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Antimicrobial Resistance and Infection... May 2021With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of...
BACKGROUND
With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of extraordinary measures to minimize the negative health impact from an insufficient supply of masks. The decontamination, and reuse of healthcare workers' N95/FFP2 masks is a promising solution which needs to overcome several pitfalls to become a reality.
AIM
The overall aim of this article is to provide the reader with a quick overview of the various methods for decontamination and the potential issues to be taken into account when deciding to reuse masks. Ultraviolet germicidal irradiation (UVGI), hydrogen peroxide, steam, ozone, ethylene oxide, dry heat and moist heat have all been methods studied in the context of the pandemic. The article first focuses on the logistical implementation of a decontamination system in its entirety, and then aims to summarize and analyze the different available methods for decontamination.
METHODS
In order to have a clear understanding of the research that has already been done, we conducted a systematic literature review for the questions: what are the tested methods for decontaminating N95/FFP2 masks, and what impact do those methods have on the microbiological contamination and physical integrity of the masks? We used the results of a systematic review on the methods of microbiological decontamination of masks to make sure we covered all of the recommended methods for mask reuse. To this systematic review we added articles and studies relevant to the subject, but that were outside the limits of the systematic review. These include a number of studies that performed important fit and function tests on the masks but took their microbiological outcomes from the existing literature and were thus excluded from the systematic review, but useful for this paper. We also used additional unpublished studies and internal communication from the University of Geneva Hospitals and partner institutions.
RESULTS
This paper analyzes the acceptable methods for respirator decontamination and reuse, and scores them according to a number of variables that we have defined as being crucial (including cost, risk, complexity, time, etc.) to help healthcare facilities decide which method of decontamination is right for them.
CONCLUSION
We provide a resource for healthcare institutions looking at making informed decisions about respirator decontamination. This informed decision making will help to improve infection prevention and control measures, and protect healthcare workers during this crucial time. The overall take home message is that institutions should not reuse respirators unless they have to. In the case of an emergency situation, there are some safe ways to decontaminate them.
Topics: COVID-19; Decontamination; Equipment Reuse; Ethylene Oxide; Health Personnel; Humans; Hydrogen Peroxide; N95 Respirators; SARS-CoV-2; Steam; Ultraviolet Rays
PubMed: 34051855
DOI: 10.1186/s13756-021-00921-y -
Advanced Biomedical Research 2022This systematic review and meta-analysis aimed to overview the observational studies on the association of exposure to air pollution and type 1 diabetes mellitus (T1DM).
BACKGROUND
This systematic review and meta-analysis aimed to overview the observational studies on the association of exposure to air pollution and type 1 diabetes mellitus (T1DM).
MATERIALS AND METHODS
Based on PRISMA guidelines, we systematically reviewed the databases of PubMed, Scopus, Embase, and Web of Science databases to determine the association of air pollution exposure and T1DM. Quality assessment of the papers was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the strength of the associations between air pollutants (gases and particulate matter air pollutants including PM10, PM2.5, NO2, volatile organic compound, SO4, SO2, O3) and T1DM.
RESULTS
Out of 385 initially identified papers, 6 studies were used for this meta-analysis. Fixed effects meta-analysis showed a significant association between per 10 μg/m increase in O3 and PM2.5 exposures with the increased risk of T1DM (3 studies, OR = 1.51, 95% CI: 1.26, 1.80, = 83.5% for O3 and two studies, OR = 1.03, 95% CI: 1.01, 1.05, = 76.3% for PM2.5). There was no evidence of association between increased risk of T1DM and exposure to PM10 (OR = 1.02, 95% CI: 0.99-1.06, = 59.4%), SO4 (OR = 1.16, 95% CI: 0.91-1.49, = 93.8%), SO2 (OR = 0.94, 95% CI: 0.83-1.06, = 85.0%), and NO2 (OR = 0.995,95% CI: 1.05-1.04, = 24.7%).
CONCLUSION
Recent publications indicated that exposure to ozone and PM2.5 may be a risk factor for T1DM. However, due to limited available studies, more prospective cohort studies are needed to clarify the role of air pollutants in T1DM occurrence.
PubMed: 36660754
DOI: 10.4103/abr.abr_80_21 -
Journal of Dental Research Feb 2015The present systematic review critically summarizes results of clinical studies investigating chemical agents to reduce initiation or inactivation of root caries lesions... (Meta-Analysis)
Meta-Analysis Review
The present systematic review critically summarizes results of clinical studies investigating chemical agents to reduce initiation or inactivation of root caries lesions (RCLs). Outcomes were DMFRS/DFRS (decayed, missing, filled root surfaces), surface texture (hard/soft), and/or RCI (root caries index). Three electronic databases were screened for studies from 1947 to 2014. Cross-referencing was used to further identify articles. Article selection and data abstraction were done in duplicate. Languages were restricted to English and German. Mean differences (MD) were calculated for changes in DMFRS/DFRS. Risk ratios (RR) were calculated for changes in surface texture and RCI in a random effects model. Thirty-four articles with 1 or more agents were included; they reported 30 studies with 10,136 patients who were 20 to 101 y old; and they analyzed 28 chemical agents (alone or in combination). Eleven studies investigated dentifrices, 10 rinses, 8 varnishes, 3 solutions, 3 gels, and 2 ozone applications. Meta-analyses revealed that dentifrices containing 5,000 ppm F(-) (RR = 0.49; 95% confidence interval [95% CI] = 0.42, 0.57; high level of evidence) or 1.5% arginine plus 1,450 ppm F(-) (RR = 0.79; 95% CI = 0.64, 0.98; very low level) are more effective in inactivating RCLs than dentifrices containing 1,100 to 1,450 ppm F(-). Self-applied AmF/SnF2-containing dentifrice and rinse decreased the initiation of RCLs when compared with NaF products (standardized MD = 0.15; 95% CI = -0.22, 0.52; low level). Patients rinsing with a mouth rinse containing 225 to 900 ppm F(-) revealed a significantly reduced DMFRS/DFRS (MD = -0.18; 95% CI = -0.35, -0.01; low level) when compared with a placebo rinse. Significantly reduced RCI was found for CHX (MD = -0.67; 95% CI = -1.01, -0.32; very low level) as well as SDF (MD = -0.33; 95% CI = -0.39, -0.28; very low level) when compared with placebo varnish. Regular use of dentifrices containing 5,000 ppm F(-) and quarterly professionally applied CHX or SDF varnishes seem to be efficacious to decrease progression and initiation of root caries, respectively. However, this conclusion is based on only very few well-conducted randomized controlled trials.
Topics: Cariostatic Agents; DMF Index; Dentifrices; Fluorides; Humans; Mouthwashes; Root Caries; Tooth Remineralization
PubMed: 25398366
DOI: 10.1177/0022034514557330 -
Environmental Health : a Global Access... Mar 2023The adverse effects of air pollution on human health include many diseases and health conditions associated with mortality, morbidity and disability. One example of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The adverse effects of air pollution on human health include many diseases and health conditions associated with mortality, morbidity and disability. One example of these outcomes that can be translated into economic costs is the number of days of restricted activity. The aim of this study was to assess the effect of outdoor exposure to particulate matter with an aerodynamic diameter less than or equal to 10 and 2.5 μm (PM, PM), nitrogen dioxide (NO), and ozone (O), on restricted activity days.
METHODS
Observational epidemiological studies with different study designs were included, and pooled relative risks (RR) with 95% confidence intervals (95%CI) were calculated for an increase of 10 μg/m of the pollutant of interest. Random-effects models were chosen because of the environmental differences between the studies. Heterogeneity was estimated using prediction intervals (PI) and I-Squared (I2) values, while risk of bias was assessed using a tool developed by the World Health Organization specifically designed for air pollution studies, and based on different domains. Subgroup and sensitivity analyses were performed where possible. The protocol for this review was registered with PROSPERO (CRD42022339607).
RESULTS
We included 18 articles in the quantitative analysis. Associations between pollutants and restricted activity days in time-series studies of short-term exposures, measured as work-loss days, school-loss days, or both were significant for PM (RR: 1.0191; 95%CI: 1.0058-1.0326; 80%PI: 0.9979-1.0408; I2: 71%) and PM (RR: 1.0166; 95%CI: 1.0050-1.0283; 80%PI: 0.9944-1.0397; I2: 99%), but not for NO or O. Some degree of heterogeneity between studies was observed, but sensitivity analysis showed no differences in the direction of the pooled relative risks when studies with a high risk of bias were excluded. Cross-sectional studies also showed significant associations for PM and restricted activity days. We could not perform the analysis for long-term exposures because only two studies analysed this type of association.
CONCLUSION
Restricted activity days and related outcomes were associated with some of the pollutants under evaluation, as shown in studies with different designs. In some cases, we were able to calculate pooled relative risks that can be used for quantitative modelling.
Topics: Humans; Air Pollutants; Nitrogen Dioxide; Cross-Sectional Studies; Air Pollution; Particulate Matter; Ozone; Environmental Pollutants; Environmental Exposure; Observational Studies as Topic
PubMed: 36991377
DOI: 10.1186/s12940-023-00979-8 -
Cureus May 2024Ozone has been used as an antibacterial agent for various purposes in healthcare. The use of ozone in dental practice is also well-established. Its utilization as a... (Review)
Review
Ozone has been used as an antibacterial agent for various purposes in healthcare. The use of ozone in dental practice is also well-established. Its utilization as a mouth rinse needs to be explored for further application in clinical practice, especially for cases of gingivitis, a common complaint. This systematic review aims to analyze the literature on the effects of ozonated water in managing gingival inflammation and bleeding across diverse populations. A systematic search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in PubMed, MEDLINE, Embase, and Cochrane. Studies published between January 2012 and December 2023 employing ozonated water as a treatment for gingivitis or gingival bleeding were included. Five studies met the inclusion criteria, demonstrating the varied efficacy of ozonated water. While some studies showed promising results in reducing bleeding and gingival inflammation, others indicated limitations compared to chlorhexidine. Methodological heterogeneity and lack of standardization were notable. The evidence suggests potential benefits of ozonated water in managing gingival inflammation and bleeding, but methodological variations hinder conclusive findings. Long-term studies with larger sample sizes and standardized protocols are needed to establish the effectiveness of ozonated water as an adjunctive therapy for gingival health.
PubMed: 38915955
DOI: 10.7759/cureus.61006 -
Investigative Ophthalmology & Visual... Aug 2022To compare the burden of age-related eye diseases among adults exposed to higher versus lower levels of ambient air pollutants. (Meta-Analysis)
Meta-Analysis
PURPOSE
To compare the burden of age-related eye diseases among adults exposed to higher versus lower levels of ambient air pollutants.
METHODS
MEDLINE, EMBASE, and Scopus were searched for relevant articles until September 30, 2021. Inclusion criteria included studies of adults, aged 40+ years, that provided measures of association between the air pollutants (nitrogen dioxide, carbon monoxide [CO], sulfur dioxide, ozone [O3], particulate matter [PM] less than 2.5 µm in diameter [PM2.5], and PM less than 10 µm in diameter [PM10]) and the age-related eye disease outcomes of glaucoma, age-related macular degeneration (AMD), or cataract. Pooled odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis model. PROSPERO registration ID: CRD42021250078.
RESULTS
A total of eight studies were included in the review. Consistent evidence for an association was found between PM2.5 and glaucoma, with four of four studies reporting a positive association. The pooled OR for each 10-µg/m3 increase of PM2.5 on glaucoma was 1.18 (95% CI, 0.95-1.47). Consistent evidence was also found for O3 and cataract, with three of three studies reporting an inverse association. Two of two studies reported a null association between PM2.5 and cataract, while one of one studies reported a positive association between PM10 and cataract. One of one studies reported a positive relationship between CO and AMD. Other relationships were less consistent between studies.
CONCLUSIONS
Current evidence suggests there may be an association between some air pollutants and cataract, AMD, and glaucoma.
Topics: Adult; Air Pollutants; Air Pollution; Cataract; Environmental Exposure; Glaucoma; Humans; Ozone; Particulate Matter
PubMed: 35960515
DOI: 10.1167/iovs.63.9.17 -
Environmental Research Apr 2023It remains unclear whether a total exposure to air pollution (AP) is associated with an increased risk of dementia. Little is known on the association in low- and... (Meta-Analysis)
Meta-Analysis
It remains unclear whether a total exposure to air pollution (AP) is associated with an increased risk of dementia. Little is known on the association in low- and middle-income countries. Two cohort studies in China (in Anhui cohort 1402 older adults aged ≥ 60 followed up for 10 years; in Zhejiang cohort 6115 older adults followed up for 5 years) were conducted to examine particulate matter - PM associated with all dementia and air quality index (AQI) with Alzheimer's disease, respectively. A systematic literature review and meta-analysis was performed following worldwide literature searched until May 20, 2020 to identify 15 population-based cohort studies examining the association of AP with dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI. The cohort studies in China showed a significantly increased relative risk (RR) of dementia in relation to AP exposure; in Anhui cohort the adjusted RR was 2.14 (95% CI 1.00-4.56) in people with PM exposure at ≥ 64.5 μg/m versus <63.5 μg/m and in Zhejiang cohort the adjusted RR was 2.28 (1.07-4.87) in AQI>90 versus ≤ 80. The systematic review revealed that all 15 studies were undertaken in high income countries/regions, with inconsistent findings. While they had reasonably good overall quality of studies, seven studies did not adjust smoking in analysis and 13 did not account for depression. Pooling all eligible data demonstrated that dementia risk increased with the total AP exposure (1.13, 1.08-1.19). Data analysis of air pollutants showed that the RR significantly increased with PM (1.06, 1.03-1.10 in 2nd tertile exposure; 1.13, 1.07-1.19 in 3rd tertile versus 1st tertile), PM (1.05, 0.86-1.29; 1.62, 0.60-4.36), carbon monoxide (1.69, 0.72-3.93; 1.52, 1.35-1.71), nitrogen dioxide (1.06, 1.03-1.09; 1.18, 1.10-1.28) and nitrogen oxides (1.09, 1.04-1.15; 1.26, 1.13-1.41), but not ozone. Controlling air pollution and targeting on specific pollutants would reduce dementia globally.
Topics: Humans; Aged; Environmental Exposure; Air Pollution; Air Pollutants; Particulate Matter; Nitrogen Dioxide; Dementia; China
PubMed: 36529331
DOI: 10.1016/j.envres.2022.115048 -
Frontiers in Public Health 2022Exposure to air pollution has been linked to the mortality of heart failure. In this study, we sought to update the existing systematic review and meta-analysis,... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Exposure to air pollution has been linked to the mortality of heart failure. In this study, we sought to update the existing systematic review and meta-analysis, published in 2013, to further assess the association between air pollution and acute decompensated heart failure, including hospitalization and heart failure mortality.
METHODS
PubMed, Web of Science, EMBASE, and OVID databases were systematically searched till April 2022. We enrolled the studies regarding air pollution exposure and heart failure and extracted the original data to combine and obtain an overall risk estimate for each pollutant.
RESULTS
We analyzed 51 studies and 7,555,442 patients. Our results indicated that heart failure hospitalization or death was associated with increases in carbon monoxide (3.46% per 1 part per million; 95% CI 1.0233-1.046, < 0.001), sulfur dioxide (2.20% per 10 parts per billion; 95% CI 1.0106-1.0335, < 0.001), nitrogen dioxide (2.07% per 10 parts per billion; 95% CI 1.0106-1.0335, < 0.001), and ozone (0.95% per 10 parts per billion; 95% CI 1.0024-1.0166, < 0.001) concentrations. Increases in particulate matter concentration were related to heart failure hospitalization or death (PM 1.29% per 10 μg/m, 95% CI 1.0093-1.0165, < 0.001; PM 1.30% per 10 μg/m, 95% CI 1.0102-1.0157, < 0.001).
CONCLUSION
The increase in the concentration of all pollutants, including gases (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone) and particulate matter [(PM), (PM)], is positively correlated with hospitalization rates and mortality of heart failure.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021256241.
Topics: Humans; Carbon Monoxide; Air Pollutants; Environmental Exposure; Air Pollution; Particulate Matter; Ozone; Sulfur Dioxide; Nitrogen Dioxide; Heart Failure
PubMed: 36755739
DOI: 10.3389/fpubh.2022.948765 -
The Science of the Total Environment Jan 2024Low- and middle-income countries (LMIC) are disproportionately affected by air pollution and its health burden, representing a global inequity. The COVID-19 pandemic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Low- and middle-income countries (LMIC) are disproportionately affected by air pollution and its health burden, representing a global inequity. The COVID-19 pandemic provided a unique opportunity to investigate the impact of unprecedented lockdown measures on air pollutant concentrations globally. We aim to quantify air pollutant concentration changes across LMIC settings as a result of COVID-19 restrictions.
METHODS
Searches for this systematic review and meta-analysis were carried out across five databases on 30th March 2022; MEDLINE, Embase, Web of Science, Scopus and Transport Research Information Documentation. Modelling and observational studies were included, as long as the estimates reflected city or town level data and were taken exclusively in pre-lockdown and lockdown periods. Mean percentage changes per pollutant were calculated and meta-analyses were carried out to calculate mean difference in measured ground-level observed concentrations for each pollutant (PROSPERO CRD42022326924).
FINDINGS
Of the 2982 manuscripts from initial searches, 256 manuscripts were included providing 3818 percentage changes of all pollutants. No studies included any countries from Sub-Saharan Africa and 34 % and 39.4 % of studies were from China and India, respectively. There was a mean percentage change of -37.4 %, -21.7 %, -54.6 %, -39.1 %, -48.9 %, 16.9 %, -34.9 %, -30.6 % and - 14.7 % for black carbon (BC), carbon monoxide (CO), nitric oxide (NO), nitrogen dioxide (NO), oxides of nitrogen (NO), ozone (O), particulate matter 10 (PM) and 2.5 (PM) and sulphur dioxide (SO), respectively. Meta-analysis included 100 manuscripts, providing 908 mean concentration differences, which showed significant reduction in mean concentration in all study settings for BC (-0.46 μg/m, PI -0.85; -0.08), CO (-0.25 mg/m, PI -0.44; -0.03), NO (-19.41 μg/m, PI -31.14; -7.68) and NO (-22.32 μg/m, PI -40.94; -3.70).
INTERPRETATION
The findings of this systematic review and meta-analysis quantify and confirm the trends reported across the globe in air pollutant concentration, including increases in O. Despite the majority of global urban growth occurring in LMIC, there are distinct geographical gaps in air pollution data and, where it is available, differing approaches to analysis and reporting.
Topics: Humans; Developing Countries; Nitrogen Dioxide; Pandemics; COVID-19; Communicable Disease Control; Air Pollution; Air Pollutants; Particulate Matter; Ozone; Nitric Oxide
PubMed: 37884141
DOI: 10.1016/j.scitotenv.2023.168110 -
Environment International Nov 2020WHO has published several volumes of Global Air Quality Guidelines to provide guidance on the health risks associated with exposure to outdoor air pollution. As new... (Meta-Analysis)
Meta-Analysis
BACKGROUND
WHO has published several volumes of Global Air Quality Guidelines to provide guidance on the health risks associated with exposure to outdoor air pollution. As new scientific evidence is generated, air quality guidelines need to be periodically revised and, where necessary, updated.
OBJECTIVES
The aims of the study were 1) to summarise the available evidence on the effect of long-term exposure to ozone (O) and nitrogen dioxide (NO) on mortality; 2) and to assess concentration response functions (CRF), their shape and the minimum level of exposures measured in studies to support WHO's update of the global air quality guidelines.
DATA SOURCES
We conducted a systematic literature search of the Medline, Embase and Web of Science databases following a protocol proposed by WHO and applied Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines for reporting our results.
STUDY ELIGIBILITY CRITERIA
Cohort studies in human populations (including sub-groups at risk) exposed to long-term concentrations of NO and O. Outcomes assessed were all-cause, respiratory, Chronic Obstructive Pulmonary Disease (COPD) and Acute Lower Respiratory Infection (ALRI) mortality.
STUDY APPRAISAL AND SYNTHESIS METHODS
Studies included in the meta-analyses were assessed using a new Risk of Bias instrument developed by a group of experts convened by WHO. Study results are presented in forest plots and quantitative meta-analyses were conducted using random effects models. The certainty of evidence was assessed using a newly developed adaptation of GRADE.
RESULTS
The review identified 2068 studies of which 95 were subject to full-text review with 45 meeting the inclusion criteria. An update in September 2018 identified 159 studies with 1 meeting the inclusion criteria. Of the 46 included studies, 41 reported results for NO and 20 for O. The majority of studies were from the USA and Europe with the remainder from Canada, China and Japan. Forty-two studies reported results for all-cause mortality and 22 for respiratory mortality. Associations for NO and mortality were positive; random-effects summary relative risks (RR) were 1.02 (95% CI: 1.01, 1.04), 1.03 (1.00, 1.05), 1.03 (1.01, 1.04) and 1.06 (1.02, 1.10) per 10 μg/m for all-cause (24 cohorts), respiratory (15 cohorts), COPD (9 cohorts) and ALRI (5 cohorts) mortality respectively. The review identified high levels of heterogeneity for all causes of death except COPD. A small number of studies investigated the shape of the concentration-response relationship and generally found little evidence to reject the assumption of linearity across the concentration range. Studies of O using annual metrics showed the associations with all-cause and respiratory mortality were 0.97 (0.93, 1.02) and 0.99 (0.89, 1.11) per 10 μg/m respectively. For studies using peak O metrics, the association with all-cause mortality was 1.01 (1.00, 1.02) and for respiratory mortality 1.02 (0.99, 1.05), each per 10 μg/m. The review identified high levels of heterogeneity. Few studies investigated the shape of the concentration-response relationship. Certainty in the associations (adapted GRADE) with mortality was rated low to moderate for each exposure-outcome pair, except for NO and COPD mortality which was rated high.
LIMITATIONS
The substantial heterogeneity for most outcomes in the review requires explanation. The evidence base is limited in terms of the geographical spread of the study populations and, for some outcomes, the small number of independent cohorts for meta-analysis precludes meaningful meta-regression to explore causes of heterogeneity. Relatively few studies assessed specifically the shape of the CRF or multi-pollutant models.
CONCLUSIONS
The short-comings in the existing literature base makes determining the precise nature (magnitude and linearity) of the associations challenging. Certainty of evidence assessments were moderate or low for both NO and O for all causes of mortality except for NO and COPD mortality where the certainty of the evidence was judged as high.
Topics: Air Pollutants; Air Pollution; Canada; China; Europe; Humans; Japan; Nitrogen Dioxide
PubMed: 33032072
DOI: 10.1016/j.envint.2020.105998