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1.
Value Health ; 24(5): 625-631, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33933230

RESUMO

The potential health and economic value of a vaccine for coronavirus disease (COVID-19) is self-evident given nearly 2 million deaths, "collateral" loss of life as other conditions go untreated, and massive economic damage. Results from the first licensed products are very encouraging; however, there are important reasons why we will likely need second and third generation vaccines. Dedicated incentives and funding focused explicitly on nurturing and advancing competing second and third generation vaccines are essential. This article proposes a collaborative, market-based financing mechanism for the world to incentivize and pay for the development of, and provide equitable access to, second and third generation COVID-19 vaccines. Specifically, we propose consideration of a Benefit-Based Advance Market Commitment (BBAMC). The BBAMC uses health technology assessment to determine value-based prices to guarantee overall market revenues, not revenue for any specific product or company. The poorest countries would not pay a value-based price but a discounted "tail-price." Innovators must agree to supply them at this tail price or to facilitate technology transfer to local licensees at low or zero cost to enable them to supply at this price. We expect these purchases to be paid for in full or large part by global donors. The BBAMC therefore sets prices in relation to value, protects intellectual property rights, encourages competition, and ensures all populations get access to vaccines, subject to agreed priority allocation rules.


Assuntos
/prevenção & controle , Saúde Global/economia , Programas de Imunização/economia , /tratamento farmacológico , /economia , Defesa Civil/métodos , Defesa Civil/tendências , Competição Econômica/normas , Competição Econômica/tendências , Saúde Global/tendências , Humanos , Programas de Imunização/métodos
2.
J Emerg Manag ; 19(2): 143-163, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33954964

RESUMO

OBJECTIVE: To understand how elderly and medically frail adults have experienced disasters and how this experience impacts what they do now to prepare for disasters and to generate theory regarding the process through which community members prepare for disasters. DESIGN: This study employed a qualitative descriptive methodology, Situational Analysis (SA), to explore the social processes of disaster preparedness in vulnerable community members. The Protective Action Decision Model was used to inspire the interview guide and initial coding of the data. Discourse analysis was performed on noninterview data. SETTING: A coastal urban community heavily damaged by Hurricane Sandy in 2012. PARTICIPANTS: Convenience sample of 33 elderly or medically frail community members. RESULTS: Based on the findings, it was theorized that these community members are unprepared for disasters. Their lack of preparedness is due in large part to a lack of education on how best to prepare. If these community members are incidentally prepared, it is largely due to their past experience with disaster or their professional experience. The preparedness discourse did not recognize the extent to which elderly and medically frail populations rely on institutions and social support networks to meet their disaster resilience antecedents. CONCLUSIONS: Community interventions such as distributing disaster supply kits and offering evacuation assistance can help to overcome situational impediments to preparedness and provide the best chance for community members to survive disasters without becoming ill or injured. Study results can inform emergency plans and policy efforts to better meet the needs of these community members during disasters.


Assuntos
Defesa Civil , Tempestades Ciclônicas , Planejamento em Desastres , Desastres , Adulto , Idoso , Emergências , Idoso Fragilizado , Humanos
3.
Lupus Sci Med ; 8(1)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33875571

RESUMO

OBJECTIVE: To report the results of a survey exploring the experience of patients with SLE facing hydroxychloroquine (HCQ) shortage that occurred during the early phases of the COVID-19 pandemic. METHODS: A survey was designed by Lupus Europe's patient advisory network and distributed through its social media, newsflash and members' network. People with lupus were asked about their last HCQ purchases and their level of anxiety (on a 0-10 scale) with regard to not being able to have access to HCQ, once in April 2020 (first wave) and after 11 August (second wave). The results were compared. RESULTS: 2075 patients responded during the first wave; 1001 (48.2%) could get HCQ from the first place they asked, 230 (11.1%) could get the drug by going to more than one pharmacy, 498 (24.0%) obtained HCQ later from their usual pharmacy and 126 (6.1%) from other sources. 188 (9.1%) could not get any; 32 (1.5%) did not respond to this question. All countries showed significant improvement in HCQ availability during the second wave. 562 (27.4%) patients reported an extremely high level of anxiety in wave 1 and 162 (10.3%) patients in wave 2; 589 (28.7%) and 268 (17.1%) patients reported a high level of anxiety in wave 1 and wave 2, respectively. CONCLUSIONS: The HCQ shortage had a significant impact on patients with SLE and has been responsible for psychological consequences including anxiety. Indeed, despite an objective improvement in drug availability, the event is leaving significant traces in patients' mind and behaviours.


Assuntos
Ansiedade , Serviços Comunitários de Farmácia/estatística & dados numéricos , Acesso aos Serviços de Saúde , Hidroxicloroquina , Lúpus Eritematoso Sistêmico , Antirreumáticos/provisão & distribução , Antirreumáticos/uso terapêutico , Ansiedade/diagnóstico , Ansiedade/etiologia , /epidemiologia , Defesa Civil/métodos , Defesa Civil/normas , Europa (Continente)/epidemiologia , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Hidroxicloroquina/provisão & distribução , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/psicologia , Angústia Psicológica , Autorrelato/estatística & dados numéricos , Inquéritos e Questionários
5.
Indian Pediatr ; 58(4): 391-392, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33883315

RESUMO

To examine the impact of the COVID-19 pandemic, we interviewed 26 patients with lysosomal storage disorders receiving enzyme replacement therapy. 20 (77 %) had significant interruption in their treatment, with an average of 8 (range 2-28) missed doses. Alternate methods of delivering uninterrupted care including home therapy were used. Vulnerable patients with chronic genetic disorders require organization for their multidisciplinary needs of care.


Assuntos
Terapia de Reposição de Enzimas/métodos , Acesso aos Serviços de Saúde , Doenças por Armazenamento dos Lisossomos , Conduta do Tratamento Medicamentoso , Adolescente , /prevenção & controle , Defesa Civil/normas , Feminino , Doenças Genéticas Inatas/epidemiologia , Doenças Genéticas Inatas/terapia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Índia/epidemiologia , Controle de Infecções , Doenças por Armazenamento dos Lisossomos/epidemiologia , Doenças por Armazenamento dos Lisossomos/terapia , Masculino , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/normas , Inquéritos e Questionários
6.
Medicine (Baltimore) ; 100(15): e25495, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847662

RESUMO

ABSTRACT: While the new Coronavirus Disease 2019 (COVID-19) pandemic rapidly spread across the world, South America was reached later in relation to Asia, Europe and the United States of America (USA). Brazil concentrates now the largest number of cases in the continent and, as the disease speedily progressed throughout the country, prompt and challenging operational strategies had to be taken by institutions caring for COVID-19 and non-COVID-19 patients in order to assure optimal workflows, triage, and management. Although hospitals in the USA, Europe and Asia have shared their experience on this subject, little has been discussed about such strategies in South America or by the perspective of outpatient centers, which are paramount in the radiology field. This article shares the guidelines adopted early in the pandemic by a nationwide outpatient healthcare center composed by a network of more than 200 patient service centers and nearly 2,000 radiologists in Brazil, discussing operational and patient management strategies, staff protection, changes adopted in the fellowship program, and the effectiveness of such measures.


Assuntos
Assistência Ambulatorial , Gestão de Mudança , Defesa Civil , Procedimentos Clínicos , Planejamento Estratégico , Tecnologia Radiológica , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Brasil/epidemiologia , /epidemiologia , Defesa Civil/organização & administração , Defesa Civil/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos , Inovação Organizacional , Guias de Prática Clínica como Assunto , Planejamento Estratégico/normas , Planejamento Estratégico/estatística & dados numéricos , Tecnologia Radiológica/métodos , Tecnologia Radiológica/organização & administração , Tecnologia Radiológica/estatística & dados numéricos
7.
Artigo em Inglês | MEDLINE | ID: mdl-33801535

RESUMO

Radiation emergency medicine systems are operated around the world to provide special care for the injured that require immediate medical attention in accidents. The objective of this survey was to evaluate people's perception of those who design the emergency medical plan for radiation accidents and those who supervise it in Korea. A questionnaire survey was conducted on the people involved in a regulatory system for medical response in a radiation emergency. Of 150 survey recipients, 133 (88.7%) completed the survey, including 92 workers and 41 inspectors. The respondents expressed the view that the national emergency medical plan is prepared above the average level using a Likert-style scale of 1 to 5 (mean = 3.55, SD = 0.74). Interestingly, using the Mann-Whitney U test, it could be shown that inspectors evaluated the emergency medical system for radiation accidents more strictly in all of the questions than the licensee workers, especially on radiation medical emergency preparedness (p = 0.004) and the governmental regulatory policy for radiation safety (p = 0.007). For a more efficient system of radiation emergency medicine, licensee workers prioritized the workforce, whereas inspectors favored laws and regulations for safety. The survey results show different perspectives between inspectors and licensee workers, which stem from the actual properties of each occupational role in the regulatory system for radiation medical emergency. These data could be utilized for communication and interaction with relevant people to improve the medical response preparedness against radiation accidents.


Assuntos
Defesa Civil , Medicina de Emergência , Liberação Nociva de Radioativos , Emergências , Humanos , República da Coreia
9.
Pan Afr Med J ; 38: 130, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912300

RESUMO

Introduction: the Democratic Republic of Congo (DRC) declared its 10thoutbreak of Ebola virus disease (EVD) in 42 years on August 1st 2018. The rapid rise and spread of the EVD outbreak threatened health security in neighboring countries and global health security. The United Nations developed an EVD preparedness and readiness (EVD-PR) plan to assist the nine neighboring countries to advance their critical preparedness measures. In Uganda, EVD-PR was implemented between 2018 and 2019. The World Health Organization commissioned an independent evaluation to assess the impact of the investment in EVD-PR in Uganda. Objectives: i) to document the program achievements; ii) to determine if the capacities developed represented good value for the funds and resources invested; iii) to assess if more cost-effective or sustainable alternative approaches were available; iv) to explore if the investments were aligned with country public health priorities; and v) to document the factors that contributed to the program success or failure. Methods: during the EVD preparedness phase, Uganda's government conducted a risk assessment and divided the districts into three categories, based on the potential risk of EVD. Category I included districts that shared a border with the DRC provinces where EVD was ongoing or any other district with a direct transport route to the DRC. Category II were districts that shared a border with the DRC but not bordering the DRC provinces affected by the EVD outbreak. Category III was the remaining districts in Uganda. EVD-PR was implemented at the national level and in 22 category I districts. We interviewed key informants involved in program design, planning and implementation or monitoring at the national level and in five purposively selected category I districts. Results: Ebola virus disease preparedness and readiness was a success and this was attributed mainly to donor support, the ministry of health's technical capacity, good coordination, government support and community involvement. The resources invested in EVD-PR represented good value for the funds and the activities were well aligned to the public health priorities for Uganda. Conclusion: Ebola virus disease preparedness and readiness program in Uganda developed capacities that played an essential role in preventing cross border spread of EVD from the affected provinces in the DRC and enabled rapid containment of the two importation events. These capacities are now being used to detect and respond to the COVID-19 pandemic.


Assuntos
/prevenção & controle , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/prevenção & controle , /epidemiologia , Defesa Civil/organização & administração , Doença pelo Vírus Ebola/epidemiologia , Humanos , Saúde Pública , Uganda/epidemiologia
11.
Am J Public Health ; 111(5): 860-866, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33734852

RESUMO

The COVID-19 pandemic has precipitated an acute blood shortage for medical transfusions, exacerbating an already tenuous blood supply system in the United States, contributing to the public health crisis, and raising deeper questions regarding emergency preparedness planning for ensuring blood availability. However, these issues around blood availability during the pandemic are related primarily to the decline in supply caused by reduced donations during the pandemic rather than increased demand for transfusion of patients with COVID-19.The challenges to ensure a safe blood supply during the pandemic will continue until a vaccine is developed, effective treatments are available, or the virus goes away. If this virus or a similar virus were capable of transmission through blood, it would have a catastrophic impact on the health care system, causing a future public health emergency that would jeopardize the national blood supply.In this article, we identify the impact of the COVID-19 pandemic on blood supply adequacy, discuss the public health implications, propose recovery strategies, and present recommendations for preparing for the next disruption in blood supply driven by a public health emergency.


Assuntos
Segurança do Sangue/normas , Defesa Civil/normas , Saúde Pública , Política Pública , Assistência à Saúde , Humanos , Estados Unidos
12.
J Public Health Manag Pract ; 27(3): 246-250, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729203

RESUMO

CONTEXT: Existing hospitalization ratios for COVID-19 typically use case counts in the denominator, which problematically underestimates total infections because asymptomatic and mildly infected persons rarely get tested. As a result, surge models that rely on case counts to forecast hospital demand may be inaccurately influencing policy and decision-maker action. OBJECTIVE: Based on SARS-CoV-2 prevalence data derived from a statewide random sample (as opposed to relying on reported case counts), we determine the infection-hospitalization ratio (IHR), defined as the percentage of infected individuals who are hospitalized, for various demographic groups in Indiana. Furthermore, for comparison, we show the extent to which case-based hospitalization ratios, compared with the IHR, overestimate the probability of hospitalization by demographic group. DESIGN: Secondary analysis of statewide prevalence data from Indiana, COVID-19 hospitalization data extracted from a statewide health information exchange, and all reported COVID-19 cases to the state health department. SETTING: State of Indiana as of April 30, 2020. MAIN OUTCOME MEASURES: Demographic-stratified IHRs and case-hospitalization ratios. RESULTS: The overall IHR was 2.1% and varied more by age than by race or sex. Infection-hospitalization ratio estimates ranged from 0.4% for those younger than 40 years to 9.2% for those older than 60 years. Hospitalization rates based on case counts overestimated the IHR by a factor of 10, but this overestimation differed by demographic groups, especially age. CONCLUSIONS: In this first study of the IHR based on population prevalence, our results can improve forecasting models of hospital demand-especially in preparation for the upcoming winter period when an increase in SARS CoV-2 infections is expected.


Assuntos
/epidemiologia , Defesa Civil/organização & administração , Defesa Civil/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Vigilância da População , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Previsões , Humanos , Indiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
15.
JAMA Netw Open ; 4(3): e212382, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739431

RESUMO

Importance: The 2017-2018 influenza season in the US was marked by a high severity of illness, wide geographic spread, and prolonged duration compared with recent previous seasons, resulting in increased strain throughout acute care hospital systems. Objective: To characterize self-reported experiences and views of hospital capacity managers regarding the 2017-2018 influenza season in the US. Design, Setting, and Participants: In this qualitative study, semistructured telephone interviews were conducted between April 2018 and January 2019 with a random sample of capacity management administrators responsible for throughput and hospital capacity at short-term, acute care hospitals throughout the US. Main Outcomes and Measures: Each participant's self-reported experiences and views regarding high patient volumes during the 2017-2018 influenza season, lessons learned, and the extent of hospitals' preparedness planning for future pandemic events. Interviews were recorded and transcribed and then analyzed using thematic content analysis. Outcomes included themes and subthemes. Results: A total of 53 key hospital capacity personnel at 53 hospitals throughout the US were interviewed; 39 (73.6%) were women, 48 (90.6%) had a nursing background, and 29 (54.7%) had been in the occupational role for more than 4 years. Participants' experiences were categorized into several domains: (1) perception of strain, (2) effects of influenza and influenza-like illness on staff and patient care, (3) immediate staffing and capacity responses to influenza and influenza-like illness, and (4) future staffing and capacity preparedness for influenza and influenza-like illness. Participants reported experiencing perceived strain associated with concerns about preparedness for seasonal influenza and influenza-like illness as well as concerns about staffing, patient care, and capacity, but future pandemic planning within hospitals was not reported as being a high priority. Conclusions and Relevance: The findings of this qualitative study suggest that during the 2017-2018 influenza season, there were systemic vulnerabilities as well as a lack of hospital preparedness planning for future pandemics at US hospitals. These issues should be addressed given the current coronavirus disease 2019 pandemic.


Assuntos
Fortalecimento Institucional , Gestão de Mudança , Defesa Civil/organização & administração , Planejamento em Desastres/métodos , Surtos de Doenças , Influenza Humana , /epidemiologia , Fortalecimento Institucional/métodos , Fortalecimento Institucional/organização & administração , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Mão de Obra em Saúde/organização & administração , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Influenza Humana/terapia , Administração de Recursos Humanos/métodos , Pesquisa Qualitativa , Estações do Ano , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
16.
BMC Public Health ; 21(1): 580, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33757461

RESUMO

BACKGROUND: The World Health Organization (WHO) declared the COVID-19 pandemic a public health emergency of international concern. South Africa, like many other countries, initiated a multifaceted national response to the pandemic. Self-isolation and quarantine are essential components of the public health response in the country. This paper examined perceptions and preparedness for self-isolation or quarantine during the initial phase of the pandemic in South Africa. METHODS: The analysis used data obtained from an online quantitative survey conducted in all nine provinces using a data-free platform. Descriptive statistics and multivariable logistic regression models were used to analyse the data. RESULTS: Of 55,823 respondents, 40.1% reported that they may end up in self-isolation or quarantine, 32.6% did not think that they would and 27.4% were unsure. Preparedness for self-isolation or quarantine was 59.0% for self, 53.8% for child and 59.9% for elderly. The odds of perceived possibility for self-isolation or quarantine were significantly higher among Coloureds, Whites, and Indians/Asians than Black Africans, and among those with moderate or high self-perceived risk of contracting COVID-19 than those with low risk perception. The odds were significantly lower among older age groups than those aged 18-29 years, and those unemployed than fully employed. The odds of preparedness for self-isolation or quarantine were significantly less likely among females than males. Preparedness for self, child and elderly isolation or quarantine was significantly more likely among other population groups than Black Africans and among older age groups than those aged 18-29 years. Preparedness for self, child and elderly isolation or quarantine was significantly less likely among those self-employed than fully employed and those residing in informal dwellings than formal dwellings. In addition, preparedness for self-isolation or quarantine was significantly less likely among those with moderate and high self-perceived risk of contracting COVID-19 than low risk perception. CONCLUSION: The findings highlight the challenge of implementing self-isolation or quarantine in a country with different and unique social contexts. There is a need for public awareness regarding the importance of self-isolation or quarantine as well as counter measures against contextual factors inhibiting this intervention, especially in impoverished communities.


Assuntos
/prevenção & controle , Defesa Civil/organização & administração , Controle de Doenças Transmissíveis/organização & administração , Planejamento em Desastres/organização & administração , Pandemias/prevenção & controle , Quarentena , Adolescente , Adulto , Idoso , Criança , Planejamento em Desastres/métodos , Feminino , Humanos , Masculino , Saúde Pública , Quarentena/psicologia , África do Sul , Inquéritos e Questionários , Adulto Jovem
18.
J Emerg Manag ; 19(1): 39-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33735434

RESUMO

Over the last 3 years at a large, -midwestern, pediatric hospital, there have been near -disaster events, a few of which required transfer or evacuation of patients. The responses from the inpatient units to these events have varied greatly and can be traced back to communication, knowledge, comfort level, and effectiveness of the charge nurses on the nursing units. A task force was formed to understand the variation in their disaster response procedures and to standardize disaster response procedures. Respondents included the bedside, clinical leader-ship, managers of patient services, emergency preparedness management, and senior leadership. This resulted in the creation of a tabletop simulation exercise for use by inpatient charge nurses within the institution. The results indicated that participants reported higher levels of self-reported knowledge, confidence, and effectiveness regarding the disaster preparedness on their units (p < 0.001). The program was effective, with feedback from participants indicating the need for more frequent and/or department -specific education.


Assuntos
Defesa Civil , Planejamento em Desastres , Desastres , Criança , Humanos , Supervisão de Enfermagem , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
19.
Respirology ; 26(4): 322-333, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33690946

RESUMO

COVID-19 has hit the world by surprise, causing substantial mortality and morbidity since 2020. This narrative review aims to provide an overview of the epidemiology, induced impact, viral kinetics and clinical spectrum of COVID-19 in the Asia-Pacific Region, focusing on regions previously exposed to outbreaks of coronavirus. COVID-19 progressed differently by regions, with some (such as China and Taiwan) featured by one to two epidemic waves and some (such as Hong Kong and South Korea) featured by multiple waves. There has been no consensus on the estimates of important epidemiological time intervals or proportions, such that using them for making inferences should be done with caution. Viral loads of patients with COVID-19 peak in the first week of illness around days 2 to 4 and hence there is very high transmission potential causing community outbreaks. Various strategies such as government-guided and suppress-and-lift strategies, trigger-based/suppression approaches and alert systems have been employed to guide the adoption and easing of control measures. Asymptomatic and pre-symptomatic transmission is a hallmark of COVID-19. Identification and isolation of symptomatic patients alone is not effective in controlling the ongoing outbreaks. However, early, prompt and coordinated enactment predisposed regions to successful disease containment. Mass COVID-19 vaccinations are likely to be the light at the end of the tunnel. There is a need to review what we have learnt in this pandemic and examine how to transfer and improve existing knowledge for ongoing and future epidemics.


Assuntos
Controle de Doenças Transmissíveis , Ásia/epidemiologia , Australásia/epidemiologia , /fisiopatologia , /virologia , Defesa Civil/organização & administração , Controle de Doenças Transmissíveis/legislação & jurisprudência , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/estatística & dados numéricos , Regulamentação Governamental , Humanos , Cooperação Internacional , /fisiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-33540547

RESUMO

This study used a descriptive cross-sectional methodology to measure healthcare workers' knowledge, attitudes, perceptions, and willingness to respond to a flood scenario in Saudi Arabia. A validated survey was distributed to collect data using a convenience sampling technique through multiple social media platforms. A total of 227 participants were included in this study: 52% of them were aged between 26 to 34 years, 74% were residents from Riyadh, and 52.4% worked in nursing divisions. A significant number of respondents (73.2%) had positive perceptions towards their hospitals' ability to provide an effective response to a flood, 89% were willing to report to work following a flood, and 90% of participants reported the need to develop both guidelines and training for flood disaster preparedness. Preparation and successful flood mitigation in the hospital setting requires staff that have both knowledge and training in emergency management. One way to obtain such readiness is through competency-based training, including both table-top and full-scale live exercises. Although the willingness to respond to such a flooding emergency was high among staff, the development of guidelines and educational programs is needed in order to develop the competencies and skills sets to improve disaster preparedness response and preparedness efforts.


Assuntos
Defesa Civil , Planejamento em Desastres , Adulto , Estudos Transversais , Inundações , Pessoal de Saúde , Humanos , Arábia Saudita
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