23 research outputs found
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Atropine Use in Children After Nerve Gas Exposure
Following the FDA's approval of a pediatric dosage Atropen®, the Pediatric Expert Advisory Panel was asked to review the existing guidelines and recommendations regarding the treatment of children exposed to nerve agents and the Mark-1 Kit; review the new literature on pediatric nerve agent exposure; and to develop recommendations and guidelines for this new device including modifications to the existing recommendations and guidelines if warranted. In May 2003, the first nationally accepted pediatric disaster and terrorism preparedness recommendations and treatment guidelines were issued by the Program for Pediatric Preparedness of the National Center for Disaster Preparedness (NCDP). These guidelines were based on a National Consensus Conference sponsored by the Program for Pediatric Preparedness and funded by the Agency for Healthcare Research and Quality and the EMS for Children Program of the Health Resources and Services Administration. At that time, the only available treatment for certain types of nerve gas exposure (predominantly those with anticholinesterase properties) was the Mark 1 kit. The recommendations were based on established usage of antidotes for cholinergic toxicity and were felt to be both safe and supported by the literature. It was stated that the Mark 1 Autoinjector kits (although not approved for pediatric use) should be used as initial treatment for children with severe, life-threatening nerve agent toxicity for whom IV treatment is not possible or available, or for whom more precise IM (mg/kg) dosing would be logistically impossible. It was further felt that while not within the published dosage range for cholinergic toxicity, if a Mark 1 kit was the only source of atropine and pralidoxime available after a bona fide exposure it should be used to treat all children, even those younger than 3 years old. Furthermore, it was felt to be imperative to expedite approval of the pediatric autoinjector kit (which contains both atropine and an oxime and is designed for children) that is currently produced and marketed abroad but not available in the United States
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The American Preparedness Project: Executive Summary: Where the US Public Stands in 2011 on Terrorism, Security, and Disaster Preparedness
Ten years after the tragic events of September 11, 2001, America is, in some aspects, a different country. Significant portions of the federal budget over the past decade have been spent on enhancing preparedness and security on the home front, and prosecuting terrorism in Iraq and Afghanistan. As part of its American Preparedness Project, which has tracked US attitudes on domestic preparedness and terrorism over the last ten years, the National Center for Disaster Preparedness (NCDP) at Columbia University's Mailman School of Public Health recently surveyed the US population to determine their current attitudes and behaviors regarding disaster preparedness and the prospect of domestic terrorism. NCDP and the Children's Health Fund had conducted this survey annually from 2002 to 2008. As in prior years, the Marist Institute for Public Opinion (MIPO) executed a survey designed by NCDP and CHF. Also as before, the 2011 survey included a mix of previously-asked questions and new questions inspired by recent world events. Trended questions asked about confidence in government; extent of personal and family preparedness; and perceptions of community preparedness. All questions are shown in Table 1
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Public Confidence in Government, Health Care System Continues to Drop as 5th Anniversary of 9/11 Approaches
Survey respondents fear government is unprepared for terrorist
attacks or natural disaster; health care system judged unable to
respond to major crises or flu pandemic
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Legacy of Katrina: The Impact of a Flawed Recovery on Vulnerable Children of the Gulf Coast
It is estimated that in the aftermath of Hurricane Katrina, which made landfall on August 29th, 2005 and was followed a month later by Hurricane Rita, approximately 1.5 million people, including some 163,000 children were displaced in Louisiana and Mississippi alone.
Since children and families who had the means fled the city, those who were left were often the poorest and most vulnerable. These populations became the most dependent on the government’s efforts to help in the recovery process, and were the most affected when those efforts were less than sufficient. Those who previously had been marginalized and underserved were now faced with an unfathomably steep slope to climb in gaining access to resources. In the months after the storms, obstacles to health care became entrenched through the combination of facility closures and shortages of health care providers. In addition, federal disaster case management initiatives, which were meant to help victims access recovery resources, were slow to start and lacked both the comprehensiveness and continuity that were needed. To make matters worse, many of these case management programs were terminated prior to resolving challenges facing families and without making appropriate arrangements for satisfactory follow-up. Five years following the disasters of 2005, there have been significant signs of economic, infrastructural, and educational recovery in the Gulf. However, there are still serious shortfalls in certain areas of human recovery, particularly regarding mental health and housing stability. Compounding the remaining needs from the hurricanes, the region is now facing a man-made disaster—the aftermath of the BP oil spill. Identifying, assessing and providing professional assistance to children still in need remains an unmet challenge with highly worrisome consequences for the future. But most importantly, the affected families need urgent assistance to, five years after Katrina, return to a state of "normalcy". Immediately after Katrina, Children’s Health Fund (CHF) responded to the vital health needs of the Gulf Coast by establishing Operation Assist in collaboration with the National Center for Disaster Preparedness (NCDP) at the Mailman School of Public Health at Columbia University. As part of this project, CHF dispatched mobile medical units to provide disaster relief health services, which eventually led to the creation of three permanent CHF pediatric programs in the Gulf region. This collaboration also included a longitudinal cohort study, the Gulf Coast Child and Family Health Study (G-CAFH), which was designed to track the progress of a representative population of severely-impacted Gulf families over the ensuing years. The findings from the most recent G-CAFH surveys are included in this paper as well as on the ground anecdotal information from CHF Gulf Coast pediatric programs, which are consistent with the G-CAFH study results
A systematic review to identify areas of enhancements of pandemic simulation models for operational use at provincial and local levels
<p>Abstract</p> <p>Background</p> <p>In recent years, computer simulation models have supported development of pandemic influenza preparedness policies. However, U.S. policymakers have raised several <it>concerns </it>about the practical use of these models. In this review paper, we examine the extent to which the current literature already addresses these <it>concerns </it>and identify means of enhancing the current models for higher operational use.</p> <p>Methods</p> <p>We surveyed PubMed and other sources for published research literature on simulation models for influenza pandemic preparedness. We identified 23 models published between 1990 and 2010 that consider single-region (e.g., country, province, city) outbreaks and multi-pronged mitigation strategies. We developed a plan for examination of the literature based on the concerns raised by the policymakers.</p> <p>Results</p> <p>While examining the concerns about the adequacy and validity of data, we found that though the epidemiological data supporting the models appears to be adequate, it should be validated through as many updates as possible during an outbreak. Demographical data must improve its interfaces for access, retrieval, and translation into model parameters. Regarding the concern about credibility and validity of modeling assumptions, we found that the models often simplify reality to reduce computational burden. Such simplifications may be permissible if they do not interfere with the performance assessment of the mitigation strategies. We also agreed with the concern that social behavior is inadequately represented in pandemic influenza models. Our review showed that the models consider only a few social-behavioral aspects including contact rates, withdrawal from work or school due to symptoms appearance or to care for sick relatives, and compliance to social distancing, vaccination, and antiviral prophylaxis. The concern about the degree of accessibility of the models is palpable, since we found three models that are currently accessible by the public while other models are seeking public accessibility. Policymakers would prefer models scalable to any population size that can be downloadable and operable in personal computers. But scaling models to larger populations would often require computational needs that cannot be handled with personal computers and laptops. As a limitation, we state that some existing models could not be included in our review due to their limited available documentation discussing the choice of relevant parameter values.</p> <p>Conclusions</p> <p>To adequately address the concerns of the policymakers, we need continuing model enhancements in critical areas including: updating of epidemiological data during a pandemic, smooth handling of large demographical databases, incorporation of a broader spectrum of social-behavioral aspects, updating information for contact patterns, adaptation of recent methodologies for collecting human mobility data, and improvement of computational efficiency and accessibility.</p
Peri-Urbanisation and the Vulnerability of Population to the Effects of Climate Change in Southern Vietnam: Innovating Solutions in Research
International audienc