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1.  Ensuring safe water in post-chemical, biological, radiological and nuclear emergencies 
Disaster scenarios are dismal and often result in mass displacement and migration of people. In eventuality of emergency situations, people need to be rehabilitated and provided with an adequate supply of drinking water, the most essential natural resource needed for survival, which is often not easily available even during non-disaster periods. In the aftermath of a natural or human-made disaster affecting mankind and livestock, the prime aim is to ensure supply of safe water to reduce the occurrence and spread of water borne disease due to interrupted, poor and polluted water supply. Chemical, biological, radiological and nuclear (CBRN) emergencies augment the dilemma as an additional risk of “contamination” is added. The associated risks posed to health and life should be reduced to as low as reasonably achievable. Maintaining a high level of preparedness is the crux of quick relief and efficient response to ensure continuous supply of safe water, enabling survival and sustenance. The underlying objective would be to educate and train the persons concerned to lay down the procedures for the detection, cleaning, and treatment, purification including desalination, disinfection, and decontamination of water. The basic information to influence the organization of preparedness and execution of relief measures at all levels while maintaining minimum standards in water management at the place of disaster, are discussed in this article.
PMCID: PMC3148630  PMID: 21829321
Chemical; biological; radiological and nuclear emergency; drinking water treatment; guidelines; relief camp; standards
2.  Public perceptions of drinking water: a postal survey of residents with private water supplies 
BMC Public Health  2006;6:94.
In Canada, the legal responsibility for the condition of private water supplies, including private wells and cisterns, rests with their owners. However, there are reports that Canadians test these water supplies intermittently and that treatment of such water is uncommon. An estimated 45% of all waterborne outbreaks in Canada involve non-municipal systems. An understanding of the perceptions and needs of Canadians served by private water supplies is essential, as it would enable public health professionals to better target public education and drinking water policy. The purpose of this study was to investigate the public perceptions of private water supplies in the City of Hamilton, Ontario (Canada), with the intent of informing public education and outreach strategies within the population.
A cross-sectional postal survey of 246 residences with private water supplies was conducted in May 2004. Questions pertained to the perceptions of water quality and alternative water sources, water testing behaviours and the self-identified need for further information.
Private wells, cisterns or both, were the source of household water for 71%, 16% and 13% of respondents, respectively. Although respondents rated their water quality highly, 80% also had concerns with its safety. The most common concerns pertained to bacterial and chemical contamination of their water supply and its potential negative effect on health. Approximately 56% and 61% of respondents used in-home treatment devices and bottled water within their homes, respectively, mainly due to perceived improvements in the safety and aesthetic qualities compared to regular tap water. Testing of private water supplies was performed infrequently: 8% of respondents tested at a frequency that meets current provincial guidelines. Two-thirds of respondents wanted more information on various topics related to private water supplies. Flyers and newspapers were the two media reported most likely to be used.
Although respondents rated their water quality highly, the majority had concerns regarding the water from their private supply, and the use of bottled water and water treatment devices was extensive. The results of this study suggest important lines of inquiry and provide support and input for public education programs, particularly those related to private water testing, in this population.
PMCID: PMC1458329  PMID: 16608511
3.  Effective media communication of disasters: Pressing problems and recommendations 
BMC Public Health  2007;7:97.
Public health officials and journalists play a crucial role in disseminating information regarding natural disasters, terrorism and other human-initiated disasters. However, research suggests that journalists are unprepared to cover terrorism and many types of natural disasters, in part because of lack sufficient expertise in science and medicine and training. The objective of this research was to identify solutions to problems facing journalists and public health public information officer (PIOs) of communicating with the public during natural and human-initiated disasters.
To assist in identifying the most pressing problems regarding media response to health-related risks such as terrorism and large-scale natural disasters, 26 expert advisors were convened, including leaders representing journalists and public information officers, state health officials, experts in terrorism and emergency preparedness, and experts in health, risk, and science communication. The advisory group participated in pre-arranged interviews and were asked to identify and review bioterrorism educational resources provided to journalist. All advisory group members were then invited to attend a day long meeting January 29, 2004 to review the findings and reach consensus.
The most pressing problems were found to be a lack of coordination between PIO's and journalists, lack of resources for appropriately evaluating information and disseminating it efficiently, and a difference in perception of PIO's and journalist towards each others role during emergency situations. The advisory board developed a list of 15 recommendations that may enhance communication plans betweens PIO's, journalist and the public. The solutions were meant to be feasible in terms of costs and practical in terms of the professional and organizational realities in which journalists and PIO's work.
It is clear that PIO's and journalists play crucial roles in shaping public response to terrorism and other disasters. The findings from this formative research suggest that perspectives and organizational processes often limit effective communication between these groups; though practical solutions such as participation of journalists in drills, scenario exercises, sharing of informational resources, and raising awareness at professional trade meetings may enhance the timely dissemination of accurate and appropriate information.
PMCID: PMC1894967  PMID: 17553153
4.  Environmental health sciences center task force review on halogenated organics in drinking water 
The disinfection of drinking water by chlorination has in recent years come under closer scrutiny because of the potential hazards associated with the production of stable chlorinated organic chemicals. Organic chemical contaminants are common to all water supplies and it is now well-established that chlorinated by-products are obtained under conditions of disinfection, or during tertiary treatment of sewage whose products can ultimately find their way into drinking water supplies. Naturally occurring humic substances which are invariably present in drinking waters are probably the source of chloroform and other halogenated methanes, and chloroform has shown up in every water supply investigated thus far.
The Environmental Protection Agency is charged with the responsibility of assessing the public health effects resulting from the consumption of contaminated drinking water. It has specifically undertaken the task of determining whether organic contaminants or their chlorinated derivatives have a special impact, and if so, what alternatives there are to protect the consumer against bacterial and viral diseases that are transmitted through infected drinking waters. The impetus to look at these chemicals is not entirely without some prima facie evidence of potential trouble. Epidemiological studies suggested a higher incidence of cancer along the lower Mississippi River where the contamination from organic chemicals is particularly high. The conclusions from these studies have, to be sure, not gone unchallenged.
The task of assessing the effects of chemicals in the drinking water is a difficult one. It includes many variables, including differences in water supplies and the temporal relationship between contamination and consumption of the finished product. It must also take into account the relative importance of the effects from these chemicals in comparison to those from occupational exposure, ingestion of contaminated foods, inhalation of polluted air, and many others. The susceptibility of different age, genetic, and ethnic groups within the population must also be carefully considered. The present review discusses: the reasons for disinfection; the general occurrence of chlorinated organics in drinking water; the chemistry in the synthesis of chlorinated organics under aqueous conditions; and alternatives to chlorine for disinfection.
PMCID: PMC1637223  PMID: 17539149
5.  Dissemination of Drinking Water Contamination Data to Consumers: A Systematic Review of Impact on Consumer Behaviors 
PLoS ONE  2011;6(6):e21098.
Drinking water contaminated by chemicals or pathogens is a major public health threat in the developing world. Responses to this threat often require water consumers (households or communities) to improve their own management or treatment of water. One approach hypothesized to increase such positive behaviors is increasing knowledge of the risks of unsafe water through the dissemination of water contamination data. This paper reviews the evidence for this approach in changing behavior and subsequent health outcomes.
Methods/Principal Findings
A systematic review was conducted for studies where results of tests for contaminants in drinking water were disseminated to populations whose water supply posed a known health risk. Studies of any design were included where data were available from a contemporaneous comparison or control group. Using multiple sources >14,000 documents were located. Six studies met inclusion criteria (four of arsenic contamination and two of microbiological contamination). Meta-analysis was not possible in most cases due to heterogeneity of outcomes and study designs. Outcomes included water quality, change of water source, treatment of water, knowledge of contamination, and urinary arsenic. Source switching was most frequently reported: of 5 reporting studies 4 report significantly higher rates of switching (26–72%) among those who received a positive test result and a pooled risk difference was calculate for 2 studies (RD = 0.43 [CI0.4.0–0.46] 6–12 months post intervention) suggesting 43% more of those with unsafe wells switched source compared to those with safe wells. Strength of evidence is low since the comparison is between non-equivalent groups. Two studies concerning fecal contamination reported non-significant increases in point-of-use water treatment.
Despite the publication of some large cohort studies and some encouraging results the evidence base to support dissemination of contamination data to improve water management is currently equivocal. Rigorous studies on this topic are needed, ideally using common outcome measures.
PMCID: PMC3124476  PMID: 21738609
6.  Lessons Learned during Public Health Response to Cholera Epidemic in Haiti and the Dominican Republic 
Emerging Infectious Diseases  2011;17(11):2087-2093.
Safe water and sewage systems must be constructed to prevent future epidemics.
After epidemic cholera emerged in Haiti in October 2010, the disease spread rapidly in a country devastated by an earthquake earlier that year, in a population with a high proportion of infant deaths, poor nutrition, and frequent infectious diseases such as HIV infection, tuberculosis, and malaria. Many nations, multinational agencies, and nongovernmental organizations rapidly mobilized to assist Haiti. The US government provided emergency response through the Office of Foreign Disaster Assistance of the US Agency for International Development and the Centers for Disease Control and Prevention. This report summarizes the participation by the Centers and its partners. The efforts needed to reduce the spread of the epidemic and prevent deaths highlight the need for safe drinking water and basic medical care in such difficult circumstances and the need for rebuilding water, sanitation, and public health systems to prevent future epidemics.
PMCID: PMC3310587  PMID: 22099111
Cholera; Haiti; Dominican Republic; waterborne disease; public health response; epidemiology; sanitation; epidemic control; bacteria; safe water; sewage; infrastructure
7.  Teenage drinking, alcohol availability and pricing: a cross-sectional study of risk and protective factors for alcohol-related harms in school children 
BMC Public Health  2009;9:380.
There is a lack of empirical analyses examining how alcohol consumption patterns in children relate to harms. Such intelligence is required to inform parents, children and policy relating to the provision and use of alcohol during childhood. Here, we examine drinking habits and associated harms in 15-16 year olds and explore how this can inform public health advice on child drinking.
An opportunistic survey of 15-16 year olds (n = 9,833) in North West England was undertaken to determine alcohol consumption patterns, drink types consumed, drinking locations, methods of access and harms encountered. Cost per unit of alcohol was estimated based on a second survey of 29 retail outlets. Associations between demographics, drinking behaviours, alcohol pricing and negative outcomes (public drinking, forgetting things after drinking, violence when drunk and alcohol-related regretted sex) were examined.
Proportions of drinkers having experienced violence when drunk (28.8%), alcohol-related regretted sex (12.5%) and forgetting things (45.3%), or reporting drinking in public places (35.8%), increased with drinking frequency, binge frequency and units consumed per week. At similar levels of consumption, experiencing any negative alcohol-related outcome was lower in those whose parents provided alcohol. Drunken violence was disproportionately associated with being male and greater deprivation while regretted sex and forgetting things after drinking were associated with being female. Independent of drinking behaviours, consuming cheaper alcohol was related to experiencing violence when drunk, forgetting things after drinking and drinking in public places.
There is no safe level of alcohol consumption for 15-16 year olds. However, while abstinence removes risk of harms from personal alcohol consumption, its promotion may also push children into accessing drink outside family environments and contribute to higher risks of harm. Strategies to reduce alcohol-related harms in children should ensure bingeing is avoided entirely, address the excessively low cost of many alcohol products, and tackle the ease with which it can be accessed, especially outside of supervised environments.
PMCID: PMC2770487  PMID: 19818118
8.  Child Maltreatment and Disaster Prevention: A Qualitative Study of Community Agency Perspectives 
Child maltreatment (CM) is a significant public health problem that increases following natural disasters. Ecological approaches have been used to study these complex phenomena, and the current research fits within this perspective by conducting qualitative interviews with disaster response and family-serving community agencies. The purpose of the study was to identify whether or not community agencies identified CM as an issue that is relevant for disaster planning and response and their perspectives on risk and protective factors for CM risk following disaster.
Agencies (n=16) from 2 geographical areas participated - one that recently experienced a natural disaster (Louisiana (LA), n=7) and one that had not (Georgia (GA), n=9). Agency representatives completed semi-structured telephone interviews (n=16) and follow up in person focus groups (n=14). Theory-driven, thematic analyses were completed.
Results suggested that community agencies agree that post-disaster environments increase the risk for CM and that CM prevention has a role in disaster response planning. Risk and protective factors were identified according to Bronfenbrenner’ s ecological framework.
Study results support the need to include CM prevention efforts within disaster planning and provide guidance for future research to inform such efforts.
PMCID: PMC3756707  PMID: 23997850
9.  Invasive Fungal Infections after Natural Disasters 
Emerging Infectious Diseases  2014;20(3):349-355.
The link between natural disasters and subsequent fungal infections in disaster-affected persons has been increasingly recognized. Fungal respiratory conditions associated with disasters include coccidioidomycosis, and fungi are among several organisms that can cause near-drowning pneumonia. Wound contamination with organic matter can lead to post-disaster skin and soft tissue fungal infections, notably mucormycosis. The role of climate change in the environmental growth, distribution, and dispersal mechanisms of pathogenic fungi is not fully understood; however, ongoing climate change could lead to increased disaster-associated fungal infections. Fungal infections are an often-overlooked clinical and public health issue, and increased awareness by health care providers, public health professionals, and community members regarding disaster-associated fungal infections is needed.
PMCID: PMC3944874  PMID: 24565446
fungus; fungal infection; disasters; tsunamis; tornadoes; injuries; pneumonia; meningitis; mucormycosis; coccidioidomycosis; fungi
The extent to which drinking water turbidity measurements indicate the risk of gastrointestinal illness is not well-understood. Despite major advances in drinking water treatment and delivery, infectious disease can still be transmitted through drinking water in the U.S., and it is important to have reliable indicators of microbial water quality to inform public health decisions. The objective of our study was to assess the relationship between gastrointestinal illness, quantified through emergency department visits, and drinking water quality, quantified as raw water and filtered water turbidity measured at the treatment plant.
We examined the relationship between turbidity levels of raw and filtered surface water measured at eight major drinking water treatment plants in the metropolitan area of Atlanta, Georgia, and over 240 000 emergency department visits for gastrointestinal illness during 1993–2004 among the population served by these plants. We fit Poisson time-series statistical regression models that included turbidity in a 21-day distributed lag and that controlled for meteorological factors and long-term time trends.
For filtered water turbidity, the results were consistent with no association with emergency department visits for gastrointestinal illness. We observed a modest association between raw water turbidity and emergency department visits for gastrointestinal illness. This association was not observed for all treatment plants in plant-specific analyses.
Our results suggest that source water quality may contribute modestly to endemic gastrointestinal illness in the study area. The association between turbidity and emergency department visits for gastrointestinal illness was only observed when raw water turbidity was considered; filtered water turbidity may not serve as a reliable indicator of modest pathogen risk at all treatment plants.
PMCID: PMC3752848  PMID: 18941478
drinking water; epidemiology; time-series; infection
11.  Assessing Disaster Preparedness among Latino Migrant and Seasonal Farmworkers in Eastern North Carolina 
Natural disasters including hurricanes, floods, earthquakes, tornadoes, and fires often involve substantial physical and mental impacts on affected populations and thus are public health priorities. Limited research shows that vulnerable populations such as the low-income, socially isolated migrant and seasonal farmworkers (MSFW) are particularly susceptible to the effects of natural disasters. This research project assessed the awareness, perceived risk, and practices regarding disaster preparedness and response resources and identified barriers to utilization of community and government services during or after a natural disaster among Latino MSFWs’ and their families. Qualitative (N = 21) focus groups (3) and quantitative (N = 57) survey methodology was implemented with Latino MSFWs temporarily residing in rural eastern North Carolina to assess perceived and actual risk for natural disasters. Hurricanes were a top concern among the sample population, many participants shared they lacked proper resources for an emergency (no emergency kit in the house, no evacuation plan, no home internet, a lack of knowledge of what should be included in an emergency kit, etc.). Transportation and language were found to be additional barriers. Emergency broadcasts in Spanish and text message alerts were identified by the population to be helpful for disaster alerts. FEMA, American Red Cross, local schools and the migrant clinic were trusted places for assistance and information. In summary, tailored materials, emergency alerts, text messages, and news coverage concerning disaster threats should be provided in the population’s native language and when feasible delivered in a culturally appropriate mechanism such as “charlas” (talks) and brochures.
PMCID: PMC3499857  PMID: 23202674
disaster preparedness; Latino migrant and seasonal farmworkers; MSFW
12.  Exposure to High Fluoride Drinking Water and Risk of Dental Fluorosis in Estonia 
The purpose of this study was to assess exposure to drinking water fluoride and evaluate the risk of dental fluorosis among the Estonian population. The study covered all 15 counties in Estonia and 93.7% of population that has access to public water supplies. In Estonia groundwater is the main source for public water supply systems in most towns and rural settlements. The content of natural fluoride in water ranges from 0.01 to 7.20 mg/L. The exposure to different fluoride levels was assessed by linking data from previous studies on drinking water quality with databases of the Health Protection Inspectorate on water suppliers and the number of water consumers in water supply systems. Exposure assessment showed that 4% of the study population had excessive exposure to fluoride, mainly in small public water supplies in western and central Estonia, where the Silurian-Ordovician aquifer system is the only source of drinking water. There is a strong correlation between natural fluoride levels and the prevalence of dental fluorosis. Risk of dental fluorosis was calculated to different fluoride exposure levels over 1.5 mg/L.
PMCID: PMC2672351  PMID: 19440411
Drinking water; fluoride; exposure; dental fluorosis; Estonia
13.  Lessons from the Georgia floods. 
Public Health Reports  1995;110(6):684-688.
In July 1994, tropical storm Alberto brought heavy rains to parts of Alabama, Florida, and Georgia. In South Georgia, rivers rose 44 feet above flood stage, muddy water covered 10,000 square miles, and 31 lives were lost. In implementing the Health and Medical Services portion of the FEMA Federal Response Plan, the Public Health Service learned lessons from this experience that can be applied to planning for other natural disasters. Continuous reassessment to assure the best utilization of resources in rapidly changing conditions, cross-training in the content of emergency plans at all levels, and on-going face-to-face liaison among response managers will improve response efforts. Populations with special medical needs must become part of any response design. The effects that any response activity may have on the community as a whole should be carefully considered before action is taken.
PMCID: PMC1381807  PMID: 8570818
14.  Web 2.0 and Internet Social Networking: A New tool for Disaster Management? - Lessons from Taiwan 
Internet social networking tools and the emerging web 2.0 technologies are providing a new way for web users and health workers in information sharing and knowledge dissemination. Based on the characters of immediate, two-way and large scale of impact, the internet social networking tools have been utilized as a solution in emergency response during disasters. This paper highlights the use of internet social networking in disaster emergency response and public health management of disasters by focusing on a case study of the typhoon Morakot disaster in Taiwan.
In the case of typhoon disaster in Taiwan, internet social networking and mobile technology were found to be helpful for community residents, professional emergency rescuers, and government agencies in gathering and disseminating real-time information, regarding volunteer recruitment and relief supplies allocation. We noted that if internet tools are to be integrated in the development of emergency response system, the accessibility, accuracy, validity, feasibility, privacy and the scalability of itself should be carefully considered especially in the effort of applying it in resource poor settings.
This paper seeks to promote an internet-based emergency response system by integrating internet social networking and information communication technology into central government disaster management system. Web-based networking provides two-way communication which establishes a reliable and accessible tunnel for proximal and distal users in disaster preparedness and management.
PMCID: PMC2958996  PMID: 20925944
15.  Economic and Health Impacts Associated with a Salmonella Typhimurium Drinking Water Outbreak−Alamosa, CO, 2008 
PLoS ONE  2013;8(3):e57439.
In 2008, a large Salmonella outbreak caused by contamination of the municipal drinking water supply occurred in Alamosa, Colorado. The objectives of this assessment were to determine the full economic costs associated with the outbreak and the long-term health impacts on the community of Alamosa. We conducted a postal survey of City of Alamosa (2008 population: 8,746) households and businesses, and conducted in-depth interviews with local, state, and nongovernmental agencies, and City of Alamosa healthcare facilities and schools to assess the economic and long-term health impacts of the outbreak. Twenty-one percent of household survey respondents (n = 369/1,732) reported diarrheal illness during the outbreak. Of those, 29% (n = 108) reported experiencing potential long-term health consequences. Most households (n = 699/771, 91%) reported municipal water as their main drinking water source at home before the outbreak; afterwards, only 30% (n = 233) drank unfiltered municipal tap water. The outbreak’s estimated total cost to residents and businesses of Alamosa using a Monte Carlo simulation model (10,000 iterations) was approximately $1.5 million dollars (range: $196,677–$6,002,879), and rose to $2.6 million dollars (range: $1,123,471–$7,792,973) with the inclusion of outbreak response costs to local, state and nongovernmental agencies and City of Alamosa healthcare facilities and schools. This investigation documents the significant economic and health impacts associated with waterborne disease outbreaks and highlights the potential for loss of trust in public water systems following such outbreaks.
PMCID: PMC3601119  PMID: 23526942
16.  Katrina and the Thai Tsunami - Water Quality and Public Health Aspects Mitigation and Research Needs 
The South East Asian Tsunami in Thailand and Hurricane Katrina in the United States were natural disasters of different origin but of similar destruction and response. Both disasters exhibited synonymous health outcomes and similar structural damage from large surges of water, waves, and flooding. A systematic discussion and comparison of the disasters in Thailand and the Gulf Coast considers both calamities to be similar types of disaster in different coastal locations. Thus valuable comparisons can be made for improvements in response, preparedness and mitigation. Research needs are discussed and recommendations made regarding potential methologies. Recommendations are made to: (1) improve disaster response time in terms of needs assessments for public health and environmental data collection; (2) develop an access-oriented data sharing policy; and (3) prioritize natural geomorphic structures such as barrier islands, mangroves, and wetlands to help reduce the scale of future natural disasters. Based on the experiences gained opportunities to enhance disaster preparedness through research are presented.
PMCID: PMC3699998  PMID: 19151433
Hurricane Katrina; tsunami; disaster preparedness; research needs; lessons learned
17.  The World Trade Center Attack Disaster preparedness: health care is ready, but is the bureaucracy? 
Critical Care  2001;5(6):323-325.
When a disaster occurs, it is for governments to provide the leadership, civil defense, security, evacuation, and public welfare. The medical aspects of a disaster account for less than 10% of resource and personnel expenditure. Hospitals and health care provider teams respond to unexpected occurrences such as explosions, earthquakes, floods, fires, war, or the outbreak of an infectious epidemic. In some geographic locations where natural disasters are common, such as earthquakes in Japan, such disaster practice drills are common. In other locations, disaster drills become pro forma and have no similarity to real or even projected and predicted disasters. The World Trade Center disaster on 11 September 2001 provides new information, and points out new threats, new information systems, new communication opportunities, and new detection methodologies. It is time for leaders of medicine to re-examine their approaches to disaster preparedness.
PMCID: PMC137381  PMID: 11737919
bioterrorism; detection; disaster planning; terrorism
18.  The National Library of Medicine’s Disaster Information Management Research Center 
The Disaster Information Management Research Center (DIMRC) develops and provides access to health information resources and technology for disaster preparedness, response, and recovery. DIMRC focuses on maintaining access to health information at all phases of disasters, developing innovative products and services for emergency personnel, conducting research to support disaster health information management, and collaborating with other agencies and communities. Several tools are available to help emergency responders in hazardous materials or chemical, biological, radiological, or nuclear incidents. Access to the literature is made available through PubMed and the Resource Guide for Disaster Medicine and Public Health, with links to online documents and resources from numerous organizations and government agencies. In addition, DIMRC supports the Disaster Information Specialist Program, a collaborative effort to explore and promote the role of librarians and information specialists in the provision of disaster-related information resources to the workforce and communities.
PMCID: PMC3864260  PMID: 24380078
library; informationist; literature; tools; apps
19.  Business and public health collaboration for emergency preparedness in Georgia: a case study 
BMC Public Health  2006;6:285.
Governments may be overwhelmed by a large-scale public health emergency, such as a massive bioterrorist attack or natural disaster, requiring collaboration with businesses and other community partners to respond effectively. In Georgia, public health officials and members of the Business Executives for National Security have successfully collaborated to develop and test procedures for dispensing medications from the Strategic National Stockpile. Lessons learned from this collaboration should be useful to other public health and business leaders interested in developing similar partnerships.
The authors conducted a case study based on interviews with 26 government, business, and academic participants in this collaboration.
The partnership is based on shared objectives to protect public health and assure community cohesion in the wake of a large-scale disaster, on the recognition that acting alone neither public health agencies nor businesses are likely to manage such a response successfully, and on the realization that business and community continuity are intertwined. The partnership has required participants to acknowledge and address multiple challenges, including differences in business and government cultures and operational constraints, such as concerns about the confidentiality of shared information, liability, and the limits of volunteerism. The partnership has been facilitated by a business model based on defining shared objectives, identifying mutual needs and vulnerabilities, developing carefully-defined projects, and evaluating proposed project methods through exercise testing. Through collaborative engagement in progressively more complex projects, increasing trust and understanding have enabled the partners to make significant progress in addressing these challenges.
As a result of this partnership, essential relationships have been established, substantial private resources and capabilities have been engaged in government preparedness programs, and a model for collaborative, emergency mass dispensing of pharmaceuticals has been developed, tested, and slated for expansion. The lessons learned from this collaboration in Georgia should be considered by other government and business leaders seeking to develop similar partnerships.
PMCID: PMC1676007  PMID: 17116256
20.  Non-Communicable Diseases in Emergencies: A Call to Action 
PLoS Currents  2013;5:ecurrents.dis.53e08b951d59ff913ab8b9bb51c4d0de.
Recent years have demonstrated the devastating health consequences of complex emergencies and natural disasters and thereby highlighted the importance of comprehensive and collaborative approaches to humanitarian responses and risk reduction. Simultaneously, noncommunicable diseases are now recognised as a real and growing threat to population health and development; a threat that is magnified by and during emergencies. Noncommunicable diseases, however, continue to receive little attention from humanitarian organisations in the acute phase of disaster and emergency response. This paper calls on all sectors to recognise and address the specific health challenges posed by noncommunicable diseases in emergencies and disaster situations. This publication aims to highlight the need for: • Increased research on morbidity and mortality patterns due to noncommunicable diseases during and following emergencies; • Raised awareness through greater advocacy for the issue and challenges of noncommunicable diseases during and following emergencies; • Incorporation of noncommunicable diseases into existing emergency-related policies, standards, and resources; • Development of technical guidelines on the clinical management of noncommunicable diseases in emergencies; • Greater integration and coordination in health service provision during and following emergencies; • Integrating noncommunicable diseases into practical and academic training of emergency workers and emergency-response coordinators.
PMCID: PMC3775888  PMID: 24056956
21.  Public Health and Nursing: A Natural Partnership 
The health of individuals occurs within the context of their environment and the other individuals they interact with in the communities they live in, work in and visit. Promoting the health of the public requires multiple strategies aimed at improving the environment, the health knowledge of groups and individuals, maintaining adequate food and water, and reducing the spread of disease. Many disciplines are needed to meet these goals, but the largest segment of the professional health work force required to meet these needs is nursing. Historically, nursing leaders in public health such as Florence Nightingale and Lillian Wald made significant inroads related to serious health issues because they were nurses. Today across the globe, nurses provide the key components of public health interventions including well baby care, health education, screening and immunization clinics, disaster management and emergency preparedness. With the growing nursing shortage in acute care settings, the brain drain of nurses from certain areas of the world, the shrinking public dollars for preventive health care, the nursing workforce needed to continue to provide these essential health care services is threatened. It is essential to put the spot light on nursing’s role in public health with the hopes of attracting more public funds and more nurses to provide these essential services.
PMCID: PMC2800068  PMID: 20049229
public health; nursing; health care workforce
22.  The challenges and rewards of engaging a skeptical public 
Findings published in this issue suggest that a substantial subset of the Israeli public generally trusts government, yet is determined to make their own judgments about the need for precautionary action in certain types of public health emergencies. This reflective approach, which may be common in other countries as well, poses a substantial challenge to achieving desired levels of compliance, particularly when the threat requires swift and concerted action. The aim of this commentary is to discuss both the challenges and the rewards of engaging a public that wants to weigh evidence prior to taking action in an emergency, rather than defer to expert judgment. While engaging a skeptical public can be difficult, a reflective public acknowledges that preparedness is a shared responsibility of government and individuals and may be receptive to messages about the need for household and community self-sufficiency in a disaster. This is a commentary on the article “Analysis of Public Responses to Preparedness Policies” by Velan and colleagues.
PMCID: PMC3623629  PMID: 23537194
23.  Surveillance and Epidemiology in Natural Disasters: A Novel Framework and Assessment of Reliability 
PLoS Currents  2014;6:ecurrents.dis.6773eb9d5e64b733ab490f78de346003.
Objective: To create a framework and methodology for organizing relevant disaster epidemiology literature. The target audience for the framework is local public health practitioners conducting emergency surveillance in the setting of preparedness or response to natural disasters. Methods: The approach to developing the framework involved utilizing the public health and emergency management literature. It was created along four axes. The first was the type of natural disaster; second was according to phase of disaster cycle; third was the impact of the disaster (health, infrastructure, economic); and fourth was related to the main outcome of the study (ie. injuries or infectious diseases). A literature review was conducted and subsequently the current literature was utilized to perform a reliability test of the established framework, using two independent reviewers. Results: Using existing disaster classification systems and risk analysis tools, a framework was developed along the four axes. The final literature search resulted in 85 articles on surveillance in natural disaster settings. The majority of studies are on the subject of hurricanes with a catastrophic impact rating. The phase of testing reliability of the framework resulted in percent agreement of 74%. Conclusions: A reliable framework was developed that enables local public health practitioners to easily access appropriate and previously utilized surveillance methods for a natural disaster emergency. This framework contributes to an evidence-informed approach to surveillance in natural disasters with public health impacts.
PMCID: PMC3919830  PMID: 24524006
24.  Using a Dynamic Hydrology Model To Predict Mosquito Abundances in Flood and Swamp Water 
We modeled surface wetness at high resolution, using a dynamic hydrology model, to predict flood and swamp water mosquito abundances. Historical meteorologic data, as well as topographic, soil, and vegetation data, were used to model surface wetness and identify potential fresh and swamp water breeding habitats in two northern New Jersey watersheds. Surface wetness was positively associated with the subsequent abundance of the dominant floodwater mosquito species, Aedes vexans, and the swamp water species, Anopheles walkeri. The subsequent abundance of Culex pipiens, a species that breeds in polluted, eutrophic waters, was negatively correlated with local modeled surface wetness. These associations permit real-time monitoring and forecasting of these floodwater and nonfloodwater species at high spatial and temporal resolution. These predictions will enable public health agencies to institute control measures before the mosquitoes emerge as adults, when their role as transmitters of disease comes into play.
PMCID: PMC2730265  PMID: 11749741
entomology; hydrology; Culicidae; Aedes; Anopheles; Culex; vector control; West Nile virus; St. Louis encephalitis; dynamic modeling
25.  Corrosion and Scaling Potential in Drinking Water Distribution System of Tabriz, Northwestern Iran 
Health Promotion Perspectives  2012;2(1):103-111.
Background: This paper discusses the corrosion and scaling potential of Tabriz drinking water distribution system in Northwest of Iran. Internal corrosion of piping is a serious problem in drinking water industry. Corrosive water can cause intrusion of heavy metals especially lead in to water, therefore effecting public health. The aim of this study was to determine corrosion and scaling potential in potable water distribution system of Tabriz during the spring and summer in 2011.
Methods: This study was carried out using Langlier Saturation Index, Ryznar Stability Index, Puckorius Scaling Index, and Aggressiveness indices. Eighty samples were taken from all over the city within two seasons, spring, and summer. Related parameters including temperature, pH, total dissolved solids, calcium hardness, and total alkalinity in all samples were measured in laboratory according to standard method manual. For the statistical analysis of the results, SPSS software (version 11.5) was used
Results: The mean and standard deviation values of Langlier, Ryznar, Puckorius and Aggressiveness Indices were equal to -0.68 (±0.43), 8.43 (±0.55), 7.86 (±0.36) and 11.23 (±0.43), respectively. By survey of corrosion indices, it was found that Tabriz drinking water is corrosive.
Conclusion: In order to corrosion control, it is suggested that laboratorial study with regard to the distribution system condition be carried out to adjust effective parameters such as pH.
PMCID: PMC3963649  PMID: 24688924
Drinking water; Corrosion indices; Scaling; Corrosion potential; Iran

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