Search Results (984)

Background/Objectives: The COVID-19 pandemic caused pronounced disorder in healthcare delivery globally, including ophthalmology. Our study explores how ophthalmologists in Puerto Rico (PR) altered their practices during the pandemic, confronting obstacles such as resource shortages, evolving public health mandates, and unique socio-economic and geographic constraints. The study aims to enhance preparedness for future public health crises. Methods: We conducted descriptive analyses on four online surveys distributed at crucial time points of the pandemic (March 2020, May 2020, August 2020, August 2021) to all practicing ophthalmologists in PR (N ≈ 200), capturing data on closures, patient volume, personal protective equipment (PPE) access, telemedicine use, and financial relief. Results: Survey responses ranged from 41% (n = 81) to 56% (n = 111). By March 2020, 22% (24/111) of respondents closed their offices. By May 2020, 20% (19/93) of respondents maintained a closed office, while 89% (64/72) of open offices reported seeing less than 25% of their usual patient volume. Access to PPE was a challenge, with 59% (65/111) reporting difficulty obtaining N95 masks in March 2020. Telemedicine usage increased initially, peaking in May 2020 and declining in July 2020. By August 2021, all respondents were fully vaccinated and most practices returned to pre-pandemic levels. Overall, 86% (70/81) of respondents found the surveys to be useful for navigating practice changes during the pandemic. Conclusions: PR ophthalmologists showed adaptability during the COVID-19 pandemic to maintain care given limited resources. Guidelines from professional organizations and real time surveys play an important role in future crisis preparedness. Full article

Objectives: This study evaluates the efficacy of existing and new aerosol mitigation methods during nebulization (Neb) in combination with high-flow nasal cannula (HFNC) oxygen supplementation and non-invasive ventilation (NIV). Methods: We recorded fugitive aerosol particle concentrations over time and assessed the peak (P) and area (A) efficacy of active and passive mitigation methods, comparing them to a no-mitigation condition. Peak efficacy was measured by the reduction in maximum aerosol concentration, while area efficacy was quantified by the reduction of the area under the aerosol concentration–time curve. Results: For HFNC with Neb, we found that active mitigation using a mask with a biofilter and a fan (referred to as the aerosol barrier mask) significantly outperformed passive mitigation with a face mask. The peak and area efficacy for aerosol reduction were 99.0% and 96.4% for active mitigation and 35.9% and 7.6% for passive mitigation, respectively. For NIV with Neb, the active mitigation method, using a box with a biofilter and fan, also outperformed passive mitigation using only the box. The peak and area efficacy for aerosol reduction were 92.1% and 85.5% for active mitigation and 53.7.0% and 25.4% for passive mitigation, respectively. Conclusion: We concluded that active mitigation set up systems advantageous for effective reduction of airborne aerosols during aerosol generated procedures. Full article

Accurate classification of chest X-ray (CXR) images is crucial for diagnosing lung diseases in medical imaging. Existing deep learning models for CXR image classification face challenges in distinguishing non-lung features. In this work, we propose a new segmentation-assisted fusion-based classification method. The method involves two stages: first, we use a lightweight segmentation model, Partial Convolutional Segmentation Network (PCSNet) designed based on an encoder–decoder architecture, to accurately obtain lung masks from CXR images. Then, a fusion of the masked CXR image with the original image enables classification using the improved lightweight ShuffleNetV2 model. The proposed method is trained and evaluated on segmentation datasets including the Montgomery County Dataset (MC) and Shenzhen Hospital Dataset (SH), and classification datasets such as Chest X-Ray Images for Pneumonia (CXIP) and COVIDx. Compared with seven segmentation models (U-Net, Attention-Net, SegNet, FPNNet, DANet, DMNet, and SETR), five classification models (ResNet34, ResNet50, DenseNet121, Swin-Transforms, and ShuffleNetV2), and state-of-the-art methods, our PCSNet model achieved high segmentation performance on CXR images. Compared to the state-of-the-art Attention-Net model, the accuracy of PCSNet increased by 0.19% (98.94% vs. 98.75%), and the boundary accuracy improved by 0.3% (97.86% vs. 97.56%), while requiring 62% fewer parameters. For pneumonia classification using the CXIP dataset, the proposed strategy outperforms the current best model by 0.14% in accuracy (98.55% vs. 98.41%). For COVID-19 classification with the COVIDx dataset, the model reached an accuracy of 97.50%, the absolute improvement in accuracy compared to CovXNet was 0.1%, and clinical metrics demonstrate more significant gains: specificity increased from 94.7% to 99.5%. These results highlight the model’s effectiveness in medical image analysis, demonstrating clinically meaningful improvements over state-of-the-art approaches. Full article

Introduction: Efficient communication and collaboration among local health departments (LHDs), healthcare organizations, governmental entities, and other community stakeholders are critical for public health preparedness and response. This study evaluates (1) the impact of informatics on LHDs’ frequency and collaboration in creating consistent COVID-19 messaging; (2) the influence of informatics on targeted messaging for vulnerable populations; and (3) LHD characteristics linked to their consistent and/or targeted messaging engagement. Methods: This study analyzed the 2020 National Association of County and City Health Officials (NACCHO) Forces of Change (FOC) survey, the COVID-19 Edition. Of the 2390 LHDs invited to complete the core questionnaire, 905 were asked to fill out the module questionnaire as well. The response rate for the core was 24% with 587 responses, while the module received 237 responses, achieving a 26% response rate. Descriptive analyses and six logistic regression models were utilized. Results: Over 80% (183) of LHDs collaborated regularly with public health partners, and 95% (222) used information management applications for COVID-19. Most interacted with local and state agencies, but only half with federal ones. LHDs that exchanged data with local non-health agencies, engaged with local non-health agencies, and communicated weekly to daily with the public about long-term/assisted care had higher odds of creating consistent messages for the public, and about the use and reuse of masks had lower odds of collaborating with public health partners to develop consistent messages for the public. Conclusion: Our findings underscore the centrality of informatics infrastructure and collaboration in ensuring equitable public health messaging. Strengthening public health agencies and investing in targeted training are crucial for effective communication across the communities served by these agencies. Full article

The COVID-19 pandemic caused immense physical disruptions, affecting young adults in the U.S. The Health Belief Model is a social psychological framework that predicts the likelihood of adopting health behavior. The purpose of this research is to investigate COVID-19-related health beliefs and dietary behaviors among undergraduate students during the pandemic. Using convenience sampling, a cross-sectional survey was completed by 304 individuals at a New Jersey state university. Survey data included the frequency of COVID-19 prevention behaviors (e.g., wearing an indoor mask, handwashing), and consumption of fruit and vegetables. The Health Belief Model constructs measured perceived susceptibility to COVID-19, severity, benefits, barriers, and self-efficacy. Frequency distributions, t-tests, and Kruskal–Wallis tests were investigated for racial subgroups (Whites, Blacks, Latinos, and Asians). The mean age of the sample was 21.7, with 27% males, and 46% self-identified as White. Whites adopted fewer COVID-19 prevention behaviors (p < 0.001) than non-Whites. Black students perceived less COVID-19 severity (p < 0.01) and stronger perceived benefits (p < 0.05) than the other subgroups. Latino students perceived greater susceptibility (p < 0.01) and greater barriers than non-Latinos. Asians practiced higher mask wearing frequency (p < 0.05) but less daily fruit intake than their counterparts (p < 0.01). This research highlights the importance of handwashing, wearing indoor masks, and consuming produce among university students. Addressing barriers to health action while promoting the benefits of enacting behaviors to mitigate the risk of COVID-19 is warranted. Full article

Public media serves as a significant source of scientific information for non-scientists. However, the simplifications and omissions inherent in media reporting often alter the nature of scientific information, potentially influencing understanding and perceptions of science and the nature of science. This study investigates how mechanistic explanations about biological processes are represented in public media, focusing on two forms of incomplete mechanistic information: “gray boxes” and “black boxes”. Using COVID-19 as a case study, we analyzed 122 media reports of biological mechanisms to understand how incomplete parts are masked by more complete explanations and their implications. Our findings highlighted three main points. First, incomplete information often appears alongside complete information within other parts of the explanation. Second, some parts of similar mechanisms are presented differently, which can create a sense of conflicting information if incompleteness is not recognized. Third, multiple filler terms are used to mask black boxes within biological explanations (e.g., “cause”, “fight”, or “mutate”). While filler terms enhance narrative flow, they can obscure gaps in scientific knowledge and lead to anthropocentric or teleological explanations. We categorized these filler terms into three groups and discussed their relevance to teaching and learning. Implications for addressing partial information in the science classroom are discussed. Full article

The efficacy of steroid pulse therapy for treating severe coronavirus disease (COVID-19) pneumonia remains unclear. This study aimed to determine the efficacy of steroid pulse therapy for severe COVID-19 pneumonia in patients who did not respond to conventional therapy, including steroids. We included 76 patients with severe COVID-19 pneumonia treated with steroids in this single-facility retrospective observational study. Severe COVID-19 pneumonia was defined as requiring high-concentration oxygen administration (oxygen mask with reservoir mask (RM) > 6 L/min), high-flow nasal cannula oxygen therapy, or ventilatory support for respiratory control. The patient characteristics at admission and changes in them over time were examined in (a) a survival vs. death group, and (b) a steroid pulse vs. non-steroid pulse therapy group. Steroid pulse therapy significantly improved the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen just after the therapy and after one week of therapy, but had no effect on the sequential organ failure assessment scores over time. Multivariate logistic regression analyses showed that remdesivir use was associated with better survival outcomes, while steroid pulse therapy was associated with poor outcomes. In conclusion, steroid pulse therapy did not improve the prognosis of patients with severe COVID-19 pneumonia any more effectively than conventional steroid therapy. Full article

Background and Objectives: The aging population and the COVID-19 pandemic have led to a rise in severe conditions, including musculoskeletal (MSK) disorders. Although MSK conditions are often managed in primary care, they may sometimes mask serious illnesses requiring urgent diagnosis. The red flag (RF) concept is essential for identifying signs and symptoms of potentially severe disease. However, RF criteria vary across clinical guidelines and lack consistency. With the growing role of direct access to physiotherapy—bypassing physician referral—physiotherapists must develop strong differential diagnostic skills to identify serious pathologies that mimic MSK disorders. This review aims to systematically map how RFs are defined in MSK clinical practice guidelines (CPGs), supporting the move toward a standardized definition for clinical and research use. Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane databases. Included studies were CPGs and systematic reviews (SRs) of CPGs addressing MSK disorders and incorporating the RF concept. Data extraction followed a rigorous process, and RF definitions were synthesized and compared in table format. Results: Out of thirteen-thousand three-hundred and ninety-three articles identified, fourteen met inclusion criteria (seven CPGs and seven SRs of CPGs), spanning both physiotherapy and medical fields. All definitions described RFs as signs or symptoms indicating possible serious pathology requiring further investigation or referral. Some definitions referred broadly to “patterns of signs or symptoms”, while others offered more precise criteria. Conclusions: This review highlights the lack of a standardized RF definition in MSK care, leading to inconsistencies in clinical decision-making and diagnosis. To improve patient safety and guide clinicians—especially in direct-access contexts—a unified, internationally recognized definition of RFs is needed in future guidelines. Full article

The coronavirus (COVID-19) pandemic has profoundly affected public health and socio-economic structures globally. This research conducted a post-COVID-19 analysis of the role of fiscal support interventions on COVID-19 health regulations such as mandatory non-pharmaceutical interventions like face masks, social distancing, periodic lockdowns which include restrictions on movement, and socio-economic dimensions. This quantitative research obtained 302 responses from different households in the Eastern Cape, Gauteng, Kwa-Zulu Natal, and Limpopo Provinces in South Africa. The results reveal that the relief fund (R350 unemployment grant, unemployment insurance fund claim, and food parcel distribution, among others) mediated the relationship between COVID-19 health regulations and poverty levels and the relationship between COVID-19 health regulations and health and well-being. The relief fund also mediated the relationship between COVID-19 health regulations and employment levels. Support packages from the R500 billion government support, which included loan guarantees, job support, tax and payment deferrals and holidays, social grants, wage guarantees, health interventions, and municipalities support, moderate the relationship between COVID-19 health regulations and the family and social support. These results validate the impact of the fiscal support intervention by the government in mitigating its emergency intervention with COVID-19 health regulations. This strengthens the theory of intervention, highlighting that multiple dynamics make interventions complex as shown by mediation and moderation results. Furthermore, this study highlights intervention being central to the management of the crisis. The study highlights the importance of comprehensive intervention for future preparedness, thus advancing the crisis–intervention perspective. Advances in these areas are critical to mitigate the impact of the next pandemic or similar major events in society. This can be achieved through improved pandemic timely response with effective economic stimulus, social relief, strong legal framework, and anti-corruption policies. Full article

Background: The COVID-19 pandemic highlighted the crucial role of community preventive behaviors in controlling the virus’ spread. Studies show that people’s risk perceptions and awareness significantly contribute to the containment and prevention of infections by motivating adoption of desired actions and behaviors. This study aimed at assessing the role of risk communication and factors that influenced responses during the COVID-19 pandemic in rural communities in Western Kenya. Methods: A descriptive cross-sectional study was conducted using a quantitative research approach, collecting data from 806 individuals across Kisumu, Vihiga, and Kakamega counties. Descriptive statistics were used to detail the demographic characteristics of the study population, while logistic regression analysis estimated the associations between risk communication and demographic characteristics on COVID-19 vaccine acceptance, compliance with mitigation behaviors, perceived severity, and perceived susceptibility. Results: The results showed that 55% of participants were male and 45% were female, with an average moderate compliance with safety measures (mean = 5.15). A significant portion of participants wore face masks (85.3%), practiced hand hygiene (78.9%), and avoided close contact behaviors (66.6%). Most respondents received information through mass media (86.1%) and health workers (72.9%). Compliance with COVID-19 mitigation measures was highest among those who trusted information from official institutions, health professionals, and mass media, compared to social media, with increased odds of 2.7 times and 2.5 times, respectively. Higher risk perception was significantly associated with older age groups (above 50 years), being male, and working in the private sector. Effective risk communication significantly influenced risk perception, compliance with COVID-19 measures, and vaccination acceptance. Conclusions: The findings suggest that effective risk communication strategies are critical during public health emergencies and hence implications for future public health crises. The results underscore the importance of targeted communication and tailored interventions to improve compliance and vaccine acceptance among different demographic groups, ensuring a more robust public health response during outbreaks and pandemics. Full article

Background: Respirators are essential for protecting healthcare personnel (HCPs) from airborne infections, and were particularly valuable during the COVID-19 pandemic. However, knowledge gaps, attitudes, and perceived usability issues may hinder their proper use, especially in settings lacking formal respiratory protection programs. Objective: The aim of this study was to assess the knowledge, attitudes, practices (KAP), and perceived usability of respirators among Thai healthcare personnel at a university hospital in Northern Thailand and identify differences across job roles. Methods: A cross-sectional survey was conducted among HCPs at a university hospital in Northern Thailand. Participants completed a validated questionnaire covering demographic data, KAP, and perceived usability of respirators. Descriptive and inferential statistics were used to analyze group differences. Results: A total of 479 valid responses were analyzed from physicians (31.7%), nurses (37.6%), and other HCPs (30.7%). Only around 12% of all participants correctly identified that surgical masks are not respirators, although over 90% correctly identified the nature of N95/KN95-type filtering facepiece respirators. Nurses demonstrated higher knowledge of respirator standards and proper use. Confidence and willingness to use industrial or reprocessed sterile respirators varied significantly by role (p < 0.05). Only 30.5% had received fit-testing. Perceived usability concerns included discomfort, heat, and breathability, reported across all groups. Conclusions: Knowledge, attitudes, and practices related to respirator use varied by professional role, with notable gaps in fit-testing and perceived usability. Findings highlight the need for targeted training, consistent fit-testing protocols, and improved respirator design for comfort to ensure effective respiratory protection in healthcare settings. Full article

This study investigates the upcycling of disposable face masks, which were produced in vast quantities during the COVID-19 pandemic and are now widely stockpiled in public institutions, destined for landfills after reaching expiration dates. The research focuses on incorporating shredded mask fibers into geopolymer matrices, evaluating the effects on mechanical and thermal properties to develop sustainable, high-performance materials. This approach addresses critical environmental, social, and economic challenges by transforming problematic waste into valuable resources while promoting sustainable building practices, such as developing insulating products for the construction industry. Mechanical testing demonstrated that adding shredded mask fibers (2 mm and 6 mm in size, up to 5 wt.%) enhanced the flexural strength of geopolymeric products. The optimal performance was achieved by adding 3 wt.% of 2 mm-length fibers, resulting in a flexural strength of 4.56 ± 0.23 MPa. Regarding compressive strength, the highest value (54.78 ± 2.08 MPa) was recorded in geopolymers containing 1 wt.% of 2 mm fibers. Thermal insulation properties of the materials improved with higher mask content, as evidenced by reductions in thermal conductivity, diffusivity, and specific heat. The lowest thermal conductivity values were observed in geopolymers containing 5 wt.% (0.4346 ± 0.0043 W·m⁻¹·K⁻¹) and 3 wt.% (0.6514 ± 0.0002 W·m⁻¹·K⁻¹) of 2 mm mask fibers. To further enhance thermal insulation, geopolymers with 5 wt.% mask fibers were foamed using H₂O₂ to obtain highly porous light materials, obtaining a reduction of thermal conductivity (0.3456 and 0.3710 ± 0.0007 W·m⁻¹·K⁻¹). This research highlights the potential of integrating fibrous waste materials into advanced construction technologies, offering solutions for waste reduction and development in the building sector toward sustainability. Full article

The widespread use of disposable masks during the COVID-19 pandemic has led to a sharp increase in plastic waste, mainly due to the non-biodegradable polypropylene materials used in conventional mask production. This study aimed to develop an eco-friendly Korean filter-certified health mask using biodegradable polylactic acid fibers and natural materials. The traditional synthetic components of the outer, filter, and inner layers of the mask were replaced with sustainable alternatives. In addition, antibacterial and deodorizing properties were enhanced using jade-based coatings. Performance tests confirmed the filtration efficiency and breathability of the mask. The mask achieved over 70% biodegradability and decomposed within 45 days in composting environments, leading to a lower environmental impact than conventional masks. In addition, wearability assessments indicated significantly improved comfort, particularly in terms of breathability and hygiene. This study highlights the potential of sustainable mask production and its role in addressing plastic waste. This study presents a sustainable alternative to maximize the biodegradability of mask materials, thereby reducing carbon emissions and landfill burdens after disposal. This work reflects the social responsibility towards environmental issues through the use of eco-friendly materials and has implications for increasing the demand for sustainable products. Full article

The COVID-19 pandemic has exacerbated the problem of environmental contamination of disposable personal protective equipment, in particular face masks (FMs). As a result of environmental factors, FMs undergo aging and fragmentation processes and become a source of microplastics (MPs) and chemical additives. Taking into account the scale of accumulation of used FMs and their fragments in the coastal zone, it should be expected that the most appreciable ecotoxicological consequences should be observed in hydrobionts inhabiting coastal ecosystems. Based on this, the aim of this study was to investigate the toxicity of leachates from pristine and weathered FMs using sperm of sand dollars Scaphechinus mirabilis. In our work, we used pristine and weathered FMs, which for 200 days were kept in the external environment under natural conditions and exposed to a complex of climatic factors. Fourier transform infrared spectroscopy was used to characterize the chemical changes that occurred in the polymer structure of FMs during this period. It follows from the results obtained that leachates from pristine and weathered FMs reduced sperm viability; stimulated the accumulation of lipid peroxidation products, such as malondialdehyde (MDA); and significantly increased the destruction of DNA molecules, showing a genotoxic effect. Overall, our results complement the limited experimental data presented, indicating the genotoxic properties of face mask extracts. Full article

This study explores the association between vision/hearing impairment and COVID-19 prevention strategies in the 2020 and 2021 California Health Interview Survey (CHIS). This cross-sectional study used data from the 2020 and 2021 CHIS. The exposure of interest was self-reported history of sensory impairment. The outcome of interest was adherence to COVID-19 mitigation strategies defined as obtaining a COVID-19 vaccine, face mask adherence, hand washing, social distancing, and not gathering with non-household members. Logistic regression models examined the association between sensory impairment and adherence to COVID-19 mitigation strategies, controlling for age, sex, race and ethnicity, general health status, and household income. All analyses were weighted according to the CHIS sampling design. With 24,453 California adults representing 29,649,837 people, the weighted prevalence of sensory impairment was 6.1% (1,808,640/29,649,837). The regression revealed that adults with sensory impairment were 80% more likely not to maintain social distancing (odds ratio: 1.80, 95%CI: 1.03–3.13, p = 0.04) compared to those without impairment. No significant differences were found for adherence to other COVID-19 strategies. Individuals with sensory impairment may have increased difficulty with physical distancing due to their underlying impairment. Further studies are needed to explore risk reduction strategies for COVID-19 and the transmission of other infections for those with sensory impairment. Full article