INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, multiple guidelines have recommended videolaryngoscope (VL) for tracheal intubation. However, there is no evidence that VL reduces time to tracheal intubation, and this is important for COVID-19 patients with respiratory failure. METHODS: To simulate intubation of COVID-19 patients, we randomly assigned 28 elective surgical patients to be intubated with either McGrath™ MAC VL or direct laryngoscope (DL) by specialist anaesthetists who donned 3M™ Jupiter™ powered air-purifying respirators (PAPR) and N95 masks. The primary outcome was time to intubation. RESULTS: The median time to intubation was 61 s (interquartile range [IQR] 37-63 s) and 41.5 s (IQR 37-56 s) in the VL and DL groups, respectively ( P = 0.35). The closest mean distance between the anaesthetist and patient during intubation was 21.6 ± 4.8 cm and 17.6 ± 5.3 cm in the VL and DL groups, respectively ( P = 0.045). There were no significant differences in the median intubation difficulty scale scores, proportion of successful intubations at the first laryngoscopic attempt and proportion of intubations requiring adjuncts. All the patients underwent successful intubation with no adverse event. CONCLUSION There was no significant difference in the time to intubation of elective surgical patients with either McGrath™ VL or DL by specialist anaesthetists who donned PAPR and N95 masks. The distance between the anaesthetist and patient was significantly greater with VL. When resources are limited or disrupted during a pandemic, DL could be a viable alternative to VL for specialist anaesthetists.
Humans ; COVID-19 ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy ; Respiratory Protective Devices ; Video Recording

BACKGROUND: Owing to shortage of surgical and N95 filtering facepiece respirators (FFRs) during the COVID-2019 pandemic, various masks were developed to prevent infection. This study aimed to examine the inward leakage rate (ILR) of sealed face masks and modified surgical masks using a quantitative fit test and compared it with the ILR of unmodified N95 FFRs. METHODS: We conducted paired comparisons of ILRs of bent nose-fit wire masks, double masks, and N95 FFRs from October to December 2021. To measure the protective effectiveness of masks, participants wore masks, and the number of particles outside and inside the mask were measured. The ILR was based on the percentage of particles entering the mask using a fit tester. RESULTS: We enrolled 54 participants (20 men and 34 women) in this study. The median ILR for surgical masks without and with a W-shaped bend in the nose-fit wire were 96.44% and 50.82%, respectively. The nose-fit wire adjustment reduced the ILR of surgical masks by a mean of 28.57%, which was significantly lower than the ILR without adjustment (P < 0.001). For double masks, with surgical or polyurethane masks on top of the W-shaped mask, the ILR did not differ significantly from that of N95. Although the filtration performance of double surgical masks matched that of N95 masks, their ILR was notably higher, indicating that double masks do not provide equivalent protection. CONCLUSIONS Wearing N95 masks alone is effective in many cases. However, surgical mask modifications do not guarantee consistent effectiveness. Properly selected, sealed masks with a good fit overcome leakage, emphasizing their crucial role. Without evidence, mask-wearing may lead to unexpected infections. Education based on quantitative data is crucial for preventing adverse outcomes.
Male ; Humans ; Female ; N95 Respirators ; COVID-19/epidemiology* ; Masks ; Pandemics/prevention & control* ; Respiratory Protective Devices ; Materials Testing ; Equipment Design ; Occupational Exposure/prevention & control*

INTRODUCTION: Falls from heights contribute to 34% of fatal accidents in Singapore. Of these, 51% of the accidents occur in the construction industry. This retrospective review, of all persons falling from heights in the construction industry from 2006 to 2012 and attending a major hospital, analysed injury patterns and related them to mechanisms and contributory factors. METHODS: Information collected included injury and casualty characteristics, safety measures, pre-existing medical conditions and clinical outcomes. RESULTS: Of 1,085 patients, 951 were male with a mean age of 39.8 years, mean height of 165.9 cm and mean weight of 69.7 kg. Most of the casualties fell between 0800 and 2000 hours. Among the severely injured patients, 2.4% had head injuries, 54.9% had chest injuries and 39.2% had abdominal and pelvic injuries. For these casualties, the mortality rate was 60.8%. For patients with less than major trauma, the commonest injuries were in the lower limbs (41.8%), upper limbs (40.8%) and spine (22.2%). All the casualties survived. Falls from scaffolding, formwork and platforms were the most common causes of severe injuries (41.1%). Safety helmets and harnesses were reported to be used in 1.8% and 4.1% of instances of falls, respectively. CONCLUSION Studying the patterns of injuries following falls at construction sites has the potential for injury prevention through safe practices, use of safety equipment and targeted training.
Humans ; Male ; Adult ; Female ; Construction Industry ; Craniocerebral Trauma/etiology* ; Protective Devices ; Head Protective Devices ; Retrospective Studies ; Wounds and Injuries/etiology* ; Injury Severity Score

Objective: To get insight into the current practice of noise reduction effect of workers as they wore hearing protectors in different domestic enterprises and the possible affected factors. Methods: From October 2020 to April 2021, using a random sampling method, 1197 workers exposed to noise in petrochemical factories, textile factories, and parts manufacturing factories were selected as the study subjects. The noise reduction effect of hearing protectors worn by workers in daily use was tested using a hearing protector suitability testing system. The personal sound attenuation level (PAR) was compared among workers in three enterprises, Targeted intervention and repetitive testing were conducted for workers who did not meet the noise reduction effect required by the enterprise, and the changes in PAR of workers before and after the intervention were compared. The comparison of baseline PARs between two or more groups was performed using the Mann Whitney test, the comparison of baseline PARs with post intervention PARs was performed using the Wilcoxon signed rank sum test, and the comparison of qualitative data between two or more groups was performed using the Chi square test. Results: The median baseline PAR for all workers was 15 dB. Men, age<30 years old, education level at or above college level, working experience of 5 to 15 years, and those who used hearing protectors for 5 to 15 years had higher PARs, with statistically significant differences (P<0.05). The median difference in baseline PAR among workers from three enterprises was statistically significant (H=175.06, P<0.01). The median PAR of subjects who did not pass the baseline increased from 3 dB to 21 dB after intervention (Z=-27.92, P<0.01) . Conclusion: Some workers wearing hearing protectors do not meet the required PAR, and low PARs may be related to incorrect wearing methods and incorrect selection of hearing protectors. As a tool for testing, training, and assisting in selection, the hearing protector suitability testing system is of great significance for worker hearing protection.
Male ; Humans ; Adult ; Hearing Loss, Noise-Induced/prevention & control* ; Ear Protective Devices ; Noise, Occupational/prevention & control* ; Hearing ; Audiometry

Objective: To explore the occupational protective effect of different protective devices on the operators during manual cleaning and oiling of dental handpieces, and to provide a basis for the selection of appropriate protective methods. Methods: From November 2020 to December 2021, 20 high-speed dental handpieces of the same brand were selected and randomly divided into disposable protective bag group and small aerosol safety cabinet group by drawing lots, with 10 in each group. After recording the model, they were distributed to the clinical fixed consulting room for use, and were collected by specially-assigned personnel every day for manual cleaning under the protection of the two devices. By measuring the number of airborne colonies, the concentrations of particulate matter and the satisfaction of operators, the occupational protection effect of the two protective devices on operators was evaluated. Results: Under the protection of the two devices, the average number of airborne colonies after operation was less than 1 CFU/ml. When no protective device was used, the number concentration of particulate matter produced during operation was (21595.70±8164.26) pieces/cm(3). The number concentrations of particles produced by disposable protective bag group [ (6800.24±515.05) pieces/cm(3)] and small aerosol safety cabinet group [ (5797.15±790.50) pieces/cm(3)] were significantly lower than those without any protective device (P<0.001). The number concentration of particle matter of small aerosol safety cabinet group was significantly lower than that of disposable protective bag group (P<0.001). In the satisfaction evaluation of operators, small aerosol safety cabinet group [ (3.53±0.82) points] was significantly better than disposable protective bag group [ (2.23±1.10) points] (P<0.001) . Conclusion: The use of small aerosol safety cabinet during manual cleaning and oiling of dental handpieces has good protective effect, superior safety performance and strong clinical applicability, and has advantages in occupational protection of clinical operators.
Aerosols ; Particulate Matter ; Protective Devices

Background. The use of face shield in addition to face mask is thought to reduce the transmission of SARS-CoV-2 by blocking respiratory droplets and by preventing one from touching facial orifices.

Objective. To determine the effectiveness of face mask with face shield, compared to face mask alone, in reducing transmission of SARS-CoV-2.

Methods. We searched MEDLINE, Cochrane Library, as well as trial registers, preprint sites and COVID-19 living evidence sites as of 30 September 2021. We included studies that used face shield with face mask versus face mask alone to prevent COVID-19. We screened studies, extracted data, assessed the risk of bias and certainty of evidence using the GRADE approach. Review Manager 5.4 was used to estimate pooled effects.

Results. There is no available direct evidence for face shield plus face mask versus face mask alone in the general public. Five (5) observational studies with very low certainty of evidence due to serious risk of bias and indirectness were included. Participants in all the studies were health care workers (HCWs) who used the face shield with their standard personal protective equipment (PPE). Four (4) of the studies were in the hospital setting (three case control studies, one pre- and post-surveillance study); one was done in the community (one pre- and post-surveillance study) in which HCWs visited the residence of the contacts of SARS-CoV-2 positive patients. The case control studies done in the hospital setting showed a trend toward benefit with the use of face shield or goggle but this was inconclusive (OR 0.85, 95% CI 0.68-1.08) while the pre- and post-surveillance study showed significant benefit when face shield (OR 0.28, 95% CI 0.22-0.37) use became a requirement for HCWs upon hospital entry. In the study done in the community setting, significant protection for HCWs was noted with the use of face shield (OR 0.04, 95% CI 0.00-0.69) but the results were limited by serious risk of bias and imprecision.

Conclusion. In the hospital setting, there was a lower likelihood of COVID-19 infection in HCWs who used a face shield or goggles on top of their PPE. For the general public in the community, there is presently no study on the use of face shield in addition to the face mask to prevent COVID-19 infection.

INTRODUCTION: Wheeled recreational devices (WRDs) include tricycles, bicycles, scooters, inline skates, skateboards, longboards and waveboards, and can cause significant morbidity and mortality. This study aimed to describe the epidemiology and nature of injuries sustained by children from WRD use, and risk factors for severe injury. METHOD: We described injuries relating to WRD use in children <18 years who presented to the emergency department of an Asian tertiary hospital between 2016 and 2020. Demographic data, site and nature of the injury, and historical trends were analysed. Risk factors for severe injury (defined as fractures or dislocations), Injury Severity Score ≥9, and injuries resulting in hospitalisation, surgery or death were evaluated. RESULTS: A total of 5,002 patients with 5,507 WRD-related injuries were attended to over the 5-year study period. Median age was 4.7 years. Injuries related to bicycles (54.6%) and scooters (30.3%) were most frequent, followed by skateboards and waveboards (7.4%), inline skates (4.7%), and tricycles (3.0%). Injuries occurred most frequently in public spaces. Soft tissue injuries (49.3%) and fractures (18.7%) were the most common diagnoses. Upper limb (36.4%) and head and neck (29.0%) regions were the most common sites of injury. Among the patients, 1,910 (38%) had severe injuries with potential morbidity. On multivariate analysis, heavier children of the school-going age who use either scooters, skateboards or inline skates are more prone to severe injuries. Involvement in a vehicular collision was a negative predictor. CONCLUSION WRD use in children can result in severe injuries. Wrist and elbow guards, as well as helmets are recommended, along with adequate parental supervision.
Child ; Child, Preschool ; Emergency Service, Hospital ; Fractures, Bone/etiology* ; Head Protective Devices ; Humans ; Injury Severity Score ; Retrospective Studies ; Risk Factors ; Singapore/epidemiology*

COVID-19/transmission* ; Cesarean Section ; Emergencies ; Female ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Inservice Training ; Pregnancy ; Respiratory Protective Devices ; Time-to-Treatment

BACKGROUND: Helmet use reduces the risk and severity of head injury and death due to road traffic crash among motorcyclists. The protective efficacy of different types of helmets varies. Wearing firmly fastened full-face helmet termed as effective helmet use provides greatest protection. This study estimates the prevalence and factors associated with effective helmet use among motorcyclists in Mysuru, a tier II city in Southern India. METHODS: Cross-sectional road side observational study of 3499 motorcyclists (2134 motorcycle riders and 1365 pillion riders) at four traffic intersections was done followed by interview of random sample of 129 of the above riders. Effective helmet use proportion and effective helmet use per 100 person-minute of observation was calculated. Multivariate logistic regression analysis was done to identify factors associated with effective helmet use. RESULTS: Prevalence of effective helmet use was 28 per 100 riders and 19.5 per 100 person-minute of observation in traffic intersections. Prevalence rates of effective helmet use was higher among riders (34.5% vs pillion riders 18.1%), female riders (51.3% vs male riders 26.8%), and male pillion riders (30.5% vs female pillion riders 13.7%). Riders commuting for work and school and those ever stopped by the police in the past 3 months had significantly higher odds of effective helmet use. CONCLUSION Despite helmet use being compulsory by law for motorcyclists, the effective helmet use was low in Mysore. Strict enforcement and frequent checks by the police are necessary to increase the effective helmet use.
Adult ; Cities ; Craniocerebral Trauma ; prevention & control ; Cross-Sectional Studies ; Female ; Head Protective Devices ; statistics & numerical data ; Humans ; India ; Male ; Middle Aged ; Motorcycles ; statistics & numerical data ; Transportation ; Young Adult

PURPOSE: Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran. METHODS: In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used. RESULTS: Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%). CONCLUSION Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.
Accidental Injuries ; epidemiology ; mortality ; prevention & control ; Accidents, Traffic ; mortality ; prevention & control ; statistics & numerical data ; Adolescent ; Adult ; Child ; Cross-Sectional Studies ; Educational Status ; Female ; Head Protective Devices ; statistics & numerical data ; Health Education ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Motorcycles ; Registries ; Young Adult