Saharan dust, climate variability, and asthma in Grenada, the Caribbean.

Saharan dust is transported across the Atlantic and interacts with the Caribbean seasonal climatic conditions, becoming respirable and contributing to asthma presentments at the emergency department. This study investigated the relationships among dust, climatic variables, and asthma-related visits to the emergency room in Grenada. All asthma visits to the emergency room (n = 4411) over 5 years (2001-2005) were compared to the dust cover and climatic variables for the corresponding period. Variation in asthma was associated with change in dust concentration (R(2) = 0.036, p < 0.001), asthma was positively correlated with rainfall (R(2) = 0.055, p < 0.001), and rainfall was correlated with dust (R(2) = 0.070, p = 0.003). Despite the similarities and the short distance between Trinidad, Barbados, and Grenada, they have markedly different geographies, cultures, population sizes, industrialization level, and economies. Therefore, different than from the studies in Trinidad and Barbados, Grenada is a non-industrialized low-income small island without major industrialized air pollution addition; asthma visits were inversely related to mean sea level pressure (R(2) = 0.123, p = 0.006) and positively correlated with relative humidity (R(2) = 0.593, p = 0.85). Saharan dust in conjunction with seasonal humidity allows for inhalable particulate matter that exacerbates asthma among residents in the Caribbean island of Grenada. These findings contribute evidence suggesting a broader public health impact from Saharan dust. Thus, this research may inform strategic planning of resource allocation among the Caribbean public health agencies.

Disparate health implications stemming from the propensity of elderly and medically fragile populations to shelter in place during severe storm events.

Chronic conditions, disability limitations (mobility, cognitive, and sensory), and the need for assistance with activities of daily living are characteristics of elderly and medically fragile populations. Theory suggests that households with these vulnerability attributes are more likely to suffer storm-induced adverse and prolonged health consequences and, therefore, ought to evidence an increased propensity to evacuate prior to a severe storm event. Yet despite being more sensitive to storm disruption, the elderly and medically fragile populations are only slightly more likely to evacuate in the face of impending storms. This suggests, for these groups, there may be other factors such as income, transportation, and social and familial networks that may be attenuating the propensity to evacuate. The public health significance is found in that the propensity to shelter in place, rather than evacuate, may contribute to disparate health outcomes. Data illustrating the prevalence of these conditions and the propensity to shelter in place are derived from a sampling of Hampton Roads households following the 2011 Hurricane Irene.

Impacts of household vulnerability on hurricane logistics evacuation under COVID-19: The case of U.S. Hampton Roads.

Historical data suggest that when a severe tropical storm or hurricane impacts a community, the vulnerable segment of the population suffers the most severe consequences. With an increased aging population, it is crucial to understand how vulnerability alters evacuation behavior. Emergent variables such as fear of COVID-19 require additional exploration. People afraid of COVID-19 exposure may refuse to evacuate, exposing themselves unnecessarily. Differentiation is critical to evacuation logistics since it is needed to determine what proportion would stay in a local shelter, public or other, rather than evacuating or staying in their home and guide the logistics resource allocation process. This research uses data from a web and phone survey conducted in the Hampton Roads area of U.S. Virginia, with 2,200 valid responses to analyze the influence of social and demographic vulnerability factors and risk perception on evacuation decisions. This research contributes to the existing literature by developing a multinomial order logit model based on vulnerability factors and intended evacuation decisions, including staying at home, looking for a shelter, or leaving the Hampton Roads area. Findings show that race and risk perception are the variables that influence the decision-making process the most. Fear of COVID-19 transmission is also associated with an increased likelihood of leaving homes during evacuation. The variations in findings from previous studies are discussed regarding their implications for logistics emergency managers.

Challenges for the disaster workforce during a compound hurricane-pandemic.

The COVID-19 pandemic has created new workforce considerations for emergency management community in addressing cumulative and cascading disasters. This research identifies how emergency management planning for both the changing dynamics of COVID-19 and the upcoming hurricane season may change under a compound threat. Many jurisdictions have faced challenges in providing adequate staffing of shelters before the pandemic. Now, fatigue among staff further exacerbates these challenges as resources are stretched thin. Six workshops, involving 265 national, state, and local leaders, staff, experts, and advocates from 22 states, and a range of disciplines (disaster planning, public health, social services, academia, and healthcare), were convened to identify concerns and potential strategies to address staffing, training, logistics, and support. Strategies proposed to increase the number and skill set of staff available involve increased reliance upon volunteers and nonprofit organizations. Mental health resources, personal protective equipment, sanitation supplies, and defining roles within emergency shelters were recommended to reduce fatigue and redistribute responsibilities. Findings illuminate additional research avenues regarding assessing the underlying stressors contributing to the planning process and effective means of implementing these interventions to bolster emergency management shelter operations during a prolonged pandemic and in the future.

Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study.

OBJECTIVES: First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model. DATA SOURCE: Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department. STUDY DESIGN: Representative randomized sample of 1,443 adult patients triaged ESI levels 4-5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios. PRINCIPAL FINDINGS: 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance. CONCLUSIONS: Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.

Population vulnerability to storm surge flooding in coastal Virginia, USA.

This study aims to assess the vulnerability of populations to storm surge flooding in 12 coastal localities of Virginia, USA. Population vulnerability is assessed by way of 3 physical factors (elevation, slope, and storm surge category), 3 built-up components (road availability, access to hospitals, and access to shelters), and 3 household conditions (storm preparedness, financial constraints to recovering from severe weather events, and health fragility). Fuzzy analysis is used to generate maps illustrating variation in several types of population vulnerability across the region. When considering physical factors and household conditions, the most vulnerable neighborhoods to sea level rise and storm surge flooding are largely found in urban areas. However, when considering access to critical infrastructure, we find rural residents to be more vulnerable than nonrural residents. These detailed assessments can inform both local and state governments in catastrophic planning. In addition, the methodology may be generalized to assess vulnerability in other coastal corridors and communities. The originality is highlighted by evaluating socioeconomic conditions at refined scale, incorporating a broader range of human perceptions and predispositions, and employing a geoinformatics approach combining physical, built-up, and socioeconomic conditions for population vulnerability assessment. Integr Environ Assess Manag 2016;12:500-509. © 2015 SETAC.

Health Service Utilization and Poor Health Reporting in Asthma Patients.

UNLABELLED: The management and treatment of adult asthma has been associated with utilization of health services. OBJECTIVES: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. DATA SOURCE: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). STUDY DESIGN: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. FINDINGS: Those with asthma are found more likely (OR 1.50, 95% CI 1.05-2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56-11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32-2.65) and hospitalization (OR 2.21, 95% CI 1.39-3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. CONCLUSION: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are increasingly more likely to be characterized as frequent utilizers of both primary and emergency department care as the threshold for what constitutes frequent utilization increases. Investments in prevention and better management of the chronic condition may result in less demand for acute care services, especially among high frequency utilizers.

Framework for classifying compliance and medical immediacy among low-acuity presentations at an urban trauma center.

BACKGROUND: This research offers two exploratory frameworks, one for medical regimen compliance and one for medical immediacy. The first classifies compliance awareness, compliance mitigation, and financial limitation for those patients that exhibit nonadherence with a medical regimen. The second classifies medical immediacy and characterizes avoidable utilization. METHODS: Representative sampling of adult patients presenting at an emergency department (62,000/ppy) triaged as low acuity; emergency department physician assessment of noncompliance with medical regimen for those patients with a complaint related to a chronic condition; and emergency department physician assessment of medical immediacy and avoidable utilization. RESULTS: Physicians report 48.3% (95% confidence interval (CI) 43.5% to 53.1%) of patients with at least a single chronic condition are presenting with symptoms or complaint related to a chronic condition, and 39.6% (CI 31.7% to 47.4%) of these exhibit noncompliance with the medical regimen associated with that chronic condition. 16.4% (CI 6.6% to 26.1%) of the patients exhibit pseudo compliance, a belief that the medical regimen is in compliance when in fact it is not. If the patient had been in compliance, 85.9% (CI 77.0% to 94.8%) of the presenting conditions may have been mitigated. Noncompliance cases (34.5% (CI 22.0% to 47.1%)) are partly attributable to financial constraints. Further, 19.1% (CI 15.7% to 22.5%) are assessed as requiring no medical intervention and 3.4% (CI 1.8% to 4.9%) require immediate stabilization. CONCLUSIONS: A large portion of low-acuity presentations are related to a chronic condition and noncompliance with the associated medical regimen contributes to the need to seek medical services. Interventions addressing literacy and financial constraints may increase compliance and decrease utilization.

A system dynamics model for simulating ambulatory health care demands.

INTRODUCTION: This article demonstrates the utility of the system dynamics approach to model and simulate U.S. demand for ambulatory health care service both for the general population and for specific cohort subpopulations over the 5-year period, from 2003 to 2008. A system dynamics approach that is shown to meaningfully project demand for services has implications for health resource planning and for generating knowledge that is critical to assessing interventions. METHODS: The study uses a cohort-component method in combination with structural modeling to simulate ambulatory health care utilization. Data are drawn from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. RESULTS: The simulation of the total population requiring ambulatory services between 2003 and 2008 is performed to test the functionality and validate the model. Results show a close agreement between the simulated and actual data; the percent error between the two is relatively low, 1.5% on average. In addition, simulations of purposively selected population subsets are executed (men, 18-24 years of age, white, African American, Hispanic, and insurance coverage), resulting in error between simulated and actual data, which is 7.05% on average. CONCLUSIONS: The proposed model demonstrates that it is possible to represent and mimic, with reasonable accuracy, the demand for health care services by the total ambulatory population and the demand by selected population subsets. This model and its simulation demonstrate how these techniques can be used to identify disparities among population subsets and a vehicle to test the impact of health care interventions on ambulatory utilization. A system dynamics approach may be a useful tool for policy and strategic planners.