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1.
Public Health ; 186: 20-27, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32750505

RESUMO

OBJECTIVES: In 1984, nearly 500,000 inhabitants of Bhopal city, India, were exposed to toxic gases that leaked from a nearby pesticide manufacturing plant. In 1985, four cohorts were established to assess the long-term health impact of exposure, namely, mild, moderate, severely exposed and unexposed groups. The self-reported morbidity data of these cohorts were collected by follow-up cross-sectional surveys at regular intervals over the last 35 years. The present study aimed to analyse the long-term trend of chronic (duration of symptoms >3 months) respiratory morbidity in the four cohorts, stratified by age groups. STUDY DESIGN: The design of this study is a longitudinal analysis of cross-sectional respiratory morbidity data. METHODS: Chronic respiratory morbidity data within the cohorts were analysed at 5-year intervals (first recorded data from 1986). Based on age at the time of exposure, subjects were stratified into four age groups: children (aged <10 years), teenagers (aged ≥10 to <20 years), younger adults (aged ≥20 to <40 years) and older adults (aged ≥40 years). RESULTS: During the first decade, after exposure to the toxic gases, chronic respiratory morbidity in children and teenagers was high (up to 9.1%), which declined thereafter. Progressively increasing chronic respiratory morbidity was observed in both the younger and older adult age groups within all cohorts during the initial 5-10 years after exposure. Respiratory morbidity in both the younger and older adult age groups remained high for 15-20 years and thereafter recorded a declining trend. The highest respiratory morbidity observed during this study in the younger and older adult age groups was 38.6% and 59.5%, respectively; these values were both recorded in the severely exposed cohort. CONCLUSIONS: Exposure to toxic gases released during the Bhopal gas disaster has resulted in chronic respiratory morbidity of the exposed population; this morbidity has continued over decades. The age of the individuals at the time of exposure and exposure severity were crucial determinants of the long-term trend of respiratory morbidity.


Assuntos
Vazamento Acidental em Bhopal , Exposição Ambiental/efeitos adversos , Gases/efeitos adversos , Doenças Respiratórias/induzido quimicamente , Doenças Respiratórias/mortalidade , Adolescente , Adulto , Criança , Estudos Transversais , Desastres/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Feminino , Intoxicação por Gás/epidemiologia , Humanos , Índia/epidemiologia , Isocianatos/envenenamento , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Morbidade , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
2.
Public Health Rep ; 135(5): 565-570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735159

RESUMO

Community resilience is a community's ability to maintain functioning (ie, delivery of services) during and after a disaster event. The Composite of Post-Event Well-Being (COPEWELL) is a system dynamics model of community resilience that predicts a community's disaster-specific functioning over time. We explored COPEWELL's usefulness as a practice-based tool for understanding community resilience and to engage partners in identifying resilience-strengthening strategies. In 2014, along with academic partners, the New York City Department of Health and Mental Hygiene organized an interdisciplinary work group that used COPEWELL to advance cross-sector engagement, design approaches to understand and strengthen community resilience, and identify local data to explore COPEWELL implementation at neighborhood levels. The authors conducted participant interviews and collected shared experiences to capture information on lessons learned. The COPEWELL model led to an improved understanding of community resilience among agency members and community partners. Integration and enhanced alignment of efforts among preparedness, disaster resilience, and community development emerged. The work group identified strategies to strengthen resilience. Searches of neighborhood-level data sets and mapping helped prioritize communities that are vulnerable to disasters (eg, medically vulnerable, socially isolated, low income). These actions increased understanding of available data, identified data gaps, and generated ideas for future data collection. The COPEWELL model can be used to drive an understanding of resilience, identify key geographic areas at risk during and after a disaster, spur efforts to build on local metrics, and result in innovative interventions that integrate and align efforts among emergency preparedness, community development, and broader public health initiatives.


Assuntos
Desastres/estatística & dados numéricos , Modelos Teóricos , Características de Residência/estatística & dados numéricos , Resiliência Psicológica , Capital Social , Estresse Psicológico , Humanos , Cidade de Nova Iorque
3.
Am J Disaster Med ; 15(1): 7-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804382

RESUMO

Hospitals, which care for some of the most vulnerable individuals, have been impacted by disasters in the past and are likely to be affected by future disasters. Yet data on hospital evacuations are infrequent and outdated, at best. This goal of this study was to determine the characteristics and frequency of disasters in the United States that have resulted in hospital evacuations by an appraisal of the literature from 2000 to 2017. There were 158 hospital evacuations in the United States over 18 years. The states with the highest number of evacuations were Florida (N = 39), California (N = 30), and. Texas (N = 15). The reason for the evacuation was "natura" in 114 (72.2 percent), made-man "intentional" 14 (8.9 percent), and man-made "unintentional" or technological related to internal hospital infrastructure 30 (19 percent).The most common natural threats were hurricanes (N = 65) (57 percent), wildfires (N = 21) (18.4 percent), floods (N = 10) (8.8 percent), and storms (N = 8) (7 percent). Bombs/bomb threats were the most common reason (N = 8) (57.1 percent) for a hospital evacuation result-ing from a man-made intentional disaster, followed by armed gunman (N = 4) (28.6 percent). The most frequent infrastruc-ture problems included hospital fires/smoke (N = 9) (30 percent), and chemical fumes (N = 7) (23.3 percent). Of those that reported the duration and number of evacuees, 30 percent of evacuations lasted over 24 h and the number of evacuees was >100 in over half (55.2 percent) the evacuations. This information regarding hospital evacuations should allow hospital administrators, disaster planners, and others to better prepare for disasters that result in the need for hospital evacuation.


Assuntos
Planejamento em Desastres/organização & administração , Desastres/estatística & dados numéricos , Hospitais , Transferência de Pacientes/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Tempestades Ciclônicas , Fogo , Inundações , Administração Hospitalar , Humanos , Estados Unidos
4.
Health Qual Life Outcomes ; 18(1): 229, 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664966

RESUMO

BACKGROUND: The aim of this longitudinal study was to identify risk factors for posttraumatic stress disorder (PTSD) in inpatients injured in the Ludian earthquake and examine the relationship between PTSD symptoms and health-related quality of life (HRQoL) following the earthquake. METHODS: Three assessments were performed during an 18-month follow-up period. In total, one-hundred forty-seven inpatients of one-hundred seventy-four inpatients (85% of the initial sample) underwent all the assessments. Injured inpatients admitted to the No. 1 People's Hospital of Zhaotong City after a severe earthquake (6.5 on the Richter scale) were enrolled in the study and assessed using the Posttraumatic Stress Disorder Checklist-Civilian Version, Clinician-Administered Posttraumatic Stress Disorder Scale, and Medical Outcomes Study Short Form-36 Scale. RESULTS: At the first, third and eighteenth months after the earthquake, the prevalence rates for PTSD were 23, 14, and 7%, respectively. In a regression model, bereavement, history of major diseases, and severe injury in the earthquake were associated with severe PTSD symptoms. HRQoL was negatively correlated with PTSD symptoms. Compared to that of Chinese norms, participants' HRQoL was significantly lower in all eight HRQoL domains of the Medical Outcomes Study Short Form-36 Scale. CONCLUSIONS: The findings suggest that a substantial proportion of inpatients injured in the earthquake experienced severe PTSD symptoms and poor HRQoL. Therefore, early preventive programs and interventions should be implemented following disasters, to reduce PTSD and improve HRQoL in injured individuals.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Terremotos/estatística & dados numéricos , Pacientes Internados/psicologia , Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , China , Desastres/estatística & dados numéricos , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Sobreviventes/estatística & dados numéricos
7.
Proc Natl Acad Sci U S A ; 117(19): 10429-10434, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32341144

RESUMO

Extreme climate events such as droughts, cold snaps, and hurricanes can be powerful agents of natural selection, producing acute selective pressures very different from the everyday pressures acting on organisms. However, it remains unknown whether these infrequent but severe disruptions are quickly erased by quotidian selective forces, or whether they have the potential to durably shape biodiversity patterns across regions and clades. Here, we show that hurricanes have enduring evolutionary impacts on the morphology of anoles, a diverse Neotropical lizard clade. We first demonstrate a transgenerational effect of extreme selection on toepad area for two populations struck by hurricanes in 2017. Given this short-term effect of hurricanes, we then asked whether populations and species that more frequently experienced hurricanes have larger toepads. Using 70 y of historical hurricane data, we demonstrate that, indeed, toepad area positively correlates with hurricane activity for both 12 island populations of Anolis sagrei and 188 Anolis species throughout the Neotropics. Extreme climate events are intensifying due to climate change and may represent overlooked drivers of biogeographic and large-scale biodiversity patterns.


Assuntos
Lagartos/anatomia & histologia , Seleção Genética/fisiologia , Animais , Biodiversidade , Evolução Biológica , Clima , Mudança Climática/estatística & dados numéricos , Tempestades Ciclônicas/estatística & dados numéricos , Desastres/estatística & dados numéricos , Ecossistema , Ilhas , Filogenia , Filogeografia , Dinâmica Populacional/estatística & dados numéricos , Dedos do Pé/anatomia & histologia
8.
PLoS One ; 15(3): e0229153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32210424

RESUMO

Flood is the most devastating and prevalent disaster among all-natural disasters. Every year, flood claims hundreds of human lives and causes damage to the worldwide economy and environment. Consequently, the identification of flood-vulnerable areas is important for comprehensive flood risk management. The main objective of this study is to delineate flood-prone areas in the Panjkora River Basin (PRB), eastern Hindu Kush, Pakistan. An initial extensive field survey and interpretation of Landsat-7 and Google Earth images identified 154 flood locations that were inundated in 2010 floods. Of the total, 70% of flood locations were randomly used for building a model and 30% were used for validation of the model. Eight flood parameters including slope, elevation, land use, Normalized Difference Vegetation Index (NDVI), topographic wetness index (TWI), drainage density, and rainfall were used to map the flood-prone areas in the study region. The relative frequency ratio was used to determine the correlation between each class of flood parameter and flood occurrences. All of the factors were resampled into a pixel size of 30×30 m and were reclassified through the natural break method. Finally, a final hazard map was prepared and reclassified into five classes, i.e., very low, low, moderate, high, very high susceptibility. The results of the model were found reliable with area under curve values for success and prediction rate of 82.04% and 84.74%, respectively. The findings of this study can play a key role in flood hazard management in the target region; they can be used by the local disaster management authority, researchers, planners, local government, and line agencies dealing with flood risk management.


Assuntos
Desastres/estatística & dados numéricos , Monitoramento Ambiental/métodos , Inundações/estatística & dados numéricos , Sistemas de Informação Geográfica , Rios , Planejamento em Desastres/métodos , Desastres/prevenção & controle , Inundações/prevenção & controle , Humanos , Incidência , Modelos Estatísticos , Paquistão
9.
PLoS One ; 15(2): e0228875, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32050260

RESUMO

Mutual help is common in human society, particularly during a disaster. The psychological processes underlying such social support are of interest in social and evolutionary psychology, as well as in the promotion of community resilience. However, research in terms of personality factors or support types is sporadic and has yet to address actual emergency situations. In this study, we analyzed survey data from survivors of the 2011 Tohoku earthquake and tsunami. The data included five types of social support occurring during the evacuation from a potential tsunami area: providing and receiving actual help and oral encouragement, as well as perceived support. The personality factor items included the Big Five dimensions and eight "power to live" factors, which were identified as advantageous for survival during this disaster. While none of the Big Five dimensions were associated with social support, six of the power to live factors were. Altruism, problem solving, etiquette, and self-transcendence contributed to the provision of actual help. Leadership and active well-being contributed to oral encouragement with the latter contributing also to perceived support. The findings were largely consistent with the literature in a non-emergency context. The relevance of the majority of these pro-survival personality factors to social support appeared to support the view that the propensity to cooperate in service of human survival in a disaster situation is primarily a social, rather than an individual, phenomenon, and encourages research on the mechanisms underlying how personality factors provide a benefit to both the individual and their community.


Assuntos
Sobreviventes/psicologia , Adulto , Desastres/estatística & dados numéricos , Terremotos/estatística & dados numéricos , Feminino , Humanos , Masculino , Personalidade/fisiologia , Apoio Social , Inquéritos e Questionários , Tsunamis/estatística & dados numéricos , Adulto Jovem
11.
Global Health ; 16(1): 9, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941554

RESUMO

BACKGROUND: Emerging and re-emerging diseases with pandemic potential continue to challenge fragile health systems in Africa, creating enormous human and economic toll. To provide evidence for the investment case for public health emergency preparedness, we analysed the spatial and temporal distribution of epidemics, disasters and other potential public health emergencies in the WHO African region between 2016 and 2018. METHODS: We abstracted data from several sources, including: the WHO African Region's weekly bulletins on epidemics and emergencies, the WHO-Disease Outbreak News (DON) and the Emergency Events Database (EM-DAT) of the Centre for Research on the Epidemiology of Disasters (CRED). Other sources were: the Program for Monitoring Emerging Diseases (ProMED) and the Global Infectious Disease and Epidemiology Network (GIDEON). We included information on the time and location of the event, the number of cases and deaths and counter-checked the different data sources. DATA ANALYSIS: We used bubble plots for temporal analysis and generated graphs and maps showing the frequency and distribution of each event. Based on the frequency of events, we categorised countries into three: Tier 1, 10 or more events, Tier 2, 5-9 events, and Tier 3, less than 5 or no event. Finally, we compared the event frequencies to a summary International Health Regulations (IHR) index generated from the IHR technical area scores of the 2018 annual reports. RESULTS: Over 260 events were identified between 2016 and 2018. Forty-one countries (87%) had at least one epidemic between 2016 and 2018, and 21 of them (45%) had at least one epidemic annually. Twenty-two countries (47%) had disasters/humanitarian crises. Seven countries (the epicentres) experienced over 10 events and all of them had limited or developing IHR capacities. The top five causes of epidemics were: Cholera, Measles, Viral Haemorrhagic Diseases, Malaria and Meningitis. CONCLUSIONS: The frequent and widespread occurrence of epidemics and disasters in Africa is a clarion call for investing in preparedness. While strengthening preparedness should be guided by global frameworks, it is the responsibility of each government to finance country specific needs. We call upon all African countries to establish governance and predictable financing mechanisms for IHR implementation and to build resilient health systems everywhere.


Assuntos
Doenças Transmissíveis/epidemiologia , Desastres/estatística & dados numéricos , Epidemias/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , África/epidemiologia , Emergências , Humanos , Análise Espaço-Temporal , Organização Mundial da Saúde
13.
Artigo em Inglês | MEDLINE | ID: mdl-31963490

RESUMO

Based on survey data from 327 rural households in the areas affected by the Wenchuan Earthquake and Lushan Earthquake in Sichuan Province, this study systematically analyzed disaster risk perception, sense of place, evacuation willingness, and relocation willingness among residents in these earthquake-stricken areas. Further, this study constructed an ordinal logistic regression analysis to probe the correlations between residents' disaster risk perception or sense of place and evacuation willingness and relocation willingness, respectively. The results showed that (1) faced with the threat of earthquake disasters, residents have a strong willingness to evacuate and relocate. Specifically, 93% and 78% of the residents in the Wenchuan Earthquake and Lushan Earthquake areas were willing to evacuate and relocate, respectively, whereas 4% and 17% of the residents were unwilling to evacuate and relocate, respectively. (2) Place dependence and the severity of disaster occurrence were significantly positively correlated with residents' evacuation willingness, while the interaction term between place dependence and the severity of disaster occurrence was negatively related to residents' evacuation willingness. Specifically, when everything else remains constant, every one-unit increase in place dependence and severity corresponds to increases in the odds of willingness to evacuate by factors of 0.042 and 0.051, respectively; every one-unit increase in place dependence × severity corresponds to a decrease in the odds of willingness to evacuation by a factor of 0.004. (3) Place identity was significantly negatively correlated with residents' relocation willingness, while place dependence and severity of disaster occurrence were positively related to residents' relocation willingness. The interaction term between place dependence and the severity of disaster occurrence as well as the interaction term between place identity and severity of disaster occurrence were significantly negatively correlated with residents' relocation willingness. Specifically, every one-unit increase in place identity corresponds to a decrease in the odds of willingness to relocate by a factor of 0.034, while every one-unit increase in place dependence and severity corresponds to increases in the odds of willingness to relocate by factors of 0.041 and 0.028, respectively, and every one-unit increase in place dependence × severity and place identity × severity corresponds to decreases in the odds of willingness to relocate by factors of 0.003 and 0.003, respectively.


Assuntos
Desastres/estatística & dados numéricos , Terremotos/estatística & dados numéricos , Percepção , Medição de Risco , População Rural/estatística & dados numéricos , Adulto , Idoso , China , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
J Trauma Nurs ; 27(1): 42-49, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895319

RESUMO

Sewol Ferry sinking was a man-made disaster that happened on April 16, 2014, in South Korea, resulting in 304 deaths. In the 2 years following the disaster, the Special Investigation Commission on the Sewol Ferry Disaster conducted a qualitative study with the victim families to investigate their experience. One hundred forty-five interviews were conducted with parents, aunts, and grandparents of high school student victims by a team of clinical and community psychologists. Based on 54 in-depth interviews with parents and parent figures randomly selected out of the 145 interviews conducted, we aimed to understand the lived experience of the victim parents. The grounded theory yielded 59 codes and five categories, whose core variable was self-empowerment of the victim community. The community of victim families was supported by the engagement of other citizens, as well as the victim families themselves. The meanings implicated in the results, along with the practical implications in the community, are discussed.


Assuntos
Desastres/estatística & dados numéricos , Família/psicologia , Pais/psicologia , Navios , Transtornos de Estresse Pós-Traumáticos/psicologia , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Adulto Jovem
15.
Int J Psychol ; 55(4): 647-656, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475357

RESUMO

To add to the dialogue regarding the long-term recovery and wellbeing of war and tsunami-affected women in Sri Lanka, we utilised the Conservation of Resources Theory (COR, Hobfoll, 2009) to inform an investigation of direct and indirect effects. The study was specifically designed to assess how traumatic exposure may represent a form of loss which may associate with related losses in the form of external and internal stigma which may then associate with poor mental health outcomes. The data for this study were collected in 2016 from a sample of 379 widowed women in Eastern Sri Lanka; participant spouses died in the civil war, in the tsunami, or from health or other problems. Our analyses yielded a model suggesting associations between remembered trauma event exposure from war and disaster, external stigma, internalised stigma and mental health symptom distress. Results further yielded direct and indirect effects suggesting that trauma may represent a form of loss, and potentially lead to distress through the weight and challenges of stigma.


Assuntos
Conflitos Armados/psicologia , Desastres/estatística & dados numéricos , Saúde Mental/tendências , Transtornos de Estresse Pós-Traumáticos/psicologia , Viuvez/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estigma Social , Sri Lanka , Adulto Jovem
16.
BMC Psychiatry ; 19(1): 389, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31822278

RESUMO

BACKGROUND: Despite a relatively young average age and no routine screening, prostate cancer is one of the most common cancers in men who worked at the World Trade Center (WTC) following the 9/11/2001 disaster. This study evaluated whether re-experiencing stressful memories of a traumatic event was associated with prostate cancer incidence. METHODS: Participants were males from one clinical center that monitors the health of first-responders (N = 6857). Monitoring began in July 2002 and occurs annually but does not include prostate cancer screening. Severity of physical exposures and of re-experiencing memories and stress responses were measured at study enrollment using standardized and validated methods in all participants. The outcome was incidence of diagnosed prostate cancer after enrollment (n = 68). Bivariate analyses provided age-adjusted incidence rates (aIR). Cox proportional hazards modeling was used to calculate incidence; hazards ratios (HR) were reported. RESULTS: The mean age of responders on 9/11/2001 was 37.9 years. Prostate cancer incidence was lowest in responders with no re-experiencing stress (aIR = 250.83/100,000 person-years, [233.41-268.25]) and highest in responders with severe re-experiencing stress (aIR = 818.49/100,000 person-years, [801.07-835.91]). Cox proportional hazards regression revealed that re-experiencing the stressful events of 9/11/2001 was associated with increased prostate cancer incidence (HR = 1.96 [1.26-3.05], P = 0.003), even upon adjusting for confounders. CONCLUSIONS: This is the first study to identify a positive association between re-experiencing a traumatic event and prostate cancer incidence. Our results are consistent with recent rodent model evidence demonstrating a direct biological link between stress pathways and prostate tumorigenesis and offer new hypotheses in the causality of prostate cancer.


Assuntos
Socorristas/psicologia , Neoplasias da Próstata/epidemiologia , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Estudos de Coortes , Comorbidade , Desastres/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco
18.
Artigo em Inglês | MEDLINE | ID: mdl-31671838

RESUMO

Climate change has spurred an increase in the prevalence and severity of natural disasters. Damage from natural disasters can lead to residential instability, which negatively impacts mental health and wellbeing. However, research on the mental health of residents who are displaced after natural disasters is relatively novel and needs more study. This study investigates experiences of mental health in residents in New Brunswick, Canada, who experienced residential damage and/or displacement during the 2018 spring flood. Lived experiences were studied through focus groups with 20 residents and perceptions of community mental health and wellbeing were captured during key informant interviews with 10 local community leaders. Data collection and analysis employed grounded theory. Findings indicate that those who had residential displacement or damage due to the flooding experienced negative mental health impacts, both during and following the flood. While natural disasters have devastating impacts on mental health, the data also indicate that the communities were positively impacted by a collective and collaborative response to the flood. This paper argues for the utility of communal coping as a concept to describe the experiences of communities following residential damage and/or displacement following natural disasters.


Assuntos
Adaptação Psicológica , Desastres/estatística & dados numéricos , Inundações/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Estresse Psicológico , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Novo Brunswick
19.
Curr Top Microbiol Immunol ; 424: 121-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31667598

RESUMO

By definition, Global Catastrophic Biological Risks (GCBRs) are "beyond the collective capability of national and international governments and the private sector to control". Implicit in this definition is that no single country, sector, or entity can effectively mitigate risk and impact of GCBRs and that doing so requires public-private cooperation. This short commentary offers five trends suggesting that conditions for cooperation are favorable, along with three gaps to be addressed, and five high-level recommendations to strengthen public-private cooperation to mitigate risk and impact of GCBRs.


Assuntos
Desastres/prevenção & controle , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Parcerias Público-Privadas , Gestão de Riscos , Desastres/estatística & dados numéricos , Humanos , Setor Privado
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