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13 results

  • Posttraumatic Stress Disorder, Depression, and Alcohol and Tobacco Use in Public Health Workers After the 2004 Florida Hurricanes
  • Carol S. Fullerton, Jodi B.A. McKibben, Dori B. Reissman, Ted Scharf, Kathleen M. Kowalski-Trakofler, James M. Shultz, Robert J. Ursano
  • Journal: Disaster Medicine and Public Health Preparedness / Volume 7 / Issue 1 / February 2013
  • Published online by Cambridge University Press: 25 April 2013, pp. 89-95
  • View abstract
    Objective

    We examined the relationship of probable posttraumatic stress disorder (PTSD), probable depression, and increased alcohol and/or tobacco use to disaster exposure and work demand in Florida Department of Health workers after the 2004 hurricanes.

    Methods

    Participants (N = 2249) completed electronic questionnaires assessing PTSD, depression, alcohol and tobacco use, hurricane exposure, and work demand.

    Results

    Total mental and behavioral health burden (probable PTSD, probable depression, increased alcohol and/or tobacco use) was 11%. More than 4% had probable PTSD, and 3.8% had probable depression. Among those with probable PTSD, 29.2% had increased alcohol use, and 50% had increased tobacco use. Among those with probable depression, 34% indicated increased alcohol use and 55.6% increased tobacco use. Workers with greater exposure were more likely to have probable PTSD and probable depression (ORs = 3.3 and 3.06, respectively). After adjusting for demographics and work demand, those with high exposure were more likely to have probable PTSD and probable depression (ORs = 3.21 and 3.13). Those with high exposure had increased alcohol and tobacco use (ORs = 3.01 and 3.40), and those with high work demand indicated increased alcohol and tobacco use (ORs = 1.98 and 2.10). High exposure and work demand predicted increased alcohol and tobacco use, after adjusting for demographics, work demand, and exposure.

    Conclusions

    Work-related disaster mental and behavioral health burden indicate the need for additional mental health interventions in the public health disaster workforce.(Disaster Med Public Health Preparedness. 2013;7:89-95)

  • Sleep and Arousal as Risk Factors for Adverse Health and Work Performance in Public Health Workers Involved in the 2004 Florida Hurricane Season
  • Jodi B.A. McKibben, Carol S. Fullerton, Robert J. Ursano, Dori B. Reissman, Kathleen Kowalski-Trakofler, James M. Shultz, Leming Wang
  • Journal: Disaster Medicine and Public Health Preparedness / Volume 4 / Issue S1 / September 2010
  • Published online by Cambridge University Press: 08 April 2013, pp. S55-S62
  • View abstract

    Background: We examined the relation of sleep disturbance and arousal to work performance, mental and physical health, and day-to-day functioning in Florida Department of Health (FDOH) employees 9 months after the 2004 Florida hurricane season.

    Methods: FDOH employees were contacted via e-mail 9 months after the 2004 hurricanes. Participants (N = 2249) completed electronic questionnaires including measures of sleep disturbance, arousal, work performance, physical health, mental health, day-to-day function, hurricane injury, and work demand.

    Results: More than 18% of FDOH employees reported ≥25% reduced work performance and 11% to 15.3% reported ≥7 “bad” mental or physical health days in the past month. Sleep disturbance and elevated arousal were strongly associated with impaired work performance (odds ratios [ORs] 3.33 and 3.34, respectively), “bad” mental health (ORs 3.01 and 3.64), “bad” physical health (ORs 3.21 and 2.01), and limited day-to-day function (ORs 4.71 and 2.32), even after adjusting for sex, race, age, education, and marital status.

    Conclusions: Among public health workers exposed to the 2004 hurricanes, sleep disturbance and arousal were associated with personal and work impairment. Future research should continue to examine the effect of repeated exposure to disasters in first responders.

    (Disaster Med Public Health Preparedness. 2010;4:S55-S62)

  • The H1N1 Crisis: A Case Study of the Integration of Mental and Behavioral Health in Public Health Crises
  • Betty Pfefferbaum, David Schonfeld, Brian W. Flynn, Ann E. Norwood, Daniel Dodgen, Rachel E. Kaul, Darrin Donato, Brook Stone, Lisa M. Brown, Dori B. Reissman, Gerard A. Jacobs, Stevan E. Hobfoll, Russell T. Jones, Jack Herrmann, Robert J. Ursano, Josef I. Ruzek
  • Journal: Disaster Medicine and Public Health Preparedness / Volume 6 / Issue 1 / March 2012
  • Published online by Cambridge University Press: 08 April 2013, pp. 67-71
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    In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.

    (Disaster Med Public Health Preparedness. 2012;6:67–71)

  • Florida Department of Health Workers’ Response to 2004 Hurricanes: A Qualitative Analysis
  • Holly B. Herberman Mash, Carol S. Fullerton, Kathleen Kowalski-Trakofler, Dori B. Reissman, Ted Scharf, James M. Shultz, Robert J. Ursano
  • Journal: Disaster Medicine and Public Health Preparedness / Volume 7 / Issue 2 / April 2013
  • Published online by Cambridge University Press: 27 March 2013, pp. 153-159
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    Objective

    Examinations of the demands on public health workers after disaster exposure have been limited. Workers provide emergency care while simultaneously risking injury, damage to personal property, and threats to their own and their family's safety. We examined the disaster management experiences of 4323 Florida Department of Health workers 9 months after their response to 4 hurricanes and 1 tropical storm during a 7-week period in August and September of 2004.

    Methods

    Participants completed a self-report questionnaire focused on work performance, mental and physical health, daily functioning, sleep disturbance, physiological arousal, and injury and work demand at the time of the hurricanes, and answered open-ended questions that described their experiences in more detail.

    Results

    A qualitative analysis conducted from the write-in data yielded 4 domains: (1) work/life balance; (2) training for disaster response role; (3) workplace support; and (4) recovery.

    Conclusions

    Study findings highlighted a number of concerns that are important to public health workers who provide emergency care after a disaster and, in particular, multiple disasters such as during the 2004 hurricane season. The findings also yielded important recommendations for emergency public health preparedness. (Disaster Med Public Health Preparedness. 2013;0:1–7)

  • 23 - Public health practice and disaster resilience: a framework integrating resilience as a worker protection strategy
  • from Section 5 - Training for resilience
  • Edited by Steven M. Southwick, Brett T. Litz, Boston University, Dennis Charney, Matthew J. Friedman
  • Book: Resilience and Mental Health
  • Published online: 07 September 2011
  • Print publication: 18 August 2011, pp 340-358
  • View extract

    Summary

    Introduction

    The disciplines of emergency management and public health share objectives in hazard identification and the application of control or prevention strategies in the advent of disasters. This chapter defines resilience as it pertains to workers converging at a disaster site to perform response, recovery, or clean-up operations. A conceptual framework will be applied to disaster situations to highlight intervention avenues to preserve or enhance the resilience of the workers. Possible interventions include worker training and education, medical and emotional support services, disaster safety management, and alignment of organizational culture, policy, and procedures.

    The disciplines of public health and emergency management

    Public health is “the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort” (Winslow, 1920). Epidemiology is the basic science of public health research, policy, and practice; which provides methods to study factors affecting the health and illness of populations (Institute of Medicine, 2002). Modern public health practice requires alliance among many disciplines and emotionally charged points of view, particularly when health and safety become challenged by disasters. Public health and emergency management share the objectives of identifying hazards and managing risk, particularly before a disaster strikes (Haddow & Bullock, 2006). When looking across these disciplines, risk would be defined as susceptibility to death, injury, and illness to people; damage or destruction of the human-built or natural environment; and disruption or stoppage of services that support people from a population perspective. The purview of both disciplines has varied over time and in response to events, legislative initiatives, and leadership styles. For the purposes of this chapter, a disaster is defined as a serious disruption in the functioning of a local jurisdiction that poses a significant level of threat to life, health, property, or the environment and requires outside assistance to manage or cope with the event (International Federation of Red Cross and Red Crescent Societies, 2000). In common parlance, disasters are local events and directly impact communities.

  • 7 - Disaster Mental and Behavioral Health
  • from PART I - CONCEPTUAL FRAMEWORK AND STRATEGIC OVERVIEW
  • Edited by Kristi L. Koenig, University of California, Irvine, Carl H. Schultz, University of California, Irvine
  • Book: Koenig and Schultz's Disaster Medicine
  • Published online: 05 August 2011
  • Print publication: 30 September 2009, pp 103-112
  • View abstract

    Summary

    This chapter describes the range and timeline of typical reactions, approaches for screening, triage, and referral, preventing and managing psychological injuries, and integrated strategies to support disaster responders. Disasters and acts of terrorism produce a spectrum of common physiological, psychological, social, behavioral, emotional, cognitive, and spiritual reactions. An emerging incident management model for disaster mental and behavioral health is composed of three major components to enable a common operational picture for participating entities and jurisdictions. The components include community-based disaster systems of care, a common system for incident/event-specific rapid triage, and information technology for near-real-time data linkage. Psychological impact and resulting levels of psychiatric disorders may vary as a function of event characteristics, such as terrorism using weapons that can cause mass casualties and societal disruption. Using leadership, public messaging, and education greatly improves the mental and behavioral health of communities impacted by disasters and mass violence.
  • 4 - Disaster ecology: implications for disaster psychiatry
  • from Part II - Foundations of disaster psychiatry
    • By James M. Shultz, Director, Center for Disaster and Extreme Event University of Miami Miller School of Medicine, Zelde Espinel, Center for Disaster and Extreme Event University of Miami Miller School of Medicine, Sandro Galea, Associate Professor The University of Michigan, Dori B. Reissman, Senior Medical Advisor National Institute for Occupational Safety
  • Edited by Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland, Carol S. Fullerton, Uniformed Services University of the Health Sciences, Maryland, Lars Weisaeth, Universitetet i Oslo, Beverley Raphael, University of Western Sydney
  • Book: Textbook of Disaster Psychiatry
  • Published online: 09 August 2009
  • Print publication: 01 November 2007, pp 69-96
  • View abstract

    Summary

    This chapter describes the evolution of a disaster ecological framework for portraying the impact of disasters on human populations. It begins with a detailed look at exposure to hazards-categorized by type, intensity, time, and place factors. Globally, the cumulative impact of disasters can be estimated using multiple measures. Directly relevant to the field of disaster psychiatry, the degree of psychosocial impact varies by disaster type and generally increases with increasing magnitude and frequency of disaster occurrence. The public health consequences of disasters can be assessed in terms of mortality, morbidity and disruption of health care infrastructure. Disaster impact on citizens and whole populations varies by individual and family characteristics such as age, gender, race/ethnicity, education, occupation, employment status and income. The scope and magnitude of disasters are associated with the extent of disruption of health and social services.
  • Impact of 2003 Power Outages on Public Health and Emergency Response
  • James C. Kile, Stephen Skowronski, Mark D. Miller, Stephan G. Reissman, Victor Balaban, Richard W. Klomp, Dori B. Reissman, Hugh M. Mainzer, Andrew L. Dannenberg
  • Journal: Prehospital and Disaster Medicine / Volume 20 / Issue 2 / April 2005
  • Published online by Cambridge University Press: 28 June 2012, pp. 93-97
  • Print publication: April 2005
  • View abstract
    Introduction:

    In 2003, a major power outage occurred in the midwest and northeast United States affecting some 50 million people. The power outages affected multiple systems in state and local municipalities and, in turn, affected public health.

    Methods:

    Semi-structured interviews were conducted using open-ended questionnaires, with a convenience sample of state- and locally selected subject matter experts from Ohio, Michigan, and New York. Respondents were interviewed in groups representing one of five areas of interest, including: (1) emergency preparedness; (2) hospital and emergency medical services; (3) municipal environmental systems; (4) public health surveillance and epidemiology; and (5) psychosocial and behavioral issues. The reported positive and negative impacts of the power outage on public health, medical services, and emergency preparedness and response were documented. Responses were categorized into common themes and recommendations were formulated.

    Results:

    The amount of time that the respondents' locations were without power ranged from <1 hour to 52 hours. Many common themes emerged from the different locations, including communications failures, alternate power source problems, manpower and training issues, and psychosocial concerns. There was minimal morbidity and mortality reported that could be attributed to the event.

    Conclusion:

    Power outages negatively impacted multiple municipal infrastructures, and affected medical services, emergency response, and public health efforts. Previous federal funding positively impacted public health and emergency response capabilities. Recommendations were made based upon the common themes identified by the respondents.

    Recommendations may assist state and local health departments, medical service providers, and emergency responders in planning for future power outage problems.

  • 2 - Factors in the development of community resilience to disasters
  • Edited by Michael Blumenfield, New York Medical College, Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland
  • Book: Intervention and Resilience after Mass Trauma
  • Published online: 14 January 2010
  • Print publication: 01 January 2000, pp 49-68
  • View extract

    Summary

    Introduction

    Terrorist incidents and severe natural disasters have focused concern on preparedness and response activities to enhance psychological and social adjustment in the aftermath of extreme events and to minimize maladaptation over time. Borrowing from a growing body of work describing the characteristics that promote resilience in individuals, the concept of community resilience has emerged as a community-level construct to foster individual, family, and community adaptation. The likelihood of unanticipated terrorist events and the possibility of massive infrastructure destruction associated with major disasters increase the importance of community resilience strategies.

    Relatively little is known about what constitutes a resilient community or about the factors, conditions, and processes that promote it. In this paper, we (1) describe the construct of community resilience in the context of disasters, (2) propose a set of contributing factors, (3) identify potential barriers, and (4) make recommendations for enhancing community resilience. The paper does not constitute a formal review of the literature on community resilience.

    Definitions

    A discussion of community resilience requires consensus in our understanding of several key terms including “community,” “disaster,” and “resilience.”

    Community

    The notion of community has been widely discussed in both the social science and health literatures (Cohen, 2003; Institute of Medicine, 2003; Jewkes and Murcott, 1996). Depending on context, a variety of conceptualizations and components have been described. Traditionally, a community refers to people, organizations, structures, and systems in close geographic proximity and with physical boundaries and borders (e.g., a town).