To appraise the awareness and knowledge levels of midwives and nurses concerning early screening for Zika virus (ZIKV) infection among pregnant women attending health care facilities in Bahrain.

This was a cross-sectional, purposely chosen study of Bahraini and expatriate midwives, nurses, and supervisors employed in gynecology/obstetrics and labor wards of Salmanya hospital, a maternity hospital, 4 private hospitals, and health centers in Bahrain. The chosen individuals were invited to participate in a survey on awareness and knowledge of early screening for ZIKV infection.

Of 266 midwives and nurses employed in the study sites, 170 (64%) consented to participate in the study. Of those who agreed to participate, 76 were midwives and 94 were nurses. Admittedly, 39% of midwives and nurses were unaware of ZIKV infection. The grand mean knowledge score in the study was 39%. Expatriate midwives and nurses scored better than did Bahrainis (P<0.001). The grand mean knowledge scores of evening and night shift duty participants were significantly higher than those of the day duty participants.

The awareness and knowledge scores of midwives and nurses concerning ZIKV infection were inadequate, which supported our hypothesis. By harnessing modern technology and support systems, lifelong learning can be used as a means to enhance preparedness for public health crises such as ZIKV. (Disaster Med Public Health Preparedness. 2018;12:7–13)

To investigate the extent to which older residents feel they can remain “self-reliant” during future natural disasters and to compare the findings with the viewpoints of local policy-makers and with those charged with caring for the elderly both on a day-to-day basis and in times of crisis.

This study used an array of non-probability snowballing techniques to seek the participation of senior citizens over the age of 65 years, emergency services officers, community health carers, and local government disaster managers located in aging, remote, coastal Australian communities vulnerable to cyclones and storm surges. All respondents participated in either a face-to-face personal interview or a focus group, with senior citizens also completing a self-administered questionnaire.

This research found a discrepancy between policy expectations and the experiences of both the elderly and those who care for them, as well as a lack of understanding with regard to the term “self-reliant.”

These results highlight the inability of older adults in aging, remote, coastal Australian communities to remain “self-reliant” in the future, impacting both disaster management policies and the future capacity of these communities to remain resilient. (Disaster Med Public Health Preparedness. 2018;12:14–18)

To determine the ability of a novel responder mental health self-triage system to predict post-traumatic stress disorder (PTSD) in emergency medical responders after a disaster.

Participants in this study responded to Typhoon Haiyan, which struck the Philippines in November 2013. They completed the Psychological Simple Triage and Rapid Treatment (PsySTART) responder triage tool, the PTSD Checklist (PCL-5) and the Patient Health Questionnaire-8 (PHQ-8) shortly after responding to this disaster. The relationships between these 3 tools were compared to determine the association between different risk exposures while providing disaster medical care and subsequent levels of PTSD or depression.

The total number of PsySTART responder risk factors was closely related to PCL-5 scores ≥38, the threshold for clinical PTSD. Several of the PsySTART risk factors were predictive of clinical levels of PTSD as measured by the PCL-5 in this sample of deployed emergency medical responders.

The presence of a critical number and type of PsySTART responder self-triage risk factors predicted clinical levels of PTSD and subclinical depression in this sample of emergency medical workers. The ability to identify these disorders early can help categorize an at-risk subset for further timely “stepped care” interventions with the goals of both mitigating the long-term consequences and maximizing the return to resilience. (Disaster Med Public Health Preparedness. 2018;12:19–22)

Social media provides us with a new platform on which to explore how the public responds to disasters and, of particular importance, how they respond to the emergence of infectious diseases such as Ebola. Provided it is appropriately informed, social media offers a potentially powerful means of supporting both early detection and effective containment of communicable diseases, which is essential for improving disaster medicine and public health preparedness.

The 2014 West African Ebola outbreak is a particularly relevant contemporary case study on account of the large number of annual arrivals from Africa, including Chinese employees engaged in projects in Africa. Weibo (Weibo Corp, Beijing, China) is China’s most popular social media platform, with more than 2 billion users and over 300 million daily posts, and offers great opportunity to monitor early detection and promotion of public health awareness.

We present a proof-of-concept study of a subset of Weibo posts during the outbreak demonstrating potential and identifying priorities for improving the efficacy and accuracy of information dissemination. We quantify the evolution of the social network topology within Weibo relating to the efficacy of information sharing.

We show how relatively few nodes in the network can have a dominant influence over both the quality and quantity of the information shared. These findings make an important contribution to disaster medicine and public health preparedness from theoretical and methodological perspectives for dealing with epidemics. (Disaster Med Public Health Preparedness. 2018;12:26–37)

We evaluated the effectiveness and cost of a fungal meningitis outbreak response in the New River Valley of Virginia during 2012-2013 from the perspective of the local public health department and clinical facilities. The fungal meningitis outbreak affected 23 states in the United States with 751 cases and 64 deaths in 20 states; there were 56 cases and 5 deaths in Virginia.

We conducted a partial economic evaluation of the fungal meningitis outbreak response in New River Valley. We collected costs associated with the local health department and clinical facilities in the outbreak response and estimated the epidemiological effectiveness by using disability-adjusted life years (DALYs) averted.

We estimated the epidemiological effectiveness of this outbreak response to be 153 DALYs averted among the patients, and the costs incurred by the local health department and clinical facilities to be $30,413 and $39,580, respectively.

We estimated the incremental cost-effectiveness ratio of $198 per DALY averted and $258 per DALY averted from the local health department and clinical perspectives, respectively, thereby assisting in impact evaluation of the outbreak response by the local health department and clinical facilities. (Disaster Med Public Health Preparedness. 2018;12:38–46)

Disaster recovery efforts focus on restoring basic needs to survivors, such as food, water, and shelter. However, long after the immediate recovery phase is over, some individuals will continue to experience unmet needs. Ongoing food insecurity has been identified as a post-disaster problem. There is a paucity of information regarding the factors that might place an individual at risk for continued food insecurity post disaster.

Using data from a sample (n=737) of households severely impacted by Hurricane Katrina, we estimated the associations between food insecurity and structural, physical and mental health, and psychosocial factors 5 years after Hurricane Katrina. Logistic regression models were fit and odds ratios (OR) and 95% CI estimated.

Nearly one-quarter of respondents (23%) reported food insecurity 5 years post Katrina. Marital/partner status (OR: 0.7, CI: 0.42, 0.99), self-efficacy (OR: 0.56, CI: 0.37, 0.84), sense of community (OR: 0.7, CI: 0.44, 0.98), and social support (OR: 0.59, CI: 0.39, 0.89) lowered the odds of food insecurity and explained most of the effects of mental health distress on food insecurity. Social support, self-efficacy, and being partnered were protective against food insecurity.

Recovery efforts should focus on fostering social-support networks and increased self-efficacy to improve food insecurity post disaster. (Disaster Med Public Health Preparedness. 2018;12:47–56)

We identify characteristics of local health departments, which enhance collaborations with community- and faith-based organizations (CFBOs) for emergency preparedness and response.

Online survey data were collected from a sample of 273 disaster preparedness coordinators working at local health departments across the United States between August and December 2011.

Using multiple linear regression models, we found that perceptions of CFBO trust were associated with more successful partnership planning (β=0.63; P=0.02) and capacity building (β=0.61; P=0.01). Employee layoffs in the past 3 years (β=0.41; P=0.001) and urban location (β=0.41; P=0.005) were positively associated with higher ratings of resource sharing between health agencies and CFBOs. Having 1-3 full-time employees increased the ratings of success in communication and outreach activities compared with health departments having less than 1 full-time employee (β=0.33; P=0.05). Positive attitudes toward CFBOs also enhanced communication and outreach (β=0.16; P=0.03).

Staff-capacity factors are important for quick dissemination of information and resources needed to address emerging threats. Building the trust of CFBOs can help address large-scale disasters by improving the success of more involved activities that integrate the CFBO into emergency plans and operations of the health department and that better align with federal-funding performance measures. (Disaster Med Public Health Preparedness. 2018;12:57–66)

One of the most prominent threats to the Israeli population is the risk from armed conflicts. Yet, promoting preparedness behavior proves to be highly difficult. Arguably, this is partially due to the chronic exposure of the Israeli public to this threat, a.k.a. “Victimization.” The purpose of this study was to examine whether victimization plays a prominent role in shaping preparedness behavior toward armed conflicts in Israel.

An online survey of 502 participants representing the adult Jewish population in Israel was carried out. A set of questionnaires designed to assess public perception of preparedness-affecting factors was used. The list of preparedness-affecting factors was conceptualized by an expert panel before the survey.

The results suggest that low prioritization and ignoring of civil-defense instructions during routine times are leading causes for non-compliance with preparedness recommendations. Ignoring instructions is also negatively correlated with reported preparedness. Misunderstanding the threat and fearing it also seem to be important factors.

The results of this study support the hypothesis that victimization plays an important role in shaping preparedness behavior toward armed conflicts among Jews in Israel. The findings demonstrate the complexity of the socio-psychological perspective of preparedness behavior in victimized populations. (Disaster Med Public Health Preparedness. 2018;12:67–75)

The aim was to investigate the interface between elderly care and emergency preparedness from the elderly care staff’s perspective.

A web-based questionnaire was sent to elderly care staff in 4 Swedish municipalities. The questions involved experiences of extraordinary events, education and exercises, and risk and vulnerability analyses, evaluations of main risks and emergency preparedness, and familiarity with preparedness plans. In total, 568 elderly care staff responded.

Between 15% and 25% of the respondents claimed experiences of extraordinary events, exercises and education, and risk and vulnerability analyses. The same number claimed familiarity with the organization’s preparedness plan, whereas ~85% answered that they need more education and exercises. Emergency preparedness was evaluated as important. The experiences and risks referred to pertained to both official categories used within emergency preparedness and issues such as work conditions, seniors’ fall accidents.

Elderly care staff, though highly motivated, do not seem to be involved in emergency preparedness and are not targeted to a large extent when education and training are organized. A development of the interface between emergency preparedness and elderly care could require a clarification of the scope and context of emergency preparedness and of differing understandings of central concepts. (Disaster Med Public Health Preparedness. 2018;12:86–93)

We investigated the extent of delays in the response time of emergency medical services (EMS) as an impact of mass casualty incidences (MCIs) in the same area.

We defined an MCI case as an event that resulted in 6 or more patients being transported by EMS, and prehospital response time as the time from the call to arrival at the scene. We matched patients before and after MCIs by dividing them into categories of 3 hours before, 0-1 hour after, 1-2 hours after, and 2-3 hours after the MCIs. We compared prehospital response times using multiple linear regression.

A total of 33,276 EMS-treated patients were matched. The prehospital response time for the category of 3 hours before the MCIs was 8.8 minutes (SD: 8.2), treated as the reference, whereas that for the category of 0-1 hour after the MCI was 11.3 minutes (P<0.01). The multiple linear regression analysis revealed that prehospital response time increased by 2.5 minutes (95% CI: 2.3-2.8) during the first hour and by 0.3 minutes (95% CI: 0.1-0.6) during the second hour after MCIs.

There were significant delays in the prehospital response time for emergency patients after MCIs, and it lasted for 2 hours as the spillover effect. (Disaster Med Public Health Preparedness. 2018;12:94–100)

We aimed to identify and seek agreement on factors that may influence decision-making related to the distribution of patients during a mass casualty incident.

A qualitative thematic analysis of a literature review identified 56 unique factors related to the distribution of patients in a mass casualty incident. A modified Delphi study was conducted and used purposive sampling to identify peer reviewers that had either (1) a peer-reviewed publication within the area of disaster management or (2) disaster management experience. In round one, peer reviewers ranked the 56 factors and identified an additional 8 factors that resulted in 64 factors being ranked during the two-round Delphi study. The criteria for agreement were defined as a median score greater than or equal to 7 (on a 9-point Likert scale) and a percentage distribution of 75% or greater of ratings being in the highest tertile.

Fifty-four disaster management peer reviewers, with hospital and prehospital practice settings most represented, assessed a total of 64 factors, of which 29 factors (45%) met the criteria for agreement.

Agreement from this formative study suggests that certain factors are influential to decision-making related to the distribution of patients during a mass casualty incident. (Disaster Med Public Health Preparedness. 2018;12:101–108)