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2.
Disaster Med Public Health Prep ; 14(1): 28-33, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31304898

RESUMO

OBJECTIVE: Describe the lived experience of a grassroots, non-governmental disaster medical team (DMT) through a research lens and share practical lessons learned, based on the DMT's experience to support and inform future response teams. METHODS: Forty-five days after Hurricane Maria, a non-governmental DMT provided primary medical care via community based pop-up clinics and home visitations in 5 different areas of Puerto Rico. Observational data, photo images, and debriefing notes were collected and documented in the response team's daily activity log. Field notes were coded using a descriptive coding method and then categorized into 2 domains specific to public health and medical diagnosis. RESULTS: Medical aid was provided to nearly 300 (N = 296) residents. Field note observations identified exhaustion related to living conditions and the exacerbation of underlying conditions such as reactive airway diseases, diabetes, hypertension, and depression due to the compounding effects of multiple post-disaster triggers. During home visitations, feelings of sadness and helplessness were identified secondary to natural disaster trauma and current living conditions. CONCLUSION: Our non-governmental DMT displayed similar characteristics demonstrated by federal DMTs post natural disaster. A number of strategic lessons learned emerged from the public health intervention important to future non-governmental DMTs.


Assuntos
Tempestades Ciclônicas/estatística & dados numéricos , Medicina de Desastres/métodos , Equipe de Assistência ao Paciente/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Tempestades Ciclônicas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Porto Rico
3.
Disaster Med Public Health Prep ; 14(1): 7-9, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31854288

RESUMO

The United States (US) and Caribbean regions remain vulnerable to the impact of severe tropical storms, hurricanes, and typhoons. In 2017, a series of hurricanes posed threats to residents living in inland and coastal communities as well as on islands isolated from the US mainland. Harvey, Irma, Jose, and Maria caused catastrophic infrastructure damage, resulting in a loss of electrical power and communications due to damaged or downed utility poles, cell towers, and transmission lines. Critical services were inoperable for many months. Emergency managers are public officials who are accountable to both political leaders and the citizens. During disaster events, emergency managers must prioritize areas of effort, manage personnel, and communicate with stakeholders to address critical infrastructure interdependences. Essential lifeline services (eg, energy and communications) were inoperable for many months, which led to increased attention from policy-makers, media, and the public.


Assuntos
Redes Comunitárias/tendências , Tempestades Ciclônicas/mortalidade , Região do Caribe , Redes Comunitárias/estatística & dados numéricos , Tempestades Ciclônicas/estatística & dados numéricos , Planejamento em Desastres/métodos , Humanos
4.
Soc Sci Med ; 242: 112610, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31677480

RESUMO

In August 2005, Hurricane Katrina caused unprecedented damage, widespread population displacement, and exposed Gulf Coast residents to traumatic events. The hurricane's adverse impact on survivors' mental health was apparent shortly after the storm and persisted, but no study has examined the long-term effects now that more than a decade has transpired. Using new data from a panel study of low-income mothers interviewed once before Hurricane Katrina and now three times after, we document changes in mental health, and estimate the sociodemographic and hurricane-related factors associated with long-term trajectories of mental health. We find that post-traumatic stress symptoms (PTSS) declined at each of the three post-Katrina follow-ups, but 12 years after the hurricane, one in six still had symptoms indicative of probable post-traumatic stress disorder. The rate of non-specific psychological distress (PD) remained consistently higher in all three follow-ups, compared to the pre-disaster period. In full covariate-adjusted models, no sociodemographic variables predicted long-run combinations of PTSS and PD. However, 12 years later, exposure to hurricane-related traumatic events and pre-disaster PD significantly predicted co-occurring PTSS and PD. Hurricane-related housing damage predicted PTSS in earlier follow-ups, but no longer predicted PTSS in the long-term. Furthermore, hurricane-related traumatic events significantly differentiated the risk of having persistent PTSS, relative to recovering from PTSS. The results suggest that there is still a non-negligible group of survivors with continued need for recovery resources and that exposure to traumatic events is a primary predictor of adverse mental health more than a decade post-disaster.


Assuntos
Tempestades Ciclônicas/estatística & dados numéricos , Transtornos Mentais/etiologia , Adaptação Psicológica , Adolescente , Adulto , Tempestades Ciclônicas/mortalidade , Feminino , Golfo do México/epidemiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Pobreza/psicologia , Apoio Social , Estresse Psicológico/complicações , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Sobreviventes/psicologia
5.
Diabetes Care ; 42(11): 2090-2097, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31548250

RESUMO

OBJECTIVE: To estimate the long-run mortality effects of Hurricanes Katrina and Rita on seniors with diabetes. RESEARCH DESIGN AND METHODS: We performed a retrospective cohort analysis of Medicare enrollment and claims data covering four states and ∼10 years. Affected individuals were identified by whether they lived in a county that suffered a high impact and were stratified by whether they moved to a different county following the storms. Propensity scores matched affected and comparison subjects based on demographic and socioeconomic characteristics and the presence of chronic conditions. Our sample consisted of 170,328 matched affected subjects. RESULTS: The affected subjects had a nearly 40% higher all-cause mortality risk in the 1st month after the storms, but the difference fell to <6% by the end of the full observation period. The mortality risks of heart disease and nephritis also exhibited the largest differences immediately following the storms. Among the affected subjects, the all-cause mortality risk was higher for those who moved to a different county, with an especially large difference among those who moved to an affected county. CONCLUSIONS: The propensity matching procedure resulted in the comparison and affected groups having similar observable characteristics. However, we only examined the extreme outcome of mortality, our definition of affected was somewhat crude, and our sample did not include individuals enrolled in Medicare Advantage. Our findings highlight the importance of the immediate response to disasters, yet also demonstrate the long-lasting impact disasters can have.


Assuntos
Tempestades Ciclônicas/mortalidade , Diabetes Mellitus/mortalidade , Desastres/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Alabama/epidemiologia , Tempestades Ciclônicas/história , Desastres/história , Feminino , História do Século XXI , Humanos , Louisiana/epidemiologia , Masculino , Medicare , Mississippi/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos , Texas/epidemiologia , Estados Unidos/epidemiologia
6.
Disasters ; 43(4): 891-905, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31418909

RESUMO

Understanding the circumstances and conditions surrounding disaster-attributed deaths may contribute to designing and implementing emergency preparedness and response programmes. This paper introduces a three-step cluster analysis of multiple binary variables to investigate mortality patterns related to tropical cyclones. It is designed to overcome the difficulties of performing cluster analysis in a disaster database that is composed in part of nominal variables and is unavoidably incomplete owing to missing information. The first step in the process codes all variables as binary data in order to accommodate the nominal variables. The second step calculates Spearman's rank correlation coefficients for pairs of variables. And the third step subjects the correlation coefficients to cluster analysis. Data related to 1,575 deaths attributed to tropical cyclones (also known as typhoons) that struck Taiwan between 2000 and 2015 are used to illustrate the method. The results yield two distinct groups of variables that are worthy of further exploration.


Assuntos
Tempestades Ciclônicas/mortalidade , Desastres , Análise por Conglomerados , Feminino , Humanos , Masculino , Mortalidade/tendências , Taiwan/epidemiologia
7.
Stat Med ; 38(23): 4545-4554, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31321799

RESUMO

Estimation of excess deaths due to a natural disaster is an important public health problem. The CDC provides guidelines to fill death certificates to help determine the death toll of such events. But, even when followed by medical examiners, the guidelines cannot guarantee a precise calculation of excess deaths. We propose two models to estimate excess deaths due to an emergency. The first model is simple, permitting excess death estimation with little data through a profile likelihood method. The second model is more flexible, incorporating temporal variation, covariates, and possible population displacement while allowing inference on how the emergency's effect changes with time. The models are implemented to build confidence intervals estimating Hurricane Maria's death toll.


Assuntos
Causas de Morte , Tempestades Ciclônicas/mortalidade , Modelos Estatísticos , Intervalos de Confiança , Atestado de Óbito , Guias como Assunto , Humanos , Funções Verossimilhança , Vigilância da População , Saúde Pública/métodos , Porto Rico
8.
Soc Sci Med ; 238: 112367, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31213368

RESUMO

García Márquez's novel, "Chronicle of a Death Foretold", narrates the multiple strands of a story leading up to a murder in a small Caribbean village. The novel shows both the incredulity of those who do not believe it possible that this tragic death could occur, and the impotence of those who see it coming but can do nothing to prevent it. Something akin to this double incapacity seems to be occurring today in Puerto Rico. In September 2017, the passage of Hurricanes Irma and María caused a public health disaster with large-scale death and destruction. Paradoxically, this catastrophe has made visible the need to evaluate the critical socio-environmental situation of this country, and to analyse the underlying social factors contributing to the problems caused by the hurricanes. Why did neither the US nor the Puerto Rican government react as expected when faced with such a serious situation? For decades, this country has been suppressed by colonial domination, exploitation of the workforce, and health discrimination. It has been a "laboratory", where colonial practices have institutionalized social control, racism, and inequality, with profound negative effects on society, quality of life and health equality. Poverty and unemployment have always been very high, and thousands of families live in precarious housing situations. Additionally, current labour reforms imposed as part of a neoliberal agenda, are eroding the job security and protections of the working population, while education, health, housing, pensions, energy, and land are being progressively privatized. What are the root causes of this situation? What future does the country await? To answer these questions, critical and comprehensive scrutiny of history showing what the hurricanes have helped to make visible is required. This shows that neoliberal colonialism has shaped the social features behind the principle health and inequality problems of the Puerto-Rican population.


Assuntos
Tempestades Ciclônicas/estatística & dados numéricos , Saúde Pública/normas , Colonialismo/história , Tempestades Ciclônicas/mortalidade , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Saúde Pública/estatística & dados numéricos , Porto Rico/epidemiologia , Fatores Socioeconômicos/história , Estados Unidos , United States Public Health Service/organização & administração , United States Public Health Service/estatística & dados numéricos , United States Public Health Service/tendências
9.
Am J Public Health ; 109(7): 1050-1052, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30998411

RESUMO

Objectives. To determine the number and causes of excess deaths in Puerto Rico after Hurricane Maria made landfall on September 20, 2017. Methods. We obtained monthly vital statistics data on all deaths from January 2008 through October 2017. We conducted a time-series analysis to estimate excess mortality in September and October 2017 overall and by age, sex, and cause of death. Results. We estimated a total of 1205 excess deaths (95% confidence interval [CI] = 707, 1702). Excess deaths were slightly higher among men than women (632 and 579 deaths, respectively) and found only among people aged 60 years or older (1038 deaths). Most excess deaths occurred from heart disease (253 deaths), "other" causes (204 deaths), diabetes (195 deaths), Alzheimer's disease (122 deaths), and septicemia (81 deaths). Conclusions. The number of excess deaths was similar to recent government estimates. However, this study is the first to identify the causes of death that were exacerbated by the disaster. Public Health Implications. An accurate estimation of the top causes of excess mortality can help authorities plan resource allocation for the island's recovery and for the prevention of deaths in future disasters.


Assuntos
Tempestades Ciclônicas/mortalidade , Desastres Naturais/mortalidade , Estatísticas Vitais , Adulto , Fatores Etários , Idoso , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico
10.
Pract Radiat Oncol ; 9(5): 305-321, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999000

RESUMO

PURPOSE: Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created. METHODS AND MATERIALS: Radiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy. RESULTS: Practical measures to mitigate the medical impact of a disaster are summarized within the framework of "Prepare, Communicate, Operate, Compensate." Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients. CONCLUSIONS: These recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation.


Assuntos
Tempestades Ciclônicas/mortalidade , Desastres Naturais/mortalidade , Radioterapia (Especialidade)/normas , Humanos , Porto Rico
14.
Disaster Med Public Health Prep ; 13(2): 217-222, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29644946

RESUMO

OBJECTIVE: The purpose of this study was to investigate the 10-year impact of Hurricane Katrina on the incidence of acute myocardial infarction (AMI) along with contributing risk factors and any alteration in chronobiology of AMI. METHODS: A single-center, retrospective, comparison study of AMI incidence was performed at Tulane University Health Sciences Center from 2 years before Hurricane Katrina to 10 years after Hurricane Katrina. A 6-year, pre-Katrina and 10-year, post-Katrina cohort were also compared according to pre-specified demographic, clinical, and chronobiological data. RESULTS: AMI incidence increased from 0.7% (150/21,079) to 2.8% (2,341/84,751) post-Katrina (P<0.001). The post-Katrina cohort had higher rates of coronary artery disease (36.4% vs. 47.9%, P=0.01), diabetes mellitus (31.3% vs. 39.9%, P=0.04), hyperlipidemia (45.4% vs. 59.3%, P=0.005), smoking (34.4% vs. 53.8%, P<0.001), drug abuse (10.2% vs. 15.4%, P=0.02), psychiatric illness (6.7% vs. 14.9%, P<0.001), medication non-adherence (7.3% vs. 15.3%, P<0.001), and lack of employment (7.2% vs. 16.4%, P<0.001). The post-Katrina group had increased rates of AMI during nights (29.8% vs. 47.8%, P<0.001) and weekends (16.1% vs. 29.1%, P<0.001). CONCLUSIONS: Even 10 years after the storm, Hurricane Katrina continues to be associated with increased incidence of AMI, higher prevalence of traditional cardiovascular and psychosocial risk factors, and an altered chronobiology of AMI toward nights and weekends. (Disaster Med Public Health Preparedness. 2019;13:217-222).


Assuntos
Tempestades Ciclônicas/estatística & dados numéricos , Infarto do Miocárdio/etiologia , Adulto , Estudos de Coortes , Tempestades Ciclônicas/mortalidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Nova Orleans/epidemiologia , Estudos Retrospectivos , Fatores de Risco
18.
Lancet Planet Health ; 2(11): e478-e488, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30318387

RESUMO

BACKGROUND: Hurricane Maria struck Puerto Rico on Sept 20, 2017, devastating the island. Controversy surrounded the official death toll, fuelled by estimates of excess mortality from academics and investigative journalists. We analysed all-cause excess mortality following the storm. METHODS: We did a time-series analysis in Puerto Rico from September, 2017, to February, 2018. Mortality data were from the Puerto Rico Vital Statistics System. We developed two counterfactual scenarios to establish the population at risk. In the first scenario, the island's population was assumed to track the most recent census estimates. In the second scenario, we accounted for the large-scale population displacement. Expected mortality was projected for each scenario through over-dispersed log-linear regression from July, 2010, to August, 2017, taking into account changing distributions of age, sex, and municipal socioeconomic development, as well as both long-term and seasonal trends in mortality. Excess mortality was calculated as the difference between observed and expected deaths. FINDINGS: Between September, 2017, and February, 2018, we estimated that 1191 excess deaths (95% CI 836-1544) occurred under the census scenario. Under the preferred displacement scenario, we estimated that 2975 excess deaths (95% CI 2658-3290) occurred during the same observation period. The ratio of observed to expected mortality was highest for individuals living in municipalities with the lowest socioeconomic development (1·43, 95% CI 1·39-1·46), and for men aged 65 years or older (1·33, 95% CI 1·30-1·37). Excess risk persisted in these groups throughout the observation period. INTERPRETATION: Analysis of all-cause mortality with vital registration data allows for unbiased estimation of the impact of disasters associated with natural hazards and is useful for public health surveillance. It does not depend on certified cause of death, the basis for the official death toll in Puerto Rico. Although all sectors of Puerto Rican society were affected, recovery varied by municipal socioeconomic development and age groups. This finding calls for equitable disaster preparedness and response to protect vulnerable populations in disasters. FUNDING: Forensic Science Bureau, Department of Public Safety, and Milken Institute School of Public Health of The George Washington University (Washington, DC, USA).


Assuntos
Causas de Morte , Tempestades Ciclônicas/mortalidade , Desastres Naturais/mortalidade , Fatores Etários , Humanos , Porto Rico , Fatores Sexuais
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