bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomy of a “Mass” Mass Gathering
Authors: Molloy Michael , Browne Ciaran , Horwell Tom , VanDeVelde Jason , Plunkett Patrick 
Published: May 2019

Introduction:Mass gatherings are growing in frequency. Religious, or in this case, “mass” mass gatherings are also growing in complexity, requiring considerable effort from nations hosting a Papal Mass. Ireland hosted a papal mass in 1979 when the prospect of terrorism at such events was significantly lower. Large high-profile events such as a Papal Mass offer a platform via the media and social media to gain widespread coverage of adverse events. In 2018, a predicted 500,000 guests were scheduled to attend a Papal Mass gathering in Phoenix Park, Dublin, a bounded 1,700-hectare park in the center of Dublin.Aim:To develop a medical plan estimating numbers of people requiring medical attention at a Papal Mass held in Ireland late August 2018, and compare same with actual numbers treated post-event. This study aims to reduce the medical impact of such an event on local receiving hospitals through plans that effectively manage medical- and trauma-related presentations on site.Methods:A literature review of medical reports regarding medical care at Papal Mass gatherings worldwide found a range of predicted medical attendance from 21-61 per 10,000 attendees. On that basis we had prepared on-site facilities, facilities on travel routes and access point system for medical care for a crowd of 500,000 were selected.Results:One of 6 receiving hospitals in Dublin had an increase in average presentations on the day. Attendance was reduced significantly due to weather. 261 patients were treated on site, falling in line with lower rate predicted of 31 patients treated in hospital on site and 17 transports off-site.Discussion:A predictable number of patients presented for medical care. On-site medical services reduced transports to hospital. Reduced attendance ensured facilities were sufficient, but could have been under the pressure of the predicted attendance of 500,000.
Prediction Modeling Studies for Medical Usage Rates in Mass Gatherings: A Systematic Review
Authors: Van Remoortel Hans , Scheers Hans , De Buck Emmy , Lauwers Karen , Vandekerckhove Philippe 
Published: May 2019

Introduction:Mass gatherings attended by large crowds are an increasingly common feature of society. In parallel, an increased number of studies have been conducted to identify those variables that are associated with increased medical usage rates.Aim:To identify studies that developed and/or validated a statistical regression model predicting patient presentation rate (PPR) or transfer to hospital rate (TTHR) at mass gatherings.Methods:Prediction modeling studies from 6 databases were retained following systematic searching. Predictors for PPR and/or TTHR that were included in a multivariate regression model were selected for analysis. The GRADE methodology (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence.Results:We identified 11 prediction modeling studies with a combined audience of >32 million people in >1500 mass gatherings. Eight cross-sectional studies developed a prediction model in a mixed audience of (spectator) sports events, music concerts, and public exhibitions. Statistically significant variables (p<0.05) to predict PPR and/or TTHR were as follows: accommodation (seated, boundaries, indoor/outdoor, maximum capacity, venue access), type of event, weather conditions (humidity, dew point, heat index), crowd size, day vs night, demographic variables (age/gender), sports event distance, level of competition, free water availability, and specific TTHR-predictive factors (injury status: number of patient presentations, type of injury). The quality of the evidence was considered as low. Three studies externally validated their model against existing models. Two validation studies showed a large underestimation of the predicted patients presentations or transports to hospital (67-81%) whereas one study overestimated these outcomes by 10-28%.Discussion:This systematic review identified a comprehensive list of relevant predictors which should be measured to develop and validate future models to predict medical usage at mass gatherings. This will further scientifically underpin more effective pre-event planning and resource provision.
Effectiveness of Children’s Disaster Risk Reduction (DRR) Program on Earthquake Preparedness in Jordan
Authors: Issa Fadi S , Molloy Michael , Hart Alexander , Issa Mahmoud S , AlFalasi Reem , Alhadhira Abdullah A , Sarin Ritu R , Voskanyan Amalia , Ciottone Gregory R 
Published: May 2019

Introduction:Children represent a particularly vulnerable population in disasters. Disaster Risk Reduction refers to a systematic approach to identifying, assessing, and reducing risks of disaster through sets of interventions towards disaster causes and population vulnerabilities. Disaster Risk Reduction through the education of the population, and especially children, is an emerging field requiring further study.Aim:To test the hypothesis that an educational program on Disaster Risk Reduction can induce a sustained improvement in knowledge, risk perception, awareness, and attitudes toward preparedness behavior of children.Methods:A Disaster Risk Reduction educational program for students aged 10-12 was completed in an earthquake-prone region of Jordan (Madaba). Subject students (A) and control groups of similarly aged untrained children in public (B) and private (C) schools were surveyed one year after the program. Surveys focused on disaster knowledge, risk perception, awareness, and preparedness behavior. Likert scales were used for some questions and binary yes/no for others. Results were collated and total scores averaged for each section. Average scores were compared between groups and analyzed using SPSS.Results:Students who had completed the Disaster Risk Reduction program were found through Levene’s test to have statistically significant improvement in earthquake knowledge (5.921 vs. 4.55 vs. 5.125), enhanced risk perception (3.966 vs. 3.580 vs. 3.789), and improved awareness of earthquakes (4.652 vs. 3.293 vs. 4.060) with heightened attitudes toward preparedness behavior (8.008 vs. 6.517 vs. 7.597) when compared to untrained public and private school control groups, respectively.Discussion:Disaster Risk Reduction education programs can have lasting impacts when applied to children. They can improve students’ knowledge, risk perception, awareness, and attitudes towards preparedness. Further work is required to determine the frequency of re-education required and appropriate age groups for educational interventions.
“Operation:Navajeevan”: Novel PPP Model Flood Relief Camp
Authors: Haris Sonia , Anaswara Naveen , Poovathumparambil Venugopal 
Published: May 2019

Introduction:In August 2018, Kerala, India witnessed its worst flood in over a century. With the support of the national health mission, Operation Navajeevan, a public-private partnership between the district health administration and local hospitals was established in Kozhikode to provide medical aid to flood victims. This study identifies prerequisites, describes challenges, and depicts the epidemiology of patients seen in these camps.Aim:1.Identify prerequisites and medical needs/challenges faced by medical relief camps in a flood-affected region2.Formulate protocols to avoid duplication of services3.Prepare an ideal PPP emergency medical camp modelMethods:A control center with drugs and a logistics unit was set up at the district administration to monitor and supervise various camps. A mobile medical documentation format was created to record the details of each camp. Cases of patients seen at these camps were compiled and later analyzed. The medical officer sent reports from each camp to the control center each day to specify the daily difficulties faced by each camp. Mobile ICUs were kept on standby to respond in the event of emergent circumstances or surge demands. Transfer protocol and treatment guidelines were formulated and standardized.Results:Over two weeks, approximately 40,000 patients were seen in 280 medical camps. Major medical issues included exacerbation of chronic illnesses due to loss of medications (18,490), acute respiratory infections (7,451), psychiatric illnesses (5,327), trauma (3,736), skin infection (792), tropical fever (498), acute gastroenteritis (394), and ACS (17). Of the cases of fever, 137 people had leptospirosis. Major challenges included a lack of training in disaster management and failure of documentation systems.Discussion:A well-organized control center, improved training in disaster medicine, and reliable documentation systems are crucial for coordinating medical camps in disaster areas. Public-private partnerships offer a model for providing medical relief in disaster settings.
Study of Medical Supply and Demand Balance for the Nankai Trough Earthquake
Authors: Takada Yosuke , Otomo Yasuhiro 
Published: May 2019

Introduction:The Nankai Trough, marking the boundary between the Eurasian Plate and the Philippine Sea Plate, is forecasted to create a tragic earthquake and tsunami within 30 years.Aim:To clarify the gap between medical supplies and demand.Methods:Collected the data of the estimation of injured persons from each prefecture throughout Japan, and also the number of Intensive Care Unit (ICU) and High Care Unit (HCU) beds in Japan from the Ministry of Health database. We re-calculated the number of severe cases based on official data. Moreover, we calculated the number of beds of hospitals with the capacity to receive severe patients.Results:The total number of disaster base hospitals is 723 hospitals with 6556 ICU beds, and 545 hospitals have 5,248 HCU beds throughout Japan. When the Nankai Trough earthquake occurs, 187 disaster base hospitals would be located in the area with seismic intensity 6-upper on the Japanese Seismic Intensity Scale of 0-7, and 79 disaster base hospitals would be located in the tsunami inundation area. The estimated total number of injured persons is 661,604 including 26,857 severe cases, 290,065 moderate cases, and 344,682 minor cases.Discussion:Even if all ICU and HCU beds are usable for severe patients, there will be 15,053 more beds needed. The Cabinet Office of Japan assumes that 60% of hospital beds would not be able to be used in an area of the seismic intensity of 6-upper. If 80% of beds are used in the non-disaster time, the number of beds which are usable at the time of a disaster will decrease more. The beds needed for severe patients would be significantly lacking when the Nankai Trough earthquake occurs. It will be necessary to start treatment of the severe patients who are “more likely to be saved more.”
Advancing Performance Measurement for Public Health Emergency Preparedness: An Integrated Knowledge Translation Approach
Authors: Khan Yasmin , O’Sullivan Tracey , Brown Adalsteinn , Gibson Jennifer , Henry Bonnie , Généreux Mélissa , Schwartz Brian 
Published: May 2019

Introduction:Public health emergency management involves the timely translation of relevant evidence and effective coordination of diverse actors. In practice, this can be challenging in the absence of a common framework for action among diverse actors.Aim:To apply an Integrated Knowledge Translation (iKT) approach throughout the development of a conceptual framework and performance measurement indicators for public health emergency preparedness (PHEP), to ensure knowledge generated is relevant and useful to the field.Methods:The iKT approach was initiated by identifying a research question based on priorities from the field. The two phases of the study used participatory research methods as well as active engagement with potential end users at key study milestones. The Structured Interview Matrix (SIM) facilitation technique for focus groups and an expert panel using Delphi methodology were used to define the PHEP framework and performance measurement indicators, respectively. An advisory committee was assembled consisting of potential end-users of the research, in senior positions in applied and decision-making roles.Results:iKT was an essential component for this applied public health project, contributing to and enhancing the relevance of the knowledge generated. iKT contributed to the following: broad national engagement and interest in the study, successful recruitment in both phases, and engagement with decision-makers. This multi-dimensional participatory approach successfully generated knowledge that was important to the field demonstrated by relevance to practice and policy in jurisdictions across Canada. Furthermore, the approach fostered building resilience in local and national communities through collaboration.Discussion:The iKT approach was essential to generating knowledge that is relevant and useful to the field, mainly to promote health system preparedness and resilience. Future research to study the implementation of knowledge will be important to continue addressing the knowledge-to-action gap in health emergency management research.
Palliative Care Training for Work in an Austere Environment After a Natural Disaster
Authors: Goodman Annekathryn , Black Lynn 
Published: May 2019

Introduction:Healthcare professionals working in a disaster face destroyed physical infrastructures, scarce supplies, and a limited-in-training peer group. During a mass casualty event, disaster victims are triaged to the “expectant” category of care because either their injuries are not survivable or the resources needed to care for them are not available.Aim:To examine the challenges that disaster responders face in caring for dying patients in the field, and advocate for basic palliative care training prior to deploying to a disaster.Methods:The world’s literature was reviewed to identify challenges for disaster teams in providing compassionate end-of-life care and to find training exercises for pre-deployment competency building.Results:Training Topics in Palliative Care Prior to Disaster Deployment include the following:
1.Symptom Management Protocols:
PainAnxietyRespiratory distressDeliriumNausea and Vomiting2.Spiritual Management
GriefIdentify meaning3.Cultural Training specific to the location of the disaster
The meaning of death in the cultureWho are the decision makers in the family4.Training for difficult conversations
Delivering Bad NewsManaging a grieving family5.Self-Care Training
Develop a system for debriefingDevelop a buddy systemSelf-care exercises: deep breathing, prayer, meditation, yogaDiscussion:Challenges to the care of the dying during a disaster include a loss of medical infrastructure and scarce medical or physical resources. Palliative care training for non-palliative care specialists can be instructive for the development of palliative care training for medical care responders after disasters. Applying standards, identifying goals of care for the expectant patient, communication to the patient and family members, if available, can help reduce suffering of this group of devastatingly vulnerable patients. In addition, peer support, on-site discussions and debriefing, and problem-solving when resources are limited will help alleviate moral distress among the providers.
The Development of a Community-wide Primary Health Comprehensive Planning and Response Coordination Group to Plan for and Manage Seasonal Influenza and Possible Pandemic Response
Authors: Schroeder Philip , Robertson Kelly , Callahan Deborah , Frew Gareth , McColl Graeme 
Published: May 2019

Introduction:The Canterbury Primary Response Group (CPRG) was formed following the threats of severe acute respiratory syndrome (SARS) and avian influenza worldwide. The possible impact of these viruses alerted health care professionals that a community-wide approach was needed to manage and coordinate a response to any outbreak or potential outbreak. In Canterbury, New Zealand, the CPRG group took the responsibility to coordinate and manage the regional, out of hospital, planning and response coordination to annual influenza threats and the possible escalation to pandemic outbreaks.Aim:To outline the formation of a primary health and community-wide planning group, bringing together not only a wide range of health providers, but also key community agencies to plan strategies and responses to seasonal influenza and possible pandemic outbreaks.Methods:CPRG has developed a Pandemic Plan that focuses on the processes, structures, and roles to support and coordinate general practice, community pharmacies, community nursing, and other primary health care providers in the reduction of, readiness for, response to, and recovery from an influenza pandemic. The plan could reasonably apply to other respiratory-type pandemics such as SARS.Results:A comprehensive group of health professionals and supporting agencies meet monthly (more often if required) under the chair of CPRG to share information of the influenza-like illness (ILI) situation, virus types, and spread, as well as support strategies and response activities. Regular communication information updates are produced and circulated amongst members and primary health providers in the region.Discussion:Given that most ILI health consultations and treatments are self or primary health administered and take place outside of hospital services, it is essential for providers to be informed and consistent with their responses and knowledge of the extent and symptoms of ILI and any likelihood of a pandemic.
Using the MCRISP Network to Study Acute Gastroenteritis and Influenza-Like Illness Outbreaks in Child Care Centers Compared to Statewide Epidemics
Authors: Hashikawa Andrew , DeJonge Student Peter , Bradin Stuart , Martin Emily 
Published: May 2019

Introduction:Biosurveillance is critical for early detection of disease outbreaks and resource mobilization. Child care center (CCC) attendance has long been recognized as a significant independent predictor for respiratory and gastrointestinal diseases, but CCC surveillance is currently not part of the statewide disease surveillance system. The Michigan Child Care Related Infections Surveillance Program (MCRISP) is an independent, online reporting network with >30 local CCCs that was created to fill this surveillance gap.Aim:To describe the capability of a novel CCC biosurveillance system (MCRISP) to report pediatric Influenza-Like Illness (ILI) and Acute Gastroenteritis (AGE) illness over three years to (i) assess both the timing and magnitude of epidemics in CCCs and (ii) compare CCC outbreak patterns with those of the state database.Methods:MCRISP collates real-time syndromic reports of illness from local county CCCs. The statewide Michigan Disease Surveillance System (MDSS) collects reports of diagnosed illness from designated laboratories, clinics, and hospitals statewide. We assessed epidemic curves based on MCRISP incidence rates and MDSS case counts for ILI and AGE over three seasons (2014-7).Results:A total of 4,627 MCRISP cases (2,425 ILI and 2,202 AGE reports) were reported during the three years of study surveillance. Epidemic patterns (seasonal peaks, troughs, and breadth) for both ILI and AGE in CCCs mirrored those reported at county and state levels, respectively. Two distinguishing features of CCC ILI outbreaks were noted in all three seasons: MCRISP ILI rates remained elevated after MDSS influenza counts abated, and MCRISP rates consistently peaked prior to MDSS influenza peaks. Neither of these phenomena were observed in comparing AGE outbreaks between surveillance systems.Discussion:ILI and AGE incidence rates from the MCRISP network appeared to broadly mirror epidemics from the established state surveillance system. MCRISP may act as a sentinel system for larger community outbreaks of respiratory disease.
Primary Care Pharmacist Interventions in Risk Reduction for the Zika Virus Epidemic: A Study in Campa Grande, Mato Grosso do Sul, Brazil
Authors: Miranda Elaine , Santos-Pinto Claudia , Antunes Clarice , Ferreira Larissa , Osorio-de-Castro Claudia 
Published: May 2019

Introduction:Pharmaceutical services for public health emergencies, such as the Zika virus (ZIKV) epidemic, are relevant for service effectiveness in the Brazilian health system. Pharmacists can act strategically in risk reduction. However, official guidelines do not consider pharmaceutical services when approaching health emergencies.Aim:To identify and understand primary healthcare pharmacist interventions in risk reduction for the recent ZIKV epidemic in Brazil.Methods:The study took place in Campo Grande, Mato Grosso do Sul, in November 2017. A semi-structured questionnaire was developed, including general issues related to knowledge of Zika, risk communication, and the pharmacist's role in patient care for ZIKV disease. The instrument was pre-tested. Primary healthcare center (PHC) pharmacists were subsequently interviewed. Aspects related to knowledge, risk reduction measures, and role were categorized and analyzed. The project received approval from the Institutional Review Board (IRB) at the Sergio Arouca National School of Public Health.Results:Forty-two of the 48 PHC pharmacists in Campo Grande were interviewed. Risk reduction measures were cited by most interviewees. Among these strategies, 92% were collective measures, such as making information available for the population (30%) and for the health workers (8%), and vector control strategies (43%). Use of mosquito nets was the most cited individual risk-reduction strategy. Only one pharmacist cited risk for pregnant women and suggested birth control as a strategy. Another pharmacist pointed to ZIKV “treatment.” No interviewee mentioned measures related to preparedness of pharmaceutical services.Discussion:PHC pharmacists do not place themselves at the frontline of risk reduction for the ZIKV epidemic. In the face of potential hazards and consequences of this disease, action by pharmacists is deemed critical. This study highlights pharmacist's misconceptions and lack of focused knowledge, pointing to the need for training and capacity-building in order to increase quality of care and positive management of future epidemics.