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Background: Adequate hospital staffing during and after a disaster is critical to meet increased health care demands and to ensure continuity of care and patient safety. However, when a disaster occurs, staff may become both victim and responder, decreasing their ability and willingness to report for work. This qualitative study assessed the personal and professional challenges that affected staff decisions to report to work following a natural disaster and examined the role of management in addressing staff needs and concerns.Methods: Semi-structured interviews were conducted with individuals who filled key management roles in the United States Department of Veterans Affairs New York Harbor Healthcare System's response to Superstorm Sandy and during the facility's initial recovery phase. All interviews were audio recorded and transcribed. Three major themes were identified: 1) Barriers to reporting ("Barriers"), 2) Facilitators to reporting ("Facilitators"), and 3) Responses to staff needs and concerns ("Responses"). Atlas.ti 7.1.6 software program was used for the management and analysis of the transcripts.Results: Results indicated that staff encountered several barriers that impeded their ability to report to work at mobile vans at the temporarily nonoperational Manhattan campus or at two other VA facilities in Brooklyn and the Bronx in the initial post-Sandy period including transportation problems, personal property damage, and communication issues. In addition, we found evidence of facilitators to reporting as expressed through descriptions of professional duty. Our findings also revealed that management was aware of the challenges that staff was facing and made efforts to reduce barriers and accommodate staff affected by the storm.Conclusions: During and after a disaster event, hospital staff is often confronted with challenges that affect decisions to report for work and perform effectively under potentially harsh conditions. This study examined barriers and facilitators that hospital staff encountered following a major natural disaster from the management perspective. Insights gained from this study can be used to inform future disaster planning and preparedness efforts, and help ensure that there is adequate staffing to mount an effective response when a disaster occurs, and to recover from its aftermath. [ABSTRACT FROM AUTHOR]

Background Postnatal depression is a public health problem requiring intervention. To provide effective care, information is needed on the experiences of those with high levels of depressive symptoms who are offered and accept, or decline, psychological intervention postnatally. Aim To provide the first integrated in-depth exploration of postnatal women's experiences of the identification and management of symptoms of depression and the offer and acceptance of postnatal care by health visitors taking part in the PONDER trial. Setting General practice: primary care within the former Trent regional health authority, England. Method Thirty women with 6-week Edinburgh Postnatal Depression Scale (EPDS) scores ≥18 and probable depression completed semi-structured interviews. All women had taken part in the Post-Natal Depression Economic Evaluation and Randomised controlled (PONDER) trial where intervention group health visitors received training in identification of depressive symptoms and provided psychologically informed sessions based on cognitive-behavioural therapy or person-centred counselling principles. Results When accepted, psychological sessions were experienced as positive, effective, and 'ideal care'. Women approved of using the EPDS but did not understand the health visitor's role in supporting women. Seeking help and accepting sessions depended on women's perspectives of their health visitor as an individual. Conclusion Women's experience of their health visitors providing psychological sessions to help with postnatal depressive symptoms is highly positive. Women will better accept support from health visitors if they recognise their role in postnatal depression and find them easy to relate to on personal matters. There is a case for specific enhancement of interpersonal skills in health visiting, or alternatively offering a choice of health visitors to women. [ABSTRACT FROM AUTHOR]

The article highlights the role of diagnostic tests and reduction in the stunting among children presenting with diarrheal illness. Topics include the prolonged episodes of diarrhea during childhood that increase the risk of stunting, which is believed to be associated with significant morbidity.

Many public health departments seek to improve their capability to respond to large-scale events such as an influenza pandemic. Quality improvement (QI), a structured approach to improving performance, has not been widely applied in public health. We developed and tested a pilot QI collaborative to explore whether QI could help public health departments improve their pandemic preparedness. We demonstrated that this is a promising model for improving public health preparedness and may be useful for improving public health performance overall. Further efforts are needed, however, to encourage the robust implementation of QI in public health. [ABSTRACT FROM AUTHOR]

Hospital evacuations that occur during, or as a result of, infrastructure outages are complicated and demanding. Loss of infrastructure services can initiate a chain of events with corresponding management challenges. This report describes a modeling case study of the 2001 evacuation of the Memorial Hermann Hospital in Houston, Texas (USA). The study uses a model designed to track such cascading events following loss of infrastructure services and to identify the staff, resources, and operational adaptations required to sustain patient care and/or conduct an evacuation. The model is based on the assumption that a hospital's primary mission is to provide necessary medical care to all of its patients, even when critical infrastructure services to the hospital and surrounding areas are disrupted. Model logic evaluates the hospital's ability to provide an adequate level of care for all of its patients throughout a period of disruption. If hospital resources are insufficient to provide such care, the model recommends an evacuation. Model features also provide information to support evacuation and resource allocation decisions for optimizing care over the entire population of patients. This report documents the application of the model to a scenario designed to resemble the 2001 evacuation of the Memorial Hermann Hospital, demonstrating the model's ability to recreate the timeline of an actual evacuation. The model is also applied to scenarios demonstrating how its output can inform evacuation planning activities and timing.

Problem: Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System's (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012., Methods: Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event., Results: The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City's (NYC's) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city's order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit., Conclusions: Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.

Resilience in hospitals - their ability to withstand, adapt to, and rapidly recover from disruptive events - is vital to their role as part of national critical infrastructure. This paper presents a model to provide planning guidance to decision makers about how to make hospitals more resilient against possible disruption scenarios. This model represents a hospital's adaptive capacities that are leveraged to care for patients during loss of infrastructure services (power, water, etc.). The model is an optimization that reallocates and substitutes resources to keep patients in a high care state or allocates resources to allow evacuation if necessary. An illustrative example demonstrates how the model might be used in practice.

Experiences from recent emergencies, such as Hurricanes Katrina and Rita, have shown that current emergency preparedness plans are inadequate to address the unique issues of special needs populations. This article shares details about a toolkit meant to assist state and local public health agencies improve their emergency preparedness activities. It distills the most relevant strategies, practices, and resources from a variety of sources, including peer-reviewed research, government reports, the trade literature, and public health leaders, to identify priority populations and critical strategies. The contents include potential strategies for addressing special needs, summaries of promising practices implemented in communities across the country, information on how to select one or more practices that will work in a specific community, information on how to determine whether a practice is working, and a Web-based Geographic Information Systems (GIS) tool to identify and enumerate those with special needs in communities across the United States. Used together, the toolkit and the GIS tool are intended to provide a comprehensive resource to enable public health planners to account for special needs populations in their emergency preparedness efforts.