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PubMed1992

House dust mite sensitivity: interaction of genetics and allergen dosage.

Pairwise analysis of siblings from 21 families showed that house dust mite (HDM) sensitive children were exposed to higher concentrations of Der p I allergen in their mattress (P = 0.005) and bedding (P = 0.04), but not bedroom floor (P = 0.33), than their atopic sibling who was not sensitive to HDM antigens. There was no difference in the exposure to HDM numbers/100 mg of dust in the mattress (P = 0.61) or bedroom floors (P = 0.09). In contrast, pairwise analysis of siblings from 15 families showed that HDM sensitive children were not exposed to significantly different concentrations of Der p I in the mattress (P = 0.96), bedding (P = 0.11) or bedroom floor (P = 0.70) nor HDM numbers/100 mg of dust in the mattress (P = 0.12) and bedroom floor (P = 0.98) than their non-atopic siblings. These findings were identical when absolute allergen load was compared in these pairs. Genetic linkage studies in these families suggest the tendency to atopic IgE responses is conferred by a putative atopy locus on chromosome 11q. These results together suggest that differences in allergen levels in beds, among siblings with a comparable genetic tendency to atopy, play a significant role in determining the development of HDM allergy.

Allergens↗

PubMed1994

Natural variation in mite antigen density in house dust and relationship to residential factors.

To investigate the year-to-year variation of mite antigen density (Der p I, Der fI) in dust from mattresses and the relevance of residential factors for antigen load, information derived from an epidemiologic study including two surveys carried out in the households of a cohort of elementary school children (n = 1291) was analysed. When considering residences with measurements taken in both years in question (n = 1050), rank-correlation indicated a predominance of stability for both antigens (Der p I: rs = 0.82, P = 0.0001; Der f I: rs = 0.72, P = 0.0001). Using multiple regression analyses, significant associations between antigen concentrations and a variety of residential factors were found. Use of a blanket of animal hair, use of a cover or underblanket, wet spots in the bedroom, higher relative humidity and a low storey level were significantly associated with increased concentrations of Der p I, whereas inverse relationships between this antigen and room temperature, number of persons per m2 as well as use of underfloor heating were seen. Regarding Der fI, older mattresses, use of a cover or underblanket, higher weight of sampled dust, high educational level and higher ratio of inhabitants per m2 were significantly associated with increased concentrations of the antigen. On the other hand, lower Der fI concentrations were found when interior sprung mattresses were used and when the mattress was 'treated regularly'. In conclusion, two measurements, 1 year apart from each other, show that stability of mite antigen concentrations predominated.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗

PubMed2005

Bacterial and fungal agents in house dust and wheeze in children: the PARSIFAL study.

BACKGROUND: Growing up on a farm and an anthroposophic lifestyle are associated with a lower prevalence of allergic diseases in childhood. This might be related to increased inhalatory exposure to microbial agents. OBJECTIVE: To assess the association between microbial agents in house dust and atopic wheeze in farm children, Steiner school children and reference children. METHODS: Levels of bacterial endotoxin, fungal beta(1,3)-glucans and fungal extracellular polysaccharides (EPS) in mattress and living room floor dust were measured in a population of 270 atopic (=Phadiatop-positive) children with self-reported wheezing, including 168 current atopic wheezers, and 441 non-atopic, non-symptomatic controls. These children were selected from a cross-sectional study in five European countries. RESULTS: In the study population as a whole, average levels of mattress dust endotoxin, EPS and glucans were slightly (1.1-1.2-fold; P<0.10) higher in control children than in atopic wheezers. Atopic wheeze was related to mattress levels of endotoxin, EPS and glucans in farm and farm-reference children. However, when adjusting for group (farm vs. farm-reference children), the associations became non-significant whereas the group effect remained. No associations between atopic wheeze and microbial agents were observed in Steiner and Steiner-reference children. For current atopic wheeze, the farm effect became non-significant after adjustment for microbial agent levels. CONCLUSION: Not only bacterial endotoxin but also mould components might offer some protection against atopic wheeze in children. However, the protective effect of being raised on a farm was largely unexplained by the mattress microbial agent levels measured in this study.

Adolescent↗

PubMed1994

Mite allergens during 18 months of intervention.

In Stockholm, Sweden, 17 children with newly diagnosed sensitization to house-dust mites (HDM) and 11 children with previously diagnosed HDM-sensitization were included in a study of HDM-allergen avoidance. Mattress dust was collected on repeated occasions during 18 months and assayed for concentration of major HDM allergens. During the first 12 months, the parents of the intervention group were instructed to intensify cleaning and airing of the child's bedroom. During the last 6 months of the study, the mattresses and pillows of seven children in the intervention group and sibling controls were encased in semipermeable polyurethane covers. The homes exhibited a high absolute indoor humidity throughout the year, and even during the winter the mean levels exceeded 7 g/kg. No mite allergen reduction was seen in the intervention group during the first year. However, among the newly diagnosed HDM-sensitized children, there was a mean reduction of the mattress mite allergen concentration of 83% (P = 0.02), and this was most pronounced in the homes with low humidity. At the end of the mattress encasement period, an average difference of 98% (P < 0.001) was found between the vacuumed amount of mite allergen on top of the covers and that underneath.

Adolescent↗

PubMed1998

Deposition of cat (Fel d 1), dog (Can f 1), and horse allergen over time in public environments--a model of dispersion.

BACKGROUND: The occurrence and accumulation over time in public environments of cat, dog, and horse allergens was evaluated. METHODS: Concentrations of animal danders were analyzed by ELISA and countercurrent immunoelectrophoresis (CCIE). RESULTS: Among factory-new mattresses, 15/17 contained detectable levels of cat and/or dog allergen, whereas no horse allergen was found although six of the mattresses were stuffed with horsehair. Dust from 15 used mattresses contained significantly higher concentrations of Fe1 d 1 and Can f 1 than the factory-new ones (P < 0.001). Allergen concentrations and titers correlated to the period of time that the mattresses had been tried by customers; rs = 0.52-0.77, P = 0.04-0.001 (cat), rs = 0.38-0.48, P = 0.15-0.08 (dog), and rs = 0.64-0.74, P = 0.008-0.003 (horse). The increase over time occurred rapidly in highly frequented stores and after 3 weeks reached concentrations that have been found in homes where furred pets had formerly been kept or even the lower allergen scale of homes where pets were currently kept. CONCLUSIONS: The dispersion of allergens from furred animals to pet-free public places is likely to occur by deposition from people who have been in direct or indirect contact with pets, and high levels of such allergens seem to accumulate in a short period of time.

Allergens↗

PubMed2005

La mano de DIOS...was the PIAMA intervention study intervened upon?

The PIAMA study evaluates whether application of mite impermeable mattress covers reduces exposure to mite allergen sufficiently to reduce the incidence of asthma and mite allergy. The study started in 1996. Baseline measurements of mite allergen levels were conducted on mattresses of newborn children and their parents, mostly in 1997. Mite allergen levels were surprisingly low in this study compared with previous studies among school children and infants. Mite allergen levels were measured again on mattresses in the PIAMA study in the years 2000/2001 when the children were 4 years old, and in a new study among 6-12 year old school children conducted in the fall of 2001. Data on winter climate were collected as well. In the winters of 1995/1996 and 1996/1997, which preceded and coincided with the PIAMA baseline measurements, temperatures had been extremely low, and precipitation had been extremely low as well. It is likely that these unusual winter weather conditions affected the baseline allergen levels in the PIAMA study so that the effect of the planned intervention (mite impermeable mattress covers) was considerably smaller than it could have been.

Antigens, Dermatophagoides↗

PubMed1997

Deaths caused by bedrails.

OBJECTIVES: To determine how bedrails cause death in order to suggest clinical and ergonomic changes to prevent such deaths and to promote research to improve the use and design of bed systems. DESIGN: A review of reports of adult deaths and injuries from bedrails contained in the United States Consumer Product Safety Commission Death Certificate File and its Reported Incidents File and its National Injury Information Clearinghouse Accident Investigations from 1993 to 1996. Deaths involving the use of vest restraints were excluded. We reconstructed, reenacted, and have graphically depicted major patterns of deaths. A review of the literature to 1966 was also done. RESULTS: The 74 deaths described are categorized into three types: (1) 70% were entrapments between the mattress and a rail so that the face was pressed against the mattress, (2) 18% were entrapment and compression of the neck within the rails, and (3) 12% were deaths caused by being trapped by the rails after sliding partially off the bed and having the neck flexed or the chest compressed. CONCLUSIONS: Deaths from bedrails are underrecognized and preventable clinical events that can occur in any medical setting. Preventing these events will require a unified redesign of the relationships between rails, mattresses, and beds, which are now often assembled and used as separate products. Clinicians can prevent many of these deaths by using bedrails much more judiciously, confirming the proper relationships between beds, rails and mattresses, and using alarms.

Aged↗

PubMedDate not supplied

The effects of active peripheral skin warming on perioperative hypothermia in dogs.

OBJECTIVE: This study evaluates the efficacy of three perioperative warming protocols to improve control of body temperature in anesthetized dogs. STUDY DESIGN: A randomized controlled clinical trial. ANIMALS OR SAMPLE POPULATION: Thirty-two client-owned dogs. METHODS: We prospectively studied dogs entering the University of Pennsylvania Veterinary Teaching Hospital for orthopedic or dental procedures and assigned them to one of three perianesthetic warming protocols. Group 1 (n = 10) had a single circulating warm water mattress applied over the trunk (single-trunk warming). Group 2 (n = 12) had two circulating warm water mattresses, one placed over and one under the trunk (double-trunk warming). Group 3 (n = 10) had warm circulating mattresses applied only around the feet and legs of all available limbs (peripheral warming). The warm water mattresses were prewarmed and maintained at 40 degrees C (104 degrees F) and applied immediately after induction of general anesthesia. All dogs had a layer of thick terry cloth toweling beneath and above the trunk. Body temperature measurements were recorded every 15 minutes for the first 2.5 hours of anesthesia. RESULTS: The lowest mean temperature for dogs in group 3 was 37.4 +/- 0.2 degrees C (99.5 degrees F), compared with 36.4 +/- 0.2 degrees C (97.4 degrees F) and 36.7 +/- 0.2 degrees C (98.0 degrees F) in groups 1 and 2, respectively. CONCLUSIONS: Dogs in the peripheral warming group maintained significantly higher core body temperatures than dogs in either trunk warming groups throughout the 2.5-hour study period. CLINICAL RELEVANCE: To maintain body heat in dogs during anesthesia, it is more effective to warm the feet and legs than to warm the trunk.

Animals↗

PubMedDate not supplied

Biomechanical evaluation of suture pullout from canine arytenoid cartilages: effects of hole diameter, suture configuration, suture size, and distraction rate.

OBJECTIVE: To evaluate the mechanical properties of canine arytenoid cartilage-suture constructs. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Eighty canine cadaveric larynges. METHODS: Arytenoid cartilage-suture constructs were loaded to failure on a materials testing machine. The effect of hole size, suture configuration, suture size, and rate of distraction on load at failure, displacement at failure, energy to failure, and construct stiffness were evaluated. Polypropylene sutures were used exclusively. Specific variables evaluated were: (1) hole size-SH needle, 22, 20, and 18 ga hypodermic needles; (2) suture configurations-single dorsal and ventral articular sutures, double sutures, horizontal mattress, locking loop, and single non-articular sutures; (3) suture size-1, 0, 2-0, and 3-0; and (4) distraction rate-0.83 and 36.66 mm/s. RESULTS: Hole size had no effect on any biomechanical variable. Double suture and horizontal mattress configurations had the highest median load and energy at failure. Single dorsal suture configurations that did not include the arcuate crest had the lowest median load at failure. Larger suture sizes tended to result in stiffer constructs. Cartilage-suture constructs behaved in a viscoelastic manner where load at failure, energy at failure, and stiffness increased when distraction rate was increased, whereas displacement at failure did not. Most constructs failed by suture pullout regardless of distraction rate, although 50% of horizontal mattress configurations failed by avulsion of the muscular process. CONCLUSION: Suture and hole sizes appear to have few effects on the biomechanical performance of arytenoid-suture constructs. Double-suture and horizontal mattress suture patterns had the best overall mechanical properties for arytenoid lateralization. Single-suture techniques, which do not incorporate the arcuate crest, were biomechanically inferior. CLINICAL RELEVANCE: Cumbersome large-diameter sutures offer no advantage over smaller sutures when performing arytenoid lateralization. The cross-sectional geometry of the muscular process should be taken into account when placing sutures in the arytenoid cartilages. Single-suture techniques that do not incorporate the arcuate crest should be avoided.

Animals↗

PubMed1984

Comparative study of leg wound skin closure in coronary artery bypass graft operations.

A prospective randomised study of four different methods of leg wound skin closure after removal of the long saphenous vein was carried out in 113 patients undergoing coronary artery bypass grafting. These methods were: (1) continuous nylon vertical mattress suture (27 patients); (2) continuous subcuticular absorbable (Dexon) suture (29 patients); (3) metal skin staples (Autosuture) (27 patients); and (4) adhesive sutureless skin closure ("Op-site") (30 patients). All wounds were examined by two independent observers at five, 10, and 45 days after operation. At five days, inflammation, extent of oedema, discharge, and infection were assessed. At 10 days attention was paid to the state of wound healing and at 45 days to the final cosmetic appearance. The use of continuous subcuticular suture resulted in significantly less discharge than did the use of metal staples, nylon vertical mattress suture, or Op-site. The incidence of established wound infection was 4.5% overall, with no infection in the wounds closed with Dexon. Assessment of the healing process showed subcuticular Dexon to be more effective than metal staples or vertical mattress nylon suture. The final cosmetic result showed continuous subcuticular suture to be superior to nylon vertical mattress suture and skin staples but as effective as Op-site sutureless skin closure.

Coronary Artery Bypass↗

PubMed1996

Seasonal variations in house dust mite influence the circadian peak expiratory flow amplitude.

The aim of the study was to investigate whether seasonal differences in house dust mite (HDM) allergen exposure influence the circadian peak expiratory flow (PEF) amplitude in asthmatic children. Asthmatic children (n = 25) with a solitary allergy to HDM were studied in spring and in autumn. All used inhaled corticosteroids (ICS) regularly. Six days after withdrawal of ICS, PEF amplitude (every 4 h during 24 h, highest-lowest/percentage of mean value) was assessed. HDM allergen (HDMA) in living rooms, bedrooms, and mattresses was collected. HDMA levels were not always highest in autumn. PEF amplitudes in spring and autumn did not correlate with HDMA levels in the same season. However, the seasonal difference in PEF amplitude (autumn value - spring value) correlated positively and significantly with the seasonal difference in HDMA exposure levels from the mattresses (rho = 0.34, p < 0.05). Multivariate analysis showed that the seasonal difference in HDMA exposure in the mattress was the single parameter explaining seasonal difference in PEF amplitudes by 21.0% (p = 0.02). Our cross-sectional study showed a higher PEF amplitude not to be significantly associated with higher HDMA exposure in mattresses in a group of HDM-allergic asthmatic children. However, the change in HDMA exposure over seasons contributed significantly to the change in PEF amplitude after withdrawal of ICS in HDM-allergic asthmatic children.

Allergens↗

PubMed1993

Sensitization to domestic mites in a cold temperate region.

Factors favoring sensitization to house dust mites (HDM) were studied in a cold, temperate climate in northern Sweden. Sixty-five children previously found to react positively to a skin prick test (SPT) to HDM were included. The SPT to HDM was repeated, and serum IgE antibodies to D. pteronyssinus and D. farinae were determined. HDM, Euroglyphus maynei, Tarsonemus, or storage mites occurred in mattress dust samples from 23 of the 65 homes, and in 10 homes more than 100 HDM/g of mattress dust were found. Mites were more prevalent in mattress dust from the basement and ground levels than from the upper floors. Sensitization to HDM was strongly with the presence of domestic mites in mattress and floor dust. Previous longer stays in southern Sweden or Europe were also associated with present sensitization to HDM, and this was independent of occurrence of mites in the residence. The results indicate that HDM growth and potential for sensitization in cold, temperate regions is highly dependent on the microhabitat, and that sensitization to HDM should be possible to prevent in such climatic regions.

Adolescent↗

PubMed1999

Feasibility study of a novel approach to sore prevention in patients with spinal cord lesions: the computerized dynamic control Matrix 200 system.

OBJECTIVE: To evaluate the feasibility of a computerized mattress system based on a novel concept in sore prevention: continuous monitoring and adjustment of the interface pressure in small segments of contact between the skin and the supporting surface. DESIGN: A preliminary observational study. SETTING: The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel. SUBJECTS: Twelve patients with spinal cord lesions. INTERVENTIONS: Patients were examined for signs of impending sores after lying on the mattress for up to 4 successive hours. The pressure within each of the mattress's air cells was continuously measured and adjusted. RESULTS: No evidence of redness or excessive perspiration was found in any of the areas considered to be high risk for bed sores. Maximal interface pressure was 22-30 mm Hg in most of the examinations. Most of the patients felt comfortable on the mattress and the staff adapted easily to its operation. CONCLUSIONS: The system is apparently safe, and at least as efficient as other existing means for preventing sores. In addition, it may allow for increased intervals between bed positionings. We conclude that this approach of pressure control has the potential to improve bed sore prevention in a rehabilitation hospital setting.

Adult↗

PubMedDate not supplied

Evaluation of the new Cairwave Therapy System in one hospital trust.

The Pegasus Airwave mattress has been used for many years in the Eastbourne NHS Trust and has proven its efficiency in the prevention of pressure sores. Pegasus has now produced a new, improved, model: the Cairwave Therapy System. This article looks at criteria that may be used to determine whether the new model is suitable for patient care. The evaluation took the form of a randomized controlled study in which 12 mattresses were randomly allocated to patients--six Airwave mattresses and six Cairwave Therapy Systems--over a 4-month period. The results of the evaluation showed that patients found the mattress comfortable. An encompassing cover reduced the risk of cross-infection, rehabilitation was supported by the firm edges of the bed and patient movement was easier due to the soft cover. During the trial all patients remained free from pressure sores.

Beds↗

PubMedDate not supplied

Pressure area management in an orthopaedic setting.

Pressure area care for patients who have undergone a hip replacement is extremely difficult as patients' mobility tends to be restricted because of fear of dislocation. Orthopaedic surgeons influence the positional changes and techniques utilized by nurses in the postoperative period. This article reviews factors that prevent early rehabilitation and highlights methods of pressure relief for this patient group. Alternating-pressure mattresses are a main source of pressure-relieving equipment. A pilot study using the Nimbus II mattress was carried out to establish the role of alternating-pressure mattresses in the postoperative management of patients undergoing elective/emergency hip replacement surgery. None of the patients in the pilot study suffered prosthetic dislocation and 87% did not develop pressure sores. Three patients did develop a grade 2 pressure sore postoperatively. The results reinforce the use of alternating-pressure mattresses in the postoperative management of patients undergoing hip replacement surgery.

Aged↗

PubMedDate not supplied

Collecting pressure ulcer prevention and management outcomes: 2.

The first part of this article (Vol 11(4): 230-8) outlined the argument that a combination of efficacy and effectiveness is required to assess fully the impact of interventions such as pressure-redistributing (PR) beds and mattresses. In addition, it described the methodology of this multinational, multicentre, prospective, non-randomized cohort study designed to record the occurrence and characteristics of patients vulnerable to, or with, established pressure ulcers. This article reports further details of the characteristics of the 2507 UK adult hospital patients recruited to the study. Over 40% (42% n = 1046) of all subjects were considered to be at an elevated risk of developing ulcers (Waterlow score of 15 or greater) (Waterlow, 1985). Many were inactive with 332 (13%) confined to bed alone with a further 262 (10%) confined to bed and their chair. Most (74% n = 1868) were nursed upon PR beds and mattresses, while fewer subjects were provided with a PR seat cushion (n = 547; 27%). Two hundred and fifty-seven subjects (10%) experienced at least one change of bed mattress during their stay in hospital, with two subjects being nursed on five different mattresses during their hospital stay.

Adolescent↗

PubMed2000

[Microbiological conditions of hospital beds before and after terminal cleaning].

INTRODUCTION: The hospital's environment keeps a close relationship with hospital infection, which may promote focus of contact and transmission. The terminal cleaning of patient unit represents one way to control microbiological environmental contamination. The study has as its main objective to evaluate the microbiological conditions of hospital mattresses before and after cleaning. METHODS: Rodac plates were utilized for specimen collection with culture medium - blood agar plate. The patients beds were chosen by criteria established before hand and the places for specimen collection in the mattress were chosen by aleatory drawing. To the study of numerical alteration related to the positivity of plates before and after cleaning, Goodman' statistics tests were used. RESULTS: From 52 mattress investigated, 520 culture plates were done from which 514 (98,8%) had a positive culture, 259 before cleaning and 255 after cleaning showing a reduction of positive cultures in only 4 plates after cleaning. CONCLUSIONS: The number of plates with countable and countless colonies suggests that the cleaning, as it is done, instead of reducing the microorganism is dislocating it to other areas of the mattress keeping the microbiological condition as it was before the cleaning process.

Beds↗

PubMed2002

Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study.

BACKGROUND: Retears after rotator cuff repairs occur relatively frequently and may compromise the functional result. The goal of this study was to analyze the mechanical properties following arthroscopic techniques for rotator cuff repair and to evaluate possible alternative techniques. METHODS: In the first part, five different bone anchors (the Revo screw; Mitek Rotator Cuff anchor, 5.0-mm Statak, PANALOK RC absorbable anchor, and 5.0-mm Bio-Statak) were tested in vitro under cyclic loading on five pairs of cadaveric shoulders. Then five types of arthroscopic tendon suturing instruments were tested on rotator cuff tendons. Finally, the arthroscopically performed mattress and modified Mason-Allen stitches, fixed with either the Revo screw or the Bio-Statak, were evaluated on ten pairs of human cadaveric shoulders. RESULTS: The holding strengths of the various anchors were similar, ranging from 130 to 180 N, and approximated the holding strength of knotted number-2 suture materials. The fixation of the tested anchors yielded comparable values of stiffness except for one anchor, which showed significantly greater subsidence under cyclic load (p = 0.003). All tested, commercially available arthroscopic suturing devices were unsuitable for performing a modified Mason-Allen stitch on normal supraspinatus tendons. Modification of a commercially available suture punch with a longer needle allowed us to consistently perform a modified Mason-Allen stitch. The modified Mason-Allen stitch, which has shown favorable mechanical properties in open repairs of the rotator cuff, was not found to be stronger than the mattress stitch when performed arthroscopically and used with bone anchors. When the modified Mason-Allen stitch was fixed to one anchor, it was even weaker than a mattress stitch repaired with another anchor (168 versus 228 N). Unequal loading of the two suture branches due to the more rigid modified Mason-Allen stitch may be the reason for this difference. CONCLUSIONS: Arthroscopic techniques for rotator cuff repair with use of the mattress stitch and bone anchors allow for a relatively solid fixation. The holding strength is not improved with use of the modified Mason-Allen stitch. Although a direct comparison with previous in vitro studies is not possible, the holding strength of open fixation techniques seems to be stronger. If rotator cuffs are subjected to high postoperative loading, open repair might be preferred to reduce the risk of a retear, until stronger arthroscopic fixation techniques are developed.

Arthroscopy↗