Description of Patients Medications Needs and the Community Pharmacist's Role in Puerto Rico Following a Natural Disaster

Background: In September 2017, Puerto Rico was hit by Hurricane Maria, a natural disaster that caused devastation. Initial reports of disruption to the health care system were later followed by increases in the death toll in Puerto Rico. Objective: This project assessed patient medications needs, level of satisfaction with community pharmacy services, and perceptions about the role of the pharmacist during the emergency following Hurricane Maria in Puerto Rico. Methodology: The investigation utilized a descriptive, cross-sectional design. Data were collected at 3 community pharmacies located in San Juan, Puerto Rico: Walgreens (Specialty Pharmacy and Store 891) and Farmacia Caridad #9. Patients receiving care at these locations were invited to complete a 10-item questionnaire. These were provided with an information sheet describing details of the study prior to participation. Results: Sixty-five patients participated in the study, with an average age of 59 years. The majority (77%) of the respondents reported problems related to their medications and nearly half (47.7%) reported having trouble either contacting or getting to their pharmacy following the hurricane. Regarding the role of pharmacists following a natural disaster, 94% of respondents reported the pharmacist was available to help them and 95% reported the information provided by the pharmacist was “trustworthy/very trustworthy.” Conclusion: Although the challenges reported in Puerto Rico with regard to medications following Hurricane Maria were significant, patients reported a high level of confidence in the ability of community pharmacists to help them.

Factors Associated with Urban Risk-Taking Behaviour during 2018 Typhoon Mangkhut: A Cross Sectional Study

Although much of the health emergency and disaster risk management (Health-EDRM) literature evaluates methods to protect health assets and mitigate health risks from disasters, there is a lack of research into those who have taken high-risk behaviour during extreme events. The study's main objective is to examine the association between engaging in high-risk behaviour and factors including sociodemographic characteristics, disaster risk perception and household preparedness during a super typhoon. A computerized randomized digit dialling cross-sectional household survey was conducted in Hong Kong, an urban metropolis, two weeks after the landing of Typhoon Mangkhut. Telephone interviews were conducted in Cantonese with adult residents. The response rate was 23.8% and the sample was representative of the Hong Kong population. Multivariable logistic regressions of 521 respondents adjusted with age and gender found education, income, risk perception and disaster preparedness were insignificantly associated with risk-taking behaviour during typhoons. This suggests that other factors may be involved in driving this behaviour, such as a general tendency to underestimate risk or sensation seeking. Further Health-EDRM research into risk-taking and sensation seeking behaviour during extreme events is needed to identify policy measures.

Help-seeking preferences among Chinese college students exposed to a natural disaster: a person-centered approach

BACKGROUND

Direct exposure to natural disasters is associated with increased mental disorders. Help-seeking behaviour among Chinese adults is low and the barriers and facilitators of help-seeking among Chinese adults exposed to natural disasters is understudied.

OBJECTIVE

Using a person-centred approach, this study describes help-seeking preferences and their correlates in a sample of Chinese college students after experiencing Typhoon Hato, the strongest storm to affect Macao, China in the past 50 years.

METHOD

The baseline sample was collected one month following exposure to the Typhoon (September 2017). Six months following the baseline study (April, 2018), a total of 815 students (females = 71.5%) completed follow-up and were included in the data analysis. Latent Class Analysis (LCA) and Multinomial Logistic Regression were used to analyse the data via Mplus 7.4 and Stata 15.0.

RESULTS

Three latent classes of help-seeking preferences were identified in this study, including: 'mental health professionals and close people' (MHPCP, 52%), non-seekers (31%), and 'multiple sources' (17%). The results of multinomial logistic regression showed that region of origin (mainland versus Macao, China), self-stigma, perceived helpfulness of professional mental health help, previous professional help-seeking behaviour, and perceived social support, were significantly associated with MHPCP help-seeking preferences.

CONCLUSION

A large proportion of students preferred to seek support from loved ones and professionals. However, over 30% of the sample preferred not seeking help for mental health concerns. Further research is needed to enhance mental health treatment seeking preferences among Chinese college students.

US Department of Defense Support of Civilian Vector Control Operations Following Natural Disasters

The United States Department of Defense (DoD) employs advanced-degreed entomologists as Preventive Medicine and Public Health Officers in the Army, Navy, and Air Force. While the primary objective of military entomologists is service member health and readiness ("force health protection"), military entomology resources can provide support to civil authorities as directed by the President or Secretary of Defense through Department of Defense Directive 3025.18, Defense Support of Civil Authorities (DSCA). The employment of DSCA is complex and involves the consideration of such factors as the proper request process, funding, legality, risk, appropriateness, and readiness. Once approved and mobilized, however, military preventive medicine assets can be of significant help to civil authorities when dealing with emergency vector control. This paper will address some of the policy issues surrounding the use of DSCA, outline the resources available from the individual military services, and provide examples of DoD contingency vector control support to civil authorities.

The Impact of Hurricane Irma on Our Community and the Collier Mosquito Control District's Mission

The Collier Mosquito Control District, located in southwest Florida, is uniquely positioned in a subtropical environment between the Gulf of Mexico and Everglades National Park. The District's mission is focused on the control of disease vector and nuisance mosquitoes in Collier County, which is accomplished through integrated mosquito management. Hurricane Irma made landfall in the county on September 10, 2017, leaving in its wake tremendous property and infrastructure damage, and it also disrupted communications and airport operations. These factors greatly affected the District's operations and its ability to meet its mission. In addition, the lengthy loss of electrical power forced most residents outdoors, increasing their exposure to mosquitoes. From challenges in completing poststorm treatments to outdated policies that caught us off-guard, the event prompted a new hurricane policy and plan to ensure improved preparedness for the next natural disaster. The poststorm environment also provided a rich foundation for research into mosquito populations after tropical disturbances of this scale. Here we report the impact on the District's aerial mosquito control operations, changes to internal policies, and mosquito population abundance following Hurricane Irma.

Race and Racism as Structural Determinants for Emergency and Recovery Response in the Aftermath of Hurricanes Irma and Maria in Puerto Rico

Purpose: To explore the role of race and racism in emergency response and recovery in the aftermath of hurricanes in Puerto Rico (PR). Methods: Sixteen semistructured qualitative interviews were conducted between March and April 2018 with community members who had an active role in the process of response and relief efforts. Among participants, eight were from PR, and eight were of Puerto Rican descent living in the continental United States. Narrative text from interviews was analyzed using grounded theory approach and narrative analysis techniques. Results: Participants were adult men and women from different municipalities in PR and diverse regions of the continental United States and with diverse professional and economic backgrounds. In the analysis of the interviews, "fitting the box" of race, race in emergency and recovery response, and community philanthropy emerged across narratives as frequent and as illustrative of the issues of race/racism and response to natural disasters in PR. Participants shared a perception that the combination of disasters, including natural disasters and historic political mismanagement, is the cause of the precarious conditions in PR in the aftermath of the hurricanes. Race was perceived as a problematic construct in the understanding of Puerto Rican identities. Racism was contextualized as part of the complicated relationship between PR and the United States and as an obstacle for adequate emergency response. Conclusions: Systemic racism was perceived as a barrier to emergency and recovery response in the aftermath of natural disasters. Structural changes are required to reduce vulnerability and health inequities in PR.

Complicated Grief: What to Expect After the Coronavirus Pandemic

The COVID-19 pandemic is one of the worst public health crises in a century, with an expected amount of deaths of several million worldwide and an even bigger number of bereaved people left behind. Although the consequences of this crisis are still unknown, a significant number of bereaved people will arguably develop Complicated Grief (CG) in the aftermath of this emergency. If the current pandemic is unprecedented, the grief following the coronavirus outbreak is likely to share features with grief related to natural disasters and after Intensive Care Unit (ICU) treatment. The aim of this paper is to review the most prominent literature on CG after natural disasters, as well as after diseases requiring ICU treatment. This body of evidence may be useful for helping bereaved people during the acute phase of the COVID-19 pandemic and for drawing clinical attention to people at risk for CG.

The Role of Dental Professionals in Pandemic Events and Disaster Responses

The past 20 years have seen major public health emergencies and natural disasters, including the Severe Acute Respiratory Syndrome outbreak caused by the SARS-associated coronavirus (SARS-CoV) in 2003; the Wenchuan earthquake in 2008; and the novel coronavirus pandemic (COVID-19) of 2019, which caused mass casualties, infections, and panic. These also resulted in complex demands for medical resources and information, and a shortage of human resources for emergency responses. To address the shortage of human resources required for these emergency responses, Chinese dental professionals made useful contributions. From this work, deficiencies in emergency response training and opportunities for the expansion of rescue capabilities were identified, and relevant recommendations made.

Evaluating a community fire as human-made vs. natural disaster moderates the relationship between peritraumatic distress and both PTSD symptoms and posttraumatic growth

Objective: This study examined whether attributing a cause of a community fire to a human-made vs. natural disaster moderated the association between peritraumatic distress (PD) and posttraumatic stress (PTSD) symptoms, as well as between PD and posttraumatic growth (PTG). Method: Participants lived in Israeli communities affected by wide-scale fires in November 2016. At Time 1 (within one month of the fires), 390 participants completed measures. At Time 2 (four months after the fires), 223 of the original participants completed follow-up-questionnaires. Participants reported their PD symptoms at Time 1, and their beliefs regarding the cause of the fire, PTSD symptoms, and PTG at Time 2. Results: Higher levels of PD at Time 1 were associated with higher levels of both PTSD symptoms and PTG at Time 2. Participants who believed that the fires were more of a human-made than natural disaster had stronger associations between PD and PTSD symptoms, and stronger associations between PD and PTG. Conclusions: Attributions regarding the cause of a disaster may be related to both PTSD symptoms as well as PTG. Balanced and responsible public announcements regarding the causes of traumatic events may reduce the deleterious effects in the aftermath of a traumatic event.

Sex differences in type of lifetime trauma and suicidal ideation mediated by post-traumatic stress and anxio-depressive disorders in older adults

OBJECTIVES

Examine the association between trauma and daily stressors, post-traumatic stress syndrome (PTSS), anxio-depressive disorders, and suicidal ideation in older adults.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

This study included 1446 older adults recruited in primary care practices (2011-2013) and participating in Quebec's longitudinal study on health services in the elderly.

MEASUREMENTS

Lifetime trauma and PTSS was assessed using the validated PTSS scale for older adults based on scores from the Impact of Events Scale-Revised, number of lifetime traumatic events and interference with daily activities. The presence of an anxio-depressive disorder was based on physician diagnoses. Path analyses were conducted to determine the pathways between trauma, daily stressors, PTSS and anxio-depressive disorders and SI. Analyses were conducted on the overall sample and by sex.

RESULTS

Seven percent and 12% reported SI and PTSS. In males, traumas of sexual assault, violence/stalked, war/combat/imprisonment and daily hassles were directly associated with SI. In females, daily hassles were directly associated with SI. In males, a number of traumas were associated with SI through the mediating effect of PTSS and anxio-depressive disorders. In females, PTSS but not anxio-depressive disorders mediated the relationship between traumas and daily stressors, and suicidal ideation.

CONCLUSIONS

The effects of lifetime traumas persist well into older age. Traumas leading to SI differ between males and females as do the pathways and comorbidity with PTSS and anxio-depressive disorders. This highlights differences in etiologic patterns, which may be used in primary care practice to identify symptom profiles of older persons at risk of suicidal ideation.

Evaluation of Disaster Medicine Preparedness among Healthcare Profession Students: A Cross-Sectional Study in Pakistan

Background: Disasters are devastating incidents, especially when occurring suddenly and causing damage, great loss of life, or suffering. Disasters can affect health and the social and economic development of a nation. The article analyzes the knowledge (K), attitude (A), and readiness to practice (rP) of healthcare professional students in universities in Pakistan. Methods: We carried out a cross-sectional study using a pretested and validated self-administered disaster medicine and preparedness questionnaire. The study recruited 310 students. Responses were scored and categorized as high (75th quartile), moderate (75-25th quartiles), and low (25th quartile). Independent t-test, one-way ANOVA, Pearson correlation, and regression analyses were performed at an alpha level of 0.05. Results: The study found that most of the students had moderate knowledge, attitude, readiness to practice, and total KArP scores. All K, A, and rP scores were significantly correlated with overall KArP scores. Knowledge and attitude factors were significant predictors of readiness to practice. Conclusions: We strongly believe that educators and health policymakers should build a strong curriculum in disaster medicine management and preparedness to prepare competent future healthcare professionals for the nation.

Life stress moderates the effects of preschool behavioral inhibition on anxiety in early adolescence

BACKGROUND

Although a robust body of literature implicates temperamental behavioral inhibition (BI) as a prominent risk factor for anxiety disorders, many children with heightened BI do not develop anxiety. The current study examines the role of two forms of life stress (life events and natural disaster exposure) in moderating the relationship between BI in preschoolers and anxiety in early adolescence.

METHOD

A community sample of 392 3-year-old children was administered a laboratory observational assessment of temperament. When children were a mean age 10, the region was struck by a devastating hurricane and exposure to disaster-related stress was assessed. In early adolescence, youth and a parent were administered the UCLA Life Stress Interview (LSI) to assess behaviorally independent and dependent negative life events during the prior year and youth completed the Screen for Child Anxiety Related Emotional Disorders (SCARED).

RESULTS

The association between early childhood BI and anxiety symptoms in early adolescence was moderated by both independent life events and disaster-related stress. Children high in BI at age 3 reported greater anxiety symptoms at age 12 after exposure to higher levels of both forms of stress.

CONCLUSIONS

Stress moderated the association between early BI and later anxiety. Importantly, this was evident for two different kinds of stressors that were independent of the child's behavior that increases confidence in the causal role of stress in the development of anxiety in high BI children.

The Impact of Social Media on Risk Communication of Disasters-A Comparative Study Based on Sina Weibo Blogs Related to Tianjin Explosion and Typhoon Pigeon

Social media has brought opportunities and challenges to risk communication of disasters by undermining the monopoly of traditional news media. This paper took blogs about Tianjin Explosion and Typhoon Pigeon posted through Sina Weibo as empirical objects. Moreover, the paper used the analytical method of social network to conduct a comparative study on the network structures of information disseminated among different types of disasters, with the goal of uncovering the impact of social media on different types of risk communication of disasters. The result shows a different impact of the risk communication on the two types of disasters. While the role of social media for the risk communication of natural disasters is mainly to influence information dissemination, the roles of social media for the risk communication of man-made disasters are to transmit information as well as to communicate emotions. The differences seen within the structure of social media networks are causes differences in functions. Specifically, the structure for the social media communication network on man-made disasters takes on a "core - periphery structure" which is endowed with both information communication and emotional communication functions. Also, the role of the opinion leaders for the subnet is found to be significant while the communication within small groups is kept pretty active; additionally, the slow speed of information transmission of the network could result in easily distorted information. On top of that, the network is characterized with intense vulnerability to the attacks on core nodes. In contrast, the social media network for natural disaster risk communication is not seen with an obvious "peripheral-core" structure which is a relatively pure information transmission network with relatively equal principal status. In other words, the entire network is found with stronger connectivity and relatively faster information transmission speed. Furthermore, the nodes inside the network are found to have weaker control over information transmission. In sum, the research results are helpful in improving the risk communication theory based on social relations, optimizing the communication structure of disaster information so as to change the effect of risk communication.

Neighborhood Ties Reduced Depressive Symptoms in Older Disaster Survivors: Iwanuma Study, a Natural Experiment

Objective: As most studies relating to mental health and disasters have employed cross-sectional or follow-up assessments about psychological health with post-disaster information, the association between changes in social ties and mental health remains unclear. We examined the relationship between the changes in survivor neighborhood ties and depressive symptoms before and after a natural disaster. Methods: Participants were 3567 individuals aged ≥65 years living in Iwanuma city who had responded to questionnaires by the Japan Gerontological Evaluation Study both predating the 2011 Great East Japan Earthquake and Tsunami, and 2.5 years afterward. Changes in the depressive symptoms were assessed using the geriatric depression scale (GDS) at the baseline and follow-up survey. Changes in the neighborhood ties were assessed by asking the participants about their interactions with people in their neighborhood. Possible confounders were adjusted in a linear regression model. Results: Among the 3111 participants in this analysis, 1073 (34.5%) had increased GDS score after the disaster. There were 336 (10.8%) individuals who had neighborhood ties before the disaster, but had no ties afterward; their mean GDS score increased from 2.93 points in 2010 to 3.19 points in 2013. Among those who had not had ties before and after the disaster the mean GDS score remained almost stable, from 2.19 points in 2010 to 2.12 points in 2013. The participants with post-disaster ties were significantly less likely to have an increased GDS score compared with those who had not had ties before and after the disaster (β = −0.39; 95% confidence interval: −0.72, −0.06). Conclusions: Increased neighborhood ties after the disaster reduced the risk of depressive symptoms even when survivors suffered disaster damages. The study reinforces the importance of social capital in disaster recovery and suggests to local governments and local communities that fostering horizontal, neighborhood ties may improve disaster preparedness and mental health resilience.

Disrupted Rhythmicity and Vegetative Functions Relate to PTSD and Gender in Earthquake Survivors

Background: Increasing evidence indicates that survivors to traumatic events may show disruption of sleep pattern, eating and sexual behaviors, and somatic symptoms suggestive of alterations of biorhythmicity and vegetative functions. Therefore, the aim of this study was to investigate these possible alterations in a sample of survivors in the aftermath of earthquake exposure, with particular attention to gender differences and impact of post-traumatic stress disorder (PTSD). Methods: High school senior students, who had been exposed to the 2009 L'Aquila earthquake, were enrolled 21 months after the traumatic event and evaluated by the Trauma and Loss Spectrum Self-Report to investigate PTSD rates and by a domain of the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR), to explore alterations in circadian/seasonal rhythms and vegetative functions. Results: The rates of endorsement of MOODS-SR rhythmicity and vegetative functions domain and subdomain scores were significantly higher in survivors with PTSD with respect to those without it. Among all earthquake survivors, women reported higher scores than men on the rhythmicity and vegetative functions domain and subdomain scores, except for the rhythmicity and sexual functions ones. Female survivors without PTSD showed significantly higher scores than men in the rhythmicity and vegetative functions total scores and the sleep and weight and appetite subdomains. Potentially traumatic events burden predicted rhythmicity and vegetative functions impairment, with a moderation effect of re-experiencing symptoms. Conclusions: We report impairments in rhythmicity, sleep, eating, and sexual and somatic health in survivors to a massive earthquake, particularly among subjects with PTSD and higher re-experiencing symptoms, with specific gender-related differences. Evaluating symptoms of impaired rhythmicity and vegetative functions seems essential for a more accurate assessment and clinical management of survivors to a mass trauma.

ResilienCity: Resilience and Psychotic-Like Experiences 10 Years After L'Aquila Earthquake

An earthquake hit the city of L'Aquila in central Italy in 2009, leaving the city completely destroyed and 309 casualties. Unexpectedly, lower rates of psychotic experiences in persons affected by the earthquake compared to non-affected persons were found 10 months after the earthquake. The very long-term impact of a natural disaster on the prevalence of psychotic experiences deserves more in-depth detailing. The Authors examined resilience and psychotic experiences in a university student sample of 494. No effect of direct exposure to the earthquake (odds ratio = 0.64, 95%CI [0.37, 1.11]), material damages (odds ratio = 0.86, 95%CI [0.60, 1.23]), psychological suffering (odds ratio = 1.06, 95% CI [0.83, 1.36]), or global impact severity (odds ratio = 0.92, 95%CI [0.76, 1.12]) on psychotic experiences was detected. Resilience levels did not differ between affected and non-affected persons. Resilience showed a strong protective effect on psychotic experiences (odds ratio=0.38, 95% CI [0.28, 0.51]. The protective effect of the RSA factor "Perception of Self" was significantly stronger in individuals affected by the earthquake compared to non-affected subjects. Being affected by an earthquake is not a risk factor for psychotic experiences in a university student sample, as no direct effect of the earthquake was detected after 10 years after the event. Resilience is confirmed as a strong protective factor for psychotic experiences irrespectively of large collective traumatic events. Extension of these results to a general population sample could provide interesting insights into recovery from natural disasters.

Neonatal Intensive Care Unit Evacuation and Care During a Natural Disaster: The Experience of Cyclone Idai in Beira, Mozambique

Global warming has increased the frequency of natural disasters, such as cyclones. Mozambique is considered one of the most vulnerable countries to extreme weather events. Natural disasters particularly affect vulnerable people, including preterm and critical ill infants of Neonatal Intensive Care Units (NICUs). Literature on NICU evacuations in the case of a natural disaster has been reported in high-resource settings, but it is lacking in low-resource settings. On the 14th of March 2019, a tropical cyclone (Idai) hit Mozambique. This report is a descriptive analysis of the experience of the NICU evacuation and care during and after cyclone Idai at Beira Central Hospital, Beira, Mozambique.

Prevalence and Influencing Factors of Post-Traumatic Stress Disorder Among Survivors in the Hard-Hit Areas Ten Years After the Wenchuan Earthquake: A Cross-Sectional Study

BACKGROUND

Post-traumatic stress disorder (PTSD) is common psychological distress after natural disasters, which is persistent. Chronic PTSD leads to a heavy disease burden. The purpose of this study is to explore the prevalence and influencing factors of chronic PTSD among survivors in the hard-hit areas ten years after the Wenchuan earthquake.

MATERIALS AND METHODS

A cross-sectional survey was conducted on residents aged 16 or above in hard-hit areas through a multi-stage sampling approach ten years after the Wenchuan earthquake. The items of the questionnaire included demographic characteristics and earthquake exposure factors, and the PTSD Checklist-Civilian Version (PCL-C) was used to evaluate the PTSD of the respondents.

RESULTS

A total of 1039 complete questionnaires were obtained. The median age of 1039 respondents was 60 years, 63.2% of whom were female, 70.2% were illiterate or had received primary education, and 58% had an annual household income of less than 20,000 yuan (US$ 2871.3). The rate of PTSD was 9.1% (95/1039). After controlling for confounding factors, it was found that higher income level and education level, and moving to concentrated rural settlement (CRS) after the earthquake might be protective factors for the long-term mental health of survivors in the hard-hit areas, and the loss of immediate families in the earthquake was an important risk factor.

CONCLUSION

Even though ten years have passed since the Wenchuan earthquake, the survivors in the hard-hit areas still have a serious mental disorder. The local government and health-care institutions should take appropriate measures to improve the mental health of residents.

Women's health-related vulnerabilities in natural disasters: a systematic review protocol

INTRODUCTION

There is a paucity of evidence identifying both the physical and psychological health risks and underlying causes of women's health-related vulnerabilities related to natural disasters. Therefore, this systematic review will be conducted to determine the impact of natural disasters on women's health from a global perspective.

METHODS AND ANALYSIS

Five electronic databases of health research, including ProQuest, ProQuest Health and Medicine, PubMed, PsycINFO and CINAHL, will be searched to retrieve relevant literature where Medical Subject Headings terms and keywords will be used depending on the search method of each database. Google Scholar will also be searched for preliminary information on the topic and to check for further evidence that may have been missed. Inclusion and exclusion criteria will be developed and refined by the research team. We will restrict our search for empirical full-text articles published in the English language peer-reviewed journals between July 2008 and June 2018 to ensure contemporary evidence is retrieved. Two authors will participate in each step in the process, including title, abstract and full-text screening against inclusion criteria, data extraction and quality appraisal. The quality of selected studies will be assessed using the Mixed Method Appraisal Tool. Data synthesis will follow a sequential explanatory approach. Finally, the quantitative and qualitative findings will be merged under themes and described using a narrative approach.

ETHICS AND DISSEMINATION

Formal ethical approval is not required as primary data will not be collected. The results will be published in an international peer-reviewed journal and presented at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42019123809.

Cognitive integration of personal or public events affects mental health: Examining memory networks in a case of natural flooding disaster

OBJECTIVE

The purpose of this research was to examine whether memories of personal or public events could affect mental health through the way those memories are integrated in memory networks.

METHOD

Participants from the general population (N = 224, age mean = 36.62 years, 74% female) were either directly or indirectly personally affected by a natural flooding disaster with moderate consequences or had simply learned about it. A prospective design (during the floods and two months later) was used to examine the impact that such a personal or public event memory could have on their mental health.

RESULTS

Results showed that flood-affected individuals reported poorer mental health compared to the unaffected. However, both affected and unaffected individuals who had encoded a current floods-related event in memory as need satisfying or who had embedded such an event in need satisfying memory networks showed better mental health over time. These results held after controlling for the effect of various demographics and dispositional emotion regulation styles.

CONCLUSION

Simply learning about public events can impact mental health through the way those events are integrated in memory, which appears as a critical individual difference.

Effects of Climate Change and Maternal Morality: Perspective from Case Studies in the Rural Area of Bangladesh

This study explored the community perception of maternal deaths influenced by natural disaster (flood), and the practice of maternal complications during natural disaster among the rural population in Bangladesh. It also explored the challenges faced by the community for providing healthcare and referring the pregnant women experiencing complications during flood disaster. Three focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted in the marginalized rural communities in the flood-prone Khaliajhuri sub-district, Netrakona district, Bangladesh. Flood is one of the major risk factors for influencing maternal death. Pregnant women seriously suffer from maternal complications, lack of antenatal checkup, and lack of doctors during flooding. During the time of delivery, it is difficult to find a skilled attendant, and referring the patient with delivery complications to the healthcare facility. Boats are the only mode of transport. The majority of maternal deaths occur on the boats during transfer from the community to the hospital. Rural people feel that the maternal deaths influenced by natural disaster are natural phenomena. Pre-preparation is needed to support pregnant women during disasters. There is unawareness of maternal health, related care, and complications during disasters among local health service providers and volunteers.

How to Integrate Labor Disruption into an Economic Impact Evaluation Model for Postdisaster Recovery Periods

Evaluating the economic impacts caused by capital destruction is an effective method for disaster management and prevention, but the magnitude of the economic impact of labor disruption on an economic system remains unclear. This article emphasizes the importance of considering labor disruption when evaluating the economic impact of natural disasters. Based on the principle of disasters and resilience theory, our model integrates nonlinear recovery of labor losses and the demand of labor from outside the disaster area into the dynamic evaluation of the economic impact in the postdisaster recovery period. We exemplify this through a case study: the flood disaster that occurred in Wuhan city, China, on July 6, 2016 (the "7.6 Wuhan flood disaster"). The results indicate that (i) the indirect economic impacts of the "7.6 Wuhan flood disaster" will underestimate 15.12% if we do not consider labor disruption; (ii) the economic impact in secondary industry caused by insufficient labor forces accounts for 42.27% of its total impact, while that in the tertiary industry is 36.29%, which can cause enormous losses if both industries suffer shocks; and (iii) the agricultural sector of Wuhan city experiences an increase in output demand of 0.07% that is created by the introduction of 50,000 short-term laborers from outside the disaster area to meet the postdisaster reconstruction need. These results provide evidence for the important role of labor disruption and prove that it is a nonnegligible component of postdisaster economic recovery and postdisaster reduction.

Financing Common Goods for Health: Core Government Functions in Health Emergency and Disaster Risk Management

In the absence of good data on the costs and comparative benefits from investing in health emergency and disaster risk management (EDRM), governments have been reluctant to invest adequately in systems to reduce the risks and consequences of emergencies and disasters. Yet they spend heavily on their response. We describe a set of key functional areas for investment and action in health EDRM, and calculate the costs needed to establish and operate basic health EDRM services in low- and middle-income countries, focusing on management of epidemics and disasters from natural hazards.We find that health EDRM costs are affordable for most governments. They range from an additional 4.33 USD capital and 4.16 USD annual recurrent costs per capita in low-income countries to 1.35 USD capital to 1.41 USD recurrent costs in upper middle-income countries. These costs pale in comparison to the costs of not acting-the direct and indirect costs of epidemics and other emergencies from natural hazards are more than 20-fold higher.We also examine options for the institutional arrangements needed to design and implement health EDRM. We discuss the need for creating adaptive institutions, strengthening capacities of countries, communities and health systems for managing risks of emergencies, using "all-of-society" and "all-of-state institutions" approaches, and applying lessons about rules and regulations, behavioral norms, and organizational structures to better implement health EDRM. The economic and social value, and the feasibility of institutional options for implementing health EDRM systems should compel governments to invest in these common goods for health that strengthen national health security.

Disaster Preparedness Impact In A Complex Ophthalmology Practice: A Review Of Patients Receiving Intravitreal Injections

Purpose

A private tertiary care ophthalmology practice was analyzed to see how Hurricane Irma affected patient care.

Methods

Eighty-two patients (96 eyes) that missed their scheduled appointments due to Hurricane Irma were reviewed. Patients were being treated with intravitreal injection therapy for diabetic retinopathy, radiation retinopathy, vein occlusions, choroidal neovascularization, or neovascular age-related macular degeneration. The authors assessed patients’ visual acuity and macular thickness changes before the hurricane and their initial visit after the storm. Emergency preparedness was also evaluated in this setting.

Results

Patients on average were delayed 19.6 days. On average, best-corrected visual acuity was 20/97 (0.7 logMAR) before the hurricane and 20/82 (0.6 logMAR) after the storm. The average central macular thickness change was −1.30 μm. Intraocular pressure was not significantly affected and there were no ocular complications associated with the delay in therapy. A back-up electrical system was in place to maintain appropriate temperature for storage of medications and proper access to medical records.

Conclusion

The authors believe that minimizing delay in treatment was the most important contributing factor to preventing worsening of ocular disease. Ophthalmology clinics should strive for appropriate treatment modality regarding injection intervals prior to a natural disaster and emergency planning with excellent patient communication both before and after natural disasters.

Association between continued residence in temporary prefabricated housing and musculoskeletal pain in survivors of the Great East Japan Earthquake: a longitudinal study

OBJECTIVE

Prolonged periods of living in prefabricated houses (PHs) may increase the risk of musculoskeletal (MSK) symptoms; however, the association is not clear. This study aimed to investigate the association between continued residence in PHs and MSK pain in a population affected by a natural disaster, the Great East Japan Earthquake (GEJE) survivors.

DESIGN, SETTING AND PARTICIPANTS

A panel study was conducted including 1059 and 792 survivors at 2 and 4 years, respectively, after the GEJE, using a self-reported questionnaire. Those with no response on living status and those who did not live in a PH were excluded. Participants were classified into two groups by living status: continued residence in a PH (lived in a PH during both periods) or moving out of a PH (lived in a PH in the first period and did not live in a PH in the second).

PRIMARY OUTCOME MEASURE

MSK pain included lower back, shoulder, knee, hand or foot, and neck pain. Changes in the occurrence of MSK pain during the two periods were assessed and defined as 'new-onset' and 'continuing' MSK pain. Multiple logistic regression analysis was used to examine the influence of continued residence in a PH on new-onset and continuing MSK pain.

RESULTS

Continued residence in a PH was significantly associated with new-onset MSK pain, even after adjustment for covariates (adjusted OR 2.18, 95% CI 1.25 to 3.79, p=0.006). Participants who continued living in a PH had higher rates of continuing MSK pain than those who moved out; however, the difference was not significant (adjusted OR 1.69, 95% CI 0.94 to 3.05, p=0.079).

CONCLUSION

Continued residence in a PH was associated with new-onset MSK pain among survivors. Public support should be provided to such people to ensure a more comfortable life.