This study aims to identify error-prone operational steps and key sites of self-contamination during donning and doffing of personal protective equipment (PPE).

A total of 56 health care workers, including 37 nurses and 19 physicians, were recruited to don and doff the PPE recommended by the Chinese Center for Disease Control and Prevention. Operational errors and sites of self-contamination were recorded using UV-fluorescent labeling and video surveillance.

Three main errors during donning were identified: choosing a loose-fitting coverall that was difficult to handle; ignoring to inspect the seal of N95 respirator or gloves; and forgetting to pull up the zipper completely. Four main errors during doffing were identified: removing the N95 respirator in a wrong way; touching the scrubs with contaminated hands and elbows; touching contaminated external surfaces of the goggles; and performing insufficient hand hygiene. Key sites that were easily contaminated during the doffing of PPE included left hand and wrist, left lower leg, chest, and left abdomen.

Identifying the steps prone to errors and key sites of self-contamination in the process of PPE donning and doffing can facilitate the training of PPE use and provide detailed evidence for optimizing standardized protocols to reduce contamination.

To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific BMI categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines.

Multicentre, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the OR, 95 % CI and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1 % increase from the lowest predicted probability in each pre-pregnancy BMI group.

From nine cities in mainland China.

A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014.

The optimal GWG (ranges) by Chinese-specific BMI was 15·0 (12·8–17·1), 14·2 (12·1–16·4) and 12·6 (10·4–14·9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and caesarean section, whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes.

Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women.

It is important to maintain the psychological well-being of front-line healthcare staff during the coronavirus disease 2019 (COVID-19) pandemic.

To examine COVID-19-related stress and its immediate psychological impact on healthcare staff.

All healthcare staff working in the fever clinic, from 20 January 2020 to 26 March 2020, of a tertiary general hospital were enrolled. Stress management procedures were in place to alleviate concerns about the respondents’ own health and the health of their families, to help them adjust their work and to provide psychological support via a hotline. Qualitative interviews were undertaken and the Sources of Distress and the Impact of Event Scale-Revised (IES-R) were administered.

Among the 102 participants (25 males; median age 30 years, interquartile range (IQR) = 27–36), the median IES-R total score was 3 (IQR = 0–8), and 6 participants (6.0%) scored above the cut-off on the IES-R (≥20). Safety and security were acceptable or better for 92 (90.2%) participants. The top four sources of distress were worry about the health of one's family/others at 0.88 (IQR = 0.25–1.25), worry about the virus spread at 0.50 (IQR = 0.00–1.00), worry about changes in work at 0.50 (IQR = 0.00–1.00) and worry about one's own health at 0.25 (IQR = 0.25–0.75). There was a moderate correlation between the IES-R score and the Sources of Distress score (rho = 0.501, P = 0.001).

The stress levels of healthcare staff in the fever clinic during the COVID-19 epidemic were not elevated. Physio-psychosocial interventions, including fulfilment of basic needs, activation of self-efficacy and psychological support, are helpful and worth recommending in fighting COVID-19.

To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic.

Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome.

Outpatient cardiology clinic.

Patients undergoing MPI.

Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed.

During 2012–2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%–99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified.

This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings.

To explore if there is association between vitamin D supplementation through cod liver oil ingestion around the periconceptional period and the risk of developing severe CHD in offspring. Furthermore, we would examine the interaction between vitamin D and folic acid supplementation in the association.

A case–control study was conducted in Shanghai Children’s Medical Center, in which, a total of 262 severe CHD cases versus 262 controls were recruited through June 2016 to December 2017. All children were younger than 2 years. To reduce potential selection bias and to minimise confounding effects, propensity score matching was applied.

After propensity score matching, vitamin D supplementation seemed to be associated with decreased odds ratio of severe CHD (odds ratio = 0.666; 95% confidence intervals: 0.449–0.990) in the multivariable conditional logistic analysis. Furthermore, we found an additive interaction between vitamin D and folic acid supplementation (relative excess risk due to interaction = 0.810, 95% confidence intervals: 0.386–1.235) in the association.

The results suggested that maternal vitamin D supplementation could decrease the risk of offspring severe CHD; moreover, it could strengthen the protective effect of folic acid. The significance of this study lies in providing epidemiological evidence that vitamin D supplementation around the periconceptional period could be a potential nutritional intervention strategy to meet the challenge of increasing CHD.

No studies have reported on how to relieve distress or relax in medical health workers while wearing medical protective equipment in coronavirus disease 2019 (COVID-19) pandemic. The study aimed to establish which relaxation technique, among six, is the most feasible in first-line medical health workers wearing medical protective equipment.

This was a two-step study collecting data with online surveys. Step 1: 15 first-line medical health workers were trained to use six different relaxation techniques and reported the two most feasible techniques while wearing medical protective equipment. Step 2: the most two feasible relaxation techniques revealed by step 1 were quantitatively tested in a sample of 65 medical health workers in terms of efficacy, no space limitation, no time limitation, no body position requirement, no environment limitation to be done, easiness to learn, simplicity, convenience, practicality, and acceptance.

Kegel exercise and autogenic relaxation were the most feasible techniques according to step 1. In step 2, Kegel exercise outperformed autogenic relaxation on all the 10 dimensions among the 65 participants while wearing medical protective equipment (efficacy: 24 v. 15, no space limitation: 30 v. 4, no time limitation: 31 v. 4, no body position requirement: 26 v. 4, no environment limitation: 30 v. 11, easiness to learn: 28 v. 5, simplicity: 29 v. 7, convenience: 29 v. 4, practicality: 30 v. 14, acceptance: 32 v. 6).

Kegel exercise seems a promising self-relaxation technique for first-line medical health workers while wearing medical protective equipment among COVID-19 pandemic.

The effect of dietary vitamin D, calcium and dairy products intake on colorectal cancer risk is controversial. This study aims to investigate the associations between dietary vitamin D, calcium, dairy products intake and colorectal cancer risk among Chinese population.

During July 2010 to December 2018, 2380 incident, first primary, histologically confirmed colorectal cancer cases and 2389 sex and age-matched (5-year interval) controls were recruited. Dietary intake information was collected by face-to-face interviews using a validated food frequency questionnaire. Energy and other nutrient intakes such as dietary calcium were computed on the basis of the 2002 Chinese Food Composition Table, and the dietary vitamin D intake was calculated according to the United States Department of Agriculture Food Composition Database. Unconditional multivariable logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence interval (CI) after adjusting for various confounders, including socio-demographic characteristics, lifestyle factors, BMI, family history of cancer, energy intake and several nutrient intakes.

The energy-adjusted mean dietary vitamin D, calcium and total dairy products intakes were 5.69μg/d, 406.94mg/d, 4.02g/d for cases and 6.81μg/d, 468.21mg/d, 9.50g/d for controls. Compared with the controls, cases had a lower intake of dietary vitamin D, calcium and total dairy (P < 0.001). A higher intake of dietary vitamin D and calcium was found to be associated with 43% and 51% reduction in colorectal cancer. The ORs of the highest quartile compared with the lowest quartile intake were 0.57 (95% CI: 0.46, 0.70, Ptrend < 0.001) for dietary vitamin D and 0.49 (95% CI: 0.39, 0.61, Ptrend < 0.001) for dietary calcium. We observed a statistically significant inverse association of dairy products intake with colorectal cancer risk. Compared with the lowest tertile, the adjusted ORs for the highest tertile were 0.31 (95% CI: 0.26, 0.38, Ptrend < 0.001) for total dairy. The inverse associations of dietary vitamin D, calcium and dairy products intakes with colorectal cancer risk were observed in both men and women, colon and rectal cancer.

Our study indicated that higher dietary vitamin D, calcium and dairy products intakes were associated with a lower colorectal cancer risk.

Personal protective equipment (PPE) is a necessary item in the period of unknown and high-risk emerging infectious disease. It is not only the necessary requirement of strict isolation, but also the last line of defense to protect medical staff.

Compare the differences between contaminated frequency and sites under two types of PPE doffing.

Recruited 56 health care workers (HCWs) who worked in clinical to follow the different PPE removal guidelines issued by the Chinese Center for Disease Control (CDC) and the World Health Organization (WHO) final resolution for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion (Glitter Bug Potion, On Solution Pty Lt). Then we recorded the frequency and sites of contamination of personnel after removal of contaminated PPE by the method of visual observation.

According to China’s CDC process, the parts that are easily contaminated during PPE removal are: left hand and wrist (7 times), left calf (7 times), front chest center and left and right chest (6 times each) and left abdomen (5 times). Contaminated parts of the PPE process in accordance with the WHO process from high to low were: right hand and wrist (13 times), left hand and wrist (12 times), middle of the abdomen (10 times), left chest (9 times), and left abdomen (6 Times). There was no statistical difference between the two kinds of PPE piercing and removal (Z=1.177, P > 0. 05).

Under the guidance of the two processes recommended by China CDC and WHO, there was no significant difference in the frequency of pollution after removing PPE. It is speculated that the PPE recommendation processes issued by WHO and China CDC are effective for personal protection against fulminating infectious diseases.

Proper use of personal protective equipment (PPE) is essential when facing emerging infectious diseases. Proper training methods can promote the use of the PPE correctly.

To explore the effect of the training method of sequential operation training on medical staff to master PPE penetration and removal skills, and to study the memory attenuation after training.

Fifteen medical staff with no experience of PPE operation in a hospital were trained to wear PPE in accordance with WHO standards by illustration and sequential operation method. The training included 30 minutes of theoretical teaching and 60 minutes of practical exercises. At the end of the training and 1 week after the training, the training objects were evaluated for PPE operation. A 2.5 x 2.5 cm fluorescent agent was applied on 6 parts, such as hands, chest, abdomen, and knees, to simulate contamination. After taking the PPE off, the parts of the whole body and the inner layer of clothing that were fluorescently contaminated were recorded. The whole operation process was recorded by video to evaluate whether the operation was correct. The error rates of two operations and the contamination position and frequency were compared.

The error rate of the operating PPE after training was 18.6%, rising to 31.9% after 1 week (Z=16.0, P<0.05). After the training, the average number of contaminated PPE removal was 1.96±1.56, which rose to 2.96±2.03 one month later. The difference was statistically significant (Z=8.92, P<0.05). The main vulnerable sites are the wrist, chest, abdomen, and left calf.

Illustrative sequential operation training is an important means to improve the way for medical staff to wear PPE, but it must be completed more than once to ensure that medical staff can firmly master the skills of wearing and removing PPE.

Personal protective equipment (PPE) is a necessary item in the period of unknown and high risk emerging infectious disease. It is not only the necessary requirement of strict isolation but also the last line of defense to protect medical staff.

To determine the frequency and sites of contamination of personnel during the process of using Chinese PPE.

Recruit 56 health care workers (HCWs) who worked in front-line clinical to test PPE issued by the Chinese Center for Disease Control for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion. Then the frequency and sites of contamination of personnel were recorded after removal of contaminated PPE. The method of visual observation was used to determine contamination.

The frequency of easily contaminated parts included: left hand and wrist (7 times), left calf (7 times), front chest center, left and right chest (6 times each), and left abdomen (5 times). Mistakes in the process of wearing PPE included: clothing touching the ground (20.00%), N95 air mask tightness not checked (13.33%), glove air-tightness not checked (4.44%), protective clothing zipper not checked (4.44%). Mistakes in doffing PPE included: clothes touching the ground or the inner surface is polluted (20.00%), the wrong method of removing N95 mask (14.44%), touching the pollution goggles mirror with hands (12.22%), incomplete washing steps, insufficient time and frequency of hand hygiene (11.11%).

It is necessary to carry out training on PPE donning and doffing for Chinese medical workers.