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Martínez-Lozano M, Noboa C, Alvarado-González G, Joshipura KJ. Hurricanes Irma and Maria and Diabetes incidence in Puerto Rico. BMC Public Health 2023; 23:1019. [PMID: 37254127 DOI: 10.1186/s12889-023-15542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/27/2023] [Indexed: 06/01/2023] Open
Abstract
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.
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Affiliation(s)
- Marijulie Martínez-Lozano
- Center for Clinical Research and Health Promotion, University of Puerto Rico, Medical Sciences Campus Suite A 107, Box 365067, San Juan, Puerto Rico, 00935, USA
| | - Carlamarie Noboa
- Center for Clinical Research and Health Promotion, University of Puerto Rico, Medical Sciences Campus Suite A 107, Box 365067, San Juan, Puerto Rico, 00935, USA
| | | | - Kaumudi J Joshipura
- Center for Clinical Research and Health Promotion, University of Puerto Rico, Medical Sciences Campus Suite A 107, Box 365067, San Juan, Puerto Rico, 00935, USA.
- School of Public Health, Ahmedabad University, Ahmedabad , India.
- Department of Epidemiology, HARVARD SCHOOL OF PUBLIC HEALTH, Boston , USA.
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Disaster Preparedness: Hospital Pharmacy Strategy for Prioritized Inventory Management and Drug Procurement on Vancouver Island. Disaster Med Public Health Prep 2022; 17:e235. [PMID: 36047249 DOI: 10.1017/dmp.2022.186] [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: 02/07/2023]
Abstract
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.
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Caballero AE, Ceriello A, Misra A, Aschner P, McDonnell ME, Hassanein M, Ji L, Mbanya JC, Fonseca VA. COVID-19 in people living with diabetes: An international consensus. J Diabetes Complications 2020; 34:107671. [PMID: 32651031 PMCID: PMC7336933 DOI: 10.1016/j.jdiacomp.2020.107671] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023]
Abstract
The COVID-19 pandemic has added an enormous toll to the existing challenge of diabetes care world-wide. A large proportion of patients with COVID-19 requiring hospitalization and/or succumbing to the disease have had diabetes and other chronic conditions as underlying risk factors. In particular, individuals belonging to racial/ethnic minorities in the U.S. and other countries have been significantly and disproportionately impacted. Multiple and complex socioeconomic factors have long played a role in increasing the risk for diabetes and now for COVID-19. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience on providing diabetes care in the setting of COVID-19. In addition, understanding of the pathophysiological mechanisms that link these two diseases is being developed. The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. Notably, this worldwide experience offers us the possibility to not only prepare better for future disasters but also transform diabetes care beyond the COVID-19 era.
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Affiliation(s)
- A E Caballero
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | | | - A Misra
- Fortis-C-DOC Center of Excellence for Diabetes, Metabolic Disease and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation, New Dheli, India
| | - P Aschner
- San Ignacio University Hospital, Javeriana University School of Medicine, Bogota, Colombia
| | - M E McDonnell
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M Hassanein
- Dubai Hospital, Endocrine Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - L Ji
- Peking University People's Hospital, Peking University, Beijing, China
| | - J C Mbanya
- Central Hospital, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - V A Fonseca
- Tulane University Medical Center, Tulane University Medical School, New Orleans, USA
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Ripoll Gallardo A, Pacelli B, Alesina M, Serrone D, Iacutone G, Faggiano F, Della Corte F, Allara E. Medium- and long-term health effects of earthquakes in high-income countries: a systematic review and meta-analysis. Int J Epidemiol 2019; 47:1317-1332. [PMID: 30053061 DOI: 10.1093/ije/dyy130] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/14/2022] Open
Abstract
Background Accurate monitoring of population health is essential to ensure proper recovery after earthquakes. We aimed to summarize the findings and features of post-earthquake epidemiological studies conducted in high-income countries and to prompt the development of future surveillance plans. Methods Medline, Scopus and six sources of grey literature were systematically searched. Inclusion criteria were: observational study conducted in high-income countries with at least one comparison group of unexposed participants, and measurement of health outcomes at least 1 month after the earthquake. Results A total of 52 articles were included, assessing the effects of 13 earthquakes that occurred in eight countries. Most studies: had a time-series (33%) or cross-sectional (29%) design; included temporal comparison groups (63%); used routine data (58%); and focused on patient subgroups rather than the whole population (65%). Individuals exposed to earthquakes had: 2% higher all-cause mortality rates [95% confidence interval (CI), 1% to 3%]; 36% (95% CI, 19% to 57%) and 37% (95% CI, 29% to 46%) greater mortality rates from myocardial infarction and stroke, respectively; and 0.16 higher mean percent points of glycated haemoglobin (95% CI, 0.07% to 0.25% points). There was no evidence of earthquake effects for blood pressure, body mass index or lipid biomarkers. Conclusions A more regular and coordinated use of large and routinely collected datasets would benefit post-earthquake epidemiological surveillance. Whenever possible, a cohort design with geographical and temporal comparison groups should be used, and both communicable and non-communicable diseases should be assessed. Post-earthquake epidemiological surveillance should also capture the impact of seismic events on the access to and use of health care services.
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Affiliation(s)
- Alba Ripoll Gallardo
- Research Centre in Emergency and Disaster Medicine (CRIMEDIM), Università del Piemonte Orientale, Novara, Italy
| | - Barbara Pacelli
- Italian Association of Epidemiology.,Regional Health and Social Care Agency of Emilia-Romagna, Bologna, Italy
| | - Marta Alesina
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Dario Serrone
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Giovanni Iacutone
- Department of Life, Health and Enviromental Sciences, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Fabrizio Faggiano
- Italian Association of Epidemiology.,Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Francesco Della Corte
- Research Centre in Emergency and Disaster Medicine (CRIMEDIM), Università del Piemonte Orientale, Novara, Italy
| | - Elias Allara
- Italian Association of Epidemiology.,Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Kondo T, Miyakawa N, Motoshima H, Hanatani S, Ishii N, Igata M, Yoshinaga K, Kukidome D, Senokuchi T, Kawashima J, Furukawa N, Matsumura T, Araki E. Impacts of the 2016 Kumamoto Earthquake on glycemic control in patients with diabetes. J Diabetes Investig 2019; 10:521-530. [PMID: 29978571 PMCID: PMC6400205 DOI: 10.1111/jdi.12891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/19/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION On April 14 and 16 2016, the Kumamoto area was severely damaged by several massive magnitude 7 class earthquakes. MATERIALS AND METHODS To examine the effects of these earthquakes on glycemic control and stress factors, glycated hemoglobin, glycated albumin, other biochemical parameters, a self-administered lifestyle-associated questionnaire and disaster-associated stress scores were analyzed. A total of 557 patients with diabetes were enrolled, and data were collected at 13 months before to 13 months after the earthquakes. RESULTS In patients with type 1 diabetes and specific types of diabetes due to other causes, glycemic control was not altered during the observational period. This glycemic stability in type 1 diabetes might result from self-management of insulin doses. In patients with type 2 diabetes, glycated hemoglobin decreased by 0.11% (from 7.33 to 7.22%) at 1-2 months after the earthquakes, and increased thereafter. The reduction of glycated hemoglobin after 1-2 months in type 2 diabetes was associated with 'early restoration of lifelines' and 'sufficient sleep.' The glycemic deterioration at a later stage was related to 'shortage of antidiabetic agents,' 'insufficient amount of food,' 'largely destroyed houses' and 'changes in working environments.' Disaster-associated stress levels were positively correlated with 'age,' 'delayed restoration of lifelines,' 'self-management of antidiabetic agents' and 'increased amount of physical activity/exercise,' and negatively associated with 'early restoration of lifelines' and 'sufficient sleep.' CONCLUSIONS Glycemic control, associated factors and stress levels are altered in chronological order. Post-disaster diabetic medical care must consider these corresponding points in accordance with the time-period.
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Affiliation(s)
- Tatsuya Kondo
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Nobukazu Miyakawa
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Hiroyuki Motoshima
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Satoko Hanatani
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Norio Ishii
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Motoyuki Igata
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Kayo Yoshinaga
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Daisuke Kukidome
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Takafumi Senokuchi
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Junji Kawashima
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Noboru Furukawa
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Takeshi Matsumura
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Eiichi Araki
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
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Tomio J, Sato H. Emergency and disaster preparedness for chronically ill patients: a review of recommendations. Open Access Emerg Med 2014; 6:69-79. [PMID: 27147882 PMCID: PMC4753992 DOI: 10.2147/oaem.s48532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1) recommendations should be evidence-based; 2) recommendations should contain consistent messages; and 3) recommendations should be feasible.
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Affiliation(s)
- Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Japan
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Chronic conditions and household preparedness for public health emergencies: Behavioral Risk Factor Surveillance System, 2006-2010. Prehosp Disaster Med 2013; 29:13-20. [PMID: 24330818 DOI: 10.1017/s1049023x13009126] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Individuals with chronic conditions often experience exacerbation of those conditions and have specialized medical needs after a disaster. Less is known about the level of disaster preparedness of this particular population and the extent to which being prepared might have an impact on the risk of disease exacerbation. The purpose of this study was to examine the association between self-reported asthma, cardiovascular disease, and diabetes and levels of household disaster preparedness. METHODS Data were analyzed from 14 US states participating in the 2006-2010 Behavioral Risk Factor Surveillance System (BRFSS), a large state-based telephone survey. Chi-square statistics and adjusted prevalence ratios were calculated. RESULTS After adjusting for sociodemographic characteristics, as compared to those without each condition, persons with cardiovascular disease (aPR = 1.09; 95% CI, 1.01-1.17) and diabetes (aPR = 1.13; 95% CI, 1.05-1.22) were slightly more likely to have an evacuation plan and individuals with diabetes (aPR = 1.04; 95% CI, 1.02-1.05) and asthma (aPR = 1.02; 95% CI, 1.01-1.04) were slightly more likely to have a 3-day supply of prescription medication. There were no statistically significant differences in the prevalence for all other preparedness measures (3-day supply of food and water, working radio and flashlight, willingness to leave during a mandatory evacuation) between those with and those without each chronic condition. CONCLUSION Despite the increased morbidity and mortality associated with chronic conditions, persons with diabetes, cardiovascular disease, and asthma were generally not more prepared for natural or man-made disasters than those without each chronic condition.
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Development of Disaster Pamphlets Based on Health Needs of Patients with Chronic Illnesses. Prehosp Disaster Med 2012; 25:354-60. [DOI: 10.1017/s1049023x00008347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe aim of this research was to develop a pamphlet that would enable patients with diabetes, rheumatic diseases, chronic respiratory disease, and dialysis treatment to be aware of changes in their physical conditions at an early stage of a disaster, cope with these changes, maintain self-care measures, and recover their health.Illness-specific pamphlets were produced based on disaster-related literature, news articles, surveys of victims of the Great Hanshin-Awaji Earthquake Disaster and Typhoon Tokage, and other sources.Each pamphlet consisted of seven sections—each section includes items common to all illnesses as well as items specific to each illness. The first section, “Physical Self-Care”, contains a checklist of 18 common physical symptoms as well as symptoms specific to each illness, and goes on to explain what the symptoms may indicate and what should be done about them. The main aim of the “Changes in Mental Health Conditions” section is to detect post-traumatic stress disorder (PTSD) at an early stage. The section “Preventing the Deterioration of Chronic Illnesses” is designed to prevent the worsening of each illness through the provision of information on cold prevention, adjustment to the living environment, and ways of coping with stress. In the sections, “Medication Control” and “Importance of Having Medical Examinations”, spaces are provided to list medications currently being used and details of the hospital address, in order to ensure the continued use of medications. The section, “Preparing for Evacuations” gives a list of everyday items and medical items needed to be prepared for a disaster. Finally, the “Methods of Contact in an Emergency” section provides details of how to use the voicemail service. The following content-specific to each illness also was explained in detail: (1) for diabetes, complications arising from the deterioration of the illness, attention to nutrition, and insulin management; (2) for rheumatic diseases, a checklist of factors indicating the worsening of the illness and methods of coping with stress; (3) for chronic respiratory disease, prevention of respiratory infections and management of supplemental oxygen; and (4) for patients requiring dialysis, conditions of dialysis (such as dry weight, dialyzer, number of dialysis treatments, and dialysis hours) and what to do if a disaster occurs during dialysis.It is expected that these pamphlets will be useful to patients with chronic illnesses, and will be used to prepare for disasters, thereby helping the patients cope with the unusual situation that during a disaster and recover as soon as possible.
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Abstract
Many reports have documented the negative health consequences that environmental stressors can have on patients with diabetes. Studies examining the interaction between the environment and a patient with diabetes can be unified under a single discipline termed "geoenvironmental diabetology." Geoenvironmental diabetology is defined more specifically as the study of how geophysical phenomena impact a patient with diabetes, to include effects on metabolic control, ancillary equipment (e.g., glucometers and insulin pumps), medications, supplies, access to care, and influences on the adaptive strategies employed by patients to care for their diabetes under extreme circumstances. Geological events such as natural disasters (e.g., earthquakes) or extreme weather (e.g., heat waves) are examples of stressors that can affect patients with diabetes and that can be included under the heading of geoenvironmental diabetology. As proposed here, geoenvironmental diabetology refers to how events in the physical world affect those with diagnosed diabetes, rather than how environmental factors might trigger development of disease. As the global prevalence of diabetes continues to increase, including in parts of the world that are especially vulnerable to disasters and climate change, further discussion is warranted on how to best prepare for management of diabetes under conditions of extreme geological and weather events and a changing climate. An overview is presented of various studies that have detailed how geoenvironmental phenomena can adversely affect patients with diabetes and concludes with a discussion of requirements for developing strategies for geoenvironmental diabetes management.
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Affiliation(s)
- Curtiss B Cook
- Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona, USA.
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Renukuntla VS, Hassan K, Wheat S, Heptulla RA. Disaster preparedness in pediatric type 1 diabetes mellitus. Pediatrics 2009; 124:e973-7. [PMID: 19822589 DOI: 10.1542/peds.2008-3648] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to assess emergency preparedness among families caring for children with type 1 diabetes mellitus. METHODS A total of 115 English-speaking families caring for children with type 1 diabetes mellitus who were attending the diabetes clinic at Texas Children's Hospital agreed to a questionnaire study designed to ascertain their level of preparedness for a disaster or emergency. The study was conducted from June through September 2008 and ended just before Hurricane Ike made landfall. RESULTS Families were better prepared for self-management of diabetes, compared with general disaster preparedness. Sixty-two percent of the families were generally unprepared for a major disaster. For self-management of diabetes specifically, however, 75% of families had adequate supplies to maintain care for 3 days. Families in higher and moderate socioeconomic status strata were better equipped for an emergency (P < .002). Preparedness was found to be independent of age, gender, ethnicity, and previous experience of a disaster. CONCLUSION Disaster preparedness still lags in families of lower socioeconomic status.
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Affiliation(s)
- Venkat S Renukuntla
- Department of Pediatric Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas, USA
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McDuffie R, Summerson J, Reilly P, Blackwell C, Goff D, Kimel AR, Crago L, Fonseca V. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial and Hurricane Katrina: lessons for managing clinical trials during and after a natural disaster. Contemp Clin Trials 2008; 29:756-61. [PMID: 18577469 DOI: 10.1016/j.cct.2008.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 05/15/2008] [Accepted: 05/30/2008] [Indexed: 10/22/2022]
Abstract
Hurricane Katrina was one of the most catastrophic natural disasters to hit the United States. It had a major impact on health care in New Orleans, LA and the surrounding region, not only in relation to acute illness but also chronic disease. When Hurricane Katrina struck New Orleans on August 29, 2005, there were 193 participants being followed in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial at Tulane University Health Sciences Center. In the immediate aftermath of the storm, the Tulane University ACCORD Study site, in collaboration with the Study Coordinating Center and the Southeast Clinical Center Network office of the trial at Wake Forest University Health Sciences in North Carolina, took several actions in order to locate the participants, ensure their safety, and maintain the scientific integrity of the trial. We describe the actions taken and the relative success/failure of such actions.
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Psychological Trauma following Motor Vehicle Crashes. Prehosp Disaster Med 2005. [DOI: 10.1017/s1049023x00013881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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