, including FFP3 and heat and moisture exchangers (HME). We evaluated surgical performances of the mask, both subjectively, with a questionnaire filled in by the surgeons, as well as objectively, monitoring transcutaneous PCO2 and PO2 values of surgeons during surgical procedures. Results: The modified full-face snorkeling mask was tested during 9 otolaryngologic and 15 thoracic surgery procedures. The device demonstrated very good overall vision quality with some limitations regarding lateral vision and almost no difficulties in usability. Water condensation into the mask was absent in almost every case. Both PO2 and PCO2 parameters remained within normal ranges during every procedure. Discussion: The modified full-face snorkeling mask can be an innovative PPE. In the current COVID-19 pandemic scenario, the worldwide shortage of protective masks and goggles may exploit this ready-to-use and low-cost solution, especially for high-risk surgical procedures.
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Affiliation(s)
- Tommaso Cacco
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology - Head and Neck Surgery, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy .
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology - Head and Neck Surgery, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy .
| | - Claudio Sampieri
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology - Head and Neck Surgery, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy .
| | - Eolo Castello
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology - Head and Neck Surgery, Genoa, Italy.
| | - Carlo Risso
- IRCCS Ospedale Policlinico San Martino, Unit of Thoracic Surgery, Genoa, Italy.
| | - Maria Teresa Piras
- IRCCS Ospedale Policlinico San Martino, Unit of Thoracic Surgery, Genoa, Italy.
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Italy ; IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy.
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy .
| | | | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology - Head and Neck Surgery, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy .
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8
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Tian Y, Nian B, Ma Y, Guo X, Wang F, Rong L. The Status of Occupational Protection During COVID-19 Pandemic: Knowledge, Attitudes, and Practice of Healthcare Workers in Endoscopy Units, China. Front Public Health 2021; 9:632608. [PMID: 33829007 PMCID: PMC8019814 DOI: 10.3389/fpubh.2021.632608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background: SARS-CoV-2 spreads rapidly around the world, and some patients present gastrointestinal symptoms. The existence of the virus in the gastrointestinal tract makes digestive endoscopy a high-risk operation, which associated with an increased risk of infection rate in healthcare workers. This study aimed at exploring current knowledge, practice and attitudes of healthcare workers in endoscopy units in China regarding the status of occupational protection during COVID-19 pandemic. Methods: A cross-sectional study of a national online survey involving 717 healthcare workers in endoscopy units from 94 medical structures in 24 provinces and municipalities around China was conducted online via a questionnaire platform called Wenjuanxing (wjx.cn). The data were analyzed using correlation approaches, Kruskal-Wallis test for independent samples, and linear regression models. Results: Most Chinese healthcare workers in endoscopy units had a good knowledge of COVID-19 (median: 10; range: 7–12), showed a strikingly positive attitude (median: 65; range: 39–65), and carried out good practice (median: 47; range: 14–50) in strengthening the protection, disinfection and management of COVID-19. In terms of attitudes, female staff was more concerned about protection against COVID-19 than male staff (KW = 8.146, P = 0.004). Nurses performed better in both attitude (KW = 2.600, P = 0.009) and practice (KW = 6.358, P < 0.001) than endoscopic physicians when carrying out personal protection, patient care and environmental disinfection against SARS-CoV-2 infection. More positive attitudes in protection were related to better protective behavior in endoscopic daily medical work (r = 0.312; P < 0.001). Conclusion: The findings of this study suggest that Chinese endoscopy healthcare workers have an excellent mastery of knowledge about COVID-19, which is transformed into positive beliefs and attitudes, contributing to good practice during daily endoscopic procedures. Medical staff may benefit from further education. With the gradual normalization amid the ongoing COVID-19 pandemic, protection and management in endoscopy units may be changed accordingly.
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Affiliation(s)
- Yuan Tian
- Department of Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Bixiao Nian
- Department of Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Yongchen Ma
- Department of Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Xinyue Guo
- Department of Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Feng Wang
- Department of Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Long Rong
- Department of Endoscopy Center, Peking University First Hospital, Beijing, China
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9
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Agius RM, MacDermott N. Covid-19 and workers' protection: lessons to learn, and lessons overlooked. Occup Med (Lond) 2021; 72:62-64. [PMID: 33733272 PMCID: PMC7989182 DOI: 10.1093/occmed/kqab034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Raymond M Agius
- Emeritus Professor of Occupational and Environmental Medicine, The University of Manchester, Manchester M13 9PL, UK
| | - Nathalie MacDermott
- Academic Clinical Lecturer in Paediatric Infectious Diseases, King's College London, London SE1 7EU, UK
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10
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Yao D, Yan K, Duan J, Zhang X, Zhou L. Coronavirus Disease 2019 (COVID-19): Prevention and Control in Gynecological Outpatient Clinic. Front Public Health 2021; 8:618494. [PMID: 33490027 PMCID: PMC7820776 DOI: 10.3389/fpubh.2020.618494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/03/2020] [Indexed: 12/25/2022] Open
Abstract
Objective: The pandemic of coronavirus disease 2019 (COVID-19) has become a major public health challenge around the world, and outbreaks of the SARS-CoV-2 have constituted a public health emergency of international concern. Infection control measures are necessary to prevent further spread of the virus and to help control the epidemic situation. Due to the characteristics of gynecological settings, the risk of cross infection between patients and gynecologic practitioners can be high, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces prevention and control measures for use in gynecological outpatient clinics and provides recommended management for gynecologists in (potentially) affected areas.
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Affiliation(s)
- Dongmei Yao
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Yan
- State Key Laboratory of Virology, Modern Virology Research Center, College of Life Sciences, Wuhan University, Wuhan, China
| | - Jie Duan
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian Zhang
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Limin Zhou
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Tamin J, Samuel O, Suraya A, Ebuenyi ID, Naicker N, Rajput-Ray M. Vulnerable Workers and COVID-19: Insights from a Survey of Members of the International Commission for Occupational Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E346. [PMID: 33466436 PMCID: PMC7796473 DOI: 10.3390/ijerph18010346] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic has negatively impacted on the health and wellbeing of populations directly through infection, as well as through serious societal and economic consequences such as unemployment and underemployment. The consequences could be even more severe for those more vulnerable to the disease, such as the elderly and those with underlying health conditions. Indeed, there is evidence that such vulnerable populations are disproportionately affected in terms of both, their health and the socioeconomic impact. The aim of our study was to determine whether occupational health (OH) professionals thought that the COVID-19 pandemic might further disadvantage any particular group(s) of vulnerable workers globally, and if so, which group(s). A cross-sectional study was carried out with a sample of OH professionals by means of an online questionnaire which was shared via email within the ICOH (International Commission for Occupational Health) community. Data was collected over a period of two weeks in May 2020 and 165 responses from 52 countries were received. In this paper, the responses relating to questions about vulnerable workers are reported and discussed. Globally, our responders felt that those in less secure jobs (precarious employment (79%) and informal work (69%)), or unemployed (63%), were the most at risk of further disadvantage from this pandemic. The majority felt that their governments could act to mitigate these effects. There were suggestions of short-term alleviation such as financial and social support, as well as calls for fundamental reviews of the underlying inequalities that leave populations so vulnerable to a crisis such as COVID-19.
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Affiliation(s)
- Jacques Tamin
- Centre for Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - Oluranti Samuel
- Department of Sociology, Faculty of Social Sciences, Lagos State University, Ojo, Lagos State 10001, Nigeria;
| | - Anna Suraya
- Faculty of Public Health, Binawan University, East Jakarta, Jakarta 13630, Indonesia;
| | - Ikenna D. Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland;
| | - Nisha Naicker
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg 2000, South Africa;
| | - Minha Rajput-Ray
- NNEdPro, Global Centre for Nutrition and Health, Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge CB4 0WS, UK;
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12
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Douglas JDM, McLean N, Horsley C, Higgins G, Douglas CM, Robertson E. COVID-19: smoke testing of surgical mask and respirators. Occup Med (Lond) 2020; 70:556-563. [PMID: 33150448 PMCID: PMC7665646 DOI: 10.1093/occmed/kqaa167] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Fluid Resistant Surgical Masks have been implemented in UK personal protective equipment (PPE) guidelines for COVID-19 for all care sites that do not include aerosol-generating procedures (AGPs). FFP3 masks are used in AGP areas. Concerns from the ENT and plastic surgery communities out with intensive care units have questioned this policy. Emerging evidence on cough clouds and health care worker deaths has suggested that a review is required. Aims To test the efficacy of Fluid Resistant Surgical Mask with and without adaptions for respiratory protection. To test the efficacy of FFP and FFP3 regarding fit testing and usage. Methods A smoke chamber test of 5 min to model an 8-h working shift of exposure while wearing UK guideline PPE using an inspiratory breathing mouthpiece under the mask. Photographic data were used for comparison. Results The Fluid Resistant Surgical Mask gave no protection to inhaled smoke particles. Modifications with tape and three mask layers gave slight benefit but were not considered practical. FFP3 gave complete protection to inhaled smoke but strap tension needs to be ‘just right’ to prevent facial trauma. Facial barrier creams are an infection risk. Conclusions Surgical masks give no protection to respirable particles. Emerging evidence on cough clouds and health care worker deaths suggests the implementation of a precautionary policy of FFP3 for all locations exposed to symptomatic or diagnosed COVID-19 patients. PPE fit testing and usage policy need to improve to include daily buddy checks for FFP3 users
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Affiliation(s)
- J D M Douglas
- Tweeddale Medical Practice, Fort William Health Centre, Fort William, Scotland, UK
| | - N McLean
- Geo-Rope Ltd, West Quarry, Ballachulish, Argyll, Scotland, UK
| | - C Horsley
- Geo-Rope Ltd, West Quarry, Ballachulish, Argyll, Scotland, UK
| | - G Higgins
- Canniseburn Department of Plastic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - C M Douglas
- ENT Surgery Department, Gartnavel General Hospital, Glasgow, Scotland, UK
| | - E Robertson
- Canniseburn Department of Plastic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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Skolmowska D, Głąbska D, Guzek D. Hand Hygiene Behaviors in a Representative Sample of Polish Adolescents in Regions Stratified by COVID-19 Morbidity and by Confounding Variables (PLACE-19 Study): Is There Any Association? Pathogens 2020; 9:pathogens9121011. [PMID: 33271861 PMCID: PMC7759844 DOI: 10.3390/pathogens9121011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 12/23/2022] Open
Abstract
The hand hygiene may possibly influence the course of the COVID-19 pandemic, but the multifactorial influence on hand hygiene knowledge and behaviors is proven. The aim of the study was to analyze hand hygiene behaviors in a national representative sample of Polish adolescents in regions stratified by COVID-19 morbidity, while taking socioeconomic status of the region, as well rural or urban environment, into account as possible interfering factors. The study was conducted Polish Adolescents’ COVID-19 Experience (PLACE-19) Study population (n = 2323) that was recruited based on a random sampling of schools, while the pair-matching procedure was applied within schools and age, in order to obtain adequate number of boys and girls, representative for the general Polish population (n = 1222). The participants were asked about their handwashing habits while using Handwashing Habits Questionnaire (HHQ) and about applied procedure of washing hands. The results were compared in subgroups that were stratified by region for COVID-19 morbidity, socioeconomic status of the region, and rural/urban environment. In regions of low COVID-19 morbidity, a higher share of adolescents, than in regions of high morbidity, declared washing their hands before meals (p = 0.0196), after meals (p = 0.0041), after preparing meals (p = 0.0297), before using the restroom (p = 0.0068), after using the restroom (p = 0.0014), after combing their hair (p = 0.0298), after handshaking (p = 0.0373), after touching animals (p = 0.0007), after contacting babies (p = 0.0278), after blowing nose (p = 0.0435), after touching sick people (p = 0.0351), and after cleaning home (p = 0.0234). For the assessed steps of the handwashing procedure, in regions of low COVID-19 morbidity, a higher share of adolescents included them to their daily handwashing, than in regions of high morbidity, that was stated for removing watch and bracelets (p = 0.0052), removing rings (p = 0.0318), and drying hands with towel (p = 0.0031). For the comparison in regions stratified by Gross Domestic Product, the differences were only minor and inconsistent. For the comparison in place of residence stratified by number of residents in city, there were some minor differences indicating better hand hygiene behaviors in the case of villages and small towns when compared with medium and large cities (p < 0.05). It may be concluded that, in a population-based sample of Polish adolescents, individuals from regions of low COVID-19 morbidity presented more beneficial hand hygiene habits than those from regions of high COVID-19 morbidity.
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Affiliation(s)
- Dominika Skolmowska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
| | - Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-593-71-34
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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14
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Abstract
Background By law, covid-19 disease and deaths in workers may lead to coroners’ inquests and/or Health and Safety Executive (HSE) investigations. Aims This study assesses the adequacy of these statutory means to yield recommendations for prevention of acquiring covid-19 infection from work. Methods Covid-19 guidance from the chief coroner and the HSE was appraised, including using Office for National Statistics (ONS) data. Practitioners were asked to estimate the likelihood that covid-19 disease may have arisen from ‘near-miss’ scenarios. Data from the judiciary and the HSE were analysed. Results The coroners’ guidance allowed a wider range of reports of death than did the HSE and conformed better with ONS data on covid-19 mortality by occupation. In the practitioner survey, 62 respondents considered a higher likelihood that reported covid-19 cases would have arisen from the scenario deemed unreportable as a ‘dangerous occurrence’ by HSE than the reportable scenario (P < 0.001). On average there was only one coroner’s report to prevent future death from occupational disease every year in England and Wales. The HSE dealt with a yearly average of 1611 reports of work-related disease including 104 on biological agents, but has received about 9000 covid-19 reports. Conclusions Current HSE guidance for reporting work-related covid-19 may miss many thousands of cases and needs further iteration. Coroners have very limited experience of inquiry into occupational disease caused by biological agents compared with the HSE. Concerns regarding national policy such as on protective equipment warrant a full public inquiry.
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Affiliation(s)
- R M Agius
- Emeritus Professor of Occupational and Environmental Medicine, The University of Manchester, Manchester, UK
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15
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Bhandari P, Subramaniam S, Bourke MJ, Alkandari A, Chiu PWY, Brown JF, Keswani RN, Bisschops R, Hassan C, Raju GS, Muthusamy VR, Sethi A, May GR, Albéniz E, Bruno M, Kaminski MF, Alkhatry M, Almadi M, Ibrahim M, Emura F, Moura E, Navarrete C, Wulfson A, Khor C, Ponnudurai R, Inoue H, Saito Y, Yahagi N, Kashin S, Nikonov E, Yu H, Maydeo AP, Reddy DN, Wallace MB, Pochapin MB, Rösch T, Sharma P, Repici A. Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus. Gut 2020; 69:1915-1924. [PMID: 32816921 DOI: 10.1136/gutjnl-2020-322329] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.
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Affiliation(s)
- Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK .,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Sharmila Subramaniam
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Asma Alkandari
- Department of Gastroenterology, Al Jahra Hospital, Kuwait City, Al Jahra, Kuwait
| | - Philip Wai Yan Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - James F Brown
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Rajesh N Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Raf Bisschops
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Vlaams Brabant, Belgium
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology and Nutrition, Universidad of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - V Raman Muthusamy
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Gary R May
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michal Filip Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Centre for Postgraduate Medical Education, Warsaw, Poland.,Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Instytute of Oncology, Warsaw, Poland
| | - Maryam Alkhatry
- Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates
| | - Majid Almadi
- Department of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia
| | - Mostafa Ibrahim
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Giza, Egypt
| | - Fabian Emura
- Gastroenterology Division, Universidad de La Sabana, Chia, Colombia.,Department of Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogota, Colombia
| | - Eduardo Moura
- Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | | | - Adolfo Wulfson
- Department of Gastroenterology, Hospital de Emergencias Dr Clemente Alvarez, Rosario, Rosario, Argentina
| | - Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Ryan Ponnudurai
- Department of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Naohisa Yahagi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.,Cancer Center, Keio University, Tokyo, Japan
| | - Sergey Kashin
- Department of Endoscopy, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation
| | - Evgeniy Nikonov
- Department of Gastroenterology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Amit P Maydeo
- Department of Surgery, Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
| | - D Nageshwar Reddy
- Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
| | - Michael B Wallace
- Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Prateek Sharma
- Endoscopy Unit, Veteran Affairs Medical Center and University of Kansas, Kansas City, Kansas, USA
| | - Alessandro Repici
- Gastroenterology and Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
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16
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Quadros CA, Leal MCBDM, Baptista-Sobrinho CDA, Nonaka CKV, Souza BSDF, Milan-Mattos JC, Catai AM, Pires Di Lorenzo VA, Ferreira AG. Preclinical validation of occupational and environmental safety of an isolation system for noninvasive ventilation in COVID-19 and other aerosol-transmitted infections. Expert Rev Med Devices 2020; 17:1211-1220. [PMID: 33103939 DOI: 10.1080/17434440.2020.1842190] [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: 10/23/2022]
Abstract
Background: The current SARS-CoV-2 pandemic has provoked the collapse of some health systems due to insufficient intensive care unit capacity. The use of continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) therapies has been limited in consideration of the risk of occupational infection in health-care professionals. Aims: In preclinical experimental simulations, evaluate occupational and environmental safety of the newly developed isolation system for aerosol-transmitted infections (ISATI). Method: Simulations were conducted to test ISATI's capability to isolate aerosolized molecular (caffeine), and biological (SARS-CoV-2 synthetic RNA) markers. Caffeine deposition was analyzed on nitrocellulose sensor discs by proton nuclear magnetic resonance spectroscopy. Synthetic SARS-CoV-2 detection was performed by reverse transcription-polymerase chain reaction. Results: ISATI demonstrated efficacy in isolating molecular and biological markers within the enclosed environment in simulated conditions of CPAP, HFNO and mechanical ventilation therapy. Neither the molecular marker nor substantial amounts of synthetic SARS-CoV-2 RNA were detected in the surrounding environment, outside ISATI, indicating appropriate occupational safety for health-care professionals. Conclusion: Aerosolized markers were successfully contained within ISATI in all experimental simulations, offering occupational and environmental protection against the dissemination of aerosolized microparticles under CPAP or HFNO therapy conditions, which are indicated for patients with acute respiratory infections.
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Affiliation(s)
- Claudio Almeida Quadros
- Department of Life Sciences, Bahia State University, Medical School , Salvador, Bahia, Brazil
| | | | | | - Carolina Kymie Vasques Nonaka
- Center for Biotechnology and Cell Therapy, São Rafael Hospital , Salvador, Bahia, Brazil.,D'Or Institute for Research and Education , Rio De Janeiro, Brazil
| | - Bruno Solano De Freitas Souza
- Center for Biotechnology and Cell Therapy, São Rafael Hospital , Salvador, Bahia, Brazil.,D'Or Institute for Research and Education , Rio De Janeiro, Brazil.,Gonçalo Moniz Institute, FIOCRUZ , Salvador, Bahia, Brazil
| | | | - Aparecida Maria Catai
- Department of Physiotherapy, São Carlos Federal University , São Carlos, São Paulo, Brazil
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17
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Affiliation(s)
- Raymond Agius
- Emeritus Professor of Occupational and Environmental Medicine, The University of Manchester, Manchester, UK
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18
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Weingarten K, Galván‐Durán AR, D’Urso S, Garcia D. The Witness to Witness Program: Helping the Helpers in the Context of the COVID-19 Pandemic. FAMILY PROCESS 2020; 59:883-897. [PMID: 32621761 PMCID: PMC7361603 DOI: 10.1111/famp.12580] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The Witness to Witness Program (W2W), based on Weingarten's witnessing model (2000, 2003, 2004), began in July 2018 and originally was established to support healthcare workers and attorneys (our partners) who were experiencing empathic distress working with people involved in various stages of the detention process. The W2W program evolved to offer four primary components: clinician listening sessions geared to deep understanding of the person's story of their work and its challenges; an inventory of the person's current internal and external resources both in the present and in the past; help with removal of barriers to those resources; and development of a personal toolkit to handle stress. Additional services available to partners and their organizations included psycho-educational webinars, facilitated peer support groups, and organizational consultations to foster trauma-sensitive and resilience-hardy work environments. In March, after lockdowns due to the coronavirus pandemic, W2W pivoted to focus on handouts and webinars addressing how to cope with distress and moral injury, maintaining resilience, coping with grief, and dealing with multiple losses caused by the pandemic. Disaster sparked collaboration and innovation. A train the trainer model was developed to reach more community health workers providing services to the Latinx community dealing with losses similar to those experienced by the clients they serve. W2W continues to create virtual communities of support. In doing so we practice doing reasonable hope together (Weingarten, Family Process, 2010, 49, 5).
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Affiliation(s)
| | | | - Sol D’Urso
- MFT Program USD and Private PracticeSan DiegoCAUSA
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19
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Iliadi A, Koletsi D, Eliades T, Eliades G. Particulate Production and Composite Dust during Routine Dental Procedures. A Systematic Review with Meta-Analyses. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E2513. [PMID: 32486443 PMCID: PMC7321425 DOI: 10.3390/ma13112513] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 12/22/2022]
Abstract
Composite dust generation is most likely a continuous and daily procedure in dental practice settings. The aim of this systematic review was to identify, compile and evaluate existing evidence on interventions and composite material properties related to the production of aerosolized dust during routine dental procedures. Seven electronic databases were searched, with no limits, supplemented by a manual search, on 27 April 2020 for published and unpublished research. Eligibility criteria comprised of studies of any design, describing composite dust production related to the implementation of any procedure in dental practice. Study selection, data extraction and risk of bias (RoB) assessment was undertaken independently either in duplicate, or confirmed by a second reviewer. Random effects meta-analyses of standardized mean differences (SMD) with associated 95% confidence intervals (CIs) were employed where applicable. A total of 375 articles were initially identified, resulting in 13 articles being included in the qualitative synthesis, of which 5 contributed to meta-analyses overall. Risk of bias recordings ranged between low and high, pertaining to unclear/raising some concerns, in most cases. All types of composites, irrespective of the filler particles, released significant amounts of nano-sized particles after being ground, with potentially disruptive respiratory effects. Evidence supported increased % distribution of particles < 100 nm for nanocomposite Filtek Supreme XTE compared to both conventional hybrid Z100MP (SMD: 1.96, 95% CI: 0.85, 3.07; p-value; 0.001) and nano- hybrid Tetric EvoCeram (SMD: 1.62, 95% CI: 0.56, 2.68; p-value: 0.003). For cytotoxicity considerations of generated aerosolized particles, both nanocomposites Filtek Supreme XTE and nanohybrid GradiO revealed negative effects on bronchial epithelial cell viability, as represented by % formazan reduction at 330-400 μg/ml for 24 hours, with no recorded differences between them (SMD: 0.19; 95% CI: -0.17, 0.55; p-value: 0.30). Effective and more rigorous management of dental procedures potentially liable to the generation of considerable amounts of aerosolized composite dust should be prioritized in contemporary dental practice. In essence, protective measures for the clinician and the practices' personnel should also be systematically promoted and additional interventions may be considered in view of the existing evidence.
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Affiliation(s)
- Anna Iliadi
- Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.I.); (G.E.)
| | - Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland;
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland;
| | - George Eliades
- Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.I.); (G.E.)
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