Category Archives: Disasters
Just over a year ago, Hurricane Sandy made landfall in the United States. Estimated damage came to $65 billion, at least 181 people in the United States died and power outages left tens of millions of people without electricity for weeks.
In the aftermath of this devastating event, the public health community continued efforts to make Americans aware that public health needs to play a much larger role in emergency response and recovery.
And in an American Public Health Association (APHA)-sponsored session on Wednesday, panelists discussed how they can draw on disaster response incidents to analyze policy implications for preparedness and response efforts to protect the health of workers, communities and the environment—with particular emphasis on promoting health equity.
"Addressing health disparities and environmental justice concerns are a key component of Sandy impacted communities," said the moderator of the panel, Jim Hughes of the National Institute of Environmental Health Sciences (NIEHS).
Kim Knowlton of the Natural Resources Defense Council and Columbia Mailman School of Public Health stressed that public health needs to advance environmental health policies post-Sandy, especially in regards to helping vulnerable populations.
"Climate change is a matter of health. It's such a deep matter of public health," she said. "We have to make a bridge between public health and emergency response preparedness communities," adding that "This is also an opportunity for FEMA to put climate change into their process for hazard mitigation planning and risk assessment.”
How do you prepare for the safety and health of 27,000 runners and 500,000 spectators? And how do you prepare for the unexpected—such as a terrorist attack—so that the public health response can be as swift and effective as possible?
That was the first topic of Monday's American Public Health Association (APHA) session, "Late Breaking Developments in Public Health." Mary E. Clark, Director of Emergency Preparedness Bureau at the Massachusetts Department of Public Health, presented on "Public Health and Medical Response to the Boston Marathon Bombing."
Discussing the particular difficulties of staffing an event such as the Boston Marathon, Clark noted that the route goes through 26.2 miles, crosses through eight different communities in Massachusetts and then goes straight into the city of Boston. Along the way, there are thousands of runners and hundreds of thousands of spectators.
"This presents us with medical and health challenges, as well as security challenges," Clark explained.
"This year was the 117th running of the Boston Marathon, and each year we plan this as a planned mass casualty event," Clark said. "We have to build on the work that has gone on in the 116 years before."
To do this, Clark said, the department takes at least four months of preparedness planning, with the assumption that at least 1,000 runners or spectators will need some sort of medical care.
But how did they deal effectively with the unexpected?
"We had a remarkably quick response to bombings," Clark said. She noted that less than a minute after the bombs went off, gurneys were heading to the victims. And in just 18 minutes, they were able to remove 30 critically injured spectators off the scene into ambulances. Massachusetts General Hospital received their first patient 14 minutes after the explosions.
Since the marathon bombings, though, Clark said, they have identified further needs—particularly in the areas of mental health.
"One of the key things that's happened since the Marathon is the recognition of the need for a robust mental health response,” she said. “We have created more mental health support systems for volunteers and staff.”
But her biggest takeaway from the tragedy and the response? "Lessons learned were the benefit of preparedness activities," Clark said.
"People did what they were trained to do and they did it very well."
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
On First Anniversary, States Still Helping Residents Displaced and Impacted by Hurricane Sandy
Flags will fly at half mast in New York State and other regions of the Northeast today as residents mark the one year anniversary of the day that Hurricane Sandy made landfall. New York, New Jersey, and Connecticut—which saw dozens killed and hundreds injured—continue to help residents rebuild and recover from injuries, loss of homes and loss of businesses. Read more about Hurricane Sandy.
AAP: Parental ‘Media Use Plans’ Needed to Limit Kids’ Time in Front of TVs, Other Screens
Parents should create a “media use plan” that limits kids’ screen time to no more than two hours per day, as well as keeps television and Internet access out of their bedrooms, according to a new policy statement from the American Academy of Pediatrics (AAP) Council on Communications and Media. Marjorie Hogan, MD, one of the statement's lead authors, said the issue isn’t television and other media access overall, but the fact that excessive media use been linked to obesity, sleep problems, school problems and aggression; the average child spends about eight hours each day in front of various screens. The key is for parents to find a balance between the positives and negatives of media. "We're not media-bashers," said Hogan. "We love media…For teens, connectivity, being connected to your peers, having a chance to create your persona, can be a really positive thing.” Read more on pediatrics.
Study: Smokers Most Likely to Think About Quitting on Mondays
An analysis of online searches related to smoking cessation shows that smokers are most likely to think about quitting smoking on Mondays, which could give anti-tobacco efforts a new way to make anti-smoking campaigns more effective by enacting weekly cues to remind smokers to keep trying on Mondays, according to a new study in JAMA Internal Medicine. Researchers found the number of Monday searches was 25 percent higher than the combined average of the rest of the days of the week; the findings were the same for searches conducted in English, French, Chinese, Portuguese, Russian and Spanish. "Popular belief has been that the decision to quit smoking is unpredictable or even chaotic," said study lead author John Ayers, of San Diego State University."By taking a bird's-eye view of Google searches, however, we find anything but chaos. Instead, Google search data reveals interest in quitting is part of a larger collective pattern of behavior dependent on the day of the week." Read more on tobacco.
FDA Recommends Tighter Regulations for Hydrocodone
The U.S. Food and Drug Administration (FDA) is recommending that products that contain hydrocodone be reclassified more restrictively, possibly putting them in the Schedule II category that already includes other opioid painkillers such as oxycodone and morphine. Products that contain less than 15 milligrams of hydrocodone, such as Vicodin, are currently classified as Schedule III controlled substances. The change would mean patients would need to present a written prescription at a pharmacy and could not get as many refills before returning to their doctors for a new prescription. While this would help limit access by addicts, these greater restrictions would also affect people with legitimate chronic pain, potentially placing undue hardship on their already painful conditions. The Drug Enforcement Agency (DEA) is pushing for the restrictions in an effort to combat the increasing problem of prescription drug abuse;
the change must be approved by the U.S. Department of Health and Human Services and the DEA, which will make a final scheduling decision. This Saturday is also National Prescription Drug Take-Back Day, sponsored by the DEA, when people can anonymously and safely dispose of expired or unused prescription medicines. Read more on prescription drugs.
ONC Releases New Online Security Tool for Disaster Preparedness
The Office of the National Coordinator for Health Information Technology (ONC), part of the U.S. Department of Health and Human Services, has released a new online security training tool to help health care providers and staff with contingency planning in the case of power outages, floods, fires, hurricanes or other events. Such events can damage important patient information, or even make it unavailable. "We know from recent experiences such as Hurricane Sandy, that these events can very adversely impact the delivery of health care," said ONC Chief Privacy Officer Joy Pritts. "We hope that this video game will raise awareness of contingency planning and help practices begin to develop their own disaster plans, backup and recovery processes and other vital activities." The "CyberSecure: Your Medical Practice” tool is available here. Read more on disasters.
Study: Kids with Concussion at Higher Risk for Depression
Children with concussions or other head injuries are at increased risk of later being diagnosed with depression, according to new findings to be presented today at the American Academy of Pediatrics national conference in Orlando, Fla. Researchers found that about 15 percent of children and teenagers who ever suffered a brain injury were later diagnosed with depression, compared to the national average of 4 percent. While the findings did not determine causation, they do suggest that doctors should make assessments or mood and behavior problems part of and follow-up treatment for head injuries. Read more on mental health.
HHS: $8M in Research Grants to Support Hurricane Sandy Recovery
The U.S. Department of Health and Human Services (HHS) has awarded more than $8 million in research grants to support the long-term recovery of areas of the country damaged by Hurricane Sandy in late 2012. The grants, which are part of the Hurricane Sandy Recovery and Rebuilding Supplemental Appropriation Act of 2013, will go toward research on issues such as community resilience; risk communications and the use of social media; health system response and health care access; evacuation and policy decision making; and mental health. “We hope the grants provide a catalyst for the scientific community to put more emphasis on the study of recovery from disasters; much more research is needed to support decision making in the long-term recovery process and ultimately to improve resilience,” said Nicole Lurie, MD, HHS assistant secretary for preparedness and response. “We anticipate that the findings not only will help community leaders make evidence-based decisions about recovery plans and policies in affected areas but also that the knowledge gained can improve resilience across the entire country.” Read more on disasters.
NIH, CDC Launch National Registry on Sudden Deaths in the Young
The U.S. National Institutes of Health (NIH) and the U.S. Centers of Disease Control and Prevention have come together in the launch of the Sudden Death in the Young Registry. The registry will catalogue conditions such as heart disease and epilepsy in order to help researchers better understand the issues and establish future research priorities. According to the NIH, up until now there have not been agreed upon standards or definitions for reporting these deaths, which has impeded efforts to determine the best prevention efforts. "The sudden death of a child is tragic and the impact on families and society is incalculable," said Jonathan Kaltman, MD, chief of the Heart Development and Structural Diseases Branch within the Division of Cardiovascular Sciences at the NIH's National Heart, Lung, and Blood Institute. "This registry will collect comprehensive, population-based information on sudden unexpected death in youths up to age 24 in the United States. It is a critical first step toward figuring out how to best prevent these tragedies." Read more on research.
Mother’s Smoking During Pregnancy Increases Infant’s Risk of Infections, Death
Mothers who smoked during pregnancy are more likely to have children who are at increased risk for hospitalization and death during infancy, according to a new study in the journal Pediatric Infectious Diseases. The study analyzed hospital records and death certificates of approximately 50,000 Washington state infants born between 1987 and 2004. Researchers say a weakening of the child’s immune system may be responsible for the heightened risk. "We've known for a long time that babies born to mothers who smoke during pregnancy are at high risk for serious medical problems relating to low birth weight, premature delivery and poor lung development," said lead author Abigail Halperin, MD. "While respiratory infections have been recognized as a common cause of these sometimes life-threatening illnesses, this study shows that babies exposed to smoke in utero [in the womb] also have increased risk for hospitalization and death from a much broader range of infections—both respiratory and nonrespiratory—than we knew before.” Read more on tobacco.
Four U.S. Regions on Alert for Severe Weather this Weekend
Severe weather is expected to impact at least four regions of the United States this weekend. That includes a tropical storm—downgraded from a hurricane for now—in the Gulf Coast; a tornado threat in the Midwest; early snow in the West that, in part because trees still have leaves that can be weighed down by wet snow, could lead to power outages; and spreading fires in California fueled by dry weather. The Federal Emergency Management Agency (FEMA) has already recalled some furloughed staff to prepare for the storms expected on the Gulf Coast. Read more on preparedness.
Study: Unnecessary Antibiotic Prescriptions Remain High, Endanger Public Health
Despite ongoing efforts by the U.S. Centers for Disease Control and Prevention (CDC) and other public health organizations, doctors continue to overprescribe antibiotics for sore throats, increasing the risk of the development of antibiotic-resistant bacteria, according to a new study in JAMA Internal Medicine. “Our research shows that while only 10 percent of adults with sore throat have strep, the only common cause of sore throat requiring antibiotics, the national antibiotic prescribing rate for adults with sore throat has remained at 60 percent,” said senior author Jeffrey A. Linder, MD, MPH, a physician and researcher in the Division of General Medicine and Primary Care at Brigham and Women’s Hospital. “For acute bronchitis, the right antibiotic prescribing rate should be near zero percent and the national antibiotic prescribing rate was 73 percent.” The researchers said the findings demonstrate the need to study and implement new interventions to reduce unnecessary antibiotic prescriptions. Read more on infectious disease.
Daily Walks Can Reduce Breast Cancer Risk for Older Women
Post-menopausal women can reduce their risk of developing breast cancer through physical activity as simple as a daily walk, according to a new study in Cancer Epidemiology, Biomarkers & Prevention. More intense exercise may have an even more profound impact. "The nice message here is, you don't have to go out and run a marathon to lower your breast cancer risk," said study researcher Alpa Patel, senior epidemiologist at the American Cancer Society, which funded the study. "Go for a nice, leisurely walk an hour a day to lower risk.” However, the study authors noted that they found only a correlation, not a causation, so further study is needed. Experts believe the reason exercise reduces breast cancer risk is related to hormones; they also recommend maintaining a healthy body weight and minimizing the consumption of alcohol as ways to reduce the risk of breast cancer. Read more on cancer.
Tropical Storm Karen Could Hit U.S. Gulf Coast by Weekend
CNN is reporting that a hurricane watch is in effect for parts of the U.S. Gulf Coast after a tropical storm, named Karen, formed in the southeastern portion of the Gulf of Mexico. A hurricane watch means that hurricane conditions are possible within the watch area; a watch is typically issued 48 hours before a storm is expected to hit, according to the National Hurricane Center website. Much of the National Weather Service operations are closed because of the federal shutdown, however, the National Hurricane Center website will be regularly updated, an exception to the shutdown because severe weather poses a risk to life and property. And while much of the Federal Emergency Management Agency (FEMA) is also shuttered, DisasterAssistance.gov remains fully operational, according to FEMA’s website, although “due to a lapse in federal funding, portions of some government websites linked to or from DisasterAssistance.gov may not be updated and some non-disaster assistance transactions submitted via those websites may not be processed or responded to until after funding is enacted.” Ready.gov, FEMA’s disaster preparedness website, was last updated on September 30, according to the agency, and will not be updated until after funding is enacted. A notice on the site says “information on Ready.gov may not be up to date.” Read more on disasters.
Study: Cesarean-section Delivery May Not Be Needed for Twin Births
Despite the common opinion, vaginal delivery may be just as safe as scheduled cesarean-section delivery for pregnant women with twins, according to a new study in the New England Journal of Medicine. Researchers looked at multiple subject groups, tracking the pregnancies and finding the no difference in the rate of serious adverse outcomes for either the babies or the mothers. "Studies have suggested that maybe cesarean delivery is the best way, but there's no evidence to support the swing to cesarean birth,” said lead author, Jon Barrett, MD, chief of maternal-fetal medicine at Sunnybrook Health Sciences Center in Toronto, Canada. “Perhaps the perception is that it's better for the baby.” According to the U.S. Centers for Disease Control and Prevention, as recently as 2008 about one in three single births was performed by planned cesarean section, while about three in every four twin births was via planned cesarean section. Read more on infant and maternal health.
Study: Melanoma Patients End Up Back in the Sun in 2-3 Years
While they remain appropriately cautious for the first year or so, people who were diagnosed and treated for melanoma end up going back to their old habits within two to three years, spending as much time in the sun as people who were never diagnosed with the skin cancer, according to a new study in JAMA Dermatology. People who previously had melanoma are at increased risk of developing the dangerous cancer. The American Cancer Society estimates that about 76,000 new cases of melanoma will be diagnosed this year. Brenda Cartmel, from the Yale School of Public Health, said health professionals need to rethink exactly how they’re advocating the importance of staying out of the sun. "I don't think what we are going to advise people to do is going to be different," she said. "I just think somehow we need to get that message over maybe in a different way." Read more on cancer.
New NIH Study to Look at House-to-House HIV Testing, Other Measures, to Reduce HIV Burden in Africa
A study in South Africa and Zambia is assessing whether house-to-house voluntary HIV testing and prompt treatment of HIV infection, along with other proven HIV prevention measures, can substantially reduce the number of new HIV infections across communities. The trial is funded primarily by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), administered by the Office of the Global AIDS Coordinator. “Through this new study, we aim to learn whether the treatment of HIV-infected individuals as a form of HIV prevention, an approach previously tested in roughly 1,800 heterosexual couples where one partner was infected, will be just as effective when implemented across an entire adult population,” said NIAID Director Anthony S. Fauci, MD. “The study also will tell us whether this method of delivering population-wide HIV treatment as prevention is feasible and cost-effective.” The trial is being conducted in South Africa and Zambia because the HIV prevalence in those countries is among the highest in the world. An estimated 12.5 percent of adults in Zambia and 17.3 percent of adults in South Africa are infected. The study team will measure the impact of the two HIV prevention packages by determining the number of new HIV infections among a representative sample of 52,500 adults drawn from the 21 study communities and followed for three years. The study is expected to end in 2019. Read more on AIDS.
Study: Better Awareness Likely Reason for Increase in ER Visits for Youth Concussions
Improved awareness of the signs and symptoms of traumatic brain injuries (TMI)—such as concussions—is likely the cause of a noticeable increase in TMI-related emergency department visits by children, according to a new study from doctors at the Cincinnati Children's Hospital Medical Center. The study appeared in the journal pediatrics. Visits for these types of injuries climbed about 92 percent from 2002 to 2011, while the overall severity of the injuries decreased and the hospitalization rate remained at around 10 percent. "We are doing a better job at educating ourselves and educating the public about concussion," said Dr. Holly Hanson, lead study author and an emergency medicine fellow. "People and doctors are recognizing sports-related concussions more. People are recognizing the signs and symptoms. People are more aware of the complications. So people are coming in more." According to the U.S. Centers for Disease Control and Prevent, each year TMI accounts for about 630,000 emergency department visits, 67,000 hospitalizations and 6,100 deaths in children and teens annually. Read more on injury prevention.
HHS Developing New Burn Treatments to Improve Disaster Response, Daily Care
Through its Biomedical Advanced Research and Development Authority (BARDA), the U.S. Department of Health and Human Services (HUD) is working to develop five new types of burn treatments for disaster response and daily emergency medical care. The thermal burn medical countermeasures—which could take the form of drugs, vaccines or medical products—will be for chemical, radiological or nuclear incidents. Developing new measures is critical, because with only 127 burn centers in the country, a mass casualty event could quickly overwhelm the public health response. “Sustainability of these medical countermeasures for thermal burns is critical for their availability when they are needed most,” said BARDA Director Robin Robinson, PhD. “Our repurposing and multi-purpose strategy facilitates development, ensures availability, and reduces overall costs for thermal burn medical countermeasures.” Read more on disasters.
AAP: Children Should Be Immunized Against Influenza As Soon As Possible this Season
Parents and caregivers should have all children ages 6 months or older immunized against influenza as soon as possible, according to new updated recommendations from the American Academy of Pediatrics (AAP). Immunization options include the trivalent vaccine that protects against three influenza strains and the new quadrivalent vaccine that protects against four strains. “Parents should not delay vaccinating their children to obtain a specific vaccine,” said pediatrician Henry Bernstein, DO, FAAP, the lead author of the flu recommendations. “Influenza virus is unpredictable, and what’s most important is that people receive the vaccine soon, so that they will be protected when the virus begins circulating.” Other vulnerable groups that should definitely be vaccinated include children with chronic health conditions, children of American Indian or Alaskan Native heritage, health care workers, pregnant women, women who may become pregnant or are breastfeeding and people who have contact with children in high-risk populations. The U.S. Centers for Disease Control and Prevention estimates that between 135 million and 139 million doses of vaccine will be manufactured for the 2013-14 influenza season. Read more on influenza.
HUD: $37M to Oklahoma for ‘Unmet Needs’ of Disaster Recovery
The U.S. Department of Housing and Urban Development (HUD) has allocated approximately $37 million in disaster recovery funds for the state of Oklahoma and the City of Moore, Okla., which were severely damaged by extreme storms—including an EF5 tornado—on May 20. Dozens were killed and more than $1 billion in property damage was caused. The grants are part of HUD’s Community development Block Grant Program, which supports long-term disaster recovery efforts in places of “unmet need.” “The May storms cost the lives of dozens of Oklahomans and over $1 billion in property damage. “We are steadily rebuilding, but many families are still struggling to get back on their feet,” said Oklahoma Governor Mary Fallin. “The disaster relief grants provided by HUD—along with continued work from state and local governments and non-profits—will make a big difference in the lives of those affected by this year’s tornadoes. They will be particularly helpful as we work to provide assistance to low income Oklahomans, many of whom are uninsured.” About $26.3 million of the funds will go toward Moore, with the rest going toward the state. Read more on disasters.
Boys Faced Higher Death Risk than Girls from Multiple Causes
Boys on average face a higher risk of death than girls—not just from traumatic events such as accidents, homicides and suicides, but also from cancers and diseases of the heart, lungs and nervous system. The study found that from 1999 to 2008 there were about 76,700 more deaths among boys than girls, and that boys from infancy to age 20 were 44 percent more likely to die. The findings appear in the latest edition of the journal Pediatrics. The findings are not entirely surprising, as past research has indicated that girls have a certain survival advantage and experts already knew that boys are at increased risk of developing certain chronic health conditions. Still, the question is why. "This could be a story of resilience and ability to overcome," said study author Chris Feudtner, MD, a pediatrician at the Children's Hospital of Philadelphia. "Maybe there's some robustness factor that males are missing." Feudtner said that learning why boys faced these higher risks—and for chronic diseases in particular—could help health care experts better understand and treat the conditions. Read more on mortality.