The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach.

The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations.

Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions.

The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.

Excessive salt intake raises blood pressure and increases the risk of non-communicable diseases (NCD), such as CVD, chronic kidney disease and stomach cancer. Reducing the Na content of food is an important public health measure to control the NCD. This study quantifies the amount of salt reduced by using umami substances, i.e. glutamate, inosinate and guanylate, for adults in the USA.

The secondary data analysis was performed using data of the US nationally representative cross-sectional dietary survey, the National Health and Nutrition Examination Survey (NHANES) 2017–2018. Per capita daily salt intake corresponding to the NHANES food groups was calculated in the four hypothetical scenarios of 0 %, 30 %, 60 % and 90 % market share of low-Na foods in the country. The salt reduction rates by using umami substances were estimated based on the previous study results.

The USA

4139 individuals aged 20 years and older in the USA

Replacing salt with umami substances could help the US adults reduce salt intake by 7·31–13·53 % (7·50–13·61 % for women and 7·18–13·53 % for men), which is equivalent to 0·61–1·13 g/d (0·54–0·98 g/d for women and 0·69–1·30 g/d for men) without compromising the taste. Approximately, 21·21–26·04 % of the US adults could keep their salt intake below 5 g/d, the WHO’s recommendation in the scenario where there is no low-Na product on the market.

This study provides essential information that the use of umami substances as a substitute for salt may help reduce the US adults’ salt intake.

The current study aimed to predict disability-adjusted life years (DALY) rate in Japan through 2040 with plausible future scenarios of fruit intake for neoplasms, cardiovascular diseases (CVD) and diabetes and kidney diseases (DKD).

Data from National Health and Nutrition Surveys and the Global Burden of Diseases study in 2017 were used. We developed an autoregressive integrated moving average model with four future scenarios. Reference scenario maintains the current trend. Best scenario assumes that the goal defined in Health Japan 21 is achieved in 2023 and is kept constant afterwards. Moderate scenario assumes that the goal is achieved in 2040. Constant scenario applies the same proportion of 2016 for the period between 2017 and 2040.

DALY rates in Japan were predicted for the period between 2017 and 2040.

Population aged more than than 20 years old.

In our reference forecast, the DALY rates in all-ages group were projected to be stable for CVD and continue increasing for neoplasms and DKD. Age group-specific DALY rates for these three disease groups were forecasted to decrease, with some exceptions. Among men aged 20–49 years, DALY attributable to CVD differed substantially between the scenarios, implying that there is a significant potential for reducing the burden of CVD by increasing fruit intake at the population level.

Our scenario analysis shows that higher fruit intake is associated with lower disease burden in Japan. Further research is required to assess which policies and interventions can be used to achieve an increase in fruit intake as modelled in the scenarios of the current study.

To obtain projections of the prevalence of childhood malnutrition indicators up to 2030 and to analyse the changes of wealth-based inequality in malnutrition indicators and the degree of contribution of socio-economic determinants to the inequities in malnutrition indicators in Bangladesh. Additionally, to identify the risk factors of childhood malnutrition.

Cross-sectional study. A Bayesian linear regression model was used to estimate trends and projections of malnutrition. For equity analysis, slope index, relative index and decomposition in concentration index were used. Multilevel logistic models were used to identify risk factors of malnutrition.

Household surveys in Bangladesh from 1996 to 2014.

Children under the age of 5 years.

A decreasing trend was observed for all malnutrition indices. In 1990, predicted prevalence of stunting, wasting and underweight was 55·0, 15·9 and 61·8 %, respectively. By 2030, prevalence is projected to reduce to 28·8 % for stunting, 12·3 % for wasting and 17·4 % for underweight. Prevalence of stunting, wasting and underweight were 34·3, 6·9 and 32·8 percentage points lower in the richest households than the poorest households. Contribution of the wealth index to child malnutrition increased over time and the largest contribution of pro-poor inequity was explained by wealth index. Being an underweight mother, parents with a lower level of education and poorer households were the key risk factors for stunting and underweight.

Our findings show an evidence-based need for targeted interventions to improve education and household income-generating activities among poor households to reduce inequalities and reduce the burden of child malnutrition in Bangladesh.

There has been little research on the health consequences of evacuation in the disaster context. A comparative analysis of survival between evacuated and nonevacuated hospital dialysis patients was conducted following Japan’s Fukushima Dai-ichi nuclear power plant incident, which occurred on March 11, 2011.

The study included 554 patients (mean age: 70.9) receiving dialysis therapy at one of the Tokiwakai Group hospitals—all of which are located in and around Iwaki City, approximately 50 km from the Fukushima nuclear plant—as of the incident date. The patients’ survival after the incident was tracked until March 3, 2017. Significant differences in mortality rates between postincident evacuees and nonevacuees were tested using the Bayesian survival analysis with Weibull multivariate regression.

Out of 554 dialysis patients, 418 (75.5%) were evacuated after the incident. The postincident mortality rate (adjusted for covariates) of evacuees was not statistically significantly different from that of nonevacuees. The hazard ratio was 1.17 (95% credible intervals: 0.77-1.74).

If performed in a well-planned manner with satisfactory arrangements for appropriate selection of evacuees and their transportation, evacuation could be a reasonable option, which might save more lives of vulnerable people.

Animals, including arthropods, are one health threat that can be affected by disasters. This institution-based study aimed to assess trends in Hymenoptera stings following the 2011 Fukushima nuclear disaster.

We reviewed the medical records of patients with hymenopteran stings who visited Minamisoma Municipal General Hospital, located 23 km from Fukushima Daiichi Nuclear Power Plant, from March 2005 to March 2016. Patient and sting characteristics of post-disaster patients were examined, and the annual incidence of hospital visits for hymenopteran stings was compared with the pre-disaster baseline, calculating an incidence rate ratio (IRR) for each year.

We identified 152 pre-disaster patients (2005-2011) and 222 post-disaster patients (2011-2016). In the post-disaster period, 160 males (72.1%) were identified, with a median age of 59 years (range: 2-89 years). A total of 45 patients (20.3%) were decontamination workers. Post-disaster increases were found in the IRR for hymenopteran stings, peaking first in 2011 (IRR: 2.8; 95% confidence interval [CI]: 1.9-4.2) and later in 2014 (IRR: 3.2; 95% CI: 2.4-4.3) and 2015 (IRR 3.3; 95% CI: 2.5-4.4).

Long-term increases were found in the IRR of hospital visits for hymenopteran stings in an institution affected by the Fukushima nuclear disaster. Decontamination workers appear to have been particularly affected by this phenomenon. Better disaster field worker monitoring and education about potential environmental health hazards may help to identify and prevent worker exposure to insect stings and other vectors in these settings. (Disaster Med Public Health Preparedness. 2017;11:545–551)