Following adverse work conditions, health consequences can be explained by an imbalance between the effort made and the reward received. We investigated the association between extra effort, perceived reward, and post-traumatic stress disorder (PTSD). The Effort-Reward Imbalance Model was used to examine whether extra effort at work in the aftermath of a workplace-related terrorist attack affected the risk of PTSD and the effects of reward for extra effort from a leader or colleagues.

Cross-sectional data were collected 10 months after a terrorist attack in Norway in 2011. Out of 3520 Ministry employees invited, 1927 agreed to participate. Employees reported any extra effort performed as a result of the bomb explosion and any reward received from a leader or colleagues. PTSD was assessed with the PTSD Checklist.

Employees who reported extra effort displayed increased risk for PTSD (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.15-2.55, P=0.008). Perceived reward for extra effort from a leader was associated with lower risk for PTSD (OR=0.39, 95% CI: 0.23-0.64, P<0.001) but not perceived reward from colleagues.

Extra effort may increase the risk of PTSD, but reward from a leader may mitigate this effect. The Effort-Reward Imbalance Model appears to be an appropriate approach that may contribute to understanding of the etiology of work-related PTSD. (Disaster Med Public Health Preparedness. 2016;10:219–224)

Although much attention is now being paid to the health risks associated with nuclear disasters, reliable information is lacking. We retrospectively evaluated the health effects of living in highly contaminated radioactive areas in Japan.

The health evaluation was conducted in Tamano district, Fukushima prefecture, in 2011 and 2012. The surface deposition density of cesium in Tamano was 600 to 1000 kBq/m2 shortly after the Fukushima nuclear accident. Clinical parameters included body mass index, blood pressure, and laboratory examinations for blood cell counts, glucose levels, and lipid profiles. A screening program for internal and external exposure was also implemented.

One hundred fifty-five residents participated in the health evaluation. Significant decreases in average body mass index and blood pressure were observed from 2011 to 2012. Annual internal exposure levels did not exceeded 1 mSv in any participants. The levels of external exposure ranged from 1.3 to 4.3 mSv/y measured in the first test period but decreased to 0.8 to 3.6 mSv/y in the second test period.

These findings suggest that inhabiting nuclear contaminated areas is not always associated with short-term health deterioration and that radiation exposure can be controlled within safety limitations. (Disaster Med Public Health Preparedness. 2016;10:34–37)

Drawing on pre-disaster, peri-disaster, and post-disaster data, this study examined factors associated with the development of post-traumatic stress disorder (PTSD) symptoms in older adults exposed to Hurricane Sandy.

We used a sample of older participants matched by gender, exposure, and geographic region (N=88, mean age=59.83 years) in which one group reported clinically significant levels of PTSD symptoms and the other did not. We conducted t-tests, chi-square tests, and exact logistic regressions to examine differences in pre-disaster characteristics and peri-disaster experiences.

Older adults who experienced PTSD symptoms reported lower levels of income, positive affect, subjective health, and social support and were less likely to be working 4 to 6 years before Hurricane Sandy than were people not experiencing PTSD symptoms. Those developing PTSD symptoms reported more depressive symptoms, negative affect, functional disability, chronic health conditions, and pain before Sandy and greater distress and feelings of danger during Hurricane Sandy. Exact logistic regression revealed independent effects of preexisting chronic health conditions and feelings of distress during Hurricane Sandy in predicting PTSD group status.

Our findings indicated that because vulnerable adults can be identified before disaster strikes, the opportunity to mitigate disaster-related PTSD exists through identification and resource programs that target population subgroups. (Disaster Med Public Health Preparedness. 2016;10:362–370)

This descriptive study aimed to determine the disaster preparedness of a senior class of undergraduate nursing students.

The study sample was composed of 73 undergraduate nursing school students from Ankara, Turkey. Data were collected by using a questionnaire developed by the researchers and were evaluated with descriptive statistics.

More than half (56.1%) of the students stated that the disaster competencies of nurses should include leadership, manager, and coordinator skills; 42.4% of them indicated the competencies of decision-maker, critical thinking, autonomy, and planning skills. Regarding education, 56.4% of the students considered their education on disaster nursing as “efficient”; however, 35.9% of them considered their education as “partly efficient” or “inefficient.”

Many correct concepts related to the definition, features, competencies, and roles of disaster nurses were stated by students. However, low percentages and insufficient statements showed low preparedness for disasters. Curriculum development or redesign is necessary to include content and clinical experiences related to disasters. (Disaster Med Public Health Preparedness. 2016;10:557–561)

Devastating disasters around the world directly contribute to significant increases in human mortality and economic costs. The objective of this study was to examine the current state of the Korea Disaster Relief Team that participated in an international training module.

The whole training period was videotaped in order to observe and evaluate the respondents. The survey was carried out after completion of the 3-day training, and the scores were reported by use of a 5-point Likert scale.

A total of 43 respondents were interviewed for the survey, and the results showed that the overall preparedness score for international disasters was 3.4±1.6 (mean±SD). The awareness of the Incident Command System for international disasters was shown to be low (3.5±1.1). Higher scores were given to personnel who took on leadership roles in the team and who answered “I knew my duty” (4.4±0.6) in the survey, as well as to the training participants who answered “I clearly knew my duty” (4.5±0.5).

The preparedness level of the Korea Disaster Relief Team was shown to be insufficient, whereas understanding of the roles of leaders and training participants in the rescue team was found to be high. It is assumed that the preparedness level for disaster relief must be improved through continued training. (Disaster Med Public Health Preparedness. 2016;1–5)

We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP).

We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting data with all ED visits in all 50 states and Washington, DC.

Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented.

NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. (Disaster Med Public Health Preparedness. 2016;10:562–569)

The aim of the study was to verify the effectiveness of short text messages (short message service, or SMS) as an additional notification tool in case of fire or a mass casualty incident in a hospital.

A total of 2242 SMS text messages were sent to 59 hospital workers divided into 3 groups (n=21, n=19, n=19). Messages were sent from a Samsung GT-S8500 Wave cell phone and Orange Poland was chosen as the telecommunication provider. During a 3-month trial period, messages were sent between 3:35 PM and midnight with no regular pattern. Employees were asked to respond by telling how much time it would take them to reach the hospital in case of a mass casualty incident.

The mean reaction time (SMS reply) was 36.41 minutes. The mean declared time of arrival to the hospital was 100.5 minutes. After excluding 10% of extreme values for declared arrival time, the mean arrival time was estimated as 38.35 minutes.

Short text messages (SMS) can be considered an additional tool for notifying medical staff in case of a mass casualty incident. (Disaster Med Public Health Preparedness. 2016;10:38–41)

The present study aimed to investigate the effect of the socioeconomic status and interpersonal trust of elderly victims of the Ya’an earthquake on their ability to perform activities of daily living (ADLs).

Random sampling was done in the 8 counties of Ya’an in Sichuan, China (N=691). A multistage random sampling method was used. Samples were selected from counties, towns, and villages, respectively. The Faith in People Scale was used to measure interpersonal trust, and the Barthel ADL Index was used to measure ADLs. Both scales have strong reliability.

A total of 37.34% of elderly earthquake victims relied on others moderately to live, and their self-rating of interpersonal trust was relatively unfavorable. Factors such as being female, being widowed, having a low educational level, and income negatively affected ADLs, among which education had the greatest influence. Interpersonal trust was vital in enhancing the level of ADLs of elderly victims.

A high level of interpersonal trust can significantly improve the ADLs of elderly persons. However, this may be achieved by weakening the negative effect of deteriorating social structure of victims. Attention should be focused on elderly victims whose social network worsens to improve their ADLs. (Disaster Med Public Health Preparedness. 2016;page 1 of 7)

We aimed to quantitatively gauge local public health workers’ perceptions toward disaster recovery role expectations among jurisdictions in New Jersey and Maryland affected by Hurricane Sandy.

An online survey was made available in 2014 to all employees in 8 Maryland and New Jersey local health departments whose jurisdictions had been impacted by Hurricane Sandy in October 2012. The survey included perceptions of their actual disaster recovery involvement across 3 phases: days to weeks, weeks to months, and months to years. The survey also queried about their perceptions about future involvement and future available support.

Sixty-four percent of the 1047 potential staff responded to the survey (n=669). Across the 3 phases, 72% to 74% of the pre-Hurricane Sandy hires knew their roles in disaster recovery, 73% to 75% indicated confidence in their assigned roles (self-efficacy), and 58% to 63% indicated that their participation made a difference (response efficacy). Of the respondents who did not think it likely that they would be asked to participate in future disaster recovery efforts (n=70), 39% indicated a willingness to participate.

The marked gaps identified in local public health workers’ awareness of, sense of efficacy toward, and willingness to participate in disaster recovery efforts after Hurricane Sandy represent a significant infrastructural concern of policy and programmatic relevance. (Disaster Med Public Health Preparedness. 2016;10:371–377)

The purpose of this study was to describe disaster preparedness strategies and behaviors among rural families who have children with special health care needs and to examine the effect of self-efficacy and response-efficacy on disaster preparedness.

Data for this study were drawn from the baseline surveys of 287 rural families with children with special health care needs who were part of a randomized controlled trial examining the impact of an intervention on disaster preparedness. Distributions of child, parent, and family characteristics were examined by preparedness. Linear regression models were built to examine the impact of self-efficacy and response-efficacy on level of disaster preparedness.

Disaster preparedness (overall, emergency plan, discussion/practice, and supplies) was low (40.9-69.7%) among study families. Disaster preparedness was found to increase with each unit increase in the level of self-efficacy and family resilience sources across all 4 categories of preparedness.

Disaster preparedness among rural families with children with special health care needs is low, which is concerning because these children may have increased vulnerability to adverse outcomes compared to the general population. Results suggest that increasing the levels of self-efficacy and family resilience sources may increase disaster preparedness. (Disaster Med Public Health Preparedness. 2016;10:225–232)

The Great East Japan Earthquake triggered a massive tsunami that devastated the coasts of northern Japan on March 11, 2011. Despite the large number of “resident survivors,” who have continued to reside on the upper floors of damaged houses, few studies have examined the mental health of these residents. We explored the prevalence and risk factors of post-traumatic stress reaction (PTSR) among resident survivors.

A cross-sectional household screening for health support needs was conducted among resident survivors in Higashi-Matsushima city, Miyagi, 2 to 4 months after the tsunami. Questions assessing PTSR were included in the screening interviews.

Of 5103 resident survivors, 5.7% experienced PTSR. PTSR risk factors, identified via regression analysis, differed according to the height of house flooding. When house flooding remained below the ground floor, PTSR was significantly associated with being female and regular psychotropic medication intake. These 2 factors in addition to being middle-aged or elderly and living alone were also risk factors when flood levels were above the ground floor.

Following the tsunami, PTSR was found in a considerable number of resident survivors. Attention and support for people who use psychiatric medication, their families, and people living alone are suggested as possible directions for public health strategies. (Disaster Med Public Health Preparedness. 2016;page 1 of 8)

This project aimed to describe demographic patterns and circumstances surrounding injury deaths in New York City (NYC) related to Hurricane Sandy.

Injury deaths related to Hurricane Sandy were classified by using data from multiple sources: NYC’s Office of Vital Statistics death records, Office of Chief Medical Examiner case investigation files, and American Red Cross disaster mortality data. Injury deaths were classified as being related to Hurricane Sandy if they were caused directly by the storm’s environmental forces or if they were indirectly caused by an interruption of services, displacement, or other lifestyle disruption.

We identified 52 injury deaths in NYC related to Hurricane Sandy. Most decedents were male (75%); nearly half were aged 65 years and older (48%). Most (77%) deaths were caused by injuries directly related to Hurricane Sandy. Ninety percent of direct deaths were caused by drowning; most (73%) occurred within 3 days of landfall. Half (50%) of the 12 indirect deaths that occurred up to 30 days after the storm were caused by a fall. Nearly two-thirds (63%) were injured at home. Three-quarters (75%) of fatal injuries occurred in evacuation Zone A.

Risk communication should focus on older adults, males, and those living in evacuation zones; more evacuation assistance is necessary. NYC’s fatal injury profile can inform future coastal storm planning efforts. (Disaster Med Public Health Preparedness. 2016;10:378–385)

The mainstay of India’s disaster management policy until the early 2000s had been relief and rescue operations. The Odisha Super Cyclone (1999) with 10,000 deaths and US $3 billion economic damage provided a rude awakening. Recognizing the importance of preemptive preparedness, the government initiated systematic steps to implement a national framework interlinking economic, environmental, and overall developmental issues for efficient response to and mitigation of disasters.

We attempted a critical analysis of this paradigm shift in India’s disaster management policy through the prism of 2 cyclones, 14 years apart in time.

With improved preparedness and response measures, the death toll in 2013 Cyclone Phailin was 0.5% and the economic loss was about one-third of that during 1999. Concomitant improvements in the technological expertise of the early warning system, an integrated approach at all levels of administration including joint planning with major nongovernmental organizations, and improved community participation were identified as game-changers. An unbelievable 1 million people were evacuated to safety.

Our essay aims to highlight key steps in this success and calls for futuristic approaches like insurance programs and gender-sensitive recovery plans. With thorough scrutiny, India’s model may well stand to be replicated in resource-restricted settings. (Disaster Med Public Health Preparedness. 2016;10:42-46)

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)

This study aimed to determine the prevalence of and risk factors for skin problems among flood victims and army personnel during the 2011 floods in Thailand.

To determine the prevalence of and risk factors for skin symptoms, standardized questionnaires were used to collect demographic data, current skin symptoms, history of water exposure, and sanitary behaviors. A certified dermatologist evaluated those who presented with skin problems and provided diagnoses. Univariate and multivariate analyses were performed to assess independent risk factors for skin symptoms.

The most prevalent skin disease was irritant contact dermatitis. Flood victims showed a higher prevalence of skin symptoms compared with army personnel. Development of skin symptoms after exposure to floodwater was also observed earlier among flood victims. Having a history of skin diseases and delayed skin cleaning after exposure were also significant risk factors for the development of skin symptoms.

This information might be used as guidelines for protecting military personnel and to educate the general public regarding flood disaster management. (Disaster Med Public Health Preparedness. 2016;10:570–575)

On November 8, 2013, Typhoon Haiyan (Yolanda) made landfall in the Philippines. The literature characterizing the medical, surgical, and obstetrics burden following typhoons is lacking. This study aimed to improve disaster preparedness by analyzing medical diagnoses presenting to a city district hospital before, during, and after Typhoon Haiyan.

The assessment of disease burden and trends was based on logbooks from a local hospital and a nongovernmental organization field hospital for the medicine, surgical, and obstetrics wards before, during, and after the typhoon.

The hospital provided no services several days after typhoon impact, but there was an overall increase in patient admissions once the hospital reopened. An increase in gastroenteritis, pneumonia, tuberculosis, and motor vehicle collision-related injuries was seen during the impact phase. A dengue fever outbreak occurred during the post-impact phase. There was a noticeable shift in a greater percentage of emergent surgical cases performed versus elective cases during the impact and post-impact phases.

Overall, several public health measures can prevent the increase in illnesses seen after a disaster. To prepare for the nonfatal burden of disease after a typhoon, health care facilities should increase their resources to accommodate the surge in patient volume. (Disaster Med Public Health Preparedness. 2016;10:240–247)