Outdoor air pollutants exposure associated with pulmonary function and EBC pH value in atopic asthmatic and non-asthmatic children.

OBJECTIVE: Air pollution is associated with the prevalence of respiratory diseases. This study aimed to evaluate the impacts of outdoor air pollutants and indoor Dermatophagoides pteronyssinus 1 (Der p 1) exposure on levels of fractional exhaled nitric oxide (FeNO), exhaled breath condensate (EBC) pH, and pulmonary function in atopic children. METHODS: This study recruited 59 atopic mild-to-moderate asthmatic children and 23 atopic non-asthmatic children. Data on personal characteristics, FeNO, EBC pH, and pulmonary function were collected. Group 1 allergens of Der p 1 were measured on the tops of mattresses and on bedroom floors in the children's homes, and outdoor air pollutant concentrations were estimated from air quality monitoring stations, using the ordinary kriging method. RESULTS: Exposure levels of outdoor air pollutants, except for particulate matter (PM)2.5, for the recruited children met outdoor air quality standards set by the Taiwan Environmental Protection Agency. The lag effect of outdoor PM10 exposure was negatively associated with the forced expiratory volume in one second (FEV1) [(Lag 1: ß=-0.771, p = 0.028), and O3 (Lag 1-7: ß=-2.02, p = 0.04, Lag 1-28: ß=-3.213, p = 0.029)]. Median pulmonary function parameters differed significantly in forced vital capacity (FVC) (p = 0.004) and FEV1 (p = 0.024) values between atopic asthmatic and non-asthmatic children. No association was found between the FeNO/EBC pH level and exposure to Der p 1 allergen and air pollutants in the recruited children. CONCLUSIONS: Outdoor PM10 and O3 exposure was associated with reduction in FEV1 in atopic asthmatic and non-asthmatic children.

The association between maternal exposure to outdoor air pollutants, inflammatory response, and birth weight in healthy women.

Increased maternal inflammatory response has been noted in women with pregnancies complicated by preterm birth and small-for-gestational age infants. However, the association between gestational exposure to air pollutants, maternal inflammatory response, and fetal growth remains unclear. In this study, we aimed to investigate the association between exposure to air pollutants during pregnancy and the concentration of inflammatory indicators in maternal and fetal circulations, as well as fetal growth. We recruited 108 healthy pregnant women living in northern (n = 55) and southern (n = 53) areas of Taiwan and prospectively collected information of exposure to outdoor air pollutants throughout gestation. Maternal blood from each trimester and umbilical cord blood after delivery were collected and analyzed for inflammatory indicators including high sensitivity C-reactive protein (hs-CRP), interleukin-1ß (IL-1ß), and tumor necrosis factor (TNF)-α. Our results showed that exposure to particulate matter less than or equal to 10 µm (PM10) and ozone (O3) during the first trimester had a direct effect on reduction of birth weight, but the direct effect of PM10 mediated by hs-CRP and the direct effect of O3 mediated by TNF-α on fetal birth weight were not significant. Exposure to PM10 and PM2.5 during the second and third trimesters also directly affected birth weight. Furthermore, exposure to sulfur dioxide (SO2) caused changes in the concentrations of TNF-α in maternal blood during the second trimester, which subsequently resulted in reduced fetal weight. Together, these results indicate that exposure to air pollutants may cause both direct and indirect effects on the reduction of fetal weight.

Sources and components of volatile organic compounds in breast surgery operating rooms.

OBJECTIVES: The composition and concentration distribution of volatile organic compounds (VOCs) in surgical smoke had seldomly been reported. This study aimed to investigate the profile of VOCs and their concentration in surgical smoke from breast surgery during electrocautery in different tissues, electrosurgical units, and electrocautery powers. METHODS: Thirty-eight surgical smoke samples from 23 patients performed breast surgery were collected using evacuated stainless steel canisters. The concentrations of 87 VOCs in surgical smoke samples were analyzed by gas chromatography-mass spectrometry. The human tissues, electrosurgical units, and electrocautery power were recorded. RESULTS: The median level of total VOCs concentrations in surgical smoke samples from mammary glands (total VOCs: 9953.5 ppb; benzene: 222.7 ppb; 1,3-butadiene: 856.2 ppb; vinyl chloride: 3.1 ppb) using conventional electrosurgical knives were significantly higher than that from other tissues (total VOCs: 365.7-4266.8 ppb, P < 0.05; benzene: 26.4-112 ppb, P < 0.05; 1,3-butadiene: 15.6-384 ppb, P < 0.05; vinyl chloride: 0.6-1.8 ppb, P < 0.05) using different electrosurgical units. A high methanol concentration was found in surgical smoke generated during breast surgery (641.4-4452.5 ppb) using different electrosurgical units. An electrocautery power of ≥ 27.5 watts used for skin tissues produced a higher VOCs concentration (2905.8 ppb). CONCLUSIONS: The surgical smoke samples collected from mammary glands using conventional electrosurgical knives had high VOCs concentrations. The carcinogens (including benzene, 1,3-butadiene, and vinyl chloride) and methanol were found in the surgical smoke samples from different electrosurgical units. The type of electrosurgical unit and electrocautery power used affected VOCs concentrations in surgical smoke.

Use of urinary hippuric acid and o-/p-/m-methyl hippuric acid to evaluate surgical smoke exposure in operating room healthcare personnel.

Toluene and xylene are common components of surgical smoke, whereas hippuric acid (HA) and methylhippuric acid (MHA) are the products of toluene and xylene metabolism in humans, respectively. HA and MHA can be used as indicators to evaluate the exposure hazards of toluene and xylene. In this study, we used liquid chromatography tandem mass spectrometry (LC-MS/MS) to simultaneously analyze the HA, o-/m-/p-MHA, and creatinine contents in the urine of healthcare personnel. Concentrations of HA and o-/m-/p-MHAs were normalized to those of creatinine and used to analyze urine samples of 160 operating room (OR) healthcare personnel, including administrative staff, surgical nurses, nurse anesthetists, and surgeons. The results showed that the five analytes could be accurately separated and exhibited good linearity (r > 0.9992). The rate of recovery was between 86% and 106%, and the relative standard deviation was less than 5%. Urine from administrative staff presented the highest median concentration of hippuric acid (0.25 g/g creatinine); this was significantly higher than that found in the urine of surgeons (0.15 g/g). The concentrations of urinary o-/m-/p-MHAs in surgical nurses were higher than those in administrative staff, nurse anesthetists, and surgeons. Furthermore, the type, sex, and age of healthcare personnel were associated with changes in urine HA and o-/m-/p-MHA concentrations. Healthcare personnel should be aware of the risk of exposure to surgical smoke.

Aerosol delivery during spontaneous breathing with different types of nebulizers- in vitro/ex vivo models evaluation.

BACKGROUND: Nebulizers for spontaneous breathing have been evaluated through different study designs. There are limitations in simulated bench models related to patient and nebulizer factors. The aim of this study was to determine the correlation of inhaled drug mass between in vitro and ex vivo studies by testing aerosol deposition of various types of nebulizers. METHODS: Ten healthy subjects were recruited to receive aerosol therapy with five nebulizers in random order: 1) a jet nebulizer (JN); 2) a breath-enhanced nebulizer (BEN); 3) a manually triggered nebulizer (MTN), 4) a breath-actuated nebulizer (BAN), and 5) a vibrating mesh nebulizer (VMN) with valved-adapter. A unit dose of salbutamol containing 5 mg in 2.5 mL was placed into the nebulizer and administered for 10 min. For the ex vivo study, minute ventilation of healthy subjects was recorded for 1 min. For the in vitro study a breathing simulator was utilized with adult breathing patterns. Aerosolized drug from the nebulizers and the accessory tubes was captured using inspiratory and expiratory collecting filters. Captured drug was eluted, measured and expressed as inhaled and exhaled mass using spectrophotometry at a wavelength of 276 nm. RESULTS: 10 healthy subjects were recruited, aged 20.8 ±â€¯0.7 years old, with a mean height of 166.2 ±â€¯9.2 cm and weight of 64.7 ±â€¯12.4 kg. There was no significant difference in the inhaled drug dose between the JN and BEN (15.0 ±â€¯1.94% and 17.74 ±â€¯2.65%, respectively, p = .763), yet the inhaled doses were lower than the other three nebulizers (p < .001). The VMN delivered greater inhaled dose than the other four nebulizers (p < .01). The respiratory rate of the cohorts was significantly correlated with the inhaled drug dose. For the in vitro model, the JN delivered a lower inhaled dose (11.6 ±â€¯1.6, p < .001) than the other nebulizers, whereas the MTN and BAN deposited significantly lower exhaled doses (1.7 ±â€¯0.4 and 2.7 ±â€¯0.2, respectively, p < .001). The VMN demonstrated a greater drug dose with the in vitro study than the ex vivo model (44.0 ±â€¯0.9% and 35.5 ±â€¯6.3% respectively, p = .003), whereas the JN in the ex vivo model resulted in a greater inhaled drug dose (15.0 ±â€¯1.9% for ex vivo vs 11.6 ±â€¯1.6% for in vitro, p = .008). CONCLUSIONS: These in vitro/ex vivo model comparisons of nebulizers performance indicated that breath-related nebulizers can be estimated using an in vitro model; however, the JN and VMN delivered inhaled drug mass differed between models. There was a significant correlation between respiratory rate and inhaled mass, and the inhaled drug dose generated by VMN correlated with minute ventilation. This study demonstrated that the VMN produced greater inhaled drug dose and lowest residual dose, whereas the BEN, BAN, and MTN produced lower exhaled drug dose in both in vitro and ex vivo models.

Size distribution of salbutamol/ipratropium aerosols produced by different nebulizers in the absence and presence of heat and humidification.

BACKGROUND: Few studies have evaluated the size distribution of inhaled and exhaled aerosolized drugs, or the effect of heated humidification on particle size and lung deposition. The present study evaluated these aspects of bronchodilator (salbutamol/ipratropium) delivery using a lung model in the absence and presence of heat and humidification. METHODS: We positioned filters to collect and measure the initial drug, inhaled drug, and exhaled drug. Particle size distribution was evaluated using an 8-stage Marple personal cascade impactor with 0.2-µm polycarbonate filters. RESULTS: A greater inhaled drug mass was delivered using a vibrating mesh nebulizer (VMN) than by using a small volume nebulizer (SVN), when heated humidifiers were not employed. When heated and humidified medical gas was used, there was no significant difference between the inhaled drug mass delivered by the VMN and that delivered by the SVN. A significantly greater mass of inhaled 1.55-µm drug particles was produced by the VMN than with the SVN, under heated and humidified conditions. However, the mass median aerodynamic diameters (MMADs) of the aerosolized drug produced by the SVN and VMN did not differ significantly under the same conditions. CONCLUSIONS: The VMN produced more fine particles of salbutamol/ipratropium, and the drug particle size clearly increased in the presence of heat and humidification.

Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time series design.

BACKGROUND: For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent-infant interactions. A substantial lack of interactional knowledge can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers' mother-infant interaction quality and parenting sense of competence. METHODS: Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother-infant interactions. RESULTS: We observed an increase in the quality of mother-infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother-infant interaction. CONCLUSIONS: Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants' abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction.

Effect of ventilation rate on air cleanliness and energy consumption in operation rooms at rest.

The interrelationships between ventilation rate, indoor air quality, and energy consumption in operation rooms at rest are yet to be understood. We investigate the effect of ventilation rate on indoor air quality indices and energy consumption in ORs at rest. The study investigates the air temperature, relative humidity, concentrations of carbon dioxide, particulate matter (PM), and airborne bacteria at different ventilation rates in operation rooms at rest of a medical center. The energy consumption and cost analysis of the heating, ventilating, and air conditioning (HVAC) system in the operation rooms at rest were also evaluated for all ventilation rates. No air-conditioned operation rooms had very highest PM and airborne bacterial concentrations in the operation areas. The bacterial concentration in the operation areas with 6-30 air changes per hour (ACH) was below the suggested level set by the United Kingdom (UK) for an empty operation room. A 70% of reduction in annual energy cost by reducing the ventilation rate from 30 to 6 ACH was found in the operation rooms at rest. Maintenance of operation rooms at ventilation rate of 6 ACH could save considerable amounts of energy and achieve the goal of air cleanliness.

High total volatile organic compounds pollution in a hospital dental department.

Bioaerosols produced by dental procedures may affect indoor air quality and cause infections in dental healthcare workers. To provide air quality data that can be used to protect dental healthcare workers, this study evaluated the air quality and its influencing factors in the dental department of the Chang Gung Memorial Hospital in Taiwan. The study was a cross-sectional study design. Indoor air quality (IAQ) evaluations were conducted in six locations: pediatric dentistry, craniofacial orthodontic dentistry, periodontal dentistry, and general practice dentistry, instrument washing room, and patient waiting area. The measured air quality parameters included temperature, relative humidity, and concentrations of CO2, total volatile organic compounds (TVOCs), suspended particulate matter (PM), and bacteria. TVOCs concentrations at all six sampling stations were found to exceed the indoor air quality standards prescribed by the Taiwan Environmental Protection Agency. The highest concentrations of atmospheric PM10, PM2.5, and PM1 were found in the periodontal dentistry department, while the lowest concentrations occurred in the patient waiting area. The detection rate for Gram-positive bacteria was highest in the pediatric department (25%) and lowest in the instrument washing room (9%). Micrococcus luteus and Bacillus cereus were the primary pathogens detected. The dental departments of the hospital had a serious TVOCs pollution. The air quality of dental departments deserves long-term surveillance and attention.

Urban Air Pollution in Taiwan before and after the Installation of a Mass Rapid Transit System.

Urbanization causes air pollution in metropolitan areas, coupled with meteorological factors that affect air quality. Although previous studies focused on the relationships of urbanization, air pollution, and climate change in Western countries, this study evaluated long-term variations of air quality and meteorological factors in Taiwanese metropolitan areas (Taipei area, Taichung City, and Kaohsiung City) and a rural area (Hualien County) between 1993 and 2012. The influence of a mass rapid transit (MRT) system on air quality was also evaluated. Air pollutant concentrations and meteorology data were collected from Taiwan Environmental Protection Administration (TEPA) air monitoring stations and Central Weather Bureau stations in the surveyed areas, respectively. Analyses indicate that levels of air pollution in metropolitan areas were greater than in the rural area. Kaohsiung City had the highest levels of O, SO, and particulate matter 2.5 or 10 µm in diameter (PM and PM). Clear downward trends for CO, NO, PM, PM, and especially SO concentrations were found in the surveyed areas, whereas O showed no decrease. Both O and PM concentrations showed similar bimodal seasonal distributions. Taiwan's air quality has improved significantly since 1993, indicating the effectiveness of promoting air pollution strategies and policies by the TEPA. Air pollution had an obvious improvement in Taipei area after the MRT system began operations in 1996. Because global climate may potentially affect urban air pollution in Taiwan, further study to clarify the mechanisms by which air pollution may affect human health and other biological effects is warranted.

The impact of aerosolized mucolytic agents on the airflow resistance of bacterial filters used in mechanical ventilation.

BACKGROUND/PURPOSE: In order to reduce the contamination in the ventilator, bacterial filters were placed on the expiratory limb of a ventilator circuit. Aerosolized mucolytic agents may increase the resistance of the ventilator. The goal of this study is to determine the impact of aerosolized mucolytic agents on the pressure change during mechanical ventilation. METHODS: A lung model was investigated with mucolytic inhaled agents of 10% acetylcysteine and 2% hypertonic saline. The agents were administered using a jet nebulizer every 45 minutes for 15 minutes. The pressure drop was measured after nebulization. The end point was referred to the 45(th) dose or obstruction of the filter. Furthermore, the pressure drop after steam autoclaving was also measured. RESULTS: The maximum pressure was significantly higher with 10% acetylcysteine than with 2% sodium chloride (39.32 ± 7.22 cmH2O vs. 3.53 ± 0.90 cmH2O, p < 0.001). With acetylcysteine filters, the pressure drop over 4 cmH2O occurred earlier and had a good relationship between the degree of pressure drop and doses. The acetylcysteine group yielded a significant difference in the pressure drop compared to the newly autoclaved and the end point of inhalation (p = 0.043). CONCLUSION: This study demonstrated the aerosolized mucolytic agents could increase the pressure drop of the bacterial filters during mechanical ventilation. The pressure drop of the bacterial filters was higher with 10% acetylcysteine. It is critical to continuously monitor the expiration resistance, auto-positive end-expiratory pressure, and ventilator output waveform when aerosolized 10% acetylcysteine was used in mechanical ventilation patients.

Using high-performance liquid chromatography with UV detector to quantify exhaled leukotriene B4 level in nonatopic adults.

This study aimed to evaluate the feasibility of the chemical method to analyze exhaled breath condensate (EBC) leukotriene B4 (LTB4) level in humans. High-performance liquid chromatography with a UV detector was applied to quantify the inflammatory biomarker. The LTB4 concentration in the concentrated pooled EBC samples was 1.19 ng/µL, and the average LTB4 concentration of each EBC sample was 15.38 ng/µL. This analytical technique was feasible to evaluate the levels of inflammatory mediators such as LTB4 in human EBCs without any complicated sample pretreatment processes.

Influence of gestational hypertension and maternal air pollutant exposure on birth outcomes.

The relationship between exposure to air pollutants and fetal growth outcomes has shown inconsistency, and only a limited number of studies have explored the impact of air pollution on gestational hypertension and birth outcomes. This study aimed to evaluate how maternal exposure to air pollutants and blood pressure could influence fetal birth outcomes. A total of 55 women with gestational hypertension and 131 healthy pregnant women were enrolled in this study. Data pertaining to personal characteristics, prenatal examinations, outdoor air pollutant exposure, and fetal birth outcomes were collected. The study revealed that fetal birth weight and abdominal circumference exhibited a significant reduction among women with gestational hypertension compared to healthy pregnant women, even after adjustments for body mass index, gestational age, and exposure to air pollutants had been made. Moreover, maternal exposure to outdoor air pollutants displayed a notable correlation with decreased birth length of fetuses. Consequently, the study concluded that maternal blood pressure and exposure to outdoor air pollutants during pregnancy potentially stand as pivotal factors influencing fetal birth outcomes.

Cysteinyl leukotriene levels correlate with 8-isoprostane levels in exhaled breath condensates of atopic and healthy children.

BACKGROUND: Cysteinyl leukotrienes are important mediators of airway inflammation, whereas 8-isoprostane is a biomarker of oxidative stress. This study evaluated the distributions of cysteinyl leukotriene and 8-isoprostane concentrations in exhaled breath condensates (EBCs) of children. The relationship between cysteinyl leukotriene and 8-isoprostane concentrations in the EBCs was also evaluated. METHODS: The EBCs were collected from 34 children with allergic respiratory diseases and 24 healthy children. All recruited children underwent pulmonary function testing every season. The severity of allergic respiratory diseases and medication status were assessed every month in children with allergic respiratory diseases. RESULTS: The EBC cysteinyl leukotriene and 8-isoprostane levels were higher in children with asthma and allergic rhinitis than in those with asthma only and healthy children. In asthmatic children, cysteinyl leukotriene and 8-isoprostane levels peaked in the summer. All children showed a clear association between EBC cysteinyl leukotriene and EBC 8-isoprostane levels. CONCLUSION: The cysteinyl leukotriene and 8-isoprostane concentrations in the EBCs of children significantly varied by season. Oxidative stress correlated with airway inflammation in children.

[Sexual satisfaction and related factors in women previously treated for gynecological cancer].

BACKGROUND: Recent studies have demonstrated that women treated for gynecological cancer experience long-term sexual problems. Although several studies have described physical sexual dysfunction among gynecological cancer survivors, there is a relative dearth of research related to sexual satisfaction in women treated for this disease. PURPOSE: This study explores sexual satisfaction and related factors in women who have undergone gynecological cancer therapy. METHODS: This study used a cross-sectional and descriptive-correlational design. A total of 158 female participants were recruited from the gynecology and obstetrics department of a medical center in northern Taiwan. Eighty-three were women treated more than one year ago for stage 1 to 3 gynecological cancer; the remaining 75 had no history of cancer who had visited the medical center for routine cervical cancer screening. Structured questionnaires collected data on participant demographics, gynecological cancer characteristics, and sexual satisfaction. Data were analyzed using the Chi-Square test, Mann-Whitney U test, Krauskal-Wallis test, and Spearman rank correlation. RESULTS: (1) Participants in the recent gynecological cancer group reported significantly less sexual satisfaction than their healthy control peers; (2) Level of sexual satisfaction reported by participants in the recent gynecological cancer group was significantly related to the following factors: number of years since treatment, participant age, relationship status, and financial condition. Those who received therapy one year ago reported low levels of sexual satisfaction; those who were younger, richer, or had a better relationship status reported better levels of sexual satisfaction. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Study findings can help healthcare professionals understand and educate patients about the potential sexual health implications of gynecological cancer treatment. Healthcare professionals can focus particular attention on patients who are older, poorer, or have a relatively poor relationship status.

Risks of preterm birth and low birth weight and maternal exposure to NO2/PM2.5 acquired by dichotomous evaluation: a systematic review and meta-analysis.

No consistent results from past studies have been found on the relationship between the effects of air pollutant exposure, preterm birth (PTB) and low birth weight (LBW) in fetuses. This study aimed to analyze the impact of high concentrations of air pollutants on the health outcomes of fetuses, especially regarding PTB and LBW. This study used keywords related to air pollutants, pregnancy, and birth outcomes, to search the literature within the databases of the Cochrane Library, PubMed, and Embase, which were published as of July 26, 2022. A total of 24 studies were included in this meta-analysis. This meta-analysis revealed that nitrogen dioxide (NO2) exposure throughout pregnancy was associated with an increased risk of PTB. Maternal exposure to PM2.5 (particulate matter sized less than 2.5 µm) during gestation was associated with the risk of LBW. The findings of this meta-analysis provide an important foundation for evaluating the relationship between exposure of air pollutants and fetal birth outcomes in countries with severe air pollution in the future.

An aerosol inhalation monitor would improve the accuracy of checklist assessment in drug inhalation techniques.

BACKGROUND: Checklists are usually employed to assess the inhalation techniques in patients, but partial techniques are difficult to evaluate visually. This study aimed to assess the checklist validity and an agreement between checklists and an aerosol inhalation monitor (AIM) assessments. METHODS: This study used a checklist and an AIM to evaluate the participants' inhalation techniques with a pressurized metered-dose inhaler (MDI) and two dry powder inhalers (DPIs). The kappa (κ) coefficient, prevalence-adjusted and bias-adjusted κ (PABAK), sensitivity, specificity, positive predictive value, and negative predictive value were all calculated to determine the agreement between the checklist and AIM in an MDI and DPIs with different inhalation technique steps. RESULTS: The checklist and AIM exhibited poor agreement in the MDI for actuation and inhalation time, and a moderate agreement for inspiratory flow. The fair agreement was observed in DPIs for inspiratory flow between the checklist and AIM. The steps of holding breath in MDI and DPIs were highly correlated between both assessments. The lowest accuracy evaluated with an AIM was found in the step of actuation and inhalation time in the MDI and in the inspiratory flow step in DPIs. CONCLUSION: The checklist tended to overestimate the accuracy of critical techniques including the actuation and inhalation time in MDIs and the inspiratory flow in DPIs. Thus, the AIM device can be used as an objective auxiliary tool to assess and quantify the specific steps of inhalation technique for the users with MDI and DPIs.

Effectiveness of bacterial disinfectants on surfaces of mechanical ventilator systems.

BACKGROUND: Pathogens in healthcare settings can be transmitted via skin contact and environmental media. This study investigates bacterial contamination rate on surfaces of mechanical ventilator systems and bedside equipment. An experimental study evaluates the effectiveness of 75% alcohol in killing bacteria on surfaces. METHODS: Surface swab sampling was conducted on ventilator systems and patient bedside equipment for detection of bacterial contamination. Surfaces of ventilator systems, such as faceplates, Y-pieces, and water traps, were swab sampled at 0.5, 8, and 24 hours after initial disinfection using a solution containing 0.5% sodium hypochlorite and pasteurization. The 75% alcohol aerosol was sprayed on the surfaces of faceplates, Y-pieces, and water traps on ventilator systems at 24 hours after initial disinfection, and then bacterial levels on the surfaces were evaluated. RESULTS: Detection rates of Staphylococcus aureus were measured on the handrails of mechanical ventilators (64.7%), Y-pieces of breathing circuits (86.7%), and resuscitators (60.0%). Pseudomonas aeruginosa was identified on the surfaces of Y-pieces (6.7%) and water traps (13.3%) of breathing circuits, and also on suction systems (6.7%) and resuscitators (13.3%). The positive rate for total bacterial count was clearly increased on the surfaces of faceplates, Y-pieces, and water traps at 8 hour following disinfection by 0.5% sodium hypochlorite solution and pasteurization. Concentrations of S. aureus on surfaces decreased following treatment with 75% alcohol. However, considerable P. aeruginosa growth on water trap surfaces was observed after treatment with 75% alcohol. CONCLUSIONS: The surfaces of ventilator systems, including faceplates, Y-pieces, and water traps, must be disinfected frequently (at least every 8 h) to control bacterial growth. Disinfection using 75% alcohol spray with air drying effectively decreased S. aureus on ventilator system surfaces.

Influence of nebulizer type with different pediatric aerosol masks on drug deposition in a model of a spontaneously breathing small child.

BACKGROUND: The performance of nebulizers varies with the design type as well as the breathing patterns of various age groups. The present study quantified aerosol delivery using spontaneously breathing parameters of a small child (2-4 years) by a lung simulator to determine the influence of nebulizer type, actuation mechanisms, and pediatric aerosol masks. METHODS: Three types of nebulizer (constant-output, breath-enhanced, and breath-actuated nebulizer) and 3 masks (standard pediatric mask, the Fish mask, and a valved mask) were chosen for the testing. The actuation mechanism of the breath-actuated nebulizer was tested by manual synchronization with inspiration, breath actuation, and continuous nebulization. The nebulizer performance was determined by determining mass median aerodynamic diameter and analyzing drug deposition distal to the trachea (inhaled mass), on the face, on the mask, residual drug in the nebulizer, and the time of nebulization. The quantity of salbutamol deposited was determined by spectrophotometry (276 nm). RESULTS: Mass median aerodynamic diameter was similar across nebulizers. Breath-actuated nebulization generated a lower inhaled dose and higher nebulization time than continuous nebulization (P = .001). Breath synchronized aerosol generation, whether breath-actuated or manually actuated, yielded 10-20 times lower inhaled mass than continuous nebulization (0.1-0.6% vs 5-11%, respectively). The AeroEclipse, operated continuously, delivered greater inhaled dose than the LC Plus (P = .025). Higher inhaled dose was achieved with the Fish mask than standard or valved mask, with all nebulizers tested (P = .001). CONCLUSIONS: In this model using ventilatory parameters associated with a 2-4-year-old child, breath-actuated nebulization was not as effective as continuous nebulization. Aerosol mask design can impact inhaled drug dose across the range of nebulizers tested.

Sexual positions and sexual satisfaction of pregnant women.

The purpose of this study was to investigate the sexual positions and sexual satisfaction of women during pregnancy. The authors sampled pregnant women (N = 215) from outpatients registered at the antepartum clinic of a medical center in northern Taiwan. The authors gathered data on recent sexual satisfaction, general sexual satisfaction, and sexual position using a self-report, structured questionnaire. The results showed that coital frequency decreased from the first to third trimester (p < .05). The most common sexual position for pregnant women (67.6%) was man on top, face-to-face. Sexual position did not change significantly by trimester. More women with more sexual satisfaction than women with poor sexual satisfaction tended to adopt the woman-on-top, face-to-face, and abdominal-supportive sexual positions.