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PubMedDate not supplied

Rehabilitating public health infrastructure in the post-conflict setting: epidemic prevention and preparedness in Kosovo.

The war in Kosovo in 1999 resulted in the displacement of up to 1.5 million persons from their homes. On the subsequent return of the refugees and internally displaced persons, one of the major challenges facing the local population and the international community, was the rehabilitation of Kosovo's public health infrastructure, which had sustained enormous damage as a result of the fighting. Of particular importance was the need to develop a system of epidemic prevention and preparedness. But no single agency had the resources or capacity to implement such a program. Therefore, a unique six-point model was developed as a collaboration between the Kosovo Institute of Public Health, the World Health Organization, and an international, non-governmental organization. Important components of the program included a major Kosovo-wide baseline health survey, the development of a province-wide public health surveillance system, rehabilitation of microbiology laboratories, and the development of a local capacity for epidemic response. While all program objectives were met, important lessons were learned concerning the planning, design, and implementation of such a project. This program represents a model that potentially could be replicated in other post-conflict or development settings.

Case Management↗

PubMed1993

Resistance to extinction of fear-relevant stimuli: preparedness or selective sensitization?

Human conditioning research has revealed an apparent resistance to extinction of aversive conditioning to pictures of fear-relevant stimuli such as snakes and spiders, supporting M. E. P. Seligman's (1971) preparedness theory of fears and phobias. This article examines an alternative account based on activation of preexisting response tendencies under threat (selective sensitization). Two experiments demonstrate that selective sensitization of electrodermal responses is attenuated when a fear-relevant stimulus serves as a negative conditioned stimulus (CS-), but is maintained when it serves as a positive conditioned stimulus (CS+). Previous extinction results may therefore be due to preservation of initial responding to CS+ but not CS-. Selective sensitization offers a model for the nonassociative activation of fears and phobias to prepotent stimuli under conditions of stress or threat. Possible genetic and cognitive mechanisms are discussed.

Acoustic Stimulation↗

PubMed1997

Frequency and structure of precautionary behavior in the domains of hazard preparedness, crime prevention, vehicular safety, and health maintenance.

A sample of 831 adults were interviewed by researchers using a 72-item inventory about their precautionary behaviors and attitudes. Exploratory and confirmatory factor analyses conducted on random halves of the sample provided evidence of consistency and structure in precautionary behavior both within and across domains of concern. Hazard preparedness activities clustered into having basic supplies on hand, advance planning, and hazard alertness. Crime prevention acts organized according to person protection, neighborly cooperation, and professional guidance. Vehicular safety factored into auto care, responsible driving, and seat belt use. Health maintenance activities entailed healthy habits (diet and exercise), risk monitoring, and avoiding tobacco and alcohol. Higher order factor analyses evidenced intra-individual consistency in the use of Disciplined, Vigilant, and Proactive Behaviors across precautionary domains. At all levels, perceptions of the usefulness of precautionary measures were related strongly to the frequency of self-protective acts.

Adult↗

PubMed2006

Using the concept of wisdom to enhance the expression of wisdom knowledge: not the philosopher's dream but differential effects of developmental preparedness.

In this study, the authors explored whether wisdom-related performance could be enhanced by an instruction referring to the abstract concept of wisdom ("try to give a wise response"). The authors used three levels of activation of the concept of wisdom as well as intelligence-activation and control conditions in a heterogeneous sample of three age groups (N = 318). Results showed no general effect of the wisdom-concept instructions but did show an aptitude (resource) treatment interaction: Participants high in preparedness resources associated with wisdom exhibited some gains, whereas the performance of resource-low participants actually declined after the instruction. Implications and consequences with respect to ways of enhancing the expression of wisdom-related knowledge are discussed.

Achievement↗

PubMed2002

Biological weapons and bioterrorism preparedness: importance of public-health awareness and international cooperation.

Biological weapons and biological terrorism have recently come into focus due to the deliberate release of Bacillus anthracis via mail delivered in the USA. Since the 1930s, biological weapons have been developed in a number of countries. In 1975, the Biological and Toxin Weapons Convention entered into force; this prohibits the use of these weapons and has been signed by a large majority of countries (144). Unfortunately, several countries failed to respect this treaty. The Soviet Union continued and expanded its biological weapons program, and after the Gulf War it was revealed that Iraq also had an extensive biological weapons program. Large-scale deliberate release of, Bacillus anthracis, for example, or an epidemic following a release of smallpox virus, would have a devastating effect. This has motivated the world community to strengthen the Biological and Toxin Weapons Convention with a control mechanism which has, as yet, not been successful. Sweden, like other countries, is enhancing its preparedness with regard to stocks of antibiotics and vaccines, related to these improving the diagnostics these and similar agents, and is setting up an epidemiologic task force that can be used in infectious disease emergencies such as the deliberate release of biological warfare agents. International cooperation in this area has to be enhanced, not least in the European Union.

Biological Warfare↗

PubMedDate not supplied

The role of an advanced practice public health nurse in bioterrorism preparedness.

The 2001 anthrax events have vividly illustrated that terrorism involving the release of a biological agent is a major public health emergency requiring an immediate and well-coordinated response. If healthcare professionals and emergency responders are to be prepared to manage such attacks, unprecedented cooperative efforts at the national, state, and local levels are necessary. To aid such efforts, advanced practice public health nurses (PHNs) must exercise their ability to collaborate with a variety of disciplines and communities. Using the Los Angeles County Public Health Nursing Practice Model, advanced practice PHNs can be trained to deal effectively with acts of bioterrorism. This model defines the practice of public health nursing as working on a population-based level to create conditions under which healthy people can live within healthy communities. This article will discuss the threat of bioterrorism and describe how the Public Health Nursing Practice Model can be applied to assist advanced practice PHNs in the development of a public health plan for preparedness and response to bioterrorism. Six specific interventions that enable advanced practice PHNs to affect populations at the community and systems level will be discussed along with the implications of bioterrorism for advanced practice public health nursing.

Bioterrorism↗

PubMed2001

Preparedness and response to bioterrorism.

As we enter the 21st century the threats of biological warfare and bioterrorism (so called asymmetric threats) appear to be more real than ever before. Historical evidence suggests that biological weapons have been used, with varying degrees of success, for many centuries. Despite the international agreements to ban such weapons, namely the 1925 Geneva Protocol and the 1975 Biological and Toxin Weapons Convention, there is no effective international mechanism for challenging either the development of biological weapons or their use. Advances in technology and the rise of fundamentalist terror groups combine to present a significant threat to western democracies. A timely and definitive response to this threat will require co-operation between governments on a scale never seen before. There is a need for proper planning, good communication between various health, home office, defence and intelligence agencies and sufficient financial support for a realistic state of preparedness. The Department of Health has produced guidelines for responding to real or suspected incidents and the Public Health Laboratory Service (PHLS) has produced detailed protocols to inform the actions required by microbiologists and consultants in communicable disease control. These protocols will be published on the Department of Health and PHLS web sites.

Anthrax↗

PubMed2002

Bioterrorism preparedness: a survey of Nebraska health care institutions.

In March 2001, a 6-question survey was mailed to all hospitals and long-term care facilities in Nebraska to assess preparedness for bioterrorism. Only half of the respondents at that time believed that bioterrorism was something their community was likely to experience. We found that most facilities (98%) believed that they were unprepared for a bioterrorism event, and many did not know whom to contact in the event of such an emergency. We concluded from the results of the survey that the greatest needs to facilitate preparation were policies and procedures, identification of contacts, medications, protective equipment, laboratory support, and communication.

Bioterrorism↗

PubMed2004

Preparedness for cardiopulmonary resuscitation in primary care.

OBJECTIVE: To evaluate preparedness for resuscitation of patients in cardiac arrest in primary care. DESIGN: Questionnaire study sent to every health centre in Finland (n = 277). SETTING: Primary care. MAIN OUTCOME MEASURES: Resuscitation training frequency and prevalence of automated external defibrillators and nurse-performed early defibrillation. RESULTS: One-hundred-and-forty-one health centres (51%) responded to the survey. Fifty-nine percent had appointed one person to be in charge of resuscitation training. The nurses in these health centres were trained to defibrillate (p < 0.001), physicians had advanced life support training (p < 0.001) and the first defibrillation was likely to be performed by a nurse on the ward (p < 0.01) more often. In 87% of health centres, it was not customary to defibrillate before the physician arrived beside the patient. Forty-four percent of the health centres used only manual defibrillators, 26% used automated external defibrillators and 30% used both. Only 18% of respondents considered resuscitation training in their health centre to be sufficient and systematic. CONCLUSION: Resuscitation training appears insufficient and non-systematic in most health centres in Finland. Automated external defibrillators are not in common use. In health centres with an appointed person in charge of resuscitation training, the training is more often regular.

Cardiopulmonary Resuscitation↗

PubMed2006

Disaster mental health preparedness plan in Indonesia.

The tsunami brought into focus many issues related to mental health and psychosocial distress. A prompt response to the disaster relies on existing disaster management plans so that appropriate interventions can be put in place in order to meet the needs of the affected populations. The response must involve both physical and psychological aspects of care. The Indonesian experience was unique in a number of ways and it allowed us to explore the lessons in order to develop strategies to maximize the resources in order to ensure that the whole affected population was cared for. Massive destruction of the physical structures and the work force made the task particularly difficult. Existing policies did not include psychosocial efforts in the plan. However, mental health and psychosocial relief efforts are now being integrated into the disaster preparedness plan of Indonesia. To further implement the plan, a strong community mental health system is being developed. This system will be able to deliver mental health and psychosocial interventions on a routine basis and could be scaled up in times of disasters.

Disaster Planning↗

PubMed2006

Mental health and psychosocial support aspects of disaster preparedness in the Maldives.

The tsunami has been instrumental in motivating the Government of the Maldives to give high priority to mental health and psychosocial support services. Moreover such services will be delivered in a co-ordinated manner in the long-term. The Maldives had particular problems in responding to the tsunami and these were a result of large geographical spread of small islands, communication difficulties and limited work force. However, voluntary organizations became active very rapidly and also responded beyond the call of duty. This, combined with clear chain of command, helped generate proper response. As a result not only was the immediate response to the tsunami well organized, clear plans for the long-term mental healthcare and delivery of services are being developed, which includes not only mental health services, but also mental health policy and legislation. Also, a disaster preparedness plan which includes mental health and psychosocial aspects is under way, indicating that a future disaster will find the Maldives better prepared to respond to it.

Disaster Planning↗

PubMed2000

Early human immunodeficiency virus (HIV) infection in the HIV Network for Prevention Trials Vaccine Preparedness Cohort: risk behaviors, symptoms, and early plasma and genital tract virus load.

Risk behaviors, symptoms, and virologic characteristics were studied among 103 human immunodeficiency virus (HIV) seroconverters in vaccine preparedness cohorts during 1995-1998. Overall, 83% of subjects were men who had sex with men; most reported multiple risk episodes and symptoms (84%, > or =1 symptom) during seroconversion. Acute HIV was diagnosed in only 8 of 50 who sought medical care. Median initial pretreatment plasma virus load was 25,800 copies/mL (range, undetectable-262,000 copies/mL) a mean of 4 months after seroconversion, and 9.7% had nucleoside-associated mutations; none had multidrug resistance. Semen virus load was more variable, 1.3 log(10) lower and modestly correlated (r=.28; 95% confidence interval, 0.16-0.42) with plasma among untreated men. When the plasma RNA level was <5000 copies/mL, 32% of untreated men, 13% on nucleoside regimens, and 7% on protease inhibitor-containing regimens had detectable seminal RNA. Acute HIV was seldom diagnosed, representing missed opportunities for early treatment and prevention. Most subjects had several relatively stable virus loads before initiation of antiretrovirals, indicating feasibility of assessing HIV vaccines on virus set point in efficacy trials.

Acute Disease↗

PubMed2002

Influenza pandemic preparedness action plan for the United States: 2002 update.

Preparation for the next influenza pandemic includes development of a national plan that has 3 goals: to limit the burden of disease, to minimize social disruption, and to reduce economic losses attributable to the pandemic. Priority areas to be addressed and improved in the plan to achieve these goals include global and national influenza surveillance, vaccine development and production, vaccine use and coverage, chemoprophylaxis and therapy, guidelines for clinical care and health resources management, emergency preparedness, and research. This multifaceted plan will require close collaboration between public and private sectors to ameliorate the potentially devastating impact of pandemic influenza.

Disease Outbreaks↗

PubMed2004

Hospital preparedness for severe acute respiratory syndrome in the United States: views from a national survey of infectious diseases consultants.

In this survey of infectious diseases consultants, 90% reported that their health care facilities have plans in place to address severe acute respiratory syndrome (SARS). Some plan elements exceed current recommendations, whereas others are less stringent. Resource issues associated with airborne isolation and respirators were reported. Sixty-one percent of the respondents expressed some concern about their facility's preparation and capacity for managing patients with SARS. Recent draft guidance on SARS preparedness from the Centers for Disease Control and Prevention may help address some of these issues.

Communicable Diseases, Emerging↗

PubMed2006

Seasonal and pandemic influenza: recommendations for preparedness in the United States.

There is a continued need to improve the state of preparedness for a potential influenza pandemic in the United States despite the publication of a pandemic influenza plan by the Department of Health and Human Services. Of particular importance are the sense of urgency for a coordinated response plan, an allocation of adequate funds to deal with this issue, and the need for a national leader to coordinate the development and execution of a national plan, including its relationship to the control of seasonal influenza. In addition, an infrastructure needs to be established in the United States to enable the rapid development and large-scale production of a safe and effective vaccine for new influenza strains; methods to treat influenza pneumonia need to be evaluated; a coordinated public health response needs to be defined; a nationally developed blueprint to deal with logistics of pandemic prevention is required; and there is a need to establish reliable communication systems on a national and local basis, to provide accurate information to the lay public, health care workers, and the agricultural sector.

Antiviral Agents↗

PubMed2006

Epidemiology of pandemic influenza: use of surveillance and modeling for pandemic preparedness.

Along with continual enhancement of current influenza surveillance programs, pandemic preparedness also involves application of current surveillance techniques to past pandemics to identify their viruses and patterns, as well as estimation of the potential burden of future pandemics. Although mortality surveillance has been in place in selected locations for more than a century, the recent development of molecular diagnostics has shed new light on the origin and structure of the viruses responsible for the past 3 pandemics, allowing for comparisons with new viruses identified through ongoing viral surveillance. Models previously used to estimate hospitalizations and mortality associated with past epidemics and pandemics have evolved to estimate the burden and required surge capacity of future pandemics of different severities.

Adolescent↗

PubMed1997

Influenza pandemic preparedness plan for the United States.

In preparation for the next influenza pandemic, a comprehensive and action-oriented plan is presently under development that focuses on six major areas: (1) improvements in ongoing virologic and disease-based surveillance systems; (2) vaccination of high-priority target groups, and, given sufficient vaccine supplies, the entire US population; (3) liability programs for vaccine manufacturers and health care providers; (4) research to improve detection of new variants and to accelerate the availability of existing and novel vaccines and antiviral agents; (5) integrated, multicomponent communication systems for rapid information dissemination and exchange; and (6) emergency preparedness plans to provide for adequate medical care and maintenance of essential community services. The sudden and unpredictable emergence of pandemic influenza and its potential for causing severe health and social consequences dictate the need for close collaboration among a wide variety of organizations in both the public and private sectors.

Humans↗

PubMed2005

Evaluation of public health interventions for Anthrax: a report to the secretary's council on Public Health Preparedness.

To aid in understanding how best to respond to a bioterror anthrax attack, we analyze a system of differential equations that includes a disease progression model, a set of spatially distributed queues for distributing antibiotics, and vaccination (pre-event and/or post-event). We derive approximate expressions for the number of casualties as a function of key parameters and management levers, including the time at which the attack is detected, the number of days to distribute antibiotics, the adherence to prophylactic antibiotics, and the fraction of the population that is preimmunized. We compare a variety of public health intervention policies in the event of a hypothetical anthrax attack in a large metropolitan area. Modeling assumptions were decided by the Anthrax Modeling Working Group of the Secretary's Council on Public Health Preparedness. Our results highlight the primary importance of rapid antibiotic distribution and lead us to argue for ensuring post-attack surge capacity to rapidly produce enough anthrax vaccine for an additional 100 million people.

Anthrax↗