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The aim of this study was to examine the most cost-effective strategy of screening and vaccinating measles- and varicella-susceptible health care workers (HCWs). A retrospective cost-effectiveness analysis was conducted at a tertiary hospital in Korea with 300 HCWs who were at high risk of infection. Self-reported histories of vaccinations, infectious diseases, and contact with such cases were collected. Serological tests for immunoglobulin G titers of measles and varicella were performed. Data were analyzed using analysis of variance, Kruskal-Wallis test, χ2 test, and Fisher exact test. Seropositivity rates were 96.3% for measles and 95.7% for varicella. Four different strategies (cases) for vaccination were investigated. Considering the progressive decline in antibody concentrations and the false-positive responses in self-reported histories, case 3, which involved administering 2-dose vaccinations to susceptible HCWs demonstrated by antibody screening tests for both measles and varicella, was the most cost-effective strategy. Health care facilities should establish mandatory immunization policies that reduce the risk of transmission of vaccine-preventable diseases.

Iron deficiency anemia (IDA) is a common public health occurrence of pregnancy which is particularly prevalent in developing countries like Pakistan. During this critical period, the deficiency of iron is very common as the iron requirements are greatly enhanced. IDA during pregnancy is associated with intrauterine growth retardation, premature birth, low birthweight, increased labor time, higher risk of infection, elevated maternal and prenatal mortality, muscle dysfunction, and low physical capacity. The present study was aimed to check the prevalence, effect of diet on IDA and its association with the pregnancy outcome, that is, birthweight. Five different public sector hospitals of Rawalpindi and Islamabad were analyzed. A sample size of 500 pregnant females of third trimester was observed which were then followed after delivery from September 2020 to January 2021. A well‐designed questionnaire was developed where different demographic factors, dietary recalls, biomarkers, and other determinants were obtained. The data from the questionnaires were later coded for the purpose of analysis in the statistical package (SPSS) using chi‐square test. Our study indicated that IDA is a moderate public health problem among pregnant women in twin cities and more than half of study subjects have depleted iron stores. Approximately 63% of the subjects were having iron deficiency and 24.8% were facing severe iron deficiency anemia. Only 12% of the subjects were considered as normal. The high prevalence of anemia in our subjects was probably due to low iron intake and poor dietary habits. The results of the study may not be generalizable due to time constraints and other factors. Maternal anemia still remains a major public health concern that requires more attention especially in developing and underdeveloping countries., Maternal iron deficiency is associated with intrauterine growth retardation, premature birth, low birthweight, increased labor time, higher risk of infection, elevated maternal and prenatal mortality, muscle dysfunction, and low physical capacity. Our study indicated that IDA is a moderate public health problem among pregnant women in twin cities and more than half of study subjects have depleted iron stores. Maternal hemoglobin status was found to affect pregnancy outcome. Newborns born to women with low hemoglobin levels tended to have lower birthweight. Therefore, the etiological factors associated with maternal anemia during pregnancy in Pakistan should deserve more attention.

Summary Background Coronavirus disease 2019 (COVID-19) infection has caused huge impacts on all of people’s lives and health systems. In response to the COVID-19 pandemic, China was the first country to impose lockdown. We aimed to study the influence of COVID-19 on the outpatient visits of rheumatic patients in a non-outbreak area of China. Methods We selected three provincial or ministerial hospitals in Jinan, and collected the outpatient appointments data in rheumatology and immunology departments during the Shandong Province first-level public health emergency response period from 25 January 2020 to 8 March 2020. Results In the early stage, the number of outpatient appointments in the rheumatology and immunology departments of the three provincial or ministerial hospitals were significantly reduced, and gradually restored in the late stage. It showed that in the face of major infectious diseases, strict quarantine measures with the cooperation of the public not only controls the epidemic in a short time, but also lifts the quarantine measures and opens general outpatient clinics in hospitals as soon as possible, thus minimizing the impact on other patients. Interpretation The impact on the western hospital was greater than that on the Chinese medicine hospital, and the impact on the back-up designated hospitals for COVID-19 was the greatest. Online appointment can reduce the risk of infection in outpatients, but not completely solve the follow-up problem of rheumatic patients. Telemedicine provides a new solution for both management of rheumatic patients and control of COVID-19.

Introduction There have been promising developments in technologies and associated algorithm-based prescribing (‘stratified approach’) to target biologics to sub-groups of people with rheumatoid arthritis (RA). The acceptability of using an algorithm-guided approach in practice is likely to depend on various factors. Objective This study quantified preferences for an algorithm-guided approach to prescribing biologics (termed ‘biologic calculator’). Methods An online discrete choice experiment (DCE) was designed to elicit preferences from patients and the public for using a ‘biologic calculator’ compared with conventional prescribing. Treatment approaches were described by five attributes: delay to starting treatment; positive and negative predictive value (PPV/NPV); risk of infection; and cost saving to the UK national health service. Each survey contained six choice sets asking respondents to select their preferred option from two hypothetical biologic calculators or conventional prescribing. Background questions included sociodemographics, health status and healthcare experiences. DCE data were analysed using mixed logit models. Results Completed choice data were collected from 292 respondents (151 patients with RA and 142 members of the public). PPV, NPV and risk of infection were the most highly valued attributes to respondents deciding between prescribing strategies. Conclusion Respondents were generally receptive to personalised medicine in RA, but researchers developing personalised approaches should pay close attention to generating evidence on both the PPV and the NPV of their technologies. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00533-z.

This review aimed to focus on using foods to boost immunity against COVID-19 in all age groups. In human, coronavirus causes the common cold, severe acute respiratory syndrome (SARS), and a major threat to public health. The novel coronavirus was declared a pandemic by the World Health Organization due to its rapid infectivity. COVID-19 infection is most probably reported in people with low immunity response. The nutrients, which show beneficial effects on the immune system, are called immune nutrients and diet is called immune diet. A healthy diet can reduce the risk of infection of COVID-19 and can prevent disease. Nutritional food intake is also necessary for people with chronic illness, obese persons, diabetes, cardiovascular disease, cognitive dysfunction like anxiety and depression. All nutrients are essential for maintaining immunity and providing appropriate amounts of protein, fat, carbohydrate, vitamins, and minerals for the surveillance mode of keeping us from getting sick. The use of plenty of water, minerals such as micronutrients, zinc, copper, selenium, iron, magnesium, food rich in vitamins, and a good lifestyle can promote health and overwhelm this coronavirus infection.

Objective The COVID-19 pandemic is currently ongoing. Presently, due to the unavailability of a definitive vaccine to decrease its acquiring, it’s essential to understand its transmissibility in the community by undetected cases to control its transmission. This study aims to study this context using mathematical modelling. Methods A COVID-19 transmission model was framed that estimated the basic reproduction number \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R_{0}$$\end{document}R0 (a measurement of disease risk) using the next-generation method. It explored the contribution of exposed and infected (detected and undetected) individuals, and environmental pathogen to the overall risk of infection spreading, utilizing the publicly reported data of this infection in Maharashtra between March 22, 2020, and May 4, 2020. A sensitivity analysis was performed to study the effect of a rising number of undetected cases to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R_{0}$$\end{document}R0. Results The estimated basic reproduction number is \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\varvec{R}}_{0} = 4.63$$\end{document}R0=4.63, which increases rapidly with the rise in the undetected COVID-19 cases. Although the exposed individuals made the largest contribution to infection transmission (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\varvec{R}}_{1} = 2.42$$\end{document}R1=2.42), the contaminated environment also played a significant role. Conclusions It is crucial to identify the individuals exposed and infected to COVID-19 disease and isolate them to control its transmission. The awareness of the role of fomites in infection transmission is also important in this regard.

The relationship of COVID-19 and pregnancy implies a novel clinical condition, information regarding the true medical picture is currently being collected. The present work aims to carry out a review of the most prominent publications on COVID-19 and Pregnancy: epidemiology and clinical evolution based on currently available evidence. The risk of infection in the pregnant woman, clinical findings, infection by gestation trimester and risks, risk of perinatal death, cesarean section and delivery, and finally maternal risk of admission to intensive care, mechanical ventilation, and death are summarized. © 2021 Academia Nacional de Medicina. All rights reserved.

The SARS-CoV‑2 pandemic has affected the health and practice of otorhinolaryngologists (ORLs) for over 1 year. Follow-up data of a national survey with German ORLs were evaluated regarding differences between the two waves of the pandemic.As in the initial survey, German ORLs were addressed via e‑mail through the German Society of ORL, Head and Neck Surgery and the German ENT Association. All ORLs afflicted with SARS-CoV‑2 were invited to participate in a web-based survey. General data on infections and concomitant parameters were evaluated.Since the start of the pandemic, 129 ORLs reported testing positive for SARS-CoV‑2 in Germany. The ORLs infected during the first wave had a relative risk (RR) of 4.07 (95% CI: 3.20; 5.19) of contracting SARS-CoV‑2. During the second wave, the RR decreased to 0.35 (95% CI: 0.28; 0.45). The availability of personal protective equipment (PPE) increased from the first to the second wave along with an increased perception of protection in the professional environment. The source of infection shifted from infections via medical staff during the first wave to patients and household exposure during the second wave. Regular medical practice was resumed by clinicians and general practitioners in the second wave. Nevertheless, a proportionally lower infection rate was observed compared with the German population as a whole.The data reflect a unique long-term survey of ORLs during the pandemic. Differences in the source of infection were seen between the first and second wave, confirming the need for appropriate PPE for medical professionals working in high-risk environments. Further strategies to reduce the risk of infection include consistent testing for SARS-CoV‑2 in healthcare professionals, patients, and the general public as well as vaccination of high-risk medical groups.ZIEL: Die Pandemie mit SARS-CoV‑2 bedroht seit nunmehr über einem Jahr die eigene Gesundheit und beeinflusst das alltägliche Arbeiten von HNO-Ärzt*innen in Deutschland. Die Nachfolgedaten einer initialen Web-basierten Befragung werden im Hinblick auf Unterschiede zwischen der ersten und zweiten Infektionswelle mit SARS-CoV‑2 vorgestellt.Im Unterschied zur ersten Befragung (April bis Mai 2020), bei der alle HNO-Ärzt*innen – unabhängig vom Infektionsstatus – aufgerufen waren teilzunehmen, waren in der Nachfolgeerhebung (Juni 2020 bis Februar 2021) nur infizierte Kolleg*innen aufgerufen, daran teilzunehmen. Persönliche Daten zu Krankheitsverlauf, Symptomen, Arbeitsort, aber auch Informationen zu Infektionsursache, Verfügbarkeit von Schutzmaterialien und empfundener Sicherheit wurden via E‑Mail von der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO KHC) und dem Deutschen Berufsverband der Hals-Nasen-Ohrenärzte e.V. (BVHNO) erfragt.Seit Beginn der Pandemie infizierten sich 129 HNO-Ärzt*innen mit SARS-CoV‑2. Das relative Risiko für HNO-Ärzt*innen lag während der ersten Welle bei 4,07 (95%-Konfidenzintervall, 95%-KI: 3,20; 5,19) und sank während der zweiten Welle auf 0,35 (95%-KI: 0,28; 0,45). Persönliche Schutzmaterialien waren während der zweiten Welle in ausreichendem Maß verfügbar, wohingegen viele Teilnehmer einen Mangel daran während der ersten Welle empfanden. Die gesicherten Infektionsketten zwischen erster und zweiter Welle wiesen Unterschiede auf. Während der ersten Welle spielte die Übertragung durch infiziertes Personal eine große Rolle. In der zweiten Welle lag der Schwerpunkt der Infektionsübertragung bei dem Kontakt zu COVID-19-Patient*innen und infizierten Familienmitgliedern. Die reguläre medizinische Tätigkeit wurde von Klinikärzt*innen und niedergelassenen Ärzt*innen in der zweiten Welle wieder aufgenommen. Dennoch zeigte sich eine anteilig geringere Infektion mit SARS-CoV‑2 im Vergleich zur deutschen Gesamtbevölkerung.Die vorliegenden Daten der einzigen Langzeiterhebung unter HNO-Ärzt*innen während der Pandemie sprechen dafür, dass eine Rückkehr zu einer regulären HNO-ärztlichen Tätigkeit unter konsequenter Beachtung persönlicher Schutzmaßnahmen möglich ist. Zu den weiteren Strategien, um das Infektionsrisiko zu senken, gehören auch konsequentes Testen auf SARS-CoV‑2 bei im Gesundheitswesen Tätigen, Patient*innen und der allgemeinen Bevölkerung sowie die frühzeitige Impfung für medizinische Hochrisikogruppen.

Fasciola hepatica is highly prevalent in the highlands of Peru. School-age children have the greatest risk of infection. Mass treatment of at-risk populations has been proposed to control the infection and prevent complications. However, the decreasing effectiveness of triclabendazole raises concerns regarding this strategy. Previous studies reported aggregation of Fasciola infection among family members. This study aimed to determine the risk of fascioliasis among household members living with Fasciola-infected children identified through school-based testing. We conducted a cross-sectional study including adult members of households where children with and without fascioliasis were identified. Demographic, epidemiological, and socioeconomic information was collected. One blood sample was drawn to test for Fasciola antibodies, and three stool samples were collected for microscopy for Fasciola ova. We tested 326 adults from 213 households. Of these adult subjects, chronic fascioliasis (24 of 326, 7.4%) was the most common helminth infection. Thirty-nine subjects (12.7%) tested positive for Fasciola antibodies. Combining microscopy and serum antibody tests, 13.2% (43 of 326) had evidence of Fasciola infection. One third (104 of 326, 31.9%) of the participants lived with at least one child infected with Fasciola hepatica. Adults with fascioliasis were four times more likely to live with an infected child. Poverty and diet were associated with increased risk of Fasciola infection. Adults with fascioliasis were significantly more likely to live with Fasciola-infected children.

The recent coronavirus disease 2019 (COVID-19) pandemic has required the adoption of precautionary health behaviours to reduce the risk of infection. This study examines adherence, as well as changes in adherence, to four key precautionary behaviours among Canadian adults: wearing face masks, social distancing, hand washing, and avoiding large crowds. Data are drawn from Series 3 and 4 of the nationally representative Canadian Perspectives Survey Series, administered by Statistics Canada in June and July 2020. We calculate overall adherence levels as well as changes over time. Logistic regression models estimate each behaviour as a function of demographic and socio-economic characteristics to identify adherence disparities across population segments. We find a nearly universal increase in precautionary behaviours from June to July in mask wearing (67.3 percent to 83.6 percent), social distancing (82.4 percent to 89.2 percent), and avoiding crowds (84.1 percent to 88.9 percent); no significant change occurred in the frequency of hand washing. We observe significant disparities in adherence to precautionary behaviours, especially for mask wearing, in June; female, older, immigrant, urban, and highly educated adults were significantly more likely to adhere to precautionary behaviours than male, younger, Canadian-born, rural, and low-educated adults. By July 2020, these disparities persisted or were slightly attenuated; women, however, had consistently higher adherence to all behaviours at both time points. These findings have substantial implications for policy and potential public health interventions.La pandémie de COVID-19 (la maladie à coronavirus 2019) a exigé l’adoption de comportements préventifs en matière de santé afin de réduire les risques d’infection. La présente étude est consacrée à l’examen de l’adhésion, ainsi que de son évolution, à quatre comportements préventifs principaux chez les Canadiens adultes : le port de masques antiprojections, la distanciation physique, le lavage des mains et l’évitement des foules. Les données étudiées sont tirées des enquêtes 3 et 4 de la série d’enquêtes sur les perspectives canadiennes, réalisée par Statistique Canada en juin et juillet 2020. Nous calculons les niveaux globaux d’adhésion ainsi que l’évolution de cette adhésion dans le temps. Des modèles de régression logistique permettent d’estimer chaque comportement en fonction des caractéristiques démographiques et socio-économiques, et de cerner ainsi les disparités d’adhésion dans différents segments de population. Nous observons une augmentation quasi universelle des comportements préventifs de juin à juillet pour ce qui est du port du masque (67,3 pour cent à 83,6 pour cent), de la distanciation physique (82,4 pour cent à 89,2 pour cent) et de l’évitement des foules (84,1 pour cent à 88,9 pour cent) ; aucun changement significatif ne se manifeste dans la fréquence du lavage des mains. Nous observons également d’importantes disparités d’adhésion aux comportements préventifs, en particulier pour ce qui est du port du masque, en juin ; les femmes, les aînés, les immigrants, les citadins et les adultes très scolarisés sont sensiblement plus enclins à adhérer aux comportements préventifs que les hommes, les plus jeunes, les Canadiens de naissance, les résidents des régions rurales et les adultes peu scolarisés. En juillet 2020, ces disparités persistent ou s’atténuent légèrement ; les femmes, toutefois, affichent uniformément une plus grande adhésion à tous les comportements préventifs aux deux moments. Ces observations ont d’importantes conséquences pour la politique et les interventions potentielles en santé publique.

Objective This study aimed to estimate the risk of SARS-Cov2 infection and severe COVID-19 among healthcare workers from a major social security system. Methods This study actively followed a cohort of social security workers from March to December 2020 to determine the number of laboratory-confirmed symptomatic cases, asymptomatic associated contacts and COVID-19-associated hospitalizations and deaths. Workers were classified into those providing direct care to infected patients (COVID teams), other active healthcare workers (OAHCW), and workers under home protection (HPW). The number of cases and rates were also estimated by job category. Results Among a total of 542 381 workers, 41 461 were granted stay-at-home protection due to advanced age or comorbidities. Among the 500 920 total active workers, 85 477 and 283 884 were classified into COVID teams and OAHCW, respectively. Infection rates for COVID teams, OAHCW, and HPW were 20.1% [95% confidence interval (CI) 19.8–20.4], 13.7% (95% CI 15.0–15.3), and 12.2% (95% CI 11.8–12.5), respectively. The risk of hospitalization was higher among HPW. COVID teams had lower mortality rate per 10 000 workers compared to HPW (5.0, 95% CI 4.0–7.0 versus 18.1, 95% CI 14.0–23.0). Compared to administrative workers, ambulance personnel (RR 1.20; 95% CI 1.09–1.32), social workers (RR 1.16; 95% CI 1.08–1.24), patient transporters (RR 1.15; 95% CI 1.09–1.22) and nurses (RR 1.13; 95% CI 1.10–1.15) had a higher risk of infection after adjusting for age and gender. Crude differences in mortality rates were observed according to job category, which could be explained by differences in age, sex, and comorbidity distribution. Diabetes, obesity, hypertension, hemolytic anemia, and HIV were associated with increased fatality rates. Conclusions COVID team workers had higher infection rates compared to the total population of active workers and HPW. Doctors had lower risk of infection than respiratory therapists, nurses, and patient transporters, among whom interventions should be reconsidered to reduce risks. The presence of comorbidities, such as diabetes, obesity, arterial hypertension, hemolytic anemia, and HIV, increased the likelihood of complications caused by COVID-19, culminating in a poor prognosis.

Background: A year after the COVID-19 pandemic spread around the world, the pandemic is still affecting healthcare systems with an increasing number of infected healthcare workers. Such a unique situation may often result in emotional turmoil, anxiety, depression, and fear, which could lead to resignation and burnout. The study intended to assess the feelings of nurses toward the COVID-19 outbreak; ascertain the factors that cause stress; and determine their coping strategies and factors contributing to coping.Methods: A descriptive cross-sectional design was utilized to recruit 313 nurses working in the Ministry of Health (Saudi Arabia) hospitals that accommodate COVID-19 patients. The study instrument was adapted and modified from the ”MERS-CoV Staff Questionnaire” and the Brief COPE.Results: The results showed that female, married, those with a bachelor’s degree, and aged 25–34 years had higher significant coping strategies. On the other hand, Filipino nurses assigned in the Outpatient Department and COVID-19 Isolation Ward had more negative feelings and encountered several factors causing stress but were coping in a better way than others.Conclusion: Nurses’ commitment to their profession appears to be an intrinsic motivation to continue caring for COVID-19 patients despite the risk of infection. Comfort with religion, spiritual beliefs, and the presence of a support system were the coping strategies used by nurses to ameliorate the stress and negative feelings during the COVID-19 outbreak. Keywords: COVID-19, Saudi Arabia, nurses, feelings, factors causing stress, coping strategies

The notions of risk and crisis, which shape the management of epidemics, were studied from a social sciences perspective. An angle which provides further reflection on how teams are prepared for epidemics in hospital, by highlighting the construction of trust and uncertainty faced with the risk of infection, notably in the interdependence of the players with the measures and tools designed by experts.

Background and study aims The COVID-19 outbreak has reorganized surgical team conditions regarding endoscopy . The number of interventions has been reduced, the number of healthcare professionals must be limited, and both the patients and physicians are more protected than ever. Patients and Methods In the highest peak of contagion in Colombia, endoscopy, colonoscopy, and esophagogastroduodenoscopy were performed using a low-cost disposable device. A total of 1388 procedures were performed. Every patient was assessed for symptoms via a telephone call, at the health center, and after the procedure, following specific attention routes. Results After procedure follow-up, no positive cases of COVID-19 were noted. Conclusion The methodology reduced the risk of infection during the COVID-19 pandemic.

Introduction: A good comprehension of the clinical profile and nursing diagnosis of newborn in Special Care Nursery (SCN) unit guides decision-making by nurses. In addition, it can become an initial basis for making plans for improving quality of care, management and nursing research. The purpose of this study was to identify clinical profile and nursing diagnosis of newborns in an SCN unit.Methods: It is a quantitative, cross-sectional, descriptive study in SCN (Level II and III) with a sample of 77 medical records of newborns less than 31 days old in a national referral hospital. Descriptive analysis was used to identify demographic characteristic, the medical diagnosis and nursing diagnosis of newborns at birth and hospitalization.Results: Newborns treated in SCN unit are dominated by preterm with low birth weight (74%). Respiratory system disorders (55.8%) and infections (35.1%) dominate newborn problems both at birth or coming. Most nursing diagnoses when the baby is born or coming are the risk of infection (90.9%) and ineffective breathing patterns (76.6%). As for the treatment, most diagnoses show the risk of infection and hypovolemia.Conclusion: A good clinical profile and nursing diagnosis of newborns can guide nurses to decision-making. Continuous update on nursing diagnosis determination, improvement of nurses’ knowledge about the signs of deterioration, and future research that prioritizes issues in neonates are required to optimize nurses’ role in SCN units.

O presente protocolo aborda o risco, prevenção e tratamento da infeção no doente sob terapêutica imunomoduladora ou imunossupressora em contexto de doença autoimune ou autoinflamatória. Subdivide-se nas seguintes secções: fármacos e risco associado de infeção; imunizações; risco, prevenção e tratamento de infeções específicas. Com um número crescente de novos fármacos em utilização nos últimos anos, o tratamento de doenças autoimunes envolve a utilização de terapêuticas imunossupressoras ou imunomoduladoras e associa-se a aumento do risco de infeção, que pode estar presente de uma forma global ou apenas para infeções por agentes específicos, variando amplamente consoante a classe farmacológica e mesmo dentro desta. Na estruturação da estratégia preventiva são fundamentais a caracterização da patologia que motiva a imunossupressão, a compreensão do mecanismo de ação do imunossupressor, a aferição de infeções prévias, o reconhecimento de fatores de risco, a realização de rastreios laboratoriais, a administração de vacinas, a educação do doente e a monitorização de sintomas e sinais clínicos, na dependência de uma gestão clínica necessariamente individualizada.

Cardiovascular implantable electronic devices (CIED) are effective and important components of modern cardiovascular care. Despite the dramatic improvements in the functionality and reliability of these devices, over time patients are at risk for developing several morbidities, the most feared of which are local and systemic infections. Despite significant financial investment and aggressive therapy with hospitalization, intravenous antibiotics, and transvenous lead extraction, the outcomes include a 1-year mortality rate as high as 25%. This risk of infection has increased over time, likely due to the increased complexity of the surgical interventions required to insert and replace these devices. The only way to reduce this morbidity and mortality is to prevent these infections, and other than preoperative antibiotics, there were little data supporting effective therapy until the WRAP-IT trial provided randomized data showing that pocket infections can be reduced by 60% at 12 months and major CIED infections reduced by 40% at 1 year with the use of the absorbable antibiotic eluting envelope in patient CIED procedures at high risk of infection. Not all CIED procedures are at high risk of infection and justify the use of the envelope, but cost-effectiveness data support the use of the antibiotic envelope particularly in patients with defibrillator replacements, revisions, and upgrades, such as to a resynchronization device and in patients with prior CIED infection, history of immunocompromise, two or more prior procedures, or a history of renal dysfunction.

Understanding the risk of infection from household- and community-exposures and the transmissibility of asymptomatic infections is critical to SARS-CoV-2 control. Limited previous evidence is based primarily on virologic testing, which disproportionately misses mild and asymptomatic infections. Serologic measures are more likely to capture all previously infected individuals. We apply household transmission models to data from a cross-sectional, household-based population serosurvey of 4,534 people ≥5 years from 2,267 households enrolled April-June 2020 in Geneva, Switzerland. We found that the risk of infection from exposure to a single infected household member aged ≥5 years (17.3%,13.7-21.7) was more than three-times that of extra-household exposures over the first pandemic wave (5.1%,4.5-5.8). Young children had a lower risk of infection from household members. Working-age adults had the highest extra-household infection risk. Seropositive asymptomatic household members had 69.4% lower odds (95%CrI,31.8-88.8%) of infecting another household member compared to those reporting symptoms, accounting for 14.5% (95%CrI, 7.2-22.7%) of all household infections., Household-based studies can provide insights into SARS-CoV-2 transmission. Here, the authors fit transmission models to serological data from Geneva, Switzerland, and estimate that the risk of infection from single household exposure (17.3%) was higher than for extra-household exposure (5.1%).

Objectives: A novel coronavirus was first proclaimed in Hubei province, China, 213 countries worldwide also became an epicenter of the virus until June 17, 2020. The dental team has a high risk of infection as a result of the specificity of their procedures. The aim of this questionnaire was to estimate the preventive measures and the awareness methods that may be adopted by the dentists to prevent or reduce the transmission of COIVD-19. Material and Methods: The questionnaire was an electronic survey contained 23 questions, which were designed based on the instruction given for dental setting by CDC during COVID-19 pandemic; the respondents in this study were dental practitioners in Syria. Results: A total of 1013 dentists have responded to this survey 61% of the participants treated only the emergent treatment, 84% of them wear facial masks, while the prevalence for other protective equipment was low. The majority of the participants schedule the appointments as there is only one patient in the waiting room. More than half of the dentists sterilize the patients’ hands before and after the dental treatment, and 59% of them choose 70% ethyl alcohol as a disinfectant. Most of the respondents use dental mouthwashes before the initiation of the treatment. Almost three-quarters of the dentists use high vacuum. Only 15% of dentists sterilize the dental handpieces in the autoclaves after each patient. Most of dentists educate their patients about preventive methods. Conclusion: Based on these results, the Syrian dentists should take more strict measures during dental practice.

Although the World Scientific Society of Educators does not yet have sufficient evidence to measure the impact of school attendance on the risk of disease transmission, the harmful effects of a full transition to distance education are indisputable and affect the safety, well-being and education of children / students. and documents of many states. The purpose of the article is to determine the risks of the absence of a traditional educational process in educational institutions during the Covid-19 pandemic using the materials of the United Nations Educational, Scientific and Cultural Organization. The study was based on the following theoretical methods: analytical and descriptive methods of developing theoretical and critical sources and resources related to the implementation of the educational process, in order to determine the risks associated with providing distance learning during the Covid-19 pandemic. Analysis of contextual benefits and risks allows to determine the priority of educational institutions (or their components) to resume their work; priority of measures to reduce the risk of infection in educational institutions and communities; and focus areas for distance learning. Direct funding for education institutions most affected by the crisis, for example through formula-based funding, which gives priority to the most marginalized groups of pupils / students. From the point of view of mechanisms, scholarships for certain blocks and remittances (conditional or unconditional) to pupils / students should be considered. Tuition and other costs (school uniforms, etc.) should be waived where possible and other barriers to entry should be removed to maximize re-enrollment. We see prospects for further research in the analysis of ensuring the availability of educational materials / platforms, information, services and learning tools for people with disabilities in the process of obtaining education.

[...]we propose psychological contracts, specifically in relation to workplace health and safety (Rousseau, 1989;Walker & Hutton, 2006), as an area warranting greater attention at this time from researchers and practitioners alike. According to recent prepandemic estimates, 10% of workers in the United States are exposed at work to disease or infection more than once per week and 18.4% are exposed more than once per month (Barker etal., 2020). [...]it is estimated that pandemic disease exposure may be greater at work than elsewhere, which has implications for disease transmission to workers and communities alike. [...]although federal, state, and local authorities have issued a variety of pandemic-related guidelines and legal responsibilities for employers toward creating safe work environments for employees, especially those at higher risk of infection, there is also considerable complexity to these guidelines.

As part of the SARS-CoV‑2 pandemic, the district of Heinsberg developed into an infectiological epicentre for Germany in February 2020. Our hospital, which is located in the immediate vicinity, reacted very quickly in addition to adapting patient care by implementing an organizational structure for recording SARS-CoV-2-positive employees, patients and their contact persons.The infections recorded in contact tracing were analysed and, based on an exemplary outbreak, infection chains and follow-up processes were evaluated.Comprehensive data on contact types, oropharyngeal swab results for SARS-CoV‑2 and quarantine days were documented and retrospectively evaluated using a self-developed database.Of the 568 employees recorded by in-house contact tracing, 32 employees (1.2%, n = 2567) were detected as SARS-CoV‑2 positive. Of those, 50% (n = 16) tested positive due to contact tracing, 15.6% (n = 5) were recorded by routine smears and 34.4% (n = 11) were returning travellers. The variable PCR results of the control smears from these positive employees were noticeable. In 18.8% (n = 6) of the initially negative control smears, positive PCR results were found in the following control smear. The inhouse contact tracing team was able to detect infection clusters on non-COVID-19 wards at an early stage and, together with clinical hygiene and the public health department, initiated comprehensive measures to limit the spread of the virus. Infection chains could thus be interrupted.The work of the clinic's own contact tracing unit has proven to be an essential part of clinical pandemic management not least against the background of new waves of infection and is indispensable for the detection of local infection clusters.HINTERGRUND: Im Rahmen der SARS-CoV-2-Pandemie entwickelte sich der Kreis Heinsberg im Februar 2020 zu einem infektiologischen Epizentrum für Deutschland. Unser in unmittelbarer Nachbarschaft gelegenes Krankenhaus implementierte neben der Anpassung der Patientenversorgung sofort zusätzlich eine krankenhausinterne Organisationsstruktur zur Erfassung SARS-CoV-2-positiver Mitarbeiter, Patienten und deren Kontaktpersonen.Die im Contact Tracing erfassten Infektionen wurden analysiert und anhand eines beispielhaften Ausbruchs Infektionsketten und Nachverfolgungsprozesse evaluiert.Daten zu Kontakten, Abstrichergebnissen und Quarantänetagen wurden mittels einer eigenen Datenbank dokumentiert und retrospektiv ausgewertet.568 Mitarbeiter wurden vom krankenhausinternen Contact Tracing erfasst. 32 Mitarbeiter (1,2 %, n = 2567) wurden als SARS-CoV-2-positiv erfasst. 50 % (16) davon wurden im Rahmen der Kontaktpersonennachverfolgung positiv getestet, 15,6 % (5) durch Routineabstriche erfasst. 34,4 % (11) waren Reiserückkehrer. Auffällig waren variable PCR-Ergebnisse der Kontrollabstriche dieser positiven Mitarbeiter. Bei 18,8 % (6) wurden bei zunächst negativem Kontrollabstrich im folgenden Kontrollabstrich wieder positive PCR-Ergebnisse gefunden. Das eigene Contact Tracing konnte Infektionshäufungen auf Non-COVID-19-Stationen frühzeitig aufdecken und gemeinsam mit der Klinikhygiene und dem Gesundheitsamt umfassende Maßnahmen zur Begrenzung der Virusausbreitung einleiten. Infektionsketten konnten früh durchbrochen werden.Ein krankenhausinternes Contact Tracing erweist sich vor allem bei nicht auszuschließenden zukünftigen Infektionswellen als ein wesentlicher Bestandteil des klinischen Pandemiemanagements und ist essenziell zur Aufdeckung von lokalen Infektionsclustern.

As COVID-19 puts older people in long-term institutional care at the highest risk of infection and death, the need for home-based care has increased. Germany relies largely on migrant caregivers from Poland. Yet the pandemic-related mobility restrictions reveal the deficiencies of this transnational elder care system. This article asks if this system is resilient. In order to answer this question, the research team conducted interviews with 10 experts and randomly selected representatives of brokering and sending agencies in Germany and Poland. We interviewed 13 agencies in Germany and 15 in Poland on the agencies' characteristics, recruitment strategies, challenges of the pandemic, and impact of legal regulations in the sector. The analysis shows that the system could mobilize adaptive capacities and continue to deliver services, but its absorptive capacity is limited. To enhance resilience, policies working toward formalization and legalization of care services across national borders are required.

Personal hygiene for school-age children is a public health problem that still needs attention, including for the Suku Laut Duano children. The lack of implementation of personal hygiene in children can increase the risk of infection. The results showed that there was a relationship between personal hygiene and health problems. Therefore, it is necessary to know the application of personal hygiene in school-age children in the Suku Laut Duano. This study aimed to determine the description of personal hygiene based on skin hygiene, foot, hand, and nail hygiene, oral and dental hygiene, and hair hygiene. This research was a descriptive study using a cross-sectional design. Collecting data was carried out through interviews using a questionnaire. The population in this study were all school-age children, totaling 27 children. Data were analyzed by univariate. The results showed that the personal hygiene of the children was mostly in the poor category, both based on skin hygiene (66.7%), cleanliness of feet, hands, and nails (74%), oral hygiene, and teeth (66, 7%), and hair hygiene (70.4%). Poor personal hygiene can cause health problems in children. Therefore, the implementation of personal hygiene in children needs to be improved by involving parents and school.

Weather variables are one of the crucial factors affecting respiratory infectious diseases; however, the effect of weather variables on the coronavirus disease 2019 (COVID-19) is still inconclusive and varies in different regions. The present study investigated the effects of weather variables (maximum temperature, MT; relative humidity, RH; wind speed, WS; precipitation, PR; and dew point, DP) on daily infection and death cases in three lockdown phases in Asia as of November 1, 2020. Generalized additive lag model was used to analyze the risk associated with weather variables, with confounders like median age of the national population, population density, country and lockdown phases. Our findings revealed that during lockdown phases all five weather variables show association with daily confirmed, and death cases. On the other hand, PR (pre-lockdown phase) and DP (lockdown phase) showed positive association with both daily confirmed and death cases. Throughout the three lockdown phases MT, RH and PR showed strong positive associations with daily confimed/death cases. A lag period of 0–4-days possess higher risk of infection and death due to the varied ratios of different weather variables. The relative risk indicated that the infection and mortality risk was higher in India as compared to the rest of the countries. Here, unique combination of weather variables together with higher population density makes this region as one of the hotspots for COVID-19. This shows that the COVID-19 pandemic may be suppressed or enhanced with combination of different weather conditions together with factors like population density and median age of the country, which shall be useful for better implementation of health policies and further preparedness in Asia. Supplementary Information The online version contains supplementary material available at 10.1007/s42398-021-00176-8.

Background : One of the problems that must be considered by young women is their reproductive health. It is very important to inform young women about the menstrual process knowledge so that they will be able to maintain personal hygiene. Lack of knowledge about personal hygiene can increase the risk of infection. This study aims to determine the relationship between knowledge of young girls and personal hygiene behavior. Method : The research method used was an analytic survey with a cross sectional approach. Conducted at SMPN 036 Batam City, the study was conducted for 6 months, the population in this study were all 270 students of SMPN 036 class VIII, with a total sample of 162, the sampling technique was carried out by purposive sampling technique with research instruments using a questionnaire. Data analysis using Chi square. Result :The results of the study were obtained from 162 respondents, the majority of respondents had good knowledge of 110 people (68%), and good personal hygiene behavior as many as 152 people (94%). Chi-square statistical test obtained p-value = 0.008

Both Pfizer-BioNTech’s and Moderna’s corona virus vaccines have been developed on the basis of the mRNA-mediated therapy, discovered by Katalin Karikó, Hungarian-born professor and senior vice president of BioNTech and her co discover, Drew Weissman, professor of the University of Pennsylvania. The greatest scientific achievement of Katalin Karikó’s research work over more than two decades is the elaboration of the mRNA-mediated method for therapeutic application. For Professor Karikó the special milestone was the moment when the first vaccine for COVID-19 was created based on this technology. Her breakthrough discovery has a potent scientific importance in vaccine research, as people are all around the world are hoping for the end of pandemic and lockdown restrictions with arrival of vaccines, wishing that life could finally return to normality. However, we have to remark that several questions emerge concerning the mechanism of action of this new type of vaccines, their side or long-term effects, as well as the duration of immunity or the risk of reinfection. These questions lead to uncertainty in connection with vaccination, therefore clear answers needed. In the fight against the virus, beside healthcare workers, military and police personnel belong to the category of highest risk of infection, therefore, it is crucial to achieve as high vaccination rates in their ranks as possible. To reach this goal, it is important to have authentic information about the vaccine and the indicators of the immune response. As, the unknown always creates fear and uncertainty we intend to put an end to such fears with the help of this interview with Katalin Karikó and to support hesitant colleagues’ decision-making process to get themselves vaccinated. We asked Professor Katalin Karikó about vaccine research, the wide area of application of the mRNA-mediated therapy, about skepticism concerning vaccination and about her personal connections to police forces and to scientific research in the field of law enforcement. She was interviewed by Valér Dános and Csaba Szabó.

Introduction: Healthcare staffs are first-line fighters who handle COVID-19 patients.They face a high risk of infection every day, and are subject to long and distressingwork hours in order to meet health needs. Aim of work: To evaluate the psychologicalimpact of COVID-19 pandemic on health care workers (HCWs). Materials andMethods: All categories of health care workers in Egypt were invited to participatein the study through sharing the link to online professional groups between 21st Juneto 9th July 2020. The survey included a self-administered- Arabic questionnaireincluding information related to socio- demographic characteristics, medical historyincluding diseases and medications, work characteristics and COVID -19 experienceof the studied participants. The survey also included validated Depression, Anxiety,and Stress Scales (DASS-21) and 7 items work-related burnout Copenhagen BurnoutInventory (CBI). Results: The total number of health care workers who shared in thestudy was 764. There were psychological disorders of varying degrees in the formof depression (41.5%), anxiety (67%), and stress (27.7 %). Working as nurses, age

Coronavirus disease 2019 (COVID-19) was first detected in December 2019. In March 2020, the World Health Organization declared COVID-19 a pandemic. People with underlying medical conditions may be at greater risk of infection and experience complications from COVID-19. COVID-19 has the potential to affect People living with HIV (PLWH) in various ways, including be increased risk of COVID-19 acquisition and interruptions of HIV treatment and care. The purpose of this review article is to evaluate the impact of COVID-19 among PLWH. The contents focus on 4 topics: (1) the pathophysiology and host immune response of people infected with both SARS-CoV-2 and HIV, (2) present the clinical manifestations and treatment outcomes of persons with co-infection, (3) assess the impact of antiretroviral HIV drugs among PLWH infected with COVID-19 and (4) evaluate the impact of the COVID-19 pandemic on HIV services.

Aim: To clarify how the medical institutions overcame the first wave of coronavirus disease 2019 (COVID–19) in Japan and to discuss its impact on the medical labor force. Methods: We analyzed questionnaire data from the end of May 2020 from 180 hospitals (102,578 beds) certified by the Japanese Association for Acute Medicine. Results: Acute (emergency) medicine physicians treated severe COVID–19 patients in more than half of hospitals. Emergency medical teams consisted of acute medicine physicians and other specialists. Frontline acute care physicians were concerned about their risk of infection in 80% of hospitals, and experienced stress due to a lack of personal protective equipment. Twenty–six of the 143 hospitals that had a mental health check/consultation system in place indicated that there was a doctor who experienced mental health problems. Of the 37 hospitals without a system, only one hospital was aware of the presence of a doctor complaining of mental health problems. Conclusion: Acute care physicians and physicians in other departments experienced high levels of stress as they fought to arrange COVID–19 treatment teams and inpatient COVID–19 wards for infected patients. Medical materials and equipment may be sufficient for a second or third wave; however, active support is needed for the physical and mental care of medical staff. Mental health problems may be missed in facilities without mental check and consultation system.

Background and Aims Multidrug-resistant infectious outbreaks associated with duodenoscopes have been documented internationally. Single-use duodenoscopes, disposable distal ends, or distal end cap sealants could eliminate or reduce exogenous patient-to-patient infection associated with ERCP. Methods This document reviews technologies that have been developed to help reduce or eliminate exogenous infections because of duodenoscopes. Results Four duodenoscopes with disposable end caps, 1 end sheath, and 2 disposable duodenoscopes are reviewed in this document. The evidence regarding their efficacy in procedural success rates, reduction of duodenoscope bacterial contamination, clinical outcomes associated with these devices, safety, and the financial considerations are discussed. Conclusions Several technologies discussed in this document are anticipated to eliminate or reduce exogenous infections during endoscopy requiring a duodenoscope. Although disposable duodenoscopes can eliminate exogenous ERCP-related risk of infection, data regarding effectiveness are needed outside of expert centers. Additionally, with more widespread adoption of these new technologies, more data regarding functionality, medical economics, and environmental impact will accrue. Disposable distal end caps facilitate duodenoscope reprocessing; postmarketing surveillance culture studies and real-life patient infection analyses are important areas of future research.

Prenatal exposure to the Zika virus (ZIKV) is associated with a significant risk of neurological impairment for infants. ZIKV serves as a cautionary model with significant parallels to the current coronavirus 2019 (COVID‐19) pandemic. A limited literature search was performed to compare and contrast the clinical and psychosocial aspects of infection with ZIKV and COVID‐19. There are significant parallels between ZIKV disease and COVID‐19 in terms of limited diagnostic techniques, therapeutics, and prognostic uncertainties. Both infections are associated with a significant risk of adverse outcomes for either the pregnant individual or the fetus. Existing social and economic inequalities amplify the risk burden of ZIKV disease and COVID‐19 in vulnerable communities. Although each pathogen has unique features, there are underlying common principles with regard to the recognition, communication, and mitigation of risk of infection. Misinformation spread by social media platforms has undermined public health efforts and patient adoption of recommended mitigation strategies. Health care providers can provide partnership, social support, and evidence‐based information to enhance health‐seeking behaviors, thereby minimizing the risks for pregnant and reproductive‐aged persons.

SummaryWe performed a time series analysis in Vienna, Austria, investigating the temporal association between daily air pollution (nitrogen dioxide, NO2 and particulate matter smaller than 10 µm, PM10) concentration and risk of coronavirus disease 2019 (COVID-19) infection and death. Data covering about 2 months (March–April 2020) were retrieved from public databases. Infection risk was defined as the ratio between infected and infectious. In a separate sensitivity analysis different models were applied to estimate the number of infectious people per day. The impact of air pollution was assessed through a linear regression on the natural logarithm of infection risk. Risk of COVID-19 mortality was estimated by Poisson regression. Both pollutants were positively correlated with the risk of infection with the coefficient for NO2 being 0.032 and for PM10 0.014. That association was significant for the irritant gas (p = 0.012) but not for particles (p = 0.22). Pollutants did not affect COVID-19-related mortality. The study findings might have wider implications on an interaction between air pollution and infectious agents.

Introduction Deterministic compartmental models of infectious diseases like measles typically reflect biological heterogeneities in the risk of infection and severity to characterize transmission dynamics. Given the known association of socioeconomic status and increased vulnerability to infection and mortality, it is also critical that such models further incorporate social heterogeneities. Methods Here, we aimed to explore the influence of integrating income-associated differences in parameters of traditional dynamic transmission models. We developed a measles SIR model, in which the Susceptible, Infected and Recovered classes were stratified by income quintile, with income-specific transmission rates, disease-induced mortality rates, and vaccination coverage levels. We further provided a stylized illustration with secondary data from Ethiopia, where we examined various scenarios demonstrating differences in transmission patterns by income and in distributional vaccination coverage, and quantified impacts on disparities in measles mortality. Results The income-stratified SIR model exhibited similar dynamics to that of the traditional SIR model, with amplified outbreak peaks and measles mortality among the poorest income group. All vaccination coverage strategies were found to substantially curb the overall number of measles deaths, yet most considerably for the poorest, with select strategies yielding clear reductions in measles mortality disparities. Discussion The incorporation of income-specific differences can reveal distinct outbreak patterns across income groups and important differences in the subsequent effects of preventative interventions like vaccination. Our case study highlights the need to extend traditional modeling frameworks (e.g. SIR models) to be stratified by socioeconomic factors like income and to consider ensuing income-associated differences in disease-related morbidity and mortality. In so doing, we build on existing tools and characterize ongoing challenges in achieving health equity.

About 4.25% of people have lost their lives due to COVID-19 disease, among SARS-CoV-2 infected patients. In an unforeseen situation, approximately 25,000 frontline healthcare workers have also been infected by this disease while providing treatment to the infected patients. In this devastating scenario, without any drug or vaccine available for the treatment, frontline healthcare workers are highly prone to viral infection. However, some countries are drastically facing a shortage of healthcare workers in hospitals.The literature search was conducted in ScienceDirect and ResearchGate, using words "Medical Robots", and "AI in Covid-19" as descriptors. To identify and evaluate the articles that create the impact of robots and artificial intelligence in pandemic diseases. Eligible articles were included publications and laboratory studies before and after covid-19 and also the prospective and retrospective of application of Robots and AI.In this pandemic situation, robots were employed in some countries during the COVID-19 outbreak, which are medical robots, UV-disinfectant robots, social robots, drones, and COBOTS. Implementation of these robots was found effective in successful disease management, treatment, most importantly ensures the safety of healthcare workers. Mainly, the Disposal of deceased bodies and the location and transportation of infected patients to hospitals and hospitals were tough tasks and risk of infection. These tasks will be performed by employing mobile robots and automated guided robots respectively. Therefore, in the future, advanced automated robots would be a promising choice in hospitals and healthcare centers to minimize the risk of frontline healthcare workers.Cerca de un 4,25% de personas han perdido la vida a causa de la COVID-19, entre los pacientes infectados por SARS-CoV-2. En esta situación imprevista, aproximadamente 25.000 trabajadores sanitarios de primera línea se han visto también infectados por esta enfermedad, al proporcionar tratamiento a los pacientes infectados. En este escenario devastador, en el que no se dispone de fármacos o vacunas para el tratamiento, el personal sanitario de primera línea está altamente expuesto a la infección vírica. Sin embargo, algunos países se están enfrentando a un recorte drástico de personal sanitario en sus hospitales.Se realizó una búsqueda en la literatura en ScienceDirect y ResearchGate, utilizando los términos «En esta situación de pandemia, algunos países utilizaron robots durante el brote de COVID-19, es decir, robots médicos, robots desinfectantes de rayos UV, robots sociales, drones, y cobots. Se encontró que la implementación de estos robots era eficaz para la gestión y tratamiento de la enfermedad y, más importantemente, la garantía de la seguridad del personal sanitario. En particular, la eliminación de cadáveres y la localización y transporte de pacientes infectados a los hospitales eran tareas duras que suponían un riesgo de infección. Dichas tareas podrán realizarse utilizando robots móviles y robots automatizados, respectivamente. Por tanto, en el futuro, los robots automatizados avanzados constituirán una elección prometedora en hospitales y centros sanitarios, para minimizar el riesgo del personal sanitario de primera línea.

From early in the COVID-19 pandemic, economists have stressed the importance of individuals endogenously changing their behavior to reduce their risk of infection. This paper quantifies time variation in the endogenous behavioral response of economic activity to the prevalence of the virus using an estimated behavioral SIR model with time-varying parameters. We find significant variation in both the relationship between economic activity and viral prevalence and the relationship between transmissibility and economic activity. This variation reflects adaptation to the pandemic and has implications both for specification of behavioral SIR models and for the next stage of the pandemic.

Background It is unclear if the prevalence of COVID‐19 in rheumatologic patients is similar to that of the general population. There are no reports of seroprevalence of SARS‐CoV‐2 in these patients. Aims To investigate prevalence of COVID‐19 cases and seroprevalence among rheumatologic patients and the risk factors for infection. Methods A cross‐sectional study in a rheumatologic population. An online questionnaire was sent on 31 April 2020. Blood samples from 20% sample of patients were drawn for SARS‐CoV‐2 antibodies. Patients were divided based on autoimmune (AI) diagnosis. Prevalence of COVID‐19 by nasopharyngeal swab and by serology (seroprevalence) was compared to national data. Risk factors for infection of SARS‐CoV‐2 were assessed. Results The study group included 1204 patients, 74.5% had an AI diagnosis. The prevalence of COVID‐19 was 0.16% in the rheumatologic patient population and 0.22% in the AI group, which was not different from prevalence in Israel on 4 May 2020 (0.18%, P = 0.912 and P = 0.759 respectively). Serologic tests were performed in 242 patients, of which five were found positive pointing to a seroprevalence of 2.07%. Exposure to a known COVID‐19 patient was the only significant risk factor for being positive by swab or by serology. AI diagnosis, immunosuppression, corticosteroid, hydroxychloroquine did not influence the risk. Conclusions The prevalence of COVID‐19 in a population of rheumatologic patients was similar to that of the general population. Mild/asymptomatic cases may be prevalent according to serologic tests. The major risk factor for infection is exposure to a known case of COVID‐19, and immunosuppression did not play a role in the risk of infection.

The major concern that has confronted surgeons during the COVID-19 pandemic is the risk of infection during surgery. So far, no studies have found SARS-CoV-2 in surgical smoke, and if it was found, whether it was infectious or not is unknown. To date, no evidence shows that respiratory viruses can be transmitted through a surgical plume or an aerosolized gas. There are various advantages of laparoscopy over laparotomy that must be kept in mind in the COVID-19 era, such as early recovery and shorter hospital stay, which can greatly help to conserve valuable hospital resources, and reduced risk of spillage of blood and body fluids, which can help to reduce transmission risk; most importantly, the distances between surgeons and between surgeons and patients are greater. Certain precautionary measures can be taken to reduce SARS-CoV-2 transmission during laparoscopy. Whenever possible, it should be the surgical option of choice.

Anesthesiologists have a high risk of infection with COVID-19 during perioperative care and as first responders to airway emergencies. The potential of becoming infected can be reduced by a systematic and integrated approach that assesses infection risk. The latter leads to an acceptable choice of materials and techniques for personal protection and prevention of cross-contamination to other patients and staff. The authors have presented a protocolized approach that uses diagnostic criteria to clearly define benchmarks from the medical history along with clinical symptoms and laboratory tests. Patients can then be rapidly assigned into 1 of 3 risk categories that direct the choice of protective materials and/or techniques. Each hospital can adapt this approach to develop a system that fits its individual resources. Educating medical staff about the proper use of high-risk areas for containment serves to protect staff and patients.

Introduction It is unclear whether smokers are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate the association between smoking and the risk of SARS-CoV-2 infection. Methods A matched case–control study was conducted using a large nationwide database. The case group included patients with SARS-CoV-2 infection confirmed by the Korea Centers for Disease Control and Prevention, and the control group was randomly sampled from the general Korean population in the National Health Insurance Service database by matching sex, age, and region of residence. Conditional logistic regression models were used to investigate whether the risk of infection with SARS-CoV-2 was affected by smoking status. Results A total of 4167 patients with SARS-CoV-2 infection and 20 937 matched controls were enrolled. The proportion of ex-smokers and current smokers was 26.6% of the total participants. In multivariate analysis, smoking was not associated with an increased risk of SARS-CoV-2 infection (odds ratio [OR] = 0.56, confidence interval [CI] = 0.50–0.62). When ex-smokers and current smokers were analyzed separately, similar results were obtained (current smoker OR = 0.33, CI = 0.28–0.38; ex-smoker OR = 0.81, CI = 0.72–0.91). Conclusions This study showed that smoking may not be associated with an increased risk of SARS-CoV-2 infection. Smoking tends to lower the risk of SARS-CoV-2 infection; however, these findings should be interpreted with caution. Implications It is unclear whether smokers are more vulnerable to coronavirus disease 2019. In this large nationwide study in South Korea, smoking tended to lower the risk of infection with severe acute respiratory syndrome coronavirus 2. However, these findings should be interpreted with caution, and further confirmatory studies are required.

Lombardy has represented the Italian and European epicenter of the coronavirus disease 2019 (COVID-19) pandemic. Although most clinical efforts within hospitals were diverted towards the care of virally infected patients, therapies for patients with cancer, including radiotherapy (RT), have continued. During both the first and second pandemic waves, several national and regional organizations provided Italian and Lombardian RT departments with detailed guidelines aimed at ensuring safe treatments during the pandemic. The spread of infection among patients and personnel was limited by adopting strict measures, including triage procedures, interpersonal distance, and adequate implementation of personal protective equipment (PPE). Screening procedures addressed to both the healthcare workforce and patients, such as periodic nasopharyngeal swabs, have allowed the early identification of asymptomatic or pauci-symptomatic COVID-19 cases, thus reducing the spread of the infection. Prevention of infection was deemed of paramount importance to protect both patients and personnel and to ensure the availability of a minimum number of staff members to maintain clinical activity. The choice of treating COVID-19–positive patients has represented a matter of debate, and the risk of oncologic progression has been weighted against the risk of infection of personnel and other patients. Such risk was minimized by creating dedicated paths, reserving time slots, applying intensified cleaning procedures, and supplying personnel and staff with appropriate PPE. Remote working of research staff, medical physicists, and, in some cases, radiation oncologists has prevented overcrowding of shared spaces, reducing infection spread.

Introduction: The COVID-19 pandemic has led to remarkable changes in several aspects of medical practice. Elective surgeries, including orthopedic surgery, were deferred worldwide, allowing hospitals to accommodate higher numbers of COVID-19 patients and reduce the possible risk of infection among healthcare workers. However, healthcare systems aimed to continue providing emergency services at similar standards. In this study, we aim to highlight the impact of lockdowns secondary to the pandemic on orthopedic trauma practice in a country that was described to have one of the strictest lockdowns worldwide. We aim to examine the trends of change in number and type of orthopedic trauma cases and the changes to decision making and patient care among orthopedic surgeons. Methods: This cross-sectional study is based on a survey that was designed and delivered to orthopedic surgeons from different health sectors i.e. governmental, military, private and university hospitals. The questionnaire was distributed through the official Jordan orthopedic association WhatsApp group by the end of the 4th week of strict lockdown. A total of 256 orthopedic surgeons were invited to participate and responses were limited to one per participant. 147 replies were received with a response rate of 57.4%. Data were analyzed using the Statistical Package for the Social Sciences Version 23 (SPSS Inc., Chicago, IL) statistical software. Results: A total of 147 surgeons participated in the study with a response rate of 57.4%. The mean age of the participants was 39.8 years, with the majority being between 30 and 40 years (n=70; 48%). There was a significant decline in the number of trauma cases admitted to the Emergency Departments (ER), especially cases with polytrauma. During this period, the most common reported fractures were proximal femur fractures (47.6%) followed by distal radius fracture (17%). 30% of participants used to perform more than 10 trauma operations per week. This percentage dropped to 7.5% during the pandemic lockdown. 25% did not operate at all during the lockdown period. Outpatients practice was significantly affected with almost 40% of orthopedic surgeons not managing any single patient. Regarding the use of Personal Protective Equipment (PPE), 85% of the surgeons used face masks and gloves only during their patient's encounter. Inside the operating room, only 9.5% of surgeons used fully protective PPEs. Regarding the changes in practice, 62% of surgeons reported an increased tendency toward non-operative management with a significant delay in follow up of patients. The use of telemedicine was effective in the management of less than 50% of patient encounters, according to our participants. Private practice respondents reported more than 50% drop in their income during the lockdown. Conclusion: Strict lockdown in Jordan led to significant changes to orthopedic trauma practice in terms of the number and type of cases. Emergency and outpatient services were similarly affected. Orthopedic surgeons developed a tendency towards more conservative management and less surgical treatment. There is a need for stricter implementation of guidelines regarding the use of PPE especially in the operating theatre. Telemedicine use in management and follow up of trauma patients needs further assessment in terms of its efficacy and efficiency to patients and to healthcare professionalswith regards to its medico-legal aspects.

Municipal solid waste (MSW) represents an inevitable by-product of human activity and a major crisis for communities across the globe. In recent times, the recycling of MSW has drawn attention as the process can add value through resources from the recovered waste materials and facilitates the process of circular economy. However, during the unprecedented coronavirus (COVID-19) outbreak, the risk of infection with the highly contagious virus has proven detrimental to the continuation of MSW as a valuable resource. The volume of waste, especially household waste, is higher; face masks, PPE (personal protective equipment), and hazardous materials such as batteries and empty chlorine bottles are examples of extra waste that have arisen during the pandemic. Various countries have set up initiatives for MSW management, including safety measurements for employees in the MSW management sector. The use of disinfectant prior to sorting waste, as well as storing waste for 9 days, may help to inactivate the COVID-19 virus, ensuring an appropriate safety level for MSW management. This work aimed at studying different MSW management strategies, specific challenges, and possible solutions for better understanding for those involved in waste management, in addition to providing a possible management strategy during and post-COVID-19 pandemic. Graphical abstract

A new 2019 coronavirus disease has been spreading worldwide for more than a year, with a high risk of infection and death. Various sequelae and complications can develop in COVID-19 survivors, lasting from several weeks to several months after initial recovery, affecting different organs and systems. Various sequelae and complications can occur in COVID-19 survivors not only in adults and the elderly, but also in young people. A wide range of neurological manifestations of COVID-19 are now described in the available literature. The incidence of selected neurological symptoms, syndromes and nosological forms in individuals both in the acute period of COVID-19 disease and in the short- and long-term follow-up of these patients is presented. In this article, cognitive impairments occurring in individuals who have had coronavirus disease are discussed in depth. Data on the prevalence of cognitive impairment in different regions and at different periods of the disease are presented. The main possible pathophysiological processes and risk factors for the development of cognitive impairment in COVID-19 are described. Possible ways of drug and non-drug rehabilitation of patients with cognitive impairment in coronavirus infection that is a new problem of modern medicine are considered. Attention is also paid to neuroprotection as one of the therapy areas.

Youths living in crowded impoverished urban areas face higher risk of infection by SARS-CoV-2. This article presents lessons learned from a preventive intervention project intersected by the COVID-19 crisis that moved from a mix-methods study design to online ethnography. The 'home-officed' research team e-witnessed high-school students' daily lives and collaborated in youths' and community-based organisations' responses in the territories where they study and live. Psychosocial distress increased, also driven by the disastrous governmental response to the health and economic crises. There was growing anxiety about meeting friends and dating, with structural limits for sustaining the recommended social distancing, which added to gender/sexuality-based violence. Simultaneously, we observed students becoming relevant actors through co-producing preventive practices, surpassing risk-group notions and combining SARS-CoV-2 prevention with sexuality, gender, racism and mental-health issues. They managed internet-mediated applications to promote critical thinking and collective actions aimed at health promotion among their peers, from their homes. Freire's concept of 'untested-feasibility' fostered researchers', students' and community leaders' imaginations in the face of this unprecedented crisis, thereby enhancing social responses to the epidemic to become rights-based comprehensive dialogical preventive activities. This ongoing intervention-research stresses how prevention sciences can go beyond reduction of this pandemic to a viral event.

Introduction. Ascariasis is one of the most common parasitic diseases that infect about 1.5 million people in the world every year. In Russia, from 40 to 60 thousand cases are registered annually. To make effective management decisions on sanitary-epidemiological and preventive measures, the search for environmental factors that potentially affect the epidemic process of ascariasis in the Vladimir region was carried out. Materials and methods. The study analyzed archived statistical data on the incidence of ascariasis in the population, the state of the environment (air, water, and soil pollution), the socio-economic situation (unemployment rate, average salary, number of doctors and nurses, housing provision), as well as climate indices (average monthly temperature, number of days in a month with precipitation, humidity and snow cover) in the region. Statistical data processing and correlation and regression analysis were performed using the Statistica software. The maps were built and edited using the ArcView 3.1 GIS program and the standard Paint computer program. Results. The incidence of ascariasis in the region is characterized by significant diversity. Statistically reliable correlations of morbidity with environmental indices were obtained, and a mathematical equation was constructed using linear regression to predict the level of morbidity in the region. Conclusion. In the epidemiology of ascariasis in the Vladimir region, a leading role retains climatic, environmental indices determining the possibility of developing eggs of ascarids in the environment to the infective stage. A regional factor that affects the epidemiological process (indirectly through the suppression of the protective functions of the child’s body and reducing the development time of Ascaris eggs) is air pollution by stationary objects. The data obtained can assess the risk of infection with ascariasis to ensure biological safety in the region.

Background: Urinary tract infections (UTIs) are one of the most seen infection among community. Objectives: In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI). Methods: Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied. Results: In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. Escherichia coli (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times. Conclusion: Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI. Keywords: Urinary tract infection; community acquired; multidrug-resistant; male; multiple antibiotic usage; advanced age.

Introduction. Healthcare practitioners are at increased risk of infection with infectious diseases, including the inhalation route. Healthcare practitioners use respirators of various designs providing different efficiency of protection. The purpose of the study was to improve efficiency of the respiratory protection of the healthcare practitioners in Russian Federation. There were analyzed available NIOSH publications, articles in journals Taylor & Francis, Oxford University Press, published materials of Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor), and western training manuals. Differences in the requirements of the legislation were identified that increase the risk of infection in healthcare practitioners. There are no methods for assessing the risk level, and there are no specific requirements for selecting the respirator’s type that corresponds to the risk level. The employer is not obliged to provide the fit test for all employees. The respirator must be used timely, so it should not negatively affect the worker. But the average carbon dioxide concentration can exceed the STEL by more than two times. The certification requirements for respirators do not correspond to the conditions of their use in the hospitals. Respirators were not certified as means of protection against bioaerosols. Conclusions. Identified shortcomings in the respiratory safety of health care workers show possible ways to improve their protection by harmonizing national legislation with the best of existing Western requirements.

The purpose of this article is to identify the specific trends of migration flows induced by negative environmental changes in the context of the COVID-19 pandemic. First of all, based on an analysis of meteoro-logical data it was proved that in the near future, the risk of dangerous natural disasters that might cause large-scale population movements remains no less high than in the past few years. A temporary reduction in CO2 emissions due to a reduction in industrial production and transportation along with restrictive infection control measures will be short-term and insufficient to slow down climate change. Consequently, we can expect that during the pandemic the number of environmental migrants throughout the world will not decrease and might reach about 20 million people a year only due to forced relocations caused by weather-related hazards. In this study, we use the term environmental migrants to refer to both those people who have been forced to leave their place of residence due to natural or technological disasters, and those people who have voluntarily decided to migrate under amid slow-onset environ-mental degradation. Both of these categories of migrants are already exposed to the risks posed by adverse environ-mental conditions. In the context of a coronavirus pandemic, additional risks begin to affect each group differently. Internally displaced people will face problems caused by restrictions on movement imposed in most countries, as well as poor sanitary and hygienic conditions during evacuation and at temporary accommodation centers, which greatly increase the risk of infection and further spread of the virus. Voluntary environmental migrants in most cases move because of the inability to continue their usual economic activities in the changing environmental situation in their home region and the need to find a job in a sphere which does not depend directly on natural and climatic conditions. Most often these are farmers who look for temporary employment in cites. This category of migrants will be adversely affected by the economic consequences of the coronavirus pandemic, namely, the reduction of jobs and wages in a number of industries, especially ones that are related to public services and transportation. A cut in remittances will reduce the adaptive potential of their environmentally vulnerable home areas, and lead to further deterioration of the environment and living conditions of the population.