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Eyes of a Hurricane: The Effect of Hurricane Harvey on Ophthalmology Consultations at Houston's County Hospital. Disaster Med Public Health Prep 2021; 17:e13. [PMID: 33818371 DOI: 10.1017/dmp.2020.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to characterize ophthalmology consultations ordered after Hurricane Harvey compared to consultations ordered during the same time period of the prior year. METHODS A retrospective chart review was performed at an urban, level 1 trauma center of a county hospital. All patients were included who received an electronic health record, documented ophthalmology consultation order between September 2017 and October 2017 (the time period immediately following Hurricane Harvey) or September 2016 and October 2016. Patient demographic risk factors were collected. Patient ICD10 clinical diagnoses were categorized as extraocular, intraocular, infectious, physiological, or other, and then subcategorized as trauma or non-trauma-related. A geographical heat map was generated to compare the changes in diagnosis volume by zip code to the magnitude of rainfall in the county. RESULTS Following Hurricane Harvey, ophthalmology consultation volume decreased, number of infectious ophthalmology diagnoses increased (P < 0.001), percentage of patients on immunosuppression increased (P < 0.001), and the number of private insurance payers increased while the number of county-funded insurance payers decreased (P = 0.003). CONCLUSIONS The risk of infectious eye diagnosis was double the risk of traumatic eye diagnosis from Hurricane Harvey flooding. During public disaster planning, different ophthalmological medical resources and responses should be considered for flooding versus high-wind events.
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Shackelford BB, Cronk R, Behnke N, Cooper B, Tu R, D'Souza M, Bartram J, Schweitzer R, Jaff D. Environmental health in forced displacement: A systematic scoping review of the emergency phase. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 714:136553. [PMID: 31982735 DOI: 10.1016/j.scitotenv.2020.136553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/03/2020] [Accepted: 01/04/2020] [Indexed: 06/10/2023]
Abstract
There are 70.8 million forcibly displaced people worldwide, including internally displaced persons, refugees, and asylum seekers. Since mortality rates are highest in the first six months of displacement, the provision of adequate services and infrastructure by relief organizations is critical in this "emergency phase." Environmental health provisions such as adequate water supply, excreta management, solid waste management, and vector control measures are among those essential services. We conducted a systematic scoping review of environmental health in the emergency phase of displacement (the six months following first displacement). A total of 122 publications, comprising 104 peer-reviewed and 18 grey literature publications, met the inclusion criteria. We extracted data relating to environmental health conditions and services, associated outcomes, and information concerning obstacles and recommendations for improving these conditions and services. Despite the fact that most displaced people live outside of camps, publications largely report findings for camps (n = 73, 60%). Water supply (n = 57, 47%) and excreta management (n = 47, 39%) dominate the literature. Energy access (n = 7, 6%), exposure to harsh weather from inadequate shelter (n = 5, 4%), food hygiene and safety (n = 4, 3%), indoor air quality (n = 3, 3%), menstrual hygiene management (n = 2, 2%), dental hygiene (n = 2, 2%), and ambient air quality (n = 1, 1%) are relatively understudied. The most common health outcome attributed to inadequate environmental conditions in the included publications is diarrhea (n = 43, 35%). We found that organizations and governments often embrace their own standards, however we call for policymakers to adopt standards no less rigorous than Sphere for the emergency phase of displacement. Although other reviews examine water, sanitation, and hygiene interventions in emergencies, this is the first systematic review of environmental health more broadly in the first six months of displacement.
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Affiliation(s)
- Brandie Banner Shackelford
- The Water Institute, Department of Environmental Sciences and Engineering, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States of America.
| | - Ryan Cronk
- The Water Institute, Department of Environmental Sciences and Engineering, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States of America
| | - Nikki Behnke
- The Water Institute, Department of Environmental Sciences and Engineering, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States of America
| | - Brittany Cooper
- The Water Institute, Department of Environmental Sciences and Engineering, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States of America
| | - Raymond Tu
- The Water Institute, Department of Environmental Sciences and Engineering, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States of America
| | - Mabel D'Souza
- The Water Institute, Department of Environmental Sciences and Engineering, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States of America
| | - Jamie Bartram
- The Water Institute, Department of Environmental Sciences and Engineering, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States of America; School of Civil Engineering, University of Leeds, UK
| | - Ryan Schweitzer
- Water, Sanitation, and Hygiene Section, The United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Dilshad Jaff
- Gillings Global Gateway, Department of Maternal and Child Health, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States of America
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