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Department: ADVICE P.R.N.

Advice P.R.N.

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doi: 10.1097/01.NURSE.0000615108.62845.33
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WILDFIRE POLLUTION

Do dust masks protect from smoke inhalation?

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Because of the prevalence of wildfires in my region, many of my patients are asking how to protect themselves from smoke inhalation when they are outdoors. Should I advise them to wear dust masks, which are inexpensive and available at hardware stores?—M.S., CALIF.

The CDC does not recommend relying on common dust masks for protection from smoke in the atmosphere. These masks are designed to filter large particles such as sawdust, not ash and other small particles found in wildfire smoke. Instead, the CDC recommends particulate respirators that have been tested and approved by the National Institute of Occupational Safety and Health (NIOSH). These respirators are also sold at hardware stores and some pharmacies. Tell patients to look for respirators labeled with the words “NIOSH” and either “N95” or “P100.” In addition, tell patients to:

  • use a respirator with two straps to go around your head. Those with only one strap, or two straps that go around the ears, will not fit tightly enough. Any leakage around the edge of the mask will let unfiltered air enter to be inhaled.
  • choose a size that fits over your nose and under your chin and seals tightly to your face. Follow instructions on the package to ensure a tight fit. Respirators are not available in children's sizes.
  • replace the respirator if it becomes visibly dirty or makes breathing difficult.

Using a respirator is not without risks. For example, a respirator makes breathing more difficult and increases the risk of heat-related illness when patients are active. Patients with chronic conditions, especially cardiac or pulmonary disorders, should check with their healthcare provider before using a respirator.

For more advice from the CDC, including recommendations for safely cleaning up after a wildfire, go to www.cdc.gov/features/wildfires/index.html.

PREMATURE DELIVERY

Good news for preemies

At 34 weeks of gestation, my patient delivered a preterm infant who was treated in the neonatal ICU for several weeks. Although the infant is home now and doing well, my patient is worried about the risk of long-term complications as he matures. Has any research been done on comorbidities in adolescents or adults who were born prematurely?—L.N., TEX.

Yes. In a recent study, researchers examined data on 2,566,699 people born in Sweden from Jan. 1, 1973, through Dec. 31, 1997, with follow-up through Dec. 31, 2015. Nearly 6% of the study population was born preterm, defined as delivery at less than 37 weeks gestation. Overall, about 55% of all those born preterm were alive with no significant comorbidities at ages 18 to 43 years, compared with 63% of those born full term. Comorbidities were defined using the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Comorbidity Index, which measures conditions that commonly manifest in adolescence or young adulthood, such as neuropsychiatric disorders; and the Charlson Comorbidity Index, which includes major chronic disorders predictive of mortality in adulthood.

Broken down by gestational age, the percentage of preterm survivors with no AYA HOPE comorbidities was as follows:

  • 22.3% for those born extremely preterm (22 to 27 weeks)
  • 48.5% for very preterm (28 to 33 weeks)
  • 58% for late preterm (34 to 36 weeks)
  • 61.2% for early term (37 to 38 weeks).

The authors write that the relatively high prevalence of favorable outcomes “reflects not only the treatment advances that have occurred over the past 50 years but also the apparent resilience of preterm survivors in maintaining good health.”

For more information about the care and development of premature infants, refer your patient to this American Academy of Pediatrics website: www.healthychildren.org/English/ages-stages/baby/preemie/Pages/default.aspx.

Sources: Crump C, Winkleby MA, Sundquist J, Sundquist K. Prevalence of survival without major comorbidities among adults born prematurely. JAMA. 2019;322(16):1580-1588. Most preemies survive into adulthood without major comorbidities. HealthDay. October 22, 2019.

UNDIAGNOSED DISEASES

Investigating mysterious maladies

One of my patients is struggling with a constellation of signs and symptoms that are extremely debilitating. Despite consulting with various specialists, he has received no diagnosis or effective treatment. His healthcare provider suggested applying to the Undiagnosed Diseases Network for evaluation. What can you tell me about this organization?—T.R., N.C.

Funded by the National Institutes of Health Common Fund, the Undiagnosed Diseases Network (UDN) is a research study that brings clinical and research experts together to diagnose rare and undiagnosed conditions. The UDN defines an undiagnosed disease as “a medical condition without a known cause despite a lot of evaluation.” Participating patients are evaluated at clinical sites located in 12 cities across the US.

As part of the application process, the patient's healthcare provider must submit a recommendation letter describing the patient's signs and symptoms, history of evaluations and treatments, current medications, and other relevant details. If the patient is accepted into the program, the UDN will provide information from the evaluation to the patient and the referring healthcare provider, who will be responsible for the patient's follow-up medical care.

Because of the large number of applicants, relatively few patients are accepted. However, each application is carefully reviewed and patients who are not accepted may still receive helpful feedback.

For more information about joining the study, refer the patient to https://undiagnosed.hms.harvard.edu/about-us/faqs.

Source: Undiagnosed Diseases Network. https://undiagnosed.hms.harvard.edu.

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