Displacement during Hurricane Sandy: The impact on mental health.

OBJECTIVE: To assess the effect of displacement due to Hurricane Sandy on mental health outcomes among residents of the greater New York City (NYC) area. DESIGN: Prospective, cross sectional. SETTING: NYC area residents, including Queens, Staten Island, and Long Island. PARTICIPANTS: In a 4.25 year period (June 2012 to September 2016), a convenience sample of 1,615 adult residents from the greater NYC area completed validated measures of hurricane exposure (including displacement), perceived stress, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms as well as indicators of alcohol, illicit substance, and tobacco use. MAIN OUTCOME MEASURES: Perceived stress, depression, anxiety and PTSD symptoms and alcohol, illicit substance, and tobacco use. RESULTS: Multivariable analyses indicated that displaced participants were more likely to have PTSD (adjusted odds ratio [AOR]: 2.21, 95% CI: 1.73-2.82), depression (AOR: 1.37, 95% CI: 1.05-1.79) and anxiety symptoms (AOR: 1.30, 95% CI: 1.01-1.67) and had a 1.16 unit increase in perceived stress score (SE = 0.38) compared to nondisplaced participants. Staying with friends/family versus at a shelter was significantly associated with a 48 percent decreased odds of having PTSD symptoms (AOR: 0.52, 95% CI: 0.31-0.88) and of being a current tobacco user (AOR: 0.52, 95% CI: 0.30-0.92). CONCLUSIONS: Displacement is associated with negative mental health outcomes, particularly displacement to shelters. Disaster preparedness efforts should involve increasing mental health resources to those who are displaced and providing support services within the shelter setting.

Thoracic surgeon and patient focus groups on decision-making in early-stage lung cancer surgery.

AIM: To investigate medical decision-making from the thoracic surgeons' and patients' perspectives in early-stage lung cancer. PATIENTS & METHODS: We conducted one focus group with thoracic surgeons (n = 15) and one with a group of early-stage lung cancer patients treated with surgery (n = 7). Focus groups were recorded, transcribed and coded for themes. RESULTS: For surgeons, surgical procedure choice was a primary concern, followed by the surgical treatment plan decision-making process. Survivors focused primarily on the physical and mental health-related postsurgical burden for which they felt they were not well prepared and placed less emphasis on surgical decision-making. CONCLUSION: As early-stage lung cancer mortality rates are improving, surgeons and patients can prioritize surgical approaches and postsurgical care that enhance quality of life.

The lasting mental health effects of Hurricane Sandy on residents of the Rockaways.

OBJECTIVE: To examine the impact of Hurricane Sandy on the mental health and substance use of residents of the Rockaways, which is a lower income, ethnically diverse region of NYC that was devastated by the hurricane. DESIGN: Prospective, cross sectional. SETTING: Rockaways, Queens, NYC community residents. PARTICIPANTS: From October 2013 to April 2015, 407 adult residents of the Rockaways completed self-report, validated measures of depression, anxiety, and post-traumatic stress symptoms as well as indicators of substance use (alcohol, illicit substance, and tobacco use) and exposure to Hurricane Sandy. MAIN OUTCOME MEASURES: Depression, anxiety, post-traumatic stress, alcohol use, illicit substance use, and tobacco use. RESULTS: Differences in exposure scores on outcomes were compared using Wilcoxon tests. Associations between hurricane exposure (categorized into "personal" and "property" exposure) and outcomes were investigated using logistic regression, adjusting for demographic covariates, mental health history, and time since hurricane. The study participants were predominately female (57.5 percent) and black (63.9 percent) and average age was 44.7 years. Multivariable results showed that property exposure scores were positively associated with increased risks of mental health difficulties across all three mental health symptom outcomes, but not substance use. Increased personal and total exposures were also significantly associated with increased Posttraumatic Stress Disorder symptoms. Substance use variables were not significantly associated with any of the hurricane exposure indicators. CONCLUSIONS: The present study quantifies the lasting impact that Hurricane Sandy has had on the mental health of Rockaways residents indicating the need for continued recovery efforts and increased mental health service provision in this vulnerable region.

Myelodysplastic syndromes spatial clusters in disease etiology and outcome.

The myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic disorders. This study aims to advance the use of spatial modeling in disease etiology and monitoring based on reports on a large population (n = 984) of MDS patients diagnosed in the Eastern United States. The spatial MDS clustering was analyzed using SaTScan, and patient clinical characteristics were analyzed using logistic regression and Cox hazards models adjusting for covariates. One main and five secondary spatial clusters (p-value < 10-17-10-7) were identified. Patients living in high vs. low MDS incidence clusters tended to be older (ORadj = 1.04 [1.004, 1.07]) and smokers (ORadj = 2.9 [1.1, 7.4]). Mortality was associated with hemoglobin (HRadj = 0.7 [0.5, 0.9]), neutrophils (HRadj = 0.7 [0.6, 0.96]), platelets (HRadj = 0.5 [0.4, 0.7]), and blast (HRadj = 1.4 [1.1, 1.8]), but not clusters. The results suggest large geographic variations in MDS incidence rates. The biological aggressiveness of the disease is unlikely to be associated with its spatial distribution.