Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
It is critical to understand how gender relations shape women’s and men’s lives to enhance their resilience toward disaster because women and men have different roles, responsibilities, and access to resources. Unequal participation between women and men in a disaster risk reduction program will influence how each can be affected by various hazards, and how they will cope with and recover from disaster. Even though women are often considered to have incredible resilience and capacity to survive in the face of disasters, they also experience a range of gender-specific vulnerabilities.
Aim:
This study aims to evaluate women’s participation in current efforts of the Disaster-Resilient Village Program and to develop a conceptual framework for implementing gender-based a disaster resilience program at the community level.
Methods:
This study employed a mixed-method approach and adopted several major activities including literature review, interview, focus group discussion, and a questionnaire survey with a total of 300 respondents. Three selected villages in Aceh Besar District, Aceh Province, were the study area of this study.
Results:
By using descriptive and inferential statistics, this study proposed a gender-based framework for implementing Disaster-Resilient Village Program.
Discussion:
This framework contributes to the emerging literature on gender-based disaster risk reduction and may assist policymakers in formulating regulations related to the community-based disaster risk management program. On the practical front, this study provided indicators to practitioners regarding some conditions that should be taken into account when mainstreaming gender in community-based disaster risk management programs. This study offered an original contribution to the existing bodies of knowledge on gender studies in disaster risk reduction efforts.
Both India and Nepal are prone to a wide range of natural and man-made disasters. Almost 85% of India’s area is vulnerable to one or more hazards, and more than 80% of the total population of Nepal is at risk of natural hazards. In terms of the number of people affected in reported disastrous events, India is in the top 10 and Nepal is in the top 20 globally. Over the last two decades, India and Nepal have taken steps to establish their respective National Disaster Management organizations, which provide essential disaster responses. However, key gaps still remain in trained clinical capacity for managing impacts from various disasters. Our review of the region has shown that large parts of the population suffer injuries, diseases, disabilities, psychosocial, and other health-related problems from disasters.
Aim:
Develop disaster medicine clinical capacity to reduce morbidities and mortalities from disasters.
Methods:
Independent published data and work undertaken by the lead author in various disasters in India and Nepal since 1993 formed the basis of establishing the Faculty of Disaster Medicine for South Asia. The Faculty of Disaster Medicine - India and Nepal (FDMIN) was launched from Pune in March 2015. This initiative is supported by the National Association of Primary Care (UK), Public Health England, Faculty of Pre-hospital Care of Royal College of Surgeons - Edinburgh and CRIMEDIM (Novara) - Italy.
Discussion:
FDMIN has international expert advisors and has outlined 16 modules training curriculum for health care professionals. FDMIN currently has partnerships for teaching disaster medicine program with 3 medical universities and 12 major health care providers. Six pilot training programmes have been conducted in Pune, Delhi, Chennai, and Kochin. Work is underway to submit an application to the Indian regulatory bodies for approval to establish a post-graduate diploma and Master’s for Disaster Medicine.
The acute care of stroke involves the administration of a clot-dissolving drug (thrombolysis) and/or its removal using endovascular clot retrieval. Earlier intervention results in significantly improved patient outcomes. Clinical assessment scores have limitations, and studies have shown that even the most robust scores have a reported false-negative rate of >20% for large vessel occlusive strokes that may be eligible for clot retrieval, while inappropriate bypass may delay delivery of thrombolysis.1 Quantitative Electroencephalography (QEEG) has been shown to have a very high sensitivity and specificity in the identification of acute stroke versus matched controls in an in-hospital setting.(2,3)
Aim:
The SPIDER study commenced in Brisbane, Queensland on September 3, 2018, and is investigating the use of an EEG recorder to gather data on acute stroke patients presenting to a metropolitan ambulance service.
Discussion:
The data collected will guide the development of a simple numerical output reference to guide decision making. The data may aid in identifying large vessel occlusive stroke and patients eligible for endovascular intervention. The QEEG will provide a more accurate and cost-effective tool for the prehospital clinician over other imaging technologies and can guide early destination decisions. This presentation discusses the implementation of a pre-hospital research platform, integration with the clinical dispatch matrix, staff engagement, patient recruitment, and the success of the project so far.
Smallpox has been eradicated, but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously vaccinated may mitigate the impact of an outbreak, but there is a high degree of uncertainty regarding the duration and degree of residual immunity.
Methods:
A systematic literature review using the PRISMA criteria was conducted to quantify the duration and extent of residual immunity to smallpox after vaccination. 29 papers related to quantifying residual immunity to smallpox after vaccination were identified.
Results:
Duration of protection of >20 years was consistently shown in the 16 retrospective cross-sectional studies, while the lowest estimated duration of protection was 11.7 years among the modeling studies. Childhood vaccination conferred longer duration of protection than vaccination in adulthood. Multiple vaccinations did not appear to improve immunity. Most studies suggest a longer duration of residual immunity (at least 20 years) than assumed in smallpox guidelines. Estimates from modeling studies were less but still greater than the 3-10 years suggested by the WHO Committee on International Quarantine or US CDC guidelines. These recommendations were probably based on observations and studies conducted while smallpox was endemic. The cut-off values for pre-existing antibody levels of >1:20 and >1:32 reported during the period of endemic smallpox circulation may not be relevant to the contemporary population but have been used as a threshold for identifying people with residual immunity in post-eradication era studies.
Discussion:
Of the total antibodies produced in response to smallpox vaccination, neutralizing antibodies have shown to contribute significantly to immunological memory. Although the mechanism of immunological memory and boosting is unclear, revaccination is likely to result in a more robust response. There is a need to improve the evidence base for estimates on residual immunity to better inform planning and preparedness for re-emergent smallpox.
Vanuatu is situated in the Pacific Ring of Fire. In July 2018, there was increased volcanic activity on Ambae, an island with a population of 11,000 people. Due to the destruction of food sources, contamination of water supply, and respiratory issues caused by ash fall, an immediate compulsory evacuation was ordered by the government.
Aim:
To describe the role of the primary care team response to urgent and ongoing healthcare needs of evacuees following volcanic activity.
Methods:
A non-governmental organization (NGO) primary care team of a general practitioner, nurse practitioner, and two healthcare assistants undertook the initial assessment of a group of newly arrived evacuees. This allowed the identification and management of urgent care needs. Over the subsequent weeks, the primary care clinic provided care to the evacuees. A prospective database of anonymized case files was undertaken to monitor evolving primary healthcare needs of the evacuees.
Results:
Twenty-five patients were assessed initially. Two patients required urgent transfer to a hospital for acute management. Six diabetic patients required medication supplies. There were eight hypertensive patients. Two patients required urgent BP reduction and four required medication supplies. Over the following two weeks, 104 patients were reviewed at the clinic. During this time, 45 patients were treated for respiratory tract infections. Medication supplies were replenished for antihypertensives and diabetic medications for seven patients. Opportunistic cardiovascular and diabetes risk reviews were performed and follow up arranged for nine patients.
Discussion:
The primary care team role was part of a local services collaborative approach initiated by the government. Involving local primary care clinicians in disaster management builds local capacity. Patients are able to receive continuity of care for acute and ongoing medical problems. Clinicians are able to evaluate evolving care needs and gain an improved understanding of the impact of displacement on the community.
Cultural awareness is the understanding of differences in cultures, and openness to these differences. It is a vital step in the development of cultural sensitivity and becoming operationally effective when working within different cultures. The benefits of Cultural Awareness have become apparent in recent decades, including within governments, militaries, and corporations. Many organizations have developed Cultural Awareness training for their staff to improve cross-cultural cooperation. However, there has not been a large movement toward cultural sensitivity training among Non-Governmental Organizations (NGOs) who provide aid across a number of countries and cultures. Cultural Awareness can be a useful tool which enables an NGO to better serve the populations with which they engage.
Aim:
To evaluate the presence within International NGOs of Cultural Awareness Training to employees and volunteers.
Methods:
Ten of the largest international NGOs were identified. Their websites were evaluated for any mention of training in Cultural Awareness available to their employees and volunteers. All 10 were then contacted via their public email addresses to find out if they provide any form of Cultural Awareness training.
Results:
Of the ten NGOs identified, none have any publicly available Cultural Awareness training on their websites. One NGO deals with cultural awareness by only hiring local staff, who are already a part of the prevalent culture of the area. None of the others who responded have any cultural awareness training which they provide.
Discussion:
Cultural awareness is a vital tool when acting internationally. Large NGOs, which operate in a wide range of cultures, have an obligation to act in a culturally aware and accepting manner. Most large NGOs currently lack cultural awareness training for their employees and volunteers. It is time for these NGOs to develop, and begin to employ, cultural awareness training to better prepare their staff to serve international populations.
Sri Lanka has a rapidly aging population with an exponential rise in chronic morbidity. There had been no parallel development of palliative and end-of-life care-specific approach in health care.
Aim:
To implement sustainable palliative and end-of-life care services in Sri Lanka through the existing systems and resources by advocacy, collaboration, and professional commitment.
Methods:
Sri Lanka Medical Association established a volunteer task force for palliative and end-of-life care (PCTF) in October 2016, which comprised of multi-disciplinary health care professionals, legal fraternity, and civil society. PCTF identified the need for sensitizing the general public on the importance of palliative care, for standard guidelines and formal training for practicing health care professionals engaged in hospital and community-based palliative care. These needs are addressed through activities of PCTF in collaboration with the Ministry of Health.
Results:
Representing the National Steering Committee of Palliative Care, the members of the PCTF were instrumental in developing the National Strategic Framework to fill the major gap of affordable quality palliative care in the country. PCTF also published the “Palliative Care Manual for Management of Non-Cancer Patients” as a preliminary guide for health care professionals. The draft document on the End-of-Life Care Guidelines has been formulated and is currently being reviewed by the relevant medical and legal stakeholders. PCTF has organized CME lectures on palliative care all over the country for health care professionals, and also conducted lectures, exhibitions, and mass media programs to sensitize the public on palliative care.
Discussion:
Within a brief period, PCTF has played a key role to recognize palliative care by contributing to policy making, training, and public sensitization in palliative and end-of-life care in Sri Lanka.
Japan is known worldwide as an earthquake-prone country, and large-scale landslide disasters have occurred frequently in recent years. Early preparation is essential for taking precise action in case of an emergency. People with disaster experience are often discussed in the importance of evacuation drills. However, most people have no disaster experience, so awareness of disaster countermeasures is desirable for non-experienced people.
Aim:
To clarify the concerns of non-experienced people and consider how to strengthen disaster measures as an evacuation drill host or educator.
Methods:
From February to March 2018, we enrolled teachers and parents whose children attend Hiroshima City Elementary School. Based on disaster experiences, we divided them into two groups, non-experienced and experienced, and a comparison of measures was performed between them. We used SPSS ver.22 and did a chi-square test.
Results:
There were 1,702 valid responses (145 teachers and 1,557 parents); 1,406 were non-experienced, and 289 were experienced. The issues both groups were most concerned about were “children’s safety at school” (non-experienced 61.7%, experienced 57.3%), “securing food and drink at school” (39.0%, 3.3.9%), “acceptance and distribution of relief supplies” (28.1%, 2.6.6%), and “resident evacuation” (25.4%, 2.4.0%). The experienced were most concerned with “children’s mental care” (60.2%), and the non-experienced were most concerned with “children’s safety at school” (61.7%).
Discussion:
Regardless of experience, parents tend to be deeply concerned about all things pertaining to their children. Physical safety, as well as psychological needs, were of high importance. For non-experienced, we should develop interest by focusing on children’s needs when writing manuals for disaster measures and evacuation drills. Therefore, future projects to strengthen awareness of disaster prevention for the non-experienced should focus on three key issues: “step-by-step approaches for children,” “physiological needs,” and “safety of schools and shelters.”
With increasing disaster risks from extreme weather, climate change, and emerging infectious diseases, the public health system plays a crucial role in community health protection. The disproportionate impacts of disaster risks demonstrate the need to consider ethics and values in public health emergency preparedness (PHEP) activities. Established PHEP frameworks from many countries do not integrate ethics into operational approaches.
Aim:
To explore the ethical dimensions of all-hazards public health emergency preparedness in Canada.
Methods:
A qualitative study design was employed to explore key questions relating to PHEP. Six focus groups, using the Structured Interview Matrix (SIM) format, were held across Canada with 130 experts from local, provincial, or federal levels, with an emphasis on local/regional public health. An inductive approach to content analysis was used to develop emergent themes, and iteratively examined based on the literature. This paper presents analyses examining the dimensions of ethics and values that emerged from the focus group discussions.
Results:
Thematic analysis resulted in the identification of four themes. The themes highlight the importance of proactive consideration of values in PHEP planning: challenges in balancing competing priorities, the need for transparency around decision-making, and consideration for how emergencies impact both individuals and communities.
Discussion:
Lack of consideration for the ethical dimensions of PHEP in operational frameworks can have important implications for communities. If decisions are made ad-hoc during an evolving emergency situation, the ethical implications may increase the risk for some populations, and lead to compromised trust in the PHEP system. The key findings from this study may be useful in influencing PHEP practice and policy to incorporate fairness and values at the core of PHEP to ensure readiness for emergencies with community health impacts.
A large number of visitors to Tokyo during the Tokyo Olympic and Paralympic Games in 2020 resulted in an increase of injury/illness and burden to the routine emergency medical services system. Furthermore, extremely hot and humid weather, terrorism, and outbreaks of infectious diseases are marked risks.
Aim:
We introduce the present status of an academic consortium (AC2020) to fulfill our mission as academic organizations. The Japanese Association for Acute Medicine (JAAM) and six academic associations have initially established the AC2020 since 2016, which consists of the 23 associations at this time. The role of the AC2020 is to provide knowledgeable evidence, intelligence, and support for constructing response plans for medical problems via the website (http://2020ac.com/).
Methods:
The joint committee of the AC2020 (JC-AC2020) has been launched to accomplish consortium activities; make statements and recommendations, compile manuals, conduct seminars, and coordinate the training program of on-site medical teams. The JC-AC2020 organizes nine working groups of heat stroke, lightning strike, nursing, athletes, first responders, foreigners, pre and in-hospital response of MCI, and data collection for audit.
Results:
As of December in 2018, AC2020 has released 30 documents and 10 event-news on the website including seven statements, two recommendations of a prerequisite of the on-site medical team, and two manuals concerning the treatment of gunshot and explosive injuries. Based on some of these statements, the Tokyo government has already enhanced the previous plan.
Discussion:
The AC2020 will propose the web site as a portal site and platform, disseminate the activities widely to society, and ask for the cooperation of other related organizations and academic societies. The AC2020 will aim to provide the landmark project of mass-gathering medical care in Japan as well as the transition to the Olympic Games in Paris in 2024.
Located on the Pacific Ring of Fire, Indonesia has to cope with the constant risk of many disasters. Hospitals in Indonesia are very vulnerable. Around 1,300 hospitals suffered damage since the Aceh tsunami (2006), with losses reaching 3 billion USD. Muhammadiyah is an Indonesian non-governmental organization (NGO) that has more than 300 hospitals. It is one of the forerunners in the Safe Hospital Initiative in Indonesia and has implemented a program named Hospital Preparedness and Community Readiness for Emergency and Disaster (HPCRED), which strengthened PKU Muhammadiyah hospitals in Bima (West Nusa Tenggara), the only hospital in Bima City, and in Palangkaraya (Central Borneo), funded by the Australian government.
Methods:
HPCRED improved the hospital through implementing two trainings (Hospital Disaster Management and Disaster Medical Officer), three workshops (Disaster Risk Management Policy, Hospital Emergency Response Plan, and Forming Hospital Disaster Management Committee and Disaster Medical Team), four exercises (Medical Skill Drill, Table Top, Command Post, and Full Scale). The improvement was evaluated through Muhammadiyah Safe Hospital Standard and Assessment Tool, which assessed four standards based on WHO Comprehensive Safe Hospital Framework (2015): (1) Management, (2) Human Resource, (3) Structure and Infrastructure, and (4) Integration and Cooperation.
Results:
After two years of program, both hospitals improved significantly. The PKU Muhammadiyah Palangkaraya index improved from 53 to 331 while the PKU Muhammadiyah Bima Hospital index improved from 83 to 374.
Discussion:
Before the program, hospitals were not ready to face disasters. The PKU Muhammadiyah Bima Hospital collapsed during a flash flood in December 2016. PKU Muhammadiyah Palangkaraya was overwhelmed during a haze disaster that occurred in April 2016. After the program, the hospitals were safe and ready to face similar disasters. They also already had the ability to respond to disasters on other islands, such as the earthquake in Lombok and Palu (2018).
“Tailor-made” training programs have been started in two theme parks in North and East Taiwan after the dust explosion of Ba-xien theme park in 2015. The training programs emphasized several areas. They work to strengthen the incident command system (ICS) and the skills of first responders, especially evacuation, placement, triage, and first aid, as well as to assist the park’s cooperation with local disaster response units, such as the fire department and Health Bureau.
Methods:
The first step was to find out the practical problems of the two theme parks, and then make a one-year, tailor-made training program according to the needs of parks and different levels of staff: senior supervisors, middle-level district supervisors, and frontline colleagues. After the phased training, the training results are inspected in the non-scripted exercise mode.
Results:
It was found that the staff are relatively familiar with the evacuation process and placement of tourists. The initial emergency responses such as triage, first aid skills, and patient transport gradually improve after several drills. The ICS operation and communication also became more effective and efficient. The regional emergency response units could understand these theme parks capability and how to cooperate with them.
Discussion:
The experience of emergency response training and exercise in these two theme parks has shown that such a model is feasible and should be valued.
Antibiotic resistance is when bacteria change and adapt in response to antibiotics, becoming able to defeat these drugs when used to treat infections. A direct consequence of this adaptation is an increased difficulty in treating multiple diseases. Because of increased antibiotic resistance, the World Health Organization has declared it a significant threat to public health.
Aim:
One frequent consequence of natural disasters is infections, as seen in the December 2004 Indian Ocean tsunami. Survivors sustained a variety of wound infections that ranged from common pathogens to rarely seen organisms including fungi.
Methods:
This research analyzes the microbiology observed in wound infections associated with exposure to freshwater, seawater, soil, fecal, and other contamination after Hurricane Harvey in 2017 and Hurricane Florence in 2018.
Discussion:
Therapies for infections will also be discussed in addition to how the utilization of rapid detection technology for antimicrobial resistance and correct treatments require antimicrobial susceptibility knowledge to improve health outcomes, lower economic costs, prevent further spread of multi-drug resistant outbreaks and assist with antimicrobial stewardship.
Health effects of disasters are mostly consistent across hazard types. Those working in communities affected by disasters have an opportunity to provide surveillance and early management to patients affected by disaster through increased understanding of the epidemiology or health consequences in the days, weeks, months, and years after disasters. Disasters have been called a social determinant of health and population-level changes or social determinants that have been documented post-incident. Environmental and community disruption contribute to health effects. Consequent health effects are evidenced across body systems, affecting both physical and mental health.
Aim:
To develop guidelines for primary care patient review following a disaster, based on the temporal pattern of disease epidemiology.
Methods:
A systematic review of the literature was undertaken to examine the epidemiology of health consequences following disasters.
Results:
Guidelines for Family Doctors based on the literature review were developed to assist preventative care, surveillance, early identification of emerging conditions, and ongoing management of pre-existing disease.
Discussion:
Healthcare management in disasters focuses on acute healthcare in emergency departments and hospitals. However, healthcare is also being provided in primary healthcare settings during the first days to weeks of the catastrophe, with many health consequences ongoing in the weeks, months, and years after the event.
Providing culturally sensitive disaster nursing is essential to enhance survivors’ resilience, especially in Pacific Rim island countries, which are home to 80% of the disaster victims of the world. Until now, most studies have focused on immigrant culture or language, and few have explored the idea of disaster nursing adjusted to the affected area’s culture.
Aim:
The study explores public health nurses’ (PHNs) tacit knowledge regarding culturally sensitive disaster nursing focusing on the Pacific Rim island countries. This first report is the result of the study that clarified how Japanese PHNs, as relief nurses, considered the local culture to provide care to survivors in Japan.
Methods:
Study participants were nine PHNs from seven prefectures, who provided care to survivors of natural disasters that occurred in 2011–2017 in Japan. Semi-structured interviews were conducted with questions such as, “Which culture did you consider while providing care to survivors in each disaster phase?” Data were analyzed qualitatively and inductively and were sorted according to the four disaster phases. The study was approved by the ethical committee at the National Institution of Public Health.
Results:
In the acute phase, PHNs utilized close relationships between local residents and health care providers to collect information. They balanced local habits and the prevention of secondary health damage in the subacute phase; for example, balancing sanitation habits and prevention of contaminations. Additionally, they, as strangers to the community, played a role in alleviating tensions between residents under stress. During the recovery phase, they strengthened survivors’ attachment to the area.
Discussion:
PHNs dispatched from the outside of the affected areas must be culturally malleable to adjust their practice to the local context. Being strangers in an affected area can be advantageous if they utilize their position effectively.
The World Health Organization’s (WHO) minimum standards are used to verify Emergency Medical Teams (EMTs) internationally. The National Critical Care and Trauma Response Center (NCCTRC) was one of the first few EMT 2 verified teams globally.
Aim:
The NCCTRC aims to innovate and provide leadership in the provision of best practice clinical care in the EMT 2 setting in disaster-affected countries.
Methods:
The NCCTRC developed a clinical governance framework and committee with a view of improving practice in the deployed environment. A gap analysis against the Australian National Standards was done and a decision was made to proceed with accreditation against the ACHS EQUIP 6 framework.
Results:
The process of accreditation required a self-assessment that identified gaps in our guidelines and care processes thereby leading to innovative projects to meet the criterion in a sustainable way for the deployed field hospital environment. The NCCTRC has developed adapted clinical tools to manage pressure injury, falls risk, handover, hand hygiene, audits, and consumer feedback.
Discussion:
The deployed field hospital environment can meet national accreditation standards for clinical care. The WHO minimum standards were introduced in 2013 and serve as a marker of the minimum requirements in the field. The challenge is to do better than the minimum. This study demonstrated that it is possible to adapt hospital accreditation standards to the field environment and provide a higher, safer quality of care to affected populations. EMT teams should maintain their clinical care standards from their home environment wherever possible in the field hospital environment. Striving to provide the best and safest care is the duty of care for vulnerable populations.
Globally, women are considered to be more vulnerable during disasters. South Asia including India, Pakistan, Bangladesh, Sri Lanka, Myanmar, and Nepal experience many disasters, and are also ranked lowest on the gender equality index. Women of these countries tend to face many health challenges while staying at evacuation centers after disasters.
Aim:
This study highlights the health challenges South Asian women face while staying in evacuation centers after disasters.
Methods:
A narrative review was conducted using the keywords, “women after disaster,” “evacuation centers,” and “emergency health care.” Literature identified from the references were also added until reaching saturation. 47 articles were obtained through Elsevier, Google Scholar, Scopus, and ProQuest.
Results:
Women in shelters in South Asian countries experienced many health challenges including genito-urinary tract infections (studies from India, Sri Lanka and Bangladesh), increased maternal mortality (Nepal and Pakistan), and sexual assault with resulting unwanted pregnancies and sexually transmitted diseases, including HIV (Nepal). Factors that contributed were the unavailability of separate toilets, inadequate sanitation, lack of sanitary supplies, and inadequate childbirth and maternity care resources. Rape victims at the shelters of Myanmar received delayed medical treatments, causing long-term health complications. Post-disaster stress and trauma were evident among women at the shelters initiated by insecurity, fear of abuse, and unfair relief distribution.
Discussion:
Women face certain challenges when staying in evacuation shelters in South Asian countries, which impacts their wellbeing after disasters. It is important to recognize women’s special requirements and to preserve women’s rights while developing disaster preparedness strategies. Socio-cultural perspectives of the disaster-prone areas should be considered at the policy planning level to ensure an effective and practical health-safety system. Additionally, further research focusing on women’s wellbeing at the evacuation centers is required to inform and overcome health challenges faced by women living in the shelters.
The collapsed inferior vena cava (IVC) in computed tomography (CT) images can be found in patients with hypovolemic shock, making it an attractive diagnostic sign in early treatment of trauma patients. However, current research results are controversial.
Aim:
To examine the dimensional change of IVC during acute hemorrhage through a volume controlled acute hemorrhagic shock model in swine.
Methods:
Volume controlled hemorrhage was performed in 10 adult Bama minipigs. Enhanced CT scan and hemodynamic monitoring were performed when the cumulative blood loss volume reached 0%, 10%, 20%, 30%, and 40%. The transverse diameter (T) and anteroposterior diameter (AP) of IVC were measured in axial images. Hemodynamic parameters were obtained with a Pulse Contour Cardiac Output (PiCCO) hemodynamic monitor device. Arterial blood samples were also collected for artery blood gas analysis at each time point.
Results:
As the blood loss volume increased, the collapsibility (T/AP) and cross section area (CSA) of IVC significantly changed in hepatic level and pre-renal level. The significant decrease of the CSA of IVC (shrink) occurred early when the blood loss volume reached only 10%.
Discussion:
The IVC shrank early but collapsed late during acute hemorrhages in swine. The collapsed IVC on CT scans suggested a severe hypovolemic shock state but not an early indicator for shock.
Biosurveillance is critical for early detection of disease outbreaks and resource mobilization. Child care center (CCC) attendance has long been recognized as a significant independent predictor for respiratory and gastrointestinal diseases, but CCC surveillance is currently not part of the statewide disease surveillance system. The Michigan Child Care Related Infections Surveillance Program (MCRISP) is an independent, online reporting network with >30 local CCCs that was created to fill this surveillance gap.
Aim:
To describe the capability of a novel CCC biosurveillance system (MCRISP) to report pediatric Influenza-Like Illness (ILI) and Acute Gastroenteritis (AGE) illness over three years to (i) assess both the timing and magnitude of epidemics in CCCs and (ii) compare CCC outbreak patterns with those of the state database.
Methods:
MCRISP collates real-time syndromic reports of illness from local county CCCs. The statewide Michigan Disease Surveillance System (MDSS) collects reports of diagnosed illness from designated laboratories, clinics, and hospitals statewide. We assessed epidemic curves based on MCRISP incidence rates and MDSS case counts for ILI and AGE over three seasons (2014-7).
Results:
A total of 4,627 MCRISP cases (2,425 ILI and 2,202 AGE reports) were reported during the three years of study surveillance. Epidemic patterns (seasonal peaks, troughs, and breadth) for both ILI and AGE in CCCs mirrored those reported at county and state levels, respectively. Two distinguishing features of CCC ILI outbreaks were noted in all three seasons: MCRISP ILI rates remained elevated after MDSS influenza counts abated, and MCRISP rates consistently peaked prior to MDSS influenza peaks. Neither of these phenomena were observed in comparing AGE outbreaks between surveillance systems.
Discussion:
ILI and AGE incidence rates from the MCRISP network appeared to broadly mirror epidemics from the established state surveillance system. MCRISP may act as a sentinel system for larger community outbreaks of respiratory disease.