Safety of Prolonged Exposure of Human Skin to Aqueous Ozone in a Test Hand Hygiene Model.

AIMS: This research assessed the safety of aqueous ozone (AO) on human skin after multiple exposures for up to 40 hours. METHODS AND RESULTS: Full thickness recombinant human skin (EpiDerm FT, EFT-400) was exposed to AO for 7 seconds per minute for the first 6 minutes of each hour, repeated hourly over four time periods (4, 10, 20 and 40 hours). An MTT assay assessed viability of skin cells after exposure, compared to incubator control, negative control and vehicle control (distilled water). No significant difference in tissue viability was found between the AO condition and any of the control conditions through 20 hours of exposures. At 40 hours of exposure, tissue viability was lower in the AO group when compared with negative control (p = 0.030) but not the other controls. CONCLUSIONS: The current study supports further consideration of repeated application of AO on human skin, such as for hand hygiene. IMPACT STATEMENT: The present research is the first well-controlled in vitro study assessing the cytotoxicity of repeated exposures of AO on a full-thickness human skin model. This information helps to inform the evaluation of AO as a potential alternative for hand and wound antisepsis.

In vitro inactivation of SARS-CoV-2 by ozonated water via novel hand hygiene device.

AIMS: The COVID-19 pandemic has heightened awareness of the need for novel surface disinfectants and hand-hygiene modalities. Ozone gas is an effective surface disinfectant, but toxicity limits its use in human applications. Ozonated water is a safer means to use ozone for disinfection, especially for human antisepsis. However, there are little data available regarding the effectiveness of ozonated water in eliminating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). METHODS AND RESULTS: This study utilizes a novel hand hygiene device that produces a stable ozone concentration of 0.5 +/-0.1 ppm in water and applies it using a proprietary spray that controls droplet size, velocity, and direction. The Device was used to apply ozonated water to a known quantity of SARS-CoV-2 Delta Variant viral particles on a non-porous surface (glass) for seven seconds. Post-exposure growth was compared to the unexposed matched control utilizing the Spearman-Karber method. Compared to control, ozonated water decreased SARS-CoV-2 viral growth by a mean log10 reduction of 4.33, or >99.99% reduction. CONCLUSIONS: These results suggest that the ozonated water, when applied by a spray hand hygiene device, is highly effective at surface disinfection of SARS-CoV-2.

Novel Approach to Integrating Mental Health Care into a Primary Care Setting: Development, Implementation, and Outcomes.

It is now widely accepted that there is a growing discrepancy between demand and access to adequate treatment for behavioral or mental health conditions in the United States. This results in immense personal, societal, and economic costs. One rapidly growing method of addressing this discrepancy is to integrate mental health services into the primary care setting, which has become the de facto service provider for these conditions. In this paper, we describe the development and implementation of a novel integrated care program in a large mid-western university-based healthcare system, drawn from the collaborative care model, and describe the benefits in terms of both health care utilization and depression outcomes. Limitations and proposed future directions are discussed.

Liquid ozone therapies for the treatment of epithelial wounds: A systematic review and meta-analysis.

Ozonated water and ozonated oils are emerging as potential therapies for wound care, but their efficacy has not been appropriately evaluated. The aim of this systematic review and meta-analysis was to evaluate the therapeutic potential of topical ozone in the treatment of mammalian wounds. A structured search of five scientific databases returned a total of 390 unique studies. Of these, 22 studies were included in this review. Four studies provided enough data to be included in a meta-analysis evaluating the time to complete wound healing. All studies were randomised controlled trials of humans or other mammalian animals that reported clinical signs of wound healing. Each study was critically analysed by a six-point assessment of the risk of bias. Wounds treated with topical ozone had a greater reduction in wound size than similar wounds treated with controls or standard of care in all studies. Those treated with ozonated liquids also had a shorter time to wound healing by approximately one week. In conclusion, topical ozone contributed to enhanced wound healing in all studies. While additional human experiments would be helpful to quantify ozone's specific effects on wound healing compared to standard treatment, topical ozone should be considered as part of an overall wound management strategy.

Risks of ozonated oil and ozonated water on human skin: A systematic review.

Ozonated water and oil are emerging as potential dermatologic therapeutics, particularly for the treatment of various wounds. However, the safety of these liquids has not been extensively studied. The aim of this systematic review was to evaluate the risks of ozonated liquids to human skin tissue based on the available literature. We completed a structured search of five scientific databases and identified 378 articles for consideration. Based on pre-established inclusion/exclusion criteria, nine studies were included in this review. Two studies specifically evaluated the cytotoxicity of ozonated liquids on human cells, five studies evaluated ozonated liquids in randomised controlled trials (RCTs), one was a post-market surveillance study, and one was a crossover study in humans. None of the included studies found any significant human dermatologic risks associated with ozonated water or liquid. Because of the small sample size, however, additional short- and long-term RCTs specifically designed to evaluate the dermatological risks of ozonated liquids are recommended.

Olfactory Reference Syndrome: A Case Report and Screening Tool.

Olfactory reference syndrome (ORS) is a lesser known disorder that is related to obsessive-compulsive disorder. ORS is the obsessional and inaccurate belief that one is emitting a foul odor leading to embarrassment or concern about offending others, excessive hygiene behaviors, and social avoidance that significantly interferes with daily functioning. Although ORS is rare, it is challenging to diagnose. ORS-sufferers first seek treatment from non-psychiatric providers (e.g., dermatologists, dentists.) to alleviate the perceived odor, which frequently leads to misdiagnosis and unnecessary treatments. Additionally, because ORS-sufferers can have limited insight and ideas of reference, they can be misdiagnosed as having a psychotic or delusional disorder. We present a case report of a 42-year-old woman with ORS, and how the correct diagnosis of ORS provided with psychiatric treatment led to significant improvement in her daily functioning. We provide a literature review on the disorder as well as a short screener to assess ORS.

Psychiatric diagnoses and psychosocial needs of outpatient deaf children and adolescents.

Deaf youth may be more vulnerable to psychiatric disorders but very little research data is available. The current study identified prevalence rates of psychiatric disorders and examined the psychosocial needs and strengths of deaf youth aged 4-17 receiving specialized outpatient mental health services for the deaf. Compared to hearing peers, deaf youth had greater rates of attention deficit hyperactivity disorder, conduct, autism-spectrum and bipolar disorders and spent three times longer in treatment than their hearing peers. In the deaf subsample, moderate-severe risk was found in social functioning (33.3 %) and suicidal behavior (14 %). Deaf youth had moderate to severe impairment in social relationships (54.8 %), school functioning (42.9 %). Over one-third of deaf youth had impaired family relationships, living situation, communication, judgment and physical health. Deaf youth present with higher rates of certain clinical disorders and have deficits in multiple life domains that may impact functioning and create a longer treatment course.

Psychiatric disorder prevalence among deaf and hard-of-hearing outpatients.

OBJECTIVES: To contribute to the dearth of literature on the prevalence rates of psychiatric disorders in deaf adults, this study examined the diagnostic and clinical characteristics of deaf psychiatric outpatients in comparison to hearing psychiatric outpatients. METHODS: Archival clinical data for deaf adults (N=241), treated at a specialized, linguistically and culturally affirmative outpatient community mental health program from 2002 to 2010, was compared to data from a random sample of hearing adult outpatients (N=345) who were treated at the same community mental health center. RESULTS: In various diagnostic categories, significant differences were seen between the deaf and hearing groups: bipolar disorders (3.7% versus 14.2%), impulse control disorders (15.8% versus 5.2%), anxiety disorders (18.7% versus 30.1%), attention deficit hyperactivity disorder (11.2% versus 4.9%), pervasive developmental disorders (3.3% versus 0.3%), substance use disorders (27.8% versus 48.4%), and intellectual disabilities (10.4% versus 2.9%). CONCLUSIONS: The deaf outpatient group evidenced a different diagnostic profile than the hearing sample. It is suggested that the use of culturally competent and fluent ASL-signing clinicians provides more diagnostic clarity and is encouraged as a best practice for the care of deaf individuals.

Differential diagnosis of psychosis in a deaf inpatient with language dysfluency: a case study.

This case report demonstrates challenges diagnosing psychosis in language dysfluent deaf patients. Treatment of a 34-year-old deaf man on an inpatient psychiatric unit is described. He had a history of physical aggression and possible symptoms of paranoia and thought disorganization, in addition to learning difficulties and minimal language skills. The patient was placed on a combined hearing/deaf inpatient unit, received specialized programming for deaf patients and was prescribed risperidone and divalproex sodium to treat his aggressive behavior and possible psychosis. Uncertainty if the patient were having psychotic symptoms remained throughout his hospitalization, although he improved behaviorally and was discharged after 13 months of treatment. The patient's pre-existing language deficits made accurate diagnosis and appropriate treatment challenging. It is important for clinicians to be aware of the frequency of language dysfluency in the deaf inpatient population and have a strategy for evaluating and treating this complex subgroup of deaf people.

Assessment and treatment of deaf adults with psychiatric disorders: a review of the literature for practitioners.

Many deaf individuals comprise a unique cultural and linguistic minority group. This article reviews the current research literature related to the evaluation, diagnosis, and treatment of culturally deaf individuals suffering from mental disorders. Appropriate psychiatric assessment and treatment requires that clinicians be sensitive to issues of language and differences in social norms and cultural values. Emerging trends in research indicate greater diagnostic specificity and a broader range of diagnoses being assigned in services that are specialized for the treatment of deaf people with mental health issues. Culturally sensitive evaluation and treatment involves a thorough assessment of language modality and language fluency, deafness/audiological history, and cultural identification. Failure to consider these factors during the mental status exam can lead to misdiagnosis. Important issues that confound differential diagnosis and psychiatric treatment of the deaf population are highlighted and discussed. Recommendations for the provision of culturally and linguistically appropriate care are provided.

Identifying and assessing psychosis in deaf psychiatric patients.

This article reviews recent research in the area of psychotic disorders in deaf psychiatric patients. Comparisons of the rates of psychotic disorders in the deaf and hearing populations suggest that psychotic disorders occur equally as often or even somewhat less often in the deaf population as in the hearing population. Consideration is given to the limitations of this small body of research, and recommendations for future research are provided. The contradictory literature on hallucinations in the deaf is also reviewed, and current theory about the manner in which hallucinations are manifested and experienced based on audiological history is presented. The challenges encountered by clinicians in accurately assessing symptoms of thought disorganization in deaf people are reviewed. Specifically, the etiology of deafness, language dysfluency, and the skill and training of American Sign Language interpreters are considered as factors impacting accurate diagnosis. Recommendations from the current literature are also provided.

Exploring the use of seclusion and restraint with deaf psychiatric patients: comparisons with hearing patients.

Archival data of seclusion and restraint events in a group of deaf adults (n = 30) was compared with a random sample of hearing adults with intellectual disabilities (ID) (n = 30) and a random sample of hearing adults without ID (n = 51) admitted to a state hospital from 1998 to 2008. Only 12% of the hearing non-ID group experienced a seclusion or restraint versus 43% of the deaf group. The ID group also showed significantly higher rates of seclusion and restraint than the hearing non-ID group (30 vs. 12%). Patients in the deaf and ID group were significantly more likely to be diagnosed with impulse control disorders (23 and 23%, respectively), which may have contributed to the higher utilization of seclusion and restraint procedures in these groups. Deafness-related cultural and linguistic variables that impact the use of seclusion and restraint are reviewed.

Inpatient psychiatric treatment of deaf adults: demographic and diagnostic comparisons with hearing inpatients.

OBJECTIVE: This study examined the diagnostic and clinical features of deaf psychiatric inpatients. METHODS: Archival clinical data for deaf and hard-of-hearing adults (N=30) were compared with data for a random sample of hearing adults (N=60) admitted to a state psychiatric hospital from 1998 to 2008. RESULTS: Significant differences were found between deaf and hearing inpatient groups in the frequency of impulse control disorders (23% versus 2%), pervasive developmental disorders (10% versus 0%), substance use disorders (20% versus 45%), mild mental retardation (33% versus 3%), and personality disorders (17% versus 43%). The deaf group had a larger proportion with diagnoses of psychotic disorder not otherwise specified (17% versus 2%). Deaf inpatients had longer hospitalizations than hearing inpatients (17 months versus ten months). CONCLUSIONS: Clinicians working with the underserved, understudied population of deaf and hard-of-hearing psychiatric inpatients should be aware of the cultural and linguistic differences in assessment and treatment and make efforts to modify their approach.

The effects of atypical antipsychotic medications on psychosocial outcomes.

This review examines the question--Do atypical antipsychotic medications improve psychosocial outcomes?--by examining studies that compared the effects of atypicals to conventional antipsychotics or to other atypical medications. The authors reviewed randomized clinical trials of atypical antipsychotic medication that included psychosocial variables as outcomes. Findings from 31 published studies on more than 12,000 individuals generally showed that atypical medications led to significant improvements in negative symptoms compared to conventional antipsychotics. Effects on global assessment of psychosocial functioning and on the quality of life were mixed with only about half the studies reporting significant improvements. Olanzapine yielded the best results on psychosocial functioning; remoxipride was found to yield few significant changes on these variables. This review provides evidence that some atypical antipsychotics may have direct effects on some of the psychosocial disabilities that result from serious mental illness.