***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Please cite this paper as : MacIntyre et al. ( 2011 ) A cluster r and omized clinical trial comparing fit‐tested and non‐fit‐tested  N95 respirators to medical masks to prevent respiratory virus infection in health care workers . Influenza and Other Respiratory Viruses DOI : 10.1111/j.1750‐2659.2010.00198.x . Background We compared the efficacy of medical masks , N95 respirators ( fit tested and non fit tested ) , in health care workers ( HCWs ) . Methods A cluster r and omized clinical trial ( RCT ) of 1441 HCWs in 15 Beijing hospitals was performed during the 2008/2009 winter . Participants wore masks or respirators  during the entire work shift for 4 weeks . Outcomes included clinical respiratory illness ( CRI ) , influenza‐like illness ( ILI ) , laboratory‐confirmed respiratory virus infection and influenza . A convenience no‐mask/respirator group of 481 health workers from nine hospitals was compared . Findings The rates of CRI ( 3·9 % versus 6·7 % ) , ILI ( 0·3 % versus 0·6 % ) , laboratory‐confirmed respiratory virus ( 1·4 % versus 2·6 % ) and influenza ( 0·3 % versus 1 % ) infection were consistently lower for the N95 group compared to medical masks . By intention‐to‐treat analysis , when P values were adjusted for clustering , non‐fit‐tested N95 respirators were significantly more protective than medical masks against CRI , but no other outcomes were significant . The rates of all outcomes were higher in the convenience no‐mask group compared to the intervention arms . There was no significant difference in outcomes between the N95 arms with and without fit testing . Rates of fit test failure were low . In a post hoc analysis adjusted for potential confounders , N95 masks and hospital level were significant , but medical masks , vaccination , h and washing and high‐risk procedures were not . Interpretation Rates of infection in the medical mask group were double that in the N95 group . A benefit of respirators is suggested but would need to be confirmed by a larger trial , as this study may have been underpowered . The finding on fit testing is specific to the type of respirator used in the study and can not be generalized to other respirators . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) , ACTRN : ACTRN12609000257268 ( http://www.anzctr.org.au ) Background The H1N1 influenza p and emic had garnered a large amount of attention . Currently , the most effective preventive measure available is the H1N1 vaccine . We aim ed to assess the willingness of our study participants to receive the H1N1 vaccination prior to the annual Hajj season . If any participant declined , we investigated the reasons for vaccine rejection . Findings We conducted a prospect i ve cohort study of National Guard employees during the 1430 ( 2009 ) Hajj season . A survey was used as the primary method for data collection . Participants were vaccinated one to two weeks prior to their trip to Mona , and any side effects reported at the time of injection and three weeks post vaccination were recorded . There were 100 male and 26 female participants in the study . In total , 66.7 % ( n = 84 ) of the participants were health care workers ( HCWs ) and 33.3 % ( n = 42 ) were non-health care workers ( non-HCWs ) . Less than half of the respondents ( 46.8 % , n = 59 ) accepted the vaccination . The vaccination acceptance rate was higher among non-HCWs , at a rate of 71.4 % ( n = 30 ) ; HCWs only accepted at a rate of 34.5 % ( n = 29 ) ( OR 1.103 , 95 % CI [ 0.488 - 2.496 ] ) . The most common reason for vaccine refusal was the impression that the disease was not fatal ( 25.4 % , n = 32 ) . Finally , all participants reported pain at the injection site and 18.3 % ( n = 11 ) reported swelling . All other side effects were reported in less than 15 % of the participants . Conclusions Despite fears of the new H1N1 vaccine , there was a reasonable rate of vaccine acceptance among our study participants . Early health education may increase the rate of acceptance of the H1N1 vaccine . Furthermore , additional research is needed on long-term adverse effects of the H1N1 vaccine Background The prevalence of self-reported preventive behaviors in response to an anticipated local human-to-human H5N1 transmission outbreak and factors associated with such behaviors have not been examined . Methods A r and om , anonymous , cross-sectional telephone survey of 503 Hong Kong Chinese adults . Results The public in Hong Kong is likely to adopt self-protective behaviors ( e.g. , wearing face mask in public venues ( 73.8 % ) , increasing the frequency of h and washing ( 86.7 % ) ) and behaviors that protect others ( e.g. , wearing face masks when experiencing influenza-like illness ( ILI , 92.4 % ) , immediately seeking medical consultation ( 94.2 % ) , making declarations when crossing the border with ILI ( 87.1 % ) , complying to quarantine policies ( 88.3 % ) ) . Multivariate analyses indicated that factors related to age , full-time employment , perceived susceptibility , perceived efficacy of preventive measures , perceived higher fatality as compared to SARS , perceived chance of a major local outbreak , and being worried about self/family members contracting the virus were significantly associated with the inclination to adopt self-protective measures . Similar analyses showed that education level , variables related to perceived efficacy , perceived major local outbreak and such were significantly associated with various behaviors directed towards protecting others . Conclusion In the event of a human-to-human H5N1 outbreak , the public in Hong Kong is likely to adopt preventive measures that may help contain the spread of the virus in the community Please cite this paper as : Simmerman et al. ( 2011 ) Findings from a household r and omized controlled trial of h and washing and face masks to reduce influenza transmission in Bangkok , Thail and . Influenza and Other Respiratory Viruses 5(4 ) , 256–267 Background Evidence is needed on the effectiveness of non‐pharmaceutical interventions ( NPIs ) to reduce influenza transmission . Methodology We studied NPIs in households with a febrile , influenza‐positive child . Households were r and omized to control , h and washing ( HW ) , or h and washing plus paper surgical face masks ( HW + FM ) arms . Study nurses conducted home visits within 24 hours of enrollment and on days 3 , 7 , and 21 . Respiratory swabs and serum were collected from all household members and tested for influenza by RT‐PCR or serology . Principal Findings Between April 2008 and August 2009 , 991 ( 16·5 % ) of 5995 pediatric influenza‐like illness patients tested influenza positive . Four hundred and forty‐two index children with 1147 household members were enrolled , and 221 ( 50·0 % ) were aged < 6 years . Three hundred and ninety‐seven ( 89·8 % ) households reported that the index patient slept in the parents ’ bedroom . The secondary attack rate was 21·5 % , and 56/345 ( 16·3 % ; 95 % CI 12·4–20·2 % ) secondary cases were asymptomatic . H and ‐washing subjects reported 4·7 washing episodes/day , compared to 4·9 times/day in the HW + FM arm and 3·9 times/day in controls ( P = 0·001 ) . The odds ratios ( ORs ) for secondary influenza infection were not significantly different in the HW arm ( OR = 1·20 ; 95 % CI 0·76–1·88 ; P‐0.442 ) , or the HW + FM arm ( OR = 1·16 ; 95 % CI .0·74–1·82 ; P = 0.525 ) . Conclusions Influenza transmission was not reduced by interventions to promote h and washing and face mask use . This may be attributable to transmission that occurred before the intervention , poor facemask compliance , little difference in h and ‐washing frequency between study groups , and shared sleeping arrangements . A prospect i ve study design and a careful analysis of sociocultural factors could improve future NPI studies OBJECTIVES To investigate the community responses and preparedness for a possible epidemic of H1N1 influenza in Hong Kong shortly after an imported case was confirmed . METHODS A r and om sample of 550 Chinese adults in the Hong Kong general population was interviewed during May 7 - 9 , 2009 . RESULTS The public did not perceive a high likelihood of having a local H1N1 outbreak , nor did they regard H1N1 as a threatening disease . Frequent h and -washing ( 73.6 % ) and use of face-masks in case of flu symptoms ( 47.9 % ) were prevalent . The public approved of governmental policies including the quarantining of hotel guests , was not panicking and perceived a high self-efficacy of self-protection . However , misconceptions were prevalent and the public avoided visiting crowded places ( 9.3 % ) , which many people wrongly believed was a government recommendation . CONCLUSION Although the public response demonstrated vigilance and preparedness there were signs of complacency . Clear communication , up date d scientific information and transparency on government decision making are warranted . Data of the study provide a baseline for an ongoing surveillance program to help shape policy and provide information to the international community Background Previous controlled studies on the effect of non-pharmaceutical interventions ( NPI ) - namely the use of facemasks and intensified h and hygiene - in preventing household transmission of influenza have not produced definitive results . We aim ed to investigate efficacy , acceptability , and tolerability of NPI in households with influenza index patients . Methods We conducted a cluster r and omized controlled trial during the p and emic season 2009/10 and the ensuing influenza season 2010/11 . We included households with an influenza positive index case in the absence of further respiratory illness within the preceding 14 days . Study arms were wearing a facemask and practicing intensified h and hygiene ( MH group ) , wearing facemasks only ( M group ) and none of the two ( control group ) . Main outcome measure was laboratory confirmed influenza infection in a household contact . We used daily question naires to examine adherence and tolerability of the interventions . Results We recruited 84 households ( 30 control , 26 M and 28 MH households ) with 82 , 69 and 67 household contacts , respectively . In 2009/10 all 41 index cases had a influenza A ( H1N1 ) pdm09 infection , in 2010/11 24 had an A ( H1N1 ) pdm09 and 20 had a B infection . The total secondary attack rate was 16 % ( 35/218 ) . In intention-to-treat analysis there was no statistically significant effect of the M and MH interventions on secondary infections . When analysing only households where intervention was implemented within 36 h after symptom onset of the index case , secondary infection in the pooled M and MH groups was significantly lower compared to the control group ( adjusted odds ratio 0.16 , 95 % CI , 0.03 - 0.92 ) . In a per- protocol analysis odds ratios were significantly reduced among participants of the M group ( adjusted odds ratio , 0.30 , 95 % CI , 0.10 - 0.94 ) . With the exception of MH index cases in 2010/11 adherence was good for adults and children , contacts and index cases . Conclusions Results suggest that household transmission of influenza can be reduced by the use of NPI , such as facemasks and intensified h and hygiene , when implemented early and used diligently . Concerns about acceptability and tolerability of the interventions should not be a reason against their recommendation .Trial registration The study was registered with Clinical Trials.gov ( Identifier NCT00833885 ) Abstract Objective We compared the efficacy of medical masks ( MM ) and N95 respirators ( N95 ) in preventing bacterial colonization/infection in healthcare workers ( HCWs ) . Methods A cluster r and omized clinical trial ( RCT ) of 1441 hospital HCWs r and omized to medical masks or N95 respirators , and compared to 481 control HCWs , was performed in Beijing , China , during the winter season of 2008–2009 . Participants were followed for development of clinical respiratory illness ( CRI ) . Symptomatic subjects were tested for Streptococcus pneumoniae , Bordetella pertussis , Chlamydia pneumoniae , Mycoplasma pneumoniae or Haemophilus influenza type B by multiplex polymerase chain reaction ( PCR ) . Results The rate of bacterial colonization was 2.8 % in the N95 group ( p=0.02 ) , 5.3 % among medical mask users ( p<0.01 ) and 7.5 % among the controls ( p=0.16 ) . N95 respirators were significantly protective ( adjusted RR 0.34 , 95 % CI : 0 
    Output:
    
Conclusion A modest proportion of attendees of MGs use facemask , the practice is more widespread among health care workers .
Facemask use seems to be beneficial against certain respiratory infections at MGs but its effectiveness against specific infection remains unproven