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The World Health Organization (WHO) has developed and supported numerous initiatives to build capacity and awareness about health emergency and disaster risk management (Health EDRM). These include establishing the Health EDRM Research Network (Health EDRM RN) in 2018 and the publication of the Health EDRM Framework in 2019. These initiatives recognize that research is vital to generating the evidence to inform decision making and research that is integral to disaster preparedness, response and recovery will be vital to delivering the aspirations associated with caring, coping and overcoming in an increasingly challenging world.
To strengthen the capacity for conduct and use of research, resources were developed by the WHO Guidance on Research Methods for Health EDRM.
This first WHO textbook on Health EDRM research methods was published in 2021 and updated in 2022 with a chapter on Health EDRM research in the context of COVID-19. The 44 chapters offer practical advice about how to plan, conduct and report on a variety of quantitative and qualitative studies that can inform questions about policies and programs for health-related emergencies and disasters across different settings and level of resources. Case studies of direct relevance to Health EDRM provide real-life examples of research methods and how they have modified policies.
More than 160 authors in 30 countries contributed to the guidance, which is relevant to researchers, would-be researchers, policy makers and practitioners. It should help improve the quality of Health EDRM research; the quality of policy, practice and guidance supported by the evidence generated; and research capacity, collaboration and engagement among researchers, the research community, policy-makers, practitioners and other stakeholders.
The Guidance is being supplemented by additional resources, including audio podcasts, slideshows, video presentations and webinars, and the content as a whole will be discussed in this presentation.
The concept of disaster related internal displacement is typically seen as something that occurs in low-income countries and is rarely considered in the setting of high-income countries. This leads to a paucity of data to support contextually appropriate best practices to address displacement. This research, funded by the Australian government, explores the lived experiences of those faced with forced displacement from disasters in high-income countries and aims to improve outcomes for this vulnerable cohort.
The first phase of the research, guided by a broad-based Steering Group, included a rapid literature review and thematic analysis of peer-reviewed literature of disaster related, internal displacement in high-income countries, including Australia.
The peer reviewed literature review identified only 12 papers that met the inclusion criteria. The literature from Australia and other developed countries indicated that internal displacement is a prominent feature of disaster impacts and that needs are complex, dynamic and diverse. Common themes of need were revealed: the need for the development of an evolving displacement policy framework to support human rights; the co-creation, coordination and provision of timely and flexible support services, and on-going data collection and sharing. No displacement, specific frameworks, measurable thresholds, or central data registries exist at federal or state government levels in Australia to support these needs.
Inclusive policies, practices, and resources are required in Australia to support assets of displaced people and address their unmet needs in disasters, which also remain largely unmet in other high-income countries. Australia can learn from all countries faced with the challenges of managing displacement and also share its own experiences. Furthermore, it is recommended that WADEM consider extending its current Position Statement relating to Refugees and Internally Displaced Persons to include high-income countries based on the findings of our study and other sources.
As populations worldwide are experiencing more frequent and intense weather and climate extremes, many professionals of the WADEM community are at the frontline of managing compounding and cascading impacts on physical and mental health. Vulnerable, isolated, and marginalized people are the most affected by climate and weather threats. The elderly and children faced 3.7 billion more life-threatening heatwave days in 2021 than annually in 1986-2005 increasing the need for emergency care on a large scale.
The World Health Organization (WHO) and World Meteorological Organization (WMO), together with partners from health agencies, climate services, academia and other sectors are collaborating to accelerate the use of climate, weather and environmental science and services for better health protection. A selection of key resources and tools will be highlighted that can be used by the WADEM community to better understand, anticipate, and manage health risks from extreme weather and climate.
Participants will learn about the new WHO-WMO ClimaHealth Portal, a global knowledge and action hub with huge potential for facilitating learning and action to better protect health from climate risks. Tools and resources include the Global Heat Health Information Network (GHHIN) Checklist and Technical Brief for improved heatwave preparedness and response in the context of COVID-19, and a new WHO Guidance Document on Measuring the Climate Resilience of Health Systems providing a framework and indicators for assessing and protecting health systems from climate threats.
As extreme weather intensifies, integrated climate-informed services for the health sector including multi-hazard early warning systems and action plans, as well as strengthened partnerships between the health community and hydrometeorological services are indispensable to further restrict adverse health impacts. Accelerating the uptake and upscale of existing tools and resources is urgently needed to meet the increasing health and societal challenges caused by climate change and weather extremes.
A prepared and well-trained workforce is essential to reducing the loss of lives from health emergencies. However, it is uncertain what should be included in the common set of core competencies for the health emergency and disaster risk management (Health EDRM) workforce. The objective of the study is to provide evidence mapping for the competencies in existing professional development programs and courses in Health EDRM.
A survey conducted using an online platform (Survey Monkey) was conducted from October to November 2021. Experts in the Health EDRM Research Network including experts identified for the Delphi studies were invited to join the study. Participants should be ≥ 18 years of age, and had relevant experience in Health EDRM and in disaster education and training programs. A self designed questionnaire containing 28 questions in four domains including competencies; curriculum; evidence gaps; work and personal details were used.
There were 65 respondents from 20 countries participating in the survey. Most of the respondents worked in academic institutions (60%), followed by government employees (19%), and non-governmental organizations (7%). These organizations have roles throughout the disaster cycle with 95% in the preparedness phase. For management skills, EDRM managers should be competent in planning, organizing, applying management processes, establishing effective communication systems and providing effective leadership. For technical competencies, emergency communications, hazard specific knowledge, communicable diseases were essential for frontline workers. In terms of designing the competency matrix, WHO resources were frequently used for the competencies and the curriculum design.
Health EDRM managers are expected to master a large number of managerial and technical skills, including the increasingly recognized leadership and decision-making skills for effective planning and implementation. These competencies need to be established for the development of a Health EDRM workforce.
WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Network (Health EDRM RN) is a global expert network, launched in 2018, aiming to strengthen the scientific evidence for managing health risks associated with all types of emergencies and disasters, and to foster global collaboration among academia, government officials and other stakeholders. The Health EDRM RN’s activities are in line with WHO Health EDRM Framework, which support Sendai Framework for Disaster Risk Reduction 2015-2030.
Health EDRM RN’s strategic direction is discussed and advised by its Core Group that consists of focal points of WHO HQ responsible unit, all six Regional Offices, WHO Center for Health Development (Secretariat), RN co-chairs, and key external stakeholders. Based on the strategic direction, the Secretariat facilitates global, regional, and local collaborative activities with the RN participants and partners. As of 2022, over 250 global experts participate in the network.
Following the results of the Core Group Meeting in 2019, 2020 and 2021, multiple activities and results were generated including the identification of five Health EDRM key research areas. WHO Guidance on Research Methods for Health EDRM developed in collaboration with over 150 global experts, initiation of the project to establish WHO Health EDRM Knowledge Hub for developing WHO Health EDRM Research Agenda and aligning with UNDRR research agenda on thematic areas including developing a special supplement on mid-term review of Sendai Framework implementation in health. The 2022 Core Group Meeting, held on October 27, 2022, agreed to promote knowledge dissemination and implementation research for better outputs for regions and countries.
WHO Health EDRM RN will continue its unique function as the platform of global experts and stakeholders to produce, disseminate, and apply knowledge. Participation and engagement by more and broader experts are expected.
According to the Internal Displacement Monitoring Centre (IDMC), more than 60% of the internal displacements recorded worldwide in 2021 were due to disasters. A conservative estimate by IDMC reports 65,000 new displacements between July 2019 and February 2020 as a result of the Black Summer bushfires and more than 42,000 displacements due to flooding in February and March 2022 in Australia. These are estimates as there are no consistent or consolidated data on those who are displaced in Australia affecting the measurement of the magnitude of displacement, and the knowledge of experience, impact and needs of displaced people to inform policy and practice. Thus, the aim of this study, as part of a larger project, is to review key international and Australian policies about data on internal displacement due to disasters.
We conducted a desk review of key international policies, such as the Sendai Framework for Disaster Risk Reduction and from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), as well as Australian policies such as the Australian Disaster Preparedness Framework, Emergency Management Arrangements Handbook and even state level emergency legislation/acts and plans to understand the data collection and supports and services provided to those who become displaced due to disasters.
This review found that both international and Australian policies lacked specific focus on internal displacement, despite it being a key issue. While international policies and procedures in low income countries exist, in particular where the international humanitarian system is operational, this review found that Australia lacked specific focus on internal displacement.
Data on displacement due to disasters, including the number of people displaced, and the patterns of their displacement is critical to inform better policies on prevention, emergency planning, evacuation response and finally to improve the support that people who are experiencing displacement receive.
Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM).
The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC).
A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking.
In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were “Human Resources” (n = 15), “Planning and Coordination” (n = 7), and “Community Capacities for Health EDRM” (n = 6) in the LMIC group. “Policies, Strategies, and Legislation” (n = 7) and “Human Resources” (n = 7) were the components with the most recommendations for the HIC group.
The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
Prospective studies are needed to assess the influence of pre-pandemic risk factors on mental health outcomes following the COVID-19 pandemic. From direct interviews prior to (T1), and then in the same individuals after the pandemic onset (T2), we assessed the influence of personal psychiatric history on changes in symptoms and wellbeing.
Two hundred and four (19–69 years/117 female) individuals from a multigenerational family study were followed clinically up to T1. Psychiatric symptom changes (T1-to-T2), their association with lifetime psychiatric history (no, only-past, and recent psychiatric history), and pandemic-specific worries were investigated.
At T2 relative to T1, participants with recent psychopathology (in the last 2 years) had significantly fewer depressive (mean, M = 41.7 v. 47.6) and traumatic symptoms (M = 6.6 v. 8.1, p < 0.001), while those with no and only-past psychiatric history had decreased wellbeing (M = 22.6 v. 25.0, p < 0.01). Three pandemic-related worry factors were identified: Illness/death, Financial, and Social isolation. Individuals with recent psychiatric history had greater Illness/death and Financial worries than the no/only-past groups, but these worries were unrelated to depression at T2. Among individuals with no/only-past history, Illness/death worries predicted increased T2 depression [B = 0.6(0.3), p < 0.05].
As recent psychiatric history was not associated with increased depression or anxiety during the pandemic, new groups of previously unaffected persons might contribute to the increased pandemic-related depression and anxiety rates reported. These individuals likely represent incident cases that are first detected in primary care and other non-specialty clinical settings. Such settings may be useful for monitoring future illness among newly at-risk individuals.
Social cognition is frequently impaired following an acquired brain injury (ABI) but often overlooked in clinical assessments. There are few validated and appropriate measures of social cognitive abilities for ABI patients. The current study examined the validity of the Edinburgh Social Cognition Test (ESCoT, Baksh et al., 2018) in measuring social cognition following an ABI.
Forty-one patients with ABI were recruited from a rehabilitation service and completed measures of general ability, executive functions and social cognition (Faux Pas; FP, Reading the Mind in the Eyes; RME, Social Norms Questionnaire; SNQ and the ESCoT). Forty-one controls matched on age, sex and years of education also performed the RME, SNQ and ESCoT.
A diagnosis of ABI was significantly associated with poorer performance on all ESCoT measures and RME while adjusting for age, sex and years of education. In ABI patients, the ESCoT showed good internal consistency with its subcomponents and performance correlated with the other measures of social cognition demonstrating convergent validity. Better Trail Making Test performance predicted better ESCoT total, RME and SNQ scores. Higher TOPF IQ was associated with higher RME scores, while higher WAIS-IV working memory predicted better FP performance.
The ESCoT is a brief, valid and internally consistent assessment tool able to detect social cognition deficits in neurological patients. Given the prevalence of social cognition deficits in ABI and the marked impact these can have on an individual’s recovery, this assessment can be a helpful addition to a comprehensive neuropsychological assessment.
In this three-generation longitudinal study of familial depression, we investigated the continuity of parenting styles, and major depressive disorder (MDD), temperament, and social support during childrearing as potential mechanisms. Each generation independently completed the Parental Bonding Instrument (PBI), measuring individuals’ experiences of care and overprotection received from parents during childhood. MDD was assessed prospectively, up to 38 years, using the semi-structured Schedule for Affective Disorders and Schizophrenia (SADS). Social support and temperament were assessed using the Social Adjustment Scale – Self-Report (SAS-SR) and Dimensions of Temperament Scales – Revised, respectively. We first assessed transmission of parenting styles in the generation 1 to generation 2 cycle (G1→G2), including 133 G1 and their 229 G2 children (367 pairs), and found continuity of both care and overprotection. G1 MDD accounted for the association between G1→G2 experiences of care, and G1 social support and temperament moderated the transmission of overprotection. The findings were largely similar when examining these psychosocial mechanisms in 111 G2 and their spouses (G2+S) and their 136 children (G3) (a total of 223 pairs). Finally, in a subsample of families with three successive generations (G1→G2→G3), G2 experiences of overprotection accounted for the association between G1→G3 experiences of overprotection. The results of this study highlight the roles of MDD, temperament, and social support in the intergenerational continuity of parenting, which should be considered in interventions to “break the cycle” of poor parenting practices across generations.
In this paper we undertake a quantitative analysis of the dynamic process by which ice underneath a dry porous debris layer melts. We show that the incorporation of debris-layer airflow into a theoretical model of glacial melting can capture the empirically observed features of the so-called Østrem curve (a plot of the melt rate as a function of debris depth). Specifically, we show that the turning point in the Østrem curve can be caused by two distinct mechanisms: the increase in the proportion of ice that is debris-covered and/or a reduction in the evaporative heat flux as the debris layer thickens. This second effect causes an increased melt rate because the reduction in (latent) energy used for evaporation increases the amount of energy available for melting. Our model provides an explicit prediction for the melt rate and the temperature distribution within the debris layer, and provides insight into the relative importance of the two effects responsible for the maximum in the Østrem curve. We use the data of Nicholson and Benn (2006) to show that our model is consistent with existing empirical measurements.
Libman–Sacks endocarditis is rare in children and adolescents, more so as a first manifestation of systemic lupus erythematosus. Currently, sterile verrucous lesions of Libman–Sacks endocarditis are recognised as a cardiac manifestation of both systemic lupus erythematosus and antiphospholipid syndrome. They are clinically silent in a majority of the cases. The presence of antiphospholipid antibodies in systemic lupus erythematosus is associated with three times higher prevalence of mitral valve nodules and significant mitral regurgitation. We present the case of isolated mitral regurgitation with abnormal looking mitral valve, detected in early childhood, which deteriorated to a severe degree in the next decade and was diagnosed as Libman–Sacks endocarditis after surgical repair from histopathology. The full-blown clinical spectrum of systemic lupus erythematosus with antiphospholipid antibodies was observed several weeks after cardiac surgery. We discuss the atypical course of Libman–Sacks endocarditis with follow-up for 10 years, along with a review of the literature.
Introduction: The 2009 Global Platform for Disaster Risk Reduction/Emergency Preparedness (DRR/EP) and the Hyogo Framework for Action 2005-2015 demonstrate increased international commitment to DRR/EP in addition to response and recovery. In addition, the World Health Report 2008 has re-focused the world's attention on the renewal of Primary Health Care (PHC) as a set of values/principles for all sectors. Evidence suggests that access to comprehensive PHC improves health outcomes and an integrated PHC approach may improve health in low income countries (LICs). Strong PHC health systems can provide stronger health emergency management, which reinforce each other for healthier communities.
Problem: The global re-emphasis of PHC recently necessitates the health sector and the broader disaster community to consider health emergency management from the perspective of PHC. How PHC is being described in the literature related to disasters and the quality of this literature is reviewed. Identifying which topics/lessons learned are being published helps to identify key lessons learned, gaps and future directions.
Methods: Fourteen major scientific and grey literature databases searched. Primary Health Care or Primary Care coupled with the term disaster was searched (title or abstract). The 2009 ISDR definition of disaster and the 1978 World Health Organization definition of Primary Health Care were used. 119 articles resulted.
Results: Literature characteristics; 16% research papers, only 29% target LICs, 8% of authors were from LICs, 7% clearly defined PHC, 50% used PHC to denote care provided by clinicians and 4% cited PHC values and principles. Most topics related to disaster response. Key topics; true need for PHC, mental health, chronic disease, models of PHC, importance of PHC soon after a natural disaster relative to acute care, methods of surge capacity, utilization patterns in recovery, access to vulnerable populations, rebuilding with the PHC approach and using current PHC infrastructure to build capacity for disasters.
Conclusions: Primary Health Care is very important for effective health emergency management during response and recovery, but also for risk reduction, including preparedness. There is need to; increase the quality of this research, clarify terminology, encourage paper authorship from LICs, develop and validate PHC- specific disaster indicators and to encourage organizations involved in PHC disaster activities to publish data. Lessons learned from high-income countries need contextual analysis about applicability in low-income countries.