This study aimed to explore the correlation between the 2011 Great East Japan Earthquake and postpartum depression among perinatal subjects in the Miyako region of Iwate, an area damaged by earthquakes and tsunamis.

We retrospectively compared the percentages of women with scores ≥9 on the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) among 3 groups of women who gave birth prior to the disaster (before-disaster group: n=141), within 3 months after the disaster (within-3-months group: n=70), and 4-6 months after the disaster (4-6-months group: n=89) at the Iwate Prefectural Miyako Hospital. The risk factors for EPDS scores ≥9 were estimated with multivariate logistic regression analyses.

Compared with the before-disaster group, a significantly greater number of women in the within-3-months group had EPDS scores ≥9 at hospital discharge (31.4% versus 9.9%, P<.0001), whereas women in the 4-6-months group did not (10.1% versus 9.9%, P=.96). In both the after-disaster groups, the destruction of their home (adjusted odds ratio [AOR], 3.68; 95% confidence interval [CI], 1.46-9.26) and dissatisfaction with their living conditions (AOR, 3.02; 95% CI, 1.20-7.59) were significantly associated with EPDS scores ≥9.

An increase in postpartum depression was observed after the Great East Japan Earthquake among perinatal women. (Disaster Med Public Health Preparedness. 2015;9:307-312)

To test the feasibility of developing evidence-based mental health training to build capacity to respond to natural disasters in black communities and the adaptation of a train-the-trainer (TTT) model for black community leaders and clinical providers in distressed areas at risk of natural disasters.

A core curriculum was developed based on a training needs assessment and resource review. Participants were recruited using network sampling in eastern North Carolina. The core curriculum was tested for usability, revised, and then pilot tested among five mental health providers. Three of the five were trained to lead one-day workshops tailored for black community leaders and clinical providers. Process data were collected, and workshop participants completed posttraining knowledge tests, evaluation forms, and debriefing focus groups.

Ten providers and 13 community leaders pilot tested the training. Posttest knowledge scores were generally higher among clinical providers. Perceived effectiveness of training was higher among community-based organization leaders than clinical providers. Evaluations indicated that the workshop components were culturally relevant and well received by all participants. We identified ways to facilitate recruitment, provide optional e-learning, evaluate effectiveness, and extend trainer support in future field trials.

The curriculum and TTT model provide culturally competent disaster mental health preparedness training for black communities. (Disaster Med Public Health Preparedness. 2013;7:302-312)

To provide a more comprehensive view than previously available of US physician preparedness for public health emergencies, this study examined physicians’ assessments of their preparedness, training, participation in institutional activities, information practices, and experiences with patient education. Four kinds of public health emergencies were considered: natural disasters, major airborne infections, major foodborne illness outbreaks, and chemical, biological, radiological, nuclear, or explosives (CBRNE) incidents.

Between October 19, 2011, and January 11, 2012, researchers conducted a national poll among 1603 practicing physicians in a range of specialties in hospital and nonhospital settings.

More than one-half of physicians felt prepared to handle a natural disaster, a major outbreak of an airborne infection, or a major foodborne illness outbreak, whereas one-third (34%) felt prepared to handle a CBRNE incident. About one-half of physicians (55%) had participated in training or a conference related to emergencies in the past 2 years. Sizable fractions of physicians were unaware of emergency response tools in their care setting. For example, nearly one-half in hospitals (44%) did not know whether their care setting had an emergency response plan, and less than one-quarter had participated in a drill using such a plan in the past 2 years. Less than one-third (31%) of physicians had signed up to receive alerts in the case of future emergencies. One in 10 reported sharing emergency information with patients at least “sometimes.”

Significant gaps remain in physician preparedness for public health emergencies, as well as in related training and participation in institutional activities. New efforts, with a focus on possible collaborations between public health institutions and health system leaders combined with effective use of online resources, are needed to bring more physicians on board and to develop relevant and useful key tools. New approaches, including those that rely on different types of care providers, may be needed to enhance patient education regarding emergency preparedness. (Disaster Med Public Health Preparedness. 2015;9:666–680)

Early Identification of disaster victims with mental health problems may be useful, but information within a short period after a disaster is scarce in developing countries. This study examined anxiety, depression, and post-traumatic stress symptoms at 1 month following 2019 Cyclone Fani in Odisha, India.

Post-traumatic stress symptoms (PTSS) were assessed by the Primary care PTSD screen for DSM 5 (PC-PTSD-5), anxiety symptoms by the Generalised Anxiety Disorder (GAD-7), and depression by the Patient Health Questionnaire (PHQ-9). The survey included participants’ disaster experience e.g., evacuation, fear of death, injury, death in family, damage to house, difficulty for food, displacement, and effect on livelihood.

Proportion of sample (n = 80) with probable PTSD was 42.9%, with severe anxiety was 36.7%, moderately severe depression was 16.5%, and severe depression was 3.8%. Suicidal cognitions were reported to increase by 14%. Comorbidity was common; with significant (P < 0.01) correlation between PTSS and anxiety (r = 0.69), depression (r = 0.596), and between anxiety and depression (r = 0.63). Damage of house and displacement were associated significantly with PTSD; evacuation and displacement with moderate and severe depression; and displacement with severe anxiety. No specific demographic factors were significantly linked to the psychiatric morbidities.

A considerable proportion of victims had psychiatric morbidities at 1 month. Associated risk factors included housing damages, evacuation, and displacement, suggesting the need to improve the disaster-management process.

Prehospital time affects survival in trauma patients. Mass casualty incidents (MCIs) are overwhelming events where medical care exceeds available resources. This study aimed at evaluating the prehospital time during MCIs and investigating the effect of triage.

A retrospective analysis was performed using Florida’s Event Medical Services Tracking and Reporting System database. All patients involved in MCIs during 2018 were accessed, and prehospital time intervals were evaluated and compared to that of non-MCIs. The effect of MCI triage and field triage (Field Triage Criteria) on prehospital time was evaluated.

In 2018, it was estimated that 2236 unique MCIs occurred in Florida, with a crude incidence of 10.1-10.9/100000 people. 2180 EMS units arrived at the hospital for patient disposition with a median alarm-to-hospital time of 43.74 minutes, significantly longer than non-MCIs (39.15 min; P < 0.001). MCI triage and field triage were both associated with shorter alarm-to-hospital time (39.37 min and 37.55 min, respectively).

MCIs resulted in longer prehospital time intervals than non-MCIs. This finding suggests that additional efforts are needed to reduce the prehospital time for MCI patients. MCI triage and field triage were both associated with shorter alarm-to-hospital times. Widespread use may improve prehospital MCI care.

National interpersonal distance preference is considered a cultural characteristic. Interpersonal distance is critical for the spread dynamics of coronavirus disease 2019 (COVID-19). COVID-19’s spread trend shows various characteristics in different countries. We believe that 1 of the factors influencing this variation could be national interpersonal distance preference.

We used regression analysis based on data of national interpersonal distance preferences (social, personal, and intimate) presented by Sorokowska et al. and COVID-19 rate of spread data for 40 different countries that were calculated using Our World in Data’s data.

National interpersonal distance preferences, with its 3 dimensions, significantly influence the rate of spread of COVID-19 in countries.

Understanding the relation between national interpersonal distance preference and spread of COVID-19 might be very useful information in decision-making processes of individuals, societies, and governments to develop culturally well-suited counter-pandemic policies, strategies, and procedures during the COVID-19 pandemic or any epidemic or pandemic threats in the future, instead of standard fit-to-all strategies.

The aim of this study was to evaluate the mortality rates of 566,602 patients with coronavirus disease (COVID-19) based on sex, age, and the presence or absence of underlying diseases and determine whether the underlying disease provides prognostic information specifically related to death.

The mortality rate was evaluated using conditional probability to identify the significant factors, and adjusted odds ratios (ORs) using a multivariable logistic regression analysis were estimated.

The mortality rate of patients with underlying health conditions was 12%, which was 4 times higher than that of patients without underlying health conditions. Furthermore, the mortality rates of women and men with underlying health conditions were 5.5 and 3.4 times higher than the mortality rates of patients without underlying health conditions, respectively. In a multivariable logistic regression analysis including sex, age, and underlying health conditions, male sex (OR: 1.83), age ≥ 41 y (ORs > 2.70), and underlying health conditions (OR: 2.20) were confirmed as risk factors for death.

More attention should be paid to older patients with underlying diseases and male patients with underlying diseases as the probability of death in this population was significantly higher.

The Association of American Medical Colleges recommended an increase in medical education for public health emergencies, bioterrorism, and weapons of mass destruction in 2003. The University of South Dakota Sanford School of Medicine (USD SSOM) implemented a 1-day training event to provide disaster preparedness training and deployment organization for health professions students called Disaster Training Day (DTD).

Hospital staff and emergency medical services personnel provided the lecture portion of DTD using Core Disaster Life Support (CDLS; National Disaster Life Support Foundation) as the framework. Pre-test and post-test analyses were presented to the students. Small group activities covered leadership, anaphylaxis, mass fatality, points of dispensing deployment training, psychological first aid, triage, and personal protective equipment. Students were given the option to sign up for statewide deployment through the South Dakota Statewide Emergency Registry of Volunteers (SERV SD). DTD data and student satisfaction surveys from 2009 to 2016 were reviewed.

Since 2004, DTD has provided disaster preparedness training to 2246 students across 13 health professions. Significant improvement was shown on CDLS post-test performance with a t-score of −14.24 and a resulting P value of <0.00001. Students showed high levels of satisfaction on a 5-level Likert scale with overall training, small group sessions, and perceived self-competency relating to disaster response. SERV SD registration increased in 2015, and 77.5% of the participants registered in 2016.

DTD at the USD SSOM provides for an effective 1-day disaster training course for health professions students. Resources from around the state were coordinated to provide training, liability coverage, and deployment organization for hundreds of students representing multiple health professions. (Disaster Med Public Health Preparedness. 2017;11:735–740)

To date, we have only limited evidence of the determinants of earthquake inpatient mortality-related factors. This study is among the first to explore related factors of inpatient deaths using data from multiple hospitals and multiple earthquakes.

We included and retrospectively analyzed data on 32,976 earthquake inpatients in the West China Earthquake Patients Database. Of these, we analyzed the records of 284 patients who died during hospitalization. We collected 12 dichotomous variables with reference to previous reports: patients’ age (both ≤ 15 years and ≥ 65 years), gender, prehospital treatment, intensive care unit (ICU) admission, the presence of severe traumatic brain injury (TBI), trunk injury, severe poly-trauma, crush syndrome, multiple-system organ failure (MSOF), infection, and cardiac/respiratory disease. We performed multivariate logistic regression analysis to explore independent related factors of mortality.

Ultimately, we identified severe TBI, MSOF, old age (≥ 65 years), ICU admission, crush syndrome, and cardiac/respiratory disease as independent mortality-related factors. Severe TBI was the greatest risk factor of inpatient death (ods ratio [OR], 31.913, 95% confidence interval [CI], 20.484-49.720), followed by MSOF (OR 30.905, 95% CI, 21.733-43.947).

To reduce earthquake inpatient mortalities, the related factors analyzed in this study should be prioritized in future inpatient earthquake response strategies.

On March 1, 2020, the Kurdistan Region Government (KRG) announced 4 confirmed cases of coronavirus disease (COVID-19). We aimed to explore the response of the public toward the prevention principles against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

The investigators invited individuals from different geographic areas of Duhok Governorate of Iraqi Kurdistan in March 2020.

The mean age of the participants was 25.74 (16‐95 years). The mean score and prevalence of fear toward SARS-CoV-2 infection was 4.40 of 10 and 81.9%, respectively. A small percentage of participants did not minimize their exposures by reducing close contacts and transmission of respiratory droplets (14.5%) and visited public areas during the epidemic (28.7%). The study revealed that 30.8% of the participants do not use face masks or tissues when they sneeze in public areas. Most of the participants wash their hands when they suspect a possible transmission of the SARS-CoV-2 pathogen (94.6%) and clean or disinfect pathogen contamination-suspected areas at home (84.6%). The study also revealed that some participants (11.2%), due to a lower education, did not visit a medical clinic when they experienced possible symptoms of SARS-CoV-2 infection. Participants agreed with the health policies of KRG against the COVID-19 outbreak (90.8%).

Some individuals do not adhere to preventive measures against SARS-CoV-2 infection.

We aimed to explore how perceived safety after terrorism is connected to views on security measures and emergency preparedness in a workplace setting.

Using a questionnaire-based, cross-sectional study of ministerial employees in Norway who were targeted in a terrorist attack in 2011 (n=3344), we investigated how employees’ perceived safety at work 9 to 10 months after the attack was associated with their perceptions of whether security measures were sufficiently prioritized at work, whether there had been sufficient escape and evacuation training, and whether they were confident with evacuation procedures.

We found strong evidence of increasing perceived safety at work the more employees believed security measures were sufficiently prioritized at work (partially confounded by post-traumatic stress disorder), and the better their knowledge of evacuation procedures (modified by gender and education).

The present study suggests that employers may enhance perceived safety at work for terror-exposed employees by showing a commitment to security measures and by ensuring employees know evacuation procedures well. More research is needed to investigate causality patterns behind the associations found in this cross-sectional study. (Disaster Med Public Health Preparedness. 2016;10:805–811)

Coronavirus disease 2019 (COVID-19) has posed formidable challenges, including overwhelming biomedical waste management. Guidelines have been rapidly changing along with the mounting pressure of waste generation.

These challenges were managed by smart re-engineering of structure and processes for the desired outcomes. Dedicated staff, in personal protective equipment with appropriate training, were deployed to collect waste using dedicated trolleys. A dedicated route plan was drawn with a dedicated elevator meant for COVID-19. A new temporary holding area was created. Dedicated trucks with requisite labels were deployed to transport COVID-19 waste to a common biomedical waste treatment facility. Communication challenges were addressed through timely circulars, which were further reinforced and reiterated during various on-going training programs.

Before the onset of COVID-19 pandemic, the amount of biomedical waste generated was 1.93 kg/bed/day; currently, the quantity of COVID-19 biomedical waste generated is 7.76 kg/COVID bed/day. Daily COVID-19 waste generation data are maintained and uploaded in an android application monitored by Central Pollution Control Board, Government of India. To date, none of the workers handling COVID-19 waste has acquired health-care associated COVID-19 infection, which reflects on the soundness of the new system and the infection control practices in the institute.

A responsive leadership harmonizing with a robust communication and training system has augmented timely re-engineering of structure and processes for better outcomes in the war on waste.