Project description:BackgroundIn the context of the COVID-19 pandemic, cases of adverse skin reactions related to the wearing of masks have been observed.ObjectivesTo analyze the short-term effects of N95 respirators and medical masks, respectively, on skin physiological properties and to report adverse skin reactions caused by the protective equipment.MethodsThis study used a randomized crossover design with repeated measurements. Twenty healthy Chinese volunteers were recruited. Skin parameters were measured on areas covered by the respective masks and on uncovered skin 2 and 4 hours after donning, and 0.5 and 1 hour after removing the masks, including skin hydration, transepidermal water loss (TEWL), erythema, pH, and sebum secretion. Adverse reactions were clinically assessed, and perceived discomfort and non-compliance measured.ResultsSkin hydration, TEWL, and pH increased significantly with wearing the protective equipment. Erythema values increased from baseline. Sebum secretion increased both on the covered and uncovered skin with equipment-wearing. There was no significant difference in physiological values between the two types of equipment. More adverse reactions were reported following a N95 mask use than the use of a medical mask, with a higher score of discomfort and non-compliance.ConclusionsThis study demonstrates that skin biophysical characters change as a result of wearing a mask or respirator. N95 respirators were associated with more skin reactions than medical masks.
Project description:ImportanceClinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections.ObjectiveTo compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP.Design, setting, and participantsA cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups.InterventionsOverall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness.Main outcomes and measuresThe primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed.ResultsAmong 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group.Conclusions and relevanceAmong outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.Trial registrationClinicalTrials.gov Identifier: NCT01249625.
Project description:ObjectiveDuring the coronavirus disease 2019 (COVID-19) pandemic, the N95 mask is an essential piece of protective equipment for healthcare workers. However, the N95 mask may inhibit air exchange and odor penetration. Our study aimed to determine whether the use of N95 masks affects the odor discrimination ability of healthcare workers.MethodsIn our study, all the participants were asked to complete three olfactory tests. Each test involved 12 different odors. The participants completed the test while wearing an N95 mask, a surgical mask, and no mask. The score for each olfactory test was documented.ResultsThe olfactory test score was significantly lower when the participants wore N95 masks than when they did not wear a mask (7 vs. 10, p < 0.01). The score was also lower when the participants wore N95 masks than surgical masks (7 vs. 8, p < 0.01).ConclusionWearing N95 masks decreases the odor discrimination ability of healthcare workers. Therefore, we suggest that healthcare workers seek other clues when diagnosing disease with a characteristic odor.
Project description:Face coverings are a key component of preventive health measure strategies to mitigate the spread of respiratory illnesses. In this study five groups of masks were investigated that are of particular relevance to the SARS-CoV-2 pandemic: re-usable, fabric two-layer and multi-layer masks, disposable procedure/surgical masks, KN95 and N95 filtering facepiece respirators. Experimental work focussed on the particle penetration through mask materials as a function of particle diameter, and the total inward leakage protection performance of the mask system. Geometric mean fabric protection factors varied from 1.78 to 144.5 for the fabric two-layer and KN95 materials, corresponding to overall filtration efficiencies of 43.8% and 99.3% using a flow rate of 17 L/min, equivalent to a breathing expiration rate for a person in a sedentary or standing position conversing with another individual. Geometric mean total inward leakage protection factors for the 2-layer, multi-layer and procedure masks were <2.3, while 6.2 was achieved for the KN95 masks. The highest values were measured for the N95 group at 165.7. Mask performance is dominated by face seal leakage. Despite the additional filtering layers added to cloth masks, and the higher filtration efficiency of the materials used in disposable procedure and KN95 masks, the total inward leakage protection factor was only marginally improved. N95 FFRs were the only mask group investigated that provided not only high filtration efficiency but high total inward leakage protection, and remain the best option to protect individuals from exposure to aerosol in high risk settings. The Mask Quality Factor and total inward leakage performance are very useful to determine the best options for masking. However, it is highly recommended that testing is undertaken on prospective products, or guidance is sought from impartial authorities, to confirm they meet any implied standards.
Project description:BACKGROUND:Due to the SARS-CoV2 pandemic, medical face masks are widely recommended for a large number of individuals and long durations. The effect of wearing a surgical and a FFP2/N95 face mask on cardiopulmonary exercise capacity has not been systematically reported. METHODS:This prospective cross-over study quantitated the effects of wearing no mask (nm), a surgical mask (sm) and a FFP2/N95 mask (ffpm) in 12 healthy males (age 38.1?±?6.2 years, BMI 24.5?±?2.0 kg/m2). The 36 tests were performed in randomized order. The cardiopulmonary and metabolic responses were monitored by ergo-spirometry and impedance cardiography. Ten domains of comfort/discomfort of wearing a mask were assessed by questionnaire. RESULTS:The pulmonary function parameters were significantly lower with mask (forced expiratory volume: 5.6?±?1.0 vs 5.3?±?0.8 vs 6.1?±?1.0 l/s with sm, ffpm and nm, respectively; p?=?0.001; peak expiratory flow: 8.7?±?1.4 vs 7.5?±?1.1 vs 9.7?±?1.6 l/s; p?<?0.001). The maximum power was 269?±?45, 263?±?42 and 277?±?46 W with sm, ffpm and nm, respectively; p?=?0.002; the ventilation was significantly reduced with both face masks (131?±?28 vs 114?±?23 vs 99?±?19 l/m; p?<?0.001). Peak blood lactate response was reduced with mask. Cardiac output was similar with and without mask. Participants reported consistent and marked discomfort wearing the masks, especially ffpm. CONCLUSION:Ventilation, cardiopulmonary exercise capacity and comfort are reduced by surgical masks and highly impaired by FFP2/N95 face masks in healthy individuals. These data are important for recommendations on wearing face masks at work or during physical exercise.
Project description:According to the familiar axiom, the eyes are the window to the soul. However, wearing masks to prevent the spread of viruses such as COVID-19 involves obscuring a large portion of the face. Do the eyes carry sufficient information to allow for the accurate perception of emotions in dynamic expressions obscured by masks? What about the perception of the meanings of specific smiles? We addressed these questions in two studies. In the first, participants saw dynamic expressions of happiness, disgust, anger, and surprise that were covered by N95, surgical, or cloth masks or were uncovered and rated the extent to which the expressions conveyed each of the same four emotions. Across conditions, participants perceived significantly lower levels of the expressed (target) emotion in masked faces, and this was particularly true for expressions composed of more facial action in the lower part of the face. Higher levels of other (non-target) emotions were also perceived in masked expressions. In the second study, participants rated the extent to which three categories of smiles (reward, affiliation, and dominance) conveyed positive feelings, reassurance, and superiority, respectively. Masked smiles communicated less of the target signal than unmasked smiles, but not more of other possible signals. The present work extends recent studies of the effects of masked faces on the perception of emotion in its novel use of dynamic facial expressions (as opposed to still images) and the investigation of different types of smiles.Supplementary informationThe online version contains supplementary material available at 10.1007/s42761-021-00097-z.
Project description:BACKGROUND: Patients with end-stage renal disease (ESRD) have multiple comorbid conditions. Obtaining comorbidity data from medical records is cumbersome. A self-report comorbidity questionnaire is a useful alternative. Our aim in this study was to examine the predictive value of a self-report comorbidity questionnaire in terms of survival in ESRD patients. METHODS: We studied a prospective cross-sectional cohort of 282 haemodialysis (HD) patients in a single centre. Participants were administered the self-report questionnaire during an HD session. Information on their comorbidities was subsequently obtained from an examination of the patient's medical records. Levels of agreement between parameters derived from the questionnaire, and from the medical records, were examined. Participants were followed-up for 18 months to collect survival data. The influence on survival of comorbidity scores derived from the self-report data (the Composite Self-report Comorbidity Score [CSCS]) and from medical records data--the Charlson Comorbidity Index [CCI] were compared. RESULTS: The level of agreement between the self-report items and those obtained from medical records was almost perfect with respect the presence of diabetes (Kappa score ? 0.97), substantial for heart disease and cancer (? 0.62 and ? 0.72 respectively), moderate for liver disease (? 0.51), only fair for lung disease, arthritis, cerebrovascular disease, and depression (? 0.34, 0.35, 0.34 and 0.29 respectively). The CSCS was strongly predictive of survival in regression models (Nagelkerke R(2) value 0.202), with a predictive power similar to that of the CCI (Nagelkerke R(2) value 0.211). The influences of these two parameters were additive in the models--suggesting that these parameters make different contributions to the assessment of comorbidity. CONCLUSION: This self-report comorbidity questionnaire is a viable tool to collect comorbidity data and may have a role in the prediction of short-term survival in patients with end-stage renal disease on haemodialysis. Further work is required in this setting to refine the tool and define its role.
Project description:Hydrogen peroxide is commonly used as a sterilizing agent for medical devices and its use has recently been extended to N95 masks during PPE shortages as a result of the COVID-19 pandemic. The hydrogen peroxide remaining on the masks after sterilization could potentially pose a health hazard to the mask users. In the present study a colorimetric method was optimized for the determination of hydrogen peroxide on N95 masks following chemical sanitizations. The developed analytical method demonstrated an overall recovery of 98% ± 7%. The limit of detection ranged from 0.16 to 0.25 mg/mask, depending on the type of mask. The expanded measurement uncertainty was 13% (at a 95% confidence interval). The sanitization process itself introduced a significant variation in hydrogen peroxide load between masks. The ozone used in the sanitization process had no significant impact on analytical performance. Stamped and printed marks on the mask surfaces could induce biased readings. Hydrogen peroxide decomposes quickly on the mask surfaces so timing of analysis is an important factor in method standardization.•The validation data demonstrated that the in-house method is reliable and fit for the intended purpose, offering a sensitive, simple, rapid, and inexpensive method of residue monitoring.