Malaysian Disaster Medicine Research: A Bibliographic Study of Publication Trends

INTRODUCTION

Despite the increasing risks and complexity of disasters, education for Malaysian health care providers in this domain is limited. This study aims to assess scholarly publications by Malaysian scholars on Disaster Medicine (DM)-related topics.

METHODOLOGY

An electronic search of five selected journals from 1991 through 2021 utilizing multiple keywords relevant to DM was conducted for review and analysis.

RESULTS

A total of 154 articles were included for analysis. The mean number of publications per year from 1991 through 2021 was 5.1 publications. Short reports were the most common research type (53.2%), followed by original research (32.4%) and case reports (12.3%). Mean citations among the included articles were 12.4 citations. Most author collaborations were within the same agency or institution, and there was no correlation between the type of collaboration and the number of citations (P = .942). While a few clusters of scholars could build a strong network across institutions, most research currently conducted in DM was within small, isolated clusters.

CONCLUSION

Disaster Medicine in Malaysia is a growing medical subspecialty with a significant recent surge in research activity, likely due to the SARS-CoV-2/coronavirus disease 2019 (COVID-19) global pandemic. Since most publications in DM have been on infectious diseases, the need to expand DM-related research on other topics is essential.

Associating Increased Chemical Exposure to Hurricane Harvey in a Longitudinal Panel Using Silicone Wristbands

Hurricane Harvey was associated with flood-related damage to chemical plants and oil refineries, and the flooding of hazardous waste sites, including 13 Superfund sites. As clean-up efforts began, concerns were raised regarding the human health impact of possible increased chemical exposure resulting from the hurricane and subsequent flooding. Personal sampling devices in the form of silicone wristbands were deployed to a longitudinal panel of individuals (n = 99) within 45 days of the hurricane and again one year later in the Houston metropolitan area. Using gas chromatography−mass spectroscopy, each wristband was screened for 1500 chemicals and analyzed for 63 polycyclic aromatic hydrocarbons (PAHs). Chemical exposure levels found on the wristbands were generally higher post-Hurricane Harvey. In the 1500 screen, 188 chemicals were detected, 29 were detected in at least 30% of the study population, and of those, 79% (n = 23) were found in significantly higher concentrations (p < 0.05) post-Hurricane Harvey. Similarly, in PAH analysis, 51 chemicals were detected, 31 were detected in at least 30% of the study population, and 39% (n = 12) were found at statistically higher concentrations (p < 0.05) post-Hurricane Harvey. This study indicates that there were increased levels of chemical exposure after Hurricane Harvey in the Houston metropolitan area.

Returning Individual Tap Water Testing Results to Research Study Participants after a Wildfire Disaster

After the devastating wildfire that destroyed most of the town of Paradise, California in 2018, volatile organic compounds were found in water distribution pipes. Approximately 11 months after the fire, we collected tap water samples from 136 homes that were still standing and tested for over 100 chemicals. Each participant received a customized report showing the laboratory findings from their sample. Our goal was to communicate individual water results and chemical information rapidly in a way that was understandable, scientifically accurate, and useful to participants. On the basis of this process, we developed a framework to illustrate considerations and priorities that draw from best practices of previous environmental results return research and crisis communication, while also addressing challenges specific to the disaster context. We also conducted a follow-up survey on participants’ perceptions of the results return process. In general, participants found the results return communications to be understandable, and they felt less worried about their drinking water quality after receiving the information. Over one-third of the participants reported taking some kind of action around their water usage habits after receiving their results. Communication with participants is a critical element of environmental disaster research, and it is important to have a strategy to communicate results that achieves the goals of timeliness, clarity, and scientific accuracy, ultimately empowering people toward actions that can reduce exposure.

Potential Human Health Hazard of Post-Hurricane Harvey Sediments in Galveston Bay and Houston Ship Channel: A Case Study of Using In Vitro Bioactivity Data to Inform Risk Management Decisions

Natural and anthropogenic disasters may be associated with redistribution of chemical contaminants in the environment; however, current methods for assessing hazards and risks of complex mixtures are not suitable for disaster response. This study investigated the suitability of in vitro toxicity testing methods as a rapid means of identifying areas of potential human health concern. We used sediment samples (n = 46) from Galveston Bay and the Houston Ship Channel (GB/HSC) areas after hurricane Harvey, a disaster event that led to broad redistribution of chemically-contaminated sediments, including deposition of the sediment on shore due to flooding. Samples were extracted with cyclohexane and dimethyl sulfoxide and screened in a compendium of human primary or induced pluripotent stem cell (iPSC)-derived cell lines from different tissues (hepatocytes, neuronal, cardiomyocytes, and endothelial) to test for concentration-dependent effects on various functional and cytotoxicity phenotypes (n = 34). Bioactivity data were used to map areas of potential concern and the results compared to the data on concentrations of polycyclic aromatic hydrocarbons (PAHs) in the same samples. We found that setting remediation goals based on reducing bioactivity is protective of both "known" risks associated with PAHs and "unknown" risks associated with bioactivity, but the converse was not true for remediation based on PAH risks alone. Overall, we found that in vitro bioactivity can be used as a comprehensive indicator of potential hazards and is an example of a new approach method (NAM) to inform risk management decisions on site cleanup.

PhotoKwento: co-constructing women's narratives of disaster recovery

A recent appraisal of disaster studies undertaken over the past 40 years draws attention to the urgency of advancing different epistemologies that reflect local realities of disaster experiences and of developing appropriate instruments with which to do so. This paper argues that feminist methods and perspectives can contribute greatly to this important endeavour of promoting epistemic diversity in research on disasters, advancing approaches that engender the co-construction of knowledge, and consequently challenging the 'hegemonic' (and often gender-blind) narratives that dominate disaster studies today. Specifically, the paper makes a case for a feminist photo-based approach that I designed (PhotoKwento) to examine women's experiences of disaster recovery in Tacloban City, Philippines. It demonstrates how the technique fosters engaged research relationships and participatory knowledge construction practices pertaining to disaster experiences. In addition, it highlights the potential of PhotoKwento to embody the qualities of research that are necessary for the progress of disaster studies 'from below'.

[COVID-19, and the History of Social Science Disaster Research]

This paper is part of Forum COVID-19: Perspectives in the Humanities and Social Sciences.The article connects and juxtaposes current day (social scientific) discussions on the social effects of the COVID-crisis with the history of social science disaster research during the Cold War. It elaborates on statements regarding the role of social inequalities in disaster, the idea of the "revealing" nature of disaster and crisis, and the relationship between disaster science, public and politics.

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Practical Knowledge, Science and Disasters. The History of Social Science Disaster Research, 1949-1979. During the second half of the twentieth century several US-American social science "disaster research groups" conducted field studies after earthquakes, factory explosions and "racial riots". Their aim was to provide practical knowledge that could be applied in the planning and managing of future disasters of both peace- and wartime nature. In this paper, I will elaborate on how this research goal conflicted with some scientists' aspirations to develop more theoretical knowledge and their own ideals of "scientificity". I will also show how the generated research results came to be 'impractical knowledge', which was difficult or impossible to apply. Furthermore this paper analyzes the scientific practices that were involved at different stages of the knowledge production process and contributed to disaster research's 'precarious' character.

Integrating Health Research into Disaster Response: The New NIH Disaster Research Response Program

The need for high quality and timely disaster research has been a topic of great discussion over the past several years. Recent high profile incidents have exposed gaps in knowledge about the health impacts of disasters or the benefits of specific interventions—such was the case with the 2010 Gulf Oil Spill and recent events associated with lead-contaminated drinking water in Flint, Michigan, and the evolving health crisis related to Zika virus disease. Our inability to perform timely research to inform the community about health and safety risks or address specific concerns further heightens anxiety and distrust. Since nearly all disasters, whether natural or man-made, have an environmental health component, it is critical that specialized research tools and trained researchers be readily available to evaluate complex exposures and health effects, especially for vulnerable sub-populations such as the elderly, children, pregnant women, and those with socioeconomic and environmental disparities. In response, the National Institute of Environmental Health Science has initiated a Disaster Research Response Program to create new tools, protocols, networks of researchers, training exercises, and outreach involving diverse groups of stakeholders to help overcome the challenges of disaster research and to improve our ability to collect vital information to reduce the adverse health impacts and improve future preparedness.

Consent in escrow

Disasters such as flash flooding, mass shootings, and train and airplane accidents involving large numbers of victims produce significant opportunity for research in the biosciences. This opportunity exists in the extreme tails of life events, however, during which decisions about life and death, valuing and foregoing, speed and patience, trust and distrust, are tested simultaneously and abundantly. The press and urgency of these scenarios may also challenge the ability of researchers to comprehensively deliver information about the purposes of a study, risks, benefits, and alternatives. Under these circumstances, we argue that acquiring consent for the immediate use of data that are not time sensitive represents a gap in the protection of human study participants. In response, we offer a two-tiered model of consent that allows for data collected in real-time to be held in escrow until the acute post-disaster window has closed. Such a model not only respects the fundamental tenet of consent in research, but also enables such research to take place in an ethically defensible manner.

Using natural disasters to study the effects of prenatal maternal stress on child health and development

Research on the developmental origins of health and disease highlights the plasticity of the human fetus to a host of potential teratogens. Experimental research on laboratory animals has demonstrated a variety of physical and behavioral effects among offspring exposed to prenatal maternal stress (PNMS). However, these studies cannot elucidate the relative effects of the objective stress exposure and the subjective distress in a way that would parallel the stress experience in humans. PNMS research with humans is also limited because there are ethical challenges to designing studies that involve the random assignment of pregnant women to varying levels of independent stressors. Natural disasters present opportunities for natural experiments of the effects of pregnant women's exposure to stress on child development. In this review, we present an overview of the human and animal research on PNMS, and highlight the results of Project Ice Storm which has been following the cognitive, behavioral, motor and physical development of children exposed in utero to the January 1998 Quebec Ice Storm. We have found that both objective degree of exposure to the storm and the mothers' subjective distress have strong and persistent effects on child development, and that these effects are often moderated by the timing of the ice storm in pregnancy and by the child's sex.

Experiences from coordinating research after the 2011 terrorist attacks in Norway

This brief report presents some of the lessons learned from coordinating research in which people directly affected by terrorist attacks in Norway in 2011 are taking part. After the terrorist attacks, it was decided to establish a national coordinating function in order to protect those who were affected when they participate in research. By gathering key stakeholders, it is possible to avoid duplication of research through practical measures such as information sharing, facilitating cooperation, and working toward sharing of data. In addition, a coordinating function provides a platform for working to increase the impact of the research among practitioners and policy makers, and inform the general public. The conclusions are that coordination should be interdisciplinary, that it is important to plan for the sharing and reuse of data, and that both the research community and the research infrastructure should take steps to improve preparedness when disaster inevitably strikes again.

Challenges Encountered During the Veterinary Disaster Response: An Example from Chile

Simple Summary

Disaster preparedness for companion animals has economic, social and welfare benefits, yet many countries continue to omit dogs and cats from their national and regional contingency planning. Responses therefore, are often chaotic, inefficient and uncoordinated, or absent altogether. Documented experiences in Chile contribute to the information supporting the inclusion of companion animals into locally relevant disaster plans. These plans serve to prepare communities and authorities, identify resources available, establish a chain of command, develop local priorities, and subsequently reduce the negative impacts on both human and animal communities.

Abstract

Large-scale disasters have immeasurable effects on human and animal communities. Evaluating and reporting on the response successes and difficulties encountered serves to improve existing preparedness documents and provide support to those in the process of developing plans. Although the majority of disasters occur in low and middle income nations, less than 1% of the disaster literature originates from these countries. This report describes a response to a disease outbreak in domestic dogs in Dichato, Chile following the 2010 earthquake/tsunami. With no national plan coordinating the companion animal response, there was a chaotic approach among animal welfare organizations towards rescue, diagnosis, treatment and record-keeping. Similar to the medical response following the 1985 earthquake near Santiago, we experienced problems within our own teams in maintenance of data integrity and protocol compliance. Loss of infrastructure added complications with transportation, communications and acquisition of supplies. Similar challenges likely occur in most disasters, but can be reduced through pro-active planning at national and local levels. There is sufficient information to support the human and animal welfare benefits of including companion animals in national planning, and lessons learned through this and other experiences can assist planners in the development of comprehensive and locally relevant contingency plans.

Research with children exposed to disasters

A number of logistical issues complicate the conduct of child disaster research. Like studies of adults, much of the child research has used a single cross-sectional assessment of non-representative samples, it fails to consider pre-disaster contribution to post-disaster problems, and it leaps to unwarranted causal conclusions from results providing mere associations. Despite concern about the accuracy of parental report and concern about children's understanding of certain terms, most child studies have used a single source of information - either the children themselves or their parents. As the field matures, greater attention to the sophistication of research methods and design will increase our understanding of children in the context of disasters.

Crisis Management in the Twenty-First Century: “Unthinkable” Events in “Inconceivable” Contexts

“Unbelievable,” “unthinkable,” “inconceivable”: the twenty-first century opens a new era in the field of risk and crisis management. Many of the major recent crises, including the unconventional 9/11 terrorist attacks; the swift worldwide contamination by the bovine spongiform encephalopathy (BSE, “mad cow disease”), SARS virus, or avian flu; continental blackouts occurring within a few seconds, continent-wide effects of a tsunami in unstable geopolitical zones; and Hurricane Katrina seem to differ fundamentally from the seminal cases that gave birth to disaster research in the 1950s and the 1960s (specific floods, hurricanes, earthquakes) and the crisis management studies in the 1980s (e.g., the Tylenol tampering). The trend seems to be accelerating, so that crises today are increasingly global, intertwined, and “non-textbook” events.