Treatment Interruptions and Mortality Among Puerto Rican Women With Gynecologic Cancers in Puerto Rico After Hurricanes Irma and María: A Retrospective Cohort Study.

OBJECTIVE: Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María. METHODS: A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed. RESULTS: Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment (P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01). CONCLUSIONS: Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.

Evacuation and Health Care Outcomes Among Assisted Living Residents After Hurricane Irma.

Importance: Evacuation has been found to be associated with adverse outcomes among nursing home residents during hurricanes, but the outcomes for assisted living (AL) residents remain unknown. Objective: To examine the association between evacuation and health care outcomes (ie, emergency department visits, hospitalizations, mortality, and nursing home visits) among Florida AL residents exposed to Hurricane Irma. Design, Setting, and Participants: Retrospective cohort study using 2017 Medicare claims data. Participants were a cohort of Florida AL residents who were aged 65 years or older, enrolled in Medicare fee-for-service, and resided in 9-digit zip codes corresponding to US assisted living communities with 25 or more beds on September 10, 2017, the day of Hurricane Irma's landfall. Propensity score matching was used to match evacuated residents to those that sheltered-in-place based on resident and AL characteristics. Data were analyzed from September 2022 to February 2024. Exposure: Whether the AL community evacuated or sheltered-in-place before Hurricane Irma made landfall. Main Outcomes and Measures: Thirty- and 90-day emergency department visits, hospitalizations, mortality, and nursing home admissions. Results: The study cohort included 25 130 Florida AL residents (mean [SD] age 81 [9] years); 3402 (13.5%) evacuated and 21 728 (86.5%) did not evacuate. The evacuated group had 2223 women (65.3%), and the group that sheltered-in-place had 14 556 women (67.0%). In the evacuated group, 42 residents (1.2%) were Black, 93 (2.7%) were Hispanic, and 3225 (94.8%) were White. In the group that sheltered in place, 490 residents (2.3%) were Black, 707 (3.3%) were Hispanic, and 20 212 (93.0%) were White. After 1:4 propensity score matching, when compared with sheltering-in-place, evacuation was associated with a 16% greater odds of emergency department visits (adjusted odds ratio [AOR], 1.16; 95% CI, 1.01-1.33; P = .04) and 51% greater odds of nursing home visits (AOR, 1.51; 95% CI, 1.14-2.00; P = .01) within 30 days of Hurricane Irma's landfall. Hospitalization and mortality did not vary significantly by evacuation status within 30 or 90 days after the landfall date. Conclusions and Relevance: In this cohort study of Florida AL residents, there was an increased risk of nursing home and emergency department visits within 30 days of Hurricane Irma's landfall among residents from communities that evacuated before the storm when compared with residents from communities that sheltered-in-place. The stress and disruption caused by evacuation may yield poorer immediate health outcomes after a major storm for AL residents. Therefore, the potential benefits and harms of evacuating vs sheltering-in-place must be carefully considered when developing emergency planning and response.

Global population profile of tropical cyclone exposure from 2002 to 2019.

Tropical cyclones have far-reaching impacts on livelihoods and population health that often persist years after the event1-4. Characterizing the demographic and socioeconomic profile and the vulnerabilities of exposed populations is essential to assess health and other risks associated with future tropical cyclone events5. Estimates of exposure to tropical cyclones are often regional rather than global6 and do not consider population vulnerabilities7. Here we combine spatially resolved annual demographic estimates with tropical cyclone wind fields estimates to construct a global profile of the populations exposed to tropical cyclones between 2002 and 2019. We find that approximately 560 million people are exposed yearly and that the number of people exposed has increased across all cyclone intensities over the study period. The age distribution of those exposed has shifted away from children (less than 5 years old) and towards older people (more than 60 years old) in recent years compared with the early 2000s. Populations exposed to tropical cyclones are more socioeconomically deprived than those unexposed within the same country, and this relationship is more pronounced for people exposed to higher-intensity storms. By characterizing the patterns and vulnerabilities of exposed populations, our results can help identify mitigation strategies and assess the global burden and future risks of tropical cyclones.

Seasonal advance of intense tropical cyclones in a warming climate.

Intense tropical cyclones (TCs), which often peak in autumn1,2, have destructive impacts on life and property3-5, making it crucial to determine whether any changes in intense TCs are likely to occur. Here, we identify a significant seasonal advance of intense TCs since the 1980s in most tropical oceans, with earlier-shifting rates of 3.7 and 3.2 days per decade for the Northern and Southern Hemispheres, respectively. This seasonal advance of intense TCs is closely related to the seasonal advance of rapid intensification events, favoured by the observed earlier onset of favourable oceanic conditions. Using simulations from multiple global climate models, large ensembles and individual forcing experiments, the earlier onset of favourable oceanic conditions is detectable and primarily driven by greenhouse gas forcing. The seasonal advance of intense TCs will increase the likelihood of intersecting with other extreme rainfall events, which usually peak in summer6,7, thereby leading to disproportionate impacts.

Health Care Utilization Among Texas Veterans Health Administration Enrollees Before and After Hurricane Harvey, 2016-2018.

Importance: Hurricanes and flooding can interrupt health care utilization. Understanding the magnitude and duration of interruptions, as well as how they vary according to hazard exposure, race, and income, are important for identifying populations in need of greater retention in care. Objective: To determine how the differential exposure to Hurricane Harvey in August 2017 is associated with changes in utilization of Veterans Health Administration health care. Design, Setting, and Participants: This is a retrospective cohort analysis of primary care practitioner (PCP) visits, emergency department visits, and inpatient admissions in the Veterans Health Administration among Texas veterans residing in counties impacted by Hurricane Harvey from 2016 to 2018. Data analysis was performed from September 2020 to May 2021. Exposures: Residential flooding after Hurricane Harvey. Main Outcomes and Measures: Interrupted time series analysis measured changes in health care utilization over time, stratified by residential flood exposure, race, and income. Results: Of the 99 858 patients in the cohort, 89 931 (90.06%) were male, and their median (range) age was 58 (21 to 102) years. Compared with veterans in nonflooded areas, veterans living in flooded areas were more likely to be Black (24 715 veterans [33.80%] vs 4237 veterans [15.85%]) and low-income (14 895 veterans [20.37%] vs 4853 veterans [18.15%]). Rates of PCP visits decreased by 49.78% (95% CI, -64.52% to -35.15%) for veterans in flooded areas and by 45.89% (95% CI, -61.93% to -29.91%) for veterans in nonflooded areas and did not rebound until more than 8 weeks after the hurricane. Rates of PCP visits in flooded areas remained lower than expected for 11 weeks among White veterans (-6.99%; 95% CI, -14.36% to 0.81%) and for 13 weeks among racial minority veterans (-7.22%; 95% CI, -14.11% to 0.30%). Low-income veterans, regardless of flood status, experienced greater suppression of PCP visits in the 8 weeks following the hurricane (-13.72%; 95% CI, -20.51% to -6.68%) compared with their wealthier counterparts (-9.63%; 95% CI, -16.74% to -2.26%). Conclusions and Relevance: These findings suggest that flood disasters such as Hurricane Harvey may be associated with declines in health care utilization that differ according to flood status, race, and income strata. Patients most exposed to the disaster also had the greatest delay or nonreceipt of care.

Local information sources received the most attention from Puerto Ricans during the aftermath of Hurricane Maria.

In September 2017, Hurricane Maria made landfall across the Caribbean region as a category 4 storm. In the aftermath, many residents of Puerto Rico were without power or clean running water for nearly a year. Using both English and Spanish tweets from September 16 to October 15 2017, we investigate discussion of Maria both on and off the island, constructing a proxy for the temporal network of communication between victims of the hurricane and others. We use information theoretic tools to compare the lexical divergence of different subgroups within the network. Lastly, we quantify temporal changes in user prominence throughout the event. We find at the global level that Spanish tweets more often contained messages of hope and a focus on those helping. At the local level, we find that information propagating among Puerto Ricans most often originated from sources local to the island, such as journalists and politicians. Critically, content from these accounts overshadows content from celebrities, global news networks, and the like for the large majority of the time period studied. Our findings reveal insight into ways social media campaigns could be deployed to disseminate relief information during similar events in the future.

Hurricanes and hashtags: Characterizing online collective attention for natural disasters.

We study collective attention paid towards hurricanes through the lens of n-grams on Twitter, a social media platform with global reach. Using hurricane name mentions as a proxy for awareness, we find that the exogenous temporal dynamics are remarkably similar across storms, but that overall collective attention varies widely even among storms causing comparable deaths and damage. We construct 'hurricane attention maps' and observe that hurricanes causing deaths on (or economic damage to) the continental United States generate substantially more attention in English language tweets than those that do not. We find that a hurricane's Saffir-Simpson wind scale category assignment is strongly associated with the amount of attention it receives. Higher category storms receive higher proportional increases of attention per proportional increases in number of deaths or dollars of damage, than lower category storms. The most damaging and deadly storms of the 2010s, Hurricanes Harvey and Maria, generated the most attention and were remembered the longest, respectively. On average, a category 5 storm receives 4.6 times more attention than a category 1 storm causing the same number of deaths and economic damage.

Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause.

The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.

Movements of marine and estuarine turtles during Hurricane Michael.

Natural disturbances are an important driver of population dynamics. Because it is difficult to observe wildlife during these events, our understanding of the strategies that species use to survive these disturbances is limited. On October 10, 2018, Hurricane Michael made landfall on Florida's northwest coast. Using satellite and acoustic telemetry, we documented movements of 6 individual turtles: one loggerhead sea turtle, one Kemp's ridley sea turtle, three green sea turtles and one diamondback terrapin, in a coastal bay located less than 30 km from hurricane landfall. Post-storm survival was confirmed for all but the Kemp's ridley; the final condition of that individual remains unknown. No obvious movements were observed for the remaining turtles however the loggerhead used a larger home range in the week after the storm. This study highlights the resiliency of turtles in response to extreme weather conditions. However, long-term impacts to these species from habitat changes post-hurricane are unknown.

Physical Health Symptoms and Hurricane Katrina: Individual Trajectories of Development and Recovery More Than a Decade After the Storm.

Objectives. To examine how physical health symptoms developed and resolved in response to Hurricane Katrina.Methods. We used data from a 2003 to 2018 study of young, low-income mothers who were living in New Orleans, Louisiana, when Hurricane Katrina struck in 2005 (n = 276). We fit logistic regressions to model the odds of first reporting or "developing" headaches or migraines, back problems, and digestive problems, and of experiencing remission or "recovery" from previously reported symptoms, across surveys.Results. The prevalence of each symptom increased after Hurricane Katrina, but the odds of developing symptoms shortly before versus after the storm were comparable. The number of traumatic experiences endured during Hurricane Katrina increased the odds of developing back and digestive problems just after the hurricane. Headaches or migraines and back problems that developed shortly after Hurricane Katrina were more likely to resolve than those that developed just before the storm.Conclusions. While traumatic experiences endured in disasters such as Hurricane Katrina appear to prompt the development of new physical symptoms, disaster-induced symptoms may be less likely to persist or become chronic than those emerging for other reasons.

Hurricane Katrina and the Gulf Oil Spill: Lessons learned about short-term and long-term effects.

The impact and lessons learned from Hurricane Katrina and the Gulf Oil Spill are described as an example of work done reflecting best practices and theory to gain a better understanding of risk and resilience for children and families. Hurricane Katrina, described as the worst natural disaster in the US history, resulted in traumatic separations of children and families and devastation of communities and schools. The impact was greater on families with fewer resources before the hurricane who were provided limited support to return and rebuild. Insufficient community support and economic resources contributed to prolonged traumatiaation and slow recovery. Many were still recovering from Hurricane Katrina when impacted by the Gulf Oil Spill. For families with multigenerational ties to the fishing and oil industries, the Gulf Oil Spill resulted in both cumulative trauma and increased risk. In implementing the behavioural health response, much was learned about promotive and protective factors for individual and community resilience. Services provided following the disasters were based on precepts of individual, family, and community resilience. To enhance recovery and support resilience, the development of regional coalitions across at risk areas provides important coordination before disasters occur for better preparation and response.

Reporte de Situacion Emergencia por Huracan IOTA y temporada de lluvias Colombia No. 09: 05 de diciembre 2020 / Emergency Situation Report for Hurricane IOTA and rainy season Colombia No. 09: December 05, 2020

A la fecha Colombia reporta 1.334.089 casos (9.297 casos nuevos en las últimas 24h) con un incremento nacional del 0,7% en las últimas 24h y 37.117 defunciones (183 las últimas 24 Horas) con un aumento nacional del 0,5% en las últimas 24h. Los departamentos y distritos que presentaron los aumentos relativos más altos de COVID-19 en los últimos 7 días fueron: Caldas 11,9% (2.070), Quindío 11,5% (1.397), Tolima 11,5% (2.445), Norte Santander 10,3% (2.075), Boyacá 9,3% (1.302), Casanare 9,0% (504), Cartagena 8,7% (2.044), Risaralda 7,8% (1.297), Santa Marta 7,3% (765), Santander 7,1% (2.658). La tasa de incidencia nacional es de 2.648,5 casos por cada 100.000 habitantes; los departamentos y/o distritos que superan la tasa nacional son en su orden: Bogotá (4.905,8), Amazonas (3.992,7), Barranquilla (3.590,0), San Andrés (3.433,7), Caquetá (3.275,8), Antioquia (3.247,0), Quindío (3.157,9), Cartagena (3.107,4), Huila (2.713,3), Meta (2.686,8). La tasa de mortalidad nacional es de 736,9 muertes por cada millón de habitantes; se observa una tasa de mortalidad mayor a la nacional en: Amazonas (1.556,6), Barranquilla (1.375,7), Caquetá (1.169,2), Bogotá (1.110,5), Santa Marta (943,2), Córdoba (904,3), Santander (893,5), Huila (870,3), Norte Santander (865,9), Quindío (831,8), Valle del Cauca (778,9).

Food Insecurity in the Post-Hurricane Harvey Setting: Risks and Resources in the Midst of Uncertainty.

Food insecurity is of heightened concern during and after natural disasters; higher prevalence is typically reported in post-disaster settings. The current study examines food insecurity prevalence and specific risk/resource variables that may act as barriers or advantages in accessing food in such a setting. Using a modified quota sample (n = 316), Hurricane Harvey survivors participated in face-to-face interviews and/or online surveys that assessed health, social and household factors, and sociodemographic characteristics. Using logistic regression analyses we find that social vulnerabilities, circumstantial risk, and social and psychological resources are important in determining the odds of food insecurity. Hispanic and/or Nonwhite survivors, renters, and those persons displaced during the natural disaster have higher food insecurity odds. Survivors with stronger social ties, higher levels of mastery, and a greater sense of connectedness to their community are found to have lower food insecurity odds. A more nuanced analysis of circumstantial risk finds that while the independent effects of displacement and home ownership are important, so too is the intersection of these two factors, with displaced-renters experiencing significantly higher odds than any other residence and displacement combinations, and particularly those who are homeowners not displaced during the disaster. Strategies for addressing differential risks, as well as practical approaches for implementation and education programming related to disaster recovery, are discussed.

Reporte de situacion emergencia por huracan IOTA y temporada de lluvias Colombia No. 05: 23 de Noviembre 2020 / Emergency situation report due to hurricane IOTA and rainy season Colombia No. 05: 23 November 2020

Según el reporte informativo N°170 del IDEAM la habitual temporada de lluvias que se registra cada año para esta época, sumado a la influencia del Fenómeno La Niña y a una actividad ciclónica muy activa, ha generado que las lluvias de este segundo semestre del 2020 hayan aumentado considerablemente. Estas precipitaciones han generado que departamentos como Antioquia, Bolívar, Chocó, La Guajira, Magdalena, Norte de Santander y el Archipiélago de San Andrés, Providencia y Santa Catalina hayan tenido situaciones de emergencia más complejas.

The Paradoxical Effects of Hurricane Katrina on Births and Adverse Birth Outcomes.

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.

Social cohesion and quality of life among survivors of a natural disaster.

PURPOSE: The purpose of the current study was to examine the association between social cohesion and two domains of quality of life (QOL) among individuals affected by Hurricane Ike, which made landfall on September 13, 2008. Psychosocial and physical QOL were measured using the Short form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF; Endicottn et al. in Psychopharmacol Bull 29: 321-326, 1993). METHODS: The participants were 658 survivors who participated in the Galveston Bay Recovery Study (GBRS; National Center for Disaster Mental Health Research, Galea, and Norris in Galveston Bay Recovery Study, 2008-2010, Inter-university Consortium for Political and Social Research [distributor], Ann Arbor, MI, https://doi.org/10.3886/ICPSR34801.v1 , 2016). Assessments were conducted at approximately 3, 6, and 15 months after the disaster. Longitudinal structural equation modeling was conducted to examine the association between social cohesion and both psychosocial and physical QOL at 6 and 15 months after the hurricane. RESULTS: The results revealed no significant association between social cohesion and physical QOL at either 6 or 15 months. Furthermore, no association was found between social cohesion and psychosocial QOL at 6 months. However, there was a significant positive association between social cohesion and psychosocial QOL at 15 months, even after controlling for the previous levels of posttraumatic stress and demographic variables. CONCLUSION: The current study highlights a potential effect of social cohesion on QOL, specifically the psychosocial domain, which may manifest after 6 months among survivors of a hurricane. The current results also suggest the importance of long-term programs and interventions to help survivors adjust after experiences of disaster.

Mitigating the Twin Threats of Climate-Driven Atlantic Hurricanes and COVID-19 Transmission.

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.