Ethnic differences in risk: experiences, medical needs, and access to care after hurricane Sandy in new jersey.

This survey investigation assessed an economically challenged and largely minority population regarding concerns, evacuation status, medical needs and access to care during, and after, Hurricane Sandy by ethnicity status for patients using New Jersey's Federally Qualified Health Centers (FQHC). Data obtained contribute to understanding risk from disasters, and improving environmental justice for vulnerable populations following disasters. FQHCs provide medical and dental services for 5% of New Jersey 's population; 95% of those served are uninsured, underinsured, or live below the poverty level. Economically vulnerable individuals are more at risk and were disproportionately harmed by Sandy. There were ethnic differences in days evacuated, days without power and heat, self-rating of personal/family impact, center use, need and access, and interruptions of care and medications. Hispanics and Blacks reported needing centers significantly more than White population. Primary medical conditions were diabetes, asthma, hypertension, and arrhythmia and heart disease, which did not vary ethnically. Understanding medical needs and concerns of vulnerable populations may help policymakers and practitioners prepare and respond promptly to disasters, reducing risk, and building resiliency for the medical care system.

Concerns and future preparedness plans of a vulnerable population in New Jersey following Hurricane Sandy.

Knowing how people prepare for disasters is essential to developing resiliency strategies. This study examined recalled concerns, evacuation experiences, and the future preparedness plans of a vulnerable population in New Jersey, United States, following Hurricane Sandy in 2012. Understanding the responses of minority communities is key to protecting them during forthcoming disasters. Overall, 35 per cent of respondents were not going to prepare for an event. Intended future preparedness actions were unrelated to respondents' ratings of personal impact. More Blacks and Hispanics planned on preparing than Whites (68 versus 55 per cent), and more Hispanics planned on evacuating than did others who were interviewed. A higher percentage of respondents who had trouble getting to health centres were going to prepare than others. Respondents' concerns were connected to safety and survival, protecting family and friends, and having enough food and medicine, whereas future actions included evacuating earlier and buying sufficient supplies to shelter in place.

Passenger rail security, planning, and resilience: application of network, plume, and economic simulation models as decision support tools.

We built three simulation models that can assist rail transit planners and operators to evaluate high and low probability rail-centered hazard events that could lead to serious consequences for rail-centered networks and their surrounding regions. Our key objective is to provide these models to users who, through planning with these models, can prevent events or more effectively react to them. The first of the three models is an industrial systems simulation tool that closely replicates rail passenger traffic flows between New York Penn Station and Trenton, New Jersey. Second, we built and used a line source plume model to trace chemical plumes released by a slow-moving freight train that could impact rail passengers, as well as people in surrounding areas. Third, we crafted an economic simulation model that estimates the regional economic consequences of a variety of rail-related hazard events through the year 2020. Each model can work independently of the others. However, used together they help provide a coherent story about what could happen and set the stage for planning that should make rail-centered transport systems more resistant and resilient to hazard events. We highlight the limitations and opportunities presented by using these models individually or in sequence.

Disaster Preparedness: Biological Threats and Treatment Options.

Biological disasters can be natural, accidental, or intentional. Biological threats have made a lasting impact on civilization. This review focuses on agents of clinical significance, bioterrorism, and national security, specifically Category A agents (anthrax, botulism, plague, tularemia, and smallpox), as well as briefly discusses other naturally emerging infections of public health significance, Ebola virus (also a Category A agent) and Zika virus. The role of pharmacists in disaster preparedness and disaster response is multifaceted and important. Their expertise includes clinical knowledge, which can aid in drug information consultation, patient-specific treatment decision making, and development of local treatment plans. To fulfill this role, pharmacists must have a comprehensive understanding of medical countermeasures for these significant biological threats across all health care settings. New and reemerging infectious disease threats will continue to challenge the world. Pharmacists will be at the forefront of preparedness and response, sharing knowledge and clinical expertise with responders, official decision makers, and the general public.

Health Care Student Knowledge and Willingness to Work in Infectious Disease Outbreaks.

OBJECTIVE: Health care workers are critical first responders. Understanding which factors motivate their willingness to work (WTW) during infectious disease outbreaks may guide improvements in preparedness. The perspective of health care students, the future workforce, remains largely unexplored. This study compared factors influencing WTW among medical, nursing, and pharmacy students. METHODS: A printed survey was administered to 631 medical, nursing, and pharmacy students. The questionnaire elicited information regarding prior disaster training, disease-related knowledge, and WTW in the setting of infectious diseases with contact or respiratory transmission. RESULTS: Analyses of the 579 respondents (92% response rate) demonstrated that students were less fearful for their health and more willing to work during outbreaks with contact transmission than during those with respiratory transmission. Medical students were the most fearful for their health, but they demonstrated the greatest WTW, followed by nursing students, and then pharmacy students. Medical students were also the most knowledgeable about infectious diseases. Prior disaster training was associated with greater WTW. CONCLUSIONS: Extent of disease-related knowledge and prior disaster training appear to influence WTW. Our findings, taken in the context of a remarkable underemphasis on disaster preparedness in health care curricula, call for a broader incorporation of disaster training to improve the WTW of health care students, and, ultimately, health care workers. (Disaster Med Public Health Preparedness. 2017;11:694-700).

Impact of a targeted intervention on lipid-lowering therapy in patients with coronary artery disease in the hospital setting.

BACKGROUND: Although lipid-lowering therapy according to the National Cholesterol Education Program guidelines decreases mortality and morbidity in patients with coronary artery disease (CAD), significant undertreatment of hyperlipidemia continues to occur. This study was designed to determine the impact of an intervention targeted at improving the use of lipid-lowering therapy in patients with CAD in the hospital setting. METHODS: Cardiac case managers prompted physicians to obtain lipid profiles for patients with CAD who were not receiving lipid-lowering therapy on admission and initiate lipid-lowering therapy for patients with a low-density lipoprotein level of 130 mg/dL (3.37 mmol/L) or higher during hospitalization. The study population comprised 813 patients with CAD admitted for percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, or myocardial infarction. A retrospective chart review of lipid testing and treatment rates was conducted in 300 patients in the preintervention period, and a prospective review of rates was conducted in 513 patients during the intervention period. RESULTS: The percentage of patients with CAD not receiving lipid-lowering therapy on admission who had fractionated lipid profiles obtained during hospitalization increased from 27% preintervention to 89% during intervention (odds ratio, 18.27; 95% confidence interval, 11.61-28.74; P<.001). The percentage of patients with a low-density lipoprotein level of 130 mg/dL or higher for whom lipid-lowering therapy was initiated during hospitalization increased from 17% preintervention to 82% during intervention (odds ratio, 24.50; 95% confidence interval, 7.33-81.83; P<.001). CONCLUSIONS: The intervention provided by specialized cardiac case managers significantly increased physicians' adherence to the National Cholesterol Education Program treatment guidelines. The results of the present study suggest that intervention programs of this nature could produce a significant positive impact on cardiovascular outcomes if implemented nationally.

Effect of anemia on 1-year mortality in patients with acute myocardial infarction.

BACKGROUND: Limited data are available on the effect of anemia on mortality in patients with acute myocardial infarction (MI). METHODS: We examined the association of anemia with mortality at 1 year among 30,341 patients hospitalized with acute MI in 1986 (prethrombolytic era, n = 15,584) and 1996 (thrombolytic era, n = 14,757). The records were obtained from the Myocardial Infarction Data Acquisition System, a database of all patients with MI admitted to nonfederal hospitals in New Jersey. RESULTS: Anemia was present in 996 patients (6.4%) in 1986 and 1510 patients (10.2%, P <.0001) in 1996. In both years, patients with anemia were older, more frequently female and nonwhite, and more likely to have left ventricular dysfunction, non-Q MI and coronary artery bypass graft. In addition, in 1996, patients with anemia were more likely to undergo percutaneous transluminal coronary angioplasty and less likely to have a history of MI. One-year mortality was lower overall in 1996 compared with 1986 (1996 23.6%, 95% CI 22.9-24.3 vs 1986 24.9%, 95% CI 24.2-25.6, P =.0001). In both years, patients with anemia had significantly higher unadjusted risk for 1-year mortality (RR = 1.40, P =.0001 in both years). However, after controlling for demographics, left ventricular dysfunction, arrhythmias, Q versus non-Q MI, comorbid conditions, and revascularization procedures in a multivariable regression model, 1-year mortality in the anemia group was similar to the nonanemia group in both years. CONCLUSION: In the Myocardial Infarction Data Acquisition System database, anemia appears to have no significant direct effect on 1-year mortality. The higher unadjusted mortality observed among patients with acute MI and anemia is probably the result of older age, higher comorbidity, and more left ventricular dysfunction.

Persistence of normotension after discontinuation of lifestyle intervention in the trial of TONE. Trial of Nonpharmacologic Interventions in the Elderly.

BACKGROUND: Weight loss and sodium reduction programs are effective in treating hypertension, but there is little information about the persistence of the benefit after discontinuation of the intervention. METHODS: The Trial of Nonpharmacologic Interventions in the Elderly (TONE) was a four-center controlled clinical trial of weight loss, reduced sodium intake, or both in maintaining normotension after withdrawal of antihypertensive drug therapy in older men and women whose hypertension was controlled with a single antihypertensive medication. Information on maintenance of normotension without need for drug therapy was obtained on 222 of 223 participants at the Robert Wood Johnson Medical School clinical center on average of 48.4 months (range 45 to 54 months) after the end of TONE. RESULTS: At the end of TONE follow-up, 43% of participants in the combined intervention group were off medication compared with 25% in the usual care group (P = .011). At 48 months after the end of TONE and discontinuation of contact of the participants with the clinical center, 23% of the combined intervention group v 7% in the usual care group were off medication (P = .012). CONCLUSIONS: Some benefits of structured dietary intervention appears to persist long term in a significant number of patients after discontinuation of the intervention.