False Beliefs and Attitude Are Barriers to COVID-19 Vaccination.

As of October 2021, Medical Reserve Corps (MRC) volunteers donated over 2 million h to coronavirus disease 2019 (COVID-19). The Health Belief Model (HBM) is used to understand the value a person places on preventative behavior against the risk of disease. A mixed method, unmatched, prospective case-control study was conducted regarding volunteers' experience during the pandemic, reasons why these highly trained persons volunteer, what barriers to vaccination they observed, and how they helped others overcome those barriers. The HBM can elucidate the cognitive process to vaccinate. Regression analysis found a person's attitude (which includes beliefs, peer pressure, preconceptions, unwillingness, and other indicators) is a barrier to vaccination. Service hours increased from 20 to 56 h among volunteers who saw attitude as a barrier to vaccination. Superstition and fear accounted for 99.8% of unvaccinated persons (P < 0.001). Fear was a barrier to protective health behavior. The public health system must do better to build trust as an ongoing endeavor, as even the increased service volunteers provided in response to the observed attitudes, was not enough to stem exponential transmission once the pandemic had begun. Policy-makers and the public health authority should take all necessary steps early in the pandemic to ensure the effectiveness of the vaccination program.

Medical Reserve Corps Volunteers' Characteristics Affect Disaster Survival.

OBJECTIVE: Medical Reserve Corps' volunteers underwent stop-the-bleed, triage, and disaster preparedness training to improve victim survival of a mass casualty event. METHODS: Volunteer responses to 16 disaster vignettes were recorded as 'survived' if correct, or 'died' if incorrect. Volunteers' characteristics were evaluated based on the health outcomes of the vignette victims via logistic regression. RESULTS: Overall, 69 volunteers evaluated 1104 vignette victims. STB training significantly improved survival from 77.2% to 93.2% (P < 0.001). The training did not improve disaster preparedness (75.5% to 73%) nor triage (33.5% to 35.1%). Volunteer first care provider training in psychological first aid improved victim survival from 10.32 (9.6 - 10.9, 95% CI) to 11.9 (11.28 - 12.5, 95% CI). The odds of survival increased when disaster victims received first care from a volunteer who had a positive perception of the public authority's truthfulness (1.50, range 1.07 - 2.10); stated a willingness to volunteer (1.65, range 1.2 - 2.26); completed psychological first aid training (1.557, range 1.08 - 2.22); or had 4-or-more years of post-secondary education (1.30, range 1.00 - 1.701). CONCLUSION: Psychological first aid training should be a basic requirement for disaster volunteers. Trust in public authority to provide protective public health recommendations increases disaster survival.

Pandemic Isolation and Mental Health Among Children.

OBJECTIVE: Mental health issues increased during the COVID - 19 pandemic, especially among children. Our past research efforts found that surveillance data can address a variety of health concerns; that personal psychological awareness impacted ability to cope, and mental health outcomes were improved when survivors were triaged to mental health countermeasures. To build upon our public health efforts, we wanted to see if increased screen time due to remote learning caused by the pandemic influenced school aged children's mental health. METHODS: With the hypothesis that excessive time spent isolated during remote learning increased the amount of mental health events in children, we conducted a public health surveillance project on actual diagnoses rather than just symptoms, controlling for historical mental health and emotional disorders. RESULTS: The entire cohort of children aged 6 to 17 years were studied over time before and during the pandemic for their medically diagnosed mental health and emotional outcomes by the amount of pandemic induced social isolation. CONCLUSIONS: After controlling for historical diagnoses and the rate of COVID - 19, the effect of pandemic - induced social isolation had a linear increase on the amount of anxiety, resulting in a 4-fold increase in pandemic social isolation - induced anxiety.

Syndromic Surveillance Data for Accidental Fall Injury.

BACKGROUND: Fall injuries (FI) are a priority for public health planning. Syndromic surveillance (SS) is used to detect outbreaks, environmental exposures, and bioterrorism in real time. Since information is gathered on patients, the utility of using this system for FI should be evaluated. METHODS: Strategies to integrate FI medical and SS data were compared using a cohort versus case control (CC) study design. RESULTS: The CC study was accurate 77.7% (57.7-91.3) of the time versus 100% for a cohort design. The CC study design found FI increased for older age groups, female gender, November, and December months. Dates with any freezing temperature had a higher case fatality rate. Repeat acute care visits increased the risk of FI diagnosis by over 6% and trended upward with each visit (R=.333, p<.001). CONCLUSIONS: The CC diagnostic quality of FI were better for age and gender than for area. The CC study found the indicators of increased risk of FI including freezing temperature, repeat acute care visits, older age groups, female gender, November, and December months. A gradient of increasing odds of FI with the number of acute care visits provides proof that community fall prevention programs should focus on those most likely to fall. A CC design of SS data can quickly identify indicators of FI with a lower accuracy but with less cost than a full cohort study, thus providing a method to focus local public health interventions.

International Air Travel to Ohio, USA, and the Impact on Malaria, Influenza, and Hepatitis A.

The State of Ohio led the United States in measles in 2014, ostensibly related to international air travel (IAT), and ranked lower than 43 other states in infectious disease outbreak preparedness. We conducted a retrospective cohort study using surveillance data of the total Ohio population of 11 million from 2010 through 2014 with a nested case control of air travelers to determine the risk of malaria, seasonal influenza hospitalizations (IH), and hepatitis A (HA) disease related to international travel and to estimate the association with domestic enplanement. IAT appeared protective for HA and IH with a risk of 0.031 (.02-.04) but for malaria was 2.7 (2.07-3.62). Enplanement increased the risk for nonendemic M 3.5 (2.5-4.9) and for HA and IH 1.39 (1.34-1.44). IAT's ratio of relative risk (RRR) of malaria to HA and IH was 87.1 (55.8-136) greater than 219 times versus domestic enplanement which was protective for malaria at 0.397 (0.282-0.559). Malaria is correlated with IAT with cases increasing by 6.9 for every 10,000 passports issued.

Medical Allocations to Persons with Special Needs during a Bioterrorism Event.

After the bioterrorism-anthrax attacks of 2001, public health officials were tasked with planning population-wide medicine dispensing. This planning started with assumptions and then evaluations of seasonal immunization clinics. Research on the 2009 H1N1 pandemic-vaccination campaign showed that an adequately prepared public health system could have prevented over 16% of flu-associated hospitalizations. The 2011 ice storms revealed difficulties with sheltering medically fragile persons with disabilities. Later research showed that training and preparedness levels increased responders' willingness to serve. When triaging disaster survivors to community-mass-care-services of general shelters, medical shelters, or mental health services; sorting improved up to 15% when past traumatic effects, personal care assistance, or service methodology were accounted for. The number of persons who are disabled and dependent on electric medical equipment are increasing. This current study compared the time it takes to dispense medication to two different cohorts: a general-population cohort (n=31) and a special-needs cohort (n=30). The cohort comprised entirely of persons with special needs took 4.1 compared to 2.48 minutes per person in a general population cohort (p=.057). A person with any special needs took 3.73 versus 2.43 minutes for a person with no special needs (p=.082). Modeling of service times per station and cohort type found significant delays at the medical station among persons in the general population who are pregnant (14 minutes or 840 seconds, p=.002) and persons in the special needs cohort with a language barrier (12.5 minutes or 750 seconds, p=.001). Recommendations include planning for closed Points of Dispensing Sites (PODS) to those with special needs, ensuring a sufficient number of medical dispenser in open PODS, and assigning extra capacity at the medical station area for special needs involving children, language, or pregnancy issues.

Using Functional Needs and Personal Care Assistance Rather Than Disability Status During Chronic Care Triage in Community Mass Care.

OBJECTIVE: To evaluate Medical Reserve Corps volunteers and public health workers in conducting chronic care triage by use of a rubric prior to sheltering to connect survivors with services. METHODS: Participants were randomly assigned to 1 of 3 algorithms or a control group during a simulated disaster scenario and were asked to rate 20 survivors arriving at a chronic care triage station with situation-appropriate transport services. Survivors were simulated on the basis of the expected disability distributions of mobility, sensory-visual, cognition, medical devices, capacity to perform activities of daily living (ADLs), age (18 to 90 years), weight, and gender expected in the general population but expanded to 90% of those presenting. Mean percentage correct scores were assessed by using one-way analysis of variance. RESULTS: Accounting for personal care assistance and service methodology during chronic care triage increased efficiency by up to 8% in meeting chronic care health service needs during disaster community mass care management. CONCLUSIONS: A chronic care triage process as part of community mass care management that considers the availability of personal care assistance and service methodology will enhance the allocation of functional needs support services and increase compliance with Americans with Disabilities Act requirements regarding not segregating persons because of disability. (Disaster Med Public Health Preparedness. 2015;9:265-274).

Mental health triage tools for medically cleared disaster survivors: an evaluation by MRC volunteers and public health workers.

OBJECTIVE: Psychological assessment after disasters determines which survivors are acutely distressed or medically compromised and what kind of assistance is needed (whether practical or psychological). A mental health triage tool can help direct more people to the appropriate type of help. The purpose of this study was to determine the effectiveness of the Fast Mental Health Triage Tool (FMHT) and the Alsept-Price Mental Health Scale (APMHS) among public health workers and Medical Reserve Corps (MRC) volunteers in conducting mental health triage. Both tools screen for ability to follow simple commands, chronic medical conditions, mental health conditions and services, occult injuries, and traumatic events in the past year. Both were designed for use in disasters where mental health resources are scarce and survivors are already medically triaged. METHODS: Volunteers (n = 204) and workers (n = 66) were randomized into 3 groups, with 79 participating. Fifty-nine raters completed 20 each of 1180 mental health clinical vignettes of disaster survivors. RESULTS: The survey presenting the vignettes was highly reliable at 0.771; the study model was parallel between baseline and treatment; and the interclass correlation among the raters was high at 0.852. Each rater triaged the same cases, but the rater was randomly assigned to use FMHT, APMHS, or no tool or scale. Between-subject effect for the tools used was significant (P = .039). The FMHT was significantly better than no tool in correct mental health triage, 67.3% to 51.5% (P = .028). CONCLUSION: The incorporation of a temporal component should be evaluated for potential inclusion in existing mental health triage systems.

Critical issues in bioterrorism preparedness: before and after September 2001.

The Bioterrorism Preparedness and Response Survey (BPRS) was a survey of Ohio local health departments' capacity to respond to bioterrorism. Soon after completion of the BPRS, the events of September 11 occurred, followed by the human cases of anthrax. The Ohio Response to Bioterrorism 2001 Survey (ORB) identified bioterrorism preparedness issues related to the suspected anthrax incidents. The BPRS measured capacity before September 11, 2001, and the ORB measured Ohio communities' response to white powder incidents. The BPRS and ORB provided independent and outcome measures related to the 2001-bioterrorism events. The significant bioterrorism response issues were: monitoring critical or unexplained deaths and clusters or symptoms; training on bioterrorism agents; integration of medical and criminal investigations of bioterrorism incidents; development of bioterrorism emergency response plans to include agencies to be contacted, management strategies for implementing mass vaccination, prophylaxis, treatment distribution and administration; and participation in a bioterrorism field or tabletop exercise. These results are confirmed and extended by studies by the US General Accounting Office, the Rand Corporation, Trust in the Future of America's Health foundation, and a follow-up survey of issues during a simulated covert smallpox attack.

Health effects in community residents near a uranium plant at Fernald, Ohio, USA.

OBJECTIVES: Health outcomes in persons who lived in the area surrounding a U.S. Department of Energy (DOE) uranium processing plant near Fernald, Ohio were evaluated using data of Fernald Medical Monitoring Program (FMMP) participants. METHODS: Residential history information was used to identify participants who lived in close proximity to the plant (less than 2 miles), in the direction of groundwater runoff (south of the plant), or used a well or cistern as a drinking water source. Standardized prevalence ratios (SPRs) for certain disease endpoints were calculated using the U.S. National Health Interview Survey(NHIS) and the National Health and Nutrition Examination Survey (NHANES) data files for comparison rates. RESULTS: Findings suggest that prior living within the Fernald exposure domain is related to increased prevalence of urinary system disease. Statistically significant elevations of bladder disease (standardized prevalence ratio or SPR = 1.32) and kidney disease (SPR = 2.15), including sub-categories, kidney stones (SPR = 3.98) and chronic nephritis (SPR = 2.03) were noted, as well as increased rates for hematuria and urethral stricture. In regression analyses with adjustment forage and sex, serum creatinine levels were increased in those who had lived close to the plant. Increased white blood cell count and hemoglobin levels, and decreased mean corpuscular volume were also found in those living less than 2 miles from the plant. Those who used a well or cistern for drinking water were found to have increased urinary microalbumin, red blood cell count and hematocrit. CONCLUSIONS: These preliminary findings will provide the basis for future hypothesis testing incorporating important determinants of exposure not included in this study, such as duration and calendar year of exposure, location relevant to prevailing wind direction, and age at exposure.