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1.
Health Promot Pract ; 20(3): 338-343, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30773046

RESUMEN

Emergence of a novel infectious disease, such as pandemic influenza, is the one global crisis most likely to affect the greatest number of people worldwide. Because of the potentially severe and contagious nature of influenza, a rapid multifaceted pandemic response, which includes nonpharmaceutical interventions (NPIs) and effective strategies for communication with the public are essential for a timely response and mitigating the spread of disease. A web-based questionnaire was administered via email in July 2015 to 62 Public Health Emergency Preparedness (PHEP) directors across jurisdictions that receive funding through the Centers for Disease Control and Prevention PHEP cooperative agreement. This report focuses on two modules: Public Information and Communication and Community Mitigation. Consistent and targeted communication are critical for the acceptability and success of NPIs. All 62 jurisdictions have developed or are in the process of developing a communications plan. Community-level NPIs such as home isolation, school closures, and respiratory etiquette play a critical role in mitigating the spread of disease. Effective, ongoing communication with the public is essential to ensuring wide spread compliance of NPI's, especially among non-English-speaking populations. Planning should also include reaching vulnerable populations and identifying the correct legal authorities for closing schools and canceling mass gatherings.

2.
MMWR Morb Mortal Wkly Rep ; 68(7): 174-176, 2019 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-30789877

RESUMEN

On January 13, 2018, at 8:07 a.m. Hawaii Standard Time, an errant emergency alert was sent to persons in Hawaii. An employee at the Hawaii Emergency Management Agency (EMA) sent the errant alert via the Wireless Emergency Alert (WEA) system and the Emergency Alert System (EAS) during a ballistic missile preparedness drill, advising persons to seek shelter from an incoming ballistic missile. WEA delivers location-based warnings to wireless carrier systems, and EAS sends alerts via television and radio (1). After 38 minutes, at 8:45 a.m., Hawaii EMA retracted the alert via WEA and EAS (2). To understand the impact of the alert, social media responses to the errant message were analyzed. Data were extracted from Twitter* using a Boolean search for tweets (Twitter postings) posted on January 13 regarding the false alert. Tweets were analyzed during two 38-minute periods: 1) early (8:07-8:45 a.m.), the elapsed time the errant alert circulated until the correction was issued and 2) late (8:46-9:24 a.m.), the same amount of elapsed time after issuance of the correction. A total of 5,880 tweets during the early period and 8,650 tweets during the late period met the search criteria. Four themes emerged during the early period: information processing, information sharing, authentication, and emotional reaction. During the late period, information sharing and emotional reaction themes persisted; denunciation, insufficient knowledge to act, and mistrust of authority also emerged as themes. Understanding public interpretation, sharing, and reaction to social media messages related to emergencies can inform development and dissemination of accurate public health messages to save lives during a crisis.


Asunto(s)
Comunicación , Urgencias Médicas , Salud Pública , Medios de Comunicación Sociales , Armas , Hawaii , Humanos , Riesgo
4.
Am J Public Health ; 107(S2): S180-S185, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28892440

RESUMEN

OBJECTIVES: To evaluate the Public Health Emergency Preparedness (PHEP) program's progress toward meeting public health preparedness capability standards in state, local, and territorial health departments. METHODS: All 62 PHEP awardees completed the Centers for Disease Control and Prevention's self-administered PHEP Impact Assessment as part of program review measuring public health preparedness capability before September 11, 2001 (9/11), and in 2014. We collected additional self-reported capability self-assessments from 2016. We analyzed trends in congressional funding for public health preparedness from 2001 to 2016. RESULTS: Before 9/11, most PHEP awardees reported limited preparedness capabilities, but considerable progress was reported by 2016. The number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had the largest increase, almost 200%, by 2014. However, more than 20% of jurisdictions still reported underdeveloped coordination between the health system and public health agencies in 2016. Challenges and barriers to building PHEP capabilities included lack of trained personnel, plans, and sustained resources. CONCLUSIONS: Considerable progress in public health preparedness capability was observed from before 9/11 to 2016. Support, sustainment, and advancement of public health preparedness capability is critical to ensure a strong public health infrastructure.


Asunto(s)
/tendencias , Defensa Civil/tendencias , Planificación en Desastres/tendencias , Servicios Médicos de Urgencia/historia , Servicios Médicos de Urgencia/tendencias , Salud Pública/historia , Salud Pública/tendencias , /historia , Defensa Civil/historia , Defensa Civil/estadística & datos numéricos , Planificación en Desastres/historia , Planificación en Desastres/estadística & datos numéricos , Servicios Médicos de Urgencia/estadística & datos numéricos , Historia del Siglo XXI , Humanos , Salud Pública/estadística & datos numéricos , Estados Unidos
5.
Am J Public Health ; 107(S2): S200-S207, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28892441

RESUMEN

OBJECTIVES: To evaluate and describe outcomes of state and local medical countermeasure preparedness planning, which is critical to ensure rapid distribution and dispensing of a broad spectrum of life-saving medical assets during a public health emergency. METHODS: We used 2007 to 2014 state and local data collected from the Centers for Disease Control and Prevention's Technical Assistance Review. We calculated descriptive statistics from 50 states and 72 local Cities Readiness Initiative jurisdictions that participated in the Technical Assistance Review annually. RESULTS: From 2007 to 2014, the average overall Technical Assistance Review score increased by 13% for states and 41% for Cities Readiness Initiative jurisdictions. In 2014, nearly half of states achieved the maximum possible overall score (100), and 94% of local Cities Readiness Initiative jurisdictions achieved a score of 90 or more. CONCLUSIONS: Despite challenges, effective and timely medical countermeasure distribution and dispensing is possible with appropriate planning, staff, and resources. However, vigilance in training, exercising, and improving plans from lessons learned in a sustained, coordinated way is critical to ensure continued public health preparedness success.


Asunto(s)
/organización & administración , Ciudades/estadística & datos numéricos , Defensa Civil/organización & administración , Redes Comunitarias/organización & administración , Planificación en Desastres/organización & administración , Servicios Médicos de Urgencia/organización & administración , Administración en Salud Pública , Humanos , Evaluación de Programas y Proyectos de Salud , Gobierno Estatal , Estados Unidos
6.
Am J Public Health ; 107(S2): S177-S179, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28892450

RESUMEN

OBJECTIVES: To assess how US Public Health Emergency Preparedness (PHEP) awardees plan to respond to an influenza pandemic with vaccination. METHODS: The Centers for Disease Control and Prevention developed the Pandemic Influenza Readiness Assessment, an online survey sent to PHEP directors, to analyze, in part, the readiness of PHEP awardees to vaccinate 80% of the populations of their jurisdictions with 2 doses of pandemic influenza vaccine, separated by 21 days, within 16 weeks of vaccine availability. RESULTS: Thirty-eight of 60 (63.3%) awardees reported being able to vaccinate their populations within 16 weeks; 38 (63.3%) planned to allocate more than 20% of their pandemic vaccine supply to points of dispensing (PODs). Thirty-four of 58 (58.6%) reported staffing as a challenge to vaccinating 80% of their populations; 28 of 60 (46.7%) reported preparedness workforce decreases, and 22 (36.7%) reported immunization workforce decreases between January 2012 and July 2015. CONCLUSIONS: Awardees relied on PODs to vaccinate segments of their jurisdictions despite workforce decreases. Planners must ensure readiness for POD sites to vaccinate, but should also leverage complementary sites and providers to augment public health response.


Asunto(s)
/organización & administración , Defensa Civil/organización & administración , Planificación en Desastres/organización & administración , Servicios Médicos de Urgencia/organización & administración , Gripe Humana/prevención & control , Vacunación Masiva/organización & administración , Pandemias/prevención & control , Humanos , Encuestas y Cuestionarios , Estados Unidos
7.
Am J Public Health ; 107(10): 1643-1645, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28817330

RESUMEN

OBJECTIVES: To assess the readiness to vaccinate critical infrastructure personnel (CIP) involved in managing public works, emergency services, transportation, or any other system or asset that would have an immediate debilitating impact on the community if not maintained. METHODS: We analyzed self-reported planning to vaccinate CIP during an influenza pandemic with data from 2 surveys: (1) the Program Annual Progress Assessment of immunization programs and (2) the Pandemic Influenza Readiness Assessment of public health emergency preparedness programs. Both surveys were conducted in 2015. RESULTS: Twenty-six (43.3%) of 60 responding public health emergency preparedness programs reported having an operational plan to identify and vaccinate CIP, and 16 (26.2%) of 61 responding immunization programs reported knowing the number of CIP in their program's jurisdictions. CONCLUSIONS: Many programs may not be ready to identify and vaccinate CIP during an influenza pandemic. Additional efforts are needed to ensure operational readiness to vaccinate CIP during the next influenza pandemic.


Asunto(s)
Actitud del Personal de Salud , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Pandemias/prevención & control , Planificación en Desastres , Humanos , Estados Unidos
8.
Vaccine ; 34(46): 5643-5648, 2016 11 04.
Artículo en Inglés | MEDLINE | ID: mdl-27686834

RESUMEN

BACKGROUND: During an influenza pandemic, to achieve early and rapid vaccination coverage and maximize the benefit of an immunization campaign, partnerships between public health agencies and vaccine providers are essential. Immunizing pharmacists represent an important group for expanding access to pandemic vaccination. However, little is known about nationwide coordination between public health programs and pharmacies for pandemic vaccine response planning. METHODS: To assess relationships and planning activities between public health programs and pharmacies, we analyzed data from Centers for Disease Control and Prevention assessments of jurisdictions that received immunization and emergency preparedness funding from 2012 to 2015. RESULTS: Forty-seven (88.7%) of 53 jurisdictions reported including pharmacies in pandemic vaccine distribution plans, 24 (45.3%) had processes to recruit pharmacists to vaccinate, and 16 (30.8%) of 52 established formal relationships with pharmacies. Most jurisdictions plan to allocate less than 10% of pandemic vaccine supply to pharmacies. DISCUSSION: While most jurisdictions plan to include pharmacies as pandemic vaccine providers, work is needed to establish formalized agreements between public health departments and pharmacies to improve pandemic preparedness coordination and ensure that vaccinating pharmacists are fully utilized during a pandemic.


Asunto(s)
Prestación Integrada de Atención de Salud , Gripe Humana/prevención & control , Pandemias/prevención & control , Farmacias , Salud Pública , Defensa Civil/economía , Defensa Civil/estadística & datos numéricos , Planificación en Desastres/estadística & datos numéricos , Humanos , Inmunización , Subtipo H1N1 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/administración & dosificación , Farmacéuticos , Estados Unidos , Cobertura de Vacunación
9.
Health Secur ; 13(5): 317-26, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26348094

RESUMEN

Our objective was to inform state and community interventions focused on increasing household preparedness by examining the association between self-reported possession of household disaster preparedness items (ie, a 3-day supply of food and water, a written evacuation plan, and a working radio and flashlight) and perceptions of household preparedness on a 3-point scale from "well prepared" to "not at all prepared." Data were analyzed from 14 states participating in a large state-based telephone survey: the 2006-2010 Behavioral Risk Factor Surveillance System (BRFSS) (n = 104,654). Only 25.3% of the population felt they were well prepared, and only 12.3% had all 5 of the recommended items. Fewer than half the households surveyed had 4 or more of the recommended preparedness items (34.1%). Respondents were more likely to report their households were well prepared as the number of preparedness items possessed by their household increased. Risk factors for having no preparedness items were: younger age, being female, lower levels of education, and requesting the survey to be conducted in Spanish. To increase household disaster preparedness, more community-based preparedness education campaigns targeting vulnerable populations, such as those with limited English abilities and lower reading levels, are needed.


Asunto(s)
Planificación en Desastres/estadística & datos numéricos , Urgencias Médicas , Salud Pública/educación , Adolescente , Adulto , Sistema de Vigilancia de Factor de Riesgo Conductual , Suministros de Energía Eléctrica , Composición Familiar , Femenino , Alimentos , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Práctica de Salud Pública , Clase Social , Estados Unidos , Agua , Adulto Joven
10.
BMC Endocr Disord ; 14: 86, 2014 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-25348326

RESUMEN

BACKGROUND: Polycystic Ovary Syndrome (PCOS) is an endocrine-metabolic disorder that affects approximately 6-10% of women of child-bearing age. Although preliminary studies suggest that certain pollutants may act as endocrine disruptors in animals, little is known about their potential association with PCOS. The objective of this case-control pilot study is to determine whether women with PCOS have higher concentrations of specific environmental contaminants compared to women who have not developed PCOS. METHODS: Fifty-two PCOS case-patients (diagnosed using the National Institutes of Health 1990 definition) and 50 controls were recruited in 2007-2008, from an urban academic medical center in Los Angeles, CA. Brominated diphenyl ethers, polychlorinated biphenyls (PCBs), organochlorine pesticides, and perfluorinated compounds (PFCs) were measured in serum, and phthalates metabolites and bisphenol A (BPA) in urine. RESULTS: PCOS case-patients had significantly higher geometric mean (GM) serum concentrations of two PFCs: perfluorooctanoate (PFOA) (GMcases = 4.1 µg/L, GMcontrols = 2.3 µg/L; p = 0.001) and perfluorooctane sulfonate (PFOS) (GMcases = 8.2 µg/L, GMcontrols = 4.9 µg/L; p = 0.01), and lower urinary concentrations of monobenzyl phthalate (mBzP) (GMcases = 7.5 µg/g creatinine, GMcontrols = 11.7 µg/g creatinine; p = 0.02). Logistic regression, controlling for body mass index, age and race, identified an increased likelihood of PCOS in subjects with higher serum concentrations of PFOA and PFOS (adjusted-ORs = 5.8-6.9, p < 0.05), and with lower urine concentrations of mBzP and mono-n-butyl phthalate (mBP) (aORs = 0.14-0.25, p < 0.05). CONCLUSIONS: Our data suggest that PCOS case-patients may differ from controls in their environmental contaminant profile. PCOS subjects had higher serum concentrations of two PFCs, PFOA and PFOS, and lower urine concentrations of mBP and mBzP. Future studies are needed to confirm these preliminary findings and determine if these chemicals or their precursors may have a role in the pathogenesis of PCOS.


Asunto(s)
Disruptores Endocrinos/sangre , Monitoreo del Ambiente , Contaminantes Ambientales/efectos adversos , Síndrome del Ovario Poliquístico/inducido químicamente , Adolescente , Adulto , Compuestos de Bencidrilo/sangre , Caprilatos/sangre , Estudios de Casos y Controles , Cromatografía de Gases , Disruptores Endocrinos/efectos adversos , Contaminantes Ambientales/sangre , Femenino , Fluorocarburos/sangre , Éteres Difenilos Halogenados/sangre , Humanos , Hidrocarburos Clorados/sangre , Espectrometría de Masas , Persona de Mediana Edad , Plaguicidas/sangre , Fenoles/sangre , Ácidos Ftálicos/sangre , Proyectos Piloto , Bifenilos Policlorados/sangre , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/epidemiología , Prevalencia , Extracción en Fase Sólida , Manejo de Especímenes , Estados Unidos/epidemiología
11.
Weather Clim Soc ; 6: 22-31, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27239260

RESUMEN

Dangerously cold weather threatens life and property. During periods of extreme cold due to wind chill, the National Weather Service (NWS) issues wind chill warnings to prompt the public to take action to mitigate risks. Wind chill warnings are based on ambient temperatures and wind speeds. Since 2010, NWS has piloted a new extreme cold warning issued for cold temperatures in wind and nonwind conditions. The North Dakota Department of Health, NWS, and the Centers for Disease Control and Prevention collaborated in conducting household surveys in Burleigh County, North Dakota, to evaluate this new warning. The objectives of the evaluation were to assess whether residents heard the new warning and to determine if protective behaviors were prompted by the warning. This was a cross-sectional survey design using the Community Assessment for Public Health Emergency Response (CASPER) methodology to select a statistically representative sample of households from Burleigh County. From 10 to 11 April 2012, 188 door-to-door household interviews were completed. The CASPER methodology uses probability sampling with weighted analysis to estimate the number and percentage of households with a specific response within Burleigh County. The majority of households reported having heard both the extreme cold and wind chill warnings, and both warnings prompted protective behaviors. These results suggest this community heard the new warning and took protective actions after hearing the warning.

13.
Am J Public Health ; 103(8): e52-8, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23763401

RESUMEN

OBJECTIVES: We describe the demographics of the decedents from the tornado outbreak in Alabama on April 27, 2011; examine the circumstances of death surrounding these fatalities; and identify measures to prevent future tornado-related fatalities. METHODS: We collected information about the decedents from death certificates, disaster-related mortality surveillance, and interview data collected by American Red Cross volunteers from the decedent's families. We describe demographic characteristics, circumstances and causes of death, and sheltering behaviors before death. RESULTS: Of the 247 fatalities, females and older adults were at highest risk for tornado-related deaths. Most deaths were directly related to the tornadoes, on scene, and trauma-related. The majority of the deceased were indoors in single-family homes. Word of mouth was the most common warning mechanism. CONCLUSIONS: This tornado event was the third deadliest in recent US history. Our findings support the need for local community shelters, enhanced messaging to inform the public of shelter locations, and encouragement of word-of-mouth warnings and personal and family preparedness planning, with a special focus on assisting vulnerable individuals in taking shelter.


Asunto(s)
Desastres/estadística & datos numéricos , Tornados , Heridas y Traumatismos/mortalidad , Distribución por Edad , Factores de Edad , Alabama/epidemiología , Femenino , Humanos , Masculino , Vigilancia de la Población , Factores de Riesgo , Factores Sexuales
14.
Ann Emerg Med ; 61(4): 468-74, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23374417

RESUMEN

STUDY OBJECTIVE: To characterize the demographic, clinical, and epidemiologic features of levamisole-associated neutropenia in cocaine or heroin users. METHODS: State health departments were recruited for participation when the Centers for Disease Control and Prevention (CDC) was notified of potential cases by a clinician, a health department official, or a poison center between October 15, 2009, and May 31, 2010. A case was defined as a person with an absolute neutrophil count less than 1,000 cells/µL (or a WBC count <2,000 cells/µL) and a self-reported history or laboratory confirmation of cocaine or heroin use. Health department officials abstracted data from medical charts, attempted a patient interview, and submitted data to CDC for descriptive analysis. RESULTS: Of the 46 potential cases reported from 6 states, half met eligibility criteria and had medical chart abstractions completed (n=23; 50%). Of these, close to half of the patients were interviewed (n=10; 43%). The average age was 44.4 years; just over half were men (n=12; 52%). The majority of patients presented to emergency departments (n=19; 83%). More than half presented with infectious illnesses (n=12; 52%), and nearly half reported active skin lesions (n=10; 44%). The majority of interview respondents used cocaine greater than 2 to 3 times a week (n=9; 90%), used cocaine more than 2 years (n=6; 60%), and preferred crack cocaine (n=6; 60%). All were unaware of exposure to levamisole through cocaine and of levamisole's inherent toxicity (n=10; 100%). CONCLUSION: Physicians should suspect levamisole exposure in patients using illicit drugs, cocaine in particular, who present with unexplained neutropenia. Most patients reported chronic cocaine use and were unaware of levamisole exposure. Cocaine use is more prevalent among men; however, our results identified a higher-than-expected proportion of female users with neutropenia, suggesting women may be at higher risk. Emergency physicians and practitioners are uniquely positioned to recognize these patients early during their hospital course, elucidate a history of cocaine or other drug exposure, and optimize the likelihood of confirming exposure by arranging for appropriate drug testing.


Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Contaminación de Medicamentos , Dependencia de Heroína/complicaciones , Levamisol/efectos adversos , Neutropenia/inducido químicamente , Adulto , Cocaína/efectos adversos , Contaminación de Medicamentos/estadística & datos numéricos , Femenino , Heroína/efectos adversos , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Neutropenia/epidemiología , Vigilancia de la Población , Estados Unidos/epidemiología
15.
J Anal Toxicol ; 35(8): 545-50, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22004673

RESUMEN

The United States Public Health Service Substance Abuse and Mental Health Services Administration is alerting medical professionals that a substantial percentage of cocaine imported into the United States is adulterated with levamisole, a veterinary pharmaceutical that can cause blood cell disorders such as severe neutropenia and agranulocytosis. Levamisole HCl is the active ingredient in a number of veterinary drugs approved to treat worm infestations in animals. Levamisole HCl was also the active ingredient in a human drug for oral administration approved on June 18, 1990, as adjuvant treatment in combination with fluorouracil after surgical resection in patients with Duke's stage C colon cancer. This drug was withdrawn from the U.S. market around 2000, and it has not been marketed in the U.S. since then. The objective of this study was to develop a method to determine the amount of levamisole in urine samples. The procedure will be provided to state health laboratories as needed to be used in the evaluation of patients that have developed neutropenia or agranulocytosis in the setting of recent cocaine use. A gas chromatography-mass spectrometry method was validated and tested at two different laboratories, and the method limit of detection for levamisole is 1 ng/mL in urine when using a 5-mL sample. Confirmation of the stereoisomer of levamisole was done by high-performance liquid chromatography using a chiral column.


Asunto(s)
Trastornos Relacionados con Cocaína/diagnóstico , Cocaína/orina , Contaminación de Medicamentos , Cromatografía de Gases y Espectrometría de Masas , Levamisol/orina , Detección de Abuso de Sustancias/métodos , Drogas Veterinarias/orina , Agranulocitosis/inducido químicamente , Calibración , Cocaína/química , Trastornos Relacionados con Cocaína/orina , Cromatografía de Gases y Espectrometría de Masas/normas , Humanos , Levamisol/efectos adversos , Límite de Detección , Neutropenia/inducido químicamente , Reproducibilidad de los Resultados , Detección de Abuso de Sustancias/normas , Estados Unidos , Drogas Veterinarias/efectos adversos
16.
Am J Ment Retard ; 111(4): 299-306, 2006 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-16792431

RESUMEN

Educational outcomes were evaluated for 2,046 preschool children identified with developmental delay. Results indicated that at third grade, 26% were in regular education and the remaining 74% were receiving special education services. The most common disability classifications at outcome were specific learning disabilities and educable mentally handicaps. Regular education, but not special education, children had higher retention rates than did the general population. The presence of one or more secondary exceptionalities in preschool was more common for special education than regular education children. Regular education and special education children did not differ on other factors studied. This study highlights the importance of developmental delay as an exceptionality category and advances our understanding of the long-term implications of such delay.


Asunto(s)
Discapacidades del Desarrollo/diagnóstico , Educación Especial , Preescolar , Discapacidades del Desarrollo/psicología , Discapacidades del Desarrollo/terapia , Educación de las Personas con Discapacidad Intelectual , Femenino , Florida , Estudios de Seguimiento , Humanos , Discapacidad Intelectual/diagnóstico , Discapacidad Intelectual/psicología , Discapacidad Intelectual/terapia , /psicología , Masculino
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