Maternal health in pregnancy and birth outcomes were compared between pre- and post-Varzaghan earthquake.

In this retrospective descriptive study, before and after the earthquake, 550 and 450 women were enrolled respectively. Neonatal weight, height, and head circumference, as well as maternal weight gain and hemoglobin (Hb) levels were obtained using medical records at health centers. Chi-square test and Independent t-test were used to analyze differences in pregnancy outcomes. A P-value less than 0.05 was considered significant.

A significant increase in inadequate gestational weight gain (44.1% vs 58.9%) was observed (P = 0.043) before and after the earthquake. The mean hemoglobin level in the first trimester before the earthquake was significantly higher than after the earthquake (P = 0.001). Before–after earthquake comparisons showed that the mean birth weight, birth height, and birth head circumference were decreased significantly (P < 0.05). In addition, the rates of preterm birth (18.91% vs 10.90%), abortion (17.11% vs 10.54%), and stillbirth (3.78% vs 1.82%) were increased significantly after the earthquake (P < 0.05).

Earthquake causes inadequate gestational weight gain and decreased hemoglobin levels, which lead to adverse birth outcomes. More longitudinal and well-designed studies are desired to investigate the longitudinal consequences of disasters on susceptible groups.

This study, which aims to reveal the metaphorical perceptions of social media users regarding the term, COVID-19, is in accordance with the phenomenological method.

The phenomenological method was used in this study. In July 2020, a total of 125 social media users voluntarily participated in this research study and were asked to derive metaphors regarding the concept of COVID-19.

With the participation of social media users, metaphors about COVID-19 were determined. These metaphors, which were provided completely voluntarily in response to social media posts, reveals that the participants approached the COVID-19 phenomenon with a variety of meanings.

When the metaphors derived by the participants are examined through different categories, it can be seen that a variety of metaphors are produced and almost all of them attribute negative meanings to COVID-19. A significant part of the metaphors evoke disasters and unexpected events. The absence of more hopeful metaphors regarding the end of the pandemic, may stem from the fact that this study took place during the middle of the pandemic, when discussions of the “new normal” were being made just after the first wave.

Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak.

Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS.

The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and student’s worry regarding their studies/graduation. Perceived stress was decreased if participants’ self-rated health status score increased.

In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.

We aimed to investigate the relationships between use of media to obtain information on radiation and radiation anxiety among community residents in Fukushima, 5.5 years after the nuclear power plant accident.

A questionnaire survey was administered between August and October 2016 to 2000 randomly sampled residents in Fukushima prefecture. Radiation anxiety toward health and regarding discrimination and prejudice were assessed with 4- and 3-item scales, respectively. Participants nominated their most-used media for acquiring information on radiation by choosing up to 3 sources from 12 information sources listed (eg, local newspaper, TV news, websites, social networking sites [SNS], local government newsletter, word of mouth). We investigated associations of most-used media types and radiation anxiety, controlling for sociodemographic characteristics and anxiety regarding radiation’s health effects immediately after the accident, using multivariate linear regression analyses.

Valid responses were obtained from 790 (39.5%) residents. Acquiring information about radiation by word of mouth was related to higher radiation anxiety toward health. Regarding radiation anxiety concerning discrimination and prejudice, SNS use was related to higher anxiety, whereas acquiring information through Nippon Hoso Kyokai (NHK) TV news was related to lower anxiety.

Interpersonal interactions rather than gaining information from media – characterized by unidirectional information exchange – may increase radiation anxiety.

Coronavirus disease 2019 (COVID-19) began to spread across Wuhan, China, by the end of 2019, and patients were unable to be hospitalized because medical resources were limited.

A questionnaire survey was conducted among 108 participants with mild COVID-19 who have isolated at home under the guidance of doctors. The results of the questionnaire and outpatient data were integrated to evaluate participants’ compliance with various epidemic prevention measures.

During isolation, most participants were able to follow epidemic prevention measures under the guidance of doctors. After 14 d from the start of isolation, 45.37% of the participants recovered. Approximately half of the participants were relieved of symptoms, and most of them were transferred to mobile cabin hospitals to continue isolation. Three participants with worsening symptoms were transferred to the designated hospitals. There were no deaths of the participants, but there were 7 family members that were infected.

During a period of home isolation under the guidance of a doctor, individuals can comply with epidemic prevention measures and symptoms can be improved. Scientific home isolation may be an effective way to relieve the strain of medical and social resources during the epidemic of COVID-19.

The response to the 2010 Deepwater Horizon oil spill was impacted by heat. We evaluated the association between environmental heat exposure and self-reported heat-related symptoms in US Coast Guard Deepwater Horizon disaster responders.

Utilizing climate data and postdeployment survey responses from 3648 responders, we assigned heat exposure categories based on both wet bulb globe temperature (WBGT) and heat index (HI) measurements (median, mean, maximum). We calculated prevalence ratios (PRs) and 95% confidence intervals (CIs) via adjusted Poisson regression models with robust error variance to estimate associations with reported heat-related symptoms. We also evaluated the association between use of personal protective equipment (PPE) and heat-related symptoms.

Those in the highest WBGT median–based heat exposure category had increased prevalence of heat-related symptoms compared to those in the lowest category (PR=2.22 [95% CI: 1.61, 3.06]), and there was a significant exposure-response trend (P<.001). Results were similar for exposure categories based on WBGT and HI metrics. Analyses stratified by use of PPE found significantly stronger associations between environmental heat exposure and heat-related symptoms in those who did not use PPE (PR=2.23 [95% CI: 1.10, 4.51]) than in those who did (PR=1.64 [95% CI: 1.14, 2.36]).

US Coast Guard Deepwater Horizon disaster responders who experienced higher levels of environmental heat had higher prevalences of heat-related symptoms. These symptoms may impact health, safety, and mission effectiveness. As global climate change increases the frequency of disasters and weather extremes, actions must be taken to prevent heat-related health impacts among disaster responders. (Disaster Med Public Health Preparedness. 2019;13:561-569)

The object of this study was to examine the accuracy in prehospital shock index (SI) for predicting intensive care unit (ICU) requirement and 30-d mortality among from coronavirus disease 2019 (COVID-19) patients transported to the hospital by ambulance.

All consecutive patients who were the age ≥18 y, transported to the emergency department (ED) by ambulance with a suspected or confirmed COVID-19 in the prehospital frame were included in the study. Four different cutoff points were compared (0.7, 0.8, 0.9, and 1.0) to examine the predictive performance of both the mortality and ICU requirement of the SI. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate each cut-off value discriminatory for predicting 30-d mortality and ICU admission.

The total of 364 patients was included in this study. The median age in the study population was 69 y (range, 55-80 y), of which 196 were men and 168 were women. AUC values for 30-d mortality outcome were calculated as 0.672, 0.674, 0.755, and 0.626, respectively, for threshold values of 0.7, 0.8, 0.9 and 1.0. ICU admission was more likely for the patients with prehospital SI > 0.9. Similarly, the mortality rate was higher in patients with prehospital SI > 0.9.

Early triage of COVID-19 patients will ensure efficient use of health-care resources. The SI could be a helpful, fast, and powerful tool for predicting mortality status and ICU requirements of adult COVID-19 patients. It was concluded that the most useful threshold value for the shock index in predicting the prognosis of COVID-19 patients is 0.9.

To examine the adverse effects of benzene exposure in adults from a prolonged flaring disaster at the BP refinery in Texas City, Texas.

Adults aged 18 years and older who had been exposed and unexposed to benzene were included. We reviewed medical charts and compared measures of white blood cells (WBCs), platelets, hemoglobin, hematocrit, blood urea nitrogen (BUN), creatinine, alkaline phosphatase (ALP), aspartate amino transferase (AST), and alanine amino transferase (ALT) in exposed and unexposed adults.

Records from 2213 adults (benzene exposed, n=1826; unexposed, n=387) were reviewed. Benzene-exposed subjects had significantly higher WBC counts (7.9±2.3 vs 6.8±1.6×103 per µL, P=0.0000) and platelet counts (270.8±60.9 vs 242.5±53.7×103 per µL, P=0.0000) than did the unexposed subjects. Serum creatinine levels were also significantly higher in the exposed group than in the unexposed group (1.0±0.2 vs 0.8±0.2 mg/dL, P=0.000). Serum levels of ALP were significantly higher in the exposed subjects than in the unexposed subjects (82.1±15.6 vs 71.8±8.2 IU/L, P=0.000). Similarly, benzene-exposed subjects had significantly higher levels of AST (26.2±6.4 vs 19.7±5.3 IU/L, P=0.000) and ALT (30.6±10.8 vs 20.9±9.6 IU/L, P=0.000) than in those unexposed to benzene.

Benzene exposure resulted in significant alterations in hematologic and liver profiles in adults. (Disaster Med Public Health Preparedness. 2016;10:233–239)

The 2014 Ebola virus disease (EVD) outbreak in West Africa remains the most deadly in history. Emergency departments (EDs) are more likely to come into contact with potential EVD patients. It is important for EDs to be prepared to care for suspected EVD patients. Our objective was to understand the perceived challenges experienced by Washington State ED medical directors in EVD preparedness.

An anonymous, electronic survey was sent to a convenience sample of ED medical directors across Washington State between November and February of 2014–2015. The perceived challenges of and attitudes toward EVD preparations were assessed and reported as stratified proportions.

Of 85 medical directors contacted, 59 responses (69%) were received. This included EDs with annual patient volumes of <20,000 (20 hospitals, 34%), 20,000 to 40,000 (21 hospitals, 36%), 41,000 to 60,000 (4 hospitals, 6.8%), and >60,000 (12 hospitals, 20%). Among the perceived challenges in EVD preparations were spatial modifications (eg, building an anteroom for donning and doffing of personal protective equipment) and waste management planning. Ninety-five percent of respondents moderately or strongly agreed that it is important to have a predesignated hospital to care for EVD patients.

Washington State ED medical directors have faced significant challenges in ensuring their EDs are prepared to safely care for suspected EVD patients. Attitudes toward EVD preparations are mixed. Varying levels of perceived importance may represent an additional barrier to statewide EVD preparedness. (Disaster Med Public Health Preparedness. 2016;10:662–668)

On August 12, 2015, a hazardous chemical explosion occurred in the Tianjin Port of China. The explosions resulted in 165 deaths, 8 missing people, injuries to thousands of people. We present the responses of emergency medical services and hospitals to the explosions and summarize the lessons that can be learned.

This study was a retrospective analysis of the responses of emergency medical services and hospitals to the Tianjin explosions. Data on injuries, outcomes, and patient flow were obtained from the government and the hospitals.

A total of 46 ambulances and 143 prehospital care professionals were dispatched to the scene, and 198 wounded were transferred to hospitals by ambulance. More than 4000 wounded casualties surged into hospitals, and 798 wounded were admitted. Both emergency medical services and hospitals were quick and successful in the early stage of the explosions. The strategy of 4 centralizations (4Cs) for medical services management in a mass casualty event was successfully applied.

The risk of accidental events has increased in recent years. We should take advantage of the lessons learned from the explosions and apply these in future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 411–414)

This research aims to provide guidance on means to bolster safe and effective emergency response. Safe and effective performance among firefighters is key to protecting firefighters, to ensure mission completion, and to protect the public during emergency response situations. Although some studies have shown the impact of safety climate on firefighter performance, few studies have explored the impact of safety climate on affective organizational commitment and safety behaviors among firefighters, which are critical to more effective emergency response.

Data collected from 349 career firefighters in the southern United States were analyzed by means of structural equation modeling to assess posited relationships in the proposed model.

This study confirmed a model that describes the relationships between safety climate, affective organizational commitment, and safety behaviors. Safety climate significantly predicted affective organizational commitment (P < 0.001) and affective organizational commitment was positively associated with both safety compliance (P < 0.001) and safety participation (P < 0.001).

This study has implications for researchers and practitioners. Firefighters exhibit positive affective organizational commitment as a result of positive safety climate perceptions. This commitment is then associated with positive safety behavior outcomes, which bolsters personal safety and enhances the likelihood of safe and effective mission completion to protect the public.

This study assessed the health-related quality of life (HRQOL) and the adaptation to harsh conditions (APHC) of residents living in post-earthquake zones in Sichuan Province, China, as well as the effect of HRQOL on APHC.

A sample survey was conducted in 5 counties in Sichuan in May and June 2013 (N=2000). The 12-item Short Form Health Survey (SF-12) was used to measure HRQOL. The APHC scale was self-developed and was based on real-life conditions in China. Confirmatory factor analysis and structural equation model were used to analyze how HRQOL affected APHC.

Cronbach α coefficients indicated that the internal reliability of both scales were good. Results showed that the physical component summary significantly affected APHC, while the effect of the mental component summary was insignificant. APHC had the greatest effect on the adaptation to poor infrastructures (r=0.721) and the least effect on the adaptation to poor social security systems (r=0.608).

The HRQOL of residents living in post-earthquake zones positively affected APHC, particularly physical health. These findings suggested the need for governmental improvement of infrastructures in post-disaster areas. (Disaster Med Public Health Preparedness. 2014;0:1-7)

Iran, in terms of disasters, is among the top 10 countries in the world. Therefore, timely coordination and provision of rescue, transport, and treatment services after disasters are of particular importance. This study aimed to investigate and provide a short report on the provision of rescue, transport, and treatment services after the 2017 earthquake in Kermanshah.

This was a review and a descriptive study conducted using the analysis of documents and news published on valid Iranian sites and reports of some service providers in 2017 after the earthquake in Kermanshah.

The most important strengths of post-earthquake services were the military force’s cooperation, people’s support, sending the popular aid and donations to earthquake areas, and the tremendous national support and religious sympathy among the people. Sending the popular aid and donations was such that they resulted in the blockage of communication routes, heavy traffic on the roads, and disrupted the relief and rescue efforts process. However, the most important weaknesses in the provision of services after this earthquake were the lack of preparedness of the government systems and the lack of orderly management for appropriate assistance and relief and, therefore, there was an inappropriate distribution of popular aid and donations among the earthquake victims.

Proper coordination and service delivery after unexpected events in Iran have a considerable distance to reaching the desired point. Unfortunately, similar problems had also occurred in other earthquakes such as the Bam and Rudbar earthquakes. The repetition of these problems indicates the authorities’ lack of readiness and commitment to troubleshoot weaknesses in their emergency response plan. Therefore, it is necessary for government officials to have more preparedness in all related affairs and aspects. (Disaster Med Public Health Preparedness. 2019;13:691–694)

In refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.

The comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.

Physicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers’ knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.

A long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.(Disaster Med Public Health Preparedness. 2013;7:82-88)

Rapid response to a trauma incident is vital for saving lives. However, in a mass casualty incident (MCI), there may not be enough resources (first responders and equipment) to adequately triage, prepare, and evacuate every injured person. To address this deficit, a Volunteer First Responder (VFR) program was established.

This paper describes the organizational structure and roles of the VFR program, outlines the geographical distribution of volunteers, and evaluates response times to 3 MCIs for both ambulance services and VFRs in 2000 and 2016.

When mapped, the spatial distribution of VFRs and ambulance stations closely and deliberately reflects the population distribution of Israel. We found that VFRs were consistently first to arrive at the scene of an MCI and greatly increased the number of personnel available to assist with MCI management in urban, suburban, and rural settings.

The VFR program provides an important and effective life-saving resource to supplement emergency first response. Given the known importance of rapid response to trauma, VFRs likely contribute to reduced trauma mortality, although further research is needed in order to examine this question specifically. (Disaster Med Public Health Preparedness. 2019;13:287–294)

We intended to build consensus on appropriate disaster mental health services among professionals working in the area affected by the Great East Japan Earthquake.

We focused on the first 3 months after the disaster, divided into 3 phases: immediate aftermath, acute phase, and midphase. We adopted the Delphi process and asked our survey participants (n=115) to rate the appropriateness of specific mental health services in each phase and comment on them. We repeated this process 3 times, giving participants feedback on the results of the previous round. Through this process, we determined the criterion for positive consensus for each item as having the agreement of more than 80% of the participants.

We found that the importance of acute psychiatric care and prescribing regular medication for psychiatric patients gained positive consensus in the immediate aftermath and acute phase. Counseling and psychoeducation after traumatic events or provision of information gained consensus in the acute phase and midphase, and screening of mental distress gained consensus in the midphase.

Higher priority was given to continuous psychiatric services in the immediate aftermath and mental health activities in later phases. (Disaster Med Public Health Preparedness. 2015;9:359–366)