Influence of Mask Wearing during COVID-19 Surge and Non-Surge Time Periods in Two K-12 Public School Districts in Georgia, USA

BACKGROUND

Into the third year of the COVID-19 pandemic and the second year of in-person learning for many K-12 schools in the United States, the benefits of mitigation strategies in this setting are still unclear. We compare COVID-19 cases in school-aged children and adolescents between a school district with a mandatory mask-wearing policy to one with an optional mask-wearing policy, during and after the peak period of the Delta variant wave of infection.

METHODS

COVID-19 cases during the Delta variant wave (August 2021) and post the wave (October 2021) were obtained from public health records. Cases of K-12 students, stratified by grade level (elementary, middle, and high school) and school districts across two counties, were included in the statistical and spatial analyses. COVID-19 case rates were determined and spatially mapped. Regression was performed adjusting for specific covariates.

RESULTS

Mask-wearing was associated with lower COVID-19 cases during the peak Delta variant period; overall, regardless of the Delta variant period, higher COVID-19 rates were seen in older aged students.

CONCLUSION

This study highlights the need for more layered prevention strategies and policies that take into consideration local community transmission levels, age of students, and vaccination coverage to ensure that students remain safe at school while optimizing their learning environment.

Autistic People's Perinatal Experiences II: A Survey of Childbirth and Postnatal Experiences

Qualitative accounts indicate there are sensory and communication related barriers to adequate childbirth and postnatal healthcare for autistic people. However, little quantitative work has explored the topic. This online survey study explored childbirth and postnatal experiences among 384 autistic and 492 non-autistic people. Compared with non-autistic people, autistic people were more likely to find the sensory aspects of birth overwhelming, and experienced lower satisfaction with birth-related and postnatal healthcare. Autistic people were more likely to experience postnatal depression and anxiety. The findings highlight that sensory and communication adjustments should be made to birth and postnatal healthcare for autistic people. The findings indicate the need for greater autism understanding among professionals and greater postnatal mental health support for autistic people.

Report on a clinical evaluation of the KerraPro Heel silicone heel pad

Heels are at increased risk of injury due to the posterior prominence and lack of padding over the calcaneus. Pressure injuries, once established, are extremely costly, both in terms of the detrimental effect on psychosocial wellbeing and threat to life, as well as financially due to length of hospital stay and resources used to heal the wounds. A new and inexpensive silicone heel pad has been designed to simplify the necessary decisions and to address the problems associated with pressure injuries to the heels. This article will describe an observational evaluation of the product. KerraPro Heel pads were evaluated in two separate cohorts of 17 participants over a 4-week period with the primary aim to evaluate the efficacy of the product in preventing and alleviating pressure injuries on the heels. All participants had been reported as 'at risk' or 'at high risk' of pressure injury to the heels and had a history of developing such lesions. The KerraPro heel pads were compared with the participant's standard protocol. The outcome of the evaluation demonstrated the effectiveness of the KerraPro Heel pads in the prevention and treatment of heel pressure injuries.

Empowering patients to take control of leg ulcer treatment through individualised management

Leg Clubs have been established to empower patients to become stakeholders in their own treatment. This case report describes how attendance at a Leg Club resulted in healing in a patient who previously was non-concordant with treatment.

The role of the expert witness

Juries do not have extensive health-care knowledge, so expert witnesses are needed to explain standards of care. Here, expert witness Sylvie Hampton describes this role and how these witnesses participate in court proceedings.

A small study in healing rates and symptom control using a new sheet hydrogel dressing

OBJECTIVE

This study set out to investigate the pain control and absorptive properties of a new sheet hydrogel dressing (ActiFormCool, Activa).

METHOD

This was a simple evaluation involving 20 wounds. Compression was used when appropriate, although each patient receiving compression had used short-stretch bandages before entering the study.

RESULTS

Pain was reduced from an average of 8.65 to an average of 3.75, where 10 represents the worst pain possible and one represents no pain. Exudate reduction was assessed by the number of dressing changes required each week. The dressing-change rate reduced from an average of 2.8 times weekly to an average of 1.3 times weekly. Skin condition improved in all three cases in which the surrounding skin had been a problem before the study. Over a four-week period, two wounds healed, four healed by 90% and two by 80%, with an overall average healing rate of 46%.

CONCLUSION

ActiFormCool provides an optimum wound-healing environment, reduces pain and absorbs fluid, making it an excellent alternative to loose hydrogels.

Eczema and early solid feeding in preterm infants

AIMS

To establish whether development of eczema is influenced by feeding practices in preterm infants, while taking account of confounding factors.

METHODS

Data were assembled from 257 infants born prematurely and studied to 12 months post-term. Logistic regression analysis was performed to establish the association between feeding practices and eczema, allowing for potential confounding factors including the infants' gender, parental atopic status, social background, and parental smoking habits.

RESULTS

For the development of eczema (with or without other symptoms) by 12 months post-term, the introduction of four or more solid foods by or before 17 weeks post-term was a significant risk (odds ratio 3.49). Male infants were at significantly higher risk (odds ratio 1.84). In addition, having non-atopic parents who introduced solid foods before 10 weeks post-term or having at least one atopic parent represented a significant risk scenario (odds ratio 2.94).

CONCLUSIONS

Early introduction of a diverse range of solid foods may predispose the preterm infant to eczema development by 12 months post-term. Furthermore, non-atopic parents who practice early as opposed to late introduction of solid foods may be exposing preterm infants to a greater risk of eczema by 12 months post-term.

Short-stretch compression bandages and the foot pump: their relationship to restricted mobility

Practitioners are generally advised not to use short-stretch bandages on patients who are immobile. But this appears to reflect confusion about calf muscle function, which research indicates still occurs during periods of limited mobility.

Can wounds be left uncovered 48 hours after surgery?

The editor welcomes readers' questions and alternative answers to questions and letters.These should be sent to the Journal of Wound Care, Greater London House, Hampstead Road, London NW1 7EJ. Fax: +44 (0)20-7874 0386. Email: jwc@emap.com

Adaptation of the circadian rhythm of 6-sulphatoxymelatonin to a shift schedule of seven nights followed by seven days in offshore oil installation workers

This study evaluated circadian adaptation in a 'swing shift' schedule (seven nights, 18:00-06:00 h; then 7 days, 06:00-18:00 h) on North Sea oil installations. Eleven healthy men provided sequential urine collections for the study period offshore. The urinary melatonin metabolite 6-sulphatoxymelatonin (aMT6s) was used as an index of circadian phase. A significant difference (P=0.0004) was found between the mean aMT6s acrophase (calculated peak time) at the start (+/-SD: 05:34+/-2.42 h) and end (+/-SD: 10.95+/-3.34 h) of the night shift week, but not between the start (+/-SD: 11:04+/-4.03 h) and end (+/-SD: 12:59+/-8.83 h) of the day shift week. As a group, the subjects adapted to the night shift but very large individual variations were seen during the day shift. These individual differences clearly require further study.

Should we use the 30 degrees tilt?

I have been using the 30° tilt as a means of pressure relief for many years. While I appreciate it has its limits and does not negate the need for an appropriate pressure-relieving support surface when indicated, I now understand there is some contention around its use. Please could you advise?

Pressure ulcer prevention and wound management in Bulgaria

This short report describes the author's involvement in the first ever wound management conference, held in Bulgaria, from original concept through to the event, and examines how Bulgaria intends to apply the latest clinical findings, given the difficulties with obtaining all types of products for tissue viability.

SuperSkin: the management of skin susceptible to breakdown

Few studies have been undertaken in the area of skin protection, even though maintaining tissue viability in the event of incontinence, shear forces and the potential for exudate to macerate periwound areas remains a challenge for any nurse caring for patients. This article outlines and discusses the problems associated with overhydrated tissues and shear forces and the potential for SuperSkin liquid film dressing, marketed by CliniMed, to provide a solution.

Latex allergy

In her article on hospital-acquired heel ulcers, published in the April issue, J. Donnelly concluded there was no evidence of therapeutic benefit from pressure-relieving mattresses in the prevention of heel ulcers.

The pressure ulcer benchmark: will it improve patient care?

A benchmarking resource pack has been produced in an attempt to reduce national variations in pressure ulcer prevention and management. How likely is it to meet its objectives?

Pressure ulcer care: can we learn from poorer countries?

Within the UK, nursing and medicine is demanding increased evidence-based care and randomized controlled trials (RCTs) have become the gold standard for research (Fogg and Gross, 2000). Indeed, the NHS Executive recommends RCTs as the most reliable evidence for the efficacy of interventions (NHS Centre for Reviews and Dissemination, 1997).

A difficult wound to treat?

I was referred a patient from a ward that was having difficulty managing this wound (Fig 1). The patient is paralysed down one side and has an acquired blood-borne disorder. The patient cannot control their body functions and has an indwelling catheter. On examination the wound was malodorous, with a diameter of 8cm and a depth of 4.5cm. The injury had occurred on transfer to the hospital. At first it manifested itself as a small nick on the skin with surrounding discoloration. The patient was on a pressure-relieving bed borrowed from the tissue viability team and had been in the ward for eight weeks. Wound swabs were taken. The patient was sensitive to vancomycin, penicillin and metronidazole. Taking into account the blood-borne disorder, how would you treat this wound and what form of secondary dressing would you use? There are problems with large amounts of exudate.

Evaluating a superabsorbent hydropolymer dressing for exuding venous leg ulcers

A new hydropolymer dressing was compared with an alginate dressing in a multicentre, prospective, controlled, randomised, stratified, open label trial of 113 patients with exuding venous leg ulcers. The study aimed to evaluate the performance of the dressings in terms of their ability to handle exudate, patient and user acceptability and cost-effectiveness. Patients were stratified according to volume of wound exudate (moderate/heavy) and randomised to the hydropolymer dressing or the alginate plus a secondary dressing. A statistically significant difference between treatment groups was observed in mean wear time, with a longer wear time observed in the hydropolymer group (3.91 days) compared with the alginate group (3.09 days, p = 0.001). In terms of patient and user acceptability, all 10 overall evaluations made by both patient and investigator were markedly in favour of the hydropolymer dressing (p < 0.001 to p = 0.020). The use of the hydropolymer dressing for patients with moderate to heavily exuding venous leg ulcers has statistically significant advantages over the alginate dressing in terms of wear time and investigator and patient acceptability. It is anticipated that this reduction in dressing frequency will translate into a cost-effective wound treatment.

Repose: the cost-effective solution for prompt discharge of patients

Pressure ulcer prevention is expensive and at times difficult to achieve. Formation, or the potential formation, of pressure ulcers can lead to delayed patient discharge, particularly when the appropriate equipment is unavailable on the day of discharge. This article reviews the potential of Repose, an inflatable mattress overlay, to be an inexpensive and clinically effective alternative to alternating air mattress systems.

Use of iodine in a dehisced thoracotomy wound

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Use of Pressurease and Airform mattresses in pressure ulcer care

Large cell dynamic air mattresses are effective in the prevention of pressure ulcers but they still have inherent problems, e.g. the ability of the mattresses to move patients along the mattress through the inflation and deflation of the cells. Also, there have been reports that the inflation and deflation of cells can cause motion sickness. This article reviews two mattresses from Sareo Healthcare Ltd: a static system, Pressurease; and a unique dynamic system, Airform. These two systems offer a cost-effective and clinically effective method of pressure ulcer prevention and therapy.

Oesophageal ulceration caused by doxycycline: an unusual complication

Oesophageal ulceration is an unusual complication of doxycycline treatment (Vibramycin) presenting to an Otorhinolaryngology department. A case report is presented with discussion of investigations and management of the patient.

Hyperproinsulinaemia in elderly subjects: evidence for age-related pancreatic beta-cell dysfunction

We investigated whether pancreatic beta-cell dysfunction has a role in the pathogenesis of glucose intolerance in the elderly by comparing plasma glucose, immunoreactive insulin, C-peptide and proinsulin concentrations during a 100-g oral glucose load in six healthy older male volunteers [aged 69 (65.9-74.9) years; median (95% confidence limits)] and seven young male controls [aged 24.0 (21.9-26.3) years]. Fasting and integrated concentrations of glucose and C-peptide were similar in the elderly and young. Although fasting, insulin and proinsulin levels were similar, integrated insulin (P=0.05) and proinsulin (P<0.05) concentrations were higher in the elderly than in controls. Insulin resistance, measured as homeostasis model assessment, was greater (P<0.05) in the elderly than in controls. Elderly men had greater molar ratios of integrated insulin:C-peptide (P<0.05) and proinsulin:C-peptide (P<0.01) but their respective fasting molar ratios were similar when compared with controls. Pancreatic beta-cell secretion in older subjects, as assessed by C-peptide concentrations, was inappropriately low in the presence of insulin resistance. Their post-prandial 'hyperinsulinaemia' is probably due to a combination of hyperproinsulinaemia and reduced metabolic clearance of insulin. Older subjects had disproportionately high proinsulin to C-peptide levels, suggesting pancreatic beta-cell dysfunction. These results are consistent with the notion that decreased insulin sensitivity and pancreatic beta-cell dysfunction may predispose the elderly to glucose intolerance.

Case study: the treatment or palliative care of pressure ulcers

As nurse education increases there are reduced justifications for the existence of pressure ulcers. Patient assessment, along with rationalization of equipment and repositioning techniques, reduces the potential for pressure ulcer formation. Therefore, the future for pressure ulcer prevention will rely on nurse education and motivation. The patient featured in this case study suffered unnecessarily from pressure ulcers as, after her admission to a new nursing home where she was given the appropriate pressure-relieving and wound-dressing treatment, the ulcers were showing signs of healing.

Efficacy and cost-effectiveness of the Thermo contour mattress

Use of air mattresses in reduction of pressure sore incidence is an important part of quality patient care. However, there will never be enough air mattresses to match the demand as increased education and an increase in the general provision of air mattresses can lead to an unrealistic expectation of obtaining air mattresses when required for patients. This raises the demand for air mattresses and increases costs within hospital trusts. This study examined a way to redress the balance through use of an alternative, cost-effective type of mattress (thermoelastic polymer) in the prevention of pressure sores. Prime consideration was given to the comfort of the patient. The claims of the manufacturers, Barrington Healthcare, that 'patients with Waterlow scores of 23 can be nursed safely on this product' were explored as part of the study. A total of 407 patients took part over a 6-month period. Twenty-four Thermo contour mattresses were loaned to one ward for the study and patients were allocated to the mattress through admission to the experimental ward. Patients were then split into two groups on two wards. Group B were allocated to a Thermo contour mattress and group A were nursed on air mattresses and foam mattresses generally used throughout the trust. Results showed that more patients were comfortable on the Thermo contour mattresses than on all other mattresses. Patients with Waterlow scores under 25 did not develop pressure sores on the Thermo contour mattress. However, the sample of patients with a Waterlow score of between 20 and 25 was small and therefore further research is required.

Proinsulin and insulin responses to a mixed meal in hypertriglyceridaemic men

AIM

To investigate the contribution of proinsulin to the "hyperinsulinaemia" of hypertriglyceridaemia.

METHODS

Plasma glucose, triglyceride, immunoreactive insulin, and intact proinsulin concentrations were measured before and after a mixed meal in 11 hypertriglyceridaemic men and six healthy normotriglyceridaemic male controls.

RESULTS

Hypertriglyceridaemic subjects had greater fasting (101 v 50 pmol/l) and integrated (139 v 81 x 0(-3) pmol/l/h) insulin concentrations than controls. Fasting and integrated glucose and proinsulin concentrations were similar in the two groups.

CONCLUSIONS

Proinsulin does not contribute to the hyperinsulinaemia observed in hypertriglyceridaemic subjects and is therefore unlikely to contribute to the increased cardiovascular risk associated with hypertriglyceridaemia.

Cochlear implantation following temporal bone fracture

Seven cases of profound hearing impairment following either unilateral or bilateral temporal bone fracture are presented who were implanted with the Nucleus 22 channel or Ineraid devices. Six patients suffered bilateral temporal bone fractures. One patient had prior congenital unilateral profound hearing impairment. This patient suffered a unilateral temporal bone fracture. Six patients became regular users of their implants. One gained little benefit and became a non-user. Two of the regular users experienced facial nerve stimulation, which could not be programmed out. In these two cases the implant was removed and the contralateral ear successfully implanted. Implant-aided audiometry demonstrated a hearing threshold of 40-50 dB at nine months after switch-on. The reliability of computed tomography (CT) scanning in predicting cochlear patency in cases of temporal bone fracture will be discussed. The benefit of complimentary imaging with magnetic resonance (MR) is highlighted.

Bandage application

The application of external compression is known to be an effective treatment for venous ulcers and the skills required to provide adequate pressure depend on the type of compression to be applied. Holistic assessment of the patient, along with education of the practitioner, leads to safe application of compression bandages. Incorrectly applied bandages can cause an increase in the size of the ulcer and may lead to amputation if used on ischaemic limbs1.

Can electric beds aid pressure sore prevention in hospitals?

The purchase, cleaning and maintenance of air mattresses can be an expensive part of pressure sore prevention and repositioning of patients can be time consuming and costly in terms of possible nursing injuries. The King's Fund bed has been a friend to the health service for many years but the time has come to look for an alternative system that will support patient comfort and independence, will assist nurses in implementation of a no-lifting policy and aid pressure sore prevention policies. This article describes a study that was undertaken in two medical wards to assess the value of electrically controlled beds in relation to the prevention of pressure sores, implementation of a no-lifting policy and quality of patient care. A total of 782 patients took part in the study over a 6-month period and 726 replies were obtained from nurses. The ward had similar profiles of patients' medical conditions and age; they were being medically managed by the same consultants. Results showed that patients experienced greater comfort on beds with the electric facility, produced less pressure sores, mobilized easily and pressure sore prevention costs could be reduced. There is a need to be proactive in prevention of pressure sores and not reactive to a pressure sore that is already developing.

Extraocular light exposure does not suppress plasma melatonin in humans

Light affects the circadian axis in at least two ways. It can cause the acute suppression of pineal melatonin synthesis, and/or a phase-shift of the circadian oscillator. As recent evidence has suggested that extraocular light exposure may cause phase-shifts of the circadian clock, we have investigated whether suppression of melatonin can be induced by the same type of light exposure. In the first study subjects' eyes were exposed to white light (2250 lux for 30 mins) via a fibre optic cable. As expected, suppression of nighttime plasma melatonin levels (61 +/- 6%) was observed. In the second study, light of the same quality but higher intensity (14,000 or 67,500 lux for 180 mins) was delivered in the same manner to the popliteal region behind the subjects' knees, whilst shielding their eyes. No suppression of plasma melatonin levels (4 +/- 7%) was detected in any of the subjects. Thus, extraocular photoreception, if it exists in mammals, does not affect the suprachiasmatic nucleipineal pathway.

Effects of the endogenous clock and sleep time on melatonin, insulin, glucose and lipid metabolism

This study was undertaken to determine whether the internal clock contributes to the hormone and metabolic responses following food, in an experiment designed to dissociate internal clock effects from other factors. Nine female subjects participated. They lived indoors for 31 days with normal time cues, including the natural light: darkness cycle. For 7 days they retired to bed from 0000 h to 0800 h. They then underwent a 26-h 'constant routine' (CR) starting at 0800 h, being seated awake in dim light with hourly 88 Kcal drinks. They then lived on an imposed 27-h day (18 h of wakefulness, 9 h allowed for sleep), for a total of 27 days. A second 26-h CR, starting at 2200 h, was completed. During each CR salivary melatonin and plasma glucose, triacylglycerol (TAG), non-essential fatty acids (NEFA), insulin, gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1) were measured hourly. Melatonin and body temperature data indicated no shift in the endogenous clock during the 27-h imposed schedule. Postprandial NEFA, GIP and GLP-1 showed no consistent effects. Glucose, TAG and insulin increased during the night in the first CR. There was a significant effect of both the endogenous clock and sleep for glucose and TAG, but not for insulin. These findings may be relevant to the known increased risk of cardiovascular disease amongst shift workers.

Elevated post-prandial gastric inhibitory polypeptide concentrations in hypertriglyceridaemic subjects

1. We investigated whether abnormalities of gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (7-36 amide) (GLP-1) contribute to the hypertriglyceridaemia and hyperinsulinaemia in hypertriglyceridaemic subjects. Serum triglycerides and plasma glucose GIP, GLP-1 and immunoreactive insulin (IRI) concentrations were measured before and after a mixed meal in 15 hypertriglyceridaemic patients and in eight healthy normotriglyceridaemic control subjects. 2. Integrated post-prandial GIP concentrations were greater than in controls (P < 0.05) and correlated positively with both fasting and integrated post-prandial triglyceride concentrations (P < 0.05 for both). Fasting and integrated post-prandial IRI levels were higher in hypertriglyceridaemic subjects than in controls (P < 0.02 and P < 0.05 respectively) and correlated positively with fasting triglycerides (P < 0.02 and P < 0.001 respectively) and integrated post-prandial triglycerides (P < 0.005 and P < 0.05 respectively). There was no correlation between GIP concentrations and either fasting or post-prandial IRI levels. Fasting and post-prandial concentrations of GLP-1 were similar in patients and controls. 3. Hypertriglyceridaemic subjects have post-prandial hyperGIPaemia in addition to the well-documented hyperinsulinaemia. We found no association between GIP and insulin. There is, however, clear evidence for an association between post-prandial GIP concentrations and triglyceride levels. We suggest that this association may depend on changes in lipoprotein lipase activity and that there may be a feedback loop between GIP and triglyceride lipolysis.

Venous leg ulcers: short-stretch bandage compression therapy

Graduated compression therapy is rapidly becoming the treatment of choice for venous leg ulcers; it is cost-effective and offers faster healing rates than without compression. Holistic assessment of the patient along with education of the practitioner leads to the safe application of compression bandages. This article looks at the assessment of venous ulcers and how application of short-stretch bandages can achieve graduated compression, leading to rapid healing. As with any new skill, compression bandaging requires the practitioner to have received research-based education and practice and to have a clear understanding of how the technique achieves the objective.

Wound assessment

Wound healing will not be achieved if a wound management product is inappropriate for an individual patient. An holistic approach using a nursing model is required to assess the needs of the patient and the wound.

Reliability in reporting pressure sore incidence

Encouraging the accurate reporting of pressure sores can be a difficult task. A telephone line for recording details on pressure damage may help to encourage reporting. An organisation-wide protocol for tackling pressure sores is needed.