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Siddiqi SM, Kareddy V, Uscher-Pines L, Chari R. Building Public Health Emergency Preparedness, Response, and Recovery Capabilities Through Disaster Citizen Science: Perspectives From Local Health Department, Academic, and Community Representatives. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:473-486. [PMID: 36867462 PMCID: PMC10198799 DOI: 10.1097/phh.0000000000001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
CONTEXT Disaster citizen is the use of scientific methods by the public to address preparedness, response, or recovery needs. Disaster citizen science applications with public health relevance are growing in academic and community sectors, but integration with public health emergency preparedness, response, and recovery (PHEPRR) agencies is limited. OBJECTIVE We examined how local health departments (LHDs) and community-based organizations have used citizen science to build public health preparedness and response (PHEP) capabilities. The purpose of this study is to help LHDs make use of citizen science to support PHEPRR. DESIGN We conducted semistructured telephone interviews (n = 55) with LHD, academic, and community representatives engaged or interested in citizen science. We used inductive and deductive methods to code and analyze interview transcripts. SETTING US and international community-based organizations and US LHDs. PARTICIPANTS Participants included 18 LHD representatives reflecting diversity in geographic regions and population sizes served and 31 disaster citizen science project leaders and 6 citizen science thought leaders. MAIN OUTCOMES We identified challenges LHDs and academic and community partners face in using citizen science for PHEPRR as well as strategies to facilitate implementation. RESULTS Academic and community-led disaster citizen science activities aligned with many PHEP capabilities including community preparedness, community recovery, public health surveillance and epidemiological investigation, and volunteer management. All participant groups discussed challenges related to resources, volunteer management, collaborations, research quality, and institutional acceptance of citizen science. The LHD representatives noted unique barriers due to legal and regulatory constraints and their role in using citizen science data to inform public health decisions. Strategies to increase institutional acceptance included enhancing policy support for citizen science, increasing volunteer management support, developing best practices for research quality, strengthening collaborations, and adopting lessons learned from relevant PHEPRR activities. CONCLUSIONS There are challenges to overcome in building PHEPRR capacity for disaster citizen science but also opportunities for LHDs to leverage the growing body of work, knowledge, and resources in academic and community sectors.
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Affiliation(s)
- Sameer M Siddiqi
- Division of Social and Economic Wellbeing, RAND Corporation, Arlington, Virginia (Drs Siddiqi, Uscher-Pines, and Chari); and University of Virginia School of Law, Charlottesville, Virginia (Ms Kareddy)
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Siddiqi SM, Uscher-Pines L, Leinhos M, Dekker D, Chari R. Public Health Readiness for Citizen Science: Health Department Experiences. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:464-472. [PMID: 36214659 PMCID: PMC10082856 DOI: 10.1097/phh.0000000000001658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to examine the experiences of US health departments with citizen science. DESIGN In 2019, we conducted a national survey of 272 local health department (LHD) representatives about knowledge and attitudes, readiness, experiences, and barriers related to citizen science (response rate = 45%). SETTING LHDs in the United States in 2019. PARTICIPANTS LHD representatives. MAIN OUTCOME MEASURES Knowledge and attitudes, readiness, experiences, and barriers related to citizen science. RESULTS Sixty-two percent of respondents reported LHD experience with citizen science in areas such as health promotion, emergency preparedness, and environmental health. LHDs in large jurisdictions (78%) were more likely to report staff familiarity with citizen science than small (51%) and medium (59%) jurisdictions ( P = .01). Although 64% reported readiness for citizen science, only 32% reported readiness for community-led activities. We found that LHDs use citizen science more for community engagement activities, such as public education, than data collection activities. Respondents indicated that staff education and training in citizen science methods, funding, and partners with relevant expertise were priority needs. CONCLUSION LHDs have leveraged citizen science for community engagement, but barriers to technical uses remain.
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Affiliation(s)
- Sameer M Siddiqi
- Division of Social and Economic Well-Being, RAND Corporation, Arlington, Virginia (Drs Siddiqi, Uscher-Pines, and Chari); Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Leinhos); and National Association of County and City Health Officials, Washington, District of Columbia (Dr Dekker)
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Kennedy M, Gonick SA, Errett NA. Are We Ready to Build Back "Healthier?" An Exploratory Analysis of U.S. State-Level Disaster Recovery Plans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8003. [PMID: 34360292 PMCID: PMC8345761 DOI: 10.3390/ijerph18158003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
As communities recover from disasters, it is crucial to understand the extent to which states are prepared to support the recovery of health systems and services. This need has been emphasized by the United States' experience with COVID-19. This study sought to assess public health activities in state disaster recovery implementation plans. In this exploratory, descriptive study, state-wide disaster recovery implementation plans were collected from emergency management agency websites and verified (n = 33). We reviewed and coded the recovery plans to identify health-related activities. While 70% and 64% of reviewed plans included activities to address short-term healthcare and behavioral health needs, respectively, one-third or less of the plans included activities to address long-term healthcare and behavioral health needs. Further, plans have limited descriptions of health-related data collection, analysis, or data-driven processes. Additional evidence-informed public health requirements and activities are needed in disaster recovery implementation plans. State disaster recovery plans would benefit from additional description of public health roles, responsibilities, and activities, as well as additional plans for collecting and analyzing public health data to drive recovery decision making and activities. Plans should include approaches for ongoing evaluation of recovery activities.
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Affiliation(s)
| | | | - Nicole A. Errett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA; (M.K.); (S.A.G.)
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Howell AV, Vena JE, Cai B, Lackland DT, Ingram LA, Lawson AB, Svendsen ER. Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina. Front Public Health 2019; 7:112. [PMID: 31134174 PMCID: PMC6517492 DOI: 10.3389/fpubh.2019.00112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/17/2019] [Indexed: 01/14/2023] Open
Abstract
Background: On January 6, 2005, a train derailed in Graniteville, South Carolina, releasing nearly 60,000 kg of toxic chlorine gas. The disaster left nine people dead and was responsible for hundreds of hospitalizations and outpatient visits in the subsequent weeks. While chlorine gas primarily affects the respiratory tract, a growing body of evidence suggests that acute exposure may also cause vascular injury and cardiac toxicity. Here, we describe the incidence of cardiovascular hospitalizations among residents of the zip codes most affected by the chlorine gas plume, and compare the incidence of cardiovascular discharges in the years leading up to the event (2000-2004) to the incidence in the years following the event (2005-2014). Methods: De-identified hospital discharge information was collected from the South Carolina Revenue and Fiscal Affairs Office for individuals residing in the selected zip codes for the years 2000 to 2014. A quasi-experimental study design was utilized with a population-level interrupted time series model to examine hospital discharge rates for Graniteville-area residents for three cardiovascular diagnoses: hypertension (HTN), acute myocardial infarction (AMI), and coronary heart disease (CHD). We used linear regression with autoregressive error correction to compare slopes for pre- and post-spill time periods. Data from the 2000 and 2010 censuses were used to calculate rates and to provide information on potential demographic shifts over the course of the study. Results: A significant increase in hypertension-related hospital discharge rates was observed for the years following the Graniteville chlorine spill (slope 8.2, p < 0.001). Concurrent changes to CHD and AMI hospital discharge rates were in the opposite direction (slopes -3.2 and -0.3, p < 0.01 and 0.14, respectively). Importantly, the observed trend cannot be attributed to an aging population. Conclusions: An unusual increase in hypertension-related hospital discharge rates in the area affected by the Graniteville chlorine spill contrasts with national and state-level trends. A number of factors related to the spill may be contributing the observation: disaster-induced hypertension, healthcare services access issues, and, possibly, chlorine-induced susceptibility to vascular pathologies. Due to the limitations of our data, we cannot determine whether the individuals who visited the hospital were the ones exposed to chlorine gas, however, the finding warrants additional research. Future studies are needed to determine the etiology of the increase and whether individuals exposed to chlorine are at a heightened risk for hypertensive heart disease.
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Affiliation(s)
- Ashley V. Howell
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Bo Cai
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Daniel T. Lackland
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Lucy A. Ingram
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Erik R. Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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Généreux M, Schluter PJ, Takahashi S, Usami S, Mashino S, Kayano R, Kim Y. Psychosocial Management Before, During, and After Emergencies and Disasters-Results from the Kobe Expert Meeting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1309. [PMID: 31013679 PMCID: PMC6518049 DOI: 10.3390/ijerph16081309] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/24/2019] [Accepted: 04/01/2019] [Indexed: 11/16/2022]
Abstract
Emergencies and disasters typically affect entire communities, cause substantial losses and disruption, and result in a significant and persistent mental health burden. There is currently a paucity of evidence on safe and effective individual- and community-level strategies for improving mental health before, during, and after such events. In October 2018, the World Health Organization (WHO) Centre for Health Development (WHO Kobe Centre) convened a meeting bringing together leading Asia Pacific and international disaster research experts. The expert meeting identified key research needs in five major areas, one being "Psychosocial management before, during, and after emergencies and disasters". Experts for this research area identified critical gaps in observational research (i.e., the monitoring of long-term psychological consequences) and interventional research (i.e., the development and evaluation of individual- and community-level interventions). Three key research issues were identified. First, experts underscored the need for a standardized and psychometrically robust instrument that classified the mental health/psychosocial risk of people within both a clinical and community setting. Then, the need for a standardization of methods for prevention, screening, diagnosis, and treatment for affected people was highlighted. Finally, experts called for a better identification of before, during, and after emergency or disaster assets associated with greater community resilience.
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Affiliation(s)
- Mélissa Généreux
- Sherbrooke Hospital University Centre, Eastern Townships Integrated University Centre in Health and Social Services, Sherbrooke, QC J1J 3H5, Canada.
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1G 1B1, Canada.
| | - Philip J Schluter
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch 8140, New Zealand.
- Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane QLD 4006, Australia.
| | - Sho Takahashi
- Department of Disaster Psychiatry, University of Tsukuba, Tsukuba 305-8575, Japan.
- Ibaraki Prefectural Medical Center of Psychiatry, Kasama 309-1717, Japan.
| | - Shiori Usami
- Department of Mental Health and Psychiatric Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8555, Japan.
| | - Sonoe Mashino
- Research Institute of Nursing Care for People and Community, University of Hyōgo, Akashi 673-8588, Japan.
| | - Ryoma Kayano
- World Health Organization Centre for Health Development, Kobe 651-0073, Japan.
| | - Yoshiharu Kim
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira 187-0031, Japan.
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Généreux M, Lafontaine M, Eykelbosh A. From Science to Policy and Practice: A Critical Assessment of Knowledge Management before, during, and after Environmental Public Health Disasters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040587. [PMID: 30781625 PMCID: PMC6407109 DOI: 10.3390/ijerph16040587] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/03/2019] [Accepted: 02/11/2019] [Indexed: 11/16/2022]
Abstract
Canada regularly faces environmental public health (EPH) disasters. Given the importance of evidence-based, risk-informed decision-making, we aimed to critically assess the integration of EPH expertise and research into each phase of disaster management. In-depth interviews were conducted with 23 leaders in disaster management from Canada, the United States, the United Kingdom, and Australia, and were complemented by other qualitative methods. Three topics were examined: governance, knowledge creation/translation, and related barriers/needs. Data were analyzed through a four-step content analysis. Six critical success factors emerged from the analysis: blending the best of traditional and modern approaches; fostering community engagement; cultivating relationships; investing in preparedness and recovery; putting knowledge into practice; and ensuring sufficient human and financial resources. Several promising knowledge-to-action strategies were also identified, including mentorship programs, communities of practice, advisory groups, systematized learning, and comprehensive repositories of tools and resources. There is no single roadmap to incorporate EPH expertise and research into disaster management. Our findings suggest that preparation for and management of EPH disaster risks requires effective long-term collaboration between science, policy, and EPH practitioners at all levels in order to facilitate coordinated and timely deployment of multi-sectoral/jurisdictional resources when and where they are most needed.
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Affiliation(s)
- Mélissa Généreux
- Eastern Townships Integrated University Centre in Health and Social Services-Sherbrooke Hospital University Centre, Sherbrooke, QC J1G 1B1, Canada.
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
| | - Marc Lafontaine
- Chemical Emergency Preparedness and Response Unit, Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON K1A 0K9, Canada.
| | - Angela Eykelbosh
- National Collaborating Centre for Environmental Health, Vancouver, BC V5Z 4C2, Canada.
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Winters CA, Moore CF, Kuntz SW, Weinert C, Hernandez T, Black B. Principal components analysis to identify influences on research communication and engagement during an environmental disaster. BMJ Open 2016; 6:e012106. [PMID: 27507235 PMCID: PMC4985910 DOI: 10.1136/bmjopen-2016-012106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/06/2016] [Accepted: 07/05/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To discern community attitudes towards research engagement in Libby, Montana, the only Superfund site for which a public health emergency has been declared. STUDY DESIGN Survey study of convenience samples of residents near the Libby, Montana Superfund site. PARTICIPANTS Residents of the Libby, Montana area were recruited from a local retail establishment (N=120, survey 1) or a community event (N=127, survey 2). MEASURES Two surveys were developed in consultation with a Community Advisory Panel. RESULTS Principal components of survey 1 showed four dimensions of community members' attitudes towards research engagement: (1) researcher communication and contributions to the community, (2) identity and affiliation of the researchers requesting participation, (3) potential personal barriers, including data confidentiality, painful or invasive procedures and effects on health insurance and (4) research benefits for the community, oneself or family. The score on the first factor was positively related to desire to participate in research (r=0.31, p=0.01). Scores on factors 2 and 3 were higher for those with diagnosis of asbestos-related disease (ARD) in the family (Cohen's d=0.41, 0.57). Survey 2 also found more positive attitudes towards research when a family member had ARD (Cohen's d=0.48). CONCLUSIONS Principal components analysis shows different dimensions of attitudes towards research engagement. The different dimensions are related to community members' desire to be invited to participate in research, awareness of past research in the community and having been screened or diagnosed with a health condition related to the Superfund contaminant.
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Affiliation(s)
| | - Colleen F Moore
- Psychology Department, Montana State University, Bozeman, Montana, USA
| | - Sandra W Kuntz
- Montana State University, College of Nursing, Kalispell, Montana, USA
| | - Clarann Weinert
- Montana State University, College of Nursing, Bozeman, Montana, USA
| | | | - Brad Black
- Center for Asbestos Related Disease, Libby, Montana, USA
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Hoyle GW, Svendsen ER. Persistent effects of chlorine inhalation on respiratory health. Ann N Y Acad Sci 2016; 1378:33-40. [PMID: 27385061 PMCID: PMC5063681 DOI: 10.1111/nyas.13139] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 12/12/2022]
Abstract
Chlorine gas is a toxic respiratory irritant that is considered a chemical threat agent because of the potential for release in industrial accidents or terrorist attacks. Chlorine inhalation damages the respiratory tract, including the airways and distal lung, and can result in acute lung injury. Some individuals exposed to chlorine experience a full recovery from acute injury, whereas others develop persistent adverse effects, such as respiratory symptoms, inflammation, and lung-function decrements. In animal models, chlorine can produce persistent inflammation, remodeling, and obstruction in large or small airways, depending on species. Airways with pseudostratified epithelia are repaired efficiently, with surviving basal epithelial cells serving as progenitor cells that repopulate the complement of differentiated cell types. Distal airways lacking basal cells are repaired less efficiently, leading to chronic inflammation and fibrosis at these sites. Persistent chlorine-induced airway disease in humans is treated with asthma medication to relieve symptoms. However, such treatment does not ameliorate the underlying disease pathogenesis, so treatments that are more effective at preventing initial development of airway disease after irritant gas exposure and at reversing established disease are needed.
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Affiliation(s)
- Gary W Hoyle
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky.
| | - Erik R Svendsen
- Division of Environmental Health, Department of Public Health Services, Medical University of South Carolina, Charleston, South Carolina
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Carlisle M, Lam A, Svendsen ER, Aggarwal S, Matalon S. Chlorine-induced cardiopulmonary injury. Ann N Y Acad Sci 2016; 1374:159-67. [PMID: 27303906 DOI: 10.1111/nyas.13091] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chlorine (Cl2 ) is utilized worldwide for a diverse range of industrial applications, including pulp bleaching, sanitation, and pharmaceutical development. Though Cl2 has widespread use, little is known regarding the mechanisms of toxicity associated with Cl2 exposure, which occurs during industrial accidents or acts of terrorism. Previous instances of Cl2 exposure have led to reported episodes of respiratory distress that result in high morbidity and mortality. Furthermore, studies suggest that acute Cl2 exposure also results in systemic vascular injury and subsequent myocardial contractile dysfunction. Here, we review both lung and cardiac pathology associated with acute Cl2 inhalation and discuss recently published data that suggest that mitochondrial dysfunction underlies the pathogenesis of Cl2 -induced toxicity. Last, we discuss our findings that suggest that upregulation of autophagy protects against Cl2 -induced lung inflammation and can be a potential therapeutic target for ameliorating the toxic effects of Cl2 exposure.
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Affiliation(s)
- Matthew Carlisle
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam Lam
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Erik R Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.,Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Saurabh Aggarwal
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sadis Matalon
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Molecular and Translational Biomedicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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The Medical Home and Care Coordination in Disaster Recovery: Hypothesis for Interventions and Research. Disaster Med Public Health Prep 2015; 9:337-43. [DOI: 10.1017/dmp.2015.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIn postdisaster settings, health care providers encounter secondary surges of unmet primary care and mental health needs that evolve throughout disaster recovery phases. Whatever a community’s predisaster adequacy of health care, postdisaster gaps are similar to those of any underserved region. We hypothesize that existing practice and evidence supporting medical homes and care coordination in primary care for the underserved provide a favorable model for improving health in disrupted communities. Elements of medical home services can be offered by local or temporary providers from outside the region, working out of mobile clinics early in disaster recovery. As repairs and reconstruction proceed, local services are restored over weeks or years. Throughout recovery, major tasks include identifying high-risk patients relative to the disaster and underlying health conditions, assisting displaced families as they transition through housing locations, and tracking their evolving access to health care and community services as they are restored. Postdisaster sources of financial assistance for the disaster-exposed population are often temporary and evolving, requiring up-to-date information to cover costs of care until stable services and insurance coverage are restored. Evidence to support disaster recovery health care improvement will require research funding and metrics on structures, processes, and outcomes of the disaster recovery medical home and care coordination, based on adaptation of standard validated methods to crisis environments. (Disaster Med Public Health Preparedness. 2015;9:337–343)
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A critical review of an authentic and transformative environmental justice and health community--university partnership. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12817-34. [PMID: 25514142 PMCID: PMC4276648 DOI: 10.3390/ijerph111212817] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/11/2014] [Accepted: 11/17/2014] [Indexed: 01/08/2023]
Abstract
Distressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case study examines the process of building and sustaining a successful transformative and authentic community-university partnership. We apply the framework established by Community-Campus Partnerships for Health (CCPH), focusing on four of the nine principles of Good Practice of Community Campus Partnerships.
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Culley JM, Svendsen E, Craig J, Tavakoli A. A validation study of 5 triage systems using data from the 2005 Graniteville, South Carolina, chlorine spill. J Emerg Nurs 2014; 40:453-60. [PMID: 25063047 DOI: 10.1016/j.jen.2014.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/26/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Lack of outcomes-based research results in uncertainty about the effectiveness of any of the current triage systems in determining priority of care during actual chemical disasters. The purpose of this study was to determine whether the level of injury severity extrapolated from 5 triage systems correlated with actual injury severity outcomes of victims exposed to a chlorine disaster. METHODS Using secondary data analysis, data for 631 victims were merged, de-identified, and analyzed. Using logic models from the triage systems, the actual injury severity was compared with the extrapolated injury severity classifications. RESULTS Analysis showed weak to modest correlations between the extrapolated injury severity triage outcome classifications and the actual injury severity outcomes (Spearman correlation range 0.38 to 0.71, P < .0001). There was slight to fair agreement between the extrapolated injury severity triage outcome classifications and the actual injury severity outcomes (weighted κ = - 0.23 to 0.42). DISCUSSION The extrapolated injury severity triage outcome categories from the 5 triage systems did not agree with the actual injury severity categories. Oxygen saturation measured by pulse oximetry provides early indications and is very predictive of outcome severity in incidents involving irritant chemical exposures such as chlorine, and should be a part of a mass casualty protocol for any irritant chemical incident. Additional research is needed to identify the most sensitive clinical measures for triaging victims of toxic inhalation disasters.
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Affiliation(s)
| | | | - Jean Craig
- Columbia and Charleston, SC; New Orleans, LA
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Engaging a chemical disaster community: lessons from Graniteville. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5684-97. [PMID: 24871259 PMCID: PMC4078542 DOI: 10.3390/ijerph110605684] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/25/2014] [Accepted: 05/21/2014] [Indexed: 02/06/2023]
Abstract
Community engagement remains a primary objective of public health practice. While this approach has been adopted with success in response to many community health issues, it is rarely adopted in chemical disaster response. Empirical research suggests that management of chemical disasters focuses on the emergency response with almost no community engagement for long-term recovery. Graniteville, an unincorporated and medically underserved community in South Carolina was the site of one of the largest chlorine exposures by a general US population. Following the immediate response, we sought community participation and partnered with community stakeholders and representatives in order to address community-identified health and environmental concerns. Subsequently, we engaged the community through regular town hall meetings, harnessing community capacity, forming coalitions with existing local assets like churches, schools, health centers, and businesses, and hosting community-wide events like health picnics and screenings. Information obtained from these events through discussions, interviews, and surveys facilitated focused public health service which eventually transitioned to community-driven public health research. Specific outcomes of the community engagement efforts and steps taken to ensure sustainability of these efforts and outcomes will be discussed.
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Clark KA, Chanda D, Balte P, Karmaus WJ, Cai B, Vena J, Lawson AB, Mohr LC, Gibson JJ, Svendsen ER. Respiratory symptoms and lung function 8-10 months after community exposure to chlorine gas: a public health intervention and cross-sectional analysis. BMC Public Health 2013; 13:945. [PMID: 24107111 PMCID: PMC3851981 DOI: 10.1186/1471-2458-13-945] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/25/2013] [Indexed: 11/16/2022] Open
Abstract
Background We implemented a community based interventional health screening for individuals located within one mile of a 54 metric tons release of liquid chlorine following a 16 tanker car train derailment on 6 January, 2005 in Graniteville, South Carolina, USA. Public health intervention occurred 8–10 months after the event, and provided pulmonary function and mental health assessment by primary care providers. Its purpose was to evaluate those exposed to chlorine for evidence of ongoing impairment for medical referral and treatment. We report comparative analysis between self-report of respiratory symptoms via questionnaire and quantitative spirometry results. Methods Health assessments were obtained through respiratory symptom and exposure questionnaires, simple spirometry, and physical exam. Simple spirometry was used as the standard to identify continued breathing problems. Sensitivity, specificity, positive and negative predictive values were applied to evaluate the validity of the respiratory questionnaire. We also identified the direction of discrepancy between self-reported respiratory symptoms and spirometry measures. Generalized estimation equations determined prevalence ratios for abnormal spirometry based on the presence of participant persistent respiratory symptoms. Covariate adjustment was made for participant age, sex, race, smoking and educational status. Results Two hundred fifty-nine people participated in the Graniteville health screening; 53 children (mean age = 11 years, range: <1-16), and 206 adults (mean age = 50 years, range: 18–89). Of these, 220 (85%) performed spirometry maneuvers of acceptable quality. Almost 67% (n = 147) displayed abnormal spirometry, while 50% (n = 110) reported persistent new-onset respiratory symptoms. Moreover, abnormal spirometry was seen in 65 participants (29%) who did not report any discernible breathing problems. This represented a net 16.8% underreporting of symptoms. Sensitivity and specificity of questionnaire self-report of symptoms were low at 55.8% and 61.6%, respectively. Persistent cough (41%) and shortness of breath (39%) were the most frequently reported respiratory symptoms. Conclusion Eight to ten months after acute chlorine exposure, the Graniteville health screening participants under-reported respiratory symptoms when compared to abnormal spirometry results. Sensitivity and specificity were low, and we determined that relying upon the self-report questionnaire was not adequate to objectively assess the lung health of our population following irritant gas exposure.
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Runkle JD, Zhang H, Karmaus W, Brock-Martin A, Svendsen ER. Prediction of unmet primary care needs for the medically vulnerable post-disaster: an interrupted time-series analysis of health system responses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:3384-97. [PMID: 23202752 PMCID: PMC3506416 DOI: 10.3390/ijerph9103384] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/06/2012] [Accepted: 09/17/2012] [Indexed: 11/16/2022]
Abstract
Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters) to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.
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Affiliation(s)
- Jennifer D. Runkle
- Nell Hodgson School of Nursing, Emory University, Atlanta, GA 30322, USA
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (H.Z.); (W.K.); (E.R.S.)
| | - Hongmei Zhang
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (H.Z.); (W.K.); (E.R.S.)
| | - Wilfried Karmaus
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (H.Z.); (W.K.); (E.R.S.)
| | - Amy Brock-Martin
- Health Services, Policy, and Management, University of South Carolina, Columbia, SC 29208, USA;
- South Carolina Rural Health Research Center, Columbia, SC 29210, USA
| | - Erik R. Svendsen
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (H.Z.); (W.K.); (E.R.S.)
- Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
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Ginsberg JP, Holbrook JR, Chanda D, Bao H, Svendsen ER. Posttraumatic stress and tendency to panic in the aftermath of the chlorine gas disaster in Graniteville, South Carolina. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1441-8. [PMID: 22072223 PMCID: PMC3407346 DOI: 10.1007/s00127-011-0449-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/27/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Relatively little is known about psychological effects of environmental hazard disasters. This study examines the development of posttraumatic stress (PTS) and tendency to limited panic attack after a large chlorine spill in a community. METHODS In January 2005, a large chlorine spill occurred in Graniteville, SC. Acute injuries were quantified on an ordinal severity scale. Eight to ten months later, participating victims completed the Short Screening Scale for PTSD (n = 225) and the Holden Psychological Screening Inventory (HPSI) (n = 193) as part of a public health intervention. Forced expiratory volume in 1 s (FEV(1)) and forced vital capacity were likewise measured via spirometry. Two sets of univariate logistic regression models were fit to detect independent effects of each potential covariate and risk factor on PTS score and tendency to panic. A supplemental analysis examined whether poor lung function may be a confounder and/or effect modifier of the effect of acute injury on PTS score and panic. RESULTS Of those who completed psychological screening, 36.9% exhibited PTS symptoms. FEV(1), acute injury, and the HPSI psychiatric subscale were independently associated with increased PTS score. Acute injury severity scale and female sex were associated with tendency to panic. Immediate acute injury severity and poor lung function later were independently associated with PTS symptomotology. CONCLUSIONS The high prevalence of PTS and endorsement of tendency to panic within our sample show a need for mental health treatment after a chemical hazard disaster. Mental health personnel should be considerate of those with serious physical injuries.
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Affiliation(s)
- Jay P. Ginsberg
- Shirley L. Buchanan Neuroscience Laboratory, Dorn VA Medical Center, Columbia, SC, USA, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Joseph R. Holbrook
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, HESC, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA
| | - Debjani Chanda
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, HESC, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA
| | - Haikun Bao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, HESC, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA
| | - Erik R. Svendsen
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, HESC, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA, South Carolina Department of Health and Environmental Control, Columbia, SC, USA
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17
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Svendsen ER, Runkle JR, Dhara VR, Lin S, Naboka M, Mousseau TA, Bennett C. Epidemiologic methods lessons learned from environmental public health disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:2894-909. [PMID: 23066404 PMCID: PMC3447594 DOI: 10.3390/ijerph9082894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/18/2012] [Accepted: 08/08/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. METHODS Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA). FINDINGS We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. INTERPRETATION These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.
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Affiliation(s)
- Erik R. Svendsen
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, Tulane University Health Sciences Center, ENHS SL-29, 1440 Canal St., Suite 2100, New Orleans, LA 70112, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA;
| | - Jennifer R. Runkle
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA;
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 62234, USA
| | | | - Shao Lin
- Bureau of Occupational and Environmental Epidemiology, State University of New York-Albany, Albany, NY 84870, USA;
| | - Marina Naboka
- Radioecological Center of the National Academy of Sciences, Kiev 04050, Ukraine;
| | - Timothy A. Mousseau
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA;
| | - Charles Bennett
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA;
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Honavar J, Samal AA, Bradley KM, Brandon A, Balanay J, Squadrito GL, MohanKumar K, Maheshwari A, Postlethwait EM, Matalon S, Patel RP. Chlorine gas exposure causes systemic endothelial dysfunction by inhibiting endothelial nitric oxide synthase-dependent signaling. Am J Respir Cell Mol Biol 2010; 45:419-25. [PMID: 21131444 DOI: 10.1165/rcmb.2010-0151oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chlorine gas (Cl(2)) exposure during accidents or in the military setting results primarily in injury to the lungs. However, the potential for Cl(2) exposure to promote injury to the systemic vasculature leading to compromised vascular function has not been studied. We hypothesized that Cl(2) promotes extrapulmonary endothelial dysfunction characterized by a loss of endothelial nitric oxide synthase (eNOS)-derived signaling. Male Sprague Dawley rats were exposed to Cl(2) for 30 minutes, and eNOS-dependent vasodilation of aorta as a function of Cl(2) dose (0-400 ppm) and time after exposure (0-48 h) were determined. Exposure to Cl(2) (250-400 ppm) significantly inhibited eNOS-dependent vasodilation (stimulated by acetycholine) at 24 to 48 hours after exposure without affecting constriction responses to phenylephrine or vasodilation responses to an NO donor, suggesting decreased NO formation. Consistent with this hypothesis, eNOS protein expression was significantly decreased (∼ 60%) in aorta isolated from Cl(2)-exposed versus air-exposed rats. Moreover, inducible nitric oxide synthase (iNOS) mRNA was up-regulated in circulating leukocytes and aorta isolated 24 hours after Cl(2) exposure, suggesting stimulation of inflammation in the systemic vasculature. Despite decreased eNOS expression and activity, no changes in mean arterial blood pressure were observed. However, injection of 1400W, a selective inhibitor of iNOS, increased mean arterial blood pressure only in Cl(2)-exposed animals, suggesting that iNOS-derived NO compensates for decreased eNOS-derived NO. These results highlight the potential for Cl(2) exposure to promote postexposure systemic endothelial dysfunction via disruption of vascular NO homeostasis mechanisms.
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Affiliation(s)
- Jaideep Honavar
- Department of Pathology, University of Alabama at Birmingham, 35294, USA
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