Classifying disaster risk reduction strategies: conceptualizing and testing a novel integrated approach.

BACKGROUND: Although disaster risk reduction (DRR) addresses underlying causes and has been shown to be more cost-effective than other emergency management efforts, there is lack of systematized DRR categorization, leading to insufficient coherence in the terminology, planning, and implementation of DRR. The aim of this study was to conceptualize and test a novel integrated DRR framework that highlights the intersection between two existing classification systems. METHODS: Grounded theory was used to conceptualize a novel DRR framework. Next, deductive conceptual content analysis was used to categorize interventions from the 2019 Cities100 Report into the proposed DRR framework. The term "connection" indicates that an intervention can be categorized into a particular section of the novel integrated approach. A "connection" was determined to be present when the intervention description stated an explicit connection to health and to the concept within one of the categories from the novel approach. Further descriptive statistics were used to give insight into the distribution of DRR interventions across categories and into the application of the proposed framework. RESULTS: The resulting framework contains nine intersecting categories: "hazard, prospective", "hazard, corrective", "hazard, compensatory", "exposure, prospective", "exposure, corrective", "exposure, compensatory", "vulnerability, prospective", "vulnerability, corrective", and "vulnerability, compensatory". The thematic analysis elucidated trends and gaps in the types of interventions used within the 2019 Cities100 Report. For instance, exposure-prospective, exposure-compensatory, and vulnerability-compensatory were the most under-utilized strategies, accounting for only 3% of the total interventions. Further descriptive statistics showed that upper middle-income countries favored "hazard, corrective" strategies over other DRR categories while lower middle-income countries favored "exposure, corrective" over other DRR strategies. Finally, European cities had the highest percentage of DRR connections (51.39%) compared to the maximum possible DRR connections, while African cities had the lowest percentage of DRR connections (22.22%). CONCLUSIONS: The study suggests that the proposed DRR framework could potentially be used to systematically evaluate DRR interventions for missing elements, aiding in the design of more equitable and comprehensive DRR strategies.

Mediterranean diet adherence and metabolic syndrome in US adolescents.

The Mediterranean diet (MD) has been found to lower the risk of heart disease, stroke, and diabetes in adults. Little is known about its acceptance and relationship to cardiovascular risk markers in US adolescents. Using data from the National Health and Nutrition Examination Survey, years 2007-2014, we performed a cross-sectional analysis of adherence to the Mediterranean diet among a representative sample of US adolescents (n = 4223), factors that influence adherence, and whether adherence is associated with cardiometabolic risk factors including metabolic syndrome. MD adherence was calculated using the KIDMED scoring system. We found that overall MD adherence was very low among US adolescents, with Mexican American youths having higher adherence compared to other groups. Higher income was associated with greater adherence. There was low intake of key MD foods including olive oil and finfish. The unadjusted prevalence of metabolic syndrome was 6.6%. MD adherence was not associated with metabolic syndrome.

Patient Travel Distance and Post Lung Transplant Survival in the United States: A Cohort Study.

BACKGROUND: In response to a longstanding Federal mandate to minimize the role of geography in access to transplant in the United States, we assessed whether patient travel distance was associated with lung transplant outcomes. We focused on the posttransplant time period, when the majority of patient visits to a transplant center occur. METHODS: We present a cohort study of lung transplants in the United States between January 1, 2006, and May 31, 2017. Travel distance was measured from the patient's permanent home zip code to the transplant center using SAS URL access to GoogleMaps. We leveraged data from the US Census, US Department of Agriculture, and the Economic Innovations Group to assess socioeconomic status. Multivariable Cox models were used to assess graft survival. RESULTS: We included 18 128 patients who met the inclusion criteria. Median distance was 69.6 miles. Among patients who traveled >60 miles to reach a transplant center, 41.8% bypassed a closer center and sought care at a more distant center. Patients traveling longer distances sought care at centers with a higher annual transplant volume. In the adjusted Cox Model, patients who traveled >360 miles had a slightly higher risk for posttransplant graft failure than patients traveling ≤60 miles (hazard ratio 1.09; 95% CI, 1.01-1.18), and a higher risk for treated acute rejection (hazard ratio, 1.63; 95% CI, 1.43-1.86). CONCLUSIONS: Travel distance was significantly associated with post lung transplant survival. However, this effect was relatively modest. Patient travel distance is an important component of access to lung transplant care.

The Future Role of the United States in Global Health: Emphasis on Cardiovascular Disease.

U.S. global health investment has focused on detection, treatment, and eradication of infectious diseases such as tuberculosis, malaria, and human immunodeficiency virus/acquired immunodeficiency syndrome, with significant results. Although efforts should be maintained and expanded to provide ongoing therapy for chronic infectious disease, there is a pressing need to meet the challenge of noncommunicable diseases, which constitute the highest burden of diseases globally. A Committee of the National Academies of Sciences, Engineering, and Medicine has made 14 recommendations that require ongoing commitments to eradication of infectious disease and increase the emphasis on chronic diseases such as cardiovascular disease. These include improving early detection and treatment, mitigating disease risk factors, shifting global health infrastructure to include management of cardiovascular disease, developing global partners and private-public ventures to meet infrastructure and funding challenges, streamlining medical product development and supply, increasing research and development capacity, and addressing gaps in global political and institutional leadership to meet the shifting challenge.