Chronic diseases and natural hazards: impact of disasters on diabetic, renal, and cardiac patients

The Influence of Climate, Atmospheric Pollution, and Natural Disasters on Cardiovascular Diseases and Diabetes Mellitus in Drylands: A Scoping Review

Objectives

In the face of escalating global aridification, this study examines the complex relationship between climate variability, air pollution, natural disasters, and the prevalence of cardiovascular disease (CVD) and diabetes mellitus (DM) in arid regions.

Methods

The study conducted a scoping review of multiple databases using JBI guidelines and included 74 studies.

Results

The results show that acute myocardial infarction (n = 20) and stroke (n = 13) are the primary CVDs affected by these factors, particularly affecting older adults (n = 34) and persons with hypertension (n = 3). Elevated air temperature and heat waves emerge as critical risk factors for CVD, exacerbating various cardiovascular mechanisms. Atmospheric pollutants and natural disasters increase this risk. Indirect effects of disasters amplify risk factors such as socioeconomic vulnerability (n = 4), inadequate medical care (n = 3), stress (n = 3), and poor diet (n = 2), increasing CVD and DM risk.

Conclusion

The study underscores the need for nations to adhere to the Paris Agreement, advocating for reduced air pollutants, resilient environments, and collaborative, multidisciplinary research to develop targeted health interventions to mitigate the adverse effects of climate, pollution, and natural disasters.

Natural and human-made disaster and associated health outcomes among community-dwelling older adults in India: Findings from LASI, 2017-18

BACKGROUND

Droughts, flash floods, rail accidents, and riots are relatively regular occurrences for those living in many low- and middle-income countries like India. While such natural and human-made disasters put everyone in harm's way, their toll on specific segments of society-like older adults-is the heaviest. Therefore, in this study, we examine (1) the prevalence of natural and human-made disasters in India and (2) the association between natural and human-made disasters and several physical and mental health outcomes among older Indians.

METHODS

A cross-sectional study was conducted utilizing data come from the 2017-18 wave 1 of the nationally representative Longitudinal Ageing Study in India, comprising a sample of 29,333 older adults (14,120 males and 15,213 females) aged 60 years and above. Multivariate random intercept multilevel logistic regression analysis is used to examine the association between natural and human-made disasters and poor self-rated health, difficulty in activities of daily living, difficulty in instrumental activities of daily living, communicable diseases, non-communicable diseases, depressive symptoms, and psychiatric disorder.

RESULTS

Overall, 3.58% of older adults reported that they have encountered any type of natural or human-made disaster in the past five years. Compared to those who did not experience any (natural or human-made) disaster, older adults who experienced any disaster had a higher prevalence of poor self-rated health (33.4% vs 23.31%), difficulty in activities of daily living (33.94% vs 23.00%), difficulty in instrumental activities of daily living (60.09% vs 47.70%), communicable diseases (49.57% vs 25.86%), depressive symptoms (17.30% vs 8.06%) and psychiatric disorders (3.42% vs 2.78%). After adjusting for the selected variables and the contextual effect, the odds of poor self-rated health (1.64 [1.40, 1.92]), difficulty in activities of daily living and instrumental activities of daily living (1.89 [1.61, 2.21] and 1.63 [1.40, 1.89]), communicable and non-communicable diseases (2.12 [1.83, 2.46] and 1.38 [1.20, 1.60]), depressive symptoms and psychiatric disorder (1.67 [1.55, 2.05] and 1.52 [1.33, 2.18]) were significantly higher among older adults who experienced a natural or human-made disaster than their counterparts without such an experience.

CONCLUSIONS

Relative to their non-exposed counterparts, older Indians who survived natural or human-made disasters endured an inflated risk of poor self-rated health, functional difficulties, communicable and non-communicable diseases, depressive symptoms, and psychiatric disorders. As such, post-disaster efforts should be grounded in policies and programs that address disaster-related trauma and diseases and improve the functional, physical, and psychological facets of health among older disaster survivors.

Perspectives on early insights: pediatric cancer caregiving amidst natural calamities - A call for future preparedness

Natural disasters cause immense damage and disruption to the environment, human lives, and property, posing a threat to safety and well-being. These disasters annually affect individuals and communities, severely impacting mental health. Research indicates a significant link between catastrophic events and an increased risk of mental disorders, including anxiety, depression, substance use, and post-traumatic stress disorder (PTSD). Individuals with chronic conditions, like cancer patients, are particularly vulnerable post-disaster due to disrupted healthcare services. The recent earthquake in Morocco highlighted the urgent need for continued care, especially for vulnerable populations living in poverty. Soleterre Foundation's interventions focus on supporting young cancer patients and their families, emphasizing psychological support following the earthquake. Effective disaster response needs coordinated efforts, clear roles, communication, and standardized healthcare procedures, especially for vulnerable groups like cancer patients. Education programs for patients and clinicians are vital for disaster preparedness. Communication challenges and lack of medical history further emphasize the need for well-defined disaster preparedness plans and continued care guidelines for cancer patients.

An Ecological Approach to Disaster Mitigation: A Literature Review

Disasters, whether natural or manmade, disrupt the functioning of communities, significantly impacting people's lives and health. To build community resilience, the Centers for Disease Control and Prevention recommends community preparedness, where multiple stakeholders work together. Disaster Preparedness Science Research (DPSR) similarly encourages the improvement of disaster relief outcomes. This literature review assesses the vulnerability of communities for prioritized intervention, summarizes disaster effects, and suggests the scope for improvement in disaster preparedness (DP). Twenty-one articles were reviewed based on disaster mitigation and economic factors from 90 studies identified through a PubMed search till September 2021. Vulnerable communities with higher hazard risks are identified by vulnerability indices (VI), including the Climate Risk Index, Environmental VI, and Socio-Economic VI. However, VI predicting one disaster may not predict another. Disaster behavioral response involves five phases. Disaster effects include medical, mental, environmental, and economic effects, as well as the unique recovery time from each domain effect. Medical effects include malnutrition, malaria, diarrhea, heat stress, exacerbations of chronic conditions, infectious disease outbreaks, trauma, and death. Mental effects are post-traumatic stress disorders, depression, anxiety, somatic complaints, psychological distress, sleep problems, and suicides. Environmental effects include isolation, migration, injury to family members, life threats, and property damage. Loss of livelihood and property are associated with worse outcomes. Disaster recovery, which is seldom measured and not clearly defined, affects measurement and comparison across settings. A uniform validated VI, including multiple indicators assessing vulnerability to various disasters, is required. Livelihood restoration is integral to mental health recovery in some disaster types. Fund diversification, prioritized to the vulnerable and to each domain effect of disaster in the immediate post-disaster phase, expedites recovery. Later recovery investments focused on helping people rebuild their community enhance psychological outcomes. Promoting job insurance in highly vulnerable labor-based communities with high VI, wherein willing-to-pay is high, could facilitate faster recovery. DPSR should be encouraged.

Lessons learned during the war in Ukraine: a report from the Renal Disaster Relief Task Force of the ERA

People living with kidney disease are among the most vulnerable at times of natural or man-made disasters. In addition to their unpredictable course, armed conflicts impose a major threat given the disruption of infrastructure, sanitation and access to food, water and medical care. The ongoing war in Ukraine has once more demonstrated the importance of preparedness, organization, coordination and solidarity during disasters. People living with kidney disease face serious challenges given their dependence on life-sustaining treatment, irrespective of whether they remain in the war zone or are displaced internally or externally. This especially affects those requiring kidney replacement therapy, dialysis or transplantation, but also patients with other kidney diseases and the medical staff who care for them. Soon after the war started, the European Renal Association assigned a Renal Disaster Relief Task Force dedicated to support the people living with kidney disease and the nephrology community in Ukraine. This report summarizes the major challenges faced, actions taken and lessons learned by this task force. We anticipate that the experience will help to increase preparedness and mitigate the devastating effects of armed conflicts on the kidney community in the future and propose to establish an international collaboration to extend this effort to other parts of the world facing similar challenges.

Maintaining quality of life and care for cancer survivors experiencing disaster disruptions: a review of the literature

Disasters caused by natural phenomena are increasing in frequency and devastation. The growing number of cancer survivors constitute a vulnerable population in their need for continuous and high-level care, a vulnerability that is exacerbated in the event of disasters. Although the evidence base on the needs of cancer survivors is growing, little is known about cancer care in disaster settings. Therefore, we prepared a narrative literature review that outlines existing evidence, identifies knowledge gaps, and clarifies key concepts that are central to the burgeoning area of research into the quality of care for cancer survivors through disasters. As the preponderance of available evidence stresses the importance of careful disaster planning for maintaining care services, this review also provides guidance in developing plans for how to proceed during, and in the aftermath of, disasters.

Hurricanes Irma and Maria and Diabetes incidence in Puerto Rico

OBJECTIVE

To evaluate the impact of Hurricanes Irma/Maria on diabetes incidence in Puerto Rico. Mortality increased substantially after the hurricanes, but morbidity was not assessed.

METHODS

We recruited 364 participants from the San Juan Overweight Adults Longitudinal Study (SOALS) aged 40-65 years who completed a three-year follow-up and were free of diabetes. We conducted additional questionnaires 1.7-2.5 years after hurricanes. Glycosylated hemoglobin (HbA1c), fasting glucose and insulin were assessed at all three visits. We compared diabetes incidence between pre-hurricane visits and between visits spanning the hurricanes using Generalized Estimating Equation (GEE) adjusting for within person repeated measures, age, and body mass index (BMI).

RESULTS

Diabetes incidence was significantly higher spanning the hurricanes than pre-hurricane (multivariate GEE model: IRR = 2.1; 95% CI: 1.4-3.1). There was a significantly higher increase spanning the hurricanes compared to pre-hurricanes for Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (median: 0.3 uIU/mL vs. 0.2 uIU/mL). HbA1c levels increased by 0.4% spanning the hurricanes.

CONCLUSION

Increases in diabetes incidence, HOMA-IR and HbA1c were higher spanning the hurricanes compared to the pre-hurricanes period. The increase in diabetes incidence remains significant after adjusting for age and BMI.

The COVID-19-wildfire smoke paradox: Reduced risk of all-cause mortality due to wildfire smoke in Colorado during the first year of the COVID-19 pandemic

BACKGROUND

In 2020, the American West faced two competing challenges: the COVID-19 pandemic and the worst wildfire season on record. Several studies have investigated the impact of wildfire smoke (WFS) on COVID-19 morbidity and mortality, but little is known about how these two public health challenges impact mortality risk for other causes.

OBJECTIVES

Using a time-series design, we evaluated how daily risk of mortality due to WFS exposure differed for periods before and during the COVID-19 pandemic.

METHODS

Our study included daily data for 11 counties in the Front Range region of Colorado (2010-2020). We assessed WFS exposure using data from the National Oceanic and Atmospheric Administration and used mortality counts from the Colorado Department of Public Health and Environment. We estimated the interaction between WFS and the pandemic (an indicator variable) on mortality risk using generalized additive models adjusted for year, day of week, fine particulate matter, ozone, temperature, and a smoothed term for day of year.

RESULTS

WFS impacted the study area on 10% of county-days. We observed a positive association between the presence of WFS and all-cause mortality risk (incidence rate ratio (IRR) = 1.03, 95%CI: 1.01-1.04 for same-day exposures) during the period before the pandemic; however, WFS exposure during the pandemic resulted in decreased risk of all-cause mortality (IRR = 0.90, 95%CI: 0.87-0.93 for same-day exposures).

DISCUSSION

We hypothesize that mitigation efforts during the first year of the pandemic, e.g., mask mandates, along with high ambient WFS levels encouraged health behaviors that reduced exposure to WFS and reduced risk of all-cause mortality. Our results suggest a need to examine how associations between WFS and mortality are impacted by pandemic-related factors and that there may be lessons from the pandemic that could be translated into health-protective policies during future wildfire events.

Time Series Analysis of Congestive Heart Failure Discharges in Florida (USA) Post Tropical Cyclones

OBJECTIVES

The aim of this study was to analyze congestive heart failure (CHF) discharges in Florida (USA) post tropical cyclones from 2007 through 2017.

METHODS

This was a retrospective longitudinal time series analysis of hospital CHF quarterly discharges across Florida using the Healthcare Cost and Utilization Project (HCUP) database. The autoregressive integrated moving average (ARIMA) model was used with correlated seasonal regressor variables such as cyclone frequency, maximum cyclone wind speed, average temperature, and reports of influenza-like illness (ILI).

RESULTS

A total of 3,372,993 patients were identified, with average age in each quarter ranging 72.2 to 73.9 years and overall mortality ranging 4.3% to 6.4%. The CHF discharges within each year peaked from October through December and nadired from April through June with an increasing overall time trend. Significant correlation was found between CHF discharge and the average temperature (P <.001), with approximately 331.8 less CHF discharges (SE = 91.7) per degree of increase in temperature. However, no significant correlation was found between CHF discharges and frequency of cyclones, the maximum wind speed, and reported ILI.

CONCLUSIONS

This study suggests that with the current methods and the HCUP dataset, there is no significant increase in overall CHF discharges in Florida as a result of recent previous cyclone occurrences.

Effect of COVID-19 on Type 2 Diabetes Self-Care Behaviors: A Rapid Review

OBJECTIVE

The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes.

Methods

A systematic rapid review was conducted using four electronic databases. Studies reporting on the lockdown's impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist.

Results

Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%).

Conclusion

The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.

Disaster Preparedness: Hospital Pharmacy Strategy for Prioritized Inventory Management and Drug Procurement on Vancouver Island

Disaster events can increase demand for medication supplies and interfere with supply chains, leading to compromised care in hospitals. Providing an organized response to an additional surge of disaster-related patients requires pre-planned emergency management procedures. Hospital pharmacists can address this with prioritized drug procurement and inventory management strategies which may improve the availability of key medications for a disaster response. Previous disaster events have provided insight on medications used to treat disaster-related injuries and exacerbations of medical conditions in emergency departments. This article provides a detailed description of Vancouver Island's hospital pharmacy strategy for the procurement and minimum stock levels of high priority medications in preparation for a disaster.

Diabetes Self-Care Behaviors and Barriers to Clinical Care During COVID-19 Pandemic for Marshallese Adults

PURPOSE

The purpose of the study was to explore experiences of Marshallese adults related to diabetes self-care behaviors during the COVID-19 pandemic.

METHODS

A qualitative descriptive design was utilized to understand participants' diabetes self-care behaviors during the pandemic. Nine focus groups with 53 participants were held via videoconference and conducted in English, Marshallese, or a mixture of both languages. A priori codes based on diabetes self-care behaviors provided a framework for analyzing and summarizing participant experiences.

RESULTS

Both increases and decreases in healthy eating and exercise were described, with improvements in health behaviors attributed to health education messaging via social media. Participants reported increased stress and difficulty monitoring and managing glucose. Difficulty obtaining medication and difficulty seeing their health care provider regularly was reported and attributed to health care provider availability and lack of insurance due to job loss.

CONCLUSIONS

The study provides significant insight into the reach of health education campaigns via social media and provides important information about the reasons for delays in care, which extend beyond fear of contracting COVID-19 to structural issues.

Preparedness, Hurricanes Irma and Maria, and Impact on Health in Puerto Rico

OBJECTIVES

Only few studies evaluated whether hurricane preparedness impacts health. The PREPARE study addresses this gap.

METHODS

We recruited participants who had pertinent pre-hurricane data from the San Juan Overweight Adults Longitudinal Study (SOALS: n=364) and 125 patients with diabetes from Federally Qualified Health Center (COSSMA) in Puerto Rico. Participants aged 42-75 years completed interviews 20-34 months after Hurricanes Irma and Maria. We evaluated associations between self-reported hurricane preparedness and health and other related associations using logistic regression controlling for age, location, education and interview date.

RESULTS

Only 41% of participants reported high pre-hurricane preparedness; 25% reported gaps (moderate/low availability) in information and 48% reported gaps in resources for hurricane preparedness. Participants reporting lower pre-hurricane preparedness had higher reported hurricane-related detrimental health impact (OR=1.96; 95% CI: 1.31, 2.95) and higher odds (OR=2.07; 95% CI: 0.92, 4.68) of developing new non-communicable disease (NCD) compared to others. Post-hurricane drinking water disruption for ≥ 3 months versus none or less (OR=2.76; 95% CI: 1.39, 5.47) and similarly diet changes due to cooking/refrigeration access (OR=1.96; 95% CI: 1.24, 3.07), and diet changes for ≥ 20 months due to finances/access to shops (OR=2.83; 95% CI: 1.85, 4.32) were also associated with detrimental health impact.

CONCLUSION

Lower preparedness was associated with higher detrimental impact of the hurricanes on overall health, and marginally significant impact on NCD. Future preparedness efforts could especially target means of coping with disruption of water services and regular diet, as these were also associated with detrimental health impact.

Control of type 2 diabetes mellitus during the COVID-19 pandemic

AIMS

Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic condition that can lead to significant complications if not well controlled. The COVID-19 pandemic created disruptions in daily life; however, it is unknown whether the pandemic's disruptions affected the ability for adults with T2DM to control their condition. This study aims to fill the knowledge gap with the experiences of adults with T2DM in Arkansas, U.S. during the COVID-19 pandemic.

METHODS

This study analyzed cross-sectional, observational survey data collected from adults (≥18 years) who live, work, or receive healthcare in Arkansas; self-reported a diagnosis of T2DM; and completed the diabetes module of the Impact of COVID-19 online survey (n = 131) fielded in July-August 2020. Descriptive statistics were used to characterize the sample and survey responses, and multivariate regression was used to identify demographics, self-care behaviors, and access issues associated with uncontrolled T2DM (HbA1c ≥ 9% or 74.9 mmol/mol) or with an increase in HbA1c.

RESULTS

28.2% reported an increase in their HbA1c since the pandemic began, and 18.2% had uncontrolled T2DM. Educational level, eating healthily, and weight gain were negatively associated with uncontrolled T2DM. Eating less healthily and having difficulty accessing diabetes related medication were positively associated with an increase in HbA1c.

CONCLUSIONS

Adults with T2DM in Arkansas were reasonably able to maintain control of their T2DM during the five months post the first case of COVD-19 diagnosed in the state. However, T2DM self-management interventions targeting those with lower educational levels that are focused on eating habits and/or that improve access to diabetes medication should be considered for future public health emergencies.

Prevalence Rate of Diabetes and Hypertension in Disaster-Exposed Populations: A Systematic Review and Meta-Analysis

Background

Non-communicable diseases (NCD) such as hypertension (HTN) and diabetes mellitus (DM) have been one of the major health problems in the world. The aim of this study was to evaluate the prevalence rate of DM and HTN following natural and man-made disasters that impose significant economic and psychological burdens on human communities.

Methods

In this systematic and meta-analysis review, all cross-sectional studies that at least one of their objectives was to measure the prevalence of HTN or DM in individuals affected by natural and man-made disasters were included. Literature review was done in international databases including PubMed, Scopus and Web of Science, from database inception to February 17, 2019. The extracted data included the bibliographic characteristics of the article, the age of the participants, number of participants, gender, sample size, outcome, duration of the follow-up, and prevalence of DM and HTN. Data were analyzed by STATA software (version 11) and random effect method and the I2 index were used to investigate heterogeneity between the articles.

Results

A total of 16 articles met the inclusion criteria. Based on the quality assessment, 11 papers were categorized as moderate and 5 paper were categorized as high quality. The prevalence of HTN and DM in disaster-exposed populations were 47.35 (CI 95%: 38.53–56.17) and 13.56 (CI 95%: 10.12–17.01), respectively.

Conclusion

The results of this study show a high prevalence of HTN and DM in survivors of major disasters, which is higher in comparison to the general population

Comparative risk assessment of non-communicable diseases by evacuation scenario- a retrospective study in the 7 years following the Fukushima Daiichi nuclear power plant accident

Background: As a result of the Fukushima Daiichi nuclear power plant accident, many residents evacuated and were exposed to changes in their living environment and socioeconomic status, and to persistent stressors. Past studies have suggested the potential for these circumstances to contribute to long-term changes to population health.Objective: The objective of this study was to gain a better understanding of long-term health effects of evacuation, by evaluating the risk of non-communicable diseases among evacuees from Minamisoma City (one of the closest municipalities to the power plant) until 2017.Methods: The study evaluated data from annual health check-ups for residents aged 40-74 years covered by National Health Insurance (who are largely self-employed) from 2010 to 2017 administered by Minamisoma City. Diabetes, hyperlipidemia, and hypertension were defined from the results of blood sampling. Annual changes in age-adjusted prevalence were estimated by evacuation scenario. We also performed an inverse-probability weighting (IPW) analysis to adjust for baseline covariates in 2010 and estimated the differences in the risk of diabetes, hyperlipidemia, and hypertension by evacuation scenario as of the 2017 health check-up in reference to the no-evacuation group.Results: A total of 1,837 individuals were considered in this study. Regardless of evacuation scenario, there was statistical evidence suggesting an upward and a downward trend in diabetes and hypertension from 2010 to 2017, respectively, while hyperlipidemia showed no remarkable change. IPW analyses demonstrated that disease risks in 2017 did not differ significantly among people with different evacuation scenarios.Conclusions: Region-specific factors played an important role in the health effects of the evacuation. Our findings have important implications for the need of an assessment of the health effects of evacuations in more localized manner. Further research in this area will strengthen the communities' preparedness for future disasters that require mass evacuation.

Cardiovascular Diseases in Natural Disasters; a Systematic Review

Introduction:

As a result of destruction and lack of access to vital infrastructures and mental stress, disasters intensify cardiovascular diseases (CVDs) and hence management of CVDs becomes more challenging. The aim of this study is investigating incidence and prevalence of CVDs, morbidity and mortality of CVDs, treatment and management of CVDs at the time of natural disasters.

Methods:

In the present systematic review, the articles published in English language until 28. 11. 2020, which studied CVDs in natural disasters were included. The inclusion criteria were CVDs such as myocardial infarction (MI), acute coronary syndrome (ACS), hypertension (HTN), pulmonary edema, and heart failure (HF) in natural disasters such as earthquake, flood, storm, hurricane, cyclone, typhoon, and tornado.

Result:

The search led to accessing 4426 non-duplicate records. Finally, the data of 104 articles were included in quality appraisal. We managed to find 4, 21 and 79 full text articles, which considered cardiovascular diseases at the time of flood, storm, and earthquake, respectively.

Conclusion:

Prevalence of CVD increases after disasters. Lack of access to medication or lack of medication adjustment, losing home blood pressure monitor as a result of destruction and physical and mental stress after disasters are of the most significant challenges of controlling and managing CVDs. By means of quick establishment of health clinics, quick access to appropriate diagnosis and treatment, providing and access to medication, self-management, and self-care incentives along with appropriate medication and non-medication measures to control stress, we can better manage and control cardiovascular diseases, particularly hypertension.

The direct and indirect impact of the COVID-19 pandemic on the care of patients with pituitary disease: a cross sectional study

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic is widely believed to have had a major impact on the care of patients with pituitary disease. The virus itself may directly result in death, and patients with adrenal insufficiency, often a part of hypopituitarism, are thought to represent a particularly susceptible subgroup. Moreover, even in patients that do not contract the virus, the diversion of resources by healthcare institutions to manage the virus may indirectly result in delays in their management. To this end, the aim of this study was to determine the direct and indirect impact of the COVID-19 pandemic on patients with pituitary disease.

METHODS

A cross-sectional study design was adopted, with all adult patients seen by our pituitary service in the year prior to the nationwide lockdown on March 23rd 2020 invited to participate in a telephone survey.

RESULTS

In all, 412 patients (412/586; 70.3%) participated in the survey. 66 patients (66/412; 16.0%) reported having suspected COVID-19 infection. Of the 10 patients in this group tested for COVID-19 infection, three received a positive test result. No deaths due to COVID-19 were identified. 267 patients (267/412; 64.8%) experienced a delay or change in the planned care for their pituitary disease, with 100 patients (100/412; 24.3%) perceiving an impact to their care.

CONCLUSIONS

Whilst only a small percentage of patients had confirmed or suspected COVID-19 infection, over half were still indirectly impacted by the pandemic through a delay or change to their planned care.

Effect of COVID-19 on control of T1DM patients in Aseer region of Saudi Arabia

BACKGROUND

The novel corona virus disease, also known as COVID-19, has emerged as a major health concern globally. Its association with comorbid condition has increased its mortality. Diabetes mellitus (DM) is associated with increased risk of infection in comparison to general population. This risk is higher in type 1 DM that type 2 DM.

METHODS

A cross sectional study was done in T1DM patients in whom a structured questionnaire was administered after lockdown. Data regarding social demographical variables, Information regarding sugar levels, psychological effects, changes in weight, exercise habits and other variables were included in the validated, electronic questionnaire. Ethic approval was obtained from the Diabetic center Abha, study duration was from January-2020 to October-2020.

RESULTS

Out of 143 total patients (46.9%) were males while 53.1% were females. Mean ± S.D of age was obtained 29.6 ± 1.8. [Figure 1] depicted that 23% of the respondents were effected psychologically. [Figure 2] depicted that 80.4% used insulin as a treatment. [Figure 3] depicted that 8% of the respondents make an emergency visit to the health care centers for high rise in diabetes during lockdown.

CONCLUSION

COVID-19 and the lockdown affected the management of T1DM. It resulted in changes in lifestyle, compliance to medication, and psychological impact on the participant.

COVID-19 Pandemic Influence on Diabetes Management in Croatia

Aim

The study aims to investigate the effects of the COVID-19 pandemic on diabetes management and diabetes patients’ healthcare utilization patterns in Croatia.

Methods

Using data contained in the Croatian diabetes registry (CroDiab), Central Health Information System of the Republic of Croatia (CEZIH), and the Croatian hospitalization database (BSO), indicators including the total number of registered diabetes patients, number of newly diagnosed diabetes cases, number of diabetes-related primary care visits and hospitalizations, and key diabetes control indicators were analyzed. Yearly values from 2017 until 2020 were compared.

Results

The age-adjusted prevalence rate increased significantly from 2017 until 2019 (2017: 6,858/100,000; 2018: 7,053/100,000; 2019: 7,160/100,000). In 2020 the age-adjusted prevalence rate was 7,088/100,000, but the decrease was insignificant compared to 2019. The age-adjusted rate of new cases decreased from 2017 until 2019 (2017: 910/100,000; 2018: 876/100,000; 2019: 845/100,000), with a significant decrease in 2020 (692/100,000) compared to 2019. The number of diabetes panels increased from 2017 (117,676) to 2018 (131,815), with a slight decrease in 2019 (127,742) and a sharp decrease in 2020 (104,159). A similar trend was observed regarding the numbers of diabetes patients with panels, visits to primary healthcare providers for diabetes-related problems and diabetes patients who visited their primary healthcare provider. A slightly different trend was observed regarding diabetes-related hospitalizations. In 2017 there were 91,192 diabetes-related hospitalizations; the number decreased to 83,219 in 2018, increased again to 102,087 in 2019 and decreased to 85,006 in 2020. The number of hospitalized diabetes patients displayed a similar tendency.

Conclusion

The COVID-19 pandemic has had a negative effect on the utilisation of healthcare by diabetes patients, which may have long-term consequences for their general health.

Social Vulnerability and Access of Local Medical Care During Hurricane Harvey: A Spatial Analysis

OBJECTIVES

When Hurricane Harvey struck the coastline of Texas in 2017, it caused 88 fatalities and over US $125 billion in damage, along with increased emergency department visits in Houston and in cities receiving hurricane evacuees, such as the Dallas-Fort Worth metroplex (DFW).This study explored demographic indicators of vulnerability for patients from the Hurricane Harvey impact area who sought medical care in Houston and in DFW. The objectives were to characterize the vulnerability of affected populations presenting locally, as well as those presenting away from home, and to determine whether more vulnerable communities were more likely to seek medical care locally or elsewhere.

METHODS

We used syndromic surveillance data alongside the Centers for Disease Control and Prevention Social Vulnerability Index to calculate the percentage of patients seeking care locally by zip code tabulation area. We used this variable to fit a spatial lag regression model, controlling for population density and flood extent.

RESULTS

Communities with more patients presenting for medical care locally were significantly clustered and tended to have greater socioeconomic vulnerability, lower household composition vulnerability, and more extensive flooding.

CONCLUSIONS

These findings suggest that populations remaining in place during a natural disaster event may have needs related to income, education, and employment, while evacuees may have more needs related to age, disability, and single-parent household status.

Perspectives on the Health Effects of Hurricanes: A Review and Challenges

Hurricanes are devastating natural disasters which dramatically modify the physical landscape and alter the socio-physical and biochemical characteristics of the environment, thus exposing the affected communities to new environmental stressors, which persist for weeks to months after the hurricane. This paper has three aims. First, it conceptualizes potential direct and indirect health effects of hurricanes and provides an overview of factors that exacerbate the health effects of hurricanes. Second, it summarizes the literature on the health impact of hurricanes. Finally, it examines the time lag between the hurricane (landfall) and the occurrence of diseases. Two major findings emerge from this paper. Hurricanes are shown to cause and exacerbate multiple diseases, and most adverse health impacts peak within six months following hurricanes. However, chronic diseases, including cardiovascular disease and mental disorders, continue to occur for years following the hurricane impact.

Non-communicable diseases in disasters: a protocol for a systematic review

Background:

NCDs require an ongoing management for optimal outcomes, which is challenging in emergency settings, because natural disasters increase the risk of acute NCD exacerbations and lead to health systems’ inability to respond. This study aims to develop a protocol for a systematic review on non-communicable diseases in natural disaster settings.

Methods:

This systematic review protocol is submitted to the International Prospective Register of Systematic Reviews (Registration No. CRD42020164032). The electronic databases to be used in this study include: Medline, Scopus, Web of Science, Clinical Key, CINAHL, EBSCO, Ovid, EMBASE, ProQuest, Google Scholar, Cochrane Library (Cochrane database of systematic reviews; Cochrane central Register of controlled Trials). Records from 1997 to 2019 are subject to this investigation. Three independent researchers will review the titles, abstracts, and full texts of articles eligible for inclusion, and if not matched, they will be reviewed by a final fourth reviewer. The proposed systematic review will be reported in accordance with the reporting guideline provided in the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. We select studies based on: PICOs (Participants, Interventions, Comparators, and Outcomes).

Results:

This systematic review identifies any impacts of natural disasters on patients with NCDs in three stages i.e. before, during and in the aftermath of natural disasters.

Conclusions:

A comprehensive response to NCD management in natural disasters is an important but neglected aspect of non-communicable disease control and humanitarian response, which can significantly reduce the potential risk of morbidity and mortality associated with natural disasters.

Impact of the SARS-CoV-2 Pandemic on Emergency Department Presentations in an Integrated Health System

OBJECTIVE

To quantify the impact of the severe acute respiratory syndrome coronavirus 2 pandemic on emergency department volumes and patient presentations and evaluate changes in community mortality for the purpose of characterizing new patterns of emergency care use.

PATIENTS AND METHODS

This is an observational cross-sectional study using electronic health records for emergency department visits in an integrated multihospital system with academic and community practices across 4 states for visits between March 17 and April 21, 2019, and February 9 and April 21, 2020. We compared numbers and proportions of common and critical chief symptoms and diagnoses, triage assessments, throughput, disposition, and selected hospital lengths of stay and out-of-hospital deaths.

RESULTS

In the period of interest, emergency department visits decreased by nearly 50% (35037 to 18646). Total numbers of patients with myocardial infarctions, stroke, appendicitis, and cholecystitis diagnosed decreased. The percentage of visits for mental health symptoms increased. There was an increase in deaths, driven by out-of-hospital mortality.

CONCLUSION

Fewer patients presenting with acute and time-sensitive diagnoses suggests that patients are deferring care. This may be further supported by an increase in out-of-hospital mortality. Understanding which patients are deferring care and why will allow us to develop outreach strategies and ensure that those in need of rapid assessment and treatment will do so, preventing downstream morbidity and mortality.

Impact of lockdown in COVID 19 on glycemic control in patients with type 1 Diabetes Mellitus

BACKGROUND AND AIMS

COVID 19 is a novel pandemic affecting globally. Although no reliable data suggests that patients of well controlled Type 1 Diabetes Mellitus (T1DM) being at increased risk of becoming severely ill with SARS-CoV2, but lockdown may impact patients with T1DM requiring regular medications and follow up. Hence this study was planned to see the impact of lockdown on glycemic control in patients with T1DM.

METHODS

A cross sectional study was done in T1DM patients in whom a structured questionnaire was administered on follow up within 15 days after lockdown. Data regarding hypoglycemic and hyperglycemic episodes, Diabetic ketoacidosis (DKA), insulin dose missed, regular glucose monitoring, dietary compliance, physical activity, hospitalization during the phase of lockdown was taken. Average blood glucose and HbA1C of lockdown phase was compared with the readings of prelockdown phase.

RESULTS

Out of 52 patients, 36.5% had hyperglycemic and 15.3% had hypoglycemic episodes. Insulin dose was missed in 26.9%, glucose monitoring not done routinely in 36.5% and 17.4% were not diet compliant during lockdown. Average blood glucose during lockdown phase was 276.9 ± 64.7 mg/dl as compared to 212.3 ± 57.9 mg/dl during prelockdown phase. Mean HbA1c value of lockdown (10 ± 1.5%) which was much higher that of pre lockdown (8.8 ± 1.3%) and the difference was statistically significant (p < 0.05).

CONCLUSION

Glycemic control of T1DM patients has worsened mainly due to non availability of insulin/glucostrips during lockdown period. There is a need for preparedness in future so that complications can be minimised.

[Natural disasters and their costs for healthcare establishments in Brazil, 2000 to 2015]

Natural disasters result in impacts on the population's health, damage to healthcare establishments, and, in extreme situations, the health systems' breakdown. National and global trends show an increase in the frequency of disasters associated with climate change. This article aims to analyze the impacts and economic costs of natural disasters for healthcare establishments, identifying the most frequent and costly types and distribution across the Brazilian territory, based on data recorded in Brazil's Integrated Disaster Information System (S2ID) from 2000 to 2015. A total of 15,950 records were systematized and analyzed, of which only 29.4% of the events showed records of costs, totaling nearly BRL 4 billion. Climate disasters were the most frequent, but they did not account for the highest costs. In the cost per event ratio, the costs of hydrological disasters were 3.2 to 3.6 higher than for climate and geologic disasters. Pernambuco, Amazonas, and Santa Catarina were the states with highest total costs in millions of Brazilian reais. The North region, especially the state of Acre, had the highest cost per disaster. Despite the study's limitations (involving the records' quality), the data should be viewed as the tip of an iceberg, since the impacts go beyond the economic damages, impacting the infrastructure and resources that support services, compromising their capacity precisely when the population most needs health services.

Evaluation of Sleep Quality in a Disaster Evacuee Environment

We aimed to evaluate sleep and sleep-related physiological parameters (heart rate variability and glucose dynamics) among evacuees by experimentally recreating the sleep environment of evacuation shelters and cars. Nine healthy young male subjects participated in this study. Two interventions, modeling the sleep environments of evacuation shelters (evacuation shelter trial) and car seats (car trial), were compared with sleep at home (control trial). Physiological data were measured using portable two-channel electroencephalogram and electrooculogram monitoring systems, wearable heart rate sensors, and flash glucose monitors. Wake after sleep onset (WASO) and stage shift were greater in both intervention trials than the control trial, while rapid-eye movement (REM) latency and non-rapid eye movement (NREM) 1 were longer and REM duration was shorter in the evacuation shelter trial than the control trial. Glucose dynamics and power at low frequency (LF.p) of heart rate variability were higher in the car trial than in the control trial. It was confirmed that sleep environment was important to maintain sleep, and affected glucose dynamics and heart rate variability in the experimental situation.

Operation Navajeevan: A Public-Private Partnership Model for Disaster Relief in Kozhikode, India

INTRODUCTION

In August 2018, India's southern state of Kerala experienced its worst flooding in over a century. This report describes the relief efforts in Kozhikode, a coastal region of Kerala, where Operation Navajeevan was initiated.

SOURCES

Data were collected from a centralized database at the command center in the District Medical Office as well as first-hand accounts from providers who participated in the relief effort.

OBSERVATIONS

From August 15 through September 8, 2018, 36,846 flood victims were seen at 280 relief camps. The most common cause for presentation was exacerbation of an on-going chronic medical condition (18,490; 50.2%). Other common presentations included acute respiratory infection (7,451; 20.2%), traumatic injuries (3,736; 10.4%), and psychiatric illness (5,327; 14.5%).

ANALYSIS

The prevalence of chronic disease exacerbation as the primary presentation during Operation Navajeevan represents an epidemiologic shift in disaster relief in India. It is foreseeable that as access to health care improves in low- and middle-income countries (LMICs), and climate change increases the prevalence of extreme weather events around the world, that this trend will continue.

Giving a voice to medically vulnerable populations: A mixed-methods investigation of their unique perceptions and needs in emergency situations

Older adults in poor health represent a growing sector of the population worldwide. These medically vulnerable individuals often tend to be ill-prepared for emergencies. In times of crisis they are at higher risk of experiencing adverse health outcomes and are liable to place an additional burden on health and social care services. The aim of this study was to explore the unique perceptions and diverse needs of community-dwelling medically vulnerable individuals in Israel in order to gain insights that could be used to promote future preparedness. A mixed methods design was employed that included 16 in-depth interviews, followed by a quantitative survey of 179 participants. Data were collected between 2016 and 2017. The analysis process included thematic analysis for qualitative data. Quantitative data analysis focused on estimating associations between preparedness levels and participants' characteristics and perceptions. The results indicated low levels of preparedness-only 13.5% of participants reported having prepared a full emergency kit with supplies. Family members played a key role in almost every dimension related to emergency preparedness; alongside certain authorities perceived by the participants as responsible for initiating the preparedness process. Additional issues that emerged were related to information and communication and to the logistics of medication handling and special nutrition. The findings suggest that it is vital to adopt a proactive approach to the problem of preparedness in this population. This conclusion should be of value to health and social care practitioners in the community as well as to family members and caregivers. Practical and simple recommendations for enhancing preparedness based on these findings are provided. Viewing preparedness as a process that is the joint responsibility of the individual, the family, caregivers, and community health and social welfare services could contribute to maintaining continuity of care among vulnerable populations and mitigate adverse health outcomes in future events.

Morbidity profile of communities in Bhopal city (India) vis-à-vis distance of residence from Union Carbide India Limited plant and drinking water usage pattern

Objective:

A cross-sectional study was undertaken to assess the prevalence of morbidities in communities residing at variable distances from the closed down insecticide manufacturing plant premises of Union Carbide India Limited (UCIL), Bhopal, India and to determine association of morbidities, if any, with their drinking water usage pattern and distance of localities from the UCIL plant.

Materials and Methods:

A total of 10,827 individuals belonging to 2,184 families, residing within 0-1 km (Stratum I) and 2.5-5.0 km (Stratum II) radial distances from UCIL plant were surveyed and 9,306 of them (86%) were clinically examined. Data were analyzed to examine the association between the groups of morbidities, likely due to biological and chemical water contamination, and the distance of locality from the UCIL plant. Multiple logistic regression was used to explore the risk factors for morbidities.

Results:

Nearly similar prevalence (25.3% in stratum I, 25.8% in stratum II) and the trend of all-cause morbidities were recorded in the two strata. While morbidities related to gastrointestinal tract system (P < 0.05), auditory system (P < 0.01), neoplasm/cancers (P < 0.01) and congenital anomalies (P < 0.01) were significantly higher in stratum I, the prevalence of hypertension (6.4% stratum II, 4.7% stratum I; P < 0.01) and diabetes mellitus (3.4% stratum II, 2.0% stratum I; P < 0.001) was found significantly higher in stratum II. No association (P > 0.05) was observed between the prevalence of morbidities, likely due to the consumption of biologically or chemically contaminated drinking water, and the distance of locality/stratum from the UCIL plant.

Discussion and Conclusion:

By and large similar pattern of morbidities were recorded in the two strata suggesting that the communities, irrespective of the distance of their residences from UCIL plant or sources of their drinking water, are equally vulnerable to various morbidities.

Emergency Preparedness in Ambulatory Surgery Centers and Office-Based Anesthesia Practices

Natural or manmade disasters, mass causality events, and other emergencies can disrupt healthcare delivery and change the demand for healthcare services. In order to protect patients, staff, and facilities it is essential that healthcare facilities be prepared for such emergency events. Ambulatory surgery centers (ASC) and Office Based Anesthesia (OBA) practices are unique healthcare settings that necessitate specific emergency planning since they typically do not have rapid response or code teams on site. In addition, they typically operate with fewer personnel and have staff members who often perform multiple functions. Previously there has been variability in the emergency preparedness amongst ASCs and OBA practices. The Centers for Medicare & Medicaid Services (CMS) has recently identified three requirements for maintaining healthcare services during an emergency. These are 1) safeguarding human resources, 2) maintaining business operations, and 3) protecting physical resources. In 2016 CMS issued new rules establishing national emergency preparedness requirements for Medicare and Medicaid participating providers in the United States. In addition there are requirements specifically for ASCs and OBAs. The first step in emergency preparedness is performing a risk assessment for a practice using an “all-hazards” approach. In this approach, the practice attempts to identify all hazards that could potentially affect the practice as well as evaluating the likelihood of such hazards. This risk assessment is then incorporated into an emergency plan for the facility. In addition to reviewing specific components of an emergency plan for ASCs and OBAs, the need to test the plan and create a subsequent corrective action plan is reviewed. It is important that healthcare providers at all ambulatory surgery centers and office based anesthesia practices are aware of regulations for emergency preparedness and work to ensure that patients, staff and physical resources are protected during natural disasters and other emergencies.

Diabetes and Disasters: Recent Studies and Resources for Preparedness

PURPOSE OF REVIEW

Studies have shown that disasters may exacerbate the comorbidities in vulnerable populations such as those with a pre-existing chronic medical condition like diabetes. This article highlights recent studies that look at the impact of disasters on people with diabetes and also shows recent resources for consumers, health care providers, and policy makers to improve resiliency in people with diabetes.

RECENT FINDINGS

Recent articles have looked at the short-term impact of disasters upon people with diabetes and its comorbidities such as Hurricane Sandy in 2012, the triple disaster of 2011 in Japan (earthquake, tsunami, and nuclear accident), and the 2016 Kumamoto earthquake in Japan as well as the long-term impact of disasters such as Hurricane Katrina in 2005. Several public and private partners have used the past and recent findings to develop resources that help consumers with diabetes and the people who care for them, prepare for a disaster BEFORE the event.

Hurricanes and healthcare: a case report on the influences of Hurricane Maria and managed Medicare in treating a Puerto Rican resident

Background

While Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria’s impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York.

Case presentation

A 59-year-old male with a history of diabetes mellitus type II, coronary artery disease, peripheral vascular disease status post right foot amputation, and end-stage kidney disease on hemodialysis was admitted in October of 2017 for chest pain and swelling of legs for 5 days. The patient had missed his last three dialysis sessions after Hurricane Maria forced him to leave Puerto Rico. In examining this patient’s treatment, we observe the effect of Hurricane Maria on the medical management of Puerto Rican residents and identify challenges managed Medicare may pose to patients who cross state or territory lines.

Conclusions

We employ this patient’s narrative to frame a larger discussion of Puerto Rican managed Medicare and provide additional recommendations for healthcare providers. Moreover, we consider this case in the context of disaster-related continuity of care for patients with complex medical conditions or treatment regimens. To address the gaps in the care of these patients, this article proposes (1) developing system-based approaches for screening displaced patients, (2) increasing the awareness of Special Enrollment Periods related to Medicare among healthcare providers, and (3) creating policy solutions to assure access to care for patients with complex medical conditions.

Promoting Integrated Mental Health Care Services in Disaster Response Programs: Lessons Learned After the Impact of Hurricane María in Puerto Rico

Meteorological and even human-made disasters are increasing every year in frequency and magnitude. The passage of a disaster affects a society without distinction, but groups with social vulnerability (low socioeconomic status, chronic medical, or psychological conditions, limited access to resources) face the most significant impact. As a result, psychological and behavioral symptoms (eg, depression and anxiety) can ensue, making the immediate response of mental health services crucial. Secondary data from a database of a temporary healthcare unit were analyzed. A total of 54 records were reviewed to collect information; univariate and bivariate analyses were done. The purpose of this article is to present our experience regarding the incorporation of a mental health services model, with its respective benefits and challenges, into a temporary healthcare unit, after Hurricane Maria in 2017.

Challenges associated with providing diabetes care in humanitarian settings

The humanitarian health landscape is gradually changing, partly as a result of the shift in global epidemiological trends and the rise of non-communicable diseases, including diabetes. Humanitarian actors are progressively incorporating care for diabetes into emergency medical response, but challenges abound. This Series paper discusses contemporary practical challenges associated with diabetes care in humanitarian contexts in low-income and middle-income countries, using the six building blocks of health systems described by WHO (information and research, service delivery, health workforce, medical products and technologies, governance, and financing) as a framework. Challenges include the scarcity of evidence on the management of diabetes and clinical guidelines adapted to humanitarian contexts; unavailability of core indicators for surveillance and monitoring systems; and restricted access to the medicines and diagnostics necessary for adequate clinical care. Policy and system frameworks do not routinely include diabetes and little funding is allocated for diabetes care in humanitarian crises. Humanitarian organisations are increasingly gaining experience delivering diabetes care, and interagency collaboration to coordinate, improve data collection, and analyse available programmes is in progress. However, the needs around all six WHO health system building blocks are immense, and much work needs to be done to improve diabetes care for crisis-affected populations.

Cancer Patients During and after Natural and Man-Made Disasters: A Systematic Review

Background: Disasters affect all social functions. In particular, hospitals must mobilize their resources for response to mass injuries. This process can affected treatment of cancer patients and may resulted in delayed care. Considering the importance of continuity of care for cancer patients, the aim of this systematic review was to identify challenges and preparedness measures for cancer patients during and after disasters. Materials and Methods: This systematic review that was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines between January 2000 to December 2017. The keywords searched included: “disaster,” “emergency,” “crisis,” “disruptive event,” “technological disaster,” “natural disaster,” “cancer,” “cancer patient,” “chronic disease,” “continuity of care,” and “patient with chronic disease. “The Google Scholar, ISI Web of Science, Science Direct, PubMed and Scopus databases were searched. Results: After screening and review of article eligibility, seven were included in the study. The selected articles were compared from several aspects. The results showed that most publications concerned all of the chronic diseases or all types of cancers. In addition breast cancer appeared a field of interest in disaster studies. Cancer studies in disaster management usually concentrated less on technological disasters. Conclusion: In aftermath of disasters, the concentration on measures to provide services for injuries and food, water and shelter, results in many challenges for cancer patients. Thus the health system must prepare cancer patients and caregivers for better responses to disasters. In addition, surge capacity must be considered in hospitals and other medical facilities to guarantee continuity of care.

Increase in the number of admissions to psychiatric hospitals immediately after the Great East Japan Earthquake

INTRODUCTION

Major natural disasters have a significant impact on the mental health of survivors in affected communities. Although it has been speculated that the number of survivors requiring admission to psychiatric hospital increases immediately after a major disaster, few studies have examined the issue.

METHODS

On March 11, 2011, the Great East Japan Earthquake and subsequent tsunami devastated the relatively isolated city of Kesennuma. We therefore compared the weekly number of patients admitted to 2 psychiatric hospitals in Kesennuma in the 4 weeks immediately after the earthquake with those in the 4 weeks immediately preceding the earthquake. We also made comparisons between this 8-week period and the corresponding 8-week periods in 2009, 2010, and 2012.

RESULTS

The number of patients admitted to the 2 psychiatric hospitals increased in 4 weeks after the disaster in 2011, with a weekly median (range) of 13 (9-16), compared with 6 (5-9) in the preceding 4 weeks in 2011. The corresponding figures were 5.5 (2-10) in 2009, 6.5 (5-9) in 2010, and 4 (3-7) in 2012 (P = .01, H = 13.05). By diagnostic category, admissions for schizophrenia spectrum disorder and neurotic stress-related disorder increased significantly following the disaster.

DISCUSSION

Demands for inpatient psychiatric treatment increased immediately after the Great East Japan Earthquake. Government officials and mental health professionals must strengthen support for survivors with mental illness, especially those with schizophrenia spectrum disorder. This should include support for mental health authorities and medical staff in the affected community.

Attitudes, Motivators, and Barriers to Emergency Preparedness Using the 2016 Styles Survey

This study assessed adults' perceptions toward preparedness to better inform emergency planning efforts for households and communities. The 2016 Styles, an Internet panel survey, was used to assess emergency preparedness competencies. Descriptive analyses were performed to describe the sociodemographic factors by preparedness status. Multivariable logistic regressions were used to examine the association between perceived preparedness and characteristics associated with preparedness attitudes, motivators, and barriers. Approximately 40% of adults surveyed reported that they were prepared for emergencies. The main motivator for those prepared was awareness of local disasters (38.9%), and a leading barrier was confusion about how to plan for the unknown (23.7%). Those prepared were more likely to have the right supplies (adjusted odds ratio [AOR] = 1.25, 95% confidence interval [CI] = [1.05, 1.50]), discuss emergency plans (AOR = 1.21, 95% CI = [1.02-1.42]), and act before an emergency occurred (AOR = 1.35, 95% CI = [1.15, 1.59]), compared with adults who did not report being prepared. Results from this research indicate that identifying motivation to prepare for emergencies can contribute to public health disaster planning. Preparation is a critical step that allows the community and its citizens to be more equipped to function during and after a disaster.

Can a disaster affect rheumatoid arthritis status? A retrospective cohort study after the 2011 triple disaster in Fukushima, Japan

OBJECTIVE

As status of rheumatoid arthritis (RA) is highly affected by environmental factors, a catastrophic disaster may also affect RA activity. Herein we conducted a retrospective cohort study in the disaster area of the 2011 triple disaster in Fukushima, Japan: an earthquake, tsunamis and a nuclear accident.

METHODS

Clinical records of RA patients who attended a hospital near the Fukushima Daiichi Nuclear Power Plant were collected. For those who underwent whole-body counter testing, internal radiation exposure levels were also collected. As clinical parameters may fluctuate in the absence of a disaster, changes in values before and after the disaster were also compared. Logistic regression was conducted to identify factors affecting RA status.

RESULTS

Fifty-three patients (average age, 64.2 years; females, 83%; average disease duration, 15.7 years) were included in the study. Five patients lived within the no-entry zone, 37 evacuated immediately after the disaster, and four temporarily stopped RA treatment. The proportions of patients who showed worsened tender joint counts, swollen joint counts and rheumatoid factor values were significantly higher after the disaster compared to those before. Among the 16 patients who underwent whole-body counter testing, only one showed a detectable, but negligible, radioactive cesium level. Use of methotrexate was identified as a possible preventive factor for RA exacerbation in this setting.

CONCLUSION

This is the first study to analyze detailed profiles of RA patients after a disaster. As methotrexate may prevent disease exacerbation, continuity of care for this common chronic disease should be considered in disaster settings.

Burden and Management of Noncommunicable Diseases After Earthquakes and Tsunamis

This integrative review examines extant literature assessing the burden and management of noncommunicable diseases 6 months or more after earthquakes and tsunamis. We conducted an integrative review to identify and characterize the strength of published studies about noncommunicable disease-specific outcomes and interventions at least 6 months after an earthquake and/or tsunami. We included disasters that occurred from 2004 to 2016. We focused primarily on the World Health Organization noncommunicable disease designations to define chronic disease, but we also included chronic renal disease, risk factors for noncommunicable diseases, and other chronic diseases or symptoms. After removing duplicates, our search yielded 6,188 articles. Twenty-five articles met our inclusion criteria, some discussing multiple noncommunicable diseases. Results demonstrate that existing medical conditions may worsen and subsequently improve, new diseases may develop, and risk factors, such as weight and cholesterol levels, may increase for several years after an earthquake and/or tsunami. We make 3 recommendations for practitioners and researchers: (1) plan for noncommunicable disease management further into the recovery period of disaster; (2) increase research on the burden of noncommunicable diseases, the treatment modalities employed, resulting population-level outcomes in the postdisaster setting, and existing models to improve stakeholder coordination and action regarding noncommunicable diseases after disasters; and (3) coordinate with preexisting provision networks, especially primary care.

Assessment of the Public Health Risks and Impact of a Tornado in Funing, China, 23 June 2016: A Retrospective Analysis

(1) Background: Tornadoes are one of the deadliest disasters but their health impacts in China are poorly investigated. This study aimed to assess the public health risks and impact of an EF-4 tornado outbreak in Funing, China; (2) Methods: A retrospective analysis on the characteristics of tornado-related deaths and injuries was conducted based on the database from the Funing's Center for Disease Control and Prevention (CDC) and Funing People's Hospital. A change-point time-series analysis of weekly incidence for the period January 2010 to September 2016 was used to identify sensitive infectious diseases to the tornado; (3) Results: The 75 to 84 years old group was at the highest risk of both death (RR = 82.16; 95% CIs = 19.66, 343.33) and injury (RR = 31.80; 95% CI = 17.26, 58.61), and females were at 53% higher risk of death than males (RR = 1.53; 95% CIs = 1.02, 2.29). Of the 337 injuries, 274 injuries (81%) were minor. Most deaths occurred indoors (87%) and the head (74%) was the most frequent site of trauma during the tornado. Five diseases showed downward change-points; (4) Conclusions: The experience of the Funing tornado underscores the relative danger of being indoors during a tornado and is successful in avoiding epidemics post-tornado. Current international safety guidelines need modification when generalized to China.

The Great East Japan Earthquake: Analyses of Disaster Impacts on Health Care Clinics

OBJECTIVE

Local health facilities play a critical role in mitigating the deterioration of health after catastrophic disasters. However, limited information is available on clinic damage. Therefore, the National Institute of Public Health conducted surveillance on clinic damage after the 2011 Great East Japan Earthquake (GEJE) to identify risk factors.

METHODS

A cross-sectional study using a paper-based questionnaire was conducted that targeted 728 clinics located in coastal areas in the 3 prefectures most affected by the GEJE.

RESULTS

The risk of building damage was inversely correlated with distance from the coast, whereas the risk of ceasing operations was significantly correlated with building damage and some specialties of clinics, namely, internal medicine and pediatrics.DiscussionIn mountainous countries like Japan, clinics often need to be built in coastal areas, where the majority of residents live. This surveillance revealed that clinics built in readily accessible locations and that provide care with high needs are more likely to get damaged by tsunamis. As clinics are often the frontline health facilities in disaster settings, local disaster plans need to include plans to reinforce disaster preparedness among clinics. For effective planning and resource allocation, nationwide hazard vulnerability analysis using a global standard will be helpful. (Disaster Med Public Health Preparedness. 2018; 12: 291-295).

Excess mortality due to indirect health effects of the 2011 triple disaster in Fukushima, Japan: a retrospective observational study

Background

Evidence on the indirect health impacts of disasters is limited. We assessed the excess mortality risk associated with the indirect health impacts of the 2011 triple disaster (earthquake, tsunami and nuclear disaster) in Fukushima, Japan.

Methods

The mortality rates in Soma and Minamisoma cities in Fukushima from 2006 to 2015 were calculated using vital statistics and resident registrations. We investigated the excess mortality risk, defined as the increased mortality risk between postdisaster and predisaster after excluding direct deaths attributed to the physical force of the disaster. Multivariate Poisson regression models were used to estimate the relative risk (RR) of mortality after adjusting for city, age and year.

Results

There were 6163 and 6125 predisaster and postdisaster deaths, respectively. The postdisaster mortality risk was significantly higher in the first month following the disaster (March 2011) than in the same month during the predisaster period (March 2006–2010). RRs among men and women were 2.64 (95% CI 2.16 to 3.24) and 2.46 (95% CI 1.99 to 3.03), respectively, demonstrating excess mortality risk due to the indirect health effects of the disaster. Age-specific subgroup analyses revealed a significantly higher mortality risk in women aged ≥85 years in the third month of the disaster compared with predisaster baseline, with an RR (95% CI) of 1.73 (1.23 to 2.44).

Conclusions

Indirect health impacts are most severe in the first month of the disaster. Early public health support, especially for the elderly, can be an important factor for reducing the indirect health effects of a disaster.

Management of Diabetic Surgical Patients in a Deployed Field Hospital: A Model for Acute Non-Communicable Disease Care in Disaster

Sudden onset disasters (SODs) have affected over 1.5 billion of the world's population in the past decade. During the same time, developing nations have faced a sustained increase in the burden of non-communicable disease (NCD) with extra pressure placed on health systems. The combined increase in SODs and the NCD epidemic facing the world's most disaster-prone nations will present new challenges to emergency medical teams (EMTs) during disaster response. This report details the experience as an EMT during the Typhoon Haiyan disaster of 2013, with particular reference to the challenges of diabetic management in a surgical field hospital. The incidence of diabetes in this surgical cohort exceeded that of the population by a factor of four. The steps to prepare for and treat diabetes in the field provide a useful model for the management of NCD in the deployed field hospital environment after a disaster. McDermott KM , Hardstaff RM , Alpen S , Read DJ , Coatsworth NR . Management of diabetic surgical patients in a deployed field hospital: a model for acute non-communicable disease care in disaster. Prehosp Disaster Med. 2017;32(6):657-661.

The Impact of Disasters and Major Incidents on Vulnerable Groups: Risk and Medical Assessment of Swedish Patients With Advanced Care at Home

In this study, we assessed the overall risks that influence advanced care at home (ACH) patients enrolled in 8 municipalities in the western region of Sweden. We also conducted a medical assessment of a limited number of ACH cases based on the registered information from the university hospital in Gothenburg, with regard to survival after a disaster. Two different questionnaires were distributed, and the results were collected separately and analyzed using descriptive statistical analysis. The results indicate that there is a low level of preparedness among the health care service providers for addressing the needs of ACH patients following a major incident or disaster. For this group, the impact of a disaster depends on their vulnerability, specific diagnosis, the medical support required, and the duration of the incident or disaster.