Health Preparedness Research Articles

Virus Metagenomics in Farm Animals: A Systematic Review.

A majority of emerging infectious diseases are of zoonotic origin. Metagenomic Next-Generation Sequencing (mNGS) has been employed to identify uncommon and novel infectious etiologies and characterize virus diversity in human, animal, and environmental samples. Here, we systematically reviewed studies that performed viral mNGS in common livestock (cattle, small ruminants, poultry, and pigs). We identified 2481 records and 120 records were ultimately included after a first and second screening. Pigs were the most frequently studied livestock and the virus diversity found in samples from poultry was the highest. Known animal viruses, zoonotic viruses, and novel viruses were reported in available literature, demonstrating the capacity of mNGS to identify both known and novel viruses. However, the coverage of metagenomic studies was patchy, with few data on the virome of small ruminants and respiratory virome of studied livestock. Essential metadata such as age of livestock and farm types were rarely mentioned in available literature, and only 10.8% of the datasets were publicly available. Developing a deeper understanding of livestock virome is crucial for detection of potential zoonotic and animal pathogens and One Health preparedness. Metagenomic studies can provide this background but only when combined with essential metadata and following the “FAIR” (Findable, Accessible, Interoperable, and Reusable) data principles.

Impact of weather conditions on incidence and mortality of COVID-19 pandemic in Africa.

The weather-related conditions change the ecosystem and pose a threat to social, economic and environmental development. It creates unprecedented or unanticipated human health problems in various places or times of the year. Africa is the world's second largest and most populous continent and has relatively changeable weather conditions. The present study aims to investigate the impact of weather conditions, heat and humidity on the incidence and mortality of COVID-19 pandemic in various regions of Africa. In this study, 16 highly populated countries from North, South, East, West, and Central African regions were selected. The data on COVID-19 pandemic including daily new cases and new deaths were recorded from World Health Organization. The daily temperature and humidity figures were obtained from the weather web "Time and Date". The daily cases, deaths, temperature and humidity were recorded from the date of appearance of first case of "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" in the African region, from Feb 14 to August 2, 2020. In African countries, the daily basis mean temperature from Feb 14, 2020 to August 2, 2020 was 26.16±0.12°C, and humidity was 57.41±0.38%. The overall results revealed a significant inverse correlation between humidity and the number of cases (r= -0.192, p<0.001) and deaths (r= -0.213, p<0.001). Similarly, a significant inverse correlation was found between temperature and the number of cases (r= -0.25, p<0.001) and deaths (r=-0.18, p<0.001). Furthermore, the regression results showed that with 1% increase in humidity the number of cases and deaths was significantly reduced by 3.6% and 3.7% respectively. Congruently, with 1°C increase in temperature, the number of cases and deaths was also significantly reduced by 15.1% and 10.5%, respectively. Increase in relative humidity and temperature was associated with a decrease in the number of daily cases and deaths due to COVID-19 pandemic in various African countries. The study findings on weather events and COVID-19 pandemic have an impact at African regional levels to project the incidence and mortality trends with regional weather events which will enhance public health readiness and assist in planning to fight against this pandemic.

Диференціація змісту навчальних занять з фізичного виховання з урахуванням показників фізичного здоров’я та фізичної підготовленості школярів 7−9-х класів

Мета: дослідити зміни показників фізичного здоров’я та фізичної підготовленості учнів 7−9-х класів під впливом програми диференціації змісту навчальних занять з фізичного виховання . Матеріал і методи: а наліз та узагальнення науково-методичної літератури; вивчення документальних матеріалів і систематизація інформації; педагогічне спостереження; медико-біологічні методи; педагогічне тестування; педагогічний експеримент; методи математичної статистики. У дослідженні приймали участь 226 учнів 7‒9-х класів. Результати: за результатами первинного дослідження виявлено «середній» рівень фізичного здоров’я у школярів 7-х класів, «нижче середнього» − учнів 8−9-х класів та «низький» рівень фізичної підготовленості досліджуваного контингенту. Висновки: встановлені позитивні та достовірні зміни (р<0,05−0,001) показників фізичного здоров’я та фізичної підготовленості учнів 7 − 9-х класів основних груп, свідчать про ефективність запропонованої програми диференціації змісту навчальних занять з фізичного виховання.

Estimation of temporal covariances in pathogen dynamics using Bayesian multivariate autoregressive models.

It is well recognised that animal and plant pathogens form complex ecological communities of interacting organisms within their hosts, and there is growing interest in the health implications of such pathogen interactions. Although community ecology approaches have been used to identify pathogen interactions at the within-host scale, methodologies enabling robust identification of interactions from population-scale data such as that available from health authorities are lacking. To address this gap, we developed a statistical framework that jointly identifies interactions between multiple viruses from contemporaneous non-stationary infection time series. Our conceptual approach is derived from a Bayesian multivariate disease mapping framework. Importantly, our approach captures within- and between-year dependencies in infection risk while controlling for confounding factors such as seasonality, demographics and infection frequencies, allowing genuine pathogen interactions to be distinguished from simple correlations. We validated our framework using a broad range of synthetic data. We then applied it to diagnostic data available for five respiratory viruses co-circulating in a major urban population between 2005 and 2013: adenovirus, human coronavirus, human metapneumovirus, influenza B virus and respiratory syncytial virus. We found positive and negative covariances indicative of epidemiological interactions among specific virus pairs. This statistical framework enables a community ecology perspective to be applied to infectious disease epidemiology with important utility for public health planning and preparedness.

CDC's Multiple Approaches to Safeguard the Health, Safety, and Resilience of Ebola Responders.

Over 27,000 people were sickened by Ebola and over 11,000 people died between March of 2014 and June of 2016. The US Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) was one of many public health organizations that sought to stop this outbreak. This agency deployed almost 2,000 individuals to West Africa during that timeframe. Deployment to these countries exposed these individuals to a wide variety of dangers, stressors, and risks.Being concerned about the at-risk populations in Africa, and also the well-being of its professionals who willingly deployed, the CDC did several things to help safeguard the health, safety, and resilience of these team members before, during, and after deployment.The accompanying special report highlights innovative pre-deployment training initiatives, customized screening processes, and post-deployment outreach efforts intended to protect and support the public health professionals fighting Ebola. Before deploying, the CDC team members were expected to participate in both internally-created and externally-provided trainings. These ranged from pre-deployment briefings, to Preparing for Work Overseas (PFWO) and Public Health Readiness Certificate Program (PHRCP) courses, to Incident Command System (ICS) 100, 200, and 400 courses.A small subset of non-clinical deployers also participated in a three-day training designed in collaboration with the Center for the Study of Traumatic Stress (CSTS; Bethesda, Maryland USA) to train individuals to assess and address the well-being and resilience of themselves and their teammates in the field during a deployment. Participants in this unique training were immersed in a Virtual Reality Environment (VRE) that simulated deployment to one of seven different types of emergencies.The CDC leadership also requested a pre-deployment screening process that helped professionals in the CDC's Occupational Health Clinic (OHC) determine whether or not individuals were at an increased risk of negative outcomes by participating in a rigorous deployment at that time.When deployers returned from the field, they received personalized invitations to participate in a voluntary, confidential, post-deployment operational debriefing one-on-one or in a group.Implementing these approaches provided more information to clinical decision makers about the readiness of deployers. It provided deployers with a greater awareness of the kinds of challenges they were likely to face in the field. The post-deployment outreach efforts reminded staff that their contributions were appreciated and there were resources available if they needed help processing any of the potentially-traumatizing things they may have experienced.

Development of the U.S. Army's Suicide Prevention Leadership Tool: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4).

Although numerous efforts have aimed to reduce suicides in the U.S. Army, completion rates have remained elevated. Army leaders play an important role in supporting soldiers at risk of suicide, but existing suicide-prevention tools tailored to leaders are limited and not empirically validated. The purpose of this article is to describe the process used to develop the Behavioral Health Readiness and Suicide Risk Reduction Review (R4) tools for Army leaders that are currently undergoing empirical validation with two U.S. Army divisions. Consistent with a Secretary of the Army directive, approximately 76 interviews and focus groups were conducted with Army leaders and subject matter experts (SMEs) to obtain feedback regarding existing practices for suicide risk management, leader tools, and institutional considerations. In addition, reviews of the empirical literature regarding predictors of suicide and best practices for the development of practice guidelines were conducted. Qualitative feedback, empirical predictors of suicide, and design considerations were integrated to develop the R4 tools. A second series of 11 interviews and focus groups with Army leaders and SMEs was also conducted to validate the design and obtain feedback regarding the R4 tools. Leaders described preferences for tool processes (eg, incorporating engaged leadership, including multiple risk identification methods), formatting (eg, one page), organization (eg, low-intermediate-high risk scoring system), content (eg, excluding other considerations related to vehicle safety, including readiness implications), and implementation (eg, accounting for leadership judgment, tailoring process to specific leadership echelons, consideration of institutional barriers). Evidence-based predictors of suicide risk and practice guideline considerations (eg, design) were integrated with leadership feedback to develop the R4 tools that were tailored to specific leadership echelons. Leaders provided positive feedback regarding the R4 tools and described the importance of accounting for potential institutional barriers to implementation. This feedback was addressed by including recommendations regarding the implementation of standardized support meetings between different echelons of leadership. The R4 development process entailed the simultaneous integration of leadership feedback with evidence-based predictors of suicide risk and design considerations. Thus, the development of these tools builds upon previous Army leadership tools by specifically tailoring elements of those tools to accommodate leader preferences, accounting for potential implementation barriers (eg, institutional factors), and empirically evaluating the implementation of those tools. Future studies should consider utilizing a similar process to develop empirically based resources that are more likely to be incorporated into the routine practice of leaders supporting soldiers at risk of suicide, very often located at the company level and below.

A Model for Assessing Necessary Conditions for Rural Health Care's Mobile Health Readiness: Qualitative Assessment of Clinician-Perceived Barriers.

BackgroundMobile health (mHealth) technology dissemination has penetrated rural and urban areas alike. Yet, health care organization oversight and clinician adoption have not kept pace with patient use. mHealth could have a unique impact on health and quality of life for rural populations. If organizations are prepared to manage mHealth, clinicians may improve the quality of care for their patients, both rural and urban. However, many organizations are not yet prepared to prescribe or prohibit third-party mHealth technologies.ObjectiveThis study explored organizational readiness for rural mHealth adoption, the use of patient-reported data by clinical care teams, and potential impact on improving rural health care delivery.MethodsSemistructured, open-ended interviews were used to investigate clinicians’ current practices, motivators, and perceived barriers to their use of mHealth technologies in rural settings.ResultsA total of 13 clinicians were interviewed, and 53.8% (7/13) reported encouraging use of mHealth apps or wearable devices with rural patients. Perceived barriers to adoption were categorized into three primary themes: (1) personal (clinician), (2) patient, and (3) organizational. Organizational was most prominent, with subcodes of time, uniformity, and policy or direction. Thematic analysis revealed code-category linkages that identify the complex nature of a rural health care organization’s current climate from a clinician’s perspective. A thematic map was developed to visualize the flow from category to code. Identified linkages guided the development of a refined rural mHealth readiness model.ConclusionsClinicians (including physicians) have limited time for continuing education, research, or exploration of emerging technologies. Clinicians are motivated to learn more, but they need guidance through organization-led directives. Rural health care institutions should consider investing in mHealth analysis, tool development, and formal recommendations of sanctioned tools for clinicians to use with patients.

Regional After-Action Review Among Local Health Department Personnel After Hurricane Matthew in Eastern North Carolina, United States.

Hurricane Matthew impacted eastern North Carolina during October 2016. A regional after-action exercise was conducted as a moderated discussion using an adaptation of Federal Emergency Management Agency's (FEMA's) after-action report format to allow health departments to communicate lessons learned across jurisdictional lines. Forty-one professionals from 18 counties participated in a 2-hour workshop. Information on strengths, weaknesses, and recommendations was collected in small-group format, organized into county clusters by hazard mitigation regions and by 3 professional roles (health director, nursing director, and preparedness coordinator). Interagency agreements varied by county, depending on regularity of hurricanes and flooding. Improvement opportunities included enhanced coordination with American Red Cross in shelter operations and opening more special medical needs shelters. Participants emphasized successful coordination with county emergency management leaders. A regional after-action exercise designed as a moderated workshop focusing on the public health response provided an opportunity to exchange strengths and lessons learned after Hurricane Matthew in eastern North Carolina. This after-action approach may be useful for similar local health jurisdictions to build regional consensus for future disaster response planning and training.

A Quantitative Public Health Risk Assessment Tool for Planning for At-Risk Populations.

The Drexel University Center for Public Health Readiness and Communication developed a quantitative public health risk assessment tool that has been used in Pennsylvania and across the United States. The tool assesses hazard impacts on health care and public health metrics and incorporates the planning needs of at-risk populations. The flexible platform using Microsoft Excel allows planners to customize hazard assessment and use jurisdiction-specific data. Findings from the risk assessment can guide planning and evaluate preparedness progress over time.

Development of an eHealth Readiness Assessment Framework for Botswana and Other Developing Countries: Interview Study.

BackgroundElectronic health (eHealth) readiness has been defined as the preparedness of health care institutions or communities for the anticipated change brought about by programs related to information and communication technology use. To ascertain the degree of such preparedness, an eHealth readiness assessment (eHRA) is needed. Literature on the existing eHRA frameworks and tools shows high inconsistency in content, definitions, and recommendations, and none have been found to be entirely suitable for assessing eHealth readiness in the context of developing countries. To develop an informed eHRA framework and tools with applicability to Botswana and similar developing countries, insight was sought from a broad spectrum of eHealth key informants in Botswana to identify and inform relevant issues, including those not specifically addressed in available eHRA tools.ObjectiveThe aim of this study was to evaluate key informant (local expert) opinions on aspects that need to be considered when developing an eHRA framework suitable for use in developing countries.MethodsInterviews with 18 purposively selected key informants were recorded and transcribed. Thematic analysis of transcripts involved the use of an iterative approach and NVivo 11 software. The major themes, as well as subthemes, emerging from the thematic analysis were then discussed and agreed upon by the authors through consensus.ResultsAnalysis of interviews identified four eHealth readiness themes (governance, stakeholder issues, resources, and access), with 33 subthemes and 9 sub-subthemes. A major finding was that these results did not directly correspond in content or order to those previously identified in the literature. The results highlighted the need to perform exploratory research before developing an eHRA to ensure that those topics of relevance and importance to the local setting are first identified and then explored in any subsequent eHRA using a locally relevant framework and stakeholder-specific tools. In addition, seven sectors in Botswana were found to play a role in ensuring successful implementation of eHealth projects and might be targets for assessment.ConclusionsInsight obtained from this study will be used to inform the development of an evidence-based eHealth readiness assessment framework suitable for use in developing countries such as Botswana.

Soldier Attitudes Toward Behavioral Health Profiles in the US Army.

Behavioral health (BH) readiness is a critical component of U.S. Army personnel readiness. Medical providers issue BH profiles in order to communicate BH-related duty limitations to the commander and reflect BH force readiness on both micro/macro-levels. A recent report indicates BH profile underutilization may be significantly elevating U.S. Army safety and mission-failure risks, and a study of BH provider decision-making suggests some providers may be hesitant to use profiles due to concerns that soldiers' attitudes toward BH profiles may negatively impact treatment utilization. This potential link, however, has not been empirically examined. This study addresses this gap by assessing soldiers' attitudes towards BH profiles to better understand how BH profiles may impact treatment utilization and explore for any BH profile-related stigma effect. Approved by the Walter Reed Army Institute of Research (WRAIR) Institutional Review Board as part of the Land Combat Study II, the survey specific to this study included eight WRAIR-developed items assessing soldier attitudes toward BH profiles. Soldiers (N = 1,043) from two active duty U.S. Army brigades completed cross-sectional, anonymous surveys in 2017-2018. Soldier self-reported BH care utilization was assessed and used to create sub-groups for analysis. A majority of soldiers indicated that being placed on a BH profile would make them as or more likely to seek (71%) and no more or less likely to drop out (84%) of BH care. Among soldiers who had received BH care, BH profiles were associated with more favorable treatment seeking attitudes among those inclined to access conventional BH services and less favorable treatment seeking and maintenance attitudes among those inclined to access BH services from sources incapable of issuing profiles. Negative attitudes towards BH profiles were significantly more prevalent when compared to physical injury profiles, except in the group who had received BH care from a source incapable of issuing a profile. No significant proportional differences were observed among soldiers toward the rationale for BH profiles. Almost all soldiers (95% or greater) preferred their BH condition not come to the commander's attention during pre-deployment screening (SRP), choosing either BH profile or crisis options instead. Results suggest soldiers who would be less likely to seek or more likely to drop out of BH care due to a BH profile may be those that are less likely to access conventional BH services in the first place. This may provide some preliminary reassurance to conventional providers that increased BH profiling practices may not be inversely proportional to the amount of BH care delivered and may encourage treatment-seeking behaviors among the population they serve. Soldiers seeking BH care from sources incapable of issuing a profile may be sensitive to a potential BH profile-related stigma effect (possibly more global profile-related effect in this group), which should be factored into policy outreach efforts. A BH profile represents a more palatable BH duty limitation disclosure option for many soldiers, and supports the merits of a disclosure process that is earlier than SRP for promoting risk mitigation and more honest appraisals of BH mission-readiness levels.

The kindness of strangers: soldiers, surgeons, civilians, and conflict intimacies in the American Civil War

ABSTRACT America’s Civil War is often identified as the instigator of a new, industrial discipline that replaced the individualism of the antebellum era. Its traditional narrative trajectory is one of consolidation and cooperation that emphasizes the emergence of order from the chaos of conflict and the ordering of idealized, individual masculine bodies in the service of an equally glorified national body. This article complicates contemporary assumptions pertaining to gender, martial manhood, and national health in a wartime context. Juxtaposing the reports produced by Draft Board doctors in the later years of the conflict against a selection of nursing memoirs, it examines the ways in which elite assumptions about national health and military preparedness were challenged by the intimate realities of the war. It explores the tensions revealed through the federal draft between voluntarism and coercion, and the resultant shift from intimacy to estrangement in the later years of the conflict. It reveals that the points of intimacy between strangers effected by the Civil War were not always positive or supportive. Too often they were controlling confrontations that challenge the national narrative that has for so long pertained in the case of America’s mid-nineteenth century civil conflict.

The Impact of Superfast Broadband, Tailored Booklets for Households, and Discussions With General Practitioners on Personal Electronic Health Readiness: Cluster Factorial Quasi-Randomized Control Trial.

BackgroundElectronic health (eHealth) may improve health outcomes, but many people remain digitally excluded. Personal readiness to use the internet for health may be limited by lack of internet infrastructure, personal skills, social support, service provision, and cost. The impact of interventions to reduce these barriers is unknown. From 2011, the British Government supported the implementation of “superfast” broadband (Superfast) across the rural county of Cornwall. This provided the opportunity to assess the impact of interventions at regional, practice, and household levels.ObjectiveThis study aimed to assess the impact of 3 interventions on personal eHealth readiness: (1) regional-level implementation of Superfast, (2) practice-level discussions with general practitioners to encourage greater internet use in health service provision, and (3) household-level tailored booklets providing information to help improve personal skills in eHealth.MethodsThis was a cluster quasi-randomized factorial controlled trial. Implementation of Superfast was monitored, and postcodes were classified as having early or late availability. An algorithm selected 78 from 16,385 eligible postcodes to minimize the possibility of overlap between general practices and ensure a balance of urban and rural areas; 1388 households were randomly selected from the 78 postcodes and allocated to the 8 (2 × 2 × 2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0 to 10) and 4 components (personal, provision, support, and economic) from baseline (August 2013) to the 18-month follow-up between the 8 arms, to assess the impact of interventions. We compared SDs of scores to assess changes in eHealth inequalities.ResultseHealth readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10 (t235=4.18; P<.001; CI=0.13 to 0.35), resulting from increases in personal and provision components of the score (t255=3.191; P=.002 and t258=3.410; P=.001). However, there were no significant differences between the 3 interventions, either singly or in combination using intention-to-treat analysis. The proportion of internet users did not significantly increase (79.2%, 205/259 to 81.5%, 211/259) and mobile use was significantly greater (50.5%, 101/199 to 64.8%, 129/199). There was no change in eHealth inequality.ConclusionsPeople in Cornwall became more ready to adopt eHealth services, increasing both their personal ability to use eHealth and their methods of access. The implementation of Superfast may have contributed to this; we are certain that our other 2 interventions did not. This increased eHealth readiness did not cause a larger digital divide. The study illustrates the complexity of conducting a randomized controlled trial to assess the impact of interventions at regional, practice, and household levels. Our method may be of use to others.Trial RegistrationClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT02355808 (Archived by WebCite at http://www.webcitation.org/75oEz0E1x)

Application of Principal Component Analysis to Assess Health Systems Capacity Using Cross Sectional Data in Rural Western Kenya

Introduction: Strong health systems are essential platforms for accessible, quality health services, and population health and attainment of the Sustainable Development Goal (SDGs). Descriptive methods have been used to assess the health systems strength and impact, however, there is inadequate knowledge on methods of analyzing huge number of indices to provide systematic evidence that service readiness is improving or deteriorating over time. Methods: We utilized data from a cross section survey of 71 health facilities in Kakamega County of western Kenya. A total of 151 indices of the health system building blocks were reduced using Principal Component Analysis (PCA) model which generated factor weights for the individual indicators. These included indices from human resources, service delivery, infrastructure, finance, health information systems, commodities and governance. Factors weights were then summed and ranked in order of their relative contribution to better performance. These were then summed and average to rank health facilities. Sum of indicators within each health system block was used as explanatory variables in a linear regression model with overall average of all indicators. Coefficients of the regression was used to assess marginal effects and p-valueResults: The top ranked indicators were basic service deliver for testing and diagnosis and the lowest ranked were infrastructure such as availability of public taps, water, toilet or privacy. The department that were highly ranked whose indicators performed better in terms of weighting, were service delivery (pConclusion: PCA is an essential methodology for assessing health system readiness and preparedness to provide accessible and quality service delivery in resource poor settings.

Maximizing the Division Psychiatrist's Garrison Prevention Role to Meet the U.S. Army's 21st Century Readiness Expectations.

The division psychiatrist has been a bedrock U.S. Army institution for nearly 100 years. The role of the position in combat is well established, but its role in garrison has historically been less well defined. Prevention of behavioral health casualties has long been a governing objective of the division psychiatrist and forms the cornerstone of the behavioral health (BH) readiness concept. Accordingly, the Army's increased emphasis on readiness mandates that the division psychiatrist maximize BH force readiness through applied prevention methods. This process begins in garrison, and the crucible of recent protracted conflict has yielded effective BH screening principles applied in that environment. Despite this achievement, an evolving operational environment threatens the blanket effectiveness of BH screening and prevention in garrison. This article examines the historical evolution of the division psychiatrist's role in garrison, elucidates division psychiatry BH readiness principles in garrison, and expands on previously documented division psychiatry led efforts to maximize BH readiness levels. A historical review of the division psychiatrist was conducted in order to analyze the role of the position in BH prevention operations. Identified division psychiatry preventive lessons are leveraged against current BH readiness challenges resulting in proposed solutions from a division psychiatry perspective. The historical trajectory of the division psychiatrist's role in garrison prevention operations has advanced significantly in the last 17 years. With the advent of evidence-based BH readiness findings, the division psychiatrist's garrison readiness duties have expanded to include analysis of unit BH readiness levels. By applying pre-deployment screening principles in new ways to existing BH readiness platforms, the division psychiatrist can analyze BH readiness levels much earlier than immediately prior to deployment. The resultant BH readiness feedback allows for individualized readiness improvements for the BH systems that serve Army units. The division psychiatrist is the natural proponent of such readiness efforts, and will require staff officer, consultant, liaison, and trainer skill sets in order to be successful. The division psychiatrist's role must adapt to a changing operational environment in order to preserve and build on historical successes. The recommended end state would see the division psychiatrist maintaining a robust pre/post-deployment BH screening process and organizing the regular analysis of BH readiness levels to optimize existing BH clinical platforms. Systematically pursued, this would not only maximize BH readiness, but dramatically enhance safety and the provision of resources towards soldier health and welfare across the Army. The division psychiatrist should lead this effort.

Lessons on environmental health and disaster preparedness, response and recovery from the severe Kelantan flooding in 2014

Flood is a natural disaster that occurs annually in Malaysia causing devastating effects and damages to property and lives. This study looks into our environmental health and disaster preparedness, response and recovery management throughout the severe 2014 Kelantan flooding. We conducted three focus group discussions (FGDs) with healthcare, rescue and welfare workers, and community representatives involved throughout the disaster. The unprecedented severe flooding affected our environmental health and disaster management leading to various prominent issues. State level officers faced greater challenges in inter-agency communication, coordination and collaboration. District level staff faced more complications during disaster and emergency response. Meanwhile, community representatives faced issues pertaining to their livelihood mainly during and after the disaster. Recommendations include improved coordination, effective communication, improved human resource management, accessible early warning system, community empowerment and awareness, and prioritisation of continuous environmental health services. We hope that these recommendations can improve our future disaster management.

Application of Public Health Risk Assessment Methodology for Typhoon Disaster in China

Objective We conducted a public health risk assessment program for the Guangxi Zhuang Autonomous Region for typhoon disaster, to provide scientific evidence for public health emergency response and preparedness. Methods The public health risk assessment model for natural disaster is established through literature reviews, brainstorming, Delphi’s expert consultation and evaluation, based on theories of management, sociology and epidemiology. Basic data related to natural disasters and public health were extensively collected before the risk assessment. 34 public health experts from different professional fields identify the risk factors based on the basic data, conduct risk analysis according to the scoring criterion, calculate the risk values of risk factors according to the evaluation model, and then conduct the risk evaluation. Results 20 major public health risks which could seriously affect the Guangxi Zhuang Autonomous Region for typhoon disaster, were identified and assessed. The results of risk analysis showed that trauma, typhoid or paratyphoid, cholera, infectious diarrhea and hepatitis A were the top five high risk factors. Conclusion This study is the first time to apply the risk assessment theory for public health emergency preparedness before the natural disaster. Try to establish assessment index system, and then calculate risk value by semi-quantitative assessment method. This study provides a technical support for early warning surveillance and dynamic risk assessment of public health events. It will eventually improve capacity of public health emergency preparedness and response on natural disaster.

An integrated approach to mental health and disaster preparedness: a cluster comparison with earthquake affected communities in Nepal

BackgroundOn 25th April 2015, Nepal experienced a 7.8 magnitude earthquake, followed by countless aftershocks. Nearly 9000 people were killed and over 600,000 homes destroyed. Given the high frequency of earthquake and other natural hazards in Nepal, disaster preparedness is crucial. However, evidence suggests that some people exposed to prior disasters do not engage in risk reduction, even when they receive training and have adequate resources. Mental health symptoms, including those associated with prior disaster exposure, may influence engagement in preparedness. Perceived preparedness for future disasters may in turn influence mental health. Social cohesion may influence both mental health and preparedness.MethodsWe developed and tested a hybrid mental health and disaster preparedness intervention in two earthquake-affected communities in Nepal (N = 240), about 2.5 months after the April 25th, 2015 earthquake. The 3-day intervention was culturally adapted, facilitated by trained Nepalese clinicians and focused on enhancing disaster preparedness, mental health, and community cohesion. Communities were selected based on earthquake impacts and matched on demographic variables. The intervention was administered initially to one community, followed by the other receiving the intervention shortly thereafter. Survey data was collected across three time points. Focus groups were also conducted to examine intervention impact.ResultsAt pre-intervention baseline, greater depression symptoms and lower social cohesion were associated with less disaster preparedness. Depression and PTSD were associated with lower social cohesion. Participation in the intervention increased disaster preparedness, decreased depression- and PTSD-related symptoms, and increased social cohesion. Mediation models indicated that the effect of intervention on depression was partially explained by preparedness. The effect of the intervention on disaster preparedness was partially explained by social cohesion, and the effect of intervention on depression and on PTSD was also partially explained by social cohesion. Data from focus groups illuminate participant perspectives on components of the intervention associated with preparedness, mental health and social cohesion.ConclusionsThis mental health integrated disaster preparedness intervention is effective in enhancing resilience among earthquake-affected communities in Nepal. This brief, cost-effective group intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes and other natural hazards.Trial registrationClinical Trials Registry-India, National Institute of Medical Statistics. Registration number: CTRI/2018/02/011688. http://ctri.nic.in/Clinicaltrials/login.php Retrospectively registered February 5th, 2018. First participant enrolled July 2015.

Global Surgery – Redirecting Strategies for a Global Research Agenda Comment on "Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa"

More than three years have passed since the publication of the Lancet Commission on Global Surgery and its recommendations on scaling up surgery in sub-Saharan Africa (SSA). An important gap, the voice of the districts as well as lack of contextualized research, has been noted in its support of national surgical plans that run the risk of being at best, aspirational. Moreover, a ‘one-size-fits-all approach’ may not adequately address country-specific challenges on the ground. There is a need to redirect attention, effort, and funding in creating a global mechanism to gather baseline country information documenting every single district level government health facility’s ability and readiness to provide safe surgical, obstetric, trauma, and anesthesia care using the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to aid in directing country-specific efforts in surgical systems strengthening and ensuring that a basic package of essential surgical and anesthesia services is made available to each citizen with adequate financial protection by 2030. This global mechanism will enable benchmarking, accountability, and streamlining of the work of the global surgical community to achieve true progress in scaling up surgery not only in SSA, but for the rest of the developing world.

Commission: communication on the future of digital health

In a communication that was published at the end of April, the European Commission provided insights on the digital transformation of health and care in the Digital Single Market. Measures...