Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study.

BACKGROUND: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. OBJECTIVE: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. METHODS: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. RESULTS: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. CONCLUSIONS: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.

Lisbon's COVID 19 response: harm reduction interventions for people who use alcohol and other drugs in emergency shelters.

Four emergency shelters were instituted in Lisbon during COVID-19, and are still in operation. Between March and August 2020, they served over 600 people. The shelters host a diverse population, including people experiencing homelessness, foreigners, LGBTI + people, those with reduced mobility, couples, those with pets, and People Who Use Drugs, including alcohol (henceforth PWUD). Individuals are provided care regardless of their immigration or residence status. In order to ensure continuity of care in the shelters and to bring in clients who usually refuse to be sheltered, a range of social and health interventions are integrated into the shelters. Harm reduction services ensure that the most vulnerable populations, PWUD and people experiencing homelessness, have access to the services they need. Innovations in service provision maximize the services impacts and pave the way for the future inclusion and development of these services.

Black Summer in the Shoalhaven, NSW: what was it like and what could we do better? A resident's perspective.

In this perspective paper, I describe the terror of being trapped in an isolated village on the New South Wales (NSW) South Coast as a catastrophic bushfire approached. In the aftermath of the 2019-20 'black summer', I reflect on factors that could have helped reduce the trauma and stress experienced by residents, both during and in the wake of the bushfire event. Education, community planning and preparedness for a situation where modern communication methods fail are key factors to consider.

Mitigating the Twin Threats of Climate-Driven Atlantic Hurricanes and COVID-19 Transmission.

The co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations - proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.

Shelter Hospital: Glimmers of Hope in Treating Coronavirus 2019.

Since the first report of the 2019 novel coronavirus disease (COVID-19) in December 2019 in Wuhan, China, the outbreak of the disease has been continuously evolving. Until March 17, 2020, 185, 178 cases had been confirmed, including 81,134 cases in China and 104,044 cases outside of China. In this comment, we report the unexpected beneficial effect of a deployable rapid-assembly shelter hospital on the prevention and treatment of COVID-19. We describe the shelter hospital maintenance, treatment mode and primary treatment methods, which will provide a valuable experience in dealing with public health emergencies, such as COVID-19, for other countries and areas.

An Optimization-Based Approach to Social Network Group Decision Making with an Application to Earthquake Shelter-Site Selection.

The social network has emerged as an essential component in group decision making (GDM) problems. Thus, this paper investigates the social network GDM (SNGDM) problem and assumes that decision makers offer their preferences utilizing additive preference relations (also called fuzzy preference relations). An optimization-based approach is devised to generate the weights of decision makers by combining two reliable resources: in-degree centrality indexes and consistency indexes. Based on the obtained weights of decision makers, the individual additive preference relations are aggregated into a collective additive preference relation. Further, the alternatives are ranked from best to worst according to the obtained collective additive preference relation. Moreover, earthquakes have occurred frequently around the world in recent years, causing great loss of life and property. Earthquake shelters offer safety, security, climate protection, and resistance to disease and ill health and are thus vital for disaster-affected people. Selection of a suitable site for locating shelters from potential alternatives is of critical importance, which can be seen as a GDM problem. When selecting a suitable earthquake shelter-site, the social trust relationships among disaster management experts should not be ignored. To this end, the proposed SNGDM model is applied to evaluate and select earthquake shelter-sites to show its effectiveness. In summary, this paper constructs a novel GDM framework by taking the social trust relationship into account, which can provide a scientific basis for public emergency management in the major disasters field.

Relation of post-traumatic stress disorder symptom severity to the efficacy of an animal-assisted intervention for stress reduction after military aeromedical evacuation.

Animal-assisted interventions (AAIs) have been found to decrease stress in some settings, but it is not known if AAI is feasible in an aeromedical staging facility or effective in reducing stress following aeromedical evacuation (AE) of military personnel. An experimental design was used to evaluate the efficacy of AAI at reducing stress in AE military patients (N = 120). Patients participated in a 20-min AAI (n = 60) or 20-min informational session about assistance dogs as an attention-control group (n = 60). Demographics, post-traumatic stress symptom severity (PTSSS), and stress biomarkers (cortisol, alpha-amylase, and immunoglobulin A) were collected regular intervals. AAI was found feasible and efficacious at reducing stress. Cortisol decreased significantly (p < .05) in the AAI group compared with the attention-control group. PTSSS moderated the immunoglobulin A responses to AAI as demonstrated by the interaction of PTSD Checklist-Military Version score, group, and time, F(1, 111.23) = 4.15 p = .044; effect size: d = 0.31. This research supports AAI as a stress-reducing modality in AE patients, particularly those who report higher PTSSS. Implications for future research are discussed.

Dallas MegaShelter Medical Operations Response to Hurricane Harvey.

On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with "mega-sheltering," beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33-37).

Characterizing peer roles in an overdose crisis: Preferences for peer workers in overdose response programs in emergency shelters.

OBJECTIVES: A growing body of research points to increasing peer involvement in programs for people who use drugs, although this work has focused primarily on naloxone education and distribution. This study extends this work by examining the roles of peers in leading a novel overdose response program within emergency shelters. METHODS: Semi-structured qualitative interviews were conducted with 24 people who use drugs, recruited from two emergency shelters, as well as ethnographic observation in these settings. Interviews were transcribed and analyzed thematically with attention to peer roles. RESULTS: Four themes emerged from the data. First, participants discussed the development of peer support through relationship building and trust. Second, participants described a level of safety using drugs in front of peer workers due to their shared lived experience. Third, peer workers were described as favorable compared to non-peer staff because of nominal power dynamics and past negative experiences with non-peer staff. Last, given the context of the overdose crisis, peer worker roles were often routinized informally across the social networks of residents, which fostered a collective obligation to respond to overdoses. CONCLUSIONS: Findings indicate that participants regarded peer workers as providing a range of unique benefits. They emphasized the critical role of both social networks and informal roles in optimizing overdose responses. The scaling up of peer programming in distinct risk environments such as emergency shelters through both formal and informal roles has potential to help improve overdose prevention efforts, including in settings not well served by conventional public health programming.

Difficulties of fathers whose families evacuated voluntarily after the Fukushima nuclear disaster.

The Fukushima nuclear disaster in 2011 resulted in radiation exposure, and many evacuees felt anxious of its health risks. However, little is known about the difficulties faced by fathers whose families evacuated voluntarily. Therefore, the aim of the present case study was to clarify the difficulties and concerns of fathers whose families evacuated voluntarily after the Fukushima nuclear disaster. Eleven fathers in Fukushima were interviewed between 14 December 2014 and 25 February 2015. Four themes emerged: (i) seeking a safe place away from radiation exposure; (ii) burdens of a double life; (iii) feelings of isolation and perceived deterioration of health; and (iv) deciding on whether to continue voluntary evacuation. Fathers were anxious about radiation exposure, similar to mothers, and faced work-family conflicts from the voluntary evacuation of their families, including financial, physical, and mental sacrifice. Half of the fathers did not express their difficulties to others. Our findings identified a new type of conflict between people of a community who did/did not choose voluntary evacuation. Occupational health nurses should understand fathers' feelings of isolation and monitor their health to prevent the development of stress-related diseases.

Negotiating space & drug use in emergency shelters with peer witness injection programs within the context of an overdose crisis: A qualitative study.

Vancouver, Canada is experiencing an overdose crisis due to the proliferation of fentanyl and related analogues and novel overdose response interventions are being implemented across multiple high overdose risk environments, including emergency shelters. We draw on ethnographic fieldwork and qualitative interviews to examine how social, structural, and physical contexts at two emergency shelters implementing a peer-based supervised injection intervention influenced injection drug use and overdose risks. Findings reveal that the implementation of this intervention reduced stigma and shame through the normalization of drug use in shelter spaces, and yet underlying social norms and material constraints led people to inject alone in non-designated injecting spaces. Whereas these spatial dynamics of injection drug use potentially increased overdose vulnerability, an emerging sense of collective responsibility in relation to the overdose crisis led to the routinization of peer witnessing practices across the shelter environment to extend the impact of the intervention.

Evacuation Decision Making and Expanded Roles of Adult Daycare Services in the Great East Japan Earthquake: Qualitative Analysis Using Semistructured Interviews.

CONTEXT: The roles of adult daycare services during disaster evacuations in the relationships with community resilience are unknown. The initial 72 hours after a disaster are crucial because people in the disaster area depend on their own efforts or the resources available at the moment until the arrival of external support. OBJECTIVE: To clarify the evacuation-related decision making of the administrators of adult daycare services within 72 hours after the Great East Japan Earthquake and to describe the roles of adult daycare services during the month following the earthquake. DESIGN: Qualitative study using semistructured interviews. The transcribed interviews were analyzed anonymously through an inductive qualitative content analysis using ATLAS.ti. SETTING: Kesennuma City, Miyagi Prefecture. PARTICIPANTS: Eleven key informants (3 primary care providers and 8 administrators) from 8 institutions. RESULTS: Immediately after the disaster, 6 institutions implemented shelter-in-place. The evacuation behaviors of the adult daycare institutions were diverse, but each institution was transformed repeatedly within 72 hours. With respect to evacuation decision making, the primary issues involved whether to go to mandatory evacuation sites. However, after 3 days, the institutions relocated from these sites to other places. During a period of approximately 1 month, 7 institutions managed the evacuation of service users and care providers. The expanded institutional roles were as follows: "confirming the safety of the users' families," "substituting residential facilities," and "imposing leadership during the evacuation." CONCLUSIONS: If institutions choose to shelter-in-place, it should be sustained for as long as possible. Sufficiently planned stores of food and water to accommodate daytime users are needed. Institutions that employ shelter-in-place as an evacuation plan should maintain close contact with local governments. Furthermore, local governments should predetermine how to manage these institutions in the event of a disaster. To build community resilience for disasters, developing linkage with private organizations' resilience is beneficial.

Sheltering for Safety in Community Women With Divorce Histories.

This cross-sectional study compared the prevalence of formal and informal sheltering (i.e., staying in an agency shelter, or with friends/family, respectively) and evaluated associations with abuse severity. Community women ( N = 197) with divorce histories reported on lifetime intimate partner abuse, including sheltering for safety. Prevalence of informal sheltering (43%) exceeded that of formal sheltering (11%). Rates/levels of coercive control, severe violence, injury, and police involvement were comparable for women who sheltered formally or informally, and exceeded those of women who never sheltered. Sheltering histories can be identified in community samples of women with divorce histories. Informal sheltering is prevalent, and comparable to formal sheltering in terms of correlations with abuse severity.

Hospital Evacuation and Shelter-in-Place: Who Is Responsible for Decision-Making?

OBJECTIVE: During natural disasters, hospital evacuation may be necessary to ensure patient safety and care. We aimed to examine perceptions of stakeholders involved in these decisions throughout the Mid-Atlantic region of the United States during Hurricane Sandy in October 2012. METHODS: Semistructured interviews were conducted from March 2014 to February 2015 to characterize stakeholders' perceptions about authority and responsibility for acute care hospital evacuation/shelter-in-place decision-making in Delaware, Maryland, New Jersey, and New York during Hurricane Sandy. Interviews were recorded, transcribed, and thematically analyzed using a framework approach. RESULTS: We interviewed 42 individuals from 32 organizations. Hospital executives from all states reported having authority and responsibility for evacuation/shelter-in-place decision-making. In New York and Maryland, government officials stated that they could order hospital evacuation, whereas officials in Delaware and New Jersey said the government lacked enforcement capacity and therefore could not mandate evacuation. CONCLUSIONS: Among government officials, perceived authority for hospital evacuation/shelter-in-place decision-making was viewed as a prerequisite to ordering evacuation. When both hospital executives and government officials perceive themselves to possess decision-making authority, there is the potential for inaction. Future work should examine whether a single entity bearing ultimate responsibility or regional emergency response coalitions would improve decision-making. (Disaster Med Public Health Preparedness. 2016;10:320-324).

[Overall principles of treatment in case of toxicological threats]. / Ogólne zasady postepowania w przypadku zagrozen toksykologicznych.

Toxins and venoms are silent weapons capable of killing people secretly. All around the world, there are a lot of such substances produced by bacteria, fungi, plants and animals. The threat to health and life, which are caused by toxins and venoms, meant that they are seen as a biological weapon. In the rescue proceedings with the victims the mechanism of toxin action is imported, because in some cases the antitoxins are known. However, in the most cases, the primary consideration is the symptomatic treatment. Conducted research on the usefulness of oxime and autofages in eliminating the effects of toxins are advanced, but not yet implemented into therapy. In each case the toxin action the victims must be evacuated to a safe location. It is also necessary to protect teams providing assistance in suitable protective clothing.

K-Shortest-Path-Based Evacuation Routing with Police Resource Allocation in City Transportation Networks.

Emergency evacuation aims to transport people from dangerous places to safe shelters as quickly as possible. Police play an important role in the evacuation process, as they can handle traffic accidents immediately and help people move smoothly on roads. This paper investigates an evacuation routing problem that involves police resource allocation. We propose a novel k-th-shortest-path-based technique that uses explicit congestion control to optimize evacuation routing and police resource allocation. A nonlinear mixed-integer programming model is presented to formulate the problem. The model's objective is to minimize the overall evacuation clearance time. Two algorithms are given to solve the problem. The first one linearizes the original model and solves the linearized problem with CPLEX. The second one is a heuristic algorithm that uses a police resource utilization efficiency index to directly solve the original model. This police resource utilization efficiency index significantly aids in the evaluation of road links from an evacuation throughput perspective. The proposed algorithms are tested with a number of examples based on real data from cities of different sizes. The computational results show that the police resource utilization efficiency index is very helpful in finding near-optimal solutions. Additionally, comparing the performance of the heuristic algorithm and the linearization method by using randomly generated examples indicates that the efficiency of the heuristic algorithm is superior.

Enhancing evacuation plans with a situation awareness system based on end-user knowledge provision.

Recent disasters have shown that having clearly defined preventive procedures and decisions is a critical component that minimizes evacuation hazards and ensures a rapid and successful evolution of evacuation plans. In this context, we present our Situation-Aware System for enhancing Evacuation Plans (SASEP) system, which allows creating end-user business rules that technically support the specific events, conditions and actions related to evacuation plans. An experimental validation was carried out where 32 people faced a simulated emergency situation, 16 of them using SASEP and the other 16 using a legacy system based on static signs. From the results obtained, we compare both techniques and discuss in which situations SASEP offers a better evacuation route option, confirming that it is highly valuable when there is a threat in the evacuation route. In addition, a study about user satisfaction using both systems is presented showing in which cases the systems are assessed as satisfactory, relevant and not frustrating.

The quality of life of flood survivors in Thailand, Nakhon Pathom Rajabhat University.

BACKGROUND: The flood crisis of 2011 was a disaster of the highest order in Thailand and Nakhon Pathom Province was among those hit. The purpose of this research was to explore quality of life of flood survivors in Thailand living in a flood shelter established by Nakhon Pathom Rajabhat University. METHODS: This study was a descriptive research. The research instrument was WHO quality of life-brief Thai questionnaire (WHOQOL-BREF-THAI). The data were collected by self administered questionnaires, or read to the subjects who cannot read, then evaluated the answers by themselves on November, 2011. Descriptive statistics, independent-sample t-test and one-way ANOVA were used in the data analysis. RESULTS: The study found that: (1) The quality of life score was found to be at a moderate level of 65.9% and a high of 34.1%. The social relationships domain of quality of life was at the highest level (47.6%). The poorest quality of life score was from the environmental domain (24.9%); (2) There was no significant difference between gender (t=0.004, p-value=0.997) or age (F=1.356, p-value=0.260), with quality of life. CONCLUSION: The quality of life evaluation of flood survivors should be further monitored after the recovery and a intervention programme should address their respective needs and covers all aged and genders.