Associations between mindfulness and mental health after collective trauma: results from a longitudinal, representative, probability-based survey.

BACKGROUND/OBJECTIVES: Trait mindfulness (TM) may protect against post-trauma mental health ailments and related impairment. Few studies have evaluated this association in the context of collective traumas using representative samples or longitudinal designs. DESIGN/METHOD: We explored relationships between TM and collective trauma-related outcomes in a prospective, representative, probability-based sample of 1846 U.S. Gulf Coast residents repeatedly exposed to catastrophic hurricanes, assessed twice during the COVID-19 outbreak (Wave 1: 5/14/20-5/27/20; Wave 2: 12/21/21-1/11/22). Generalized estimating equations examined longitudinal relationships between TM, COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment; ordinary least squares regression analyses examined the cross-sectional association between TM and COVID-19-related posttraumatic stress symptoms (PTSS) at Wave 1. Event-related stressor exposure was explored as a moderator. RESULTS: In covariate-adjusted models including pre-event mental health ailments and demographics, TM was negatively associated with COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment over time; in cross-sectional analyses, TM was negatively associated with COVID-19-related PTSS. TM moderated the relationship between COVID-19 secondary stressor exposure (e.g., lost job/wages) and both global distress and functional impairment over time. CONCLUSIONS: Results suggest TM may buffer adverse psychosocial outcomes following collective trauma, with some evidence TM may protect against negative effects of secondary stressor exposure.

Nutritional status among earthquake survivors: a systematic review and meta-analysis.

OBJECTIVE: Earthquakes, as one of the most devastating natural disasters, have many consequences, including the collapse of buildings where food is produced, stored, and distributed, which can ensue with numerous nutritional problems. This study was to investigate the nutritional status of earthquake survivors. STUDY DESIGN: This was a systematic review and meta-analysis study. METHODS: The present review was conducted according to the PRISMA guideline. The data were collected by searching the data resources of PubMed, Scopus, Web of Science, Science Direct, Google Scholar, MagIran, and Scientific Information Database. Meta-analysis was conducted using the random effects model, and the I2 index was used to assess heterogeneity among studies. Publication bias was assessed using Begg's test. RESULTS: In this study, 342 studies were identified in the primary literature search, and after removing duplicates, 14 of which were finally selected for meta-analysis. Based on the results of the meta-analysis, the overall prevalence was obtained: 4.19% for wasting, 16.78% for stunting, 12.59% for underweight, and 28.06% for anemia after the earthquake. CONCLUSION: The results indicated that earthquake survivors are exposed to malnutrition. Therefore, it is recommended that adequate food and nutritional supplements are provided to all earthquake survivors.

Desastres naturais: uma reflexão homeopática e oportunidade de intervenções / Natural disasters: a homeopathic reflection and opportunity to interventions

Os desastres naturais tem se intensificado nas últimas décadas causando impactos sobre a saúde humana e todas as esferas: física, psíquica e espiritual. Dentre as diferentes abordagens terapêuticas a Homeopatia surge como uma opção suave, segura, duradoura e de baixo custo. O objetivo deste artigo é mostrar as possibilidades de utilização da abordagem e dos medicamentos homeopáticos nestes eventos. Para tanto consideramos a Homeopatia aplicada nos diferentes níveis de atuação e complexidade dos cuidados à saúde. Concluindo, salientamos que a Homeopatia e os Médicos Homeopatas podem e devem participar nas ações de acolhimento e cuidado à saúde das pessoas direta ou indiretamente atingidas por este trágico evento.

Natural disasters have intensified in recent decades, causing impacts on human health and all spheres: physical, psychological and spiritual. Among the different therapeutic approaches, Homeopathy appears as a gentle, safe, long-lasting and low-cost option. The objective of this article is to show the possibilities of using the homeopathic approach and medicines in these events. To this end, we consider Homeopathy applied at different levels of activity and complexity of health care. In conclusion, we emphasize that Homeopathy and Homeopathic Doctors can and should participate in welcoming and caring for the health of people directly or indirectly affected by this tragic event.

Psicologias indígenas em desastres: construção de linhas de cuidado ao Bem-Viver de povos originários / Indigenous psychology in disasters: lines of care construction for the "Buen Vivir" of original peoples

Objetivo Em 2021, povos indígenas Pataxó, Pataxó Hãhãhãe e Tupinambá foram atingidos por inundações intensas na Bahia. A situação exigiu respostas imediatas das equipes locais de saúde, contando com a assessoria de especialistas em desastres e emergências em saúde pública. Esse estudo de caso aborda o processo de construção de linhas de cuidado ao Bem-Viver dos povos originários afetados, por meio do trabalho colaborativo entre etnias indígenas e equipes de políticas públicas de saúde. Método Foram analisados registros de reuniões, um curso de formação para profissionais de saúde indígena e três documentos de referência. Resultados Abordou-se possibilidades e desafios no cuidado ao Bem-Viver na fase de resposta pós-desastres e emergências em saúde pública, com a garantia da especificidade e do protagonismo das comunidades atendidas. Conclusão Foram apresentadas considerações para o processo de construção de linhas de cuidado ao Bem-Viver de povos originários, buscando oferecer subsídios à conformação de políticas públicas consoantes às particularidades sócio-histórico-culturais de cada etnia.

Objective In 2021, the indigenous communities Pataxó, Pataxó Hãhãhãe and Tupinambá, in the state of Bahia, Brazil, were hit by intense floods. The situation required immediate response from local health professionals, with advice from experts in public health disasters and emergencies. This case study focuses on the development of lines of care for the "Buen Vivir" of affected original peoples through collaborative work between indigenous ethnic groups and public health policy professionals. Method Analysis of the records of meetings, a training course for indigenous health professionals and three reference documents was carried out. Results Possibilities and challenges for assuring the "Buen Vivir" in the post-disaster and public health emergency response phase were addressed, guaranteeing the specificity and protagonism of the communities served. Conclusion Contributions were presented along the lines of care construction processes for the "Buen Vivir" of indigenous peoples, pursuing subsidies for public policies in accordance with the socio-historical-cultural particularities of each ethnic group.

A Scoping Review of Trauma-Informed Pediatric Interventions in Response to Natural and Biologic Disasters.

A scoping review was performed of trauma-informed psychological interventions to treat anxiety, depression, and posttraumatic stress symptoms in youth in response to natural/biologic disasters. The specific aims were to identify psychosocial interventions used in response to natural/biologic disasters, report the interventions' effectiveness, describe limitations, and provide treatment recommendations and future directions. Of the 45 studies extracted, 28 were on natural disasters and 17 on biologic disasters with the majority related to the COVID-19 pandemic. The most commonly implemented interventions were Cognitive Behavioral Therapy (CBT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and eye movement desensitization and reprocessing (EMDR). The UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) and the Strengths and Difficulties Questionnaire (SDQ) were the most frequently used measures. Methodological rigor was varied, with 60% randomized, controlled trials. Overall, there was a significant decrease in posttraumatic stress symptoms, distress, anxiety, and depression regardless of whether the participant received CBT, TF-CBT, or EMDR. Generally, there was not a significant decrease in anxiety and depression with yoga, cognitive fear-reduction, emotion-based drawing, and community health education. Recommendations for future directions include larger-scale studies with group and on-line interventions that include younger children with moderation analyses by gender and race/ethnicity.

Pathways to post-traumatic growth and post-traumatic stress following the Canterbury earthquakes in a cohort of 40-year-olds.

OBJECTIVE: To report on post-traumatic growth and post-traumatic stress following the Canterbury earthquakes and to quantify the relationships between exposure to the earthquakes, post-traumatic growth and post-traumatic stress. METHOD: The Christchurch Health and Development Study is a longitudinal birth cohort study of New Zealanders aged 40 years at the time of latest assessment in 2017. A total of 455 participants were exposed to the Canterbury earthquakes and assessed in 2012 and 2017. Post-traumatic growth was measured in 2017 using the Post-traumatic Growth Inventory. Earthquake-related post-traumatic stress was measured in 2012 using post-traumatic stress disorder items from the Diagnostic Interview Schedule. Post-traumatic growth and post-traumatic stress were modelled using measures of earthquake impact and subjective measures of earthquake consequences (peri-traumatic stress and disruption distress). RESULTS: There was an indirect relationship between earthquake impact and post-traumatic growth. This was mediated via disruption distress. There was also an indirect relationship between earthquake impact and post-traumatic stress. This was mediated via peri-traumatic stress and disruption distress. Post-traumatic growth and post-traumatic stress were not significantly related. CONCLUSIONS: Measurement of post-traumatic growth and post-traumatic stress is required for a holistic understanding of disaster consequences. Subjective assessment of distress following disasters is required to predict their psychological effects.

Adaptability, Interdisciplinarity, Engageability: Critical Reflections on Green Social Work Teaching and Training.

The upward tendencies of global climate change, disasters, and other diverse crises have been urgently calling for green social work (GSW) interventions which engage a holistic approach to explore diverse societal dimensions' compounded influences on inhabitants' individual and collective health and well-being in disaster settings. Though globally gaining more attention, GSW has been slow to develop in the Canadian social work curriculum and professional training. This deficit jeopardizes integrating environmental and climate justice and sustainability in social work research and practice in Canada. In response to this pedagogical inadequacy, this article employs a critical reflection approach to examine two authors' two-academic-year teaching-learning and supervision-training experiences of GSW-specific in-class and field education in a Master of Social Work program. The content analysis illustrates three essential components for GSW-specific teaching and training, namely adaptability, interdisciplinarity, and engageability. These components enhance the prospective social workers' micro-, mezzo-, and macro-level practices to better support individuals, families, and communities affected by extreme events and promote their health and well-being in disaster and non-disaster scenarios. These GSW-specific pedagogies shed light on the fact that integrading climate change, disasters, and diverse crises in pedagogical innovations should be encouraged beyond the social work profession. A multidisciplinary multi-stakeholder engagement approach would comprehensively investigate and evaluate the essential components and evidence-based strategies that better serve inhabitants and promote resilience and sustainability.

Towards a national strategy for the provision of spiritual care during major health disasters: A qualitative study.

BACKGROUND: Spirituality is beneficial to health. Evidence around the benefits of Spiritual care (SC) is advancing, and training is becoming part of healthcare professional development. As the COVID-19 crisis showed, during major health disasters (MHDs), the demand for SC grows exponentially, while the burden of care and focus on preserving life often hamper its provision. Nonetheless, existing health emergency strategic frameworks lack preparedness for the provision of SC. AIM: The aim of this study was to identify the components for a National Strategy (NS) for the provision of SC during MHDs. METHODS: Descriptive, cross-sectional, qualitative phenomenological design based on individual, semi-structured e-interviews with nursing managers and National Health Service/volunteer chaplains based in England. Thematic analysis of 25 e-interview data was performed based on a dialogic collaborative process. RESULTS AND DISCUSSION: Eleven themes were identified as components of the proposed NS. From these components, specific recommendations for practical actions are provided. An integrated framework approach and smart investments in resources, staff training and technologies should be led by the paradigm of culturally competent and compassionate care. CONCLUSION: The need to have strategic frameworks, both national and local, that better equip a country healthcare sector to prevent, face, and recover from MHDs is paramount. Catering for the spiritual needs of the affected population should be a key aspect of any health emergency strategy to ensure the preservation of quality care.

Essential Professional Competencies for Basic Midwifery Practice in Disasters: A Qualitative Study.

OBJECTIVE: Educated midwives have a range of abilities to use their skills in normal situations. Given that working under normal situations is different from critical conditions, the recognition of skills and competencies required for midwifery practice is important. The purpose of this study was to explore specific professional competencies that midwives need to have for the provision of reproductive health services during disasters. METHODS: This was a qualitative study using a content analysis method. Subjects were 19 midwives with the work experience of practice in disaster situations. Data were collected using semi-structured interviews and analysis was based on the approach suggested by Graneheim and Lundman. RESULTS: Six major categories developed in this study were "safe pregnancy," "safe childbirth," "women's health care," "contraception," "violence and sexually transmitted infections," and "infant care." CONCLUSIONS: Midwives can play a very important role in the provision of reproductive health services. Therefore, they must have special capabilities and capacities. Policies and curriculum development are recommended in accordance with the needs of reproductive health in disaster-affected communities.

Perceived and actual posttraumatic growth in religiousness and spirituality following disasters.

OBJECTIVE: Religious/spiritual (R/S) growth is a core domain of posttraumatic growth (PTG). However, research on R/S growth following disasters has over-relied on retrospective self-reports of growth. We therefore examined longitudinal change in religiousness/spirituality following two disasters. METHOD: Religious survivors of Hurricanes Harvey (Study 1) and Irma (Study 2) completed measures of perceived R/S PTG, general religiousness/spirituality ("current standing"-R/S PTG), and subfacets of religiousness/spirituality (spiritual fortitude, religious motivations, and benevolent theodicies). In Study 1, 451 participants responded at 1-month and 2-month postdisaster. In Study 2, participants responded within 5-days predisaster and at 1-month (N = 1,144) and 6-months postdisaster (N = 684). RESULTS: In both studies, perceived R/S PTG was weakly related to longitudinal increases in general religiousness/spirituality and in most of its subfacets, but reliable growth in any R/S outcome was rare. Additionally, Study 2 revealed evidence that actual change in psychological well-being is associated with actual (but not perceived) R/S PTG, but disaster survivors tend to exhibit declines in their religiousness/spirituality, spiritual fortitude, and religious motivations. CONCLUSIONS: Results suggest disaster survivors are only modestly accurate in perceiving how much positive R/S change they experience following a disaster. We discuss implications for clinical practice, scientific research, and empirical and conceptual work on PTG more broadly.

Ferramenta gerencial para integração dos serviços de saúde na gestão de riscos de desastres: o caso de Blumenau, SC / Management tool for the integration of health services in disaster risk management: the case of Blumenau, SC

RESUMO No âmbito dos desastres, os planos de contingência em saúde costumam limitar-se aos aspectos de resposta e emergência. Propõe-se que, em uma perspectiva holística, os municípios formulem planos que contemplem também aspectos de prevenção e redução de riscos. Nesse contexto, objetivou-se desenvolver e aplicar um instrumento técnico para a formulação de um plano de ação dos serviços da saúde voltado à Gestão de Riscos de Desastres (GRD). As bases conceituais apresentadas fundamentaram a elaboração do instrumento levando-se em conta uma gestão integral, integrada e participativa. Programas, projetos, ações, agentes e instrumentos jurídicos são descritos a partir dos diversos processos da GRD do município de Blumenau, Santa Catarina. Os resultados revelaram um diagnóstico das políticas do município. As ações existentes concentram-se em processos de preparação e resposta. O Programa Vigidesastres não se encontra operante. Novas ações também são propostas com o intuito de fortalecer ações de prevenção e redução de riscos. Espera-se que o estudo possa subsidiar políticas públicas que considerem os serviços de saúde sob uma perspectiva integral, reduzindo as vulnerabilidades sociais e promovendo a saúde da população.

ABSTRACT Health contingency plans are usually limited to response and emergency aspects in the context of disasters. It is proposed that, in a holistic perspective, the municipalities formulate plans that also include prevention and reduction of risks. Thus, the aim of this study was to develop and apply a technical instrument for the formulation of a health services action plan for Disaster Risk Management (GRD). The conceptual bases were used for the elaboration of the instrument, taking into account integral, integrated, and participative management. Programs, projects, actions, agents and legal instruments are described from the various GRD processes in the municipality of Blumenau, Santa Catarina. The results revealed a diagnosis of municipal policies. The actions are limited to the preparation and response processes and the 'Vigidesastres' Program is not operational. New actions are also proposed to improve public health policies in your prevention and mitigation processes. It is hoped that the study can subsidize public policies that consider health services from an integral and integrated perspective, reducing social vulnerabilities and promoting populational health.

Patient Characteristics of VA Telehealth Users During Hurricane Harvey.

Introduction: Research on patient characteristics of telehealth users is relatively new. More studies are needed to understand the characteristics of telehealth users during disasters. This study attempts to bridge this gap and examines patient characteristics of telehealth users compared with nontelehealth users at the Houston VA Medical Center (VAMC) immediately before and after Hurricane Harvey (2017). Methods: Since use of telehealth services reached its peak and gradually declined within 2 weeks after the landfall, the data analyses focused on 14 days before/14 days after Harvey. Two sets of analyses were conducted using chi-square, t test, and one-way analysis of variance: (1) Patient characteristics of telehealth users were compared with nontelehealth users. (2) Patient characteristics were compared between 3 subgroups of telehealth users. Results: Compared with nontelehealth users, telehealth users were older (mean age: 60.8 vs 58.5 years, P < .001) and had a higher mean Nosos health risk score (1.9 vs 1.4, P < .001). They also had a higher mean number of outpatient visits (28.0 vs 19.8, P < .001), higher emergency room use (37% vs 29%, P < .001), and higher rates of hospitalizations (21% vs 13%, P < .001) during the 12 months before Harvey. When compared to less frequent telehealth users, the most frequent telehealth users were the oldest and most medically complex patients. Conclusions: As the largest integrated health care system in the United States, the VA has many advantages favoring successful implementation of telehealth services during disasters. However, more research is needed to better understand how VA telehealth could meet the varying needs of veterans to lower risk of harm during differing types of disasters.

Nature's Contributions to Human Health: A Missing Link to Primary Health Care? A Scoping Review of International Overview Reports and Scientific Evidence.

Nature's contributions to human health (NCH) have gained increased attention internationally in scientific and policy arenas. However, little attention is given to the role of the health care sector in this discussion. Primary health care (PHC) is a vital backbone for linking knowledge and practice within the organization of health care. The objective of this scoping review is to evaluate how international overview reports and scientific literature on NCH address to PHC. More specifically, we extracted data on arguments, practice supporting tools and guidelines, challenges and constraints, and management approaches to integrate NCH and PHC. The scientific literature search was run in Web of Science. Two independent reviewers screened the scientific publications. Through the scientific literature search, we identified 1,995 articles of which 79 were eligible for analysis. We complemented the search with a selection of six international overview reports. Both the international overview reports and the scientific publications paid limited attention to the role of PHC regarding NCH. To cope with the current challenges and constraints to integrate NCH and PHC, more evidence on NCH, further development of PHC practice supporting tools, bottom-up integrated approaches, and closer interdisciplinary collaborations are required.

Long-term trends of hospital admissions among patients with cancer following the 2015 earthquake: a single institution observational study in Kathmandu, Nepal.

OBJECTIVES: Little is known regarding how natural disasters affect patients with cancer in low-income and middle-income countries. The objective of the present study was to assess the impact of the 2015 Nepal earthquake on the admission of patients with cancer at a core medical institution in Kathmandu. DESIGN, SETTING AND PARTICIPANTS: We considered all 3520 cancer patient admissions to Tribhuvan University Teaching Hospital, from 25 April 2013 to 24 April 2017 (2 years before and 2 years after the earthquake). OUTCOME MEASURES: The number of cancer patient admissions was calculated for each month. Using a negative binomial model, we estimated the incidence rate ratio (IRR) for admission numbers each month after the earthquake compared with the pre-earthquake baseline and investigated chronological change. RESULTS: The total admission number in the first month after the earthquake was decreased compared with that of the predisaster baseline (IRR=0.66, 95% CI 0.43 to 1.00), which largely reflected decreased admissions of patients from outside of the most disaster-affected districts. From the second month, the admission number consistently exceeded the predisaster baseline for the remaining postdisaster period. In contrast to the month of the disaster, the continuation of increased admissions was most prominent among those from outside of the most affected districts. CONCLUSIONS: After a transient decrease immediately following the 2015 Nepal earthquake, there was a long-term increase in cancer patient admissions in a core hospital in Kathmandu. These changes were seen most prominently in patients from outside the most disaster affected areas.

Traumas, sociodramas construtivistas e EMDR: Promoção de saúde com pessoas afetadas por catástrofes naturais / Trauma, constructivist sociodrama and EMDR: Health promotion for people affected by natural disasters / Trauma, sociodrama constructivista y EMDR: Promoción de salud con personas dañadas por catástrofes naturales

A partir de pesquisas realizadas ao longo de dez anos, com pessoas atingidas por catástrofes naturais no Brasil, em 25 cidades e 7 estados, a autora apresenta uma parte dos resultados obtidos em uma tese de doutorado em Psicologia (USAL, Buenos Aires, 2016) em parceria com a Rede de Ecobioética, Cátedra da UNESCO. Articula conceitos teóricos e práticos de sociodramas construtivistas e da terapia EMDR (Eye Movement Desensitization and Reprocessing), no que se refere à prevenção de traumas pós-catástrofes. Por análise de narrativas de 200 adultos, de níveis socioeconômicos e culturais variados, apresenta resultados que demonstram a eficácia dessas intervenções intra e interpsíquicas na promoção de saúde mental.

Based on research conducted over ten years, with people affected by natural disasters in Brazil, in 25 cities and 7 states, the author presents a part of the results obtained in a doctoral thesis in Psychology (USAL, Buenos Aires, 2016) in partnership with the Eco-Bioethics Network, UNESCO Chair. She articulates theoretical and practical concepts of constructivist sociodramas and EMDR therapy (Eye Movement Desensitization and Reprocessing), regarding the prevention of post-disaster trauma. Through the analysis of 200 adult narratives of varied socioeconomic and cultural backgrounds, she presents results that demonstrate the effectiveness of these intra and interpsychic interventions in the promotion of mental health.

A partir de investigaciones realizadas a lo largo de diez años, con personas danãdas por catástrofes naturales en Brasil, en 25 ciudades y 7 estados, la autora presenta una parte de los resultados obtenidos en una tesis de doctorado en Psicología (USAL, Buenos Aires, 2016), en colaboración con la Red de Ecobioética, Cátedra da UNESCO. Articula conceptos teóricos y prácticos de sociodrama constructivista y de la terapia EMDR (Eye Movement Desensitization and Reprocessing), en lo que se refiere a la prevención de traumas post-catástrofes. Por análisis de narrativas de 200 adultos de niveles socioeconómicos y culturales variados, presenta resultados que demuestran eficacia de esas intervenciones intra e interpsíquicas en la promoción de la salud mental.

Barriers to Breastfeeding in Disasters in the Context of Iran.

IntroductionNatural disasters have many effects on vulnerable groups, especially infants and children. Protecting breastfeeding in disasters is important, because artificial feeding puts a lot of risk to the child. In disasters, artificial nutrition is dangerous to children and its supplementation requires special equipment. There is little information on the nutritional status of infants after disasters in Iran.ProblemThe purpose of this study was to explore the barriers to appropriate lactation after disasters in Iran. METHOD: This was a qualitative study using a content analysis method. A total of 19 midwives with disaster-relief experiences were approached for interview. Data were collected using semi-structured interviews. Data analysis was performed using the Graneheim's approach. RESULTS: The categories of maternal factors, neonatal factors, management factors, and context-base factors were extracted from the data. CONCLUSION: The challenges of social support, mothers' self-efficacy, educated staff for disasters, and privacy for breastfeeding can be considered as important barriers to breastfeeding in disasters. Training programs, as well as health system support, can help overcome the breastfeeding barriers in disasters. MirMohamadaliIeM, Khani JazaniR, SohrabizadehS, Nikbakht NasrabadiA. Barriers to breastfeeding in disasters in the context of Iran. Prehosp Disaster Med. 2019;34(1):20-24.

The Integration of Interlinkages Between Nature and Human Health in Primary Health Care: Protocol for a Scoping Review.

BACKGROUND: International overview reports and the majority of scientific publications on interlinkages between nature and human health (NHI) do not seem to focus on the role of the health care sector. Primary health care (PHC) is often the first point of contact people have with the health care system and provides comprehensive, accessible, and community-based care that meets the health needs of individuals throughout their life. PHC is a vital backbone for linking knowledge and practice within the organization of health care. This scoping review aims to focus on the potential role of PHC in relation to NHI. OBJECTIVE: The objective of this protocol is to present the method used to scope international overview reports and scientific publications on what is mentioned on the integration of NHI in PHC. METHODS: The international overview reports have been screened for keywords relating to PHC. We developed a specific search strategy to scope scientific literature on NHI in relation to PHC. The scientific literature search ran in Web of Science (WOS) and PubMed from inception to May 2017. The scientific publications are screened by 2 independent reviewers, which will result in a list of relevant publications that meet eligibility and inclusion criteria. RESULTS: On the basis of a first screen on the title of the first 200 results in both search engines, we decided to restrict to WOS. First insights in the international overview reports and the quantitative overview of the results in WOS give a first impression of a missing link between NHI and PHC. The findings are expected to identify knowledge gaps in the translation of evidence on NHI in PHC practices and the role of PHC regarding the application of that evidence in health care practice. CONCLUSIONS: This is, to our knowledge, the first study that seeks to relate existing knowledge on NHI to PHC. The presentation of our method through this protocol allows researchers to build upon and improve our work in future research on the practical implementation of NIH. The findings of the scoping review are expected to guide future scientific research, international policy directives, and PHC workers to fill the gaps in the integration of NHI in PHC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12510.

Decision tool for climate disasters and infectious disease at sub-national level in India: Ensuring a paradigm shift in health planning from prevalence to vulnerability.

Climate change is considered as a distal determinant of public health which is increasing in importance. India, as an example, has a national action plan for climate change and human health. Sub-national (State) plans for climate change also exist, taking into account the health sector. The State of Bihar was selected for assessment because of its vulnerability (a function of exposure, sensitivity and adaptive capacity). A vulnerability framework was constructed by discussions with national and local-level specialists followed by weightage given by working in the field of climate and health with international exposure. A total of 15 districts were at a high risk of floods and these were considered for detailed analysis using the methodology for human development index as well as other examples in the field of environment. Climate health vulnerability index score were correlated with actual prevalence of flood mortality data of these 15 districts in year 2016. It was found that climate health vulnerability and flood mortality had negative low correlation of -0.25. In contrast for vector-borne diseases (VBD), both pre-flood and post-flood, the morbidity data had a correlation of 0.24 and 0.11 respectively. Possible reasons for a negative correlation for mortality could involve better preparedness by disaster district authorities. However, outbreak control is within the ambit of the health sector where a possible reason for decreased correlation coefficient in the post-flood period could be due to the impact on health facilities itself, thus leading to reduced reporting.

Telehealth at the US Department of Veterans Affairs after Hurricane Sandy.

BACKGROUND: Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. METHODS: This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare. RESULTS: During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach. CONCLUSION: Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and confidentiality, all of which are critical to telehealth success during disasters and other crises.