Frontline healthcare workers (FHCWs) exposed to COVID-19 patients are at an increased risk of developing psychological burden. This study aims to determine the prevalence of mental health symptoms and associated factors among Mexican FHCWs attending COVID-19 patients.

FHCWs, including attending physicians, residents/fellows, and nurses providing care to COVID-19 patients at a private hospital in Monterrey, Mexico, were invited to answer an online survey between August 28, and November 30, 2020. Symptoms of depression, anxiety, post-traumatic stress, and insomnia were evaluated with the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, Impact of Event Scale-Revised (IES-R), and Insomnia Severity Index (ISI). Multivariate analysis was performed to identify variables associated with each outcome.

131 FHCWs, 43.5% attending physicians, 19.8% residents/fellows, and 36.6% nurses were included. The overall prevalence of depression, anxiety, post-traumatic stress, and insomnia was 36%, 21%, 23%, and 24% respectively. Multivariate analysis revealed that residents/fellows and nurses reported more depression and insomnia than attending physicians. Although not significant, residents/fellows were more likely to experience all symptoms than nurses.

Mexican FHCWs, especially nurses and residents/fellows, experienced a significant psychological burden while attending to COVID-19 patients. Tailored interventions providing support to FHCWs during future outbreaks are required.

During an influenza or coronavirus disease 2019 (COVID-19) pandemic that results in acute respiratory distress, the number of available ventilators will not meet demand. In 2007, the New York State Task Force on Life and the Law and Department of Health released draft Guidelines for ethical allocation of ventilators for adults. In 2015, updated guidelines were released to ensure that: (1) revisions reflect the public’s values and (2) the triage protocol is substantiated by evidence-based clinical data. We summarize the development and content of the 2015 Guidelines compared with the 2007 version, emphasizing new/revised aspects of the ethical considerations and clinical protocol.

We compared the 2007 and 2015 guidelines, with particular emphasis on the ethical issues and clinical protocols.

The 2015 Guidelines retained much of the ethical and clinical framework of the 2007 draft. The triage protocol was revised using evidence-based clinical data. Patients with the highest likelihood of short-term survival with ventilator therapy have priority access. Protocol consists of exclusion criteria, the sequential organ failure assessment (SOFA) score, and periodic clinical assessments. Guidance is provided on secondary triage criteria. Other forms of medical intervention/palliative care and review of triage decisions are discussed.

The 2015 Guidelines reflect advances in medicine and societal values and provide an evidenced-based framework to save the most lives. The framework could be adapted in other emergencies, such as the COVID-19 pandemic, that require ventilators.

The purpose of this study was to clarify whether the support activities of dietitians during disasters were able to address the problems faced by mothers about their children’s diet and nutrition.

Dietitians (7 in total) and mothers (8) were selected by the snowball sampling method. Semi-structured interviews were used to conduct focus group interviews about children’s diet and nutrition. Verbatim data were generated, and an inductively qualitative descriptive analysis was conducted.

Six categories were generated for each group. Dietitians responded to problems that mothers had regarding their children’s diet and nutrition via 2 activities: [dealing with allergy food shortages] and [school lunch support].

It is important for dietitians to recommend stockpiling allergy-friendly foods to accommodate children with allergies and achieve early resumption of school lunches to meet children’s nutritional needs.

The use of the Community Assessment for Public Health Emergency Response (CASPER) method in disaster and non-disaster settings continues to grow. While CASPERs flexibility has been well demonstrated, the documentation of specific actions that have resulted from the utilization of CASPER data has been limited. We attempted to document changes in emergency preparedness planning and policy based on CASPER data.

Written reports from 19 CASPERs conducted in Texas between 2001 and 2015 were collected. Key informant interviews were conducted with 9 public health staff knowledgeable about the CASPERs. Written reports and interview transcripts were coded and analyzed for themes.

Few specific outcomes could be documented beyond a single successful grant application. Respondents felt CASPER data was not duplicative and was useful for improving existing plans. CASPER is seen as an effective way to enhance relationships with communities and partnerships with agencies including Emergency Management.

As the use of CASPER grows, it is increasingly important to document any specific and measurable benefits, actions, and changes to planning or policy taken as the result of data collected using the CASPER method. Without measurable outputs and outcomes, support for the use of CASPER from decision-makers may begin to wane. (Disaster Med Public Health Preparedness. 2018;12:680-684)

Understanding who is most vulnerable during an earthquake will help health care responders prepare for future disasters. We analyzed the demography of casualties from the Christchurch earthquake in New Zealand.

The demography of the total deceased, injured, and hospitalized casualties of the Christchurch earthquake was compared with that of the greater Christchurch population, the Christchurch central business district working population, and patients who presented to the single acute emergency department on the same month and day over the prior 10 years. Sex data were compared to scene of injury, context of injury, clinical characteristics of injury, and injury severity scores.

Significantly more females than males were injured or killed in the entire population of casualties (P<0.001). Most of the deceased and hospitalized casualties were injured in the central business district (171/182 deceased [94%]; 33/91 hospitalized [36.2%]). Approximately half of both sexes were injured at home (1002/2032 males [49%]; 2390/4627 females [52%]) and >20% were injured at commercial or service localities (444/2032 males [22%]; 1105/4627 females [24%]). Adults aged between 20 and 69 years (1639/2032 males [81%]; 3717/4627 females [80%]) were most frequently injured.

Where people were and what they were doing at the time of the earthquake influenced their risk of injury. (Disaster Med Public Health Preparedness. 2016;10:67-73)

Public health preparedness is an ever-evolving area of medicine with the purpose of helping the masses quickly and efficiently. The drive-through clinic (DTC) model allows the distribution of supplies or services while participants remain in their cars. Influenza vaccination is the most common form of DTC and has been utilized successfully in metropolitan areas.

We hypothesized that combining influenza vaccinations and child passenger seat fittings in a DTC format would be both feasible and desired by the community. Each driver was verbally surveyed at each DTC station. The project was a combination of patient survey and observation.

In the inaugural 6-hour DTC session, 86 cars were served and contained 161 children, of which 28 also participated in child passenger seat fittings. The median total clinic time regardless of services rendered was 9.0 minutes (interquartile range [IQR]: 6.0, 14.0 minutes). For those who received only an influenza vaccine, the median total time was 7.5 minutes (IQR: 6.0, 10.0 minutes). For those who received both services, the median total time was 27 minutes (IQR: 22.3, 33.5 minutes) with an average of 1.75 child passenger seat fittings per automobile.

This was a pilot study involving 2 different services using the DTC model and the first of its kind in the literature. The DTC was successful in executing both services without sacrificing speed, convenience, or patient satisfaction. Additional studies are needed to further evaluate the efficacy of the multiple-service DTC model. (Disaster Med Public Health Preparedness. 2017;11:647–651)

Patients with end stage kidney disease (ESKD) are at higher risk for increased mortality and morbidity due to disaster-related disruptions to care. We examine effects of Hurricanes Irma and Maria on access to dialysis care for US Department of Veterans Affairs (VA) ESKD patients in Puerto Rico.

A retrospective, longitudinal cohort study was conducted among VA patients with at least 1 dialysis-related encounter between September 6, 2016, and September 5, 2018. The annual number of dialysis encounters, visits to an emergency department (ED), and the number of deaths pre- and post-hurricanes were compared. A random effects logistic regression model for correlated binary outcomes was fitted for predictors of mortality. Chi-square tests were for differences between pre- and post-hurricane visits.

The number of ED visits increased in post-hurricane period (1172 [5.7%] to 1195 [6.6%]; P < 0.001). ESKD-related ED visits increased from 200 (0.9%) to 227 (1.3%) (P < 0.05). Increase in mortality was associated with age (OR = 1.66; CI: 1.23-2.17), heart failure (OR = 2.07; CI: 1.26-3.40), chronic pulmonary disease (OR = 3.26; CI: 1.28-8.28), and sepsis (OR = 3.16; CI: 1.89-5.29).

There was an increase in dialysis services at the San Juan VA Medical Center post-Irma/Maria, and access to dialysis care at the non-VA clinics was limited. The role of VA dialysis centers in providing care during disasters warrants further investigation.

As of July 25, 2021, the Korea Disease Control and Prevention Agency reported 1,422 new coronavirus disease 2019 (COVID-19) cases, 188,848 total cases, and 2,073 total deaths (1.10% fatality rates). Since the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) case was reported, efforts to find a treatment and vaccine against COVID-19 have been widespread.

Four vaccines are on the World Health Organization’s (WHO’s) emergency use listing and are approved of their usage; BNT162b2, mRNA-1273, AZD1222, and Ad26.COV2.S. Vaccines against SARS-CoV-2 need at least 14 d to achieve effectiveness. Thus, people should abide by prevention and control measures, including wearing masks, washing hands, and social distancing.

However, a lot of new cases were reported after vaccinations, as many people did not follow the prevention control measures before the end of the 14-d period. There is no doubt we need to break free from mask mandates.

But let us not decide the timing in haste. Even if the mask mandates are eased, they should be changed depending on the number of reported cases, vaccinations, as well as prevention and control measures on how circumstances are changing under the influence of mutant coronavirus.

Researchers have been evaluating several approaches to assess acute radiation injury/toxicity markers owing to radiation exposure. Keeping in mind this background, we assumed that whole-body irradiation in single fraction in graded doses can affect the antioxidant profile in skin that could be used as an acute radiation injury/toxicity marker.

Sprague-Dawley rats were treated with CO-60 gamma radiation (dose: 1-5 Gy; dose rate: 0.85 Gy/minute). Skin samples were collected (before and after radiation up to 72 hours) and analyzed for glutathione (GSH), glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), and lipid peroxidation (LPx).

Intra-group comparison showed significant differences in GSH, GPx, SOD, and CAT, and they declined in a dose-dependent manner from 1 to 5 Gy (P value<0.01, r value: 0.3-0.5). LPx value increased (P value<0.01, r value: 0.3-0.5) as the dose increased, except in 1 Gy (P value>0.05).

This study suggests that skin antioxidants were sensitive toward radiation even at a low radiation dose, which can be used as a predictor of radiation injury and altered in a dose-dependent manner. These biochemical parameters may have wider application in the evaluation of radiation-induced skin injury and dose assessment. (Disaster Med Public Health Preparedness. 2019;13:197–202).

The objective of this study is to characterize US-based disaster training courses available to disaster response and disaster health professionals. Its purpose is to better inform policies and decision-making regarding workforce and professional development to improve performance.

Courses were identified from 4 inventories of courses: (1) National Library of Medicine Disaster Lit database; (2) TRAIN National Learning Network; (3) Federal Emergency Management Agency (FEMA) National Preparedness Course Catalog; and (4) Preparedness and Emergency Response Learning Centers. An online search used 30 disaster-related key words. Data included the course title, description, target audience, and delivery modality. Levels of learning, target capability, and function were categorized by 3 expert reviewers. Descriptive statistics were used.

There were 3662 trainings: 2380 (65%) for professionals (53% for public health); 83% of the courses were distance learning, with 16% via classroom. Half of all trainings focused on 3 of 37 disaster capabilities and 38% of them were related to chemical, biological, radiological, nuclear, and explosives (CBRNE). The educational approach was knowledge-based for all courses and 99.6% imparted only lower levels of learning.

Despite thousands of courses available, there remain significant gaps in target audience, subject matter content, educational approaches, and delivery modalities, particularly for health and public health professionals.

This study aims to report the clinical features of a cohort of patients with suspected coronavirus disease (COVID-19) from Tobruk, Libya, and reflect upon the diagnosis challenge in low-resource settings.

A descriptive report of the first 100 patients with suspected COVID-19 who have visited the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 screening clinic at the National Centre for Disease Control in Tobruk, Libya.

The most common presenting symptoms were fever (90%), cough (89%), dyspnea (85%), sore throat (79%), fatigue (78%), headache (64%), loss of smell (52%), loss of taste (53%), loss of appetite (43%), nausea and vomiting (26%), diarrhea (22%), and rhinorrhea (16%); 51% of the patients had lymphocytopenia, whereas 13% had thrombocytopenia. Bilateral infiltrates were the most common radiologic finding on chest X-ray (76%), and COVID-19 IgM and/or IgG antibodies were detected in 80% of the patients, whereas only 37% of the patients were tested positive by the reverse transcriptase polymerase chain reaction (RT-PCR).

The disease continued its spread across the region. Fever, cough, and dyspnea were the main symptoms; 21% of the patients did not have any chest X-ray abnormalities. Initial negative results for either antibody testing or RT-PCR-testing for COVID-19 do not rule out the infection.

Fatalities and injuries during an earthquake can be reduced by taking preemptive measures before-hand, and furniture anchoring is an important safety measure for all residents. This study sought to clarify the factors associated with furniture anchoring within the home.

A self-administered mail survey was completed from July to August 2010 by 3500 men and women between the ages of 20 and 69 years who were chosen at random from an official government resident registry of 2 cities in Japan.

Of the 1729 valid responses, 37.1% reported furniture anchoring. An association with furniture anchoring was observed for having viewed earthquake intensity maps or damage predictions (odds ratio [OR] 1.92, 95% C1 1.54-2.39), expressing concern about a future earthquake (OR 2.07, 95% C1 1.36-3.15), feelings of urgency (OR 1.90, 95% CI 1.47-2.45), accuracy of the government disaster preparedness information (OR 1.68, 95% CI 1.17-2.42), knowledge of the meaning of emergency earthquake warnings (OR 1.67, 95% CI 1.12-2.48), and participation in voluntary disaster preparedness activities (OR 1.40, 95% C1 1.12-1.75).

Furniture anchoring was found to be associated with risk awareness, risk perception, disaster preparedness information provided by government to residents, knowledge of earthquakes, participation in voluntary disaster preparedness activities, nonwooden structures, and marital status. An increase in furniture anchoring is important and can be achieved through education and training in daily life. (Disaster Med Public Health Preparedness. 2013;7:55-64)

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)

With the intention to try to contain the spread of the viral disease, several measures were taken in Argentina for long periods of time.

The lack of labor activity, social constraints, and a strong sense of helplessness, combined with a complex economic scenario with recession, inflation, and devaluation, led to the emergence of a dense climate of discontent.

After a second wave hit the country, several measures were reinstalled. The Argentine society, polarized in many aspects, was further divided between those who supported the re-establishment of strict measures to help prevent further infections and those who desperately claimed for the urgent need to return to work to sustain their livings.

The preexisting problems to which developing countries are usually exposed have been sharpened over the last year, determining a very complex scenario where every decision is important for the country’s future. An updated report of the current situation and its management in different countries is of vital importance regarding global health issues and may serve for feedback and decision-making.