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Headaches and the N95 face-mask amongst healthcare providers
Acta Neurologica Scandinavica
Abstract
During the 2003 severe acute respiratory distress syndrome epidemic, healthcare workers mandatorily wore the protective N95 face-mask.
We administered a survey to healthcare workers to determine risk factors associated with development of headaches (frequency, headache subtypes and duration of face-mask wear) and the impact of headaches (sick days, headache frequency and use of abortive/preventive headache medications).
In the survey, 212 (47 male, 165 female) healthcare workers of mean age 31 years (range, 21-58) participated. Of the 79 (37.3%) respondents who reported face-mask-associated headaches, 26 (32.9%) reported headache frequency exceeding six times per month. Six (7.6%) had taken sick leave from March 2003 to June 2004 (mean 2 days; range 1-4 days) and 47 (59.5%) required use of abortive analgesics because of headache. Four (2.1%) took preventive medications for headaches during this period. Multivariate logistic regression showed that pre-existing headaches [P = 0.041, OR = 1.97 (95% CI 1.03-3.77)] and continuous use of the N95 face-mask exceeding 4 h [P = 0.053, OR = 1.85 (95% CI 0.99-3.43)] were associated with development of headaches.
Healthcare providers may develop headaches following the use of the N95 face-mask. Shorter duration of face-mask wear may reduce the frequency and severity of these headaches.
... Long-term usage of masks by healthcare workers has been linked to a variety of problems, including headache [6]. Several studies have found association of prolonged use of face masks by healthcare professionals and the appearance of new headaches or worsening of pre-existing headache [7,8]. In our study, we wanted to investigate mask-related headache during the COVID-19 pandemic and the possible relations between de-novo headache or exacerbation of pre-existing headache with the regular use of face masks among health workers at a tertiary hospital in Mogadishu, Somalia. ...
... Only a limited number of researches have been conducted to determine whether wearing a face mask causes headaches [4,7,8]. According to Ong et al.'s study, there was a significant increase in headaches in those with pre-existing headaches, as well as an increase in analgesic use, and a strong correlation between the use of other protective equipment (including face masks and goggles) and the development of de-novo headaches [7]. ...
... In the physiopathology of headache, there might be many mechanisms in action. Hypoxia, hypercapnia, local compression, and even mask wearing anxiety may be contributing factors to the mechanism of headache development in long-term use of face masks (especially N95) [8]. Tight-fitting masks reduce adequate ventilation, resulting in increased carbon dioxide (CO2) levels. ...
Aim: After the outbreak of Coronavirus Disease 2019 (COVID-19), new headaches have been reported to develop or worsen among healthcare workers who regularly wear personal protective equipments. In this study, we investigated the possible relationship between de-novo (new-onset) headache features associated with the mask used and pre-existing and exacerbated headaches. It is the first study on this subject on behalf of Somalia.
Methods: This is a cross-sectional study conducted at the Mogadishu COVID-19 pandemic hospital, Somalia, with volunteer healthcare workers. Data were collected through a questionnaire. Participants were asked 15 questions in the survey and Pearson-chi-square test was used as statistics.
Results: This study was conducted with 200 healthcare workers working in the hospital, 114 (57%) were male, 86 (43%) were female, and the mean age was 28. Participants 90 (45%) used surgical masks, 32 (16%) filtered masks (N95), 78 (39%) both; majority of 109 (54.5%) wore masks for more than 6 hours a day. Pre-existing headache was reported by78(39%) of the subjects. 55(70%) of those with pre-existing headache reported aggravation of their headache. Statistically significant relationship was found between duration of mask use and aggravation of pre-existing headache. De-novo headache characteristics were throbbing 21(20%), pressing 31(29%), unilateral 19(18%), and 35(33%) bilateral. A statistically significant relationship was also found between the duration of use of face mask and the development of de-novo headache, regardless of mask type.
Conclusion: As per our study, prolonged use of face masks during COVID-19 pandemics was associated with de-novo headaches and exacerbation of pre-existing headache. This situation, which has caused complaints as healthcare professionals and some patients continue to wear masks, will continue to be investigated.
... This result is in line with that of Hunt and colleagues [53], who reported that HCWs experienced symptoms comparable to heat strain in nearly 40% of the sample (level of heat perception from moderate to extreme). Significant increases in temperature and humidity attributed to the continuous use of FFP2 masks can lead to adverse effects on productivity [54] and thermal stress is documented in several other studies among HCWs [18,19]. However, Scarano et al. [55] recorded facial skin temperature in different breathing phases with a thermal imaging camera and showed that even if the perceived discomfort is greater for FFP2 masks than surgical ones, the facial skin temperature is lower during the inhalation and expiration phases. ...
... We found that 53.3% of respondents had problems communicating with patients and other medical personnel, consistent with previous studies on other health professionals [19,20,57]. Considering the pivotal role played by effective communication in safety performance, this aspect should be further analyzed in future research into emergency situations and surgical performance [20]. ...
... Taking more frequent breaks during working shifts has been reported as a precautionary measure and recommendation to avoid physical disturbance during the use of FFP masks [19,24,36]. However, during pandemic and emergency situations, it may become, in general, difficult to take frequent breaks and, upon removal, PPE needs to be thrown away. ...
Face masks represent an effective COVID-19 mitigation strategy; this study investigated the quality in use of FFP2 masks in a group of 156 frontline HCWs recruited through a snowball procedure in northwest Italy. Participants filled out an online questionnaire (January 2022) on FFP2 sources of discomfort, physical disturbance at different anatomical points and suggestions for improvement. Most of the participants (69%) reported a feeling of protection and safety, but they also reported episodes of dyspnea (70%). The majority of glasses wearers (62%) reported fogging and displacement of their glasses. Humidity and heat were the main discomfort sources (39%), followed by elastic bands (32%). Physical disturbances were frequent and heavier on the ears, nose and cheekbones. Nursing aides and nurses perceived significantly more discomfort compared to doctors and nursing aides had the highest rate of physical disturbance. To address these issues, following participants’ suggestions, FFP2 masks should be redesigned to be more adjustable, with different sizes and softer fabrics. The investigation pointed out criticalities in the use of FFP2 masks related to different professional roles within the overall group of HCWs and stressed the need for an FFP2 human-centered design that accounts not only for physical needs but also for workload and task variability.
... Those who wore an N95 face mask for less than 4 hours were excluded from the study since changes in heart rate and SpO 2 were insignificant as per available literature. Considering 72.4% prevalence of headaches after the use of masks among health care workers according to a study conducted by Lim et al., 11 and assuming α error as 5%, and error of margin as 10%, the calculated sample size was 90. However, the introduction T he coronavirus disease (COVID - 19) pandemic posed several challenges to patients as well as health care providers. ...
... In the current study, 42.3% experienced headaches after COVID-19 duty and 29.5% of them attributed it to N95 use, similar to Lim et al. 11 Higher proportion (81%) of headaches was reported by Ong et al., where 53% attributed headache to N95/PPE use 30 The proportion of participants with a history of preexisting headache was in line with both the studies. Regarding subtyping of headache, in comparison with a similar study, 11 we observed a very less proportion of tension-type headache (9% vs 54%), but a higher level of cluster headache (30.3% vs nil) unspecified pain (33.3% vs 13.9%) and an equal number of migraine type (27.2% vs 31%). ...
... In the current study, 42.3% experienced headaches after COVID-19 duty and 29.5% of them attributed it to N95 use, similar to Lim et al. 11 Higher proportion (81%) of headaches was reported by Ong et al., where 53% attributed headache to N95/PPE use 30 The proportion of participants with a history of preexisting headache was in line with both the studies. Regarding subtyping of headache, in comparison with a similar study, 11 we observed a very less proportion of tension-type headache (9% vs 54%), but a higher level of cluster headache (30.3% vs nil) unspecified pain (33.3% vs 13.9%) and an equal number of migraine type (27.2% vs 31%). Chew suggested headache as a confluent symptom due to altered physical and psychological health. ...
Background:
Prolonged use of N95 masks by healthcare workers might affect physical health due to mask-related hypoxia in addition to the psychological effects of N95 masks. We tried to explore the association of N95 mask-related hypoxia and headache with stress, quality of sleep, and anxiety in the current study.
Materials and methods:
The sample (N = 78) consisted of 41 doctors and 37 nurses involved in COVID-19 patient care and using N95 masks with or without PPE for at least 4 hours. Perceived stress scale (PSS), Coronavirus anxiety scale (CAS), and Pittsburgh sleep quality index (PSQI) were administered, and physical parameters like heart rate and oxygen saturation (SpO2) were measured.
Results:
Around 42% of the study participants experienced headaches after wearing an N95 mask and had a higher increase in heart rate (mean percent:10.5% vs 6.3%) and decline in SpO2 (mean percent: 2.6% vs 1.5%) compared to those who didn't develop a headache after N95 mask use. Independent samples t-test showed a mean difference for PSS and CAS between those who experienced headaches and those who didn't. The mean PSQI scores among the study participants were 8.91 ± 5.78; the score among those participants with and without headache was 10.57 ± 3.11 and 7.68 ± 2.53, respectively.
Conclusion:
Perceived corona anxiety, poor sleep quality, and corona anxiety are associated with N95-related headaches and SpO2 drop among health professionals who wear N95 masks for at least 4 hours.
... In one study, among healthcare professionals wearing N95 face masks, 37.3% indicated new-onset face mask-related headaches [16]. In another study conducted among nurses during the COVID-19 pandemic, 50% reported dizziness and headaches [17]. ...
... In a study conducted with intensive care nurses, headaches were one factor affecting N95 mask compliance [24]. Wear and use times of N95 masks have been shown to be an important risk factor for headaches [16]. Headache side effects have been reported with the long-term use of masks in healthcare workers [19]. ...
... Although the rate of painkiller use was high, 48.6% reported rarely needing medication. For comparison, a previous study reported 60% [16] usage of analgesics, while another study reported 28% [19]. Given that new-onset headaches are usually mild to moderate and resolve spontaneously after removing the equipment, there may be an occasional need for analgesics. ...
Objective:
Coronavirus 2019 disease (COVID-19), the cause of the ongoing pandemic, is an acute respiratory tract infection, which has made it necessary for healthcare personnel to use protective equipment such as N95 masks, protective goggles and visors. External compression headaches caused by the compression of the pericranial soft tissues by wearing hats, helmets, or goggles (worn during swimming or diving) have been previously described. In our study, we aimed to evaluate the presence and characteristics of personal protective equipment-associated headaches in healthcare workers during the COVID-19 pandemic period and to determine the effects of such headaches.
Materials and methods:
A face-to-face questionnaire was delivered to 300 male and female healthcare personnel between the ages of 18-56 working in healthcare units where COVID-19 patients were evaluated and treated. The data from 296 completed questionnaires was evaluated.
Results:
We included 296 participants (166 females and 130 males) in our study; the mean age was 33.98 ± 8.52 years (range 18-56). One hundred ninety-six (66.22%) participants indicated that they had new onset personal protective equipment-associated headaches. Percentages of those with newly emergent headaches because of protective equipment were higher in the following participant groups: females (p = 0.045), those with COVID-19 disease history (p < 0.001), and those diagnosed with headaches before the pandemic (p = 0.001).
Conclusion:
Our study showed the presence of new-onset headaches associated with personal protective equipment in healthcare workers during the COVID-19 pandemic. Personal protective equipment-related headaches were associated with the following factors: female sex, a history of COVID-19 disease, and the presence of primary headaches diagnosed before the pandemic.
... CMU can have an impact on the musculoskeletal system (Lim et al., 2006) and, specifically wearing this protective element may have myofascial effects on the craniofacial muscles. In this sense, CMU, as well as other health protective equipment, could create tensions and provoke or increase headache (Marfil Rivera et al., 2021), and as a consequence, produce a pain-related impact. ...
... It may be considered that the results obtained in this study could be taken into account in similar situations related with pandemic in the future, and thus adopt preventive measures and decrease the repercussion of CMU on QoL. With regard to the time of facemask use, previous studies have reported that headaches are most likely to appear in health care workers who wear N95-type masks for more than 4 h and had previously been headache sufferers (Lim et al., 2006). ...
Objective
The aim was to compare the effects between pre‐pandemic mask‐free living versus pandemic‐related continuous mask use.
Methods
A retrospective study was carried out. This study was conducted with 542 face mask users. Assessments included presence, frequency and impact of headache, temporomandibular disorders, and quality of life (QoL).
Results
Continuous mask use had a large main effect on headache, temporomandibular pain, and QoL (p < .0001; d = 1.25), but this effect was nuanced by mask type. Participants who declared suffering from headache increased by 84% with cloth masks, and by 25% with FFP2 masks. Temporomandibular pain increased by 50% and by 39% when wearing surgical masks and FFP2, respectively (p < .06; d = .19). The mask type did not nuance the effect on headache impact (p > .05; d = .06). QoL decreased regardless of mask type (p < .05; d = .21), the decrease being 38% for surgical masks, and 31% for either cloth or FFP2 masks.
Conclusions
Continuous mask use, regardless of type, increased existence of headache, headache impact, temporomandibular pain, and reduced QoL.
... Bansal et al. found that wearing a respirator while performing tasks requiring moderate exertion caused increased inspiratory tidal volume, minute ventilation, respiratory rate, heart rate, and duty cycle [11]. Lim et al. also found a significantly increased respiratory rate among the N95 mask wearers at four hours [12]. These findings were contrary to the study done by Fikenzer et al., who found a significant reduction in breathing frequency [8]. ...
... They link this side effect to the rebreathing of inhaled CO 2 inside the respirator microenvironment. The response to this environment is an increased rate and depth of breathing and cardiac output [12]. Roberge et al. found that continuous use of an N95 mask that exceeded four hours was associated with the development of headaches [13]. ...
Background and aims:
The N95 filtering facepiece respirator (FR) is the most commonly recommended respiratory protection used in healthcare settings. However, concerns have been raised about its use because it can increase respiratory resistance and dead space. The primary objective of this study was to determine the effect of wearing N95 masks on the vital signs, i.e., oxygen saturation, pulse rate, and respiratory rate, of the participant health workers. Our secondary objective was to assess the subjective feeling of discomfort when wearing N95 masks.
Methods:
The study participants were healthy healthcare workers taking care of coronavirus disease 2019 (COVID-19)-infected pediatric cases who did at least six hours of continuous shift duty in the pediatric COVID-19 ward at a tertiary care hospital in the eastern part of India. They were evaluated for vital signs at various time intervals while wearing N95 masks. Subjective discomfort at any point in time was also noted.
Results:
We found a significant variation in the mean oxygen saturation (SpO2) and heart rate (HR) reduction across the four different points. The pair-wise comparison showed a small but significant decrease in the mean SpO2 of 98.3% (1.1) at six hours as compared with a mean SpO2 of 98.7% (0.9) at three hours. Similarly, a significant increase was noted for a mean HR of 84.7 bpm (11.2) at six hours compared with a baseline of 82.3 bpm (9.2) and 83.2 bpm (8.8) at three hours.
Conclusion:
The continuous use of an N95 mask leads to a mild increase in respiratory rate. However, heart rate and oxygen saturation vary significantly at different points in time after N95 mask use.
... Previous studies on the N95 mask have reported that prolonged wearing causes discomfort and headache (Khoo et al. 2005;Lim et al. 2006). The level of discomfort increases over time, regardless of the type of respirator (Brian et al. 2012). ...
... Although prolonged work in an environment that causes discomfort should be avoided, using this mask is unlikely to affect medical care directly. In previous reports, even though using N95 masks was effective as an infection control measure, headaches, dryness of the eyes and nose, and acne (Lim et al. 2006; Kumar and Singh 2022) were pointed out as the adverse effects of long periods of mask use. In another study, using N95 masks signi cantly increased the occurrence of headache, dyspnea, drowsiness, and numbness compared with surgical masks, leading to decreased alertness and concentration, as assessed by a questionnaire survey (İpek et al. 2021). ...
Purpose
Healthcare workers must take stringent infection control measures against coronavirus disease. Previous reports have indicated that N95 masks cause fatigue, discomfort, and physical symptoms, such as headaches. We aimed to comparatively analyze the effect of the use of surgical and N95 masks for long hours on the performance of healthcare workers.
Methods
Healthy healthcare workers at an emergency department were subjected to a performance test program comprising four tests conducted before and after wearing a surgical mask/N95 mask for at least 4 h, and the results were compared.
Results
The study included 17 (male, 8 [47.1%]) healthcare workers. The age ranged from 22 to 32 (mean, 26.6) years. For each test, the rate of change in the percentage of correct responses, rate of decline in reaction time, and rate of decline in reaction time for correct responses were calculated before and after wearing the two types of masks. There was no statistically significant difference in the rate of decline in reaction time between the masks for all tests. However, there was a trend toward a high rate of decline in the alphanumeric detection test.
Conclusion
Using an N95 mask for 4 h continuously did not adversely affect work efficiency. Although prolonged work under conditions of discomfort should be avoided, it is unlikely that N95 masks will directly adversely affect the performance of healthcare workers.
... Use of N95-FFR/PPEs and other masks during this COVID-19 pandemic, though minimize the spread of COVID-19 virus droplets, but the gaseous exchange is considered to be compromised. [15] Thus, depending on the level of inhaled oxygen and carbon dioxide during the usage hours of mask, may be potentially hazardous depending on the individual susceptibility and pre-existing diseases. It remains as major concern among health care workers that it might lead to health problems of variable severity in them. ...
... It concluded that the use of N95 masks may cause the healthcare workers to develop headaches and wearing them for shorter amounts of time helped reduce the frequency and severity of the headaches. [15] During expiration, CO 2 levels increase and *Denotes P value significant at 0.05 among the four study groups; # denotes the significance at P<0.05 for comparison of variables between each study groups; 'Cv1' denotes comparison between control and group-1, Cv2 denotes comparison between control group '1v2 denotes comparison between groups-1 and -2, '1v3' denotes comparison between groups-1 and s-3 and '2v3' denotes comparison between groups-2 and -3; all abbreviations are depicted in abbreviation section O 2 concentration reduces significantly than the ambient concentration of the environment as CO 2 -enriched exhaled breath only partially escapes the mask and O 2 inhalation is compromised to a large extent in rebreathed air. Chen and colleagues studied the physiological and subjective responses to breathing resistance of N95 masks. ...
Background:
The study is aimed to investigate the metabolic alterations and changes in biochemical parameters associated with extended mask.
Methods:
It was a prospective comparative study conducted on 129 participants comprised of 37 healthy controls and 92 health care workers using different kind of masks like, cloth mask, surgical masks and N95-FFR/PPE. Two samples on day-1 and day-10 were collected for analysis of blood gas parameters, serum hypoxia-inducible factor-α (HIF-α), and erythropoietin (EPO).
Results:
Oxygen saturation percentage (sO2) of 72.68 (P = 0.033) was significantly low, whereas, Na+ (P = 0.05) and Ca2+ (P < 0.001) were raised in exposed individuals than the healthy controls. The serum HIF-α level of 3.26 ng/mL, was considerable higher in the exposed individuals than controls (P = 0.001). pO2 and sO2 were the lowest and HIF-α and EPO were raised in N95-FFR/PPE of all mask users (P < 0.01). A significant difference was evidenced for pCO2, pH, Na+, Ca2+, and EPO in the exposed group. A positive correlation between the duration of mask use (in hours) with HIF-α (r = 0.247, P = 0.005) and Ca2+ (r = 0.306, P < 0.001) was observed. The major complaints in N95-FFR/PPE users were headache (15.2%) and polydipsia (33.3%).
Conclusion:
The study findings depicted a significant metabolic alterations in PPE/N95 users which could be due to chronic hypoxic exposure of the tissues.
... Two of these focused specifically on skin effects, and these are discussed under that heading, with one study focusing specifically on headaches. Lim et al. (11) surveyed 212 HCPs about headaches when wearing the N95 mask. Thirty-seven percent reported headaches when wearing the N95, and over half of these (55%) had worn the mask continuously for >4 h. ...
... Two of the survey studies reported these: Foo et al. (9) found that only 1.6% of the staff who wore gowns regularly reported adverse skin reactions, whereas Hu et al. (10) found a higher rate of adverse skin reactions from using protective clothing: dry skin (22 of 65, 36.1%), itching (21, 34.4%), rashes (7,11.5%) and wheals (2, 3.3%). ...
Background: The COVID-19 pandemic has required healthcare workers to wear personal protective equipment (PPE), and although there is increasing awareness of the physical effects of wearing PPE, the literature has yet to be synthesised around this topic. Methods: A scoping review was conducted to synthesise existing literature on the physical effects of wearing PPE and identify gaps in the literature. A comprehensive search strategy was undertaken using five databases from 1995 to July 2020. Results: A total of 375 relevant articles were identified and screened. Twenty-three studies were included in this review. Studies were conducted across 10 countries, spanning 16 years from 2004 to 2020. Half (13/23) were randomised controlled trials or quasi-experimental studies, five surveys, two qualitative studies, two observational or case series and one Delphi study. Most (82%, 19/23) studies involved the N95 mask (either valved or unvalved). None specifically studied the filtering facepiece 3 mask. The main physical effects relate to skin irritation, pressure ulcers, fatigue, increased breathing resistance, increased carbon dioxide rebreathing, heat around the face, impaired communication and wearer reported discomfort. Few studies examined the impact of prolonged wear (akin to real life practice) on the physical effects, and different types of PPE had different effects. Conclusions: The physical effects of wearing PPE are not insignificant. Few studies examined the physiological impact of wearing respiratory protective devices for prolonged periods whilst conducting usual nursing activity. No ideal respirators for healthcare workers exist, and the development of more ergonomic designs of PPE is required.
... [2,3] Despite the protective function of N95 masks, other discomforts like effects on respiratory microclimate, oxygen saturation, heart rate, and individual sensational hazards, namely, breathlessness, headache, and suffocation, also need to be examined. [4][5][6] N95 masks are likely to induce different temperatures and humidification on outer and inner mask surface; it is likely to be because of lower air permeability and water vapor permeability in N95 respirator. [7,8] During these ongoing days of COVID-19 pandemic, medical staff, intensive care unit (ICU) workers, and other paramedics are wearing N95 masks for extended hours. ...
... Another factor leading to headache reported is irregular mealtimes during prolonged mask usage as well as emotional stress. [6,10,11] Frequent changing and tight fitting of masks lead to skin allergies, rash, and shearing of skin at the bridge of nose and cheeks. [12] Keeping the above points into consideration, we conducted the present study among HCWs posted in ICUs who are daily wearing N95 masks for extended hours of their duty. ...
Background and Aims: N95 mask being an essential element of personal protective equipment to be worn by health-care workers (HCWs) may lead to adverse effects and physiological stress as HCWs have to wear it for prolonged hours. Therefore, we planned to conduct a study in our intensive care unit staff to look for the effects of N95 masks on their health as well as to plan recommendations to ease them.
Material and Methods: We conducted this study on our intensive care unit nursing staff and HCWs. We noted their oxygen saturation and heart rate at baseline as well as after 1 h, 2 h, 3 h, and 6 h of duty along with their subjective sensations. Institutional ethical clearance for the same was taken. Collected data were entered in MS Excel database and analyzed using SPSS version 20.0. Fisher's Z test was applied for comparing proportion and analysis of variance for comparing two means.
Results: One hundred and nine HCWs participated in this, out of which 93 (85.3%) were females and 16 (14.7%) were males. Eighty-four (77.1%) participants were below 40 years. Twenty-three participants (21.1%) were overweight and 37 (33.9%) were obese. There was no significant drop in saturation and rise in heart rate during these hours.
Conclusions: On comparing subjective sensations of HCWs, our study found that feeling of uneasiness was found more in less than 40 years age group as compared to more than 40 years. N95 masks were found to have no impact on cardiovascular system and do not lead to hypoxia while working routinely even for prolonged hours.
... Previous studies on nose-mask-associated adverse effects have been reported among healthcare workers. These include headaches, vision obstruction, skin irritation and deterioration (pimples, itches, and rashes), facial pain and obstructions to vision, thermal equilibrium, and communication [9][10][11][12]. ...
... It has also been reported that nose mask usage worsened pre-existing rosacea, acne, and seborrheic dermatitis [21]. Frequent breaks for shorter periods of mask use can reduce the possibility of breathing difficulties and resistance [10,24]. Preventive measures such as moisturizers, emollients, and barrier creams could prevent mask-related infections [25]. ...
Background: The use of face masks was a significant part of the WHO COVID-19 preventive protocols. While their usage has been effective, lack of adherence by individuals has been associated with discomfort and adverse side effects. This might facilitate unnecessary exposure to the SARS-CoV-2 virus, thereby increasing the incidence of COVID-19. This study assessed the side effects of prolonged mask-wearing and offers recommendations for present and future pandemics. Methods: Adverse side effects of face masks were evaluated from November 2021 to February 2022 with a structured Google Forms online questionnaire. The survey targeted regular and occasional face mask users around the world. All responders anonymously completed the survey, which included ten structured questions with a sub-section on the effects of the continuous use of face masks. The information obtained was analyzed using descriptive statistics, and the data were presented in graphs. Results: Almost 60% (1243) of the 2136 participants indicated discomfort while using face masks. Breathing difficulties and pain around the ears were cited as major causes of discomfort, accounting for 32% and 22%, respectively, of responses. Headaches were reported by 26.8% (572) of the respondents, with 44.6% experiencing one within 1 h of wearing a mask. Nine hundred and eight (908) respondents experienced nasal discomfort, while 412 individuals reported various skin-related discomfort, including excessive sweating around the mouth and acne. Conclusions: This study provides baseline data as to why there was less adherence to face mask use which includes headaches, skin irritation, ear pains, breathing difficulties, sore throat, dry eyes, and increased sweating around the mouth. As a result, this may contribute to an increased risk of infection. While COVID-19 lingers and the management of its undesirable effects persists into the future, it is vital that a superior mask design, concentrating on safety, comfort, and tolerability, be developed.
... Published studies, albeit few, generally found that there are measurable effects of wearing a mask, although there are also reports in which no effects were seen. Among the former, wearing facial mask led to subjectively reported headaches [33][34][35][36][37][38], difficulty breathing [36,[39][40][41][42], and facial discomfort [27,28,35,[43][44][45][46]. Several studies showed that wearing a mask resulted in a significant increase in discomfort [33,36,40,42,43,[45][46][47][48][49][50]. ...
... While these aforementioned types of face wear may protect an individual against outside bacteria and disease, essential workers need to wear the face masks for long hours, and this may induce physiological stress on them. It was reported that healthcare workers develop de novo headaches or exacerbation of their pre-existing headache disorders because of prolonged use of N95 respirator masks (Ong et al., 2020;Lim et al., 2006). Wearing an N95 respirator mask triggers different heart rate and discomfort among healthcare providers (Zhu The COVID-19 pandemic in early 2020 has created a health crisis around the world. ...
The COVID-19 pandemic in early 2020 has created a health crisis around the world. There have been many precautions taken against the virus, such as social distancing and the use of personal protective equipment. Face masks are an essential part of personal protective equipment, especially for essential workers. Although the pandemic has caused a high demand for facemasks, there is limited scientific knowledge available on the various types of masks. Knowledge about the air quality inside the different facemasks could be beneficial for both the COVID-19 pandemic and future disease outbreaks, which will seemingly increase in the future. There are different types of masks, ranging from tight-fitting N95 respirator masks to looser surgical masks to homemade cloth masks. Herein, N95 respirator masks, surgical masks, cloth face masks, and surgical masks on top of N95 respirator masks were compared in terms of CO2 levels, Volatile Organic Compound levels (VOCs), temperature, humidity, and O2 concentrations. To record these measurements, Arduino-based sensors were constructed and utilized for the measurements. It was found that the N95 mask and the surgical mask on top of the N95 mask trapped the highest concentration of carbon dioxide, VOCs, temperature, humidity, and the lowest oxygen levels compared to the surgical mask and cloth mask.
... According to a review of previous studies [13][14][15], we further conducted a hypothetical model to describing the relationship between headache intensity, pre-existing primary headache diagnosis, anxiety, depression, sleep quality, and occupation(nurses) to the frequency of PPE-associated headaches (As shown in Fig. 1). The hypothetical model is made up of four exogenous variables (nurses, headache intensity, sleep quality and pre-existing primary headache diagnosis) and three endogenous variables (anxiety, depression, and the frequency of PPE-associated headaches). ...
Background
To evaluate the factors affecting personal protective equipment (PPE) associated with headaches in healthcare workers during the first hit of coronavirus disease 2019 (COVID-19) outbreak in China in order to provide evidence for improving the prevention and treatment of PPE-associated headaches in frontline medical personnel.
Methods
In this cross-sectional study, the baseline characteristics and the prevalence of the PPE-associated headaches among frontline healthcare workers at Wuhan Taikang Hospital were objectively evaluated by means of a questionnaire survey. We obtained predictors of PPE-associated headaches frequency by multiple regression analyses. The path analysis model was applied to determine the interrelationships between the variables related to PPE-associated headaches frequency.
Results
Among the 520 participants, 436 (83.85 %) reported PPE-associated headaches during the anti-epidemic period. Compare with non-PPE-associated headache, age, PHQ-9 score >10, nurses, and PSQI>5were statistically significant found in participants with PPE-associated headaches. Multivariable linear regression showed that the occupation(nurse), pre-existing primary headache diagnosis, headache intensity and depression were risk factors for the frequency of PPE-associated headaches. The path analysis model observed that direct effects from occupation (nurse), pre-existing primary headache diagnosis, headache intensity and depression on the frequency of PPE-associated headaches. Depression indirectly mediated the effects of headache intensity and sleep quality on headache frequency. (All P < 0.05)
Conclusion
This study provided a path analysis model that illustrates the relationships between PPE-associated headaches frequency and its related factors among healthcare workers during the COVID-19 pandemic. It is crucial to the management of PPE-associated headaches to reduce its consequences for frontline healthcare workers.
... These effects include headaches, difficulty in breathing, and impaired cognition. Moreover, the continuous use of PPE interferes with vision, and communication, and disrupts thermal equilibrium (19)(20)(21)(22)(23). These demanding circumstances have taken a toll on the mental well-being of HCWs, leading to psychological distress, anxiety, sadness, and potential posttraumatic stress symptoms (24). ...
Background
The COVID-19 pandemic has had a profound and global impact on healthcare systems worldwide, presenting unprecedented challenges for healthcare workers (HCWs) on the front. We aimed to evaluate the prevalence of anxiety and depression symptoms during the coronavirus pandemic among healthcare professionals in Qatar.
Methods
A cross-sectional study where an electronic questionnaire containing demographics, and psychosocial questions were made on Google Docs and Microsoft Team, and were sent through email and WhatsApp to healthcare workers, including doctors, nurses, allied health and others working at Hamad Medical Corporation in Qatar, from June 1, 2021, to January 1st 2023. ANOVA, t-test and multiple linear regression were used to see the association between the psychological factors and sociodemographic variables using STATA version 17 software.
Results
A total of 829 participants were included in this study (response rate: 55%). The average age of the participants is 36.0 ± 7.1; 65.9% were males; 2.3% were doctors and 53% were nurses, 38.7% were allied healthcare professionals and 6% were others. Psychological, social effects, and workplace were shown to significantly related to their marital status, career, and hospital setting (p < 0.01 for each). Similar to this, dealing with COVID-19 patients and their education level with the length of time working at the designated facility were all connected with the health professional safety score (p < 0.05).
Conclusion
During the COVID-19 epidemic, healthcare workers in Qatar experienced a high incidence of negative psychosocial symptoms. To alleviate these outcomes, it would be useful to implement screening procedures for such symptoms and to devise preventive measures accordingly.
... Participants' sociodemographic characteristics include variables related to age, gender, marriage status, nationality, educational level, duration of work experience, job category, place of work, if they received any training, education on COVID-19 management in their institutions if they handled or screened suspected or confirmed COVID-19 patients, and if they have any symptoms during the period of their care for patients infected with or were suspected of being infected with the COVID-19 virus. The HCWNS has 27 items developed by the researchers Needs of HCWs during COVID-19 after a thorough literature review (Bhagavathula et al., 2020;Centre for disease control and prevention, 2020;de Pablo G et al., 2020;Irene et al., 2021;Kao et al., 2004;Kelechi, Brunette, & Lee, 2020;Lim et al., 2006;National Nurses United, 2020;Ramaci, Barattucci, Ledda, & Rapisarda, 2020;Shaukat et al., 2020;Sun et al., 2020;WHO, 2020) to provide a comprehensive assessment of HCWs' needs. Each item is rated on a 5-point Likert scale and rates responses from 0 to 4 (4 5 always happens "five times a week to daily," 3 5 often happens "three to four times a week," 2 5 sometimes happens "once a week," 1 5 rarely happens "once a month," 0 5 never happened "not at all"). ...
Purpose
This study sought to understand the physical, educational and operational needs faced by healthcare workers (HCWs) (including physicians, nurses and allied health workers) during the COVID-19 pandemic.
Design/methodology/approach
A descriptive cross-sectional design was undertaken. HCWs working in hospitals, health centers, testing and quarantine areas in the Kingdom of Bahrain were invited to complete the online survey questionnaire developed by authors containing three domains: physical, educational, and perceived knowledge, and operational needs.
Findings
A convenient sample ( N = 627) of volunteered participants responded to the online survey. The biggest challenges that HCWs were exposed to are physical needs (experiencing dry hands, difficulty breathing while on a mask, feeling hot and sweaty, and less fluid and food intake) which were reported as the higher level, followed by operational needs (limited communication due to Personal Protective Equipment - PPE - use, longer working hours, and preparation time to get ready for duty). Other challenges pertained to education and knowledge (the presence of multiple sources of information confused them during the care practices). Females faced more challenges than males, and Bahraini HCWs handled challenges more than non-Bahrainis. A negative relationship was found between age and years of experience with the challenges of the HCWs.
Originality/value
During the COVID-19 pandemic, health systems face rapidly increasing demands. HCWs face several challenges while providing patient care, particularly physical needs. This study provides adequate data for healthcare administrators to maintain a safe working environment during pandemics.
... This is not specific to this healthcare crisis. During the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, a study by Lim et al [34] found headaches in 37% of healthcare workers wearing masks. Given that headache is known to affect attention and cognitive performance speed significantly, one might expect a decrease in concentration performance in our population. ...
... Wearing face masks is important for hygiene, prevention of infectious diseases, and protection against allergens such as dust and pollen, and is often required in environments where high hygiene levels are necessary. However, adverse effects of wearing face masks have been reported, including perceived breathlessness or dyspnea 1) , thermal changing (i.e., increase in skin temperature under the mask or exertion and heat perception) [2][3][4] , headaches 5,6) , skin reactions (i.e., acne, itches) 7) . Dyspnea or breathlessness is most likely caused by increased breathing resistance 1,8,9) , reinspiration of CO2 in exhaled air built up in the mask 9) , and an increase in the dead space, depending on mask type 8,10) . ...
The present study investigated the effects of wearing a non-woven face mask and performing a calculation task, while walking, on gait pattern, breathlessness, and calculation performance. Twenty-one healthy adult males walked 4.0 km/h and 6.0 km/h on a treadmill with and without wearing a face mask. A calculation task using a smartphone was added to the gait task, and the participants were asked to perform two-digit addition calculation tasks displayed on the screen as quickly and accurately as possible. Heart rate, perceived exercise intensity, breathlessness, and cadence during gait tasks were measured. Although wearing the mask did not significantly affect heart rate or cadence during gait, breathlessness and perceived exercise intensity were significantly increased. When the calculation task was performed during gait, wearing the mask significantly decreased the correct answer rate, although the number of responses was not affected. Wearing the mask therefore reduced the calculation performance during gait. These results suggest that wearing a mask during gait may increase breathlessness and may worsen mental demands such as performing a calculation task, even if it does not affect physiological responses or gait patterns. As walking in daily life requires a variety of cognitive/mental demands, the impact of wearing a mask on the implementation of these demands may need to be considered.
... Most important factors such as mask designed with tight elastic straps are likely to put pressure on superficial facial and cervical nerves which may result in headache [Questionnaire]. [11][12][13][14] ...
Background: Dental health-care professionals are at high risk to get infected by COVID-19 due to its spread through droplet infections. The close proximity with the patients during oral examination and treatment is added risk for this infection. Therefore, dentists are recommended to wear mask for prolonged period of time. However, prolonged mask wearing (PMW) leads to various adverse side effects. Hence, the present study is undertaken to identify adverse effects due to PMW among dentists during COVID-19. Materials and Methods: This cross-sectional study was designed to enquire about the adverse effects of PMW during COVID-19. The digital questionnaire was circulated among 1000 dentists via mail and WhatsApp, and the data were obtained within 30 days. Results: The results indicated that prolonged wearing of mask led to suffocation along with intermittent mouth breathing. Dentists, who wore ear-supported mask or head-supported masks, experienced ear pain and redness of skin behind ear, itching and prickly heat, and dryness of mouth and nose. Other ill effects such as fogging and malpositioning of spectacles, speaking loudly, difficulty in hearing, headache, and tension in muscles of mastication were also noted. Conclusion: The study recommends intermittent breaks during work and appropriate measures to prevent the ill effects of PMW for self-care of dentists during this pandemic.
... The incidence of headache development among health-care workers using N95 masks ranges between 37% and 81% in literature and was found to be directly correlated with the use of N95 face masks for more than 4 h. [15,16] The etiopathogenesis of headaches associated with long-term use of N95 face mask has been linked to hypoxemia, hypercapnia, stress, or mechanical compression on the superficial facial and cervical nerves. [17][18][19] In our study, headache was also the most common complaint with 36%. ...
Introduction:
The clinical and physiological effects of long-duration use of N95-type masks without ventilation valves, on health-care workers during the coronavirus disease-2019 (COVID-19) pandemic, were evaluated.
Methods:
All volunteering personnel working in operating theater or intensive care unit, using nonventilated N95 type respiratory masks, minimum for a 2-h noninterrupted duration were observed. The partial oxygen saturation (SpO2) and heart rate (HR) were recorded before wearing the N95 mask and at 1st and 2nd h. Volunteers were then questioned for any symptoms.
Results:
A total of 210 measurements were completed in 42 (24 males and 18 females) eligible volunteers, each having 5 measurements, on different days. The median age was 32.7. Premask, 1st h, and 2nd h median values for SpO2 were 99%, 97%, and 96%, respectively (P < 0.001). The median HR was 75 premask, 79 at 1st h, and 84/min at 2nd h (P < 0.001). A significant difference between all three consecutive measurements of HR was achieved. Statistical difference was only reached between premask and other SpO2 measurements (1st and 2nd h). Complaints seen in the group were head ache (36%), shortness of breath (27%), palpitation (18%), and nausea feeling (2%). Two individuals took off their masks to breathe, on 87th and 105th min, respectively.
Conclusions:
Long duration (>1 h) use of N95-type masks causes a significant reduction in SpO2 measurements and increase in HR. Despite being an essential personal protective equipment in COVID-19 pandemic, it should be used with short intermittent time periods in health-care providers with known heart disease, pulmonary insufficiency, or psychiatric disorders.
... Pushing back the mandible through elastic mechanics, the mask can determine compression of the retrodiscal tissue, causing pain. [7][8][9] However, no previous studies on the correlation between protective masks and temporomandibular disorders (TMD) or orofacial pain (OFP) have been reported. Temporomandibular disorders are a heterogeneous group of painful and/or dysfunctional conditions involving the TMJs, the surrounding muscles, and the bony components that contract anatomical-functional relationships with them. ...
Background:
Wearing protective face masks has been one of the indispensable measures to prevent droplets and aerosol particles transmission during the SARS-CoV-2 pandemic.
Objectives:
This observational cross-sectional survey investigated the different types and modalities of protective mask wearing and the possible association with referred signs of temporomandibular disorders and orofacial pain by respondents.
Methods:
An online-questionnaire was developed, calibrated and administered anonymously to subjects with an age of ≥ 18 years. It consisted of different sections: demographics, type and wearing modalities of the protective masks, pain in the preauricular area, noise at the temporomandibular joints and headache. Statistical analysis was performed using statistical software STATA v16.
Results:
The questionnaire received 665 replies mainly from participants aged 18-30 years (315 males, 350 females). The healthcare professionals were 37% of participants, 21.2% of them were dentists. The Filtering Facepiece 2 or 3 (FFP2/FFP3) mask was used by 334 subjects (50.3%), and 578 (87%) wore the mask with two elastics behind the ears. Pain while wearing the mask was referred by 400 participants, and 36.8% of them referred pain with a consecutive use of more than 4 hours (p = 0.042). 92.2% of participants did not report any TMJ noise. Headache associated with the FFP2/FFP3 was referred by 57.7% of subjects (p = 0.033).
Conclusion:
This survey highlighted the increased referred the presence of discomfort in the preauricular area and headache possibly associated with a prolonged use of protective face masks for more than 4 hours during the SARS-CoV-2 pandemic.
... This makes it challenging to properly don or doff the gear, further reducing compliance and possibly raising infection rates among non-compliant users. On the contrary, surgical masks are loose-fitting apparatuses that offer a simple barrier between the user's mouth-nose area and the environment (16,17). They are made to sit more loosely on the face, limit contamination, and lessen the spread of microorganisms between wearers (18). ...
Background and Objectives: There are conflicting views regarding face mask guidelines amongst healthcare staff to prevent
transmission of coronavirus disease 2019 (COVID-19), influenza and other respiratory viral infections (RVIs). We conducted
a thorough meta-analysis to statistically compare mask use versus no mask use efficacy for RVIs in healthcare settings.
Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were
used for selecting researches published between 2003 and June 2022 from different databases, including Publisher Medline (PubMed), Web of Science, etc.; 6 studies qualified for inclusion. Data was pooled from in vivo randomized control,
case-control and observational studies dealing with the relationship between face mask use and no use by patients or health
personnel and RVI prevention in healthcare setups.
Results: The fixed and random-effects model was carried out to determine pooled odds ratios (ORs) and their respective 95
percent confidence intervals (CIs). The results revealed that wearing a face mask significantly reduced the risk of contracting
a respiratory viral illness in hospital settings, with pooled OR (95% CI) of 0.11 (0.04 to 0.33) (probability value (P) <0.08).
Conclusion: Masks largely succeeded in stopping respiratory virus transmission, as evidenced by the meta-analysis of 6
studies (a total of 927 individuals).
... According to another study, applying mechanical stimuli in the form of a splint induces myofibroblasts (135). Tight-fitting clothes are suggested to promote myofascial pain (4,136,137). • Low vitamin D might predispose to disease. Vitamin D is involved in myofibroblast de-differentiation (138). ...
The coronavirus pandemic has led to a wave of chronic disease cases; "Long COVID-19" is recognized as a new medical entity and resembles "fibromyalgia" which, likewise, lacks a clear mechanism. Observational studies indicate that up to 30%-40% of convalescent COVID-19 patients develop chronic widespread pain and fatigue and fulfill the 2016 diagnostic criteria for "fibromyalgia." A recent study suggested a theoretical neuro-biomechanical model (coined "Fascial Armoring") to help explain the pathogenesis and cellular pathway of fibromyalgia, pointing toward mechanical abnormalities in connective tissue and fascia, driven by contractile myo/fibroblasts and altered extracellular matrix remodeling with downstream corresponding neurophysiological aberrations. This may help explain several of fibromyalgia's manifestations such as pain, distribution of pain, trigger points/tender spots, hyperalgesia, chronic fatigue, cardiovascular abnormalities, metabolic abnormalities, autonomic abnormalities, small fiber neuropathy, various psychosomatic symptoms, lack of obvious inflammation, and silent imaging investigations. Pro-inflammatory and pro-fibrotic pathways provide input into this mechanism via stimulation of proto/myofibroblasts. In this hypothesis and theory paper the theoretical model of Fascial Armoring is presented to help explain the pathogenesis and manifestations of "long COVID-19" as a disease of immuno-rheumo-psycho-neurology. The model is also used to make testable experimental predictions on investigations and predict risk and relieving factors.
... The degree of anxiety, depression, and symptoms of post-traumatic stress disorder were also weakened Nourian et al. 19 To TherapeuTic advances in respiratory disease personal protective equipment for a long time may increase psychological stress. 28,29 One study showed that wearing N95 facial mask for an 8-h shift had no obvious harmful effects on healthcare workers' physiological health, compared with those who wore surgical facial mask. 30 However, the limited sample size did not have adequate statistical power to detect between-group differences in outcomes. ...
Background
The coronavirus disease 2019 (COVID-19) outbreak might have a psychological impact on frontline healthcare workers. However, the effectiveness of coping strategies was less reported.
Objectives
We aimed to investigate the sources of stress and coping strategies among frontline healthcare workers fighting against COVID-19. We also performed a literature review regarding the effects of coping methods on psychological health in this population.
Methods
We included frontline healthcare workers who completed an online survey using self-made psychological stress questionnaires in a cross-sectional study. We evaluated the association between potential factors and high-stressed status using a logistic regression model. We performed the principal component analysis with varimax rotation for factor analysis. We also performed a systematic review of published randomized controlled studies that reported the effects of coping methods on psychological health in COVID-19 healthcare workers.
Results
We included 107 [32 (29–36) years] respondents in the final analysis, with a response rate of 80.5%. A total of 41 (38.3%) respondents were high-stressed. Compared with the low-stressed respondents, those with high-stress were less likely to be male (46.3% versus 72.7%, p = 0.006), nurses (36.6% versus 80.3%, p < 0.001), and more likely to have higher professional titles ( p = 0.008). The sources of high-stress in frontline healthcare workers were categorized into ‘work factor’, ‘personal factor’, and ‘role factor’. A narrative synthesis of the randomized controlled studies revealed that most of the coping methods could improve the psychological stress in healthcare workers during the COVID-19 pandemic.
Conclusion
Our findings suggest that some frontline healthcare workers experienced psychological stress during the early pandemic. Effective coping strategies are required to help relieve the stress in this population.
... Previous studies have reported constraints linked to wearing PPE, including but not limited to biological, thermal, sensorial, and biomechanical discomforts (Mayer & Korhonen, 1999). Healthcare workers' discomfort has been related to the various aspects of usability, including donning and doffing, poor size and fit, and physical symptoms such as headache, dizziness, humidity, heat, and skin irritation (Lim et al., 2006;Loibner et al., 2019;Ong et al., 2020;Suen et al., 2020). Additionally, these discomforts interfere with healthcare workers' work duties and have been linked with lowered work efficiency (Locatelli et al., 2014;Round & Isherwood, 2020). ...
Personal protective equipment (PPE) compliance in healthcare settings has continued to be an issue before and during the pandemic. The purpose of this study was to understand the overall experience of healthcare workers with PPE, including types and uses of PPE, their duties, satisfaction, and dissatisfaction with PPE. By examining the PPE design characteristics and requirements of healthcare workers, the ultimate goal is to redesign PPE to increase comfort and work efficiency. As a pilot study, one-to-one online interviews were conducted with three healthcare workers who had experience wearing PPE while working in a hospital. The transcripts were analyzed using NVivo software, and a total of 5 subgroups were created based on the 69 unique codes by grouping them into semantic units: environmental situation and characteristics, satisfaction, improvement and suggestion, issues and problems, and PPE wearing experience. Masks (N95 and surgical), eye protections (goggle and face shield), gowns, and gloves were investigated, and high risk of infection, discomfort and distrust about reusing PPE, low degree of protection, low usability, and low work efficiency were observed.
... The prolonged use of a respirator may cause fatigue, increased CO2 levels, and decreased O2 levels, resulting in hypercapnia or hypoxaemia, which can lead to headaches [41]. Likewise, hypoxaemia was observed with N95 masks, especially with greater respiratory rate and increased incidence of discomfort in the chest during a four-hour use [42], which was similar to our findings. High-resistance breathing resulted in respiratory exhaustion in muscles and physical pain. ...
This study explored the ideal period for wearing masks to prevent the physiological and psychological problems associated with long-term face mask use during respiratory infections by healthcare workers. Breathing simulators, surgical masks (SM) and medical respirators (PM) were prepared for two to eight hours. Changes in the comfort of masks (facial skin temperature, breathing resistance, and moisture permeability) and protection (filtration efficiency, resistance to blood penetration, and colony count) were assessed. The results demonstrated that the masks offered efficient liquid-particle filtering even after eight hours of use. However, the number of bacterial colonies using PM and SM grew significantly after two and four hours, respectively. Concerning comfort, the inspiratory resistance of masks rose dramatically after two hours, whereas the moisture permeability declined considerably after four hours. In addition, skin temperature had a significant increase within two hours, which may result in facial discomfort. When conditions permitted, the hospital staff was instructed to replace their masks every two hours.
... Headache is one of the most prominent complaints among those who wear masks for more than 4 h together. [20,22] Several factors have been associated with headaches in face mask wearers. Some of them can be tight mask straps, dehydration, and altered eating patterns. ...
e pandemic has forced the health-care system to adopt newer approach toward patient care. With the changing scenario of health-care delivery, ophthalmologists had to bring about several changes in the way, the patients are seen and operated on. Contact procedures were entirely restricted to emergencies while modifications were introduced to minimize the exposure of the surgeon. However, these modifications were introduced just keeping in mind the spread of infection. e probability that these modifications could affect the optics in ophthalmology is high and cannot be ruled out. e aim of the study was to highlight the effects of modifications introduced in ophthalmic equipment during the pandemic over the visibility for the surgeon and discuss its impact on patient care in ophthalmology. orough search of the literature on PubMed using keywords, visibility and personal protective equipment (PPE), fogging and PPE, face mask and fogging, aberrations and PPE, and surgeries and PPE were done. We found 35 articles which highlighted the effects on visibility with PPE and effects on eyes with prolonged wearing of masks. Several factors have contributed to reduction in visibility for the surgeon. ese factors have, in turn, affected the overall quality of examination and surgical outcome in ophthalmology. e use of PPE during the pandemic could have been a contributory factor for missing relevant findings during examination of patients. For ophthalmologists in particular, the visibility and optics play a crucial role in the management of the patient and have been invariable affected by introduction of modifications at the instrument and surgeon level.
Review of existing studies showing a possible link between prolonged mask use and temporomandibular abnormalities.
Introduction: “The surgical face mask has become a symbol of our times”. In March 17, 2020 this was headline of an article in the New York Times on the role of face mask during the COVID-19 outbreak. This study was undertaken to assess the effects of prolonged use of mask on physical well-being of employees in selected departments of Nedumkandam, Idukki, Kerala Method: The present study was an explorative study of 110 employees working in different sectors in Nedumkandam. Data were collected by using self-structured questionnaire. . There were total 20 questions related to physical effects of prolonged mask usage.. All participants wore either surgical mask or N95 respirators for a minimum of 6 hours per day. Result: Majority of the participants were male (56.3%) and between the age group of 36-45 years. The result indicated that 80.9% (N=89) were uncomfortable with mask usage. Reported side effects include head ache, breathing difficulty, nasal discomfort, skin related problems, Mask related infection. The majority of the respondents (N=89, 80.9%) report one or more of these adverse effect while 19% (N=21) report none of these side effects. Conclusion: The study was concluded that majority of the employees suffering with various physical discomforts including head ache, nose related problem, breathlessness, skin related problems. Employees who wear masks for extended periods reported increased fatigue and a sense of breathlessness.
The wearing of respirators has significantly increased over the last years mainly due to the COVID-19 pandemic. The prolonged wearing of respirators may have impacted the Heart Rate Variability (HRV) of the consumer. The scientific community has been attempting to understand the possible influential factors behind it. Unfavorable environmental factors may play a significant role in influencing the HRV for prolonged wearing of the respirators , mainly due to air pollution, and high concentrations of toxic metals and organochlorine compounds in the blood. Hence, this study aims to investigate the influence of unfavorable environmental conditions on the HRV parameters for prolonged wearing of N95 respirators. The study cohort was selected from the young volunteers living in the Aral Sea region, which is infamous for unfavorable environmental conditions due to dust storms with toxic particles, soil salinity, and high usage of pesticides. The study cohort consisted of 1110 male volunteers aged 19-22 and divided into two groups, inhabitants from unfavorable environment (North group) and inhabitants from unaffected environmental conditions (South group). HRV parameters of RMSSD, SDNN, pNN50, HF, LF/HF, SI, SBP, DBP, and SpO2 were measured and statistically compared in two stages, without wearing N95 respirators and while wearing an N95 mask for a 30-40 min period. Our analysis showed a significant increase in RMSSD, SDNN, pNN50 %, and HF parameters while wearing an N95 mask for a 30-40 min period in both groups. SI and LF/HF ratio shows a significant increase while wearing N95 in the «North » group and SI and LF/HF ratio decreased in the «South » group. The prevalence of distribution of subjects having SI more than 150 conv. units while wearing N95 marks in the «North » group were significantly higher compared to the «South » group. Autonomic tone reactivity to the N95 respirators was found in the «North » group in the form of an increase in sympathetic activity. We can conclude that the features of autonomic tone reactivity to wearing N95 respirators were found in the subjects from the environmentally unfavorable regions in the form of measuring the autonomic nervous system imbalance in favor of the increase in SNS activity. This observation is possibly related to the effects of organochlorine pesticides and heavy metals on the human nervous system in the participants living in unfavorable regions of the Aral ecological disaster.
Objective
This study aimed to investigate the relationship between the use of different types of masks (N95/filtering facepiece type 2, surgical) and Eustachian tube dysfunction in healthcare workers.
Methods
The study included 37 healthcare workers using N95/filtering facepiece type 2 masks and 35 using surgical masks for at least 6 hours per day, and 42 volunteers who are not healthcare workers using surgical masks for less than 6 hours per day. Participants’ demographic features, clinical data and Eustachian Tube Dysfunction Questionnaire scores were compared.
Results
The frequencies of autophony and aural fullness were significantly higher in the healthcare workers using N95/filtering facepiece type 2 masks. Autophony and aural fullness were significantly greater in the post-mask period than the pre-mask period. Middle-ear peak pressures and Eustachian Tube Dysfunction Questionnaire scores were higher in healthcare workers who used N95/filtering facepiece type 2 masks.
Conclusion
Healthcare workers who used N95/filtering facepiece type 2 masks had worsened middle-ear pressures and Eustachian Tube Dysfunction Questionnaire scores. Use of N95/filtering facepiece type 2 masks was associated with higher rates of autophony, aural fullness and higher Eustachian Tube Dysfunction Questionnaire scores in the post-mask period.
In the battle against the COVID-19 pandemic, the integration of Internet of Things (IoT) technologies has played a pivotal role in reshaping public health and healthcare delivery. Interconnected devices have demonstrated their capacity to collect, transmit, and analyze data, significantly impacting various aspects of pandemic management.
COVID-19 Monitoring with IoT Devices is a comprehensive guide to measuring the impact of COVID-19 infection and monitoring outbreak metrics. Beginning with an introduction to SARS-CoV-2 and its symptoms, the book presents chapters on machine learning (supervised and unsupervised algorithms) and techniques to predict COVID-19 outcomes. The book concludes with the role of IoT technology in detecting COVID-19 infections within a community, showcasing different computing models applicable to specific use-cases.
Key Features:
Explores the pivotal role of IoT technology in the fight against the COVID-19 pandemic. Covers a data-driven approach to COVID-19 monitoring by explaining methods for data collection, prediction, and analysis. Includes specific recommendations for machine learning algorithms designed for COVID-19 monitoring. Easy-to-read structured chapters suitable for novices in computer science and biomedical engineering.
COVID-19 Monitoring with IoT Devices provides a valuable resource for understanding the role of IoT technology in managing and mitigating the impact of COVID-19, and developing adequate infection control policies. It also showcases the potential of IoT for future research and applications in the healthcare sector. This book is intended for a diverse readership, including academicians, industry professionals, researchers, and healthcare practitioners.
Filtering facepiece respirators (FFR's) such as N95s have become widely used in appropriate settings for personal respiratory protection and are increasingly used beyond workplace settings. Concerns about possible adverse effects have appeared in many publications, particularly since the COVID‐19 pandemic led to much more widespread use. This paper synthesizes known effects based upon review of publications in PubMed since 1995, addressing effects other than pulmonary and cardiovascular (reviewed elsewhere). Findings: (1) Subjective discomfort is very frequently reported; this includes general discomfort or organ‐system‐specific complaints such as respiratory, headache, dermatologic, and heat. Research methods are widely divergent, and we propose a taxonomy to classify such studies by methodology, study population (subjects, experimental vs. observational methodology, comparator, specificity, and timeframe) to facilitate synthesis. (2) Objective measures of increased heat and humidity within the mask are well documented. (3) Frequency and characteristics of dermatologic effects have been insufficiently evaluated. (4) Physical mask designs are varied, making generalizations challenging. (5) More studies of impact on work performance and communication are needed. (6) Studies of effect of FFR design and accompanying training materials on ease and consistency of use are needed.
Background:
N95 filtering facepiece respirators (FFR) are used by health care workers for prevention of airborne infection, and its use has increased manifolds during COVID-19 pandemic. Prolonged use may result in carbon dioxide (CO2) accumulation, affect hemodynamics, and blood gas values. Although arterial blood gas values accurately measure the blood CO2 levels, venous blood gas values also show acceptable correlation.
Aim:
To evaluate the physiological impact of N95 FFRs on health care workers, including hemodynamic changes and venous blood levels of CO2 during a period of 6 h.
Settings and design:
Prospective observational study in a tertiary care hospital.
Methods:
The study was conducted on 30 health care workers who performed routine duties while wearing N95 FFR. Venous blood gas values (CO2, pH, and bicarbonate) and vitals (respiratory rate, heart rate, blood pressure, and saturation) were noted at baseline, 2 (T2), and 6 h (T6) after wearing the mask. Discomfort level was also measured on a Visual Analogue Scale (VAS) of 1-10.
Statistical analysis:
Repeated measures analysis was done using repeated measures ANOVA or Friedman's test. Group comparisons for continuously distributed data were made using independent sample "t" test or Wilcoxon test.
Results and conclusion:
Hemodynamic and blood gas values did not change over time. The VAS for discomfort because of respirator use was 1.33 (1.42) at T2 and 2.77 (1.91) at T6. This was a significant increase in discomfort over time (P = 0.001). About 80% of participants experienced discomfort during this period. N95 FFR did not lead to significant alteration in hemodynamics or change in blood gas values after 6 h of continuous usage. However, discomfort significantly increased over time.
To quantify the subjective and cognitive impairment caused by wearing face masks at work, 20 men and 20 women (median age 47 years, range 19–65) were tested under different ergometer workloads while wearing surgical mask, community mask, FFP2 respirator or no mask in a randomized and partially double-blinded design. Masks were worn also at the workplace for four hours. Subjective impairment was recorded by questionnaires. Cognitive performance was tested before and after the workplace examination. Subjective feeling of heat, humidity, and difficult breathing increased with rising physical exertion and wearing time for all three mask types, most notably for FFP2. Even when blinded, participants with FFP2 reported difficult breathing already at rest. During physical exertion, individuals with low tolerance to discomfort reported significantly stronger impairment (OR 1.14, 95% CI 1.02–1.27). Regarding light work, older subjects (OR 0.95, 95% CI 0.92–0.98) and women (OR 0.84, 95% CI 0.72–0.99) showed significantly lower and atopic subjects stronger impairment (OR 1.16, 95% CI 1.06–1.27). No significant influence of mask wearing was detected on cognitive performance. Wearing a mask had no effect on cognitive performance, but led to discomfort which increased with physical exertion and wearing time. Individuals who tolerate discomfort poorly felt more impaired by wearing a mask during physical exertion.
Dead-space associated rebreathing of expired air and heat-trapping with use of surgical masks and N95 respirators may underlie anecdotal reports of adverse symptoms associated with medical face barriers. Limited data exists directly comparing the physiological effects of masks and respirators at rest. We assessed the short-term physiological effects of both barrier types over 60-min at rest, including face microclimate temperature, end-tidal gases, and venous blood acid-base variables. We recruited 34 participants into two trials: surgical masks (n=17) and N95 respirators (n=17). In a seated position, participants underwent a 10-min baseline without a barrier, and then wore a standardized surgical mask or dome-shaped N95 respirator for 60-min, followed by a 10-min washout. We instrumented participants with a peripheral pulse oximeter (SpO2) and a nasal cannula connected to a dual gas analyzer for measurement of the pressure of end-tidal (PET)CO2 and PETO2, with an associated temperature probe for face microclimate temperature. Venous (v) blood samples were obtained at baseline and following 60-min mask/respirator wearing to assess PvCO2, [HCO3-]v and pHv. Compared to baseline during/following 60-min, temperature, PETCO2, PvCO2, and [HCO3-]v were mildly but significantly higher, and PETO2 and PvO2 were significantly lower, but SpO2 was unaffected. The magnitude of effects was similar between barrier types. Temperature and PETCO2 returned to baseline levels within 1-2 min following removal of the barrier. These mild physiological effects may underly reports of qualitative symptoms while wearing masks or respirators. However, the magnitudes were mild, not physiologically-relevant and reversed immediately with the removal of the barrier.
Since the advent of coronavirus disease 2019 (COVID-19), healthcare workers (HCWs) wearing personal protective equipment (PPE) has become a common phenomenon. COVID-19 outbreaks overlap with heat waves, and healthcare workers must unfortunately wear PPE during hot weather and experience excessive heat stress. Healthcare workers are at risk of developing heat-related health problems during hot periods in South China. The investigation of thermal response to heat stress among HCWs when they do not wear PPE and when they finish work wearing PPE, and the impact of PPE use on HCWs’ physical health were conducted. The field survey were conducted in Guangzhou, including 11 districts. In this survey, HCWs were invited to answer a questionnaire about their heat perception in the thermal environment around them. Most HCWs experienced discomfort in their back, head, face, etc., and nearly 80% of HCWs experienced “profuse sweating.” Up to 96.81% of HCWs felt “hot” or “very hot.” The air temperature had a significant impact on thermal comfort. Healthcare workers’ whole thermal sensation and local thermal sensation were increased significantly by wearing PPE and their thermal sensation vote (TSV) tended towards “very hot.” The adaptive ability of the healthcare workers would decreased while wearing PPE. In addition, the accept range of the air temperature (Ta) were determined in this investigation. Graphical Abstract
Background
As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.
Methods
A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.
Results
We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = −0.24, 95% CI = −0.38 to −0.11, p < 0.001) and minute ventilation (SMD = −0.72, 95% CI = −0.99 to −0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31–0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03–0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03–0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23–1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32–3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01).
Discussion
Masks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.
Conclusion
Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.
Systematic review registration
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.
During the coronavirus disease 2019 (COVID-19) pandemic, frontline healthcare workers (HCWs) suffered more distress from the possibility of contracting the virus, quarantine, social stigma, and prejudice against their families. Many studies have investigated the impact of the pandemic on HCWs; however, studies or guidelines presenting strategies to overcome these challenges are lacking. As part of a 2020 research project supported by the Ministry of Health and Welfare, titled "Health impact assessment of healthcare workers undertaking coronavirus disease 2019 treatment and management in Korea: Identifying problems and researching effective solutions" (HC20C0003), we created guidelines to respond to serious problems posed by infection control. and burnout among HCWs during COVID-19 response measures throughout the extended pandemic period. We formulated the guidelines by means of a systematic review and collated them with the latest literature. The guidelines will highlight the gravity and impact of infection control and burnout among HCWs responding to COVID-19 and include potential prevention strategies, and they can be used as a reference in the event of another emerging infectious disease outbreak in the future.
With the outbreak and spread of the COVID-19 epidemic, HCWs are frequently required to wear personal protective equipment (PPE) for nucleic acid sample collection in semi-open transition spaces. Wearing PPE causes significant psychological and physical stress in HCWs. In this study, operative temperature (Top) and wet-bulb globe temperature (WBGT) were used to assess thermal conditions through field experiments, while multiple physiological parameters were measured in the subjects. The results indicated that the subjects showed statistically significant differences in thermal perception and physiological parameters with and without PPE. Using observed increases in heart rate (HR), auditory canal temperature (Tac), mean skin temperature (MST), and end-tidal CO2 pressure, subjects were shown to have an increased metabolic rate and heat storage while wearing PPE. Additionally, a decrease in oxygen concentration was also observed, and this decrease may be linked to fatigue and cognitive impairment. Moreover, HR, MST, and Tac showed a significant linear relationship, which increased with temperature and operative temperature, and the HR response was stronger with PPE than without PPE. The neutral, preferred, and acceptable temperatures were significantly lower with PPE than without PPE, and the deviations for neutral Top/WBGT were 9.5/7.1 °C and preferred Top/WBGT was 2.2/4.0 °C, respectively. Moreover, the upper limits of acceptable WBGT, 29.4 °C with PPE and 20.4 °C without PPE, differed significantly between the two phases. Furthermore, the recorded physiological parameter responses and thermal perception responses of the subjects while wearing PPE indicated that they were at risk of thermal stress. Overall, these results suggest that people who wear PPE should focus on their health and thermal stress. This study provides a reference for the development of strategies to counteract heat stress and improve thermal comfort.
As protocols and standards of personal protective equipment are changing in the time of COVID-19, dental health care providers must brief themselves on the appropriate products to keep them and their staff safe. This article reviews the current respiratory protection devices used to minimize the risk of SARS-CoV-2 infection.
Background:
The risk of exposure to COVID-19 infection through droplets/aerosol in dental clinics has renewed focus on the utility and possible adverse effects of using personal protective equipment (PPE) on dentists.
Objective:
To obtain information from a cross-section of dentists regarding their PPE usage and to evaluate the possible risk factors that can influence their work efficiency.
Methods:
A 31-item cross-sectional survey with a structured multiple-choice questionnaire was designed. Social media and emails were used to circulate the questionnaire among dental professionals worldwide. A total of 317 respondents returned the completed forms.
Results:
A total of 184 (55%) participants reported getting soaking wet while wearing PPE at the end of the working hours (approximately eight hours of working). Many respondents (n = 286, 90%) reported that the use of PPE resulted in reduced visibility of the operating field. The majority of respondents (84%) felt that their overall work efficiency had reduced after using PPE. Binary logistic regression had shown that two significant factors that were associated with reduced work efficiency included, pre-existing systemic illness and getting soaking wet from wearing a PPE.
Conclusion:
Definite protocols should be introduced that mandate the doffing of PPE for every patient, in a separate well-ventilated area where the skin can recuperate from the heat and pressure points caused by the PPE. Dentists should take greater care in choosing the appropriate PPE to prevent exacerbation of pre-existing illnesses, which may reduce their work efficiency.
Introduction: Healthcare Professionals (HCPs) involved in managing Coronavirus Disease 2019 (COVID-19) pandemic were instructed to wear Personal Protective Equipment (PPE) to protect themselves from contracting virus. However, PPE use can sometimes lead to adverse events which create greater impact on health status of HCPs. Thus, the prevalence of adverse events and associated risk factors should be estimated for taking necessary preventive measures.
Aim: To evaluate the prevalence of adverse events in HCPs due to PPE use during second wave of COVID-19 in Tamil Nadu, India.
Materials and Methods: A cross-sectional study was conducted in different levels of healthcare centres in Tamil Nadu, India, from April to May 2021. Data were collected using a pre-validated questionnaire from HCPs of any discipline who were directly involved in managing COVID-19 patients. A total of 282 responses were collected through Google forms and proportion of HCPs who experienced adverse events due to PPE and percentage of different adverse events associated with PPE wearing were assessed. Data were analysed using Chi-square test.
Results: Out of 282 respondents of the survey included 224 doctors, 34 nurses and 24 lab technicians with a mean age of 30 years. There were 164 females and 118 males. A total of 177 (62.76%) participants experienced adverse events which included dehydration, thirst and heat, headaches, inability to go to restroom and other urinary/respiratory problems. With respect to duration of exposure to PPE, 163 (57.8%) HCPs had >6 hours/day and 102 (36.2%) had 4-6 hours/day. It was observed that factors such as age, gender, profession, various wards posted for COVID-19 duty and duration of PPE worn daily were significantly associated with adverse events to PPE (p-value
During the COVID-19 pandemic, wearing masks in public spaces has become a protective strategy. Field tests and questionnaire surveys were carried out at a university library in Guangzhou, China, during June 2021 and January 2022. The indoor environmental parameters were observed, thermal sensation votes of students on various environmental parameters were collected, symptoms of students wearing masks were quantified, and the appropriate amount of time to wear masks was established. To identify acceptable and comfortable temperature ranges, the relationship between thermal sensation and thermal index was investigated. During summer and winter, people wearing masks are symptomatic for a certain duration. The most frequently voted symptom was facial heat (62.7% and 54.6% during summer and winter, respectively), followed by dyspnea. During summer, more than 80% of the participants subjects were uncomfortable and showed some symptoms after wearing masks for more than 2 h (3 h during winter). In the summer air conditioning environment in Guangzhou, the neutral Top was 26.4 °C, and the comfortable Top range was 25.1–27.7 °C. Under the natural ventilation environment in winter, the neutral Top was 20.5 °C, and the comfortable Top range was 18.5–22.5 °C. This study may provide guidance for indoor office work and learning to wear masks in Guangzhou.
Face masks, along with other preventive measures, can help slow the spread of COVID-19. Despite the positive effect of the mask in combating the virus, it has some negative effects on the human body that must be followed up on and reduced. In this study, we discuss the impact of wearing face masks on the eye and the common issues associated with using them. The literature search was conducted using electronic databases such as PubMed and Google Scholar. Only articles published in English were included. A total of 39 relevant articles were deemed eligible. After the duplicate articles were removed, the titles and abstracts of 20 papers underwent full-text screening. The review comprised both prospective and retrospective investigations, case reports, and a series of reporting ocular symptoms following the use of face masks. The COVID-19 pandemic affected ophthalmology practices in managing patients. New factors must be considered, especially when dealing with anti-VEGF injections, such as the risk of endophthalmitis, tests and symptoms of patients with glaucoma, and the emerging symptoms associated with the COVID-19 vaccination. The use of face masks and breathing aids seemed to influence the tear film.
Background:
The COVID-19 pandemic has necessitated the use of personal protective equipment (PPE) among the frontline health care workers (HCWs). Even though PPE helps in preventing infection, it poses significant physical and psychological impacts at varying levels. Correspondingly, multiple independent studies have brought out the PPE-associated problems. However, there exists a lacuna on comprehensive information of global prevalence related to the same.
Aim:
To estimate the prevalence and risk factors of PPE among HCWs during COVID-19 across the globe.
Design:
Systematic review and meta-analysis.
Method:
The review was undertaken as per the protocol registered in PROSPERO CRD42021272216 following Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA) guidelines. Two independent reviewers have undertaken the search strategy, study selection, and methodological quality assessment. Discrepancies were addressed by the third reviewer. Heterogeneity was addressed through I2 statistics and forest plots generated by open meta-software.
Results:
A total of 16 articles conducted across 6 different countries among 10,182 HCWs were included in the review. The pooled prevalence of skin lesions, headache, sweating, breathing difficulty, vision difficulty, thirst/dry mouth, fatigue, and communication difficulty, anxiety, fear were 57 (47-66%), 51 (37-64%), 75 (56-90%), 44 (23-68%), 61 (21-94%), 54 (30-77%), 67 (58-76%), 74 (47-94%), 28 (24-33%), 14 (10-17%), respectively. Moreover, the various risk factors included are the use of PPE for >6 h and young females. In addition, the medical management of new-onset problems created an additional burden on the frontline health care personnel (HCP).
Conclusion:
The frontline HCWs encountered physical and psychological problems at varying levels as a result of wearing PPE which needs to be addressed to prevent the inadequate use of PPE leading to infections.
Background
Since the emergence of COVID-19, mandatory facemask wearing has been implemented around the world to prevent viral transmission, however, the impact of wearing facemasks on patients with COPD was unclear.
Methods
The current study undertakes a systematic review and meta-analysis of a comprehensive literature retrieval from six databases, based on the pre-determined eligibility criteria, irrespective of language. The risk of bias was assessed using an established instrument. We primarily focused on analyzing ETCO2, SpO2, and heart and respiratory rates, and also considered the impacts on physiological and exercise performance. A descriptive summary of the data and possible meta-analysis was performed. Forest plots were generated to pool estimates based on each of the study outcomes.
Results
Of the 3,751 publications considered, six publications were selected for a systematic review and two publications were included for meta-analysis, however, the quality of these six studies was relatively low overall. In the case of inactivity, the facemask wearing COPD cohort had higher respiratory rates than that of the non-facemask wearing cohort (MD = 1.00 and 95% CI 0.47–1.53, P < 0.05). There was no significant difference in ETCO2 (MD = 0.10 and 95% CI −1.57–1.78, P > 0.05) and heart rate (MD = 0.40 and 95% CI −3.59–4.39, P > 0.05) nor SpO2 (MD = −0.40 and 95% CI −0.84–0.04, P > 0.05) between the COPD patients with and without facemasks. Furthermore, it was observed that the only significant differences between the COPD patients with and without facemasks undertaking different activities were FEV1 (%) (MD = 3.84 and 95% CI 0.14–7.54, P < 0.05), FEV1/FVC (%) (MD = 3.25 and 95% CI 0.71–5.79, P < 0.05), and blood lactate (MD = −0.90 and 95% CI −1.73 to −0.07, P < 0.05).
Conclusion
Wearing facemasks decreased the exercise performance of patients with COPD, however, it had minimal impact on physiological indexes. Further investigations will be performed on the high-quality data from randomized control studies.
Systematic review registration
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=326265, identifier: CRD42022326265.
Information on the clinical features of the severe acute respiratory syndrome (SARS) will be of value to physicians caring for patients suspected of having this disorder.
We abstracted data on the clinical presentation and course of disease in 10 epidemiologically linked Chinese patients (5 men and 5 women 38 to 72 years old) in whom SARS was diagnosed between February 22, 2003, and March 22, 2003, at our hospitals in Hong Kong, China.
Exposure between the source patient and subsequent patients ranged from minimal to that between patient and health care provider. The incubation period ranged from 2 to 11 days. All patients presented with fever (temperature, >38 degrees C for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed crackles and percussion dullness. Lymphopenia was observed in nine patients, and most patients had mildly elevated aminotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive air-space disease. Two patients died of progressive respiratory failure; histologic analysis of their lungs showed diffuse alveolar damage. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy a mean (+/-SD) of 9.6+/-5.42 days after the onset of symptoms, and eight were treated earlier with a combination of beta-lactams and macrolide for 4+/-1.9 days, with no clinical or radiologic efficacy.
SARS appears to be infectious in origin. Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name. The microbiologic origins of SARS remain unclear.
Severe acute respiratory syndrome (SARS) is a condition of unknown cause that has recently been recognized in patients in Asia, North America, and Europe. This report summarizes the initial epidemiologic findings, clinical description, and diagnostic findings that followed the identification of SARS in Canada.
SARS was first identified in Canada in early March 2003. We collected epidemiologic, clinical, and diagnostic data from each of the first 10 cases prospectively as they were identified. Specimens from all cases were sent to local, provincial, national, and international laboratories for studies to identify an etiologic agent.
The patients ranged from 24 to 78 years old; 60 percent were men. Transmission occurred only after close contact. The most common presenting symptoms were fever (in 100 percent of cases) and malaise (in 70 percent), followed by nonproductive cough (in 100 percent) and dyspnea (in 80 percent) associated with infiltrates on chest radiography (in 100 percent). Lymphopenia (in 89 percent of those for whom data were available), elevated lactate dehydrogenase levels (in 80 percent), elevated aspartate aminotransferase levels (in 78 percent), and elevated creatinine kinase levels (in 56 percent) were common. Empirical therapy most commonly included antibiotics, oseltamivir, and intravenous ribavirin. Mechanical ventilation was required in five patients. Three patients died, and five have had clinical improvement. The results of laboratory investigations were negative or not clinically significant except for the amplification of human metapneumovirus from respiratory specimens from five of nine patients and the isolation and amplification of a novel coronavirus from five of nine patients. In four cases both pathogens were isolated.
SARS is a condition associated with substantial morbidity and mortality. It appears to be of viral origin, with patterns suggesting droplet or contact transmission. The role of human metapneumovirus, a novel coronavirus, or both requires further investigation.
Most patients with end-stage renal disease (ERSD) visiting our hospital for hemodialysis treatment during the SARS outbreak wore an N95 mask. Data on the physiological stress imposed by the wearing of N95 masks remains limited. This study investigated the physiological impact of wearing an N95 mask during hemodialysis (HD) on patients with ESRD.
ESRD patients who received regular HD at National Taiwan University Hospital between April to June 2003 were enrolled. Each patient wore a new N95 mask (3M Model 8210) during HD (4 hours). Vital signs, clinical symptoms and arterial blood gas measured before and at the end of HD were compared.
Thirty nine patients (23 men; mean age, 57.2 years) were recruited for participation in the study. Seventy percent of the patients showed a reduction in partial pressure of oxygen (PaO2), and 19% developed various degrees of hypoxemia. Wearing an N95 mask significantly reduced the PaO2 level (101.7 +/- 12.6 to 92.7 +/- 15.8 mm Hg, p = 0.006), increased the respiratory rate (16.8 +/- 2.8 to 18.8 +/- 2.7/min, p < 0.001), and increased the occurrence of chest discomfort (3 to 11 patients, p = 0.014) and respiratory distress (1 to 17 patients, p < 0.001). Baseline PaO2 level was the only significant predictor of the magnitude of PaO2 reduction (p < 0.001).
Wearing an N95 mask for 4 hours during HD significantly reduced PaO2 and increased respiratory adverse effects in ESRD patients.
Cephalalgia has been successful by a number of measures in the last 12 months: our circulation is up particularly through electronic penetration in libraries, our submission rate has risen substantially and our impact factor remains high amongst clinical neuroscience journals. We are entering our fifth and last year of the current publisher’s contract. In the life of the contract we have switched to a very successful on-line submission system, finalized details for a new CDROM containing all issues of Cephalalgia and Headache, and will publish this year the revised International Headache Society classification for headache (1). All of this is excellent progress The journal continues to attract a range of important, interesting and often very thought-provoking submissions. We have benefitted greatly from the broad range of interests of the Associate Editors we are able to recommend and solicit high-quality expert reviews that keep the scientific standards high. In keeping with our general philosophy there is a need for renewal amongst the Associate Editors, and Professor Peer Tfelt-Hansen will be standing down. Peer is widely regarded as one of the most authoritative figures on clinical trial methodology in headache, his wide contributions to the field have appropriately lead to his election as President of the International Headache Society. The journal thanks him for his contributions, and congratulates him on his election. After wide consultation I have invited Professor Nahib Ramadan, University of Chicago, to join the Associate Editors. Professor Ramadan was extensively involved in the journal under the previous Editor-in-Chief, Professor K. Michael Welch, and brings both excellence in academic life and a stint in industry with that important perspective to the Board. I welcome his acceptance of the invitation. From this issue Cephalalgia will become a monthly journal. We have a strong throughput of excellent work and rather than raise the rejection rate, and somewhat arbitrarily dismiss work that readers might be very interested in seeing, we felt it timely to increase to 12 issues a year. We hope this will allow more rapid publication of your accepted work and a greater range of interesting papers for readers in any one year. Let me close by thanking the Editorial Assistant Faye Cheeseman for her sterling efforts at the Blackwell’s Office in keeping the journal ticking over, our referees whose expertise is the key to our success, the Associate Editors who do so much for the journal, and you the reader for your continued support for Cephalalgia.
Most headaches, including the chronic ones, have an organic background. This applies in particular to the unilateral headaches, but also probably to some of the global ones. In spite of this, there seems to be a clear, but variable influence of stress in the various types of headache. This effect may be a dual one. Thus, in migraine the effect of the low-degree, daily, annoying stress may be much worse than that of major stress, which may in fact prevent a headache almost even completely. A distinction should be made between the influence of stress on the headache as such and on the separate attacks. An example of this may be cluster headache: the mechanism underlying the long-term development may be under influences of external stressors, whereas the shortlasting, solitary attacks are scarcely influenced by such factors. The negative influence of stress is probably most apparent in common migraine and the acute form of tension headache. Headaches like the "atypical facial neuralgia" have been thought to have a strong, psychogenic background. Atypical facial neuralgia is one of the unilateral headaches, and bears a great similarity to cervicogenic headache. In the latter headache, attacks may even be precipitated mechanically, so that a psychogenesis or a marked stress-influence seems to be unlikely. In some cases of classic migraine, attacks seem to appear in their own inherent, stereotypical rhythm irrespective of outer events of a possible harmful nature.
Although there are no data demonstrating the effectiveness of personal respiratory protection in the prevention of occupational tuberculosis, there are sound theoretical bases supporting the use of respirators to reduce the risk of inhalational exposure. The major factor that limits the effectiveness of most respirators is the leakage between the face and the mask. There are data suggesting that traditional fit testing of respirators does not adequately predict the degree of protection in actual use, and more research is needed in that area. There is a large range of infectiousness of aerosols of TB, and classes of respirators vary greatly in the degree of protection they offer. I have argued that respirator selection should be based on anticipated exposures. High-risk exposures to TB are often associated with cough-inducing procedures or with aerosolization of infected tissues during autopsies. In my opinion, the most reasonable type of respirator for such high-risk situations in health care settings is a PAPR hood. The concentration of infectious aerosols in well-ventilated respiratory isolation rooms is likely to be very low, and the new N95 respirators offer a reasonable balance of comfort, cost, practicality, and protection. Preliminary data from mathematical modeling studies suggest there may be little additional benefit from more sophisticated personal respiratory protection in such settings. Additional research is needed to more accurately assess exposures to TB, to determine the size and aerodynamic behavior of TB generated by infectious patients, and to more accurately define the role and effectiveness of personal respiratory protection against TB.
The increasing popularity of scuba diving has added a new category to the differential diagnosis of headache. Headache in divers, while uncommon and generally benign, can occasionally signify serious consequences of hyperbaric exposure such as arterial gas embolism, decompression sickness, and otic or paranasal sinus barotrauma. Inadequate ventilation of compressed gases can lead to carbon dioxide accumulation, cerebral vasodilatation, and headache. Other types of headache encountered in divers include exertional headache, cold stimulus headache, migraine, tension-type headache, acute traumatic headache, cervicogenic headache, carbon monoxide poisoning headache, and headache associated with envenomation. Correct diagnosis and appropriate treatment require a careful history and neurologic examination as well as an understanding of the unique physiologic stresses of the subaquatic environment.
Used as an adjunct or alternative to medication treatment, psychologic and behavioral approaches to tension-type headache decrease headache frequency, affective distress, and headache-related disability. These approaches directly address the psychologic and behavioral factors that contribute to the disorder and to the individual headache episodes. There is well-established evidence of efficacy for the three broad approaches: relaxation training, electromyographic biofeedback training, and cognitive-behavioral stress management. Treatment has been difficult to access, with most care provided by behavioral specialists in tertiary care settings using clinic-based or home-based treatment protocols. Recent attempts to make treatment more accessible to a wider range of tension-type headache sufferers include using medical personnel to deliver treatment from physician practices and using existing and emerging technologies to provide care in a purely self-administered format without face-to-face contact with therapists. These attempts are promising, but remain preliminary; therefore, there is a need for further development and testing.
Two women, aged 27 and 45 years, presented to the Dermatology Outpatient Clinic with acne vulgaris. Both had nodular acne in a similar distribution over the cheeks, chin, and perioral areas (Fig. 1). Each had a history of acne vulgaris as a teenager. Both were healthcare assistants working in the Singapore General Hospital throughout the severe acute respiratory syndrome (SARS) crisis, had worn N95 masks continuously for about 3 months whilst on the wards, and had suffered an outbreak of acne of the skin occluded by the mask. They were treated with topical retinoid and systemic antimicrobials, and both responded well.
Figure 1. Twenty-seven-year-old woman with acne papules and nodules on the face over the area occluded by the N95 mask
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The International Headache Society has classified the external compression headache as a kind of cranial neuralgia caused by continued external pressure over the head. This headache has peculiar characteristics and resolves after pressure is relieved. The aim of this study was to analyze the occurrence of this headache type among 82 police officers who reported headache after wearing a helmet. We retrospectively studied 82 patients (79 men, 3 women), age 19-35 years (mean, 26), who presented to an outpatient neurology department in a military police hospital with complaints of headache associated with wearing a helmet on at least 3 occasions. The headache subsided after removal of the helmet. During subsequent follow-up consultations, designed to reevaluate the patients and to renew the authorization releasing helmet use, no patients described recurrence of the head pain. We conclude that headache caused by external compression can be related to wearing a helmet, and headache relief can be obtained simply by not wearing such a helmet.
Before the advent of severe acute respiratory syndrome (SARS), use of the powered air-purifying respirator (PAPR) in the setting of pulmonary tuberculosis has been controversial. Data regarding health care worker (HCW) perceptions and problems encountered with the use of the PAPRs were lacking.
A questionnaire-based survey was conducted of HCWs who had used the PAPR in clinical practice during the SARS outbreak, when use of the PAPR was mandatory and widespread. Evaluations of the question of whether HCWs were receptive to the use of the PAPR and their perceptions of common problems that were encountered were made. Perceptions of comfort, ease of use, visual, hearing, breathing and speech impairment, perceived protection against SARS and usage preferences were recorded.
Only a minority of respondents found the PAPR uncomfortable, despite some interference with communication. Despite its much higher cost, the majority (84%) preferred to use the PAPR rather than the N-95 respirator when treating suspected SARS patients. However, opinions were equally divided regarding its use when treating patients with pulmonary tuberculosis; with 51% being in favour.
With the advent of highly contagious diseases that pose a major occupational hazard to HCWs, the use of the PAPR has become more acceptable in clinical practice.
Severe Acute Respiratory Syndrome (SARS) was responsible for outbreaks in Canada, China, Hong Kong, Vietnam, and Singapore. SARS focused attention on the adequacy of and compliance with infection control practices in preventing airborne and droplet-spread transmission of infectious agents.
This paper presents a review of the current scientific knowledge with respect to the efficacy of personal protective equipment in preventing the transmission of respiratory infections. The effectiveness of infection control policies and procedures used in clinical practice is examined.
Literature searches were conducted in several databases for articles published in the last 15 years that related to infection control practices, occupational health and safety issues, environmental factors, and other issues of importance in protecting workers against respiratory infections in health care settings.
Failure to implement appropriate barrier precautions is responsible for most nosocomial transmissions. However, the possibility of a gradation of infectious particles generated by aerosolizing procedures suggests that traditional droplet transmission prevention measures may be inadequate in some settings. Further research is needed in this area.
Avian flu outbreaks in Thailand and Vietnam, followed by a reported case of human-to-human transmission in Cambodia (http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_02_02/en/) prompted rapid responses by health authorities around the world. The WHO and local health ministries launched investigations into the potential source(s) of the outbreaks, and millions of ducks and other farm poultry were slaughtered (http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/feb0205cambodian.html). The US Centers for Disease Control responded by elevating its previous advice to travellers about avian influenza A (H5N1) in Asia from an Outbreak Notice to a Travel Health Precaution, and increased surveillance for the disease. Some experts predict that the world is on the brink of an avian flu pandemic; others say a pandemic may not be inevitable, but urge caution and ongoing monitoring. The following sites offer background information and the latest news on avian flu.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders
Headache Classification Subcommittee of the International Headache Society. The International Classification
of Headache Disorders, 2nd edn. Cephalalgia
2004;24(Suppl. 1):1-160.