A modified Community Assessment for Public Health Emergency Response (CASPER) four months after Hurricane Sandy.

This study sought to assess access to utilities, basic needs, financial burden, and perceived safety among households in the Rockaway Peninsula of New York City, United States, four months after Hurricane Sandy struck in 2012. A modified cluster survey design was used to select households for inclusion in the study. Survey content was created using the Community Assessment for Public Health Emergency Response (CASPER) toolkit, gathering relevant data on access to food and water, basic utilities, financial burden, household demographics, and safety. Four months after Sandy, electricity and heat had been restored to all households. However, around one-third of them still had difficulty in obtaining food, and about one-half believed that their neighborhood was unsafe. One-quarter had problems in acquiring prescription medications, and approximately one-half reported anxiety. While basic utilities were almost entirely restored, there were ongoing challenges in Rockaway four months after Sandy, relating to financial hardship, food insecurity, healthcare, and psychologic distress.

Acceptance of the Administration of Multiple Injectable Vaccines in a Single Immunization Visit in Albania.

Background: Albania introduced inactivated polio vaccine (IPV) into its immunization system in May 2014, increasing the maximum recommended number of injectable vaccines given in a single visit from 2 to 3. Methods: Health-care providers and caregivers were interviewed at 42 health facilities in Albania to assess knowledge, attitudes, and practices regarding injectable vaccine administration. Immunization register data were abstracted from December 2014 to July 2015 at the same facilities to explore the number of injectable vaccines children received during their 2- and 4-month visits. Results: The majority of children (87%) identified in the record review at either their 2- or 4-month immunization visit received all 3 injectable vaccines in a single visit. Almost all children who did not receive the vaccines in a single visit were subsequently fully immunized, most within a 2-week period. Over half of caregivers whose children got 3 or more injectable vaccines in a single visit reported being only comfortable with 1 or 2 injectable vaccines in a single visit. Conclusions: Despite most caregivers expressing hesitation regarding children receiving multiple injectable vaccines in a single visit, most children received vaccines according to the recommended schedule. Almost all children eventually received all recommended vaccines.

Global routine vaccination coverage, 2014.

The year 2014 marked the 40th anniversary of the World Health Organization's (WHO) Expanded Program on Immunization, which was established to ensure equitable access to routine immunization services (1). Since 1974, global coverage with the four core vaccines (Bacille Calmette- Guérin vaccine [BCG; for protection against tuberculosis], diphtheria-tetanus-pertussis [DTP] vaccine, poliovirus vaccine, and measles vaccine) has increased from <5% to ≥85%, and additional vaccines have been added to the recommended schedule. Coverage with the 3rd dose of DTP vaccine (DTP3) by age 12 months is an indicator of immunization program performance because it reflects completion of the basic infant immunization schedule; coverage with other vaccines, including the 3rd dose of poliovirus vaccine (polio3); the 1st dose of measles-containing vaccine (MCV1) is also assessed. Estimated global DTP3 coverage has remained at 84%­86% since 2009, with estimated 2014 coverage at 86%. Estimated global coverage for the 2nd routine dose of measles-containing vaccine (MCV2) was 38% by age 24 months and 56% when older age groups were included, similar to levels reported in 2013 (36% and 55%, respectively). To reach and sustain high immunization coverage in all countries, adequate vaccine stock management and additional opportunities for immunization, such as through routine visits in the second year of life, are integral components to strengthening immunization programs and reducing morbidity and mortality from vaccine preventable diseases.

A rapid needs assessment of the Rockaway Peninsula in New York City after Hurricane Sandy and the relationship of socioeconomic status to recovery.

OBJECTIVES: We conducted a rapid needs assessment in the Rockaway Peninsula-one of the areas of New York City most severely affected by Hurricane Sandy on October 29, 2012-to assess basic needs and evaluate for an association between socioeconomic status (SES) and storm recovery. METHODS: We conducted a cross-sectional survey within the Rockaways 3 weeks after the hurricane made landfall to elicit information regarding basic utilities, food access, health, relief-effort opinions, and SES. We used a modified cluster sampling method to select households with a goal of 7 to 10 surveys per cluster. RESULTS: Thirty to fifty percent of households were without basic utilities including electricity, heat, and telephone services. Lower-income households were more likely to worry about food than higher-income households (odds ratio = 4.5; 95% confidence interval = 1.43, 15.23; P = .01). A post-storm trend also existed among the lower-income group towards psychological disturbances. CONCLUSIONS: Storm preparation should include disseminating information regarding carbon monoxide and proper generator use, considerations for prescription refills, neighborhood security, and location of food distribution centers. Lower-income individuals may have greater difficulty meeting their needs following a natural disaster, and recovery efforts may include prioritization of these households.

The role of non-ordinary states of consciousness occasioned by mind-body practices in mental health illness.

BACKGROUND: Research with hallucinogens suggests that non-ordinary states of consciousness (NOSCs), particularly mystical-type experiences, predict improvements in various affective disorders and substance use disorders (SUDs). Little is known, however, about the therapeutic potential of NOSCs induced by mind-body practices such as meditation, yoga and breathwork. METHODS: We conducted a literature review in online databases (PubMed, Scopus, Google Scholar) and preprint databases (SSRN, bioRxiv) to identify studies of NOSCs induced by mind-body practices and their effects in affective disorders and SUDs. RESULTS: A wide variety of mind-body practices involving physical movement (i.e., shamanic drumming, yoga) and deliberate immersive experiences (i.e., meditation, breathwork) have been reported in the literature. Preliminary evidence, mostly from qualitative studies and open label studies, suggest that mind-body practices produce NOSCs. These experiences have also been correlated with short-term reductions in anxiety and depression, with increased motivation to change addictive behaviors, and with enhanced self-awareness and well-being. LIMITATIONS: Findings are limited by the scarcity of literature in this field. Further rigorous and methodologically sound empirical research is needed, including comparative studies of NOSCs occasioned by different methods. CONCLUSIONS: Mind-body practices may represent a promising approach for treating mental health disorders. The NOSCs induced by such practices may lead to beneficial shifts in perceptions, values, beliefs, and behaviors. Given the challenges with hallucinogen-based therapies, mind-body practices may represent a more accessible and acceptable way of eliciting potentially helpful NOSCs in clinical practice.

Predicting intracranial hemorrhage after traumatic brain injury in low and middle-income countries: a prognostic model based on a large, multi-center, international cohort.

BACKGROUND: Traumatic brain injury (TBI) affects approximately 10 million people annually, of which intracranial hemorrhage is a devastating sequelae, occurring in one-third to half of cases. Patients in low and middle-income countries (LMIC) are twice as likely to die following TBI as compared to those in high-income countries. Diagnostic capabilities and treatment options for intracranial hemorrhage are limited in LMIC as there are fewer computed tomography (CT) scanners and neurosurgeons per patient as in high-income countries. METHODS: The Medical Research Council CRASH-1 trial was utilized to build this model. The study cohort included all patients from LMIC who received a CT scan of the brain (n = 5669). Prognostic variables investigated included age, sex, time from injury to randomization, pupil reactivity, cause of injury, seizure and the presence of major extracranial injury. RESULTS: There were five predictors that were included in the final model; age, Glasgow Coma Scale, pupil reactivity, the presence of a major extracranial injury and time from injury to presentation. The model demonstrated good discrimination and excellent calibration (c-statistic 0.71). A simplified risk score was created for clinical settings to estimate the percentage risk of intracranial hemorrhage among TBI patients. CONCLUSION: Simple prognostic models can be used in LMIC to estimate the risk of intracranial hemorrhage among TBI patients. Combined with clinical judgment this may facilitate risk stratification, rapid transfer to higher levels of care and treatment in resource-poor settings.

Increase in Reported Cholera Cases in Haiti Following Hurricane Matthew: An Interrupted Time Series Model.

Matthew, a category 4 hurricane, struck Haiti on October 4, 2016, causing widespread flooding and damage to buildings and crops, and resulted in many deaths. The damage caused by Matthew raised concerns of increased cholera transmission particularly in Sud and Grand'Anse departments, regions which were hit most heavily by the storm. To evaluate the change in reported cholera cases following Hurricane Matthew on reported cholera cases, we used interrupted time series regression models of daily reported cholera cases, controlling for the impact of both rainfall, following a 4-week lag, and seasonality, from 2013 through 2016. Our results indicate a significant increase in reported cholera cases after Matthew, suggesting that the storm resulted in an immediate surge in suspect cases, and a decline in reported cholera cases in the 46-day post-storm period, after controlling for rainfall and seasonality. Regression models stratified by the department indicate that the impact of the hurricane was regional, with larger surges in the two most highly storm-affected departments: Sud and Grand'Anse. These models were able to provide input to the Ministry of Health in Haiti on the national and regional impact of Hurricane Matthew and, with further development, could provide the flexibility of use in other emergency situations. This article highlights the need for continued cholera prevention and control efforts, particularly in the wake of natural disasters such as hurricanes, and the continued need for intensive cholera surveillance nationally.

Cross-sectional Survey of Long-Term Care Facilities in the Rockaway Peninsula: Preparedness and Response During Hurricane Sandy.

BACKGROUND: Few studies have described the challenges experienced by long-term care facilities (LTCFs) following Hurricane Sandy. This study examined LTCF preparedness and experiences during and after the storm. METHODS: A cross-sectional survey was conducted 2 years after Hurricane Sandy to assess LTCF demographics, preparation, and post-storm resources. Surveys were conducted at LTCFs located on the Rockaway Peninsula of New York City. All LTCFs located in a heavily affected area were approached. RESULTS: Of 29 facilities, 1 had closed, 5 did not respond, 9 declined to participate, and 14 participated, yielding a response rate of 50% for open facilities. Twenty-one percent of the facilities had preparations specifically for hurricanes. More than 70% of the facilities had lost electricity, heat, and telephone service, and one-half had evacuated. Twenty-one percent of the facilities reported not receiving any assistance and over one-half reported that relief resources did not meet their needs. CONCLUSIONS: Many LTCFs lacked plans specific to such a large-scale event. Since nearly all of the LTCFs in the region were affected, preexisting transportation and housing plans may have been inadequate. Future preparation could include hazard-specific planning and reliance on resources from a wider geographic area. Access to electricity emerged as a top priority. (Disaster Med Public Health Preparedness. 2018;12:194-200).

Use of the revised World Health Organization cluster survey methodology to classify measles-rubella vaccination campaign coverage in 47 counties in Kenya, 2016.

INTRODUCTION: To achieve measles elimination, two doses of measles-containing vaccine (MCV) are provided through routine immunization services or vaccination campaigns. In May 2016, Kenya conducted a measles-rubella (MR) vaccination campaign targeting 19 million children aged 9 months-14 years, with a goal of achieving ≥95% coverage. We conducted a post-campaign cluster survey to estimate national coverage and classify coverage in Kenya's 47 counties. METHODS: The stratified multi-stage cluster survey included data from 20,011 children in 8,253 households sampled using the recently revised World Health Organization coverage survey methodology (2015). Point estimates and 95% confidence intervals (95% CI) of national campaign coverage were calculated, accounting for study design. County vaccination coverage was classified as 'pass,' 'fail,' or 'intermediate,' using one-sided hypothesis tests against a 95% threshold. RESULTS: Estimated national MR campaign coverage was 95% (95% CI: 94%-96%). Coverage differed significantly (p < 0.05) by child's school attendance, mother's education, household wealth, and other factors. In classifying coverage, 20 counties passed (≥95%), two failed (<95%), and 25 were intermediate (unable to classify either way). Reported campaign awareness among caretakers was 92%. After the 2016 MR campaign, an estimated 93% (95% CI: 92%-94%) of children aged 9 months to 14 years had received ≥2 MCV doses; 6% (95% CI: 6%-7%) had 1 MCV dose; and 0.7% (95% CI: 0.6%-0.9%) remained unvaccinated. CONCLUSIONS: Kenya reached the MR campaign target of 95% vaccination coverage, representing a substantial achievement towards increasing population immunity. High campaign awareness reflected the comprehensive social mobilization strategy implemented in Kenya and supports the importance of including strong communications platforms in future vaccination campaigns. In counties with sub-optimal MR campaign coverage, further efforts are needed to increase MCV coverage to achieve the national goal of measles elimination by 2020.

Reducing the environmental impact of trials: a comparison of the carbon footprint of the CRASH-1 and CRASH-2 clinical trials.

BACKGROUND: All sectors of the economy, including the health research sector, must reduce their carbon emissions. The UK National Institute for Health Research has recently prepared guidelines on how to minimize the carbon footprint of research. We compare the carbon emissions from two international clinical trials in order to identify where emissions reductions can be made. METHODS: We conducted a carbon audit of two clinical trials (the CRASH-1 and CRASH-2 trials), quantifying the carbon dioxide emissions produced over a one-year audit period. Carbon emissions arising from the coordination centre, freight delivery, trial-related travel and commuting were calculated and compared. RESULTS: The total emissions in carbon dioxide equivalents during the one-year audit period were 181.3 tonnes for CRASH-1 and 108.2 tonnes for CRASH-2. In total, CRASH-1 emitted 924.6 tonnes of carbon dioxide equivalents compared with 508.5 tonnes for CRASH-2. The CRASH-1 trial recruited 10,008 patients over 5.1 years, corresponding to 92 kg of carbon dioxide per randomized patient. The CRASH-2 trial recruited 20,211 patients over 4.7 years, corresponding to 25 kg of carbon dioxide per randomized patient. The largest contributor to emissions in CRASH-1 was freight delivery of trial materials (86.0 tonnes, 48% of total emissions), whereas the largest contributor in CRASH-2 was energy use by the trial coordination centre (54.6 tonnes, 30% of total emissions). CONCLUSIONS: Faster patient recruitment in the CRASH-2 trial largely accounted for its greatly increased carbon efficiency in terms of emissions per randomized patient. Lighter trial materials and web-based data entry also contributed to the overall lower carbon emissions in CRASH-2 as compared to CRASH-1. TRIAL REGISTRATION NUMBERS: CRASH-1: ISRCTN74459797CRASH-2: ISRCTN86750102.