Evolution of complex disasters

Dynamic Characteristics and Evolution Analysis of Information Dissemination Theme of Social Networks under Emergencies

Social media has become an essential channel for the public to create and obtain information during emergencies. As the theme of public concern for emergencies changes over time, there is a lack of research on its dynamic evolution from its latent stage. This paper selects the Henan rainstorm event as a case study and extracts the theme characteristics by combining the life cycle theory and Latent Dirichlet Allocation (LDA) model. It integrates the Term Frequency–Inverse Document Frequency (TF-IDF) and Pointwise Mutual Information (PMI) algorithms as the theme-coding data source to build a dynamic theme propagation model for emergencies. Our research results showed that the theme coding effectively verified the assumption of latent development trends. The dynamic theme model could reveal the theme characteristics of different time series stages of emergencies, analyze the law of the theme evolution of the network’s public opinion, and provide practical and theoretical insights for the emergency management of urban cities.

Spatial evolution patterns of public panic on Chinese social networks amidst the COVID-19 pandemic

Novel coronavirus pneumonia has had a significant impact on people's lives and psychological health. We developed a stage model to analyse the spatial and temporal distribution of public panic during the two waves of the coronavirus disease 2019 (COVID-19) pandemic. We used tweets with geographic location data from the popular hashtag 'Lockdown Diary' recorded from 23 January to April 8, 2020, and 'Nanjing Outbreak' recorded from 21 July to 1 September 2021 on Weibo. Combining the lexicon-based sentiment analysis and the grounded theory approach, this panic model could explain people's panic and behavioural responses in different areas at different stages of the pandemic. Next, we used the latent Dirichlet allocation topic model to reconfirm the panic model. The results showed that public sentiments fluctuated strongly in the early stages; in this case, panic and prayers were the dominant sentiments. In terms of spatial distribution, public panic showed hierarchical and neighbourhood diffusion, with highly assertive expressions of sentiment at the outbreak sites, economically developed areas, and areas surrounding the outbreak. Most importantly, we considered that public panic was affected by the 17 specific topics extracted based on the perceived and actual distance of the pandemic, thus stimulating the process of panic from minimal, acute, and mild panic to perceived rationality. Consequently, the public's behavioural responses shifted from delayed, negative, and positive, to rational behavioural responses. This study presents a novel approach to explore public panic from both a time and space perspective and provides some suggestions in response to future pandemics.

Agent-based modeling and life cycle dynamics of COVID-19-related online collective actions

The outbreak of COVID-19 has greatly threatened global public health and produced social problems, which includes relative online collective actions. Based on the life cycle law, focusing on the life cycle process of COVID-19 online collective actions, we carried out both macro-level analysis (big data mining) and micro-level behaviors (Agent-Based Modeling) on pandemic-related online collective actions. We collected 138 related online events with macro-level big data characteristics, and used Agent-Based Modeling to capture micro-level individual behaviors of netizens. We set two kinds of movable agents, Hots (events) and Netizens (individuals), which behave smartly and autonomously. Based on multiple simulations and parametric traversal, we obtained the optimal parameter solution. Under the optimal solutions, we repeated simulations by ten times, and took the mean values as robust outcomes. Simulation outcomes well match the real big data of life cycle trends, and validity and robustness can be achieved. According to multiple criteria (spans, peaks, ratios, and distributions), the fitness between simulations and real big data has been substantially supported. Therefore, our Agent-Based Modeling well grasps the micro-level mechanisms of real-world individuals (netizens), based on which we can predict individual behaviors of netizens and big data trends of specific online events. Based on our model, it is feasible to model, calculate, and even predict evolutionary dynamics and life cycles trends of online collective actions. It facilitates public administrations and social governance.

Sentiment Analysis of Rumor Spread Amid COVID-19: Based on Weibo Text

(1) Background: in early 2020, COVID-19 broke out. Driven by people’s psychology of conformity, panic, group polarization, etc., various rumors appeared and spread wildly, and the Internet became a hotbed of rumors. (2) Methods: the study selected Weibo as the research media, using topic models, time series analysis, sentiment analysis, and Granger causality testing methods to analyze the social media texts related to COVID-19 rumors. (3) Results: in study 1, we obtained 21 topics related to “COVID-19 rumors” and “outbreak rumors” after conducting topic model analysis on Weibo texts; in study 2, we explored the emotional changes of netizens before and after rumor dispelling information was released and found people’s positive emotions first declined and then rose; in study 3, we also explored the emotional changes of netizens before and after the “Wuhan lockdown” event and found positive sentiment of people in non-Wuhan areas increased, while negative sentiment of people in Wuhan increased; in study 4, we studied the relationship between rumor spread and emotional polarity and found negative sentiment and rumor spread was causally interrelated. (4) Conclusion: These findings could help us to intuitively understand the impact of rumors spread on people’s emotions during the COVID-19 pandemic and help the government take measures to reduce panic.

Self-reported diseases and their associated risk factors among camp-dwelling conflict-affected internally displaced populations in Nigeria

Background Conflict in Nigeria displaced millions of people, and some settled in camp-like locations within the country. Evidence on the association between living conditions and health outcomes among these populations are limited. This study investigated the risk factors associated with illnesses among camp-dwelling internally displaced persons (IDPs) in northern Nigeria. Methods A cross-sectional study was conducted in nine camps in 2016. Self-reported data on socio-demography, resource utilization and disease outcomes were collected. Association between health conditions and various factors, including sanitation and healthcare access, was investigated. Results Data from 2253 IDPs showed 81.1% (CI = 79.5-82.7) experienced one or more health conditions; however, over 20% did not access healthcare services. Most common diseases were malaria, fever, typhoid and diarrhoea. Multivariable logistic regression presented as adjusted odds ratios(aOR) and 95% confidence intervals(CIs) showed factors significantly associated with increased likelihood of illnesses included being female (aOR = 1.53;CI = 1.19-1.96), overcrowding (aOR = 1.07;CI = 1.00-1.36), long-term conditions (aOR = 2.72;CI = 1.88-3.94), outdoor defecation (aOR = 2.37;CI = 1.14-4.94) and presence of disease-causing vectors (aOR = 3.71;CI = 1.60-8.60). Conclusion Most diseases in the camps were communicable. Modifiable risk factors such as overcrowding and poor toilet facilities were associated with increased poor health outcomes. This evidence highlights areas of high priority when planning humanitarian public health interventions.

COVID-19 Sensing: Negative Sentiment Analysis on Social Media in China via BERT Model

Coronavirus disease 2019 (COVID-19) poses massive challenges for the world. Public sentiment analysis during the outbreak provides insightful information in making appropriate public health responses. On Sina Weibo, a popular Chinese social media, posts with negative sentiment are valuable in analyzing public concerns. 999,978 randomly selected COVID-19 related Weibo posts from 1 January 2020 to 18 February 2020 are analyzed. Specifically, the unsupervised BERT (Bidirectional Encoder Representations from Transformers) model is adopted to classify sentiment categories (positive, neutral, and negative) and TF-IDF (term frequency-inverse document frequency) model is used to summarize the topics of posts. Trend analysis and thematic analysis are conducted to identify characteristics of negative sentiment. In general, the fine-tuned BERT conducts sentiment classification with considerable accuracy. Besides, topics extracted by TF-IDF precisely convey characteristics of posts regarding COVID-19. As a result, we observed that people concern four aspects regarding COVID-19, the virus Origin (Gamey Food, 3.08%; Bat, 2.70%; Conspiracy Theory, 1.43%), Symptom (Fever, 2.13%; Cough, 1.19%), Production Activity (Go to Work, 1.94%; Resume Work, 1.12%; School New Semester Beginning, 1.06%) and Public Health Control (Temperature Taking, 1.39%; Coronavirus Cover-up, 1.26%; City Shutdown, 1.09%). Results from Weibo posts provide constructive instructions on public health responses, that transparent information sharing and scientific guidance might help alleviate public concerns.

The Role of Dental Professionals in Pandemic Events and Disaster Responses

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

Topical evolution patterns and temporal trends of microblogs on public health emergencies

Purpose

The purpose of this paper is to identify salient topic categories and outline their evolution patterns and temporal trends in microblogs on a public health emergency across different stages. Comparisons were also examined to reveal the similarities and differences between those patterns and trends on microblog platforms of different languages and from different nations.

Design/methodology/approach

A total of 459,266 microblog entries about the Ebola outbreak in West Africa in 2014 on Twitter and Weibo were collected for nine months after the inception of the outbreak. Topics were detected by the latent Dirichlet allocation model and classified into several categories. The daily tweets were analyzed with the self-organizing map technique and labeled with the most salient topics. The investigated time span was divided into three stages, and the most salient topic categories were identified for each stage.

Findings

In total, 14 salient topic categories were identified in microblogs about the Ebola outbreak and were summarized as increasing, decreasing, fluctuating or ephemeral types. The topical evolution patterns of microblogs and temporal trends for topic categories vary on different microblog platforms. Twitter users were keen on the dynamics of the Ebola outbreak, such as status description, secondary events and so forth, while Weibo users focused on background knowledge of Ebola and precautions.

Originality/value

This study revealed evolution patterns and temporal trends of microblog topics on a public health emergency. The findings can help administrators of public health emergencies and microblog communities work together to better satisfy information needs and physical demands by the public when public health emergencies are in progress.

The Role of Oral Health in Complex Emergencies and Disaster Rehabilitation Medicine

This paper presents an overview of the importance of oral health in complex emergencies. It highlights the importance of maintaining general and oral health in the acute, intermediate and long-term phases of such events which are increasing in frequency. The importance of oral health as an early warning sign for systemic disease and deprivation is also explored along with the crucial role of oral health in maintaining quality of life through adequate nutrition and speech. The overview of oral health in these situations identifies the need for training dental personnel as members of rehabilitation teams that set out to manage these disasters. They can quickly help in improving quality of life for victims by extracting carious and painful teeth as necessary, and also form part of an oral health education program for aid agencies. They can also be the first to identify systemic diseases like HIV and may also play a role in identifying victims of abuse, as non-accidental injuries can frequently present in the oro-facial region. The oral health overview concludes by describing the contents of innovative oral health packs that are tailored to prevention of dental diseases and that can be readily incorporated as part of food packs distributed by aid agencies. (Disaster Med Public Health Prepardness. 2018;12:772-777).

The mortality in Gaza in July-September 2014: a retrospective chart-review study

BACKGROUND

The majority of Gazans who were killed or injured in the 2014 Israel-Gaza war were civilians, and one-fourth of the population were internally displaced. As the Gaza Strip is a small territory, the whole population was exposed to the war and its effects on the health care system, supplies and infrastructure. Our aim was to assess the overall, sex and age-group mortality in Gaza for the period July-September 2014 that was not caused by war injuries, and the proportion of non-trauma deaths among adults that occurred outside hospital wards. A comparison was made with the mortality for the same period in 2013.

METHOD

Date, sex, age, cause and place of each death that was not attributed to war-related physical trauma were collected from death notification forms or death records in Gaza hospitals for the period 01 July to 30 September 2014. The same information was extracted from the local death register for all deaths in the same period in 2013.

RESULTS

The mean age at death was 52.4 years in 2014 and 49.7 in 2013, and about 50 % were older than 60 years in both years. The crude non-trauma death rates among adults were 11.6 per 10,000 population in 2014 and 11.3 in 2013, and the age standardised 13.2 and 12.4, respectively. Higher death rates in 2014 were observed among elderly and women. Cardiovascular disease was the most common cause of death among adults of both sexes, and infectious diseases caused less than 10 % in both periods. Three maternal deaths were observed in 2013 and six in 2014 (p = 0.17). The proportion of deaths that occurred in a hospital ward was 71.5 % in 2013 and 51.2 % in 2014.

CONCLUSIONS

The mortality from communicable diseases was low in Gaza. We did not detect a higher overall background mortality in the 2014 period compared to 2013, but the observed age and sex distribution differed. The proportion of non-trauma deaths among adults that occurred in a hospital ward was markedly lower during the war. The living conditions and health care situation in Gaza point to the need for close monitoring of mortality.

Shelter crowding and increased incidence of acute respiratory infection in evacuees following the Great Eastern Japan Earthquake and tsunami

Although outbreaks of acute respiratory infection (ARI) at shelters are hypothesized to be associated with shelter crowding, no studies have examined this relationship. We conducted a retrospective study by reviewing medical records of evacuees presenting to one of the 37 clinics at the shelters in Ishinomaki city, Japan, during the 3-week period after the Great Eastern Japan Earthquake and tsunami in 2011. On the basis of a locally weighted scatter-plot smoothing technique, we categorized 37 shelters into crowded (mean space <5·5 m2/per person) and non-crowded (⩾5·5 m2) shelters. Outcomes of interest were the cumulative and daily incidence rate of ARI/10 000 evacuees at each shelter. We found that the crowded shelters had a higher median cumulative incidence rate of ARI [5·4/10 000 person-days, interquartile range (IQR) 0–24·6,P= 0·04] compared to the non-crowded shelters (3·5/10 000 person-days, IQR 0–8·7) using Mann–WhitneyUtest. Similarly, the crowded shelters had an increased daily incidence rate of ARI of 19·1/10 000 person-days (95% confidence interval 5·9–32·4,P< 0·01) compared to the non-crowded shelters using quasi-least squares method. In sum, shelter crowding was associated with an increased incidence rate of ARI after the natural disaster.

Hunger strikers: historical perspectives from the emergency management of refugee camp asylum seekers

The treatment of hunger strikers is always contentious, chaotic and complex. The management is particularly difficult for health professionals as it raises unprecedented clinical, ethical, moral, humanitarian, and legal questions. There are never any easy answers. The current situation of prisoners from the Iraq and Afghanistan Wars currently at the Guantanamo Bay Detention Center in Cuba demands unprecedented transparency, accountability and multilevel coordination to ensure that the rights of the strikers are properly met. There are scant references available in the scientific literature on the emergency management of these tragedies. This historical perspective documents the complex issues faced by emergency physicians in Hong Kong surrounding refugee camp asylum seekers from Vietnam in 1994 and is offered as a useful adjunct in understanding the complex issues faced by emergency health providers and managers.

Barriers to Disaster Coordination: Health Sector Coordination in Banda Aceh following the South Asia Tsunami

Ecological disasters impact large populations every year, and hundreds of nongovernmental organizations, thousands of aid workers, and billions of dollars are sent in response. Yet, there have been recurring problems with coordination, leading to wasted efforts and funds. The humanitarian response to the December 2004 Earthquake and Tsunami in Asia was one of the largest ever, and coordination problems were apparent.

The coordination processes and attempts at coordination are discussed in this paper. Specific barriers to cooperation are discussed, such as weak leadership, the absence of accountability, the lack of credentialing, the diverse goals of the responding agencies, and the weaknesses in the coordination process itself.

Post-Tsunami Medical Care: Health Problems Encountered in the International Committee of the Red Cross Hospital in Banda Aceh, Indonesia

Introduction:

When the Tsunami struck Asia on 26 December 2004, Aceh, Indonesia suffered more damage than did any other region. After the Tsunami, many humanitarian organizations provided aid in Aceh. For example, the International Committee of the Red Cross (ICRC), along with the Indonesian and Norwegian Red Cross opened a field hospital in Banda Aceh on 16 January 2005. This study describes the illnesses seen in the out-patient department/casualty department (OPD/CD) of the ICRC hospital nine weeks after the Tsunami. It describes the percentage of people seen for problems directly related to the Tsunami, and includes a basic screening for depression and post-traumatic stress disorder (PTSD).

Methods:

A prospective, five-day study was performed from 01–05 March 2005. Patients registering in the ICRC field hospital in Banda Aceh were considered for the study. Data collected included: (1) age; (2) gender; (3) diagnosis in the OPD/CD; and (4) whether or not the problem was related directly to the Tsunami. Seven basic questions were asked to screen for depression and PTSD symptoms.

Results:

Twelve percent of the problems seen in the OPD/CD nine weeks after the Tsunami still were related directly to the Tsunami. Sixty-three percent of patients in the study were male. The medical problems included: (1) urological (19%); (2) digestive (16%); (3) respiratory (12%); and (4) musculoskeletal (12%). Although <2% of patients were diagnosed with a mental health problem, 24% had at least four or more of the seven depression/PTSD symptoms addressed in the study.

Conclusions:

Post-earthquake and post-tsunami health problems and medical needs differ from those found in conflict zones. After the Tsunami, both surgical and primary healthcare teams were needed. Many problems were chronic medical problems, which may be indicative of the lack of healthcare infrastructure before the Tsunami. The findings suggest that mental health issues must be taken into consideration for future planning. The ethical issues of performing research in complex emergencies also need further development at the international level.

Global health: chronic diseases and other emergent issues in global health

Infectious diseases have had a decisive and rapid impact on shaping and changing health policy. Noncommunicable diseases, while not garnering as much interest or importance over the past 20 years, have been affecting public health around the world in a steady and critical way, becoming the leading cause of death in developed and developing countries. This article discusses emergent issues in global health related to noncommunicable diseases and conditions, with focus on defining the unique epidemiologic features and relevant programmatic, health systems, and policy responses concerning noncommunicable chronic diseases, mental health, accidents and injuries, urbanization, climate change, and disaster preparedness.

Mortality and health among internally displaced persons in western Kenya following post-election violence, 2008: novel use of demographic surveillance

OBJECTIVE

To evaluate mortality and morbidity among internally displaced persons (IDPs) who relocated in a demographic surveillance system (DSS) area in western Kenya following post-election violence.

METHODS

In 2007, 204 000 individuals lived in the DSS area, where field workers visit households every 4 months to record migrations, births and deaths. We collected data on admissions among children < 5 years of age in the district hospital and developed special questionnaires to record information on IDPs. Mortality, migration and hospitalization rates among IDPs and regular DSS residents were compared, and verbal autopsies were performed for deaths.

FINDINGS

Between December 2007 and May 2008, 16 428 IDPs migrated into the DSS, and over half of them stayed 6 months or longer. In 2008, IDPs aged 15-49 years died at higher rates than regular residents of the DSS (relative risk, RR: 1.34; 95% confidence interval, CI: 1.004-1.80). A greater percentage of deaths from human immunodeficiency virus (HIV) infection occurred among IDPs aged > or = 5 years (53%) than among regular DSS residents (25-29%) (P < 0.001). Internally displaced children < 5 years of age did not die at higher rates than resident children but were hospitalized at higher rates (RR: 2.95; 95% CI: 2.44-3.58).

CONCLUSION

HIV-infected internally displaced adults in conflict-ridden parts of Africa are at increased risk of HIV-related death. Relief efforts should extend to IDPs who have relocated outside IDP camps, particularly if afflicted with HIV infection or other chronic conditions.

Identifying nutritionally vulnerable groups in case of emergencies: experience from the Athens 1999 earthquake

During emergency situations in developing countries, young children have been identified as the most nutritionally vulnerable group. Comparatively less is known regarding nutritional risk of individuals in well-nourished societies hit by a major disaster. The aim of the present study, therefore, was to assess the nutritional status of Greek people who were left homeless after the Athens 1999 earthquake. A total of 225 volunteers from two camps were surveyed for dietary intake information and surrogate measures of nutritional status. Energy consumption and anthropometric indices of the children and adolescents revealed no sign of undernourishment. On the other hand, adults and the elderly consumed considerably less energy than that required for long-term preservation of health. Short-term energy and protein deficits, however, did not jeopardise their nutritional status as it might have expected, on the basis of high body mass indexes and normal haematological and biochemical profiles that were documented. In conclusion, the results of the present study indicate that nutritional risk in the acute phase after a major emergency in a previously well-nourished population is rather low. This is especially true for younger individuals, probably due to increased provision from the family and the community. Nevertheless, older persons may face increased risk as the situation is prolonged.

Mental health service use among hurricane Katrina survivors in the eight months after the disaster

OBJECTIVE

This study examined use of mental health services among adult survivors of Hurricane Katrina in order to improve understanding of the impact of disasters on persons with mental disorders.

METHODS

A geographically representative telephone survey was conducted between January 19 and March 31, 2006, with 1,043 displaced and nondisplaced English-speaking Katrina survivors aged 18 and older. Survivors who reported serious and mild-moderate mood and anxiety disorders in the past 30 days and those with no such disorders were identified by using the K6 scale of nonspecific psychological distress. Use of services, system sectors, and treatments and reasons for not seeking treatment or dropping out were recorded. Correlates of using services and dropping out were examined.

RESULTS

An estimated 31% of respondents (N=319) had evidence of a mood or anxiety disorder at the time of the interview. Among these only 32% had used any mental health services since the disaster, including 46% of those with serious disorders. Of those who used services, 60% had stopped using them. The general medical sector and pharmacotherapy were most commonly used, although the mental health specialty sector and psychotherapy played important roles, especially for respondents with serious disorders. Many treatments were of low intensity and frequency. Undertreatment was greatest among respondents who were younger, older, never married, members of racial or ethnic minority groups, uninsured, and of moderate means. Structural, financial, and attitudinal barriers were frequent reasons for not obtaining care.

CONCLUSIONS

Few Katrina survivors with mental disorders received adequate care; future disaster responses will require timely provision of services to address the barriers faced by survivors.

Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina

OBJECTIVE

The authors examined the disruption of ongoing treatments among individuals with preexisting mental disorders and the failure to initiate treatment among individuals with new-onset mental disorders in the aftermath of Hurricane Katrina.

METHODS

English-speaking adult Katrina survivors (N=1,043) responded to a telephone survey administered between January and March of 2006. The survey assessed posthurricane treatment of emotional problems and barriers to treatment among respondents with preexisting mental disorders as well as those with new-onset disorders posthurricane.

RESULTS

Among respondents with preexisting mental disorders who reported using mental health services in the year before the hurricane, 22.9% experienced reduction in or termination of treatment after Katrina. Among those respondents without preexisting mental disorders who developed new-onset disorders after the hurricane, 18.5% received some form of treatment for emotional problems. Reasons for failing to continue treatment among preexisting cases primarily involved structural barriers to treatment, while reasons for failing to seek treatment among new-onset cases primarily involved low perceived need for treatment. The majority (64.5%) of respondents receiving treatment post-Katrina were treated by general medical providers and received medication but no psychotherapy. Treatment of new-onset cases was positively related to age and income, while continued treatment of preexisting cases was positively related to race/ethnicity (non-Hispanic whites) and having health insurance.

CONCLUSIONS

Many Hurricane Katrina survivors with mental disorders experienced unmet treatment needs, including frequent disruptions of existing care and widespread failure to initiate treatment for new-onset disorders. Future disaster management plans should anticipate both types of treatment needs.

Mental health service use among hurricane Katrina survivors in the eight months after the disaster

OBJECTIVE

This study examined use of mental health services among adult survivors of Hurricane Katrina in order to improve understanding of the impact of disasters on persons with mental disorders.

METHODS

A geographically representative telephone survey was conducted between January 19 and March 31, 2006, with 1,043 displaced and nondisplaced English-speaking Katrina survivors aged 18 and older. Survivors who reported serious and mild-moderate mood and anxiety disorders in the past 30 days and those with no such disorders were identified by using the K6 scale of nonspecific psychological distress. Use of services, system sectors, and treatments and reasons for not seeking treatment or dropping out were recorded. Correlates of using services and dropping out were examined.

RESULTS

An estimated 31% of respondents (N=319) had evidence of a mood or anxiety disorder at the time of the interview. Among these only 32% had used any mental health services since the disaster, including 46% of those with serious disorders. Of those who used services, 60% had stopped using them. The general medical sector and pharmacotherapy were most commonly used, although the mental health specialty sector and psychotherapy played important roles, especially for respondents with serious disorders. Many treatments were of low intensity and frequency. Undertreatment was greatest among respondents who were younger, older, never married, members of racial or ethnic minority groups, uninsured, and of moderate means. Structural, financial, and attitudinal barriers were frequent reasons for not obtaining care.

CONCLUSIONS

Few Katrina survivors with mental disorders received adequate care; future disaster responses will require timely provision of services to address the barriers faced by survivors.

Hurricane Katrina's impact on the care of survivors with chronic medical conditions

BACKGROUND

Hurricane Katrina affected a population with significant levels of chronic disease.

OBJECTIVE

The extent to which Hurricane Katrina disrupted treatments is not known but would be useful information for future disaster planning.

PARTICIPANTS

1,043 displaced and nondisplaced English-speaking Katrina survivors ages 18 and older who resided in affected areas before the hurricane.

DESIGN AND SETTING

A geographically representative telephone survey conducted between January 19 and March 31, 2006.

MEASUREMENTS AND MAIN RESULTS

The proportions of survivors with chronic illnesses in the 12 months before the hurricane and the extent to which those with chronic illnesses cut back or terminated treatments because of the disaster. Correlates and reasons given by survivors for disrupted treatment were identified. Most (73.9%) Katrina survivors had 1 or more chronic conditions in the year before the hurricane; of these, 20.6% cut back or terminated their treatment because of the disaster. Disruptions in treatment were significantly more common among the non-elderly, uninsured, socially isolated, those with housing needs, or for conditions remaining relatively asymptomatic but still dangerous if untreated. Frequent reasons for disrupted care included problems accessing physicians (41.1%), medications (32.5%), insurance/financial means (29.3%), transportation (23.2%), or competing demands on time (10.9%).

CONCLUSIONS

Many Katrina survivors burdened by chronic disease had their treatments disrupted by the disaster. Future disaster management plans should anticipate and address such chronic care needs, with timely reestablishment of primary care services, access to medications, and means to address financial and structural barriers to treatment.

Abstracts for the 15th World Congress for Disaster and Emergency Medicine

Introduction:

The effectiveness of cardiopulmonary resuscitation (CPR) is dependent on the technique of the rescuers and the time after arrest that CPR is initiated to the victim. Incomplete chest wall recoil during the decompression phase of CPR increases intra-thoracic pressure and decreases coronary and cerebral perfusion. The Inspiratory Impedance Valve (ITD) prevents unnecessary air from entering the lungs during the decompression phase.

The role of environmental health in disaster management: an overview and review of barriers and facilitators for action

Environmental health has a significant role to play in all stages of disaster management, from planning through to recovery. The conceptualizetion of the environmental health role by environmental health practitioners and other disciplines involved with disaster management is the focus of this review. To provide context for this discussion, we present an overview of disasters and disaster management and the public health and environmental health impact of disasters. The literature indicates that the role of environmental health in disaster management is not clearly conceptualized, and the following barriers have been identified: the continued emergence of environmental health as a professional discipline, ambiguity about environmental health functions in disasters, limited representation in disaster planning, low visibility profile of the profession, positioning of environmental health within public health, power and politics within agencies that result in a narrow assignment of the environmental health role, and a top-down approach to disaster management. The Australian experience indicates that if environmental health practitioners can overcome such barriers and increase their involvement in disaster management, then this achievement will raise the profile of the profession and renegotiate the environmental health role in disaster management. Ultimately, this success will also improve our capacity to manage disaster situations, and the higher profile, greater recognition, and representation of environmental health that is gained will then be able to flow into normal day-to-day activities.

International humanitarian assistance: Where do emergency physicians belong?

As human civilization faces new and challenging humanitarian crises, the entrance of EPs into the realm of HA is needed and timely. As noted by Jennifer Leaning [35], an EP at Harvard University, "Medical and public health personnel who respond to these crises enter a domain of perilous complexity. Road maps do not exist, but the possibility of good favors the prepared mind." Thus, with proper training in the principles of public health and experience, EPs have a tremendous opportunity to affect the realm of international HA, particularly via the analysis and development of international emergency health systems and building the capacity for effective relief. EPs with training in HA can be valuable assets to relief programs in the field and administratively, especially after the initial disaster and during the transition to health system reconstruction and development.

Lessons learned from complex emergencies over past decade

Major advances have been made during the past decade in the way the international community responds to the health and nutrition consequences of complex emergencies. The public health and clinical response to diseases of acute epidemic potential has improved, especially in camps. Case-fatality rates for severely malnourished children have plummeted because of better protocols and products. Renewed focus is required on the major causes of death in conflict-affected societies--particularly acute respiratory infections, diarrhoea, malaria, measles, neonatal causes, and malnutrition--outside camps and often across regions and even political boundaries. In emergencies in sub-Saharan Africa, particularly southern Africa, HIV/AIDS is also an important cause of morbidity and mortality. Stronger coordination, increased accountability, and a more strategic positioning of non-governmental organisations and UN agencies are crucial to achieving lower maternal and child morbidity and mortality rates in complex emergencies and therefore for reaching the UN's Millennium Development Goals.

Mortality among displaced former UNITA members and their families in Angola: a retrospective cluster survey

OBJECTIVE

To measure retrospectively mortality among a previously inaccessible population of former UNITA members and their families displaced within Angola, before and after their arrival in resettlement camps after ceasefire of 4 April 2002.

DESIGN

Three stage cluster sampling for interviews. Recall period for mortality assessment was from 21 June 2001 to 15-31 August 2002.

SETTING

Eleven resettlement camps over four provinces of Angola (Bié, Cuando Cubango, Huila, and Malange) housing 149 000 former UNITA members and their families.

PARTICIPANTS

900 consenting family heads of households, or most senior household members, corresponding to an intended sample size of 4500 individuals.

MAIN OUTCOME MEASURES

Crude mortality and proportional mortality, overall and by period (monthly, and before and after arrival in camps).

RESULTS

Final sample included 6599 people. The 390 deaths reported during the recall period corresponded to an average crude mortality of 1.5/10 000/day (95% confidence interval 1.3 to 1.8), and, among children under 5 years old, to 4.1/10 000/day (3.3 to 5.2). Monthly crude mortality rose gradually to a peak in March 2002 and remained above emergency thresholds thereafter. Malnutrition was the leading cause of death (34%), followed by fever or malaria (24%) and war or violence (18%). Most war victims and people who had disappeared were women and children.

CONCLUSIONS

This population of displaced Angolans experienced global and child mortality greatly in excess of normal levels, both before and after the 2002 ceasefire. Malnutrition deaths reflect the extent of the food crisis affecting this population. Timely humanitarian assistance must be made available to all populations in such conflicts.

Infant feeding practices in complex emergencies: a case study approach

The majority of deaths associated with complex emergencies are attributed to infants and children under the age of five years. Most of these deaths are related to preventable diseases such as malnutrition, diarrhea, and malaria. Infant feeding emergencies have emerged as a major factor in complex emergencies. This paper reviews the current information relative to infant feeding, and uses four case studies as educational tools for the management of infant feeding emergencies. Child mortality rates in refugee population have been linked directly to protein-energy malnutrition (PEM). Breast feeding has many advantages over all other forms of feeding for children up to the age of two years of age. These advantages are discussed in detail in this paper. In addition, the appropriate and inappropriate uses of breast-milk substitutes (BMS) are discussed. Breast feeding also may play a role in the spread of HIV infections from the mother to the infant. However, in the setting of complex emergencies in the developing world, the risk of an infant dying of malnutrition and infection when not breastfed is likely to be greater than is the risk of death due to HIV acquisition through breastfeeding. The physiology of lactation is reviewed with particular reference to the roles of prolactin, oxytocin, and the feedback inhibitor of lactation (FIL) hormone. No medications have been demonstrated to augment milk production that can be used in a practical sense in complex emergencies. Lastly, the principles promulgated by the WHO and UNHCR for the feeding of infants and children in emergencies and for milk powder distribution are summarized.

Medical relief personnel in complex emergencies: perceptions of effectiveness in the former Yugoslavia

Humanitarian medical assistance and intervention during the civil war in Bosnia and Croatia was felt by national health workers to be relatively ineffective (2.8 on a 5-point Likert scale), compared to other forms of humanitarian assistance such as medical supplies (4.4/5) and non-medical materials (3.9/5). Bosnian physicians treating civilians noted that the most helpful types of personnel were surgeons and emergency physicians. This study suggests that assessment of personnel needs at the recipient level, in addition to standard relief assessments, is required early in models of complex emergencies. This study supports existing epidemiological models of complex emergencies, especially when high trauma-related mortality and morbidity are likely to occur.

The unseen face of humanitarian crisis in eastern Democratic Republic of Congo: was nutritional relief properly targeted?

STUDY OBJECTIVE

Comparison of children's nutritional status in refugee populations with that of local host populations, one year after outbreak refugee crisis in the North Kivu region of Democratic Republic of Congo.

DESIGN

Cross sectional surveys.

SETTING

Temporary and other settlements, in the town of Goma and surrounding rural areas.

SUBJECTS

Anthropometric indicators of nutritional status and presence or absence of oedema were measured among 5121 children aged 6 to 59 months recruited by cluster sampling with probability proportional to size, between June and August 1995.

RESULTS

Children in all locations demonstrated a typical pattern of growth deficit relative to international reference. Prevalence of acute malnutrition (wt/ht < -2 Z score) was higher among children in the rural non-refugee populations (3.8 and 5.8%) than among those in the urban non-refugee populations (1.4%) or in the refugee population living in temporary settlements (1.7%). Presence of oedema was scarcely noticed in camps (0.4%) while it was a common observation at least in the most remote rural areas (10.1%). As compared with baseline data collected in 1989, there is evidence that nutritional status was worsening in rural non-refugee populations.

CONCLUSIONS

Children living in the main town or in the refugee camps benefited the most from nutritional relief while those in the rural non-refugee areas were ignored. This is a worrying case of inequity in nutritional relief.

Vaccination in emergencies

Nongovernmental organisations (NGOs) are the main actors of vaccine delivery during complex humanitarian emergencies such as large population displacements. This paper discusses the use of vaccinations against measles, cholera and meningitis in this context. The role of NGOs in the advocacy for making new and more effective vaccines available to the most vulnerable populations is also emphasised.

How robust are district health systems? Coping with crisis and disasters in Rutshuru, Democratic Republic of Congo

BACKGROUND

Since the eighties, the North Kivu Province socio-economic environment has been deteriorating. This province also faced an influx of Rwandan refugees in July 1994. The objective of the paper is to show how a rural health district has been able to adjust and maintain its medical activities under unfavourable conditions.

METHOD

Performances of the local health system were assessed through the analysis of routine medical data collected in the Rutshuru Health District (RHD) between 1985 and 1995. Specific data collected during the Rwandan refugee crisis measured the workload of RHD due to the refugees.

RESULTS

For 11 years, health infrastructures have remained accessible and functional in RHD. The curative utilization and preventive coverage rates increased. Obstetrical activities were intensified from a quantitative as well as from a qualitative point of view. Between July and October 1994, the RHD treated 65000 cases of various pathological conditions in Rwandan refugees settled outside the camps. This corresponds to 9.3% of consultations for Rwandan refugees settled on RHD's territory and represents a 400% increase in the curative workload for the RHD health services. Human and financial resources remained at a very low level, especially when compared with those available in the camps through relief agencies.

CONCLUSION

The RHD was severely affected by various stresses but its services managed to provide significant and efficient response to these crises. Health district systems may constitute an effective tool to provide health care under adverse conditions.

The public health aspects of complex emergencies and refugee situations

Populations affected by armed conflict have experienced severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons have experienced high mortality rates during the period immediately following their migration. In Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrheal diseases, measles, acute respiratory infections, and malaria. High prevalences of acute malnutrition have contributed to high case fatality rates. In conflict-affected European countries, such as the former Yugoslavia, Georgia, Azerbaijan, and Chechnya, war-related injuries have been the most common cause of death among civilian populations; however, increased incidence of communicable diseases, neonatal health problems, and nutritional deficiencies (especially among the elderly) have been documented. The most effective measures to prevent mortality and morbidity in complex emergencies include protection from violence; the provision of adequate food rations, clean water and sanitation; diarrheal disease control; measles immunization; maternal and child health care, including the case management of common endemic communicable diseases; and selective feeding programs, when indicated.