Breathing time: a longue-durée multidisciplinary study of respiratory illnesses and airborne diseases in Switzerland (16th-21st century CE).

There are growing concerns about poor indoor air quality in refugee shelters, particularly regarding chronic health conditions and the spread of airborne diseases like COVID-19. These issues are influenced by shelter design and occupants’ behaviours, such as cooking and window usage. However, behavioural aspects are often overlooked in shelter design due to the challenges of monitoring occupants, which can be costly and intrusive. To address this, we developed a cost-effective method for assessing shelters that combines self-assessed behavioural data, predicted ventilation rates, and a mathematical model for airborne disease transmission. This approach was tested in temporary housing following the 2020 floods in Kumamoto Prefecture, Japan. Results indicated that indoor CO 2 levels exceeded national thresholds over 70% of the time, suggesting inadequate ventilation to mitigate airborne disease transmission. We estimated a 60–80% risk of COVID-19 transmission under these conditions. Our findings highlight severe health inequalities in forcibly displaced populations and provide: (i) the first comprehensive guide to monitoring indoor conditions and behaviours in these settings; (ii) a new model for assessing airborne disease risk. While the study focuses on COVID-19, the results can be extended to other airborne respiratory diseases through our reproductive number (R 0 ) estimates. Practical application This study presents a novel, low-cost method for monitoring indoor air quality and ventilation in temporary shelters and refugee housing, which can be applied by built environment professionals and humanitarian workers without the need for advanced technical skills. By focusing on occupant behaviour and using minimal sensor data, this approach provides practical insights for improving shelter design, reducing airborne disease transmission risks like COVID-19, and enhancing overall indoor environmental quality. The method is particularly relevant for displaced populations, where ensuring healthy and sustainable living conditions is critical to occupant well-being.

Using graphical representations to compare undistorted information it was attempted to bridge the gap between medicine and concerned risk-groups. Age-standardized mortality rates in 1979-1983 for 55 occupational groups (in 11 categories) of males aged 35 to 74 years were computed and compared to the Swiss national average; simultaneously the quantitative importance and the total mortality without accidents is shown for each occupational group: as an example the figure for lung cancer is reproduced. The elevated total mortality in the upper tertile of occupational groups is significantly explained by an increased risk of dying from circulatory or respiratory diseases, liver cirrhosis or malignancies of the lung, oropharynx, oesophagus or stomach. Foreseeable decrease of high-risk occupational groups will result in a further decline in mortality due to stomach cancer and cerebrovascular diseases in Switzerland.

P119 Reviewing the rates of diagnosing Gonorrhoea in an era of COVID

Coronaviruses are causing severe respiratory and enteric diseases in humans and animals. Here, we report an outbreak of equine coronavirus disease in adult horses, detected by a voluntary syndromic surveillance scheme for equine diseases in Switzerland. This scheme allowed a rapid concerted action to diagnose and contain the disease.

Exposure to metal working fluids (MWF) is common in machining processes worldwide and may lead to diseases of the skin and the respiratory tract. The aim of the study was to investigate exposure and diseases due to MWF in Switzerland between 2004 and 2013. We performed descriptive statistics including determination of median and 90th percentile values of MWF concentrations listed in a database of Suva. Moreover, we clustered MWF-induced occupational diseases listed in a database from the Swiss Central Office for Statistics in Accident Insurance, and performed linear regression over time to investigate temporal course of the illnesses. The 90th percentile for MWF air concentration was 8.1mg (aerosol+vapor)/m3 and 0.9mg aerosol/m3 (inhalable fraction). One thousand two hundred and eighty skin diseases and 96 respiratory diseases were observed. This is the first investigation describing exposure to and diseases due to MWF in Switzerland over a timeframe of 10 years. In general, working conditions in the companies of this investigation were acceptable. Most measured MWF concentrations were below both the Swiss and most international occupational exposure limits of 2014. The percentage of workers declared unfit for work was 17% compared to the average of other occupational diseases (12%).

AimDuchenne Muscular Dystrophy (DMD) and Prader-Willi syndrome (PWS) are complex congenital disorders in which sleep disordered breathing (SDB) typically develop, and this impacts normal growth and neurological development. Due to the slow progression of SDB pathology and the lack of correlation between SDB pathology and daytime clinical symptoms, these patients are often only actively treated after SDB is fully established. This study aims: (1) to determine whether there are changes in breath timing and breath shape (morphology) during sleep in these paediatric respiratory disorders when compared with healthy children; and (2) whether there is an association between physiological markers of disorder progression with these indices of breath timing and shape.MethodsA retrospective cohort of 13patients with DMD and 11 patients with PWS whom had at least three sequential overnight polysomnograms and 27 healthy controls (2-17 years) were identified from a clinical database. The nasal pressure signal in at least two ten-minute segments of stage 2 non-rapid eye movement (NREM) sleep for each patient was extracted from each retrospective polysomnogram. Each breath was automatically segmented into inspiratory and expiratory phase using a customised algorithm, and these were used quantified using three categories of indices: (1) Timing indices including total breath time (Ttot) and fractional inspiratory time (FIT) (mean and standard deviation, SD); (2) Linear shape descriptors (skewness, kurtosis and variance); and (3) Non-linear shape descriptors (line morphology, length – ‘flatness’ – and variability). In addition, standard physiological markers of disease progression were extracted from the polysomnogram report: total apnoea-hypopnoea index (AHI), body-mass index (BMI), mean SpO2 and mean CO2. Indices of breath timing and shape were compared between the disorder cohorts and healthy controls; and the changes in indices over years for cohorts were compared to standardphysiological measures to determine if there was any association with disorder progression.ResultsIn patients with DMD, the mean FIT was statistically different than healthy controls (0.47 vs. 0.41, p<0.05) and there was a trend that SD of FIT was higher in patients with DMD going on to treatment, than those not (0.045 vs. 0.054). Linear shape indices of inspiratory kurtosis and variance linearly correlated with higher mean CO2 over years. So, too, did expiratory variance and expiratory line length, the latter with higher BMI. For patients with PWS, their SD of FIT (0.09 vs 0.06, p<0.05) was higher in than healthy controls. Their mean CO2 is positively correlated with inspiratory kurtosis and inspiratory line (flatness). The higher AHI and BMI were correlated with inspiratory line variance, butnegatively correlated for expiratory line length and variance.DiscussionBreath timing indices during sleep are different in patients with DMD or PWS relative to healthy controls. They both exhibit different timing characteristics; patients with DMD have a higher mean FIT and this appears to be more variable with impending need for treatment, whereas the patients with PWS have variability in FIT – irrespective of longitudinal trend or BMI changes. These linear and non-linear analyses correlate shape and its variability with negative physiological outcome from first to the last study in some patients with DMD or PWS. For those patients with DMD with negative physiological outcome of higher mean CO2, the inspiratory flow shape changed to a more peaked (higher inspiratory kurtosis) and narrowed shape (low variance). The expiratory flow shape in patients with DMD is more rounded as it is wider (expiratory variance high) with short ‘flat’ periods (short expiratory line length) with higher BMI – the end expiratory pause is reduced. In patients with PWS, the shape changes are different to patients with DMD in that the inspiratory flow shape has shorter ‘flat’ periods (short inspiratory line length), shape rounding, with negative physiological outcome. The expiratory shape in patients with PWS have longer line lengths (long expiratory line length) with higher variability of the line length (larger expiratory line width at half maximum). Inspiratory and expiratory flow limitation (IFL and EFL) exhibit differences in shape characteristics associated with physiological markers in these two paediatric respiratory disorders. These differences may be indicative of a deterioration of respiratory muscles in patients with DMD and an increasing upper-airway resistance and breathing control abnormalities and upper-airway resistance in patients with PWS. These indices, derived from conventional respiratory monitoring instrumentation, may be useful in monitoring the physiological status of such patients and assisting in the clinical decision to treat. They show subtle change with negative physiological outcome that is not observed with the current, coarse metric for SDB, the apnoea-hypopnoea index (AHI).

Background: The relationship between mother's behavior and the occurrence of ISPA is that the mother always burns rubbish at home. This makes it very easy for toddlers to contract acute respiratory infections. Relationship between mother's behavior shows the susceptibility of getting upper or lower respiratory tract diseases which are included in the class of Air Borne Disease or those that are transmitted through the air by inhalation which can cause various spectrum of diseases ranging from asymptomatic disease or mild infection to severe and deadly disease, depending on the causative pathogen. Objective: To determine the relationship between maternal behavior and the incidence of ISPA in toddlers in the Tanjung Karang Health Center, Mataram City. Method: This research uses an analytical survey research design with a cross sectional approach. The population in this study were 97 toddlers aged 0-5 years who had suffered from ISPA in the last 2 years. The sampling technique for this research is purposive sampling. Methods of data collection using a questionnaire. The statistical test used in this research is Chi-Square. Results: The results of this study indicate that there is a significant relationship between maternal behavior and the incidence in toddlers in the Tanjung Karang Health Center, Mataram City with a P-Value of 0.014 &lt;0.05. Conclusion: Maternal behavior is one of the causes of ISPA in toddlers in the Tanjung Karang Health Center , Mataram City. Suggestion: It is hoped that parents will pay more attention to the health of toddlers and pay attention to active behavior so that toddlers do not get ISPA. ABSTRACT Latar Belakang: Hubungan perilaku ibu dengan kejadian ispa adalah ibu selalu membakar sampah dirumah. Hal ini mudah sekali terkenanya penyakit ispa pada balita. Hubungan perilaku ibu menunjukkan mudahnya terkena penyakit saluran pernapasan atas atau bawah yang termasuk penyakit golongan Air Borne Disease atau yang ditularkan melalui udara dengan inhalasi yang dapat menimbulkan berbagai spektrum penyakit yang berkisar dari penyakit tanpa gejala atau infeksi ringan sampai penyakit yang parah dan mematikan, tergantung pada patogen penyebabnya. Tujuan: Untuk mengetahui hubungan perilaku ibu dengan kejadian ISPA pada balita di Wilayah Kerja Puskesmas Tanjung Karang Kota Mataram. Metode: Penelitian ini menggunakan desain penelitian survey analitik dengan pendekatan cross sectional. Populasi dalam penelitian ini yaitu balita berusia 0-5 tahun yang pernah menderita ISPA 2 tahun terakhir yaitu sebanyak 97 balita. Teknik sampling penelitian ini yaitu Purposive sampling. Metode pengumpulan data menggunakan kuisioner. Uji statistic yang digunakan dalam penelitian ini adalah Chi-Square. Hasil: Hasil penelitian ini menunjukkan terdapat hubungan yang signifikan antara Perilaku Ibu dengan kejadian ISPA pada balita di Wilayah Kerja Puskesmas Tanjung Karang Kota Mataram dengan P-Value 0,014&lt;0,05. Kesimpulan: Perilaku ibu merupakah salah satu penyebab terjadinya ISPA pada balita di Wilayah Kerja Puskesmas Tanjung Karang Kota Mataram. Saran: Diharapkan agar orang tua lebih memperhatikan kesehatan balita dan memperhatikan perilaku yang aktif agar balita tidak terkena ispa.

Background: The WHO reported that airborne diseases were responsible for 39 million deaths, accounting for 57% of the total 68 million deaths worldwide in 2021. Landfills are a significant source of air pollution, producing sulfur dioxide (SO2) gas, which is harmful to respiratory health, particularly the lungs. This study aims to examine the relationship between the hazard quotient of SO2 exposure and respiratory symptoms among scavengers at the Sarimukti landfill in West Bandung Regency, using an environmental health risk analysis approach.Subjects and Method: The research contributes to exposure risk management by establishing safe thresholds for SO2 concentration, exposure time, and frequency for scavengers. This study adopts a correlation design with a longitudinal approach. The sample consisted of 101 scavengers selected through accidental sampling. Pollutant measurements were taken at two locations within the Sarimukti landfill. The independent variable in this study is the hazard quotient value of SO2 expo-sure, while the dependent variable is respiratory symptoms in scavengers.Results: The results indicated a (OR= 15.83; 95% CI= 1.10 to 226.67; p= 0.008). Risk management is based on a safe SO2 concentration limit of 14.18 µg/m³, an exposure time of 15 hours, and an exposure frequency of 637 days over 30 years.Conclusion: The measurement result of SO2 concentration of 7.38 µg/m³ is still below the specified quality standard of 150 µg/m³. However, through the calculation of the hazard quotient, the concentration exceeds the safe limit (HQ &gt;= 1). The implication of this study in preventing the occurrence of respiratory symptoms in waste pickers is the use of PPE, limiting working hours and days in the landfill.

Tidal breathing measurements can be used to identify changes in respiratory status. Structured light plethysmography (SLP) is a non-contact tidal breathing measurement technique. Lack of reference equations for SLP parameters makes clinical decision-making difficult. We have developed a set of growth-adjusted reference equations for seven clinically pertinent parameters of respiratory rate (fR), inspiratory time (tI), expiratory time (tE), duty cycle (tI/total breath time), phase (thoraco-abdominal asynchrony (TAA)), relative thoracic contribution (RTC) and tidal inspiratory/expiratory flow at 50% volume (IE50).Reference equations were developed based on a cohort of 198 seated healthy subjects (age 2–75 years, height 82–194 cm, 108 males). We adopted the same methodological approach as the Global Lung Function Initiative (GLI) report on spirometric reference equations. 5 min of tidal breathing was recorded per subject. Parameters were summarised with their medians. The supplementary material provided is an integral part of this work and a reference range calculator is provided therein.We found predicted fR to decrease with age and height rapidly in the first 20 years and slowly thereafter. Expected tI, tE and RTC followed the opposite trend. RTC was 6.7% higher in females. Duty cycle increased with age, peaked at 13 years and decreased thereafter. TAA was high and variable in early life and declined rapidly with age. Predicted IE50 was constant, as it did not correlate with growth.These reference ranges for seven key measures ensure that clinicians and researchers can identify tidal breathing patterns in disease and better understand and interpret SLP and tidal breathing data.

At the end of 2019, the novel coronavirus (CoV) of severe acute respiratory syndrome (SARS), named SARS- CoV-2 was approved as a microbial agent that causes viral pneumonia in patients who are linked epidemiologically to the seafood market in Wuhan (Wuhan) Hubei province, China [1]. The World Health Organization (WHO) stated the coronavirus or COVID-19 as a pandemic because it has spread globally in the world since March 11, 2020 [2]. There have been more than 8 million cases reported with more than 450 thousand deaths around the world until June 19, 2020 [3]. Indonesia reported the first cases of COVID-19 in early March 2020 and currently 43,803 cases with 2,373 deaths [4]. Indonesia has the highest cases of COVID-19 in Southeast Asia [5]. WHO stated that according to the current evidence, coronavirus is transmitted among people through respiratory droplets and contact routes [6-8]. Droplet transmission is different from airborne disease. Droplet transmission occurs when a person closely contacted (within 1 m) with someone who has respiratory symptoms (e.g. coughing or sneezing,) and was therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets. Droplet transmission may also occur through fomites in the immediate environment around the infected person [9]. Increasing cases occur continuously become alert for our institution as health care providers.

Environmental professionals and medical practitioners have made significant contributions using statistical methods to model medical data and associated air and water pollution parameters in order to determine the cause–effect relationship between air/water-borne diseases and air/water pollution parameters. Several data-intensive studies have been carried out that primarily centered on exposure to exhaust pollution and epidemiological studies associated with various respiratory diseases. This chapter explains this causal relationship with the help of two case studies that reveal a strong correlation between polluted water and water-borne diseases (WBDs) as well as polluted air and air-borne diseases (ABDs). The perceptions of experienced medical practitioners are modelled in arriving at their collective degree of belief for all possible combinations of ABDs/WBDs, by the application of evidence theory and fuzzy relational calculus without the need of having a sizeable parametric data collected over several years. The objective of this chapter is, therefore, to critically evaluate the vast armamentarium available on these facets of air and water pollution studies.

The Role of Infectious Aerosols in Disease Transmission in Pigs

Giriş ve Amaç: COVİD-19'un hava yolu ile bulaşan bir hastalık olması nedeniyle toplumda salgının önlenmesi veya yayılım hızının azaltılması için maske kullanımı en hızlı, kolay, ucuz ve etkili korunma yöntemidir. Doktorların ve tıp fakültesi öğrencilerinin COVID-19’a yakalanma riski ve bir diğer kişiye bulaştırma olasılığı genel topluma oranla daha yüksektir. Tıp fakültesi öğrencilerinin maske kullanımına dair bilgi, tutum ve davranış durumlarının belirlenmesi, önerilen önlemlere uymadaki kırılma noktalarının belirlenmesini sağlayacaktır. Bu çalışmada, tıp fakültesi öğrencilerinin maske kullanımına ilişkin bilgi, tutum ve davranışlarının değerlendirilmesi amaçlanmıştır. Yöntem: Tanımlayıcı bir araştırmadır. 2020 Ekim, Kasım, Aralık, 2021 Ocak aylarında çevrimiçi veri toplanmıştır. Dört çeşit maske görseline ilişkin dörder soru ile bilgi ölçülmüştür. Her doğru yanıt 1 puandır. Dört senaryo verilerek, tutum değerlendirilmiştir. Uygunsuz maske kullanımları gösterilerek davranışları değerlendirilmiştir. Maskeye bağlı deneyimlenen semptomlar ve zorluklar belirlenmiştir. Kategorik değişkenler sayı ve yüzde ile, sürekli değişkenler ortalama, standart sapma, ortanca, minimum ve maksimum olarak verilmiştir İstatistiksel analizde Mann Whitney U Testi kullanılmıştır. Önemlilik değeri p&amp;lt;0,05 alınmıştır. Bulgular: Çalışmaya 209 öğrenci katılmıştı. Bilgi puanı ortanca 14(10-16)’tü. Kadınlar ile erkeklerin bilgi puanı ortalamaları benzerdi (p&amp;gt;0,05). Klinik dönem öğrencilerinin puan ortalaması (14,5±1,4) preklinik dönem öğrencilerinden (13,4±1,6) önemli şekilde yüksekti (p&amp;gt;0,05). En fazla deneyimlenen uygunsuz kullanım biçimi maskeyi çeneye indirmek (%41,1), en sık yaşanan semptomlar terleme, kulaklarda acı, nefes alamama ve kaşıntı, zorluk deneyimleri ise gözlük kullanımı, duygularını yansıtma güçlüğü ve sözlerini duyurma güçlüğüydü. Sonuç: Tıp Fakültesi öğrencilerinin maskeler hakkındaki bilgi düzeyleri yüksektir. Solunum yoluyla bulaşan hastalıklardan korunmak için en hızlı, ucuz ve ulaşılabilir araç maskedir ancak duygu ve sözlerin iletilmesinde güçlük oluşturmaktadır. Tıp öğrencilerine ve tüm sağlık çalışanlarına maske kullanırken etkili iletişim kurma becerileri eğitimi verilmelidir.

Background: Mitigating the risk of nosocomial respiratory disease transmission in the healthcare facilities of low- and middle−income countries (LMICs) poses unique challenges because mechanical ventilation and mixed−mode strategies are often unavailable. Carbon dioxide (CO2) can serve as a proxy for ventilation and, hence, airborne infectious disease transmission risk in naturally ventilated spaces. We assessed the adequacy of ventilation in Liberian hospitals. Methods: We sampled 3 hospitals, both urban and rural, in Montserrado County, Liberia. Moreover, 3 CO2 meters were concurrently utilized to measure CO2 levels at a 1-meter height in every patient-care room in each facility. We recorded temperature, humidity, room dimensions, and number of people in the rooms. From these variables, we calculated absolute ventilation using the ASHRAE equation to determine areas with the highest risk of nosocomial respiratory disease transmission. We also recorded qualitative observations about the sampled spaces. Results: From August 2022 to February 2023, 39 rooms in 3 healthcare facilities were sampled. Initial quantitative findings show that only 8 rooms (21%) met the WHO-recommended ventilation rate of 60 L per second per person. The average ventilation rate per person in the adequately ventilated settings was 86 L per second per patient, compared to 19 liters per second per patient in inadequately ventilated rooms. Additionally, 467 ppm mean CO2 was noted in well-ventilated rooms compared to 895 ppm mean CO2 in inadequately ventilated rooms.Initial qualitative observations showed that facilities with lower CO2 readings tended to be older constructions that likely had been constructed with airborne disease such as tuberculosis in mind. Willingness to open windows was limited by lack of window screens for malaria prevention, and there was a pervasive fallacy that air conditioning was a source of ventilation. Correspondingly, of the 31 inadequately ventilated rooms, 22 (71%) had operating air conditioning units compared with 4 (50%) of the 8 adequately ventilated rooms. Overall, of the 13 rooms without air conditioning, 7 (54%) were more frequently characterized by open windows compared to only 5 of 26 (28%) of rooms that did have air conditioners. Conclusions: Being prepared for the next respiratory disease outbreak and creating more resilient healthcare systems in LMICs requires a frameshift of prevention strategies. Measuring CO2 provides a simple strategy for identifying areas at highest risk for nosocomial respiratory disease transmission, which can be prioritized for low-cost environmental interventions, such as provision of window screens, as part of routine infection prevention and control efforts.Disclosure: None

Common cold outbreaks: A network theory approach