Creating a Regional Pediatric Medical Disaster Preparedness Network: Imperative and Issues

Over the past few decades, the number of disasters, both natural and human initiated has increased. As a result, since the September 11, 2001 attacks on the World Trade Center and Pentagon, there has been a new emphasis on disaster preparedness. However, the preparedness emphasis has been primarily directed toward adults and little attention has been specifically given to the needs of children.One reason for the lack of attention to pediatric needs in disaster planning is that childhood is seldom viewed as a separate and special stage of growth, fundamentally different from adulthood. The expectation during emergencies is that the care provided for adults is appropriate for children.The purpose of this paper is to examine the types of and increase in disasters and discuss the importance of specifically addressing the special needs of children in disaster planning. Further the paper argues for a regional network approach to emergency pediatric care that would increase surge capacity for children during disasters and other emergencies.     

Emergency preparedness needs assessment of centralized school foodservice and warehousing operations

Managers of onsite retail foodservice operations, particularly those in centralized school foodservice operations, are called on to provide meals during emergencies, yet there is a paucity of research on their readiness to handle emergencies. Qualitative research and a cross-sectional survey design were used to conduct a needs assessment for emergency preparedness (emergency readiness, food recalls, and food defense) in centralized school foodservice operations, including warehousing. An open-ended written questionnaire was mailed to eight foodservice directors, and responses were used to develop a written questionnaire that was mailed to school foodservice directors in 200 districts identified as having centralized food production and warehousing. Directors from 78 districts responded (39% response rate). Most districts (n=72) had an emergency response team, and foodservice was included as part of 63 of those teams. Not all districts had written procedures for food recalls (47 of 73), natural disasters (37 of 74), or food defense (30 of 74). Barriers to implementing emergency preparedness policies and procedures included limited money, emergency equipment, and time. Most current training related to food safety with little training related to emergency preparedness. Training on the emergency preparedness plan was done in 61 of 78 districts. Training on emergency procedures was done by less than half of the districts during the previous year. This study identified best practices related to emergency preparedness that can be implemented in onsite retail foodservice operations. Results indicate a need to emphasize emergency preparedness, develop written standard operating procedures, and train employees to be prepared to respond to emergencies.     

Parents’ perceptions of the role of schools in tobacco use prevention and cessation for youth

The purpose of this study was to examine Ohio parents’ perceptions of the role of schools in smoking prevention, cessation, and anti-tobacco policy for their children. A 46-item questionnaire was based on the CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. Surveys (n = 800) were sent to a stratified random sample of parents of junior high and high school aged students and 57% responded. Parents were supportive of smoking prevention activities, but almost two-thirds believed their child’s school should get parents’ input. Furthermore, mothers/step-mothers were more likely than fathers/step-fathers to agree that the school had a role in smoking prevention activities. The majority of parents were also supportive of smoking cessation activities. However, only 8% of parent respondents supported schools providing nicotine gum or patches to students trying to quit smoking. Overall, the majority of parents were supportive of the seven recommendations developed by the CDC as guidelines for school health programs to prevent tobacco use and addiction. Schools have the opportunity to impact student smoking through prevention and cessation activities. Schools need to know that parents are supportive of these activities and want to be included in the process of implementing effective prevention or cessation programs.Jodi Wyman is a Research Assistant, James H. Price, Professor of Public Health, Timothy R. Jordan, Assistant Professor of Public Health, and Susan K. Telljohann, Professor of Health Education, all are affiliated to University of Toledo, Toledo, OH, USA; Joseph A. Dake is Assistant Professor of Health Education, Wayne State University, Detroit, MI, USA.     

All-hazards preparedness in an era of bioterrorism funding.

OBJECTIVES: All-hazards preparedness was evaluated in North Carolina's 85 local health departments (LHDs). METHODS: In regional meetings, data were collected from LHD teams from North Carolina's LHDs using an instrument constructed from Centers for Disease Control and Prevention's preparedness indicators and from the Local Public Health Preparedness and Response Capacity Inventory. RESULTS AND CONCLUSIONS: Levels of preparedness differ widely by disaster types. LHDs reported higher levels of preparedness for natural disasters, outbreaks, and bioterrorist events than for chemical, radiation, or mass trauma disasters. LHDs face challenges to achieving all-hazards preparedness since preparation for one type of disaster does not lead to preparedness for all types of disasters. LHDs in this survey were more prepared for disasters for which they were funded (bioterrorism) and for events they faced regularly (natural disasters, outbreaks) than they were for other types of disasters.     

Building human resilience: the role of public health preparedness and response as an adaptation to climate change

Global climate change will increase the probability of extreme weather events, including heatwaves, drought, wildfire, cyclones, and heavy precipitation that could cause floods and landslides. Such events create significant public health needs that can exceed local capacity to respond, resulting in excess morbidity or mortality and in the declaration of disasters. Human vulnerability to any disaster is a complex phenomenon with social, economic, health, and cultural dimensions. Vulnerability to natural disasters has two sides: the degree of exposure to dangerous hazards (susceptibility) and the capacity to cope with or recover from disaster consequences (resilience). Vulnerability reduction programs reduce susceptibility and increase resilience. Susceptibility to disasters is reduced largely by prevention and mitigation of emergencies. Emergency preparedness and response and recovery activities--including those that address climate change--increase disaster resilience. Because adaptation must occur at the community level, local public health agencies are uniquely placed to build human resilience to climate-related disasters. This article discusses the role of public health in reducing human vulnerability to climate change within the context of select examples for emergency preparedness and response.     

Parents’ Perceptions of Causes of and Solutions for School Violence: Implications for Policy

This study explores perceptions of causes of and solutions for school violence in a sample of 202 parents interviewed in the wake of nationally publicized school shootings. We also investigate the effects the school shootings had on children, parents’ perceptions regarding firearms, and changes in parenting behavior. Parents exhibited strong support for almost all proposed causes and solutions, and we address their desire for immediate and often invasive interventions to prevent future violence. We contrast parents’ perceptions with their own parenting behaviors and with literature on effective interventions. Results are discussed within the context of policy implications. Editors’ Strategic Implications: Parents’ perceptions and behaviors are frequently influenced by history effects. The national attention received by school shootings provided an opportunity for exploration of those perceptions and self-reported behaviors. The authors provide evidence from timely surveys that parents struggle with identifying causal factors that may contribute to school violence and consequently support a myriad of strategies for intervention including very invasive environmental preventive strategies. The findings suggest that social scientists should play a proactive role in translating research-supported preventive strategies to effective replications in the community and make research available in formats that are available and comprehensible by the lay public.     

The Association Between Adolescent Smokers' Desire and Intentions to Quit Smoking and Their Views of Parents' Attitudes and Opinions about Smoking

Objective: To explore whether an association exists between adolescent smokers’ attitudes toward quitting and their beliefs about whether their parents know they smoke, their perceptions of whether their parents disapprove of smoking, their recollection of their parents’ expressed disapproval of smoking, and the importance they place on their parents’ opinions. Methods: This cross sectional study of US high school students included 17,287 respondents. Only those who had smoked in the past 30 days (4593 [26.6%]) were included in the analysis. “Have you ever seriously thought about quitting smoking?” was asked of all adolescent smokers. Those who had seriously thought about quitting were then asked about past attempts and how recent their last attempt was, while those who had not seriously thought about quitting were asked if they thought they would ever want to quit. Results: Regardless of whether their parents smoked, adolescents who placed value on their parents’ opinions were more likely to think seriously about quitting and to have tried to quit in the past 6 months. Recalling parents’ expressed desire that their child not smoke was associated with significant increases in the likelihood of seriously thinking about quitting even among those whose parents smoked. Agreeing with the statement, “When I’m older, my parents won't mind that I smoke” was significantly associated with decreased odds of seriously thinking about quitting and recently attempting to quit. Conclusions: Parents, both those who smoke and those who do not, may have a significant role in influencing young smokers’ desire to quit smoking.     

Externalizing Behaviors among Children of HIV Seropositive Former and Current Drug Users: Parent Support Network Factors as Social Ecological Risks

Children affected by their parents’ dual drug use and HIV/AIDS face considerable challenges to their psychosocial development, including parent dysfunction and foster care placement. While HIV/AIDS may increase parents’ mobilization of social support, their drug use may restrict who is available to help them, with potential implications to the adjustment of their children with whom they remain in contact. This study sought to identify dually affected children’s living situations, and parent and parent’s support network factors as correlates of children’s externalizing problem behaviors. An urban community sample of 462 HIV seropositive, current or former drug-using parents were queried about their children aged 5–15 years old. One hundred ninety-four children were reported by 119 parents. The outcome was children’s externalizing behaviors of ever having been suspended or expelled from school, criminal-justice system involvement, or illicit drug or heavy alcohol use. Independent variables included kin and drug users in parent’s support network. Generalized estimating equations were used to adjust for the potential correlation of children of the same parent. Among parents, 63% were mothers, 57% current opioid or cocaine users, 85% were African American, 35% had AIDS or CD <200, and 53% had high depressive symptoms (CES-D ≥ 16); median age was 38. Among children, median age was 12; 23% lived with the nominating parent, 65% with other family, and 11% in non-kin foster care. While only 34% of parents reported child custody, 43% reported daily contact with their child, and 90% reported high emotional closeness. Parents reported externalizing behaviors among 32% of the children. Logistic regression indicated that externalizing behavior was positively associated with parent’s physical limitations and proportion of illicit drug users in parent’s support network. A significant interaction was found indicating that the effect of parent’s support network-level drug use was greater for children living with versus not living with the parent. The model adjusted for parent’s current drug use and depressive symptoms, which were not significant. Results indicate that while only a minority of these dually affected children lived with the parent, the parents’ physical limitations and embeddedness in drug using support networks, particularly if living with their children, was associated with the children’s maladjustment. It is plausible that these factors interfere with parenting, expose the children to conflict or adverse social influences, or obligate children to assume caregiving for their parent. While dually affected children’s contact with their parents may have important benefits, results suggest it presents ongoing needs for intervention with the children, their parents, and caregivers. Knowlton, Wissow, and Latkin are with the Department of Health, Behavior and Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA; Buchanan is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Pilowsky is with the Departments of Epidemiology and Psychiatry, Columbia University, New York, NY, USA.     

Comprehensive Child-Oriented Preventive Resilience Program in Israel Based on Lessons Learned from Communities Exposed to War, Terrorism and Disaster

Background

Coping with mass emergencies and disasters has become a growing challenge for children, adults and entire communities. Among the population groups affected by disaster, children are particularly vulnerable. Responsible disaster intervention requires both top-down and bottom-up preparation that endorses an ecological perspective, taking into consideration the impact upon individuals and families as well as on neighborhoods and entire communities. In such an approach, preventive and post-disaster interventions with children should be integrated with community leadership, local schools, welfare units, social institutions and medical centers.

Objective

In this paper we briefly summarize how disaster affects children and their protective matrix. We further discuss the concept of personal and community resilience, its definitions and components. The worldview of this system-oriented approach encompasses perceptions of public health and administration, community capital and resilience and preventive education.

Results

We describe what makes a community a resilient one, and the role played by preparedness. Finally, we describe the Cohen-Harris Model of Urban Resilience, its rationale, and its four resilience programs (health/mental health, population, information and school resilience).In this model, the local authority serves as the command center for emergency preparedness and resilience is developed through everyday activities that are an integral part of the urban routine.

Conclusions

This model relies on interest in child welfare to enlist leaders, institutions and communities to act as well to motivate the entire community and to implement far-reaching and systemic changes. Interest in all aspects of children’s lives serves to integrate the actions of families, organizations and communities.     

Disaster preparedness of linguistically isolated populations: practical issues for planners

In the absence of culturally and linguistically appropriate disaster preparedness plans, several linguistically isolated and culturally diverse population groups are disproportionately disadvantaged in the United States. The communication gap poses challenges to emergency preparedness planners and response personnel in predisaster communication and postdisaster response efforts. Houston Department of Health and Human Services aimed to develop practical recommendations for local emergency response personnel so as to improve dissemination of emergency information and equitable delivery of services to linguistically isolated communities in the greater Houston area. Sixteen focus group discussions were conducted among linguistically isolated immigrant populations living in the greater Houston metropolitan area who primarily spoke one of the Spanish, Chinese, Vietnamese, and Somali languages. Our questions focused on general knowledge and understanding of disasters and explored experiences during Houston's most recent disaster, Hurricane Ike. We found that (a) understanding of disaster and preparedness is contextual, (b) awareness of preparedness needs and actual plans among LIPs is inadequate, and (c) word of mouth is the preferred information source for linguistically isolated groups. Disaster preparedness plans of a given jurisdiction should reflect the culturally and linguistically appropriate components addressing the needs, concerns, context-based knowledge or awareness, and perceptions of linguistically isolated populations.     

Evaluation of public health response to hurricanes finds North Carolina better prepared for public health emergencies

Reviews of state public health preparedness improvements have been primarily limited to measuring funds expenditures and achievement of cooperative agreement benchmarks. Such reviews fail to assess states' actual capacity for meeting the challenges they may face during an emergency, as evidenced by activities undertaken during the various phases of a disaster. This article examines North Carolina's public health preparedness and response performance during two hurricanes, Hurricane Floyd in 1999 and Hurricane Isabel in 2003, as well as capacity building activities in the intervening years. North Carolina created new infrastructures, enhanced laboratory capacity, and strengthened communications after Hurricane Floyd. These activities facilitated implementation of functional capabilities through effective centralized communication, command and control incident management, and a rapid needs assessment and medical surveillance during Hurricane Isabel. North Carolina continues to implement these capabilities in public health emergencies. Measuring and implementing functional capabilities during exercises or real events facilitates achievement of preparedness performance standards, goals, and objectives.     

Promoting Regional Disaster Preparedness Among Rural Hospitals

ABSTRACT:  Context and Purpose: Rural communities face substantial risks of natural disasters but rural hospitals face multiple obstacles to preparedness. The objective was to create and implement a simple and effective training and planning exercise to assist individual rural hospitals to improve disaster preparedness, as well as to enhance regional collaboration among these hospitals. Methods: The exercise was offered to rural hospitals enrolled with the Rural and Community Health Institute of the Texas A&M University System Health Science Center, and 17 participated. A 3-hour tabletop exercise emphasizing regional issues in a pandemic avian influenza scenario followed by a 1-hour debriefing was implemented in 3 geographic clusters of hospitals. Trained emergency preparedness evaluators documented observations of the exercise on a standard form. Participants were debriefed after the exercise and provided written feedback. Results: Observations included having insufficient staff for incident command, facility constraints, the need to further develop regional cooperation, and operational and ethical challenges in a pandemic. Conclusions: The tabletop exercise gave evidence of being a simple and acceptable tool for rural medical planners. It lends itself well to improving medical preparedness, analysis of weak spots, development of regional teamwork, and rapid response.     

杭州市学校症状监测系统在突发公共卫生事件中的作用

  目的  分析杭州市学校症状监测系统在突发公共卫生事件中的作用,为学校突发公共卫生事件防控策略的制定提供依据。  方法  收集《突发公共卫生事件报告管理信息系统》中杭州市2019年报告的学校突发公共卫生事件信息,以及《杭州市学校症状监测系统》中学校及自动预警相关信息。利用SAS 9.0软件对学校系统使用情况进行分析,并对阳性预警事件和突发公共卫生事件进行比较。  结果  2019年杭州市学校症状监测系统平均使用率为54.65%,自动预警平均响应率为70.68%,不同地区学校系统使用和自动预警响应率间差异均有统计学意义(χ2值分别为860.79,1 615.91,P值均 < 0.01)。全年通过学校症状监测系统发现阳性预警事件161起,通过突发网报告突发公共卫生事件197起,阳性预警事件发现越多的地区突发公共卫生事件报告越少(Z=10.65,P < 0.01),阳性预警事件与突发公共卫生事件病种构成不同(χ2=28.33,P < 0.01)。同一病种阳性预警事件发病人数均远少于未预警突发公共卫生事件发病人数,阳性预警信号发出时间距离接到突发公共卫生事件报告的时间平均提前4 d。  结论  基于智能手机的杭州市学校症状监测系统在防控学校突发公共卫生事件中发挥了哨兵作用。     

Social Vulnerability Index for the Older People—Hong Kong and New York City as Examples

Many world cities have suffered large-scale disasters, causing a significant loss of lives, property damage, and adverse social and economic impact. Those who are most vulnerable during and in the immediate aftermath of disaster crises are the elderly. Therefore, it is imperative to identify them and determine their specific needs in order to support them. Although several Social Vulnerability Indexes (SVIs) have been developed to assess different types of disaster vulnerability across geographic and population levels, few have been tailored to the older population. Building on the research of Gusmano et al., this study modifies and uses an SVI specifically designed to assess the vulnerability of older populations to emergencies and disasters across seven domains, namely, population size, institutionalization, poverty, living alone, disability, communication obstacles, and access to primary care. Moreover, it is acknowledged that availability of data largely depends on the local context and is always a barrier to production of indices across countries. The present study offers suggestions on how modifications can be made for local adaptation such that the SVI can be applied in different cities and localities. The SVI used in this study provides information to stakeholders in emergency preparedness, not only about natural disasters but also about health hazards and emergencies, which few existing SVI address.     

中小学校突发公共卫生事件应急处置能力调查

  目的  厘清中小学校应对突发公共卫生事件的应急处置能力现状,探讨存在的问题和主要困难,并提出针对性建议。  方法  2021年1—3月,采用分层整群抽样方法,以北京、重庆、云南三地的2 988所学校疫情相关工作负责人及教师为主要调查对象,开展关于学校一般情况、学校卫生及突发公共卫生事件相关知识、态度以及培训情况等内容的问卷调查。  结果  调查对象职务、职称、学历不同,各相关知识正确率不同:学历越高,相关知识正确率越高(χ2=50.73~203.36,P值均 < 0.05);高中学校定期开展健康相关课程情况最差(50.0%);配备具有执业资格的卫生保健人员情况,城区学校(42.0%)高于农村学校(18.2%),民办学校(48.5%)高于公办学校(24.7%);存在的主要困难是缺乏专业技术人员的指导和相关检测设备(84.91%,74.03%)。  结论  三地区学校突发公共卫生事件应急处置能力虽与时俱进,但仍存在诸多不足,知识掌握情况仍有疏漏,建议增加学校卫生工作岗前与专项培训, 疾控机构要加强对学校传染病管理技术指导和工作督导。     

Residential Staff’s Changing Attitudes Toward Parents of Children in their Care: Rationale and Healing Effects on Children,Parents, and Staff

A pilot project in Israel, regarding parent’s involvement in their children’s education in residential care was evaluated. The dual goals were changing staff’s attitudes toward parents, and empowering parents. During the school year, parents were invited to participate in bi-weekly dynamic group workshops in the residence (parents only and parents–children), and to 3–4 “Family Days,” in addition to sharing special parent–child summer camps. Results indicate considerable success: children, parents, and staff felt that the project had improved their ability to deal successfully with their everyday challenges, with parents viewing themselves as having been most rewarded.

Understanding the Association Between Authoritative Parenting and Adolescent Smoking

Background: Research on adolescent cigarette smoking has attempted to measure the role of parents in preventing smoking experimentation and uptake. However, aspects of parental influence have often been limited to parental smoking behavior or antismoking socialization. Only a limited number of studies considered the hypothesis that the influence of parenting on adolescent current cigarette smoking may extend beyond parental behavior and antismoking socialization to consider broader measures of the parent–child relationship, such as parenting style. Methods: The sample was nationally representative and included 17,287 high school students nationwide. Data were used to categorize the parenting style—authoritative, permissive, autocratic, and unengaged—experienced by each respondent. Logistic regression analysis was used to assess the association between parenting style and adolescent current cigarette smoking. Results: Authoritative parenting was associated with a reduction in the odds of adolescent current cigarette smoking (OR: 0.74, 99% CI: 0.58, 0.95). When authoritative parenting is simultaneously considered with believing parents’ opinions about smoking are important, authoritative parenting was no longer a significant correlate of adolescent current cigarette smoking, while believing parents’ opinions about smoking are important was associated with a 45% (99% CI: 0.48, 0.64) reduction in the odds of adolescent current cigarette smoking. Authoritative parenting was associated with a more than three-fold increase (OR: 3.65, 99% CI: 2.87, 4.66) in the odds of believing parents’ opinions about smoking are important. Discussion: Interventions may want to educate parents about authoritative parenting, which includes the importance of having appropriate and routine conversations with their children, requiring chores, and implementing general rules and boundaries.     

Risk management of international trade: emergency preparedness

Emergency preparedness and management are among the most important and critical issues facing animal health in the world today. The goals of a country for an animal health emergency management (AHEM) system should include the following: --being prepared to detect and manage an outbreak of a foreign animal disease --preventing the introduction of foreign and emerging animal pathogens --having an appropriate response system for control and eradication of the disease --having a system for recovery from animal health emergencies, including natural disasters. An AHEM system can no longer be limited to a single organisation within a country. In the event of a serious threat to the animal agriculture of a country, broader and more comprehensive participation is required. If not properly planned for, animal health emergencies can rapidly become national disasters. Therefore, it is essential that the central government of a country work towards these goals through partnerships with other Federal and State/Provincial/District organisations, academic institutions and national animal industries.     

Prozess- und Ergebnisevaluation des Schulprojektes „Schülerunternehmen zur gesunden Ernährung”

Summary Process and outcome evaluation of the school-based project „Students’ Enterprises for Healthy Nutrition” Objectives: Most food consumed in German schools is unhealthy, and evaluations of school-based interventions to improve food habits are scarce. Our study evaluates implementation and impact of „Students’ Enterprises for Healthy Nutrition”, in which students offer healthy food to their school mates. Methods: Standardised questionnaires were obtained from the supervising teachers and 923 students (grade 5–10) from the 4 intervention schools, collecting information on implementation and acceptability of the intervention (process evaluation). Data on eating habits were collected from a cohort of 475 students before and 6 months after the implementation of the Students’ Enterprises, using a modified, illustrated version of a 24-hour recall questionnaire (outcome evaluation). Results: Process: 59 % of the students appreciated the Students’ Enterprises, which varied substantially between schools, and 7–27 % regularly purchased their food there. Reasons for not using the Student’s Enterprises were food provision from home, peer pressure, and costs. Besides, there were competing sources of food supply in each school. Outcome: Data interpretation was difficult due to the heterogeneity of the Students’ Enterprises and reduced program integrity. A separate analysis of the different schools showed the reduction of sweets consumption in one school; other improvements of eating habits were not shown. Conclusions: The Students’ Enterprises represent a peer-based settings approach and were supported by the students and teachers. Further structural changes and educational means are needed to increase utilisation. Due to demand, the Enterprises’ menus risk to be extended to unhealthy food, which may be countered with innovative strategies (e. g. subsidy for healthy food). Eingereicht: 27. M?rz 2006; überarbeitet: 31. August 2006, 8. M?rz 2007; Angenommen: 16. M?rz 2007     

Beliefs and Practices of the Parents of Violent and Oppositional Adolescents: An Ecological Perspective

Parenting is a transactional process, influenced by the child’s behavior and the environmental context. The present study explores the beliefs and practices of parents of aggressive and oppositional adolescents to understand better the relation among parenting practices, context, and youth violence. Parents of juvenile offenders (N=203) completed assessments of youths’ violent and oppositional behaviors, community violence exposure, and their own beliefs and parenting behaviors and perceptions of the juvenile justice system. Parents of youth with the highest levels of violent and oppositional behavior problems reported elevated feelings of hopelessness regarding the child’s future, inadequacy as a parent, fear of physical harm by the child, anger toward the child, as well as difficulty monitoring the child. All parents reported relatively high levels of perceived support by the justice system. Parental stress was also examined as a possible influence on the parents’ beliefs and behaviors regarding the child. Results suggest that parents’ emotional and behavioral responses should be addressed when intervening with juvenile offenders. Editors’ Strategic Implications: The authors present evidence to suggest that parents’ perceptions of hopelessness/inadequacy and their fear for their child’s safety are both by-products of life with an aggressive child as well as contributing factors to that aggressive behavior. Thus, successful interventions must both target the parents as change agents in the youth’s life but also include a strong parental support component, so that parents will have an opportunity to orchestrate positive impacts in high-risk environments.