This study compared the geospatial distribution of Ebola tweets from local health departments (LHDs) to online searches about Ebola across the United States during the 2014 Ebola outbreak.

Between September and November 2014, we collected all tweets sent by 287 LHDs known to be using Twitter. Coordinates for each Ebola tweet were imported into ArcGIS 10.2.2 to display the distribution of tweets. Online searches with the search term “Ebola” were obtained from Google Trends. A Pearson’s correlation test was performed to assess the relationship between online search activity and per capita number of LHD Ebola tweets by state.

Ebola tweets from LHDs were concentrated in cities across the northeast states, including Philadelphia and New York City. In contrast, states with the highest online search queries for Ebola were primarily in the south, particularly Oklahoma and Texas. A weak, negative, non-significant correlation (r=−0.03, P=0.83, 95% CI: −0.30, 0.25) was observed between online search activity and per capita number of LHD Ebola tweets by state.

We recommend that LHDs consider using social media to communicate possible disease outbreaks in a timely manner, and that they consider using online search data to tailor their messages to align with the public health interests of their constituents. (Disaster Med Public Health Preparedness. 2018; 12: 287–290)

Local health facilities play a critical role in mitigating the deterioration of health after catastrophic disasters. However, limited information is available on clinic damage. Therefore, the National Institute of Public Health conducted surveillance on clinic damage after the 2011 Great East Japan Earthquake (GEJE) to identify risk factors.

A cross-sectional study using a paper-based questionnaire was conducted that targeted 728 clinics located in coastal areas in the 3 prefectures most affected by the GEJE.

The risk of building damage was inversely correlated with distance from the coast, whereas the risk of ceasing operations was significantly correlated with building damage and some specialties of clinics, namely, internal medicine and pediatrics.

In mountainous countries like Japan, clinics often need to be built in coastal areas, where the majority of residents live. This surveillance revealed that clinics built in readily accessible locations and that provide care with high needs are more likely to get damaged by tsunamis. As clinics are often the frontline health facilities in disaster settings, local disaster plans need to include plans to reinforce disaster preparedness among clinics. For effective planning and resource allocation, nationwide hazard vulnerability analysis using a global standard will be helpful. (Disaster Med Public Health Preparedness. 2018; 12: 291–295)

To determine whether, during a hurricane, geographic accessibility to hospitals with emergency care is compromised disproportionately for the elderly than for the nonelderly.

The locations of hospitals with emergency health care and a subset of those hospitals functional during a hurricane were compared with the distribution of the elderly population at the block group level in Palm Beach County, Florida. Geographic Information Systems (GIS) proximity analysis (minimum distance to closest hospital) and cumulative distribution functions were used to measure and compare hospital accessibility during normal and hurricane conditions for the elderly and nonelderly populations.

Accessibility to closest functional hospital during a hurricane was compromised disproportionately for the elderly.

Geographic accessibility to emergency health care is compromised disproportionately for the elderly in Palm Beach County. Compounding the risk is the likelihood of the elderly experiencing a greater health care need during a hurricane. This poses a community public health crisis and calls for effective and collaborative planning between health professionals and disaster planners to address the health care needs of the elderly. (Disaster Med Public Health Preparedness. 2018; 12: 296–300)

To explore the 3-tiered treatment model for medical treatment after an earthquake.

Based on the practices of the national emergency medical rescue services in the Lushan earthquake zone, the 3-tiered treatment classification approach was retrospectively reviewed.

Medical rescue teams assembled and reported quickly to the disaster areas after the earthquake. The number of injured people had reached 25,176 as of April 30; of these, 18,611 people were treated as outpatients, 6565 were hospitalized, and 977 were seriously or severely injured.

The 3-tiered treatment model was the main approach used by rescue services after the Lushan earthquake. Primary and secondary treatments were of the highest importance and formed the basis of the Lushan model of earthquake rescue and treatment. (Disaster Med Public Health Preparedness. 2018; 12: 301–304)

Maternal mortality may increase after a disaster. Because midwives are at the frontline of offering reproductive health care services in disasters, they should be competent.

This was a cross-sectional, descriptive study carried out in 2015 in Tehran. The sample consisted of 361 midwives selected by use of a cluster random sampling method. Data were collected by using a questionnaire on professional competency for preventing maternal mortality in disasters.

The midwives’ mean professional competency score was 177.74±31, which was an average level of professional competency. The level of knowledge and skills of the midwives was reported as inadequate for most items, particularly for the items of “managing mothers affected by chronic diseases,” “physical trauma,” “recognizing patients who needed to be referred,” and “stabilizing mothers when referring them.” Statistically significant relationships were observed between the midwives’ competencies and age (P=0.001), work experience (P=0.054), educational level (P= 0.043), previous experience in a disaster (P=0.014), and workplace (P=0.006). These data were drawn by using Spearman’s correlation, t-test, and ANOVA, respectively.

Given the average scores for midwives’ professional competency in disasters and the inadequacy of prior training courses, extra educational programs for midwives are recommended. (Disaster Med Public Health Preparedness. 2018; 12: 305–311)

The World Stroke Organization “1 in 6” campaign aims to raise awareness that 1 in 6 persons will experience a stroke during their lifetime. With aging populations and improved survival rates, an increased number of survivors live with functional limitations and require supportive care. This has important implications for implementing an all-of-society approach to disaster risk reduction. In this study, we explore the assets that stroke survivors and caregivers consider useful in supporting their capacity to manage routine activities and independent living and to respond to a disaster.

Transcripts from interviews with stroke survivors and caregivers were analyzed by use of content analysis.

Assets were categorized into 4 classes: social, physical, energy, and personal characteristics and are presented as a household map. Emergent themes suggested that understanding how to mobilize assets is complicated yet essential for building resilience. Household resilience requires people have self-efficacy and motivation to move from awareness to action. The findings informed development of a conceptual model of asset literacy and household resilience following stroke.

Interventions to enhance asset literacy can support an all-of-society approach to disaster risk reduction through awareness, empowerment, participation, innovation, and engagement. (Disaster Med Public Health Preparedness. 2018; 12: 312–320)

We aimed to identify the differences in personal disaster preparedness and disaster risk perception among child care and preschool teachers in South Korea by using demographic characteristics and disaster-related questions.

A cross-sectional self-reporting questionnaire was administered from February to October 2014.

Of all the participants, 68.1% had received disaster preparedness education and training on 2 or more occasions per year; 13.2% had received no education or training. Personal disaster preparedness differed significantly by marital status (P<0.05), the number of disaster education and training sessions attended (P<0.05), and having purchased home insurance (P<0.001). Disaster risk perception differed significantly by children’s age group under a teacher’s care (P<0.05). The topic on which child care teachers wanted more training was “fractures and bleeding emergency care” (53.9%). The most probable disaster was considered to be a typhoon (66.0%).

Disaster preparedness is important for both young children and their teachers. Field-based teacher disaster preparedness education and training should be provided so that they can respond effectively to disaster occurrence regardless of type, time, or location. (Disaster Med Public Health Preparedness. 2018; 12: 321–328)

To assess the level of all-hazards disaster preparedness and training needs of emergency department (ED) doctors and nurses in Hong Kong from their perspective, and identify factors associated with high perceived personal preparedness.

This study was a cross-sectional territory-wide online survey conducted from 9 September to 26 October, 2015.

The participants were doctors from the Hong Kong College of Emergency Medicine and nurses from the Hong Kong College of Emergency Nursing.

We assessed various components of all-hazards preparedness using a 25-item questionnaire. Backward logistic regression was used to identify factors associated with perceived preparedness.

A total of 107 responses were analyzed. Respondents lacked training in disaster management, emergency communication, psychological first aid, public health interventions, disaster law and ethics, media handling, and humanitarian response in an overseas setting. High perceived workplace preparedness, length of practice, and willingness to respond were associated with high perceived personal preparedness.

Given the current gaps in and needs for increased disaster preparedness training, ED doctors and nurses in Hong Kong may benefit from the development of core-competency-based training targeting the under-trained areas, measures to improve staff confidence in their workplaces, and efforts to remove barriers to staff willingness to respond. (Disaster Med Public Health Preparedness. 2018; 12: 329–336)

A series of sniper attacks in the Washington, DC, area left 10 people dead and 3 wounded. We developed and tested a model that examined the unique and interdependent relationships of sniper-related television viewing, prior life-threatening events, and parental status to identification with attack victims.

Participants were 1238 residents of the DC area (aged 18-90 years, mean=41.7 years; 51% female; 68% white) who completed an online survey that assessed identification with sniper attack victims, amount of television viewing, and prior life-threatening events. Identification was measured by using a previously developed scale that assessed to what extent participants identified victims as similar to themselves, a friend, or a family member.

The relationship of television viewing to identification was examined by using multivariate linear regression analyses. In univariate analyses, female gender, having children, higher levels of television viewing, and past life-threatening events were independently related to greater identification. After adjustment for demographics and life-threatening events, sniper-related television viewing continued to be associated with identification (B=0.61, P≤0.001, ∆R2=0.07). Examination of the interactions of television viewing by parental status and television viewing by life-threatening event revealed significant relationships.

Attention to events preceding and during a terrorist event could help in the recognition of those at particular risk for increased identification with attack victims. These findings also have implications for recommendations for media exposure during an event. (Disaster Med Public Health Preparedness. 2018; 12: 337–344)

Disasters occur without warning and can have devastating consequences. Emergency preparedness can reduce negative effects. It is especially important that parents prepare, as children are particularly vulnerable after disasters. This study tested 2 hypotheses: (1) adults with more children are likely to be better prepared than those with fewer or no children because greater caretaking is linked to greater perceived threat of disaster leading to greater preparedness and (2) the strength of this mediational link varies as a function of parental self-efficacy.

Data from an online survey about human-made disasters (terrorism) with a community convenience sample were used to test the hypothesis that perceived threat mediates the relationship between parental status (number of children cared for) and preparedness behaviors, moderated by level of self-efficacy for emergency preparedness.

A bootstrapping analysis with relevant covariates supported the hypothesized mediating effect of threat on the relationship between parental status and preparedness. This relationship was strengthened at higher levels of parental preparedness self-efficacy.

The results of this study are particularly relevant for preparedness interventions. Because threat leads to preparedness, particularly for parents with high self-efficacy, it is important to focus attention on factors that can improve parents’ sense of self-efficacy. (Disaster Med Public Health Preparedness. 2018; 12: 345–351)

Social media data are a highly contextual health information source. The objective of this study was to identify Korean keywords for detecting influenza epidemics from social media data.

We included data from Twitter and online blog posts to obtain a sufficient number of candidate indicators and to represent a larger proportion of the Korean population. We performed the following steps: initial keyword selection; generation of a keyword time series using a preprocessing approach; optimal feature selection; model building and validation using least absolute shrinkage and selection operator, support vector machine (SVM), and random forest regression (RFR).

A total of 15 keywords optimally detected the influenza epidemic, evenly distributed across Twitter and blog data sources. Model estimates generated using our SVM model were highly correlated with recent influenza incidence data.

The basic principles underpinning our approach could be applied to other countries, languages, infectious diseases, and social media sources. Social media monitoring using our approach may support and extend the capacity of traditional surveillance systems for detecting emerging influenza. (Disaster Med Public Health Preparedness. 2018; 12: 352–359)

Despite the frequency of disasters in Africa, almost nothing is known about ethnic affiliations in relation to psychopathology after such incidents. This study examined the mental health outcomes of members of 7 major ethnic groups exposed to the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya.

Approximately 8 to 10 months after the disaster, 229 civilian employees, 99 locally engaged staff workers of the US State Department and the US Agency for International Development, and 64 workers of the Kenyan Red Cross Society (total N=392) were assessed with the Diagnostic Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Additional data were gathered on demographic characteristics, disaster exposures and injuries, and ethnic affiliations.

Disaster-related post-traumatic stress disorder (PTSD) was significantly less prevalent among members of the Kikuyu group (28%) and post-disaster major depression was significantly more prevalent among members of the Meru group (64%), compared with all others in the sample. Preexisting psychopathology and disaster injury were independently associated with bombing-related psychopathology.

Further study of disaster-related psychopathology in relation to African ethnic affiliations is needed to better understand these associations and to assist in planning resources and interventions for African disaster survivors. (Disaster Med Public Health Preparedness. 2018; 12: 360–365)

Noncommunicable diseases (NCDs), including mental disorders, have become major threats to human health worldwide. People with NCDs are particularly vulnerable to disasters. We systematically reviewed reports describing studies of NCDs at the time of the Great East Japan Earthquake (GEJE) to clarify the circumstances of people with NCDs and to build strong measures to support them.

Relevant articles published from March 2011 through December 2016 were collected by searching the PubMed database (National Library of Medicine). We specifically examined reports describing NCDs and including the key words “East Japan Earthquake.” NCDs included every disease type aside from injury and infectious disease.

We collected 160 relevant articles, 41 of which described NCDs that existed in residents before the GEJE. Articles describing respiratory diseases and mental illnesses were found most frequently. Interruption of regular treatment was the most frequent problem, followed by lack of surveillance capacity. We found 101 reports describing NCDs that had developed after the GEJE, of which 60% were related to mental health issues.

NCDs pose major health issues after large-scale disasters. Establishment of strong countermeasures against interruption of treatment and surveillance systems to ascertain medical needs for NCDs are necessary to prepare for future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 396–407)