Deconstructing the spatial effects of El Niño and vulnerability on cholera rates in Peru: Wavelet and GIS analyses.

This study examined the spatial effects of El Niño and vulnerability on cholera in Peru across the epidemic period of 1991 to 1998. Using Wavelet and GIS analyses, relationships between sea surface temperatures and department-level cholera rates were estimated. In addition, we constructed composite indices to assess spatial vulnerability during the 1997-98 extreme El Niño. The findings demonstrated strong temporal connections in 1997-98, most evident in northern Peru, and less clear connections from 1991-93. Spatially, we found patterns of difference, greater cholera risk in northern coastal Peru in 1997-98, compared to greater risk in central and southern coastal Peru in 1991-92. Overall, the spatial vulnerability analysis suggested preexisting social conditions and disaster impacts increased cholera exposure and infection in 1998. Our study supports the notion that the spatial nature of El Niño's impacts on cholera rates exacerbated cholera vulnerability following the emergence, rather than triggered the epidemic's onset in 1991.

Mapping Multi-Disease Risk during El Niño: An Ecosyndemic Approach.

El Niño is a quasi-periodic pattern of climate variability and extremes often associated with hazards and disease. While El Niño links to individual diseases have been examined, less is known about the cluster of multi-disease risk referred to as an ecosyndemic, which emerges during extreme events. The objective of this study was to explore a mapping approach to represent the spatial distribution of ecosyndemics in Piura, Peru at the district-level during the first few months of 1998. Using geographic information systems and multivariate analysis, descriptive and analytical methodologies were employed to map disease overlap of 7 climate-sensitive diseases and construct an ecosyndemic index, which was then mapped and applied to another El Niño period as proof of concept. The main findings showed that many districts across Piura faced multi-disease risk over several weeks in the austral summer of 1998. The distribution of ecosyndemics were spatially clustered in western Piura among 11 districts. Furthermore, the ecosydemic index in 1998 when compared to 1983 showed a strong positive correlation, demonstrating the potential utility of the index. The study supports PAHO efforts to develop multi-disease based and interprogrammatic approaches to control and prevention, particularly for climate and poverty-related infections in Latin America and the Caribbean.

Update on Didactic and Clinical Education in Fluency Disorders: 2013-2014.

Purpose: This study surveyed didactic and clinical education in fluency disorders at undergraduate and graduate institutions in the United States that provide education in speech-language pathology to determine whether a previously observed reduction in requirements has continued since prior surveys (Yaruss, 1999; Yaruss & Quesal, 2002). Method: The study involved a detailed questionnaire that was sent to 282 communication science and disorders departments. Questions examined didactic and clinical education, as well as faculty knowledge about fluency disorders. Results: Comparisons with prior surveys revealed several findings, including (a) on average, programs have increased academic coursework and incorporated more practical sessions and competency-based testing in the classroom; (b) the number of faculty who possess extensive clinical experience with fluency disorders has decreased; and (c) although an increase in clinical requirements in fluency disorders was detected, the number of programs providing minimal education about fluency disorders remains high. Conclusion: Given an expanding scope of practice, many programs have continued to try to provide adequate education about fluency disorders. Still, direct clinical experiences are limited, and faculty expertise in this area has continued to decrease. To raise students' confidence and competence in fluency disorders, efforts beyond graduate work-or systemic changes in the profession-may be necessary.