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PubMed2006

Nurses' beliefs about public health emergencies: fear of abandonment.

BACKGROUND: Since the events of September 11, 2001, subsequent anthrax mailings, world political events, and natural disasters such as Hurricane Katrina and the recent tsunami, public health emergencies including bioterrorism events are viewed as realistic possibilities. Public health emergencies would stress the current health care system. OBJECTIVE: The objective was to identify beliefs and concerns of nurses who work in hospitals designated as receiving sites during public health emergencies. METHODS: A qualitative study using focus groups with a total of 33 hospital nurses in 2003 was used. Audiotapes were analyzed, and codes, categories, and a theme were identified. RESULTS: Fear of abandonment was the overarching theme. Nurses believed that clinical settings would be chaotic, without a clear chain of command, and with some colleagues refusing to work. Limited access to personal protective equipment, risk of infection, unmanageable numbers of patients, and possibly being assaulted for their personal protective equipment resulted in the sense that they would be in unsafe clinical environments. Loss of freedom to leave the hospital and fears that hospitals would not provide treatment to nurses who become ill as a result of caring for patients contributed to the sense of abandonment. CONCLUSION: Although these nurses worked in hospitals with comprehensive public health emergency plans, they believed that they would not have readily accessible material and human resources to cope with a bioterrorism event. Readiness plans should include a systematic assessment of nurses' concerns. Health care readiness plans should incorporate focused interventions to improve safety, a sense of control, and facilitate coping in public health emergencies.

Attitude of Health Personnel↗
PubMed2005

Applying educational gaming to public health workforce emergency preparedness.

From natural disasters to terrorism, the demands of public health emergency response require innovative public health workforce readiness training. This training should be competency-based yet flexible, and able to foster a culture of professional and personal readiness more traditionally seen in non-public health first-response agencies. Building on the successful applications of game-based models in other organizational development settings, the Johns Hopkins Center for Public Health Preparedness piloted the Road Map to Preparedness curriculum in 2003. Over 1500 employees at six health departments in Maryland have received training via this program through November 2004. Designed to assist public health departments in creating and implementing a readiness training plan for their workforce, the Road Map to Preparedness uses the core competencies of the Centers for Disease Control and Prevention for all public health workers as its basic framework.

Disaster Planning↗
PubMed2006

Posttraumatic stress disorder: clinical features, pathophysiology, and treatment.

Posttraumatic stress disorder (PSTD), classified as an anxiety disorder, has become increasingly important because of wars overseas, natural disasters, and domestic violence. After trauma exposes the victim to actual or threatened death or serious injury, 3 dimensions of PTSD unfold: (1) reexperiencing the event with distressing recollections, dreams, flashbacks, and/or psychologic and physical distress; (2) persistent avoidance of stimuli that might invite memories or experiences of the trauma; and (3) increased arousal. Traumatic events sufficient to produce PTSD in susceptible subjects may reach a lifetime prevalence of 50% to 90%. The actual lifetime prevalence of PTSD among US citizens is approximately 8%, with the clinical course driven by pathophysiologic changes in the amygdala and hippocampus. Comorbid depression and other anxiety disorders are common. General principles of treatment include the immediate management of PTSD symptoms and signs; management of any trauma-related comorbid conditions; nonpharmacologic interventions including cognitive behavioral treatment; and psychopharmacologic agents including antidepressants (selective serotonin reuptake inhibitors most commonly), antianxiety medications, mood stabilizing drugs, and antipsychotics. This review of PTSD will provide the reader with a clearer understanding of this condition, an increased capacity to recognize and treat this syndrome, and a greater appreciation for the role of the internist in PTSD.

Cognitive Behavioral Therapy↗
PubMed2006

A Katrina experience: lessons learned.

PURPOSE: Almost no data exist on how best to respond to the medical needs of civilians displaced by natural disasters. After Hurricane Katrina destroyed the Gulf Coast and seriously damaged the infrastructure of Jackson, Miss, the University of Mississippi Medical Center (UMMC) was challenged with serving a large group of evacuees at a major Red Cross evacuation shelter near our campus. We reviewed our experiences and share lessons learned. METHODS: This is a retrospective review of administrative and clinical records for patients served by a medical clinic established emergently after Hurricane Katrina. RESULTS: Red Cross regulations precluded their volunteers from providing medical care other than first aid. Faced with numerous evacuees seeking medical assistance, UMMC established an ambulatory clinic at the shelter. The majority of patients had multiple medical problems, no medical insurance, and limited ability to purchase medications. The greatest need was for management of chronic illnesses. The clinic provided 2394 patient visits and filled more than 4902 prescriptions over 17 days. CONCLUSION: While medical facilities have emergency response plans for epidemics and mass trauma, little attention has focused on plans for care of evacuated populations. Shelter operators should consider advance coordination of medical care with existing health care systems. Medical facilities along evacuation routes should be aware that they may be asked to provide care for sheltered evacuees.

Academic Medical Centers↗
PubMed2006

Improving hospital surge capacity: a new concept for emergency credentialing of volunteers.

In the event of a large-scale terrorist attack, natural disaster, or other public health emergency, hospitals could not absorb the thousands of victims generated by the catastrophe. Even if hospitals can increase bed capacity by 20% to 30%, as some suggest, the problem of staffing these beds remains unresolved. One possibility is to rapidly increase hospital staff by providing emergency credentialing to volunteer health care professionals. Several organizations and systems currently exist that can deliver medical providers to a stricken area. Unfortunately, all of these have serious limitations that would make it difficult for hospitals to use the health care workers provided by such entities. We propose a unique concept that will allow hospitals to rapidly expand their staff with practitioners that meet their credentialing requirements. The concept is a database created by each hospital in a community that includes credentialed physicians, nurses, behavioral health professionals, and ancillary staff. The database will be limited to physicians with full privileges and all licensed hospital employees in good standing not currently facing disciplinary issues or practice restrictions. The individual databases would then be combined and stored on a single computer system housed at the county health care agency or other mutually acceptable organization, with copies sent back to participating hospitals and the state. After a large disaster, health care workers from unaffected areas, including other states, can approach affected hospitals and volunteer their services. Practitioners listed on the database could be given privileges in their specialties for 72 hours. This process is accurate, inexpensive, efficient, sustainable, and Joint Commission on Accreditation of Healthcare Organizations compliant and permits the immediate credentialing of large numbers of medical volunteers.

Credentialing↗
PubMed2004

Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy.

The present article integrates findings from diverse studies on the generalized role of perceived coping self-efficacy in recovery from different types of traumatic experiences. They include natural disasters, technological catastrophes, terrorist attacks, military combat, and sexual and criminal assaults. The various studies apply multiple controls for diverse sets of potential contributors to posttraumatic recovery. In these different multivariate analyses, perceived coping self-efficacy emerges as a focal mediator of posttraumatic recovery. Verification of its independent contribution to posttraumatic recovery across a wide range of traumas lends support to the centrality of the enabling and protective function of belief in one's capability to exercise some measure of control over traumatic adversity.

Adaptation, Psychological↗
PubMed2005

A national curriculum for nurses in emergency preparedness and response.

Preliminary and continuing education concerning emergency preparedness is needed for nurses. Although some nurses have had natural disaster training, most have not had training to respond to bioterrorism events. Several organizations are working to develop standards and curricula for such training. This article highlights these efforts.

Curriculum↗
PubMed2005

Dynamic changes of anti-oxidative enzymes of 10 wheat genotypes at soil water deficits.

Drought is a world-spread problem seriously influencing crop production and quality, the loss of which is the total for other natural disasters, with increasing global climate change making the situation more serious. Wheat is the staple food for more than 35% of world population, so wheat anti-drought physiology study is of importance to wheat production and biological breeding for the sake of coping with abiotic and biotic conditions. Much research is involved in this hot topic, but the pace of progress is not so large because of drought resistance being a multiple-gene-control quantitative character and wheat genome being larger (16,000 Mb). On the other hand, stress adaptive mechanisms are quite different, with stress degree, different growth and developmental stages, time course, materials and experimental plots, thus increasing the complexity of the issue in question. Additionally, a little study is related to the whole life circle of wheat, which cannot provide a comprehensive understanding of its anti-drought machinery. We selected 10 kinds of wheat genotypes as materials, which have potential to be applied in practice, and measured change of relative physiological indices through wheat whole growing developmental circle (i.e. seedling, tillage and maturing). Here, we reported the dynamic anti-oxidative results of whole stage (i.e. seedling, tillage and maturing) in terms of activities of POD, SOD, CAT of 10 wheat genotypes as follows: (1) 10 wheat genotypes can be grouped into three kinds (A, B and C, respectively) according to their changing trend of the measured indices; (2) A group performed better resistance drought under the condition of treatment level 1, whose activities of anti-oxidative enzymes (POD, SOD, CAT) were higher; (3) B group exhibited stronger anti-drought under treatment level 2, whose activities of anti-oxidative enzymes were higher; (4) C group expressed anti-drought to some extent under treatment level 3, whose activities of anti-oxidative enzymes were stronger, MDA lower; (5) these results demonstrated that different wheat genotypes have different physiological mechanisms to adapt themselves to changing drought stress, whose molecular basis is discrete gene expression profiling (transcriptom); (6) our results also showed that the concept and method accepted and adopted by most researchers--that 75% FC is a proper supply for higher plants--was doubted because this level could not reflect the true suitable level of different wheat genotypes; (7) our research can provide insights into physiological mechanisms of crop anti-drought and direct practical materials for wheat anti-drought breeding; (8) POD, SOD and CAT activities of different wheat genotypes had quite different changing trend at different stages and under different soil water stress conditions, which was linked with their origin of cultivation and individual soil water stress threshold; (9) our primary results also firstly displayed that the changing trend for wheat adapting to environmental stress during life circle was an S-shaped curve, which is, by chance, consistent with Plant Growth Grand Periodicity Curve.

Antioxidants↗
PubMed2005

Changes of anti-oxidative enzymes and MDA content under soil water deficits among 10 wheat (Triticum aestivum L.) genotypes at maturation stage.

Drought is a world-spread problem seriously influencing grain production and quality, the loss of which is the total for other natural disasters, with increasing global climate change making the situation more serious. Wheat is the staple food for more than 35% of world population, so wheat anti-drought physiology study is of importance to wheat production and biological breeding for the sake of coping with abiotic and biotic conditions. Much research is involved in this hot topic, but the pace of progress is not so large because of drought resistance being a multiple-gene-control quantitative character and wheat genome being larger (16,000Mb). On the other hand, stress adaptive mechanisms are quite different, with stress degree, time course, materials, soil quality status and experimental plots, thus increasing the complexity of the issue in question. Additionally, a little study is related to the whole life circle of wheat, which cannot provide a comprehensive understanding of its anti-drought machinery. We selected 10 kinds of wheat genotypes as materials, which have potential to be applied in practice, and measured change of relative physiological indices through wheat whole growing-developmental circle (i.e. seedling, tillering and maturing). Here, we reported the anti-oxidative results of maturation stage (the results of seedling and tillering stage have been published) in terms of activities of POD, SOD, CAT and MDA content as follows: (1) 10 wheat genotypes can be grouped into three kinds (A-C, respectively) according to their changing trend of the measured indices; (2) A group performed better resistance drought under the condition of treatment level 1 (appropriate level), whose activities of anti-oxidative enzymes (POD, SOD, CAT) were higher and MDA lower; (3) B group exhibited stronger anti-drought under treatment level 2 (light-stress level), whose activities of anti-oxidative enzymes were higher and MDA lower; (4) C group expressed anti-drought to some extent under treatment level 3 (serious-stress level), whose activities of anti-oxidative enzymes were stronger, MDA lower; (5) these results demonstrated that different wheat genotypes have different physiological mechanisms to adapt themselves to changing drought stress, whose molecular basis is discrete gene expression profiling (transcriptom); (6) our results also showed that the concept and method accepted and adopted by most researchers [T.C. Hsiao, Plant response to water stress, Ann. Rev. Plant Physiol. 24 (1973) 519-570], that 75% FC is a proper supply for higher plants, was doubted, because this level could not reflect the true suitable level of different wheat genotypes. The study in this respect is the key to wheat anti-drought and biological-saving water agriculture; (7) our research can provide insights into physiological mechanisms of crop anti-drought and direct practical materials for wheat anti-drought breeding; (8) the physiological study of wheat is more urgent up-to-date and molecular aspects are needed, but cannot substitute this important part. The combination of both is an important strategy and a key and (9) POD, SOD and CAT activities and MDA content of different wheat genotypes had quite different changing trend at different stages and under different soil water stress conditions, which was linked with their origin of cultivation and individual soil water threshold.

Antioxidants↗
PubMed2004

Lightning injuries.

Lightning is persistently one of the leading causes of death caused by environmental or natural disaster. To understand the pathophysiology and treatment of lightning injuries one must first discount the innumerable myths, superstitions, and misconceptions surrounding lightning. The fundamental difference between high voltage electrical injury and lightning is the duration of exposure to current. Reverse triage should be instituted in lightning strike victims because victims in cardiopulmonary arrest might gain the greatest benefit from resuscitation efforts, although there is no good evidence suggesting that lightning strike victims might benefit from longer than usual resuscitation times. Many of the injuries suffered by lightning strike victims are unique to lightning, and long-term sequelae should be anticipated and addressed in the lightning victim.

Burns, Electric↗
PubMed2004

Unequal respiratory health risk: using GIS to explore hurricane-related flooding of schools in Eastern North Carolina.

This cross-sectional study investigated whether schools serving populations at high risk of developing respiratory infections in the state of North Carolina (USA) were disproportionately burdened by flooding from Hurricane Floyd. We used geographic information systems (GIS) to overlay a satellite-derived image of the flooded land with school locations. We identified 77 flooded schools and 355 schools that were not flooded in 36 counties. These schools were then characterized based on the income, race/ethnicity, and age of their student populations. Prevalence ratios (PRs) revealed that low-income schools in which a majority of students were Black had twice the risk of being flooded (PR 2.01; 95% confidence interval, 1.28, 3.17) compared to the referent group (non-low-income schools with a majority of non-Black students). This analysis suggests that schools serving populations already at elevated risk of respiratory illness were disproportionately affected by the flooding of Hurricane Floyd. GIS can be used to identify and prioritize schools quickly for remediation following natural disasters.

Age Factors↗
PubMed2006

The state of US trauma systems: public perceptions versus reality--implications for US response to terrorism and mass casualty events.

BACKGROUND: Injury has long been identified as the number one killer of Americans under the age of 34, and establishment of regional trauma systems and centers incorporating primary, secondary, and tertiary care and injury-prevention strategies has proved to be a vital element in reducing injury-related sequelae, deaths, and even costs. Despite these facts, trauma system development has not been given priority for funding in many local and state governments and only intermittently at the federal level. Consequently, many of the nation's trauma centers are strapped for funds to provide emergency care to their patients. STUDY DESIGN: In response to a 2002 Health Resources and Services Administration (HRSA) report, which identified public support as a key element in the success of trauma system development in states and communities across the United States, a Harris Interactive study was undertaken in the fall of 2004 to determine the public's attitudes, awareness, and knowledge concerning the nature and availability of trauma care and systems of trauma care. Results of the poll were contrasted with current data on the state of US trauma systems to determine the degree of correspondence. RESULTS: Results of the poll indicated that fully 61% of the American public does not know that injury is the leading cause of death for those aged 1 to 34, and most believe that a trauma system is in place in every state. Almost two-thirds of the American public is confident of receiving the best medical care in the event of serious injury and would be seriously concerned if no trauma center were nearby. But only eight states have fully developed trauma systems, and most states have no federal funding or infrastructure in place for managing the aftermath of a natural disaster or terrorist event. These and other objective data reveal the mismatch between public perceptions and reality. CONCLUSIONS: Although almost 90% of Americans believe that state trauma systems and hospitals should have a coordinated trauma response, this has not been made a national priority. Trauma systems must be adequately developed and supported to fulfill the public's expectation to receive the best possible care if seriously injured, and to ensure readiness for mass casualty and terrorist incidents.

Disaster Planning↗
PubMedDate not supplied

Providing a nurturing environment for infants in adverse situations: multisensory strategies for newborn care.

Giving birth in dangerous settings, such as natural disasters and war, can have long-lasting consequences on infant growth and development. It is during birth and the neonatal period that mother and baby are particularly vulnerable to environmental stressors. This article explores the neurohormonal aspects of stress and social bonding and offers strategies aimed at reducing maternal and infant stress and improving the mother-infant relationship. Low-tech interventions, such as massage, Kangaroo Mother Care, and multisensory intervention (maternal voice, massage, eye-to-eye contact, and rocking) are described for their use in adverse environments.

Body Temperature Regulation↗
PubMedDate not supplied

Natural and unnatural triggers of myocardial infarction.

Previous analyses have suggested that factors that stimulate the sympathetic nervous system and catecholamine release can trigger acute myocardial infarction. The wake-up time, Mondays, winter season, physical exertion, emotional upset, overeating, lack of sleep, cocaine, marijuana, anger, and sexual activity are some of the more common triggers. Certain natural disasters such as earthquakes and blizzards have also been associated with an increase in cardiac events. Certain unnatural triggers may play a role including the Holiday season. Holiday season cardiac events peak on Christmas and New Year. A number of hypotheses have been raised to explain the increase in cardiac events during the holidays, including overeating, excessive use of salt and alcohol, exposure to particulates, from fireplaces, a delay in seeking medical help, anxiety or depression related to the holidays, and poorer staffing of health care facilities at this time. War has been associated with an increase in cardiac events. Data regarding an increase in cardiac events during the 9/11 terrorist attack have been mixed. Understanding the cause of cardiovascular triggers will help in developing potential therapies.

Age Factors↗
PubMed2005

Community-based public health interventions in North Korea: one non-governmental organization's experience with tuberculosis and hepatitis B.

BACKGROUND: The Democratic People's Republic of Korea, also known as North Korea, is the most isolated country in the world, and has been a source of interest, politically and socially, since the 1953 ceasefire of the Korean War. While in the past year, interest has focused on the nuclear dispute with the USA, over the past decade, most interest has revolved around the economic plight of the country, the lack of funds and resources for health care, and the subsequent public health declines. North Korea's present economic and public health problems began in the early 1990s due to the gradual loss of economic support from its communist allies (i.e. after the fall of the Soviet Union and the capitalization of China), combined with an inordinate number of natural disasters (floods, famine and drought) all occurring within the same time span. These simultaneous events initiated a 'snowball effect' of severe economic depression and a rapid deterioration of the overall public health infrastructure in the country. North Korea's continued isolation and reluctance to release health statistics has left the international community uncertain of the precise extent of the public health devastation. The uncertainty of the situation has been further complicated by disparate accounts of the public health declines. For instance, the North Korean Government has estimated that approximately 220,000 people died due to famine in the 1990s, while the World Health Organization (WHO) claims that this figure is closer to 2 million. In the past few years, the willingness of the North Korean Government to engage the outside world has increased. This is reflected by the growing number of foreign aid organizations or non-governmental organizations (NGOs) that have been permitted entry into the country. NGOs have not only served to improve various aspects of the public health system but also serve as a source of 'on-the-ground' information for the outside world. This role has proven critical not only for public health purposes but for facilitating improved international relations between countries.

Altruism↗
PubMed2005

The social structural production of HIV risk among injecting drug users.

There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. Drawing on a review of recently published literature, we seek to describe the social structural production of HIV risk associated with injecting drug use. We adopt an inclusive definition of the HIV 'risk environment' as the space, whether social or physical, in which a variety of factors exogenous to the individual interact to increase vulnerability to HIV. We identify the following factors as critical in the social structural production of HIV risk associated with drug injecting: cross-border trade and transport links; population movement and mixing; urban or neighbourhood deprivation and disadvantage; specific injecting environments (including shooting galleries and prisons); the role of peer groups and social networks; the relevance of 'social capital' at the level of networks, communities and neighbourhoods; the role of macro-social change and political or economic transition; political, social and economic inequities in relation to ethnicity, gender and sexuality; the role of social stigma and discrimination in reproducing inequity and vulnerability; the role of policies, laws and policing; and the role of complex emergencies such as armed conflict and natural disasters. We argue that the HIV risk environment is a product of interplay in which social and structural factors intermingle but where political-economic factors may play a predominant role. We therefore emphasise that much of the most needed 'structural HIV prevention' is unavoidably political in that it calls for community actions and structural changes within a broad framework concerned to alleviate inequity in health, welfare and human rights.

Environment↗
PubMed2006

Before and after the 1999 Chi-Chi earthquake: traumatic events and depressive symptoms in an older population.

Natural disasters, such as earthquakes, can have deleterious consequences for physical and psychological health. In this study, we investigate variability in resilience to depressive symptoms in the aftermath of a massive earthquake that struck Taiwan in 1999. We analyze data on 1160 older individuals from a national, longitudinal survey with interviews before and after the earthquake. This survey contains extensive information on physical and cognitive function, depressive symptoms, socio-demographic characteristics and earthquake-related exposure and experiences. We estimate regression models to identify risk factors associated with the presence of depressive symptoms after the disaster, controlling for health status and the presence of depressive symptoms beforehand. We pay special attention to how socio-demographic factors moderate the psychological impact of the earthquake. Results indicate that persons of low socioeconomic status (SES), socially isolated individuals, and women reported higher levels of depressive symptoms than their respective counterparts, as did persons who experienced damage to their homes. The psychological effects of damage were strongest among those aged 54-70. The findings suggest that people who experience damage to their home during a disaster are at risk of experiencing depressive symptoms, with the elderly being more resilient than the near-elderly.

Activities of Daily Living↗
PubMed2006

Earthquakes.

Major earthquakes have the potential to be one of the most catastrophic natural disasters affecting mankind. Earthquakes of significant size threaten lives and damage property by setting off a chain of events that disrupts all aspects of the environment and significantly impacts the public health and medical infrastructures of the affected region. This article provides an overview of basic earthquake facts and relief protocol for medical personnel.

Crush Syndrome↗