General Protective Measures Research Articles

Increase in acute mastoiditis at the end of the COVID-19 pandemic

PurposeCommon respiratory infections were significantly reduced during the COVID-19 pandemic due to general protective and hygiene measures. The gradual withdrawal of these non-pharmaceutical interventions (NPI) was associated with a notable increase in these infections, particularly in pediatric and adult otorhinolaryngology. The aim of this retrospective monocentric study was to evaluate the impact of NPI during the COVID-19 pandemic on the incidence and severity of acute mastoiditis (AM).MethodsPre-pandemic clinical data of AM cases from 2011 to 2019 were compared with infection counts from January 2020 to June 2023 for seasonal periodicity, age-specific differences, pathogens, and complication rates in a German third-level hospital.ResultsOut of 196 patients with AM 133 were children, the majority between 1 and 5 years of age. Complications of AM, such as meningitis, brain abscess, and sinus vein thrombosis, were more common in adults (87%) than in children (17%). Morbidity and mortality rates were similar before, during and after the pandemic. Pneumococci were the most common pathogen in both age groups, with a post-pandemic cumulation of Streptococcus pyogenes infections in children. While pre-pandemic cases clustered in spring, seasonality was absent in all age groups during the main phase of the pandemic. The cessation of NPI caused a steep rise in AM cases in both age groups starting from December 2022.ConclusionNPI during the COVID-19 pandemic reduced the incidence of AM. Their reversal led to a substantial increase in the incidence of AM during the post-pandemic period, which may be due to a general increase in viral respiratory infections and an insufficiently trained immune system.

Criminal procedural measures to protect victims of domestic violence

Protecting the victims of crimes is an objective of the judicial bodies to avoid the risk of revictimization, thus exercising their obligation to defend the fundamental rights of the person (the right to life, the right to health and physical and mental integrity, the protection of dignity, private life, the right to free expression etc.), as protected by a series of national and international normative acts.
 The criminal procedural measures for the protection of victims of the crime of domestic violence can belong to various criminal legal or criminal procedural institutions: general protective measures, regulated in art. 113 of Criminal Procedure Code related to art. 125-130 of Criminal Procedure Code, preventive measures, accessory and complementary punishments and administrative protective measures ordered on the basis of Law 682/2002 on the protection of witnesses.
 The development of Romanian legislation to complete the spectrum of available instruments, protective measures imposed by international legislation or inspired by the legislation of other states or from the recommendations presented by international experts, is necessary and would follow the trend on a European scale to harmonize the practices of physical and psychological protection of victims.
 Thus, the capacity of the judicial bodies to obtain the willingness of the victims to cooperate with the judicial bodies will be enhanced, the risks of exposure to any danger by participating in the trial being minimized, and they will be encouraged to adopt a sincere, unhindered attitude during the hearings.

Analyses on an electronic voltage transformer's failure by its resonance with very fast transient overvoltage and suppression

AbstractAs voltage measuring devices are widely used in the high voltage power system with a primary‐secondary‐fusion structure, electronic voltage transformers are directly connected to the primary conductor and would face much more serious electromagnetic environments than general secondary equipment. As a result, they would still experience failures even when general protection measures are adopted to suppress overvoltages' amplitudes. To address this issue, an innovative method is proposed after analyses are conducted on the resonance between a transformer and an overvoltage. Within this method, an air‐cored coil is installed in a transformer to artificially shift its natural frequency and to dodge the high‐frequency dominant component of a transient overvoltage, avoiding the aforementioned resonance and suppressing the secondary overvoltage. In addition, simulations and laboratory tests are conducted to prove this method's validity.

Timely course of SARS-CoV-2 infections and vaccinations in patients with hemato-oncological diseases: analysis of a real-life cohort

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has particularly impacted patients with hemato-oncological malignancies, as they showed not only a higher propensity for severe courses but also weaker immune responses after vaccination. Still, data on the influence of pandemic waves and vaccinations on outcomes are rare. This study aimed to analyze the timely course of infections and vaccinations in a real-life cohort of patients with hemato-oncological diseases. In this cohort study, 1817 patients with hemato-oncological diseases from 1 February 2020 to 15 December 2022 at the 'Franz Tappeiner' Hospital in Merano/Meran, Italy, were followed for SARS-CoV-2 infections and vaccinations. Of 1817 patients with hemato-oncological malignancies, 735 (40.5%) were infected at least once with SARS-CoV-2, and 1614 (88.8%) received one or more doses of the approved vaccinations. Patients receiving antineoplastic treatment had a lower SARS-CoV-2 infection rate [35.1% versus 41.0%; odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64-0.95], but higher risk of hospitalization (13.4% versus 6.9%; OR 2.11, 95% CI 1.25-3.69) compared with untreated patients. Overall, the case fatality rate (CFR) was 3.4%. Unvaccinated patients were more prone to severe coronavirus disease 2019 (COVID-19) courses requiring hospitalization (OR 2.34, 95% CI 1.25-4.36) and had a higher CFR (7.3% versus 1.6%; OR 4.98, 95% CI 2.16-12.98) than their vaccinated counterparts. In the Delta wave, patients with two vaccinations had a lower infection risk (OR 0.18, 95% CI 0.10-0.35) and tendentially lower hospitalization rates (OR 0.25, 95% CI 0.05-1.29) than unvaccinated patients. In the Omicron wave, 345/1198 (28.8%) patients with three or more vaccinations had breakthrough infections, resulting in a similar risk for infection (OR 0.88, 95% CI 0.60-1.30) but numerically lower risk for hospitalization (24/345, 7.0%) than unvaccinated individuals (4/40, 10.0%). Scheduled visits were postponed in 128/335 (38.2%) patients due to COVID-19, and deferrals correlated with pandemic wave (P= 0.002) and vaccination status (P < 0.001). SARS-CoV-2 infections and outcomes differ between distinct phases of the pandemic. Vaccination with variant-specific vaccines should be prioritized as general protective measures are increasingly lifted.

Changes in the Competitive Environment and Their Evaluation in the Context of COVID-19: A Case Study

When evaluating the competitive environment in the context of the pandemic, the pandemic’s global scale must be considered, since all products related to COVID-19 management have no regional competition but rather immediately switch to global competition and compete with similar products or substitutes. It should be noted that no products intended for managing the pandemic were available before its outburst. Even with the onset of the pandemic, not many specialized products, except for some general protection measures, were developed. However, in the two years after the pandemic began, competitive products intended for managing COVID-19 emerged into the market. The global scale of the pandemic automatically created worldwide demand for such products, which leads to a global shift in competitiveness. As a result, the competitive environment for products intended to manage COVID-19 is changing. Research purpose: To evaluate the competitive products—modern and robotized indoor disinfection equipment—available in the market and those under development. Research objectives: To develop a methodology for evaluating the competitive products and to select evaluation criteria and methods; to evaluate the competitive products in terms of their functionality and technical characteristics; and to research the channels and methods employed to launch competitive products into the market and provide analysis of best practice.

COVID-19-Infektionsquote im Bau- und Reinigungsgewerbe: bekannte Infektionen und Dunkelziffer. Teil 2: Frauen

COVID-19 infection rate in the construction and cleaning industry: known infections and under-reporting factor. Part 2: Women Aims: The aims of this study were to assess the prevalence of COVID-19 among female construction and cleaning workers in Germany, to estimate the number of unreported cases, to consider whether it is possible to assume an increased risk compared to the general population and to examine the influence on the infection rate of job-specific risk factors such as place of work and occupation. Methods: We conducted a seroepidemiological study to detect antibodies to COVID-19 among n = 219 women who attended the participating occupational health centres for medical check-ups. The study participants completed a questionnaire which included questions on living conditions, occupation, professional status and known previous infection. 43 women worked in the cleaning industry (19.6 %), whilst 134 were predominantly office workers, managers and supervisors (61.2 %). Results: 14 women (6.4 %) knew that they had already been infected with COVID-19. Among the n = 205 women without known infection, antibodies to COVID-19 were positive in n = 9 subjects (4.1 %). Overall, 23 women (10.5 %) had a previous COVID-19 infection. In relation to the known COVID-19 infections, the number of unreported cases (under-reporting factor) was 64 %. It was not possible to establish whether working on construction sites had a definite influence on the infection rate. There are indications of an increased risk of infection for cleaning activities, especially in old people’s homes and hospitals. Conclusions: Occupational health and safety measures should be strengthened and consistently implemented for this group of people. The underreporting factor of 64 % indicates that not all people with an infection are recorded. Compliance with general protective measures is therefore of great importance in containing the COVID-19 pandemic. Keywords: COVID-19 – infection rate – under-reporting – construction and cleaning industry

Electropalatography (EPG) activities in Japan and the impact of the COVID‐19 pandemic on EPG research and therapy: A report of presentations at the 7th EPG Symposium

BackgroundAt the 7th Electropalatography Symposium in Japan, held online on the 24 January 2021, a few speakers were invited to talk about how the COVID‐19 pandemic had impacted their research and/or speech therapy that involved the use of electropalatography (EPG) as well as the procedures adopted in order to continue their work in a safe manner. The information on protective measures when using instrumental techniques in speech research and therapy may be useful for colleagues in research and the clinic.AimsThe primary aims are: (1) to find out whether there are any published recommendations regarding protective measures for using EPG in research and clinic settings; (2) to discuss the impact of the pandemic and the corresponding restrictions and general protective measures directed (or advised) by local government and professional bodies at each stage of EPG work; and (3) to share experiences in using modified procedures for face‐to‐face EPG therapy sessions and combined EPG teletherapy. In addition, a brief overview of EPG and a summary of EPG research and clinical activities in Japan presented by one of the symposium organizers at the symposium are included.Methods & ProceduresA review of the literature regarding protective measures recommended for using EPG for speech assessment and treatment or research, supplemented by a discussion of our own experiences.Main ContributionThe literature review showed that there are no guidelines regarding protective measures for using EPG, but there is some advice regarding speech recording using microphones. Most published articles related to speech and language therapy (SLT) service during COVID‐19 are about telepractice or general clinical guidelines for face‐to‐face speech therapy sessions. The protective measures for using EPG developed based on the general guidelines recommended by local government and professional bodies (e.g., using visors, transparent acrylic board) were described. Using EPG in telepractice was discussed as well.ConclusionsIt has been challenging to continue EPG research and therapy during the pandemic. In order to deal with this crisis, available knowledge regarding infection control and recommendations from local government and professional bodies were applied to design methods and procedures that allowed EPG research and therapy to continue.What this paper addsWhat is already known on the subject There are general protective measures recommended by local government and professional bodies regarding speech therapy sessions (e.g., using personal protective equipment (PPE), social distancing), but little is known about the measures for using instrumental techniques in speech research and therapy, particularly EPG. The equipment of each instrumental technique is different, so measures that are appropriate for one may not be suitable for others. Hence, specific recommendations are needed for EPG. What this paper adds to existing knowledge This paper provides pointers to information about recommendations regarding protective measures for speech research and therapy, supplemented with suggestions specific to EPG provided by experienced users based on actual experience. What are the potential or actual clinical implications of this work? In evaluating the impact of the COVID‐19 pandemic on EPG research and therapy, an analytical approach was taken to break down the steps involved in carrying out those activities, and the challenges we faced and the possible alternatives for completing the tasks were discussed. A similar approach can be applied to evaluate other aspects of speech therapy service.

Ursodeoxycholic Acid Decreases Incidence of Primary Biliary Cholangitis and Biliary Complications After Liver Transplantation.

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COVID-19-Infektionsquote im Bau- und Reinigungsgewerbe: bekannte Infektionen und Dunkelziffer. Teil 1 – Männer

COVID-19 infection rate in the construction and cleaning industry: known infections and unrecorded cases. Part 1 – men Aim: The aims of this study were to assess the prevalence of COVID-19 in the construction industry in Germany, the number of unreported cases (under-recording factor) and whether an increase in risk compared to the general population can be assumed in the construction industry, and to examine the influence of certain possible job-specific risk factors such as the location and nature of the activity on the infection-rate. Methods: We conducted a COVID-19 seroepidemiological study of n = 3,493 men who attended one of the participating occupational health service centres for occupational medical examinations. A questionnaire was also completed by the study participants on living conditions, occupational activity, position in the occupation and known previous infections, among other factors. Results: 3.4% of the men disclosed a previous COVID-19 Infection. Of the n = 3,374 men with no known infection, COVID-19 antibodies were found in n = 84 of the subject group (2.4 % relative to the basic population), hence 5.8 % of the men had a COVID-19 infection. Relative to the known COVID-19 infections, the number of unreported cases of non-diagnosed COVID-19 Infections (under-reporting factor) was thus 70 %. A clear influence of work on construction sites and in the cleaning industry could not be detected. For office work, there were indications of an increased risk of infection. Compared to the general population, it is unlikely that there is an increased risk associated with working on construction sites. The infection rate was lower in smokers than in non-smokers. Conclusion: Given 70 % unreported cases, company doctors, for instance, should use the determination of COVID-19 antibodies in unvaccinated men without a known infection to offer a booster vaccination to them as well as to persons with a known infection. Furthermore, the under-reporting factor, which is not low, indicates that not all people with an infection are successfully recorded, so that compliance with general protective measures is of great importance for containing the pandemic. Keywords: COVID-19 – infection rate – unrecorded cases – construction industry

Acute and Chronic Paronychia Revisited: A Narrative Review.

Paronychia refers to the inflammation of the tissue which immediately surrounds the nail and it can be acute (<6 weeks duration) or chronic (>6 weeks duration). Disruption of the protective barrier between the nail plate and the adjacent nail fold preceded by infectious or noninfectious etiologies results in the development of paronychia. A combination of general protective measures, and medical and/or surgical interventions are required for management. This review explores the pathogenesis, clinical features, differential diagnosis, medical, and surgical management of paronychia. For the purpose of this review, we searched the PubMed, Cochrane, and Scopus databases using the following keywords, titles, and medical subject headings (MeSH): acute paronychia, chronic paronychia, and paronychial surgeries. Relevant review articles, original articles, and case reports/series published till February 2020 were included in this study.

Should We Expand the Use of Granulocyte-Colony Stimulating Factors (G-CSF) during the COVID-19 Pandemic?

Cancer patients are considered more susceptible to the SARS-CoV-2 infection. Higher rates of respiratory failure and death were reported in cancer patients and COVID-19, compared with the general population. Among other measures deemed to protect this vulnerable subcategory, both ASCO and ESMO recommended the extension of G-CSF use, to include prophylactic administration in all patients receiving regimens with 10%-20% risk of febrile neutropenia (FN) and also in regimens with risk of FN &lt;10%, if patients were considered with poor bone marrow reserve due to comorbidities or advanced age. However, accumulating data reported in several recent publications suggested a direct involvement of the high neutrophil count, due to G-CSF stimulation, in the development of the adult respiratory distress syndrome (ARDS), the hallmark of the severe COVID-19 disease. In addition, some recent evidences suggest that G-CSF may hamper the efficacy of the mRNA vaccine. This paper reviews the most important data reporting higher rates of respiratory failures and death associated with G-CSF treatment in cancer patients and SARS-CoV-2 infection. Therefore, we consider that the current recommendation of expanding the G-CSF use in cancer patients during the COVID-19 pandemic should be reconsidered. The most important protective measures for cancer patients remain specific vaccination and a rigorous compliance with the general protective measures, whereas the G-CSF should be administrated as traditionally recommended by the current guidelines.

Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence

ABSTRACT Introduction The COVID-19 pandemic has created a public health crisis, infected millions of people, and caused a significant number of deaths. SARS-CoV-2 transmits from person to person through several routes, mainly via respiratory droplets, which makes it difficult to contain its spread into the community. Here, we provide an overview of the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment of COVID-19. Areas covered Direct person-to-person respiratory transmission has rapidly amplified the spread of coronavirus. In the absence of any clinically proven treatment options, the current clinical management of COVID-19 includes symptom management, infection prevention and control measures, optimized supportive care, and intensive care support in severe or critical illness. Developing an effective vaccine is now a leading research priority. Some vaccines have already been approved by the regulatory authorities for the prevention of COVID-19. Expert opinion General prevention and protection measures regarding the containment and management of the second or third waves are necessary to minimize the risk of infection. Until now, four vaccines reported variable efficacies of between 62–95%, and two of them (Pfizer/BioNTech and Moderna) received FDA emergency use authorization. Equitable access and effective distribution of these vaccines in all countries will save millions of lives.

The risks encountered by healthcare professionals in the global COVID-19 outbreak: the importance of protection

The Novel Coronavirus Desease (COVID-19), which started on the 31st of December 2019, with the notification of cases of unknown pneumonia in Wuhan City, Hubei Province, China, was declared as a pandemic in order to increase the general protective measures in terms of its spreading rate and its effect on human health, and entered the group of pandemic diseases in history. COVID-19 infected 25 million people in about 220 countries during this 8-month period, and it became the 21st century's most life-threatening epidemic, being responsible for the death of 852.758 people (at the time of writing). The number of infected medical personnel in the COVID-19 outbreak is unprecedented in modern history due to the high amount of data (10%) that only includes this 4-month period. Problems such as the healthcare professionals being at the forefront of the fight against the epidemic, a lot of uncertainty at the beginning of the epidemic and the intense stress created by it, delay of measures to be taken, problems in the implementation of these measures, intense working hours, lack of information and lack of equipment are some of these risks. It is very important for healthcare professionals to protect their own health principally in order to fight this epidemic. This review has been prepared to draw attention to the risks faced by healthcare professionals in the COVID-19 outbreak, the repercussions of the infection, and to highlight the protection of healthcare professionals from infection.

Homecare for sick family members while waiting for medical help during the 2014-2015 Ebola outbreak in Sierra Leone: a mixed methods study

IntroductionCaring for an Ebola patient is a known risk factor for disease transmission. In Sierra Leone during the outbreak in 2014/2015, isolation of patients in specialised facilities was not always...

Recommendations for oncological surgical practice in COVID-19 pandemics: a review of literature

While the whole world is gaining more and more achievements and progression in several fields, a corona pandemic comes to brake this progress and find us lacking many crucial points. One of these points is to have an emergency protocol for performing different types of surgery in such pandemic states. This led to floundering in surgical decisions for many patients. This review summarizes some recommendations for performing surgeries, especially oncological surgery in the corona pandemic. As a general protection measure, all surgical patients and medical staff must complete preoperative screening whatever symptomatic or not. The medical staff should comply with the regulations of the health facilities to decrease the viral transmission between the medical staff themselves and their patients. Moreover, correct protective apparel (goggles, visor, mask, and protective bodysuit) must be routine. When dealing with a suspected case or a diagnosed patient, tertiary dress code, increasing the operative room ventilation, and installing air purification equipment should be applied. In conclusion, elective surgeries are recommended to be discontinued to avoid patients' and health professionals' morbidity and mortality. Emergency and oncological surgeries to be performed with extreme precautions.

Compliance with preventive measures against malaria of personnel treated in the centre of international vaccination of the Minister of Defence (Spain).

ABSTRACTObjectiveThis study evaluated the compliance with preventive measures against malaria of the personnel treated in the Spanish Defence International Vaccination Centre (CVI).Material and methodsA retrospective study was conducted from November to December 2017. The population was 534 individuals. All were treated in CVI, prior to their deployment on endemic areas of malaria, with prevention measures type C and D. A questionnaire of 23 items was elaborated.ResultsThe percentage of response to the questionnaire was 36.9% (n=194), 100% were male. Air conditioner was the most used protection measure 93.8% (IC 95% 90.4-97.2). Only 35.5% (95% CI: 28.8-42.2) of them, showed good adherence to medication. The factors that influenced in the adherence were the country and the length of deployment. It was not established a direct relationship between the occurrence of adverse reactions and low adherence to treatment.ConclusionsThe general protection measures against malaria were met in a high percentage, whilst the use of chemoprophylaxis was very low. These epidemiological data allowed us to know the validity of the health education that is provided in the traveller’s care consultation. It also allowed being aware of the possibilities of infection and import of malaria by personnel of the Spanish Armed Forces. The traveller’s office will reinforce the importance of taking the adequate chemoprophylaxis trough conferences and informative diptychs.

Környezetbiztonsági kockázatok csökkentése – árvízi elöntési területek kiterjedésének valós idejű előrejelzése – a Rába-vízgyűjtő magyarországi szakaszán

Floods – and generally the risk of harmful surplus and lack of water – are among the top environmental safety risks in Hungary. In my paper I deal with the environmental safety issues of the Raba River Valley. Its topicality is provided by a currently runningcross-border hydrological-flood protection development project. The project aims at defining the extent of valley inundations with real-time forecasting at the Hungarian section of the river. Model results can provide adequate support for disaster management emergency planning and security measures, such as protection of villages on open floodplain and general flood protection measures.

Hydrofluoric Acid: Burns and Systemic Toxicity, Protective Measures, Immediate and Hospital Medical Treatment.

BACKGROUND:Hydrofluoric acid is a commonly used chemical in many industrial branches, but it can also be found as an ingredient in household products such as cleaning agents. Possessing high corrosive potential, HF acid causes burns and tissue necrosis, while when absorbed and distributed through the bloodstream, its extremely high toxic potential is expressed. Acute symptoms are often followed by pain, particularly in the case of skin burns, which intensiveness does not often correlate with the expressiveness of the clinical findings. Even exposure to low-concentrated solutions or gasses, or low-doses of high-concentrated acid, may provoke delayed systemic disorder which may eventually have a lethal outcome.AIM:Therefore, having information regarding the possible hazardous effects of hydrofluoric acid usage, a variety of symptoms, as well as a treatment approach, is of great importance in the case of HF exposure.METHODS:Available scientific articles published in literature databases, scientific reports and governmental recommendations from the internet websites, written in English, using the following search terms “Hydrofluoric acid, skin burns, eye injury, ingestion, inhalation, systemic toxicity, decontamination, antidote, medical treatment” have been reviewed.RESULTS:This review is useful not only for physicians but for everyone who may come in contact with a person exposed to HF acid.CONCLUSION:It highlights the mechanism of action, presents the acute and chronic symptoms, personal and general protective measures and devices that should be used, as well as decontamination procedures, immediate, antidote and hospital medical treatment.

Validity of different biomonitoring parameters for the assessment of occupational exposure to N,N-dimethylformamide (DMF).

This study was performed to assess the relation between occupational exposure to N,N-dimethylformamide after an 8h work shift in the acrylic fibre industry and its three biological markers N-methylformamide (NMFtotal), N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC), and N-methylcarbamoyl adduct at haemoglobin (MCVal). External DMF exposure of 220 workers was determined during the whole shift. A standardised questionnaire was used to obtain information about the worker's general health status, medical treatment, smoking habits, protective measures, and possible symptoms caused by DMF exposure. NMF and AMCC were analysed in post-shift urine samples and MCVal in blood. For longitudinal assessment the average AMCC concentration was determined over a period of 4weeks (weekly sampling) in a sub-collective of 89 workers. The median of DMF concentration in air was 3.19mg/m3 (range < 0.15-46.9mg/m3). The biological markers showed a median of 4.80mg/L (range 0.20-50.6mg/L) for NMFtotal, 4.75mg/g creatinine (range 0.06-49.6mg/g creatinine) for AMCC, and 57.5nmol/g globin (range 0.5-414nmol/g) for MCVal. A significant linear relationship was observed between DMF in air and NMF as well as between DMF in air and AMCC in post-shift urine samples. The mean AMCC values measured weekly over a period of 4weeks correlated significantly with MCVal adducts too. Excluding workers who had been using breathing masks on the day of the study led to even tighter correlations. The results of the present study demonstrate the applicability of the DMF biomonitoring parameters NMFtotal in post-shift urine for the present-day exposure assessment, AMCC in the post-shift urine after several shifts for assessment of the cumulative exposure of the previous working days, and MCVal for assessment of long-term exposure during previous weeks and months. The data of the present study enable now the estimation of valid equivalents of these biomonitoring parameters to the external DMF exposure. From the risk assessment point of view, the exposure limit values for AMCC and MCVal, which are directly linked to the presumed toxic intermediate MIC, exhibit a significant advance.

Personal Protection Measures Against Mosquitoes, Ticks, and Other Arthropods.

Arthropod-associated diseases are a major cause of morbidity among travelers. Obtaining a detailed travel itinerary and understanding traveler-specific and destination-specific risk factors can help mitigate the risk of vector-borne diseases. DEET, picaridin, PMD, and IR3535 are insect repellents that offer sufficient protection against arthropod bites. IR3535 does not provide adequate protection against Anopheles mosquitoes, and should be avoided in malaria-endemic regions. General protective measures, such as bite avoidance, protective clothing, insecticide-treated bed nets, and insecticide-treated clothing, should be recommended, especially in malaria-endemic areas. Spatial repellents may prevent nuisance biting, but have not been shown to prevent against vector-borne disease.