Preparedness Plans Research Articles

Rapid assessment of the mental well-being of general practitioners in Serbia during crises

Abstract Background General practitioners - GPs are at risk of greater exposure to multiple stressors during emergencies. To help primary care crisis preparedness planning, we rapidly assessed GPs’ mental well-being during the COVID-19 pandemic using a cross-sectional design, and after examining the 9-item Mayo Clinic Well-being Index (MWBI) correlation with the Depression, Anxiety and Stress Scale - 21 Items (DASS21). Methods During the PRICOV-19 international study, January - June 2021, we distributed the MWBI questionnaire (forward-backwards translated) and a standardized Serbian version of DASS21 to all GPs licensed at the Serbian Medical Chamber for self-administration. Pearson's r tested the correlation of the MWBI with the DASS21 scores. Multivariate linear regression analysis identified factors of the GPs’ poorer mental well-being (if higher than the cutoff of 2). Results 116 GPs, aged 24 - 68 years (median age = 42), participated in the study, of which 78.4% were females. A total of 101 respondents completed both questionnaires. The mean of the MWBI scores was 3,3 (SD 2.6) and ranged from -2 to 9, with a median of 3. Using a cutoff of MWBI ≥2, 71.3% of participants were considered at risk of distress. MWBI score correlated strongly, positively and significantly with the DASS21 total score (r = 0.791; p < 0,001), as well as with the DASS21 subscales (i.e. depression (r = 0.730; p < 0,001), anxiety (r = 0.660; p < 0,001), and stress (r = 0.759; p < 0,001)). A lower level of material status of respondents (B = - 0,882; p < 0,001) and lack of time to uptake clinical guidelines (B = - 0,600; p = 0,001) were independently and significantly related to higher MWBI scores. Conclusions The MWBI correlates with the DASS21 scores to an acceptable level. During the peak of the COVID-19 pandemic, two-thirds of Serbian GPs were at risk of distress, including those with lower material status and lack of time to uptake guidelines. Key messages • Assessing GP’s mental well-being should be included in emergency plans for primary care preparedness. • Use of MWBI in crises helps validate and rapidly assess GPs’ mental well-being.

Investigation Effect of Online Learning and Propose an Improved Online Education Process in Bangladesh Perspective

Conventional school learning is no longer relevant during the pandemic. Internet and distance learning, generally known as online education, play a vital role in the education system. However, there are many drawbacks to online learning. This study investigates the effects of online learning on Bangladeshi students. Data is collected through surveys and interviews. This study found various serious issues regarding online education, affecting the quality of the Education System. Considering these issues, this work investigates the effect of online learning and proposes an effective online education process to enhance educational institution success. However, one significant and indispensable part of society that innovations and discoveries have also tapped is the concept of online education. By investigating limitations, we hope this study may support teachers and decision-makers in Bangladesh to make well-informed decisions to facilitate the transition to distance learning and develop preparedness plans for future pandemics.

Socioeconomic inequalities in COVID-19 - An analysis of health insurance data

Abstract Background Evidence on socioeconomic inequalities in COVID-19 outcomes largely rests on ecological studies. Only few studies investigated inequalities in different COVID-19 outcomes prospectively on an individual level. We therefore conducted an analysis of German health insurance data to assess socioeconomic inequalities in COVID-19 incidence and hospitalizations within a cohort of insured individuals. Methods We used data of 3.17 million working-aged individuals (18 to 67 years) from various statutory health insurances in Germany. Educational level and occupational position were used as measures of socioeconomic position (SEP). We calculated directly age-standardized incidence rates per 1000 person-weeks (IR) and incidence rate ratios (IRR) among the sample population for COVID-19 incidence and COVID-19 hospitalizations for each exposure during the first four pandemic waves (01.01.2020-31.12.2021). Results Age-standardized IR and IRR of COVID-19 incidence and hospitalizations showed social gradients with higher rates in socioeconomically more disadvantaged groups. Incidence risk was higher among those in a low occupational position (IRR low vs. high: 1.29, 95% CI 1.27-1.31) and with a low level of education (IRR low vs. high: 1.36, 95% CI 1.34-1.38). Inequalities in COVID-19 hospitalizations were more pronounced with an IRR for low vs. high occupational position of 2.29 (95% CI 2.10-2.50) and an IRR for low vs. high level of education of 1.86 (95% CI 1.72-2.03). Conclusions We found socioeconomic inequalities in COVID-19 by education and occupational position, with inequalities in hospitalizations being more pronounced than those in incidence risk. These results show a high potential of prevention to improve population health and health equity in pandemics with novel respiratory pathogens. Further research on the underlying mechanisms of these inequalities in COVID-19 is needed. Key messages • Socioeconomically more disadvantaged individuals have a higher risk of COVID-19 and a severe disease progression. • These inequalities should be addressed in future pandemic preparedness planning in order to minimize the unequal health impacts of pandemics with new emerging diseases.

COMMA: A microsimulation model investigating the impact of COVID-19 lockdowns on depression

Abstract Background The COVID-19 pandemic has highlighted the importance of tailored preparedness plans to cope with potential disease outbreaks. During the pandemic, a major challenge for policymakers was finding the balance between containing the disease and supporting mental health and well-being. Although COVID-19 lockdowns and accompanying restrictions mitigated the spread of the virus, many countries witnessed significant increasing rate of depression during these periods. It is not clear the extent to which different lockdown scenarios impacted depression rates, and whether these effects might be felt in the future. Methods In this study, a microsimulation model, COMMA (COvid Mental-health Model with Agents), was developed to simulate behaviors of individuals under different lockdown scenarios, both actual and hypothetical, and of varying duration, sequence and severity. COMMA helps to understand how the prevalence of depression changed in each scenario. The characteristics of simulated population were synthesized based on health cohort data from Lifelines. The data included participants living in the Dutch city of Groningen during the pandemic. Results Preliminary results show that hard lockdowns resulted in increased rates of depression. Light lockdowns had smaller effects on depression rates. In all simulations with lockdowns, depression rates had almost rebounded to pre-COVID levels, although they remained slightly higher than in simulations with no lockdowns at all. Conclusions COMMA is the first microsimulation model to examine COVID-19 lockdowns’ impact on mental health, and offers important insights into the actual, hypothetical and potential effects of lockdowns on mental health. Key messages • Simulations showed that lockdown severity mattered, with hard lockdowns resulting in elevated rates of depression. • This study highlights that lockdowns are not without secondary health consequences, which may be important for policymakers to consider during future pandemics.

Assessing resilience though a health system performance lens

Abstract Health system resilience testing has generated keen interest since the COVID-19 pandemic but so far no methodology for this complex exercise exists. Our concept of resilience testing is inspired by the experience of stress tests in the banking sector. The novel approach is a mixed-method country-led exercise, which applies a health system lens to a particular shock scenario, and identifies vulnerabilities using the Health System Performance Assessment Framework for Universal Health and the Shock Cycle. In the first part of the presentation we describe the resilience testing methodology, based on the two conceptual frameworks. We share lessons from the required preparatory work: shock scenario selection, scope of background research, formation of a resilience testing group, resilience test day structure and process, and the facilitator's role. We also discuss the outcomes of the resilience testing process, which includes a formal assessment of the resilience of the health system. This will provide workshop participants with an overview of key concepts to conduct a country-led resilience testing exercise. The second part of the presentation focuses on the overarching results from the country-led pilots. These show that the resilience testing method can identify specific health system weaknesses at different stages of the shock cycle. Given the appropriate selection of resilience test facilitator and participants, the method can also detect system-wide challenges, shock implications and spill-overs. The participant interaction on the test day may identify key priorities for action and strengthen relevant national multiprofessional networks. Overall, the resilience testing approach is an important new tool to identify strengths and weaknesses of the current health system and in scenario-specific preparedness planning.

Health financing: the impact of shocks and its role in health system resilience

Abstract Introduction Health financing plays a vital role in the performance of the health system. Shocks can have a major impact on health financing but health financing can also protect aspects of the health system during shocks. Understanding the health financing function, how different types of shocks - including pandemics and the current cost-of-living crisis -- affect health financing, and how health financing can be resilient in the presence of shocks is of utmost importance Methods A framework for understanding health financing and how a shock can affect health financing was developed by the European Observatory on Health Systems and Policies. Health financing is broken down into revenue raising, pooling, purchasing and the governance of health financing, referred to as sub-functions of health financing. We use this framework to explore country examples in an effort to identify the ways in which health financing systems are resilient to different types of shocks. Findings There a range of examples demonstrating resilience to shocks across the sub-functions of health financing. First, there are counter-cyclical financing mechanisms where the revenues allocated to health are automatically adjusted to compensate for unemployment shocks (e.g. Lithuania). Second, there are purchasing practices that ensure resources are allocated appropriately within the health system when there are significant changes in utilization patterns, (e.g. Belgium during COVID-19). Third, automatic adjustment of prices occurs, paid by the health system to compensate for inflationary pressures. Fourth,good practices in the governance of health financing involve adjusted coverage policies to improve access to services when households were under severe financial strain (e.g. Ireland). Conclusions There are many different ways to ensure that health financing is resilient to shocks. Policymakers must consider the role of their health financing systems when developing preparedness plans.

Power and politics of health system data: how data shape responses and equity during pandemics

Abstract Background Pandemics disproportionately affect vulnerable groups. There are documented socioeconomic, gendered, and racialized differences in the burden of disease during COVID-19 and previous pandemics due to factors such as lack of access to social safety nets, poor quality of housing, and precarious working conditions. Therefore, equity should be a key principle for health system preparedness. However, the monitoring and detection of inequities largely depend on the availability of disaggregated data. Often, such data are not available nor are they utilized to promote equity-based approaches during major public health crises. Methods The article builds on social epidemiology and is conducted as a theoretical review. It uses health monitoring data collected in the Finnish health system and the Finnish response to COVID-19 as case studies to investigate how data shape equity and responses during rapidly unfolding crises. Finland provides an interesting context for the case studies due to its extensive and high-quality health registers and health monitoring data. Results In the article, we present a summary of the Finnish health system monitoring data infrastructure and a review of factors affecting data collection and utilization processes in Finland. We then describe how register data was utilized as a part of the Finnish response to COVID-19. Finally, we present an example of how the utilization of disaggregated vaccination coverage data helped create an equity-based community health promotion response during COVID-19 in Finland. Conclusions The article points out several understudied populations in the Finnish health system monitoring infrastructure, including those with lower incomes, undocumented immigrants, racialized minorities, and LGBT populations. While waiting for national health monitoring systems to “catch up”, smaller-scale community-based responses can be used to tackle inequities during health system crises. Key messages • Critical research approaches to health system data and data gaps are crucial since these data are the product of decisions, prioritization and value judgments made by health system actors themselves. • Revision work of pandemic preparedness plans across Europe needs to acknowledge how health system monitoring shape both responses and equity during crises.

Covid-19 among migrants, refugees, and internally displaced persons: systematic review and synthesis of the global empirical literature

Abstract National pandemic response and preparedness plans aim at mitigating the spread of infectious diseases and protecting public health. Yet, they often fail to consider migrants. Evidence from the pandemic's early phase indicates that migrants are disproportionally affected by the Covid-19 pandemic and its consequences. Yet, synthesized evidence quantifying the magnitude of inequalities in infection risk, consequences of disease, or consequences of public health measures is lacking. We conducted a systematic review of the literature from 12/2019 to 11/2021 to synthesise the empirical evidence in this field. We considered all types of articles and study designs. The synthesis of evidence was divided into qualitative and quantitative analysis. Out of 6961 studies we included 243 to describe the heterogenous research landscape in terms of design, population, country context, and outcomes reported. The qualitative synthesis (n = 44) highlights the complex interplay of social and Covid-19 related factors at macro-, meso- and micro-level, resulting in high exposure, risk of infection, impacts of public health measures, and health impacts for migrants. The meta-analysis of n = 45 quantitative studies shows that migrants have an elevated risk of infection (RR: 2.46 (95%CI: 1.96-3.07)) compared to non-migrants, but a similar risk of hospitalization (RR: 1.05 (95%CI: 0.80-1.37)). Among those hospitalized, migrants have a lower risk of mortality (RR: 0.57 (95%CI: 0.32-1.03)). Yet, population-based excess mortality tends to be higher among migrants compared to non-migrants (RR: 1.30 (95%CI: 0.90-1.89)). Overall, high heterogeneity in reporting and quality of primary studies hampered the comparability of data. The qualitative results highlight the syndemic nature of the crisis, with cascading effects and interactions among socio-economic and health inequalities. They also illustrate the lack of evidence on some migrant categories, e.g., labor migrants, undocumented migrants, and returnees.

Effects of Wildfire Events on California Radiation Oncology Clinics and Patients

PurposeThe impact of climate-driven events, such as wildfires, on healthcare delivery and cancer care is a growing concern. Patients with cancer undergoing radiotherapy are particularly vulnerable to treatment interruptions, which have a direct impact on survival. We report the results of a study characterizing the impact of wildfires on radiation oncology clinics and their patients. Methods and MaterialsA survey of California radiation oncologists was used to evaluate emergency preparedness and the impact of wildfires on the delivery of radiotherapy services between 2017-2022. Descriptive statistics and Pearson's chi-squared tests were performed to investigate potential relationships between provider characteristics, practice settings, and perceptions of the impact of wildfire events. California Department of Forestry and Fire Protection (CAL FIRE) data were employed to map the geographic distribution of wildfires to clinic locations. ResultsResponse rate was 12.3% (51/415 radiation oncologists), representing 25% of clinics (43/176) in 41% (24/58) of California counties. 61% (31/51) of respondents reported being impacted by a wildfire, two of which are rural clinics (100%, 2/2) and 29 are (59%, 29/49) metropolitan practices. Of these, 18% (9/51) reported a clinic closure, and 29% (15/51) reported staffing shortages. Respondents reported impacts on patients, including having to evacuate (55%, 28/51), cancel/reschedule treatments (53%, 27/51), and experiencing physical, mental, or financial hardship due to wildfires (45%, 23/51). Respondents described impacts on clinical operations, including being forced to transfer patients (24%, 12/51), transportation interruptions (37%, 19/51), regional/community evacuations (35%, 18/51), and physical/mental health impacts (27%, 14/51) on clinic personnel. Less than half of the respondents (47%, 24/51) reported their workplace had a wildfire emergency preparedness plan. Additionally, geographic analysis revealed that 100% (176/176) of clinics were located within 25 miles of a wildfire. ConclusionsThis study highlights the impact of wildfires on radiation oncology clinics and patients, and underscores the need for emergency preparedness planning to minimize the consequences of such disasters.

The Well-Being of Companion Animal Caregivers and Their Companion Animals during the COVID-19 Pandemic: Scoping Review.

It is important to understand the effects of the COVID-19 pandemic on animal caregivers and their companion animals in order to inform responses to future crises. Prior research is inconsistent, with the benefits of animal companionship believed to be overstated. In this scoping review, we searched four electronic databases and hand-searched reference lists of included studies. Over 4000 citations were found, and 122 were included in the review. Reflecting on the pre-COVID literature, quantitative evidence of the association between psychological well-being and animal companionship during the pandemic was mixed, with numerous positive, negative, and null findings reported. Studies highlighted the benefits of animal companionship during the pandemic, with animals reported to provide their caregivers with a routine, a sense of greater purpose, a positive distraction from COVID-19, companionship, and emotional support. However, participants also reported concerns about meeting animals' needs, fears of animals catching or spreading the virus, and financial worries. Concerns about what would happen to animals if caregivers were hospitalized led some to delay COVID-19 testing or treatment. Animals also experienced benefits (such as increased companionship and calmer mood) and negative impacts (such as increased clinginess and separation anxiety). Companion animals should be a key consideration in emergency preparedness plans.

The need for health system strengthening in the wake of natural disasters: Lessons from the 2023 Türkiye–Syria earthquake

AbstractThe 2023 Türkiye–Syria earthquake was reported as the largest earthquake of Mw7.8, resulting in over 50,783 and 7259 deaths in Turkey and Syria, respectively. It has also damaged numerous residential buildings and other essential infrastructures, thus rendering more than 850,000 children and 356,000 pregnant women homeless, forcing them into displacement and its dire consequences, such as inadequate temporary shelters, a lack of access to safe drinking water, sanitation and hygiene (WASH), necessary for disease prevention, health promotion and maintenance. The disaster has disproportionately affected the Syrian refugee community in Turkey as it has fuelled disparities and discrimination, exacerbating the response to the disaster and forcing refugees to return to Syria due to dire living conditions. Minimizing the effects of the disaster on the communities is therefore essential. There is a need to strengthen health system resilience and emergency response to natural disasters to reduce and prevent the aftermath. Disaster preparedness plans should include regulations that ensure that local buildings and infrastructure are disaster‐resistant. Furthermore, it is vital to highlight the importance of funding and appropriate resource allocation for disaster risk reduction. These include improving plans and logistics for recovery efforts, adequate preparation of temporary shelters and evacuation centres and allocating necessities such as food and water. Investment in proper search and rescue response, a special workforce for response and the rebuilding of important infrastructure are crucial. Finally, response to disasters must be inclusive and prioritize vulnerable populations, such as children, the aged women and refugees.

Prototype Pathogens for Vaccine and Monoclonal Antibody Countermeasure Development: NIAID Workshop Process and Outcomes for Viral Families of Pandemic Potential.

Given the increased risk of pandemics driven by emerging and reemerging infectious diseases, it is imperative that the United States and global scientific community be better prepared for future threats by prioritizing and launching key research programs and strategies. In December 2021, the National Institute of Allergy and Infectious Diseases (NIAID) published its pandemic preparedness plan, which focuses on the prototype pathogen approach for medical countermeasure development. The plan was introduced before its release at a NIAID-hosted workshop in November 2021 that featured scientific experts from the extramural community, government, and the private sector and focused on selection of prototype pathogens from 10 viral families with pandemic risk and moderate resources. This article will serve as an introduction to this special issue and will briefly define the prototype pathogen approach, describe the workshop goals and process for outcomes, and provide an outline of the viral working group articles to follow and future directions for NIAID.

Influences of Geohazard Susceptibility on the Geodiversity of the Coromandel Peninsula, New Zealand

Unexpected natural hazardous events can lead communities to create preparedness plans and identify risks associated with future devastating events. In the case of Cyclone Gabrielle, which resulted in catastrophic damage throughout the North Island of New Zealand, we recognised a need for models that could define the most hazardous areas in the Coromandel Peninsula with respect to the potential risk of hazardous influences on the anthroposphere as shaped by geodiversity. In this research, we utilise a qualitative-quantitative methodology for the assessment of hazard susceptibility applied to locations with varying levels of geodiversity on the Coromandel Peninsula. Because most of the geological sites displaying high values are located near cliff sides and/or along valleys, they are likely to align with hazardous areas. Utilising the same methodology for the recognition of two different parameters will provide an opportunity to compare results to find a potential similarity and/or correlation between geological locations and hazardous zones. Meanwhile, a flood prediction model has been analysed along with hazard susceptibility to recognise potential risks in the anthropological sphere (presented as buildings) on the Coromandel Peninsula. Our research results demonstrate a significant correlation between hazard susceptibility and geodiversity models, while flood prediction models together with the hazard model define vulnerable regions in the event of future natural events on the Coromandel Peninsula.

Forecasting pandemic quarantine in New Zealand and Australia: A scoping review of quarantine characteristics and capabilities within preparedness plans and pandemic exercise reports from 2002 to 2019

BackgroundThis scoping review aims to identify and critically review quarantine preparedness in New Zealand and Australia pre-COVID-19 by categorising, comparing, and evaluating quarantine information contained within pandemic plans and exercises from both countries. MethodsParliamentary websites, including Archives New Zealand, ParlInfo and Google Scholar, were searched for publicly available plans and exercise reports from 2002 to 2019. Data were extracted from documents meeting the inclusion criteria and analysed using directive content analysis based on the Australian Disaster Preparedness Framework categories. This scoping review followed the Joanna Briggs Institute methodology for scoping reviews, which guided the data extraction, analysis, and presentation of results. ResultsA total of 16 documents mentioned quarantine and were included in this scoping review. The emphasis and level of detail regarding quarantine characteristics and capabilities varied between New Zealand's five documents (one plan and four exercise reports) and Australia's 11 documents (one Influenza pandemic plan, eight state plans and two exercise reports). New Zealand’s plan forecasted the need for both voluntary quarantine at home and involuntary quarantine in facilities for incoming travellers, whilst the Australian Influenza pandemic plan and state plans primarily considered voluntary quarantine within private residences. Capability gaps identified during exercises were not consistently incorporated into revised plans. Some government documents containing information on quarantine may not be publicly available, limiting the available evidence for this review. ConclusionThis scoping review highlights the need to incorporate a range of possible quarantine options into plans and preparation activities to test and identify gaps in government and responsible agencies' capabilities. Pandemic preparedness will be strengthened by incorporating quarantine scale and duration variables into exercise scenarios.

Application of COVIDTracer to Inform Public Health Workforce Planning in Alaska During the COVID-19 Pandemic.

The COVID-19 pandemic has caused social and economic disruption worldwide and spurred numerous mitigation strategies, including state investments in training a large contact tracing and case investigation workforce. A team at the University of Alaska Anchorage evaluated implementation of the COVID-19 contact tracing and case investigation program of the State of Alaska Department of Health and Social Services, Division of Public Health, Section of Public Health Nursing. As part of that evaluation, the team used COVIDTracer, a spreadsheet modeling tool. COVIDTracer generated projections of COVID-19 case counts that informed estimates of workforce needs and case prioritization strategies. Case count projections approximated the reported epidemiologic curve with a median 7% difference in the first month. The accuracy of case count predictions declined after 1 month with a median difference of 80% in the second month. COVIDTracer inputs included previous case counts, the average length of time for telephone calls to cases and outreach to identified contacts, and the average number of contacts per case. As each variable increased, so too did estimated workforce needs. Decreasing the average time from exposure to outreach from 10 to 5 days reduced case counts estimated by COVIDTracer by approximately 93% during a 5-month period. COVIDTracer estimates informed Alaska's workforce planning and decisions about prioritizing case investigation during the pandemic. Lessons learned included the importance of being able to rapidly scale up and scale down workforce to adjust to a dynamic crisis and the limitations of prediction modeling (eg, that COVIDTracer was accurate for only about 1 month into the future). These findings may be useful for future pandemic preparedness planning and other public health emergency response activities.

Scoping Potential Routes to UK Civil Unrest via the Food System: Results of a Structured Expert Elicitation

We report the results of a structured expert elicitation to identify the most likely types of potential food system disruption scenarios for the UK, focusing on routes to civil unrest. We take a backcasting approach by defining as an end-point a societal event in which 1 in 2000 people have been injured in the UK, which 40% of experts rated as “Possible (20–50%)”, “More likely than not (50–80%)” or “Very likely (>80%)” over the coming decade. Over a timeframe of 50 years, this increased to 80% of experts. The experts considered two food system scenarios and ranked their plausibility of contributing to the given societal scenario. For a timescale of 10 years, the majority identified a food distribution problem as the most likely. Over a timescale of 50 years, the experts were more evenly split between the two scenarios, but over half thought the most likely route to civil unrest would be a lack of total food in the UK. However, the experts stressed that the various causes of food system disruption are interconnected and can create cascading risks, highlighting the importance of a systems approach. We encourage food system stakeholders to use these results in their risk planning and recommend future work to support prevention, preparedness, response and recovery planning.

“The measures taken by the government overburdened the daily practice” – insights of the PRICOV-19 study on German general practitioners in times of COVID-19

BackgroundThe international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures?MethodsThis study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models.ResultsThe response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures.ConclusionGPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans.

Improving Adaptive Capacity of Riverine Communities in Responding to Floods in Beledweyne District, Somalia

This study aimed at improving the adaptive capacity of riverine communities in responding to floods in Beledweyne district, Somalia. The objectives of the study were to examine the factors that determine flood vulnerability of riverine communities in responding to floods in Beledweyne District, Somalia, to assess the indicators of adaptive capacity of riverine communities in responding to floods in Beledweyne District, Somalia and to evaluate the adopted strategies for improving adaptive capacities to flood hazards by riverine communities of Beledweyne District, Somalia. The study employed quantitative research approach using descriptive research design to analyse the adaptive capacity of riverine communities in responding to floods in Beledweyne District, Somalia. The research used data collection tools like questionnaire, interview and documentary review to collect the data. The main findings of the study were that there are many factors determining flood vulnerability of riverine communities in responding to floods in Beledweyne District, Somalia like staying very close to the river increases community members’ vulnerability to floods in the areas, staying near the estuary to flood, staying near the high-water mark, staying near the river defense walls, staying near the basin bridge with poor condition and many others. Secondly, the findings of the study indicate that there are indicators of adaptive capacity of riverine communities in responding to floods in Beledweyne District, Somalia which they encompass: low level of emergency and preparedness plan and resources, low level of emergency and preparedness plan and resources, low improvement of livelihoods and rural economy in the flood prone areas and low improvement of livelihoods and rural economy in the flood prone areas. Furthermore, the findings of the study indicate that the recommend strategies for improving adaptive capacities to flood hazards by riverine communities of Beledweyne District, Somalia entail: continuous assessment of the sector and infrastructure vulnerability in the riverine communities, executing early actions to increase economic resilience in livelihoods, assessment of the critical infrastructure (roads, bridges, utilities, prevention of ad hoc basin defenses, favor non-structural solutions and preparation and implementation of effective early warning messages that reach marginalized groups of people. The study recommends that there should be preparation of medium-term development and spatial plans, there should be proper preparation of medium-term development and spatial plans in Beledweyne district, preparation of proper local plans and the district authority or leaders in collaboration with the national leaders should prepare proper local plans for riverine communities.

"We lost a lot, but something good came out of it too:" Exploring the impact of the COVID-19 pandemic on the mental wellbeing of British Muslim Pakistani women with family responsibilities.

The COVID-19 pandemic and associated restrictions caused major disruption globally, shedding light on the unprecedented strain upon the mental health and wellbeing of individuals around the world. Poor mental health in the pandemic is reported to be greater in women, with mothers being at increased risk. It is unclear whether there are differences in the impact of mental wellbeing on some ethnic groups over others. The aim of this study was to explore the experiences of British Muslim Pakistani women with family responsibilities during the COVID-19 pandemic, two years on from the first lockdown. Qualitative interviews with women were conducted via telephone using a semi-structured topic guide. The sample included 25 British Muslim Pakistani women with family responsibilities, both English and non-English speaking. Women lived in households that ranged in number and included extended family. Key themes were determined using thematic analysis. Results were grouped under three themes. These were (1) Community, cultural and religious contributors to poor mental wellbeing, (2) religious and cultural mediators of mental distress, and (3) perceived positive impact on lifestyle. British Muslim Pakistani women were psychologically distressed by the high rates of virus transmission and deaths in their communities and at the prospect of older members of their extended family developing the virus. The impact of restrictions on fundamental religious and cultural interactions further exacerbated poor mental wellbeing in this population. Religion, community social capital and larger household structures were all effective coping strategies for British Muslim Pakistani women. Positive impacts of the pandemic included becoming closer to family and faith, and increased work/life harmony. An exploration of religious and cultural coping mechanisms should be used to inform future national pandemic preparedness plans, as well as effective strategies for building and maintaining social capital. This may increase adherence to physical distancing and other protective behaviours in populations.

Extreme Arctic Weather and Community Impacts in Nunavut: A Case Study of One Winter’s Storms and Lessons for Local Climate Change Preparedness

Abstract Arctic communities are experienced with severe weather, but impacts can still be serious, particularly when the intensity or persistence of hazardous conditions is extreme. Such was the case for the community of Clyde River (Kangiqtugaapik), Nunavut, Canada, which experienced 33 blizzard days during winter 2021/22—likely the most at Clyde River since at least 1978/79. Blizzard conditions resulted from unusually frequent high winds rather than excessive snowfall. The most severe stretch included eight blizzard days over an 11-day period, with top wind gusts of 98 km h−1. Winds caused severe drifting, covering homes and blocking streets. Broken heavy equipment, including snow-clearing machines, compounded the impacts, leaving homes without essential services like water delivery and sewage pump-out for days. Residents reported the storms and resulting impacts as some of the worst in memory. The drifting and volume of snow, combined with the lack of available resources to manage it, obliged the community to declare a state of emergency. Projections of increased Arctic precipitation and extreme weather events points to the need for communities to have proper resources and supports, including preparedness and adaptation and mitigation strategies, so they can be better equipped to handle storm and blizzard impacts such as those experienced at Clyde River in the winter of 2021/22. Additional steps that can be implemented to better support and prepare communities include investing in preparedness planning, expanded and enhanced weather information and services, community land-based programming to transfer Inuit knowledge and skills, assessing the usefulness of current forecasts, and new approaches to community planning. Significance Statement In this study, we consider the winter of 2021/22, during which the community of Clyde River (Kangiqtugaapik), Nunavut experienced 33 days with blizzard conditions—more than any other year since at least 1978/79. Blizzards are characterized by strong winds and blowing snow. Low visibility impedes travel, and drifting snow blocks roads and can bury equipment and buildings. In this case, broken snow-clearing equipment and other infrastructure challenges also hampered the community’s ability to respond, and residents went days without essential services. Several studies suggest that extreme winds will become more common in the Baffin Bay region in the future. This study demonstrates the need for proper resourcing of communities for preparedness, response, and adaptation strategies, especially with the possibility of extreme winter weather becoming more common.