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OBJECTIVE Natural disasters, such as hurricanes, can contribute to the development of posttraumatic stress symptoms (PTSS), anxiety, and depression. Furthermore, mothers and children are especially vulnerable postdisasters. Despite the rise in the frequency of climate-related disasters and also the threat of disasters (e.g., storms that threaten but do not make landfall), little is known about how predisaster experiences are associated with mothers' and children's postdisaster psychological functioning. This study examined evacuation-related stressors as predictors of mothers' and youths' psychological functioning 3 months after Hurricane Irma. METHOD Mothers (N = 535; 33% ethnic/racial minorities) from South Florida counties most affected by Hurricane Irma completed an online survey that assessed evacuation-related stressors (both pre- and posthurricane), hurricane exposure (i.e., life threat, loss/disruption), and posthurricane social support and mental health symptomatology (i.e., PTSS, anxiety, depression). Mothers of children aged 7-17 years (n = 226) also reported on their child's psychological functioning. RESULTS Using a risk and resilience model, evacuation stressors significantly predicted mothers' and youths' PTSS and symptoms of anxiety and depression, even after accounting for demographic factors, hurricane exposure, and availability of social support. Mothers of older children also reported significantly higher levels of PTSS, anxiety, and depression than mothers who only had young children (aged 6 or younger) at home. CONCLUSIONS Evacuation experiences represent significant stressors that may put mothers and children at risk for PTSS and psychological distress. Resilience-building efforts should include efforts to better prepare families for prestorm evacuations, thereby reducing risk in mothers and youth and ultimately contributing to better psychosocial functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Hurricane-caused stormwater runoffs transport diverse terrestrial pollutants, adversely impact microbiological water quality, and introduce fecal and other pathogens to coastal water environments. This study investigated the genotypic diversity, phylogenetic composition, antibiotic resistance patterns, and virulence gene repertoire of the Enterococcus population in the Hilo Bay coastal water after the immediate impact of Hurricane Lane. DNA fingerprinting of Enterococcus isolates exhibited large genotypic diversity, while 16S rRNA gene sequencing identified four major species, including E. faecalis (34.7%), E. faecium (22.4%), E. hirae (22.4%), and E. durans (18.4%). Four common enterococcal virulence genes (cylA, esp, asa1, and gelE) were detected in the Enterococcus population, with significant portions of E. durans (33.3%), E. faecalis (41.2%), E. faecium (36.4%), and E. hirae (27.3%) isolates possessing two or more virulence genes. Considerable antibiotic resistance to rifampin, erythromycin, tetracycline, and nitrofurantoin was detected in the Enterococcus population, with one E. durans isolate showing vancomycin resistance. The results indicate considerable health implications associated with Enterococcus spp. in the hurricane-impacted tropical coastal water, illustrating the needs for more comprehensive understanding of the microbiological risks associated with storm-impacted coastal water. HIGHLIGHTS The study investigated the Enterococcus population in a tropical coastal water immediately after the impact of a major hurricane.; Genotypic diversity and phylogenetic composition of the Enterococcus population were determined.; A significant portion of the Enterococcus population contains various virulence factors.; Considerable antibiotic resistance was detected in the Enterococcus population.

The human toll of disasters extends beyond death, injury and loss. Post-traumatic stress (PTS) can be common among directly exposed individuals, and children are particularly vulnerable. Even children far removed from harm’s way report PTS, and media-based exposure may partially account for this phenomenon. In this study, we examine this issue using data from nearly 400 9- to 11-year-old children collected before and after Hurricane Irma, evaluating whether pre-existing neural patterns moderate associations between hurricane experiences and later PTS. The ‘dose’ of both self-reported objective exposure and media exposure predicted PTS, the latter even among children far from the hurricane. Furthermore, neural responses in brain regions associated with anxiety and stress conferred particular vulnerability. For example, heightened amygdala reactivity to fearful stimuli moderated the association between self-reported media exposure and PTS. Collectively, these findings show that for some youth with measurable vulnerability, consuming extensive disaster-related media may offer an alternative pathway to disaster exposure that transcends geography and objective risk. Dick et al. show that in youth, post-traumatic stress related to Hurricane Irma was predicted by self-reported direct and media exposure. Furthermore, neural responses in brain regions associated with anxiety conferred particular vulnerability to media exposure.

The Reiwa First Year East Japan Typhoon of 2019 caused a torrential flood in Japan. In Nagano City, a large area was flooded due to the collapse of the Chikuma River embankment. After large-scale disasters, an increase in cardiovascular and cerebrovascular events has been reported on account of the stressful conditions. However, few reports of disaster-related diseases associated with flood damage have been described. Thus, our aim was to elucidate the effect of floods on the incidences of cardiovascular and cerebrovascular diseases in Nagano City.The Shinshu Assessment of Flood Disaster Cardiovascular Events (SAVE) trial enrolled 2,426 patients admitted for cardiovascular or cerebrovascular diseases at all five hospitals with an emergency department in Nagano City from October 1 to December 31 in the years 2017, 2018, and 2019. The occurrence of these diseases was calculated in every 2 weeks and the findings of 2019 (year of the flood) were compared with those of 2017 and 2018.Cardiovascular and cerebrovascular diseases significantly increased during the 2 weeks immediately after the flood disaster (149 in 2019 vs average of 116.5 in the previous 2 years, p 0.05). Unstable angina cases significantly increased 1.5-2 months after the flood disaster, and cerebral hemorrhage cases significantly increased in the 2 weeks after the flood disaster.Cardiovascular and cerebrovascular events increased significantly during the 2 weeks immediately after the large-scale flood disaster caused by the Reiwa First Year East Japan typhoon. Because of the increasing frequency of flood disasters, it is necessary to predict the occurrences of cardiovascular and cerebrovascular diseases and to implement guidelines for their appropriate and timely management.

Background Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death worldwide with continuous rise. Limited studies indicate that COPD was associated with major storms and related power outages (PO). However, significant gaps remain in understanding what PO’s role is on the pathway of major storms-COPD. This study aimed to examine how PO mediates the major storms-COPD associations. Methods In this time-series study, we extracted all hospital admissions with COPD as the principal diagnosis in New York, 2001–2013. Using distributed lag nonlinear models, the hospitalization rate during major storms and PO was compared to non-major storms and non-PO periods to determine the risk ratios (RRs) for COPD at each of 0–6 lag days respectively after controlling for time-varying confounders and concentration of fine particulate matter (PM2.5). We then used Granger mediation analysis for time series to assess the mediation effect of PO on the major storms-COPD associations. Results The RRs of COPD hospitalization following major storms, which mainly included flooding, thunder, hurricane, snow, ice, and wind, were 1.23 to 1.49 across lag 0–6 days. The risk was strongest at lag3 and lasted significantly for 4 days. Compared with non-outage periods, the PO period was associated with 1.23 to 1.61 higher risk of COPD admissions across lag 0–6 days. The risk lasted significantly for 2 days and was strongest at lag2. Snow, hurricane and wind were the top three contributors of PO among the major storms. PO mediated as much as 49.6 to 65.0% of the major storms-COPD associations. Conclusions Both major storms and PO were associated with increased hospital admission of COPD. PO mediated almost half of the major storms-COPD hospitalization associations. Preparation of surrogate electric system before major storms is essential to reduce major storms-COPD hospitalization.

The COVID-19 pandemic has created new workforce considerations for emergency management community in addressing cumulative and cascading disasters. This research identifies how emergency management planning for both the changing dynamics of COVID-19 and the upcoming hurricane season may change under a compound threat. Many jurisdictions have faced challenges in providing adequate staffing of shelters before the pandemic. Now, fatigue among staff further exacerbates these challenges as resources are stretched thin. Six workshops, involving 265 national, state, and local leaders, staff, experts, and advocates from 22 states, and a range of disciplines (disaster planning, public health, social services, academia, and healthcare), were convened to identify concerns and potential strategies to address staffing, training, logistics, and support. Strategies proposed to increase the number and skill set of staff available involve increased reliance upon volunteers and nonprofit organizations. Mental health resources, personal protective equipment, sanitation supplies, and defining roles within emergency shelters were recommended to reduce fatigue and redistribute responsibilities. Findings illuminate additional research avenues regarding assessing the underlying stressors contributing to the planning process and effective means of implementing these interventions to bolster emergency management shelter operations during a prolonged pandemic and in the future.

Frequent hurricanes affect agricultural productivity, food security, economic security, and human wellbeing in the Caribbean islands. We assessed recent hurricane effects on the agricultural sector, and the challenges faced by farmers, foresters, and advisors related to hurricane preparedness and recovery in Puerto Rico and US Virgin Islands (USVI). We used qualitative and quantitative survey methods to compile perspectives from agricultural advisors related to hurricane effects on farmlands, preparedness and recovery measures taken by land managers, and the needs regarding preparing for and responding to future hurricanes. Survey responses from over 200 advisors at eight institutions provided insight into the most devastating hurricane effects across farmlands, including issues related to power outages, communication, road access, and fallen trees. Our results highlight strategies considered critical for hurricane preparedness and recovery but not prevalent in application among land managers. Advisors’ perceptions suggested that farmers and ranchers apply essential recovery practices, but critical short-term preparedness practices are limited, and long-term preparedness practices are uncommon. Advisors also indicated the need for more training and educational resources to improve hurricane recovery response. We conclude that better planning to minimize the vulnerability to future hurricanes can be achieved through an increased understanding of how preparedness and recovery practices help mitigate hurricane effects, improved interagency coordination for hurricane response and preparedness, and integrated educational campaigns with advisors and land managers.

A large and growing segment of the United States population resides in nursing homes. Many nursing home residents have multiple comorbidities, are unable to perform activities of daily living, and need assistance for their daily functioning. They are some of the most fragile and vulnerable members of the population. Disasters are increasing in frequency and severity. This makes it likely that disasters will strike nursing homes and affect their residents. The purpose of this study was to evaluate the characteristics of disasters in the United States that resulted in nursing home evacuations. There were 51 reported nursing home evacuations due to a disaster over 22.5 years between 1995 and 2017. Natural disasters were responsible for the majority of evacuations (58.8 percent) followed by man-made unintentional disasters (37.3 percent) and man-made intentional (arson) (3.9 percent). The single most common reason for evacuation was hurricanes (23.5 percent, N = 12) and internal fires (23.5 percent, N = 12). Water-related disasters accounted for nearly three-fourths of the natural disasters (hurricanes 40 percent, N = 12; floods, 33.3 percent, N = 10; total 73.3 percent, N = 22), then snow/ice storms (13.3 percent, N = 4). Of man-made disasters, over two-thirds (66.7 percent) were due to internal fires (internal fires, n = 12, 57.1 percent and arson n = 2, 9.5 percent; total N = 14, 66.7 percent). The highest number of evacuations occurred in Texas, Louisiana, Missouri, New York, and Pennsylvania. This knowledge should enable nursing home administrators, disaster planners, public health officials, and others to improve preparedness for disasters that lead to nursing home evacuations.

Objective:The aim of this study was to compare primary care appointment disruptions around Hurricanes Ike (2008) and Harvey (2017) and identify patterns that indicate differing continuity of primary care or care systems across events.Methods:Primary care appointment records covering 5 wk before and after each storm were identified for Veterans Health Affairs (VA) facilities in the greater Houston and surrounding areas and a comparison group of VA facilities located elsewhere. Appointment disposition percentages were compared within and across storm events to assess care disruptions.Results:For Hurricane Harvey, 14% of primary care appointments were completed during the week of landfall (vs 33% for Hurricane Ike and 69% in comparison clinics), and 49% were completed the following week (vs 58% for Hurricane Ike and 71% for comparison clinics). By the second week after Hurricane Ike and third week after Harvey, the scheduled appointment completion percentage returned to prestorm levels of approximately 60%.Conclusions:There were greater and more persistent care disruptions for Hurricane Harvey relative to Hurricane Ike. As catastrophic emergencies including major natural disasters and infectious disease pandemics become a more recognized threat to primary and preventive care delivery, health-care systems should consider implementing strategies to monitor and ensure primary care appointment continuity.

The purpose of this study was to identify factors that motivate public health workers to deploy to the field during an emergency event. We conducted 25 semistructured interviews with employees at the US Centers for Disease Control and Prevention, all of whom had deployed to the field for the 2014-2016 Ebola, 2016-2017 Zika, and 2017 hurricane responses. We used a grounded theory approach in our analysis of the data. Themes that emerged from the interviews related to responder autonomy, competence, and relatedness, which are consistent with self-determination theory. Motivating factors included having clarity about the response role, desire to be challenged, ability to apply existing skills in the field (or apply new skills learned during deployment to their home office), desire to be helpful, and feeling rewarded by working with affected populations, communities, and other response staff. These preliminary findings suggest that introjected and identified motivating factors may form the foundation of willingness among public health workers to assist during an emergency event. Understanding what motivates staff at public health agencies to participate in emergency deployment can inform the development of recruitment strategies, strengthen effectiveness of response activities, and improve overall agency preparedness.

Background Flooding following heavy rains precipitated by hurricanes has been shown to impact the health of people. Earth observations can be used to identify inundation extents for subsequent analysis of health risks associated with flooding at a fine spatio-temporal scale. Objective To evaluate emergency department (ED) visits before, during, and following flooding caused by Hurricane Harvey in 2017 in Texas. Methods A controlled before and after design was employed using 2016-2018 ED visits from flooded and non-flooded census tracts. ED visits between landfall of the hurricane and receding of flood waters were considered within the flood period and post-flood periods extending up to 4 months were also evaluated. Modified Poisson regression models were used to estimate adjusted rate ratios for total and cause specific ED visits. Results Flooding was associated with increased ED visits for carbon monoxide poisoning, insect bite, dehydration, hypothermia, intestinal infectious diseases, and pregnancy complications. During the month following the flood period, the risk for pregnancy complications and insect bite was still elevated in the flooded tracts. Significance Earth observations coupled with ED visits increase our understanding of the short-term health risks during and following flooding, which can be used to inform preparedness measures to mitigate adverse health outcomes and identify localities with increased health risks during and following flooding events.

Disasters can adversely affect population health, resulting in increased need for health services. Hurricane Irma made landfall in the Florida Keys (Monroe County) as a Category 4 hurricane on September 10, 2017. The hurricane caused substantial damage to 65% of homes and resulted in 40 persons injured and 17 deaths from hurricane-related causes.* During 2018, the county suicide rate increased to 34.9 per 100,000 population from the 5-year (2013-2017) average of 25.2 per 100,000 population (1). In May 2019, 20 months after the hurricane, the Florida Department of Health (FDOH) conducted a modified Community Assessment for Public Health Emergency Response (CASPER) to assess the community's mental, physical, and economic health and develop public health interventions to decrease the suicide rate. A consenting adult member from 231 households was interviewed, and a weighted cluster analysis was conducted to estimate the number and percentage of households throughout the Florida Keys with a particular response, as well as the number and percentage of persons at risk for suicide. During the 20 months since Hurricane Irma, 17% of households reported a need for a mental health care provider; 37.9% of these did not receive those services. A modified CASPER was used to calculate population estimates of suicide risk in an area of high landfall for hurricanes; estimated population suicide risk was 7.3%. Respondents reported worsening of respiratory conditions (17.7%), anxiety (17.0%), and depression (11.3%). Emergency preparedness plans should consider strengthening mental health service delivery after a hurricane, particularly during the long-term recovery phase.

Nepal and Hong Kong both are susceptible to natural disasters due to their geographic locations. Nepal suffers from frequent earthquakes, and Hong Kong regularly experiences typhoons of varying severity. Natural disasters may present acutely or with some advance warning. In either case, it is critical that disaster response plans are well established in advance of any incident. This article discusses the anesthetic and critical care implications of such natural disasters, using Nepal and Hong Kong as case studies.

OBJECTIVES: To examine the effect of Hurricane Irma on staff-related financial expenditures and daily direct-care nurse staffing levels. DESIGN: Retrospective cohort study. SETTING: September 3(rd)-24(th), 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10(th), 2017. PARTICIPANTS: 653 nursing homes, 81 evacuated facilities and 572 facilities that sheltered-in-place. MEASUREMENTS: This study used data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida’s health providers’ emergency reporting system. PBJ provided estimates of daily direct-care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility-level characteristics such as profit status, chain membership, and special care unit availability. Florida’s emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3(rd)-September 10(th). RESULTS: Among all facilities, we found significant increases in staffing for licensed practical nurses (p = .02) and certified nursing assistants (p < .001), but not for registered nurses (p = .10) before Hurricane Irma made landfall. From one week before landfall to two weeks after landfall (September 3(rd)-September 24(th)), an additional estimated $2.41 million was spent on direct-care nurse staffing. In comparison to facilities that sheltered-in-place, evacuated facilities increased staffing levels of all nurse types (all p < .001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident while facilities that sheltered-in-place spent $76.10 on nurse staffing per resident. CONCLUSION: Nursing homes face unprecedented challenges during hurricanes, including maintaining adequate direct-care nurse staffing levels to meet the needs of their residents. Nursing homes that evacuated residents had an increase in direct-care nurse staffing that was greater than that seen in nursing homes that sheltered-in-place.

This study aimed to describe: 1) soil-transmitted helminthiasis (STH) and schistosomiasis prevalence and intensity in preschool-age children (PSAC) and school-age children (SAC), 2) schistosomiasis seroprevalence in SAC, 3) undernutrition prevalence in SAC, 4) sanitary toilet coverage in households, and 5) association between STH, Schistosoma japonicum exposure, nutritional status, and sanitation. PSAC and SAC in two Haiyan-stricken provinces were examined using Kato–Katz technique and ELISA Antibody test. Anthropometric and hemoglobin measurements were also obtained. The reported sanitary toilet coverage was validated in a survey. The prevalence of any STH in PSAC and SAC was 50.2% and 41.3%, respectively. Moderate-heavy intensity (MHI) STH prevalence in PSAC and SAC was 20.8% and 5.9%, respectively. The prevalence of any STH, MHI STH, ascariasis, MHI ascariasis, and MHI trichuriasis was significantly higher in PSAC. Stunting, underweight, wasting, overweight/obesity, and anemia prevalence was 38.4%, 24.5%, 4.8%, 2.7%, and 34.7% in PSAC, while the prevalence was 34.3%, 21.6%, 8.7%, 3.0%, and 19.2% in SAC, respectively. Anemia and wasting prevalence were significantly higher in PSAC and SAC, respectively. There were five schistosomiasis cases found (0.8% prevalence), while schistosomiasis seroprevalence was 60.1%. Validated and reported sanitary toilet coverage was significantly different in eight out of 13 barangays. Stunting and anemia were associated with STH. STH and anemia prevalence were significantly higher in non-ZOD barangays. High STH burden in PSAC and SAC persists. A more coordinated response addressing STH, undernutrition, and WASH in disaster-stricken areas will require strengthening local health systems and promoting intersectoral collaboration.

The COVID-19 pandemic, caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presents monumental challenges on multiple fronts and on a global scale Since the first report out of the Wuhan district in China in December 2019, the pandemic has resulted in nearly 75 million cases worldwide The US Centers for Disease Control and Prevention had reported more than 16 million casesand more than 300 000 deaths domestically as of December 17, 2020, making the United States the most affected country 1 When catastrophic events occur, public institutions, especially government agencies, find ways to mitigate injury and loss to their citizens Katrina, one of the costliest hurricanes to hit the United States, caused an estimated $200 billion in damage, mostly concentrated in the Gulf Coast region 4 Fortunately, the rest of the US economy was relatively stable and could support the region's recovery [ ]even excluding in-kind donations, the Department of State received $126 million from 36 countries and international organizations;the United States government had never before received such large amounts of disaster assistance 5 Unlike Katrina, the economic damage from COVID-19 is not limited in geographic scope or duration;its legacy will be far flung and long term Seven hurricane-specific and four generaldisaster recommendations resulted 18 Similarly, the US Naval War College's September 2019 urban outbreak pandemic exercise yielded 16 defensive recommendations to manage a COVID-19 pandemic-like situation 19 Dozens of additional modeling teams now offer support to policy and response directors by predicting COVID-19 trajectories through infectious disease and statistical modeling 20 Notably, the Centers for Disease Control and Prevention and the Office of the Assistant Secretary for Preparedness and Response have developed five COVID-19 pandemic planning scenarios to evaluate the potential effects of various mitigation strategies and help inform public health planning 1 DISPARITIES REVEALED BY KATRINA AND COVID-19 Inadequacies in the three principal social determinants of health-physical environments, social environments, and (inadequate) health services and health literacy-result in health disparities that amplify morbidity and

Introduction:On September 20, 2017, Hurricane Maria, a Category 4 hurricane, swept across Puerto Rico (PR), wreaking devastation to PR’s power, water, and health care infrastructure. To address the imminent humanitarian crisis, the US government mobilized Federal Medical Shelters (FMS) to serve the needs of hurricane victims. This study’s objective was to provide a description of the patients seeking emergency care at FMS and the changes in their needs over time.Methods:This retrospective, cross-sectional study included all patients presenting to the FMS Manatí from October 6, two weeks after Hurricane Maria’s landfall, to November 2, 2017. Categories were created to catalogue the nature of new acute medical issues by patients presenting to the Shelter. Descriptive, graphical analyses were performed to assess changes to presenting complaints over time, and by age groups defined as infant (age ≤1 years), child (1 year < age ≤10 years), adolescent (10 years < age ≤ 25 years), and adult (age > 25 years).Results:Over the 30-day period, 5,268 patients were seen in the FMS seeking medical care (average 188.1 patients per day), spending less than five hours in the facility. The distribution of patients’ age was bimodal: the first peak at one year and the second at age 50. The most common patient complaint was infection (38.8%), then musculoskeletal (MSK) complaints (11.8%) and management of chronic medical conditions (11.8%). The proportion of patients presenting with chronic disease complaints declined over the course of the period of observation (21.4% on Day 4 to 8.0% on Day 30) while the proportion of patients presenting with infection increased (31.0% on Day 4 to 48.6% on Day 30). Infection complaints were highest in all age groups, but most in infxants (80.2%), while MSK and chronic disease complaints were highest in adults (14.9% and 14.9%, respectively).Conclusion:Infection treatment and chronic disease management were important medical needs facing patients seeking care at FMS Manatí after Hurricane Maria. These findings suggest that basic needs related to sanitation and shelter remained important weeks after the hurricane, and a focus on access to medications, infection control, and injury prevention/management after a disaster needs to be prioritized during disaster response.

Natural disasters (NDs) experienced by women and their children during prenatal and infant growth may have long-lasting effects on offspring’s development. Handgrip strength (HGS) is one of the measures of muscular strength and an indicator of health status. This study compared HGS in children exposed to cyclone Aila in India during their prenatal and infant growth compared to a control group from a non-affected, adjacent area. The total sample involved 444 boys and 423 girls aged 7–9 years, categorised into 3 groups: prenatally exposed to Aila, exposed to Aila in infancy, and the control group, non-exposed to Aila. Results revealed that prenatally exposed children of both sexes had significantly lower HGS than the controls (at least, p

BACKGROUND: Individuals with diabetes require extensive self-management. Little is known about how Hurricane Matthew (Matthew) or Hurricane Florence (Florence) impacted diabetes self-management and outcomes in Robeson County, North Carolina. METHODS: Mixed methods were used to assess the impact of hurricanes on diabetes self-management and outcomes. Individuals with diabetes were recruited for focus groups to understand the perceived impact on diabetes self-management. Health care providers were recruited for parallel key informant interviews. Mean hemoglobin A1c (HbA1c) and frequency of diabetic ketoacidosis (DKA) from hospital data six months before and after Matthew were compared using Student t-tests. RESULTS: A demographic breakdown of 34.25% white, 21.70% Black or African American, and 21.38% American Indian or Alaska Native was observed from focus groups. Qualitative results highlight a limited access to a balanced diet and medications. No significant differences were found between mean HbA1c values before and after Matthew (before Matthew: mean HbA1c 8.34 ± 1.87%; after Matthew: mean HbA1c 8.31 ± 1.93 %; P = .366). The period prevalence (PP) of DKA was higher after Matthew than before (before Matthew: 39 cases out of 4,025 visits, PP = .010; after Matthew: 87 cases out of 3,779 visits, PP = .023; P

Background:Early Identification of disaster victims with mental health problems may be useful, but information within a short period after a disaster is scarce in developing countries. This study examined anxiety, depression, and post-traumatic stress symptoms at 1 month following 2019 Cyclone Fani in Odisha, India.Method:Post-traumatic stress symptoms (PTSS) were assessed by the Primary care PTSD screen for DSM 5 (PC-PTSD-5), anxiety symptoms by the Generalised Anxiety Disorder (GAD-7), and depression by the Patient Health Questionnaire (PHQ-9). The survey included participants’ disaster experience e.g., evacuation, fear of death, injury, death in family, damage to house, difficulty for food, displacement, and effect on livelihood.Results:Proportion of sample (n = 80) with probable PTSD was 42.9%, with severe anxiety was 36.7%, moderately severe depression was 16.5%, and severe depression was 3.8%. Suicidal cognitions were reported to increase by 14%. Comorbidity was common; with significant (P < 0.01) correlation between PTSS and anxiety (r = 0.69), depression (r = 0.596), and between anxiety and depression (r = 0.63). Damage of house and displacement were associated significantly with PTSD; evacuation and displacement with moderate and severe depression; and displacement with severe anxiety. No specific demographic factors were significantly linked to the psychiatric morbidities.Conclusion:A considerable proportion of victims had psychiatric morbidities at 1 month. Associated risk factors included housing damages, evacuation, and displacement, suggesting the need to improve the disaster-management process.

Background While injuries experienced during hurricanes and other tropical cyclones have been relatively well- characterized through traditional surveillance, less is known about tropical cyclones' impacts on non-injury morbidity, which can be triggered through pathways that include psychosocial stress or interruption in medical treatment. Methods We investigated daily emergency Medicare hospitalizations (1999-2010) in 180 United States counties, drawing on an existing cohort of high-population counties. We classified counties as exposed to tropical cyclones when storm-associated peak sustained winds were ≥ 21 m/s at the county center; secondary analyses considered other wind thresholds and hazards. We matched storm-exposed days to unexposed days by county and seasonality. We estimated change in tropical cyclone-associated hospitalizations over a storm period from 2 days before to 7 days after the storm's closest approach, compared to unexposed days, using generalized linear mixed-effect models. Results For 1999-2010, 175 study counties had at least one tropical cyclone exposure. Cardiovascular hospitalizations decreased on the storm day, then increased following the storm, while respiratory hospitalizations were elevated throughout the storm period. Over the 10-day storm period, cardiovascular hospitalizations increased 3% (95% confidence interval [CI]: 2%, 5%) and respiratory hospitalizations increased 16% (95% CI: 13%, 20%) compared to matched unexposed periods. Relative risks varied across tropical cyclone exposures, with strongest association for the most restrictive wind-based exposure metric. Conclusions In this study, tropical cyclone exposures were associated with a short-term increase in cardiorespiratory hospitalization risk among the elderly, based on a multi-year/multi-site investigation of US Medicare beneficiaries ≥ 65 years.

Introduction:The tropical cyclone Idai hit Mozambique in the city of Beira on March 15, 2019. During the following days, the Portuguese Emergency Medical Team (PT EMT) and its infrastructure deployed to Mozambique with the mission of helping local people and collaborating with the authorities.Methods:Data analyzed were collected in the period of the deployment, from April 1-April 30, 2019. All patients admitted to PT EMT were registered through the Clinical Record of PT EMT.Results:In total, 1,662 patients were admitted to PT EMT during the 30-day mission. The five most prevalent diagnoses were: 61.49% classified with “code 29” (which corresponds to “other unspecified diagnoses”), 9.15% of cases of skin disease, 8.90% of minor injuries, 6.74% of acute respiratory infection, and 3.19% of obstetric/genecology complications.Discussion and Challenges:An important challenge identified was the need for a robust and effective network for transporting patients, allowing transfers between EMTs, enabling a true network response in the provision of care to disaster victims.Conclusions:The benefit of the deployment of PT EMT in Mozambique after Cyclone Idai was in line with the EMT initiative standards, allowing a direct delivery of care to the affected Mozambican population and support to the local health authorities.

Hurricane Irma was the most powerful Atlantic hurricane in recorded history, displacing 6 million and killing over 120 people in the state of Florida alone. Unpredictable disasters like Irma are associated with poor cognitive and health outcomes that can disproportionately impact children. This study examined the effects of Hurricane Irma on the hippocampus and memory processes previously related to unpredictable stress. We used an innovative application of an advanced diffusion-weighted imaging technique, restriction spectrum imaging (RSI), to characterize hippocampal microstructure (i.e., cell density) in 9- to 10-year-old children who were exposed to Hurricane Irma relative to a non-exposed control group (i.e., assessed the year before Hurricane Irma). We tested the hypotheses that the experience of Hurricane Irma would be associated with decreases in: (a) hippocampal cellularity (e.g., neurogenesis), based on known associations between unpredictable stress and hippocampal alterations; and (b) hippocampal-related memory function as indexed by delayed recall. We show an association between decreased hippocampal cellularity and delayed recall memory in children who experienced Hurricane Irma relative to those who did not. These findings suggest an important role of RSI for assessing subtle microstructural changes related to functionally significant changes in the developing brain in response to environmental events.

Objective:The efficacy is measured for a public health intervention related to community-based planning for population protection measures (PPMs; ie, shelter-in-place and evacuation).Design:This is a mixed (qualitative and quantitative) prospective study of intervention efficacy, measured in terms of usability related to effectiveness, efficiency, satisfaction, and degree of community engagement.Setting:Two municipalities in the Commonwealth of Puerto Rico are included.Participants:Community members consisting of individuals; traditional leaders; federal, territorial, and municipal emergency managers; municipal mayors; National Guard; territorial departments of education, health, housing, public works, and transportation; health care; police; Emergency Medical Services; faith-based organizations; nongovernmental organizations (NGOs); and the private sector.Intervention:The intervention included four community convenings: one for risk communication; two for plan-writing; and one tabletop exercise (TTX). This study analyzed data collected from the project work plan; participant rosters; participant surveys; workshop outputs; and focus group interviews.Main Outcome Measures:Efficacy was measured in terms of ISO 9241-11, an international standard for usability that includes effectiveness, efficiency, user satisfaction, and “freedom from risk” among users. Degree of engagement was considered an indicator of “freedom from risk,” measurable through workshop attendance.Results:Two separate communities drafted and exercised ~60-page-long population protection plans, each within 14.5 hours. Plan-writing workshops completed 100% of plan objectives and activities. Efficiency rates were nearly the same in both communities. Interviews and surveys indicated high degrees of community satisfaction. Engagement was consistent among community members and variable among governmental officials.Conclusions:Frontline communities have successfully demonstrated the ability to understand the environmental health hazards in their own community; rapidly write consensus-based plans for PPMs; participate in an objective-based TTX; and perform these activities in a bi-lingual setting. This intervention appears to be efficacious for public use in the rapid development of community-based PPMs.

Objectives To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession. Methods We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression. Results We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy. Discussion Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.

Background Nontuberculous mycobacteria (NTM) are a rare cause of infectious tenosynovitis of the upper extremity. Using molecular methods, clinical microbiology laboratories are increasingly reporting identification down to the species level. Improved methods for speciation are revealing new insights into the clinical and epidemiologic features of rare NTM infections. Methods We encountered 3 cases of epidemiologically linked upper extremity NTM tenosynovitis associated with exposure to hurricane-damaged wood. We conducted whole-genome sequencing to assess isolate relatedness followed by a literature review of NTM infections that involved the upper extremity. Results Despite shared epidemiologic risk, the cases were caused by 3 distinct organisms. Two cases were rare infections caused by closely related but distinct species within the Mycobacterium terrae complex that could not be differentiated by traditional methods. The third case was caused by Mycobacterium intracellulare. An updated literature review that focused on research that used modern molecular speciation methods found that several species within the M. terrae complex are increasingly reported as a cause of upper extremity tenosynovitis, often in association with environmental exposures. Conclusions These cases illustrate the importance of molecular methods for speciating phenotypically similar NTM, as well as the limitations of laboratory-based surveillance in detecting point-source outbreaks when the source is environmental and may involve multiple organisms.

Displacement from one's home after a natural disaster results not only in physical separation from significant others but also in profound disruptions of psychological and social resources such as community support and sense of belonging. Frequent displacement can exacerbate health and mental health problems brought by the disaster, especially among lower-income families in resource-scarce regions. Objective The present study examined the association among frequency of displacement after the disaster, health status, and psychological adjustments among survivors four years after the 2013 Super Typhoon Haiyan in the Philippines. Method The study surveyed 345 typhoon survivors using randomized cluster samples in 13 towns in Eastern Philippines and assessed their physical and mental health status. Result Path analysis revealed that, after controlling for age, gender, and traumatic exposure severity, frequency of displacement was a significant predictor for subjective health ratings and stress but not for posttraumatic stress symptoms, depression, and anxiety. Conclusion These findings underscore the detrimental impact of long-term displacement on health outcomes following a disaster, especially in countries where public health resources are largely unavailable. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background Two devastating sequential hurricanes impacted Puerto Rico during September of 2017. The hurricanes were traumatic and created social and ecological upheaval throughout Puerto Rico, and subsequently in communities of Central Florida where affected Puerto Ricans migrated. The 2017 hurricane season exposed and exacerbated previous long-standing socio-political, economic, environmental, and health crises, generating a humanitarian emergency in the country. The consequences of these human-ecological disasters destroyed much of Puerto Rico’s residential and environmental infrastructure, displacing thousands of people and resulting in an unprecedented migration to the United States. We report on the lived experience of the investigator team and partnership in conducting community-based formative research subsequent to this disaster, research that aimed to identify salient issues relating to the impact of Hurricanes Irma and María on Puerto Rican communities both in Puerto Rico and in Central Florida. Discussion The challenges faced during the conduct of this research include but are not limited to (1) emotional distress of participants and team members, (2) access to affected populations, and (3) precarious environmental factors, such as unstable infrastructure. To address these challenges, the researchers applied a Critical Medical Ecological paradigm along with qualitative methods to assist constructing explanatory models while obtaining internally-valid (from the community perspective), cathartic narrative accounts of the lived experience of hurricane survivors. The experience of the research team may help inform other investigators conducting applied research during a humanitarian crisis. Conclusion Lessons learned in this research included: (1) usefulness of applying the Critical Medical Ecological model in the development of the project, (2) incorporating participation and methods that prioritize authenticity, (3) understanding the trauma experience and using study methods sensitive to it, and (4) innovating with best approaches to conduct the study given the challenges in post-hurricane Puerto Rico. These lessons could provide new insights on how to conduct in-depth participatory health research with community members who have been traumatized and – often – displaced. This research also demonstrates the value of pre-existing partnerships, critical consciousness in the field team, and medical ecological modeling as experiential for organizing complex, inter-related, multi-level variables that explain community and individual impact of environmental disasters.

Objectives. To review the trends in pregnancy outcomes after Hurricane Katrina and assess effects of the disaster on research and public health related to pregnant women. Methods. We reexamined the 2004–2006 vital statistics data from Alabama, Louisiana, and Mississippi, assessing what the risk of adverse pregnancy outcomes in the population would have been under varying risk scenarios. Results. We saw a reduction in number of births as well as in low birth weight and preterm birth. If the number of births had stayed constant and the relative higher risk in the “missing” births had been between 17% and 100%, the storm would have been associated with an increased risk instead of a decrease. Because the relative decline in births was larger in Black women, the higher risk in the “missing” births required to create a significant increase associated with the storm was generally not as great as for White women. Conclusions. Higher exposure to Katrina may have produced a reduction in births among high-risk women in the region rather than increasing adverse outcomes among those who did give birth.

After natural disasters, mothers and children are vulnerable to internalizing symptoms, such as depression and anxiety, and levels of mothers' and children's symptoms are significantly associated. However, the disaster literature has rarely examined reciprocal effects within families. The present study capitalizes on the occurrence of Hurricane Sandy during the course of an ongoing longitudinal study to address this gap. Three-hundred and 47 children (54.2% male, 84.7% Caucasian) and their mothers completed measures of internalizing symptoms when the children were 9-years-old. Hurricane Sandy occurred an average of 1 year later. Eight weeks after the hurricane, mothers and children completed the same measures again. Mothers also reported on their family's stress exposure from Hurricane Sandy. After controlling for predisaster symptoms, longitudinal actor-partner interdependence models indicated that mother's and children's internalizing symptoms were linked. Mothers' prehurricane depression symptoms also predicted increases in children's depression symptoms over time independent of hurricane-related stress. Children's prehurricane anxiety symptoms predicted increases in mothers' depression symptoms only at low levels of hurricane-related stress. Rather than the emergence of reciprocal effects, mother's depression symptoms and children's internalizing symptoms changed in tandem after Hurricane Sandy. High levels of Hurricane Sandy stress did not produce symptom spillover effects, but rather may have interrupted the unfolding of normative developmental parent-child reciprocal symptom processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

BackgroundThe structural changes recent-onset posttraumatic stress disorder (PTSD) subjects were rarely investigated. This study was to compare temporal and causal relationships of structural changes in recent-onset PTSD with trauma-exposed control (TEC) subjects and non-TEC subjects.MethodsT1-weighted magnetic resonance images of 27 PTSD, 33 TEC and 30 age- and sex-matched healthy control (HC) subjects were studied. The causal network of structural covariance was used to evaluate the causal relationships of structural changes in PTSD patients.ResultsVolumes of bilateral hippocampal and left lingual gyrus were significantly smaller in PTSD patients and TEC subjects than HC subjects. As symptom scores increase, reduction in gray matter volume began in the hippocampus and progressed to the frontal lobe, then to the temporal and occipital cortices (p< 0.05, false discovery rate corrected). The hippocampus might be the primary hub of the directional network and demonstrated positive causal effects on the frontal, temporal and occipital regions (p< 0.05, false discovery rate corrected). The frontal regions, which were identified to be transitional points, projected causal effects to the occipital lobe and temporal regions and received causal effects from the hippocampus (p< 0.05, false discovery rate corrected).ConclusionsThe results offer evidence of localized abnormalities in the bilateral hippocampus and remote abnormalities in multiple temporal and frontal regions in typhoon-exposed PTSD patients.

National Preparedness month is observed every September as a public service reminder of the importance of personal and community preparedness for all events; it coincides with the peak of the hurricane season in the United States. Severe storms and hurricanes can have long-lasting effects at all community levels. Persons who are prepared and well-informed are often better able to protect themselves and others (1). Major hurricanes can devastate low-lying coastal areas and cause injury and loss of life from storm surge, flooding, and high winds (2). State and local government entities play a significant role in preparing communities for hurricanes and by evacuating coastal communities before landfall to reduce loss of life from flooding, wind, and power outages (3). Laws can further improve planning and outreach for catastrophic events by ensuring explicit statutory authority over evacuations of communities at risk (4). State evacuation laws vary widely and might not adequately address information and communication flows to reach populations living in disaster-prone areas who are at risk. To understand the range of evacuation laws in coastal communities that historically have been affected by hurricanes, a systematic policy scan of the existing laws supporting hurricane evacuation in eight southern coastal states (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Texas) was conducted. After conducting a thematic analysis, this report found that all eight states have laws to execute evacuation orders, traffic control (egress/ingress), and evacuation to shelters. However, only four of the states have laws related to community outreach, delivery of public education programs, and public notice requirements. The findings in this report suggest a need for authorities in hurricane-prone states to review how to execute evacuation policies, particularly with respect to community outreach and communication to populations at risk. Implementation of state evacuation laws and policies that support hurricane evacuation management can help affected persons avoid harm and enhance community resiliency (5). Newly emerging and re-emerging infectious diseases, such as SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), have and will continue to additionally challenge hurricane evacuations.

WOS:000569098300002 PubMed: 33089080 Objectives: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. Patients and methods: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. Results: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2 +/- 128.5 per week before the pandemic, it significantly decreased to 23.4 +/- 33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7 +/- 39.3 per week to 2.5 +/- 10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. Conclusion: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians.

Objective Sleep plays a critical role in children’s growth and development. This study examined the frequency and persistence of children’s sleep problems following a natural disaster, risk factors for children’s sleep problems, and the bidirectional relationship between children’s sleep problems and posttraumatic stress symptoms (PTSS) over time. Methods This study assessed 269 children (53% female, M = 8.70 years, SD = 0.95) exposed to Hurricane Ike at 8 months (Time 1) and 15 months (Time 2) post-disaster. Children completed measures of hurricane exposure and related stressors, stressful life events, sleep problems, and PTSS. Results Children’s sleep problems were significantly correlated from Time 1 to Time 2 (r = .28, p < .001). Risk factors for sleep problems at Time 2 were younger age, sleep problems at Time 1, and PTSS, not including sleep items, at Time 1. Examinations of the bidirectional relationship between sleep problems and PTSS indicated that PTSS significantly predicted later sleep problems, but sleep problems did not significantly predict later PTSS. Conclusions Findings demonstrate that PTSS may contribute to the development and course of children’s sleep problems post-disaster.

Background:In March 2020, the Louisiana Department of Health activated the Medical Monitoring Station (MMS) in downtown New Orleans. This alternative care site is designed to decompress hospitals and nursing homes overwhelmed by the coronavirus disease 2019 (COVID-19) pandemic. Given the city’s historic vulnerability to hurricanes, planning for possible tropical weather events has been a priority for MMS leadership.Methods:The planning process incorporated input from all sectors/agencies working at the facility, to ensure consistency and cohesion. The MMS Shelter-in-Place Plan (MSIPP) was created, and a comprehensive tabletop exercise was conducted.Results:Six planning topics emerged as a result of the planning process and were used to create a comprehensive plan for sheltering-in-place. These topics address hurricane preparedness for patient care, interfacility coordination, wrap-around services, medical logistics, essential staffing, and incident command during a shelter-in-place scenario.Conclusions:The MSIPP created by the MMS helped to maximize patient safety and continuity of operations during a real-world event. Select pieces of the plan were activated to meet the needs and threat level of Tropical Storm Cristobal. This experience reinforced the need for originality, scalability, and flexibility in building emergency operations plans in the midst of an unprecedented pandemic.

Prior research has provided robust evidence that exposure to potentially traumatic events (PTEs) during a disaster is predictive of adverse postdisaster mental health outcomes, including posttraumatic stress symptoms (PTSS) and nonspecific psychological distress (PD). However, few studies have explored the role exposure to other PTEs over the life-course has in shaping postdisaster mental health. Based on the broader literature on trauma exposure and mental health, we hypothesized a path analytic model linking predisaster PTEs to long-term postdisaster PTSS and PD via predisaster PD, short-term postdisaster symptoms, and disaster-related and postdisaster PTEs. We tested this model using data from the Resilience in Survivors of Katrina study, a longitudinal study of low-income, primarily non-Hispanic Black mothers exposed to Hurricane Katrina and assessed before the disaster and at time points 1, 4, and 12 years thereafter. The models evidenced a good fit with the data, RMSEA < .01–.04, CFIs > .99. In addition, 44.1%–67.4% of the effect of predisaster PTEs on long-term postdisaster symptoms was indirect. Descriptive differences were observed across models that included PTSS versus PD, as well as models that included all pre- and postdisaster PTEs versus only those that involved assaultive violence. The results suggest the importance of incorporating disaster preparedness in clinical work with trauma survivors and the value in attending to other lifetime PTEs when working in postdisaster contexts.

Purpose To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department (TED) of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster. Methods A retrospective study was conducted in the TED in the affected zone. Data of all victims affected by the cyclone Fani on May 3, 2019 were obtained from disaster records and medical case sheets. All patients except death on admission were included. Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score (RTS) and injury severity score (ISS). Trauma injury severity score (TRISS) was also calculated. Results Of 75 patients, 74 were included and the other one was brought dead and thus excluded. The age, median ± interquartile range (IQ), was 41.0 (27.7–53.0) years. The male to female ratio was 2:1. Most of the wounded were transported by the police control room vans on day 1: first 10 h, 50.0%; 10-24 h, 20.3%. The median ± IQ range of RTS, ISS and TRISS were 20 (14–28), 7.84 (7.841–7.841), and 97.4 (91.6–98.9), respectively. Simple external injury was the dominant injury type. Polytrauma (ISS >15) was seen in 67% cases and spine injury in 14% cases (7% cervical and 7% thoracolumbar). Injury causes included sharp flying objects (broken pieces of glasses and asbestos) in 31% cases, followed by fall of trees in 20.3%. Twenty-four patients were discharged after primary treatment, 30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center. There was no in-house mortality. Challenges were related to electricity failure, mobile network breakdown, infrastructure collapse, and delay in expertise repair from outside due to airport/railway closure. Conclusion In cyclonic storm like Fani, sharp flying objects, fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions. Polytrauma was seen in the majority of patients though external injury was the commonest. The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.

This study investigated dynamic brain functional alterations in post-traumatic stress disorder (PTSD) patients with resting state functional magnetic resonance imaging.Degree centrality (DC) and seed-based functional connectivity (FC) analyses were conducted among typhoon survivours with (Both the PTSD group and the trauma-exposed control (TEC) group had increased DC in the left parahippocampal gyrus relative to the HC group. More increased DC in the left parahippocampal gyrus was found in the PTSD group. Both traumatised groups exhibited decreased left parahippocampal gyrus dynamic FC with the bilateral middle frontal gyrus and superior frontal gyrus relative to the HC group. The Checklist-Civilian Version score was positively correlated with dynamic FC between the parahippocampal gyrus and left superior frontal gyrus but was negatively correlated with dynamic FC between the parahippocampal gyrus and right middle frontal gyrus.Trauma exposure may lead to an altered dynamic FC in individuals with or without PTSD. An altered DC in the parahippocampal gyrus may be an important risk factor for PTSD development following trauma exposure. A more prominently increased DC in the parahippocampal gyrus might be a common trait in the PTSD group.

The co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations – proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.

Objectives:The aim of this study was to assess strengths and challenges experienced by HIV/STD providers in providing care during the response to Hurricane Sandy (Sandy) in New York State, and their recommendations for future preparedness.Methods:A mixed methods approach, including a focus group (n = 3), interviews (n = 3), and survey (n = 31) of HIV/STD providers, was used. Key words identified by means of open coding methodology from collected data were organized into strengths, challenges, and recommendations and then grouped into federal and study-associated preparedness capabilities.Results:Key words were organized into 81 strengths (38.8%), 73 challenges (34.9%), and 55 recommendations (26.3%). Services most interrupted during Sandy were related to HIV/STD outreach and education. While providers reported challenges with external agency communication, the ability to still connect clients to needed resources was reported as a strength. Strengthening partnerships with federal, state, and local agencies was among the major recommendations made by these providers.Conclusions:This study presents unique information about challenges experienced by HIV/STD providers in providing services during a natural disaster and the use of national public health emergency preparedness capabilities to address and overcome those challenges. Lessons learned and recommendations regarding inter-agency communications emerged as an important priority during a natural disaster to minimize or reduce service interruption.

Objectives Although research shows that public health is substantially affected during and after disasters, few studies have examined the health effects of Hurricane Harvey, which made landfall on the Texas coast in August 2017. We assessed disparities in physical health, mental health, and health care access after Hurricane Harvey among residents of the Houston–The Woodlands–Sugar Land, Texas, metropolitan statistical area (ie, Houston MSA). Methods We used structured survey data collected through telephone and online surveys from a population-based random sample of Houston MSA residents (n = 403) collected from November 29, 2017, through January 6, 2018. We used descriptive statistics to describe the prevalence of physical health/mental health and health care access outcomes and multivariable generalized linear models to assess disparities (eg, based on race/ethnicity, socioeconomic status, disability) in health outcomes. Results Physical health problems disproportionately affected persons who did not evacuate (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.19-0.87). Non-Hispanic black persons were more likely than non-Hispanic white persons to have posttraumatic stress (OR = 5.03; 95% CI, 1.90-13.10), as were persons in households that experienced job loss post-Harvey (vs did not experience job loss post-Harvey; OR = 2.89; 95% CI, 1.14-7.32) and older persons (OR = 1.04; 95% CI, 1.01-1.06). Health care access was constrained for persons whose households lost jobs post-Harvey (vs did not lose jobs post-Harvey; OR = 2.73; 95% CI, 1.29-5.78) and for persons with disabilities (vs without disabilities; OR = 3.19; 95% CI, 1.37-7.45). Conclusions Our findings underscore the need to plan for and ameliorate public health disparities resulting from climate change–related disasters, which are expected to occur with increased frequency and magnitude.

Background: Hurricane Irma, a catastrophic Category 4 storm, made landfall in Florida on September 10, 2017. Nemours CareConnect (NCC) offered direct-to-consumer (DTC) pediatric telemedicine during...

Hurricanes have profound impacts on zoonotic pathogen ecosystems that exhibit spatial and temporal waves in both distance from and time since the event. Wind, rain, and storm surge directly affect mosquito vectors and animal hosts of these pathogens. In this analysis, we apply a West Nile virus transmission model parameterized for the Northern coast of the Gulf of Mexico to explore the effect of event timing of hurricane landfall, time since the event, and damage extent on human West Nile virus neuro-invasive disease (WNV-NID) risk. Early-season hurricanes, which make landfall prior to the peak of baseline WNV transmission activity, increase the average total WNV-infectious mosquitoes for the year by 7.8% and human WNV-NID incidence by 94.3% across all areas with hurricane damage. The indirect effects on human exposure to mosquito bites in the immediate aftermath and long-term recovery from the event have strong impacts on the risk of infection. The resultant interactive direct and indirect storm effects on the pathogen system are spatially and temporally heterogenous among the generalized time and space categories modeled.

Cyclone Idai, which hit Mozambique in March 2019, was one of the worst climate-related natural disasters on record in the Southern Hemisphere causing massive destruction of housing and disruption to vital infrastructure including the electrical grid, communications and water supply. Almost two million people were affected with over 600 deaths, hundreds of thousands of people displaced accompanied by rapid spread of cholera. We describe emergency measures taken by the Government of Mozambique, in collaboration with multilateral partners, to establish a real-time disease surveillance system, implement interventions recommended by a Water, Sanitation and Hygiene (WASH) taskforce and rapidly scale up a massive community vaccination program to control a cholera epidemic.

Objectives Disaster workers are at elevated risk for mental health problems as a result of trauma exposures during response efforts. One possible way to prevent mental health problems is to build-up coping resources that promote resilience to the effects of disaster work. The primary aim of this study was to evaluate the efficacy of a resilience building workshop, the Disaster Worker Resiliency Training Program (DWRT), in disaster workers previously exposed to Hurricane Sandy. Methods Disaster workers (N = 167) were randomly assigned to the DWRT workshop (n = 78) or a waitlist (n = 89). Workers completed self-report measures on healthy lifestyle behaviors, perceived stress, depression, and Posttraumatic Stress Disorder (PTSD) symptoms at baseline and 3-month follow-up. They also completed a measure assessing subsequent trauma-exposure between the baseline and 3-month post-intervention. Results Participants in the workshop condition, as compared to those in a waitlist control, reported significantly greater improvements from pre-intervention (T1) to 3-month follow-up (T2) in healthy lifestyle behaviors (η2 = .03; p = .03), stress management (η2 = .03, p = .04), and spiritual growth (η2 = .03, p = .02). Among participants reporting subsequent trauma exposures between T1 and T2 (n = 101), participants in the waitlist condition, were more likely to report significant increases in perceived stress (η2 = .07, p

This study examined mental health status among Hurricane Sandy survivors in the most severely damaged areas of New York and New Jersey in 2014, approximately 2 years after this disaster. We used the 2014 Associated Press NORC survey of 1009 Sandy survivors to measure the prevalence of probable mental illness and to analyze its association with selected socioeconomic characteristics of survivors, direct impact by Sandy, as well as social support and social trust. The study found major disparities in mental illness by race/ethnicity, age groups, and employment status. Higher Sandy impact levels were strongly associated with higher rates of mental illness and accounted for much of the disparity between blacks and Hispanics compared with whites in our study group. Social support was more strongly associated with lower rates of mental illness than was social trust. In addition, social support served as a significant mitigating factor in the mental health disparities between blacks and whites. The severity of mental illness among Sandy survivors differed significantly among racial and ethnic groups but was moderated by both the direct impact of this disaster on their lives and the degree of social support they received, as well as how trusting they were.

Hurricane Maria struck Puerto Rico on 20 September 2017 causing catastrophic devastation. Prolonged shortage of food had been a substantial challenge to the residents after Maria. Experiencing food insecurity in utero has been associated with negative health outcomes later in life. We aim to examine whether there is any alteration in the infant gut microbiome that is associated with prenatal food insecurity.We established a cohort of infants aged 2-6 months who were exposed in utero to Hurricane Maria near San Juan, Puerto Rico and examined the gut microbiota (n = 29) using 16S ribosomal RNA gene sequencing.Among the enrolled infants, 30% of their mothers experienced "post-Maria poor access to food" for at least 1 month during pregnancy. The relative abundance of gut Veillonella spp. is significantly decreased among infants who experienced prenatal food insecurity, compared to those who did not (adjusted p = 0.025). There is no significant difference observed by prenatal food insecurity at the microbial community level in this cohort.Our finding indicated that infants who experienced prenatal food insecurity post hurricane harbor microbial alternations of specific bacterial taxa, which may further influence the microbial maturation and place the individual at a high-risk health trajectory.We identified that in utero exposure to food insecurity post Hurricane Maria is associated with decreased abundance of Veillonella in the infant gut. Our findings indicated that infants who experienced prenatal food insecurity post hurricane may harbor alterations of specific bacterial taxa in their gut microbiota. This study showed the association between prenatal adverse exposure and alterations of gut microbiome early in life in the context of an extreme event. This study provided insights into the mechanisms underlying prenatal adverse exposure and increased disease risks later in life. Our findings will potentially raise awareness of the negative impact of extreme climate events on the unborn.