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J Med Virol ; 93(10): 5676-5679, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1432416


Over the months of April and May 2021, South Africa has witnessed several outbreaks of highly infective avian influenza (H5N1) in different poultry farms. This came as a shock to a country that was already battling with the deadly COVID-19 pandemic. The emergence of the virus has spurred import bans and massive culls in the poultry business. Local experts have also called for a restriction on the movement of people and cars in and out of their chicken farms. Employees have also been encouraged to shower in the mornings when they arrive at the farms and wear fresh clothes, as the flu spreads very quickly. In a country that is already facing the economic implications of the COVID-19, this has the potential to cause a significant dent in the economy, as well as severely impact people's day-to-day life. Bird flu-also called avian influenza-is a viral infection that can infect not only birds but also humans and other animals. The threat of a new influenza pandemic has prompted countries to draft national strategic preparedness plans to prevent, contain and mitigate the next human influenza pandemic. This paper describes the South African burden, current efforts, and preparedness against the avian influenza virus.

COVID-19/epidemiology , Disease Outbreaks/veterinary , Influenza in Birds/prevention & control , Animals , Chickens , Disease Outbreaks/prevention & control , Humans , Influenza A Virus, H5N1 Subtype , Influenza in Birds/epidemiology , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Poultry/virology , SARS-CoV-2 , South Africa/epidemiology
IOP Conference Series. Earth and Environmental Science ; 842(1), 2021.
Article in English | ProQuest Central | ID: covidwho-1398055


Due to the Covid-19 pandemic, the Government of Malaysia, via the Ministry of Health and National Safety Council, has imposed the Movement Control Order (MCO). In that order, the Ministry of Health and National Safety Council has given best practices for personal hygiene during the outbreaks to ensure public health precaution among Malaysians. Thus, the objective of this study is to survey the personal hygiene practices among Tanjong Malim, Perak Community During Movement Control Order (MCO) Due to Covid-19. A survey technique with a set of questionnaires was used to collect the required data on 383 respondents. The data were collected using a cross-sectional descriptive study, and percentage were utilised to determine the level of association. The results show that most of Tanjong Malim community practice a good hand washing technique with a mean value of 4.36 and SD = 0.66. They are also practising good personal hygiene by taking a shower immediately after returning home from public places with a mean value of 4.05 and SD = 0.82. They also wash their clothes immediately after returning home from public places (mean value of 3.90, SD = 0.87). On the other hand, the practice of separating clothes during washing is also high, with a mean value of 3.95, SD = 0.93. The personal hygiene attitude, namely washing their hand before and after touching something inside and outside the house, is also high with a mean value of 4.55, SD = 0.7 and 4.67, SD = 0.5, respectively. It is found that, due to the Covid-19 pandemic crisis, most of the respondents wash their hands at least twice a day, with a majority of 5 to 7 times a day (51.2%), followed by twice to 4 times a day (21.1%) and more than ten times a day ( 9.9%). However, the practising shower for more than 15 minutes and more than three times per day was low, with a mean value of 2.44, SD = 1.32, and 2.48, SD = 0.98, respectively. Hopefully, the findings of this study can be used by authorities as a basis to craft new guidelines for hygienic practices during the virus pandemic outbreak.

Environ Dev Sustain ; : 1-17, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1391923


In this study, it has been aimed to determine the difference between water footprint values of individuals with different socio-economical levels, living in various cities, before and during COVID-19 pandemic period. For this purpose, a questionnaire study has been made and data obtained because of questionnaire have been processes in a water footprint calculation module. Data obtained from questionnaires have also been evaluated statistically in SPSS application. According to the findings obtained, while average water footprint before COVID-19 pandemic has been calculated as 4178.42 L/day, average water footprint during COVID-19 pandemic period has been calculated as 4606.18 L/day. It was determined that the percentage of participants whose water footprint increased during the COVID-19 pandemic period at all education levels was higher than other participants. When the water footprint values of the participants with an income level of 7000 TL and above were compared with the water footprint values of other income groups, it was observed that the water footprint values of the participants with an income of 7000 TL and above increased during the COVID-19 pandemic compared to before the COVID-19 pandemic. When the water footprint values of individuals according to age groups are examined, it has been determined that the water footprint values of individuals tend to increase in all age groups (except for the 51-60 age range) during the COVID-19 pandemic compared to before the COVID-19 pandemic. It has been seen that in the monthly clothing expenses and car washing numbers of participants, there was a tendency to decrease and that in their monthly kitchen expenditures there was a tendency to increase. Because of statistical evaluations, it was seen that there was a meaningful correlation between change in water footprint values and weekly shower numbers, weekly laundry washing numbers, and monthly kitchen expenses. Despite the increase in water consumption with many daily activities, it can be said that the average water footprint value did not increase much due to the decrease in clothing expenditures of the participants during the pandemic process, the change in car washing frequencies, and the fact that red meat consumption did not increase in general despite the increase in kitchen expenses.

Sci Rep ; 11(1): 12999, 2021 06 21.
Article in English | MEDLINE | ID: covidwho-1387481


An ever-increasing number of medical staff use mobile phones as a work aid, yet this may pose nosocomial diseases. To assess and report via a survey the handling practices and the use of phones by paediatric wards healthcare workers. 165 paediatric healthcare workers and staff filled in a questionnaire consisting of 14 questions (including categorical, ordinal and numerical data). Analysis of categorical data used non-parametric techniques such as the Chi-squared test. Although 98% of respondents (165 in total) report that their phones may be contaminated, 56% have never cleaned their devices. Of the respondents that clean their devices, 10% (17/165) had done so with alcohol swabs or disinfectant within that day or week; and an additional 12% respondents (20/165) within that month. Of concern, 52% (86/165) of the respondents use their phones in the bathroom, emphasising the unhygienic environments in which mobile phones/smartphones are constantly used. Disinfecting phones is a practice that only a minority of healthcare workers undertake appropriately. Mobile phones, present in billions globally, are therefore Trojan Horses if contaminated with microbes and potentially contributing to the spread and propagation of micro-organisms as per the rapid spread of SARS-CoV-2 virus in the world.

Bathroom Equipment/virology , COVID-19/prevention & control , Cell Phone/instrumentation , Cross Infection/prevention & control , Delivery of Health Care/methods , Disinfection/methods , Hospitals, Pediatric , Personnel, Hospital , SARS-CoV-2 , COVID-19/virology , Cross Infection/virology , Emergency Service, Hospital , Female , Hand Hygiene , Humans , Intensive Care Units, Neonatal , Male , Risk Factors , Self Report
Cochrane Database Syst Rev ; 4: CD013582, 2020 04 21.
Article in English | MEDLINE | ID: covidwho-1372688


BACKGROUND: This review is one of a series of rapid reviews that Cochrane contributors have prepared to inform the 2020 COVID-19 pandemic. When new respiratory infectious diseases become widespread, such as during the COVID-19 pandemic, healthcare workers' adherence to infection prevention and control (IPC) guidelines becomes even more important. Strategies in these guidelines include the use of personal protective equipment (PPE) such as masks, face shields, gloves and gowns; the separation of patients with respiratory infections from others; and stricter cleaning routines. These strategies can be difficult and time-consuming to adhere to in practice. Authorities and healthcare facilities therefore need to consider how best to support healthcare workers to implement them. OBJECTIVES: To identify barriers and facilitators to healthcare workers' adherence to IPC guidelines for respiratory infectious diseases. SEARCH METHODS: We searched OVID MEDLINE on 26 March 2020. As we searched only one database due to time constraints, we also undertook a rigorous and comprehensive scoping exercise and search of the reference lists of key papers. We did not apply any date limit or language limits. SELECTION CRITERIA: We included qualitative and mixed-methods studies (with a distinct qualitative component) that focused on the experiences and perceptions of healthcare workers towards factors that impact on their ability to adhere to IPC guidelines for respiratory infectious diseases. We included studies of any type of healthcare worker with responsibility for patient care. We included studies that focused on IPC guidelines (local, national or international) for respiratory infectious diseases in any healthcare setting. These selection criteria were framed by an understanding of the needs of health workers during the COVID-19 pandemic. DATA COLLECTION AND ANALYSIS: Four review authors independently assessed the titles, abstracts and full texts identified by our search. We used a prespecified sampling frame to sample from the eligible studies, aiming to capture a range of respiratory infectious disease types, geographical spread and data-rich studies. We extracted data using a data extraction form designed for this synthesis. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool. We used a 'best fit framework approach' to analyse and synthesise the evidence. This provided upfront analytical categories, with scope for further thematic analysis. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We examined each review finding to identify factors that may influence intervention implementation and developed implications for practice. MAIN RESULTS: We found 36 relevant studies and sampled 20 of these studies for our analysis. Ten of these studies were from Asia, four from Africa, four from Central and North America and two from Australia. The studies explored the views and experiences of nurses, doctors and other healthcare workers when dealing with severe acute respiratory syndrome (SARS), H1N1, MERS (Middle East respiratory syndrome), tuberculosis (TB), or seasonal influenza. Most of these healthcare workers worked in hospitals; others worked in primary and community care settings. Our review points to several barriers and facilitators that influenced healthcare workers' ability to adhere to IPC guidelines. The following factors are based on findings assessed as of moderate to high confidence. Healthcare workers felt unsure as to how to adhere to local guidelines when they were long and ambiguous or did not reflect national or international guidelines. They could feel overwhelmed because local guidelines were constantly changing. They also described how IPC strategies led to increased workloads and fatigue, for instance because they had to use PPE and take on additional cleaning. Healthcare workers described how their responses to IPC guidelines were influenced by the level of support they felt that they received from their management team. Clear communication about IPC guidelines was seen as vital. But healthcare workers pointed to a lack of training about the infection itself and about how to use PPE. They also thought it was a problem when training was not mandatory. Sufficient space to isolate patients was also seen as vital. A lack of isolation rooms, anterooms and shower facilities was a problem. Other important practical measures described by healthcare workers included minimising overcrowding, fast-tracking infected patients, restricting visitors, and providing easy access to handwashing facilities. A lack of PPE, and equipment that was of poor quality, was a serious concern for healthcare workers and managers. They also pointed to the need to adjust the volume of supplies as infection outbreaks continued. Healthcare workers believed that they followed IPC guidance more closely when they saw the value of it. Some healthcare workers felt motivated to follow the guidance because of fear of infecting themselves or their families, or because they felt responsible for their patients. Some healthcare workers found it difficult to use masks and other equipment when it made patients feel isolated, frightened or stigmatised. Healthcare workers also found masks and other equipment uncomfortable to use. The workplace culture could also influence whether healthcare workers followed IPC guidelines or not. Across many of the findings, healthcare workers pointed to the importance of including all staff, including cleaning staff, porters, kitchen staff and other support staff when implementing IPC guidelines. AUTHORS' CONCLUSIONS: Healthcare workers point to several factors that influence their ability and willingness to follow IPC guidelines when managing respiratory infectious diseases. These include factors tied to the guideline itself and how it is communicated, support from managers, workplace culture, training, physical space, access to and trust in personal protective equipment, and a desire to deliver good patient care. The review also highlights the importance of including all facility staff, including support staff, when implementing IPC guidelines.

Coronavirus Infections , Cross Infection/prevention & control , Guideline Adherence , Health Personnel , Infection Control , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Guideline Adherence/standards , Health Knowledge, Attitudes, Practice , Humans , Pandemics/prevention & control , Patient Isolation , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Universal Precautions
Int J Infect Dis ; 109: 160-167, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1333475


BACKGROUND: Data from Africa regarding sudden and unexpected COVID-19 community deaths and underlying pathological, demographic, and co-morbidity features require definition. METHODS: We performed a case series of COVID-19-related deaths seen at Forensic Post-Mortem examination of sudden and unexpected Community Deaths in Lusaka, Zambia, Africa. Whole-body Post-Mortem examinations were performed according to Standard Operating Procedures. Patient demographics, history, co-morbidities, pathological gross and microscopic findings, and cause(s) of death were recorded. Variables were grouped as frequencies and percentages. Comparison of data was made with autopsy findings of hospital COVID-19 deaths. FINDINGS: Of 21 COVID-19 decedents, 14/21 (66.7%) were male; 18/21, (85.7%) were below 55 years of age (mean age, 40 ± 12.3; range, 20-73). The median duration of symptoms was 1 day (range 0-2); 9/21 (42.9%) had co-morbidities, with hypertension and obesity being the most common. Main post-mortem findings were diffuse alveolar damage (DAD) (80.9%), saddle and shower emboli (38.1%, respectively), and pneumonia (14.3%). Pulmonary thromboembolism (76.2%), DAD (14.3%), and SARS-CoV-2 pneumonia (9.5%) were common causes of death. CONCLUSIONS: COVID-19 is an important cause of death to consider in forensic investigations of sudden and unexpected community deaths. Risk factors for the younger age of COVID-19 deaths and thromboembolism need to be identified.

COVID-19 , Adult , Autopsy , Humans , Male , Middle Aged , Risk Factors , SARS-CoV-2 , Zambia/epidemiology
BMJ Leader ; 4(Suppl 1):A76, 2020.
Article in English | ProQuest Central | ID: covidwho-1318172


Morale within the NHS was low before COVID-19 caused confusion, fear and loss of direction. Morale became more important to ensure the ability to navigate this difficult challenge. My role as Chief Registrar was to link executive and junior medical teams. The key to my strategy was early and continued stakeholder engagement.We identified the ability to communicate with junior medical staff as a weakness. The Trust did not have a list of all junior doctors, or a way to communicate with them. I set up a ‘WhatsApp’ group for all junior medical staff and through this, organised daily video conferences led by a member of the senior clinical team. These conferences included updates on hospital status and guidelines which were then summarised into a text update for those unable to attend. This flexible approach was devised and implemented within a week.The working environment plays a pivotal role and wellbeing is impacted by access to food and rest. We arranged free food and access to the Doctors Mess, free parking, shower facilities and a ‘wobble room’, where people could go if they felt overwhelmed. We coordinated strategies alongside the Trust wellbeing team and recruited a GP, with psychiatry experience to be available for telephone consultations daily.We used online surveys to assess the impact of our intervention collecting both quantitative and qualitive data. Over 80% of junior doctors felt supported during the pandemic and reported a reduction in anxiety.Change can happen effectively even during a crisis within a complex system. The morale of the medical workforce has a direct impact on patient safety and the quality of care delivered. The Chief Registrar role has enabled me to lead from within, which is an effective way to implement change by being an authentic voice from within an organisation.

BMJ Leader ; 4(Suppl 1):A21-A22, 2020.
Article in English | ProQuest Central | ID: covidwho-1318106


IntroductionJunior doctors are increasingly working in an overstretched NHS. In 2018 Kettering General Hospital (KGH) was awarded £60,800 of government funds to create high-quality rest facilities and improve junior doctor wellbeing.MethodsThrough auditing doctors working at KGH, alongside consulting senior management, a project initiation document was constructed to spend this money. From November 2019 to June 2020 £46,275 was spent on creating new rest facilities, including separate sleeping and working areas. Furthermore, the purchase of modern furniture and equipment met the functional needs of busy junior doctors. One month after the completion of the project, the team conducted a post-action review by re-auditing how the changes impacted morale, wellbeing and quality of patient care.ResultsNow, the majority of doctors are happy with the current rest areas on offer at KGH (60%), and a majority feel that they will use the on-call room area (63%). Overall, the feedback from both interviews and the JDF was positive and, the renovation improved morale and wellbeing. There was an increased ability to take breaks. However, the majority of doctors are still not exception-reporting missing breaks: 79% (2019), 74% (2020).Lessons LearntWhilst improved rest facilities were welcomed, this report recommends the maintenance of increased staffing levels and fatigue facilities during the recovery phase of COVID-19. The remaining £14,524.38 should be directed at creating shower facilities, upgrading computer hardware and sustaining the quality of KGH fatigue facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities not only ensure workforce wellbeing but undoubtedly translates into the safety of our patients.

Int J Environ Res Public Health ; 18(13)2021 06 29.
Article in English | MEDLINE | ID: covidwho-1288872


The COVID-19 pandemic has impacted the management of non-communicable diseases in health systems around the world. This study aimed to understand the impact of COVID-19 on diabetes medicines dispensed in Australia. Publicly available data from Australia's government subsidised medicines program (Pharmaceutical Benefits Scheme), detailing prescriptions by month dispensed to patients, drug item code and patient category, was obtained from January 2016 to November 2020. This study focused on medicines used in diabetes care (Anatomical Therapeutical Chemical code level 2 = A10). Number of prescriptions dispensed were plotted by month at a total level, by insulins and non-insulins, and by patient category (general, concessional). Total number of prescriptions dispensed between January and November of each year were compared. A peak in prescriptions dispensed in March 2020 was identified, an increase of 35% on March 2019, compared to average growth of 7.2% in previous years. Prescriptions dispensed subsequently fell in April and May 2020 to levels below the corresponding months in 2019. These trends were observed across insulins, non-insulins, general and concessional patient categories. The peak and subsequent dip in demand have resulted in a small unexpected overall increase for the period January to November 2020, compared to declining growth for the same months in prior years. The observed change in consumer behaviour prompted by COVID-19 and the resulting public health measures is important to understand in order to improve management of medicines supply during potential future waves of COVID-19 and other pandemics.

Bathroom Equipment , COVID-19 , Diabetes Mellitus , Australia/epidemiology , Consumer Behavior , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Humans , Meat , Pandemics , SARS-CoV-2
Open Access Macedonian Journal of Medical Sciences ; 9(T3):153-155, 2021.
Article in English | EMBASE | ID: covidwho-1278533


BACKGROUND: Coronavirus disease-19 (COVID-19) is a highly contagious viral disease that affects respiratory system and other organs. It is transmitted through air or contact of contaminated surfaces. Thus, physical and social distancing, hand washing with soap, or hand sanitizer are greatly persuaded. Interestingly, this pandemic does not only affect physical health, but also mental disorder, including obsessive-compulsive disorder (OCD) that is marked with the presence of either obsession or persistent compulsive behavior, or in the most common form, both are present. Obsession is thought, image or desire that preoccupies someone’s mind which commonly is related to anxiety. Compulsion, in the other hand, is repetitive behavior that strongly derives individual to do so to achieve fulfillment of one’s obsession that is not considered normal on the bases of daily norm. CASE REPORT: A 26-year-old woman as a bank employee admitted of doing repetitively unreasonable hand washing and shower within approximately the past 3 months. She even washes her hands more than 10 times in an hour and takes shower more than 5 times a day. She admitted that this is her very first experience and all were started at the beginning of COVID-19 pandemic. CONCLUSION: COVID-19 pandemic also causes serious mental disorders and has become such a nightmare or worst scenario for those experiencing OCD. Physical and social distancing, hand washing with soap, or hand sanitizer are greatly.

Access Microbiology ; 3(5):000229, 2021.
Article in English | MEDLINE | ID: covidwho-1276306


Given the importance of disinfecting showerheads from Legionella species and the lack of instructions as to how to successfully achieve this, the aim of this study was to examine the ability of domestic steam disinfection to successfully disinfect showerheads from Legionella species. Steam disinfection of Legionella pneumophila [n=3;L. pneumophila serogroup 2-15 (wildtype environmental water isolate);L. pneumophila serogroup 1 NCTC11192 (reference strain);L. pneumophila serogroup 1 (wildtype environmental water isolate)], L. erythra (wildtype environmental water isolate) and L. bozemanii CRM11368M (reference strain) were examined in this study. Steam disinfection employing a baby bottle steam disinfector device eradicated all Legionella organisms tested. Steam disinfection, when performed properly under the manufacturer's instructions, offers a relatively inexpensive, simple, versatile and widely available technology for the elimination of Legionella species from contaminated showerheads. We therefore advocate the employment of such devices to regularly disinfect showerheads and shower tubing in hairdressing salons, barber shops and gyms, as a critical control in the elimination of these organisms from these sources, thereby enhancing customer/client/staff safety.

Sci Total Environ ; 792: 148341, 2021 Oct 20.
Article in English | MEDLINE | ID: covidwho-1275700


Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.

Bathroom Equipment , COVID-19 , Aerosols , Humans , SARS-CoV-2 , Toilet Facilities
Psychiatry Res ; 303: 114062, 2021 09.
Article in English | MEDLINE | ID: covidwho-1272678


The COVID-19 pandemic led to panic buying in many countries across the globe, preventing vulnerable groups from accessing important necessities. Some reports inaccurately referred to the panic buying as hoarding. Although hoarding is a separate issue characterised by extreme saving behaviour, the two problems may be influenced by similar factors. Participants from Australia and the United States (final N = 359) completed online self-report measures of panic buying, hoarding, shopping patterns, perceived scarcity, COVID-19 illness anxiety, selfishness, and intolerance of uncertainty. Our findings showed that panic buying was related to hoarding symptoms (r's = .23 - .36), and yet, both were uniquely associated with different psychological factors. Whilst panic buying was most strongly related to greater perceived scarcity (r's = .38 - .60), hoarding was most related to a general intolerance of uncertainty (r's = .24 - .57). Based on our findings, future strategies to prevent panic buying should focus on reducing perceived scarcity cues in the community, as this seems to be the primary driver of panic buying. Another preventative strategy to reduce excessive acquiring and saving may be to implement educational programs to increase people's ability to tolerate distress and uncertainty.

Bathroom Equipment , COVID-19 , Hoarding , Humans , Pandemics , SARS-CoV-2
Asia Pacific Allergy ; 11(2), 2021.
Article in English | EMBASE | ID: covidwho-1234891


Background: This year, pollen season coincided with the first wave of the coronavirus disease 2019 pandemic. Strict preventive measures have been implemented during April and May and then a normalization phase started in our country in June. Our aim is to evaluate the effect of preventive measures during the pandemic process on allergic airway disease symptoms. Methods: A prospective questionnaire-based study was planned and a questionnaire form was sent to the cell-phones of the subjects with pollen allergy followed in our clinic. Number of airborne grass pollens was determined by Burkard volumetric 7-day spore trap. Results: A total of 222 pollen allergic patients were included in the study. At the beginning of the pandemic, majority of the subjects were spending time mostly indoors. The rate of home-office workers gradually decreased and the rate of office workers and the number of days at work increased from April to June, significantly. Nasal and ocular symptoms of the patients, also increased in June compared to April and May and, approximately one-third of the patients had less symptoms when compared to the same period of the previous year. The rates of using a face mask and taking a shower on return home were high among the subjects during all season.Conclusion: Our study showed that spending less time outside during the pollen season and wearing a mask outdoors reduces exposure to pollens and causes a reduction in symptoms. Thus, strict application of measures that cannot be applied in daily practice can make a significant contribution to the management of seasonal allergic rhinitis.

The FASEB Journal ; 35(S1), 2021.
Article in English | Wiley | ID: covidwho-1233909


An inspiration for an analysis of plausible of Pandemic impelled by Antibiotic Resistant (AR) infectious diseases (PARID) was derived from the observations during Covid-19 pandemic from February 2020 on till the time of submission of this work and also from a colloquium on the role of multiple socioeconomic factors impinging on pathophysiological factors (lymphatic system functions) contributing for the plausible sixth mass extinction. We have formulated three prong approach namely, (focusing on reducing the antibiotic footprint, drug resistance index - resistance map DRI-RM, implementation of antibiotic stewardship) I: Prevention, II: Treatment (Clinical care), and III: Rehabilitation of cohort with or without comorbidity. Here, we present a multitude of mitigation strategies as a part of I: Prevention: Non-Pharm. Intervention: i. establishment of internet site/home page for issuing and monitoring a national alert for lockdown /followed by a 48 ? 72-hour mandatory preparatory process for stay home / shelter-in order simultaneous call center for guidelines and concerted effort in undertaking the contact tracing of the infected person sustaining quarantine / social isolation, ii. hand washing for 20 seconds before and after work, preparing food, dining, sneezing, coughing, iii. avoid crowds / close contact with sick people, iv. avoid community gathering (not more than 5, no cinemas, conferences, beauty salons), v drink adequate amount of water, vi Wear personal protection equipment while maintaining six feet during the rationing or going to the groceries hospitals or other life demanding event activities then demands demanding activities and see being informed by the local city states national global morbidity and mortality data on a daily basis, vii disinfect the surface of frequent contacts (door knob, toilet seat, dining table, electronic devices namely phone, computers, tv remotes, viii Avoid shaking hands, ix Stay home while taking a short walk in the lawn maintaining 6 feet distance with other person, x Decontaminate arriving from work or unknowingly touching an infected/sick patient by taking shower, washing clothes, xi Avoid touching your face, xii Avoid non-essential travels including the hot zones from where the disease started spreading, xiii Isolate the Footwear before entering the house, xiv No personal handkerchief, xv Decontaminate the personal jewelries, xvi Preferably vegetarian food, if not well cooked meat diet, and xvii Avoid unnecessary trips domestic / aboard / cruses) and well-coordinated pause in stay-home/shelter-in laws. Prophyl. Meas : DDX of the clinically recorded signs and symptoms of infectious diseases, plasma therapy, medically supervised implementation of vaccine campaigns as needed, stock pile of vaccines at each health care centers. Taken together, effective implementation of aforesaid mitigation measures, PARID would be improbable to impart a vile mortality rate. However, the plausibility of a higher morbidity rate of asymptomatic carrier with an array of comorbidity requiring concerted integrative approach for rehabilitation.

ISRCTN; 22/04/2021; TrialID: ISRCTN48563324
Clinical Trial Register | ICTRP | ID: ictrp-ISRCTN48563324



Bathing adaptations in the homes of older adults
Not Applicable


Current interventions as of 27/07/2021:
Participants will be randomly allocated 1:1 to the usual care or intervention group. We will use “pairwise” randomisation. The randomisation will be stratified by ability to complete the SF-36; for those participants who can self-complete the SF-36, it will be further stratified by site and property tenure, and for those who can not, it will be stratified by site only. Additional flexibility of the strata will be considered in cases where finding a pair is problematic. The randomisation sequence will be generated by a statistician at York Trials Unit.

Study groups:
Control: Usual waiting list group. People in this group will remain on the usual waiting list and be allocated to a project officer surveyor to begin the adaptations process when they reach the top of the waiting list and/or by the usual processes and timescales within the local authority. The waiting list at our sites before the COVID-19 pandemic was between 4 and 9 months, but this can vary.
Intervention: Accelerated list group. People in this group will be allocated to a project officer/surveyor to begin the adaptations process and/or will have their adaptations process expedited by active management of the process and rapid or fast-tracked contracting.

Baseline consultation:
Local authority staff will contact people who have been referred for an accessible shower to let them know they have been added to a waiting list for this. If the person fulfils the eligibility criteria the administrator will also give a brief overview of the study and ask permission for a research assistant to make contact with them about the study and to send further information.

Primary outcome:

Physical Component Summary score (PCS) of the SF-36 measured in:
1. Both groups at baseline
2. Four weeks post-adaptation in the intervention group
3. Two weeks pre-adaptation in control group
4. Four weeks post-adaptation in control group
5. 12 weeks post-adaptation in control group


Inclusion criteria:
Current inclusion criteria as of 27/07/2021:
1. People aged 65 or over
2. People referred for a major adaptation for provision of an accessible (level or easy access) showering facility. This may be by removal of an existing bath or shower cubicle.
3. People living in housing owned by the local authority or living in privately-owned housing (owner-occupied, privately rented, housing association owned) and appear to be eligible for a Disabled Facilities Grant (DFG) and/or assistance from the local authority.

The study will include people who do not speak English and will provide interpreters. The researchers will use the interpreting agency at the site.

Previous inclusion criteria:
1. People aged 65 years or over
2. People referred for a major adaptation for provision of an accessible (level or easy access) showering facility. This may be by removal of an existing bath or shower cubicle.
3. People living in housing owned by the local authority or living in privately-owned housing (owner-occupied, privately rented, housing association owned) and appear to be eligible for a Disabled Facilities Grant (DFG)

The study will include people who do not speak English and will provide interpreters. The researchers will use the interpreting agency at the site.

Exclusion criteria:
1. People referred for an accessible showering facility plus one or more other adaptations (e.g. ramps, hoists, lifts) as these adaptations are more complex and will involve extended timescales
2. People referred for a rapid, fast-tracked or urgent priority bathing adaptation
3. People who lack the mental capacity to provide informed consent and we are unable to identify a personal or nominated consultee
4. People who lack the mental capacity to provide informed consent and who are unable to provide any study outcomes with support or where we are unable to identify an “alternative participant” to provide data

Pakistan Armed Forces Medical Journal ; - (1):83, 2021.
Article in English | ProQuest Central | ID: covidwho-1139088


ABSTRACT Objective: To evaluate the prevailing practices regarding personal protective equipment in operation theaters. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi, from May to Jun 2020. Methodology: After the approval of the approval of the hospital ethical committee, 300 online forms were send. A total of 227 respondents returned the 22 questions survey forms. Data was collected and analyzed using online site Results: A total of 203 forms were included in our final analysis. Most 128 (63.1%) were males with 90 (44.3%) common aged between 31-40 years and 168 (82.8%) working in tertiary care hospitals. One hundred and fifty eight (77.8%) were routinely managing known Covid cases per-operatively. One hundred and seventy four (85.7%) reported that personal protective equipment was being provided by the hospital administration;55 (27.1%) have bought part of full protective equipment at their own expense;72 (35.5%) re-using protective equipment;167 (82.3%) being provided with N-95 masks and 120 (59.1%) re-using N-95 masks. One hundred and twenty one (59.6%) wearing level III protective gear during all surgeries, 192 (94.6%) respondents reported maintaining hand hygiene after each patient. Only 65 (32%) taking shower at the hospital at the end of their shift. Conclusion: Most of the operation theaters were providing protective equipment to their staff with nearly half reusing protective gear and N-95 masks.

Transplant International ; 33(SUPPL 2):21-22, 2020.
Article in English | EMBASE | ID: covidwho-1093814


Introduction: The new coronavirus type 2 is responsible for severe acute respiratory syndrome (SARS-CoV-2). The associated disease named Coronavirus Disease 2019 (COVID-19) has spread around the world within a few weeks. Its impact on solid organ transplantation is largely unknown. It can be only assumed that immunosuppression is related with an increase of COVID-19 related morbidity and mortality. Here we describe our Transplant Center Graz guidelines including all preventive measures taken to protect liver transplant recipients from infection during COVID-19 pandemic. Methods: COVID-19 evaluation of donors and recipients comprises epidemiological and clinical evaluation as well as nasal swab COVID-19-PCR testing. An important part of the in hospital recipient management is a special training of both the whole transplant team and the recipient on protective measures against COVID-19 infection. The recipient is isolated in a single bed overpressure room with airlock including private rest room with shower for the recipient. Furthermore, strict visit ban consists and a restricted number of persons is allowed to be in the same room with the patient after transplantation (n=2). Members of the transplant team and the recipient wear ffp2 masks when they are together. It is aimed for fast extubation, fast step down from ICU to IMC / normal ward and rapid hospital discharge. The outpatient care includes phone consulting, immunomonitoring with blood samples drawn at home and sent to our center and limited social contacts to an absolute minimum. Results: During COVID-19 pandemic, LT was safely performed based on our experience and none of the patients transplanted during this time (n=4) got sick from COVID-19. Conclusion: Requirements for a safe procedure during COVID-19 pandemic are (i) a low-risk setting (both donor and recipient COVID-19 negative), (ii) internal Transplant Center Graz guidelines (described above) in combination with (iii) low disease severity recipients (labMELD score 10-14) of a low donor risk index graft.