Background: Recognition of bioterrorism-related infections by hospital and emergency department clinicians may be the first line of defense in a bioterrorist attack.

Methods: We identified unexplained infectious deaths consistent with the clinical presentation of anthrax, tularemia, smallpox, and botulism using Connecticut death certificates and hospital chart information. Minimum work-up criteria were established to assess the completeness of diagnostic testing.

Results: Of 4558 unexplained infectious deaths, 133 were consistent with anthrax (2.9%) and 6 (0.13%) with tularemia. None were consistent with smallpox or botulism. No deaths had anthrax or tularemia listed in the differential diagnosis or had disease-specific serology performed. Minimum work-up criteria were met for only 53% of cases.

Conclusions: Except for anthrax, few unexplained deaths in Connecticut could possibly be the result of the bioterrorism agents studied. In 47% of deaths from illnesses that could be anthrax, the diagnosis would likely have been missed. As of 2004, Connecticut physicians were not well prepared to intentionally or incidentally diagnose initial cases of anthrax or tularemia. More effective clinician education and surveillance strategies are needed to minimize the potential to miss initial cases in a bioterrorism attack. (Disaster Med Public Health Preparedness. 2008;2:87–94)

In the Person-Environment (P-E) Congruence model, psychological well-being is proposed to be a function of the degree of fit between the perceived environment and the important needs of the individual; and, that in more restricted environments, the relationship is stronger. The present study examined, cross-sectionally and longitudinally, the Congruence levels and well-being of elderly veterans (N = 165) in four microenvironments within a single instutition. Congruence was assessed using the multidimensional Environmental Perception, Preference and Importance Scale (EPPIS). Well-being was measured using the PGC Moral Scale, the Life Satisfaction Index A and a semantic differential self-concept scale. There were significant microenvironment differences on three of the 15 EPPIS dimensions; the P-E Congruence scores were predictive of well-being; and, the specific dimensions predictive of well-being varied across microenvironments, criterion of well-being and time. The data reinforces the notion that treatment programs must be individualized and that the P-E model, operationalized in the EPPIS, may serve as a viable clinical tool.