Psychoactive substance consumption after the Fundão dam mine tailing disaster in Minas Gerais State, Brazil.

Disasters cause changes in morbidity, mortality, and medicine use. Brazil is one of the main producers of mineral ores at great environmental cost. Mine tailings are stored in dams and ruptures have led to major disasters. We investigated the consumption of psychoactive medicines in the municipalities affected by the Fundão dam disaster in Minas Gerais State. An ecological study was carried out on drug consumption, estimated using public purchases in Minas Gerais and dispensing data from private retail pharmacies. Consumption (in number of defined daily doses/100,000 inhabitants per day) was analyzed descriptively in eight municipalities, stratified according to consumption level during a 25-month period. Six comparisons of mean consumption values for both data sets were done for pre- and post-disaster periods. The means of medicine consumption before and after the event were plotted and linear trends were added. Public purchase data evinced high consumption levels. Only pharmaceutical retail showed significant differences between the strata in the pre-disaster versus two post-disaster periods. Smaller municipalities showed an increase in consumption 15 months after the disaster. Clonazepam led the way in pharmaceutical retail consumption, followed by fluoxetine. Medicines showed an upward trend after the disaster. The high public provision may have stifled significant consumption patterns of psychoactive drugs; however, peak consumption were observed in private retail, suggesting a modification in use patterns after the disaster. The decrease in consumption immediately after the event was probably related to lower care-seeking behavior on the part of the population, and significant peaks after the disaster may reflect economic consequences of it.

Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes.

The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.

Mental Health Services Utilization by the Population That Suffered Water Supply Interruption Following Mariana Dam Failure (Brazil).

OBJECTIVE: Disasters may have major impacts to mental health and to the utilization of mental health services (MHS). Moreover, these effects may be worsened by the preclusion of access to basic services following the event. The aim of this study is to evaluate the utilization of public MHS by the population that suffered water supply interruption following the Mariana Dam Failure in Brazil, 2015. METHODS: We conducted an Interrupted Time Series analyzing secondary health data from the municipalities that faced water supply interruption, comparing it to data from the other municipalities of Minas Gerais state. RESULTS: We found a higher immediate (RR: 1.78; 95% CI: 1.25-2.53) and gradual (RR: 1.05; 95% CI: 1.03-1.06) change in the rate of mental health visits (MHV) in the affected population following the event, whereas there was an immediate fall (RR: 0.41; 95% CI: 0.29-0.59) followed by a higher gradual increase (RR: 1.04; 95% CI: 1.02-1.06) in the rate of hospital admissions (HA) in the affected population. CONCLUSION: The results suggest that there was an increase in the utilization of public MHS by the population that suffered water supply interruption following the disaster.

Health Emergency and Disaster Risk Management Workforce Development Strategies: Delphi Consensus Study.

INTRODUCTION: Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM). STUDY OBJECTIVE: The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC). METHODS: A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking. RESULTS: In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were "Human Resources" (n = 15), "Planning and Coordination" (n = 7), and "Community Capacities for Health EDRM" (n = 6) in the LMIC group. "Policies, Strategies, and Legislation" (n = 7) and "Human Resources" (n = 7) were the components with the most recommendations for the HIC group. CONCLUSION: The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.

Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service.

We aim to evaluate whether the first National Emergency Medical Service (NEMS) improved access to hospital care for the people of Sierra Leone. We performed an interrupted time-series analysis to assess the effects of NEMS implementation on hospital admissions in 25 facilities. The analysis was also replicated separately for the area of Freetown and the rest of the country. The study population was stratified by the main Free Health Care Initiative (FHCI) categories of pregnant women, children under 5 years of age, and populations excluded from the FHCI. Finally, we calculated direct costs of the service. We report a 43% overall increase in hospital admissions immediately after NEMS inception (RR 1.43; 95% CI 1.2-1.61). Analyses stratified by FHCI categories showed a significant increase among pregnant women (RR 1.54; 95% CI 1.33-1.77) and among individuals excluded from the FHCI (RR 2.95; 95% CI 2.47-3.53). The observed effect was mainly due to the impact of NEMS on the rural districts. The estimated recurrent cost per ambulance ride and NEMS yearly cost per inhabitant were 124 and 0.45 USD, respectively. To our knowledge, this is the first nationwide study documenting the increase in access to healthcare services following the implementation of an ambulance-based medical service in a low-income country. Based on our results, NEMS was able to overcome the existing barriers of geographical accessibility and transport availability, especially in the rural areas of Sierra Leone.

Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations.

The Sendai Framework for Disaster Risk Reduction 2015-2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster risk management across prevention, preparedness, readiness, response, and recovery to improve the resilience and health security of communities, countries, and health systems. Evidence-based Health EDRM workforce development is vital. However, there are still significant gaps in the evidence identifying common competencies for training and education programmes, and the clarification of strategies for workforce retention, motivation, deployment, and coordination. Initiated in June 2020, this project includes literature reviews, case studies, and an expert consensus (modified Delphi) study. Literature reviews in English, Japanese, and Chinese aim to identify research gaps and explore core competencies for Health EDRM workforce training. Thirteen Health EDRM related case studies from six WHO regions will illustrate best practices (and pitfalls) and inform the consensus study. Consensus will be sought from global experts in emergency and disaster medicine, nursing, public health and related disciplines. Recommendations for developing effective health workforce strategies for low- and middle-income countries and high-income countries will then be disseminated.

A nationwide peer-assisted learning program in disaster medicine for medical students.

OBJECTIVES: The Sendai Framework advocates the importance of training in disaster medicine as a way to improve health system resilience. In Italy, despite the official recognition of disaster medicine as a mandatory discipline in the standard curriculum, most students are never exposed to its basic concepts. DisasterSISM is a nationwide educational program in disaster medicine developed in 2008. Given the scarcity of experienced instructors, in 2013, the course adopted a peer-assisted learning (PAL) approach to correct the omission identified in the national curriculum. The new approach involved a training of trainers (ToT) and a basic course organized and delivered by certified student teachers. METHODS: The authors gathered and analyzed data from demographic questionnaires, pretest and posttests, and satisfaction questionnaires. RESULTS: From 2013 to 2018, 42 medical students attended the ToT becoming student teachers. From 2014 to 2018, 2316 medical students attended the basic course delivered by the student teachers across Italy. Thirty-six out of 41 medical schools were reached. Participation in the program improved students' knowledge in disaster medicine. Participants were satisfied with both the course structure and its PAL approach and considered disaster medicine to be highly relevant for their future professional career. CONCLUSIONS: By presenting this nationwide program and its outcomes, the authors hope to strengthen the case for including disaster medicine education in the standard medical curriculum. Because the course relies on medical students and PAL, the authors trust that it could be adapted to other countries worldwide.

Threat Perception and Public Preparedness for Earthquakes in Italy.

INTRODUCTION: Italy is prone to major earthquakes and has experienced several devastating earthquakes in the far and recent past. The objectives of this study were to assess the level of Italian households' preparedness for earthquakes and to measure the public's perception of the risk and its impact on preparedness behavior. HYPOTHESIS: Italian households' preparedness for earthquakes is insufficient and is influenced by different threat perception components that were assessed. METHODS: A cross-sectional study, using an online questionnaire, was conducted in early 2018. The sample included 1,093 responders from a diverse sociodemographic background. The primary outcome was the Preparedness Index (PI), a score indicating the number of preparedness actions complied-with out of 10. RESULTS: The PI's mean was 5.26 (SD = 2.17). The recommendation most complied-with was keeping a flashlight at home (87.7%) and the least was securing the kitchen cupboards (15.1%). The PI was positively correlated with a higher sense of preparedness (r = 0.426; P <.001). The PI was higher for responders residing in high-seismic-risk areas and those who experienced a major earthquake before. The predictors of PI were: gender, age, prior experience, sense of preparedness, searching for information, and threat intrusiveness (negatively). CONCLUSIONS: The findings demonstrate a medium-level of preparedness; however, this might be circumstantial. Italians perceive major earthquakes to be unlikely, yet severe if and when they do occur. A validated tool in Italian now exists and can be used in future studies.Bodas M, Giuliani F, Ripoll-Gallardo A, Caviglia M, Dell'Aringa MF, Linty M, Della Corte F, Ragazzoni L. Threat perception and public preparedness for earthquakes in Italy. Prehosp Disaster Med. 2019;34(2):114-124.

Rio's Mountainous Region ("Região Serrana") 2011 Landslides: Impact on Public Mental Health System.

INTRODUCTION In January 2011 landslides and floods followed heavy rain in the Mountainous Region of Rio de Janeiro State ("Região Serrana"), in southeastern Brazil. These events led to the largest disaster registered in Brazilian recent history. Few studies addressed the impacts of this disaster on public health, and we found none addressing the impact on mental health. This study reviewed the consequences of the 2011 disaster in the "Região Serrana", by comparing the demand for public mental health assistance data from time periods before and after the even  METHODS  We performed an ecologic study, analysing the aggregate data from "Região Serrana" during the period two years before and after the disaster, exporting data from the Brazilian open access public health database. The primary outcome was defined as Mental Health Care Demand, and for that we calculated the number of mental health care visits per month, the proportion of visits due to mental health care and the monthly absolute number of mental health care visits per CAPS - "Centro de Atenção Psicossocial" (Psychosocial Care Centre). For secondary outcomes we evaluated the total number of deaths by any reason, and the total number of hospitalizations. The other health administrative regions of Rio de Janeiro state were used as control group.  RESULTS  We observed that there was an important increase in the rate of visits due to mental health in the six months after the landslides, from 13,875 to 17,690, reaching its maximum one year after the event totalizing 21,980 visits (Dec 2011). It was also observed that the proportion of visits due to mental health disorders increased after the event in the "Região Serrana", as well as the number of mental health care visits per CAPS.   DISCUSSION  In conclusion, we observed that the 2011 Landslides in "Região Serrana" led to a sustained higher burden to public mental health care. There was an increase in the demand for mental health visits, and the ratio of visits per CAPS was higher during most part of the studied period after the event, even with the region having more CAPS than before.