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1.
Psychiatr Danub ; 34(2): 348-355, 2022.
Article in English | MEDLINE | ID: covidwho-1912581

ABSTRACT

BACKGROUND: The COVID-19 epidemic and earthquakes in Croatia during 2020 suddenly disrupted everyday life and caused psychological disturbances in population. The purpose of the present study was to assess the prevalence of anxiety symptoms and the level of treatment adherence in glaucoma patients during the pandemic. The paper also aimed to evaluate the correlation between anxiety symptoms, treatment adherence and treatment outcomes in the studied cohort. SUBJECTS AND METHODS: This cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, Zagreb University Hospital Center, during one year. The Beck Anxiety Inventory (BAI) was used to measure the level of anxiety symptoms. Treatment adherence was estimated by the Culig adherence scale (CAS). Glaucoma damage was determined for each patient from the level of structural and functional impairment of the worse eye, by retinal nerve fiber layer (RNFL) thickness and mean defect (MD), respectively. Statistical analyses were performed, with a P value of less than 0.05 considered being statistically significant. RESULTS: This study included 113 POAG patients, with a mean age of 65.89 years. The median of the BAI total score in all patients was 10. According to the CAS, 60.2% of patients were non-adherent to glaucoma treatment during the COVID-19 outbreak. The BAI total score was significantly negatively related to adherence to local glaucoma treatment (p<0.001). A significant negative association was also observed between adherence and MD (p=0.017), while no correlation was found between adherence and RNFL thickness (p=0.228). CONCLUSION: Considerable proportion of patients with glaucoma have shown non-adherence to treatment during the COVID-19 pandemic. Anxiety severity was associated with lower adherence, thus indirectly influencing therapeutics outcomes. Special consideration should be given to the strategies promoting mental health and interventions focusing on treatment adherence in glaucoma patients in a time of emergencies.


Subject(s)
COVID-19 , Earthquakes , Glaucoma, Open-Angle , Glaucoma , Aged , Anxiety/epidemiology , COVID-19/epidemiology , Croatia/epidemiology , Cross-Sectional Studies , Glaucoma/drug therapy , Glaucoma/epidemiology , Glaucoma, Open-Angle/complications , Glaucoma, Open-Angle/diagnosis , Humans , Nerve Fibers , Pandemics , Tomography, Optical Coherence , Treatment Adherence and Compliance
2.
Int Breastfeed J ; 17(1): 45, 2022 06 15.
Article in English | MEDLINE | ID: covidwho-1902396

ABSTRACT

BACKGROUND: Emergencies have a great impact on infant and young child feeding. Despite the evidence, the recommended feeding practices are often not implemented in the emergency response, undermining infant and maternal health. The aim of this study was to explore the experiences of pregnant and lactating women during the earthquake emergency that occurred in L'Aquila on 6 April 2009. METHODS: The study design was qualitative descriptive. Data were collected by individual semi-structured interviews, investigating the mother's experiences of pregnancy, childbirth, breastfeeding, infant formula or complementary feeding during the emergency and the post emergency phase. Data analysis was categorical and was performed by using N-Vivo software. RESULTS: Six women who were pregnant at the time of the earthquake were interviewed in January 2010. In addition to the essential needs of pregnant and lactating women, such as those related to the emergency shelters conditions, the main findings emerged from this study were: the reconfiguration of relationships and the central role of partners and family support; the need of spaces for sharing experiences and practices with other mothers; the lack of breastfeeding support after the hospital discharge; the inappropriate donations and distribution of Breast Milk Substitutes. CONCLUSIONS: During and after L'Aquila earthquake, several aspects of infant and young child feeding did not comply with standard practices and recommendations. The response system appeared not always able to address the specific needs of pregnant and lactating women. It is urgent to develop management plans, policies and procedures and provide communication, sensitization, and training on infant and young child feeding at all levels and sectors of the emergency response.


Subject(s)
Earthquakes , Breast Feeding , Child , Emergencies , Female , Humans , Infant , Italy , Lactation , Pregnancy
3.
Psychiatr Serv ; 73(6): 712-715, 2022 06.
Article in English | MEDLINE | ID: covidwho-1874940

ABSTRACT

The Tohoku Theater Project was completed 2 years after the natural and nuclear disasters in Tohoku, Japan, on March 11, 2011. It employed the dramatic arts to support the healing process, promote resilience, and increase dialogue and understanding about mental health among individuals who were directly affected by the disasters. The four performances fostered important discussions regarding the psychological impact of the Tohoku disasters. Participants (N=143) found the theater performance effective at facilitating discussion, increasing empathy, and enhancing mental health knowledge, coping, and resilience. The performances provided critical information about access to services; many participants reported that they had not known where to seek help for mental health prior to their involvement with the Tohoku Theater Project. Lessons learned may inform community-based strategies that promote mental health and healing in the wake of the COVID-19 pandemic and other public health disasters.


Subject(s)
COVID-19 , Disasters , Earthquakes , Humans , Japan , Mental Health , Pandemics
4.
Leg Med (Tokyo) ; 58: 102083, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1814922

ABSTRACT

Japan is a country that is prone to natural disasters. This study compared the characteristics of suicide trends before and after the Great Hanshin-Awaji Earthquake, and during the current COVID-19 pandemic 25 years later. In the present study, we examined the annual number of suicides, the number of suicides by age group, and the reason for suicide during the period associated with the earthquake (1994-1995) and the period associated with the pandemic (2019-2020). This study used statistical analyses to compare the two periods. Our findings suggest that research needs to be conducted from the perspective of legal medicine and social medicine to devise current and future measures to prevent suicides. During the first period, suicides increased in 1995 compared to 1994. Suicide due to economic and life problems increased significantly. During the second period, suicides increased in 2020 compared to 2019. Suicides by males decreased significantly and those by females increased significantly; suicides by individuals aged 19 or under and by those aged 20-29 increased significantly, while suicides by individuals aged 60-69 decreased significantly; and suicides due to "other problems" increased significantly, while suicides due to economic and life problems decreased significantly. Ongoing studies of detailed trends in suicides due to the effects of COVID-19 need to be conducted in the future, and it is important to determine suicide risk due to the effects of COVID-19. Legal medicine and social medicine are fields that conduct such studies and that can offer science-based responses to these trends.


Subject(s)
Suicide , Adolescent , Adult , Aged , COVID-19/epidemiology , Disasters , Earthquakes , Female , Humans , Japan/epidemiology , Male , Middle Aged , Pandemics , Suicide/prevention & control , Suicide/trends , Young Adult
5.
Longit Life Course Stud ; 13(2): 287-306, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1808515

ABSTRACT

Climate change and population growth will increase vulnerability to natural and human-made disasters or pandemics. Longitudinal research studies may be adversely impacted by a lack of access to study resources, inability to travel around the urban environment, reluctance of sample members to attend appointments, sample members moving residence and potentially also the destruction of research facilities. One of the key advantages of longitudinal research is the ability to assess associations between exposures and outcomes by limiting the influence of sample selection bias. However, ensuring the validity and reliability of findings in longitudinal research requires the recruitment and retention of respondents who are willing and able to be repeatedly assessed over an extended period of time. This study examined recruitment and retention strategies of 11 longitudinal cohort studies operating during the Christchurch, New Zealand earthquake sequence which began in September 2010, including staff perceptions of the major impediments to study operations during/after the earthquakes and respondents' barriers to participation. Successful strategies to assist recruitment and retention after a natural disaster are discussed. With the current COVID-19 pandemic, longitudinal studies are potentially encountering some of the issues highlighted in this paper including: closure of facilities, restricted movement of research staff and sample members, and reluctance of sample members to attend appointments. It is possible that suggestions in this paper may be implemented so that longitudinal studies can protect the operation of their research programmes.


Subject(s)
COVID-19/epidemiology , Earthquakes , Pandemics , Research Subjects , COVID-19/psychology , Cohort Studies , Humans , Longitudinal Studies , Natural Disasters , New Zealand , Pandemics/statistics & numerical data , Reproducibility of Results , Research Subjects/psychology , Research Subjects/statistics & numerical data
6.
Int J Environ Res Public Health ; 19(8)2022 04 09.
Article in English | MEDLINE | ID: covidwho-1785684

ABSTRACT

BACKGROUND: The ongoing SARS-CoV-2 pandemic has disrupted life and work habits and has produced landmark changes worldwide. This systematic review aimed to analyse the management of Return to Work (RTW) by work organisations following the virus spread. METHODS: A selection of 2477 papers, using string research on PubMed, Embase, Web of Science and Scopus from January 2020 to October 2021, were analysed. RESULTS: Fifty-one articles were finally included, and the results obtained were discussed from three different points of view. Twenty articles concerning 'Remodelling of Work Organization' proposed some model strategies for resumption to work. Twenty-one papers, including 'Clinical Evaluation of Workers', mostly explored the psychosocial impact of returned workers. Finally, twelve articles explored the best 'Testing Strategies related to RTW'. Despite the heterogeneity of included articles, several interesting approaches have emerged in managing RTW. CONCLUSIONS: The reported experiences could help to develop an RTW model for COVID-19 and future pandemics.


Subject(s)
COVID-19 , Earthquakes , COVID-19/epidemiology , Humans , Pandemics , Return to Work , SARS-CoV-2
7.
Int J Environ Res Public Health ; 19(7)2022 04 06.
Article in English | MEDLINE | ID: covidwho-1776242

ABSTRACT

The aftereffects of the severe 2016 Kumamoto earthquake were complicated by the COVID-19 pandemic. This study aimed to identify mental health problems and related factors among survivors five years after the earthquake and clarify its long-term effects. A cross-sectional survey was conducted in 2020 among 19,212 survivors affected by the earthquake who moved from temporary to permanent housing. We analysed 8966 respondents (5135 women, 3831 men; mean age 62.25 ± 17.29 years). Logistic regression analysis was conducted to examine associations between mental health problems and socioeconomic factors. Prevalence rates of psychological distress, insomnia, and probable post-traumatic stress disorder were 11.9%, 35.2%, and 4.1%, respectively. Female gender (OR = 1.33, 95% CI = 1.13-1.57; OR = 1.21, 95% CI = 1.08-1.34; OR = 1.81, 95% CI = 1.41-2.32), public housing (OR = 2.14, 95% CI = 1.63-2.83; OR = 1.54, 95% CI = 1.26-1.88; OR = 2.41, 95% CI = 1.62-3.58), loneliness (OR = 9.08, 95% CI = 7.71-10.70; OR = 5.55, 95% CI = 4.90-6.30; OR = 3.52, 95% CI = 2.77-4.49), COVID-19-induced activity reduction (OR = 1.41, 95% CI = 1.19-1.66; OR = 1.86, 95% CI = 1.68-2.07; OR = 1.80, 95% CI = 1.40-2.31), and COVID-19-induced income reduction (OR = 1.33, 95% CI = 1.12-1.57; OR = 1.43, 95% CI = 1.28-1.59; OR = 1.92, 95% CI = 1.51-2.43) were significantly associated with mental health problems. These results suggest that gender, current housing, loneliness, and COVID-19 affected the survivors' mental health during recovery.


Subject(s)
COVID-19 , Earthquakes , Sleep Initiation and Maintenance Disorders , Stress Disorders, Post-Traumatic , Adult , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Risk Factors , Sleep Initiation and Maintenance Disorders/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Survivors/psychology
8.
Front Public Health ; 9: 682714, 2021.
Article in English | MEDLINE | ID: covidwho-1771110

ABSTRACT

Background: Delayed-onset post-traumatic stress disorder after catastrophes is a major public health issue. However, good designs for identifying post-traumatic stress disorder (PTSD) among earthquake survivors are rare. This is the first nested case-control study to explore the possible factors associated with delayed-onset PTSD symptoms. Methods: A nested case-control study was conducted. The baseline (2011) and follow-up (2018) surveys were utilized to collect data. A total of 361 survivors of the Wenchuan earthquake were investigated and 340 survivors underwent follow-up. The survivors, from the hardest-hit areas, who met the criteria for PTSD were included in the case group, and PTSD-free survivors from the same area, matched for age, were included in the control group, with a ratio of one to four. Conditional logistic regression was used to evaluate the variables' odds ratio (OR). Results: The overall prevalence of delayed-onset PTSD symptoms in survivors of the Wenchuan earthquake was 9.7% (33/340). The unemployed earthquake survivors had a higher risk of developing delayed-onset PTSD symptoms (OR = 4.731, 95% CI = 1.408-15.901), while higher perceived social support was a protective factor against delayed-onset PTSD symptoms (OR = 0.172, 95% CI = 0.052-0.568). Conclusion: Delayed-onset PTSD symptoms, after a disaster, should not be ignored. Active social support and the provision of stable jobs can contribute to the earthquake survivors' mental health.


Subject(s)
Earthquakes , Stress Disorders, Post-Traumatic , Case-Control Studies , Humans , Risk Factors , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology
9.
Psychiatr Danub ; 33(4): 639-645, 2021.
Article in English | MEDLINE | ID: covidwho-1635255

ABSTRACT

BACKGROUND: The coronavirus outbreak was labeled a global pandemic by the WHO in March 2020. Simultaneously, an earthquake of 5.5 hit Croatia's capital Zagreb. The present study investigated the association between the sense of coherence, subjective well-being, and emotional distress (depression, anxiety, and stress) that people went through while facing an acute stress situation of COVID-19 outbreak and the earthquakes. SUBJECTS AND METHODS: This cross-sectional study included 1152 subjects. Orientation to Life Questionnaires (OLQ-13), Personal Wellbeing Index (PWI) and DASS-21 scale were used in an anonymous online survey which was conducted on 22 March 2020 (the twelfth day of the COVID-19 outbreak in Croatia and the day of the earthquakes in the Capital). The results of the questionnaires were determined by the correlation analysis. Hierarchical multiple regression was used to evaluate the association between the subjective well-being and the sense of coherence on the emotional distress. RESULTS: The sense of coherence correlated positively with subjective well-being (p<0.01) and negatively with all distress domains (p<0.01) as well as subjective well-being (p<0.01). Mild emotional distress was detected. Subjects who experienced the earthquakes showed a significantly higher degree of anxiety (p=0.005) and stress (p=0.003), with significantly decreased the two personal well-being domains: standard of living (p=0.023) and personal safety (p=0.026). Sense of coherence made a major contribution in explaining emotional distress (p<0.001). CONCLUSION: The results support the importance of improving coping efficiency of the sense of coherence with respect to obtaining an appropriate level of well-being and reducing emotional distress in acute stressful situations.


Subject(s)
COVID-19 , Earthquakes , Sense of Coherence , Cross-Sectional Studies , Disease Outbreaks , Humans , SARS-CoV-2
10.
Chin J Traumatol ; 25(3): 166-169, 2022 May.
Article in English | MEDLINE | ID: covidwho-1616420

ABSTRACT

PURPOSE: To determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia. METHODS: A case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3. RESULTS: We identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = -2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis. CONCLUSION: It is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.


Subject(s)
COVID-19 , Earthquakes , Hip Fractures , Osteoporotic Fractures , COVID-19/epidemiology , Case-Control Studies , Communicable Disease Control , Croatia/epidemiology , Female , Humans , Retrospective Studies , SARS-CoV-2 , Trauma Centers
12.
Psychiatr Danub ; 33(3): 393-401, 2021.
Article in English | MEDLINE | ID: covidwho-1527116

ABSTRACT

BACKGROUND: The course of chronic diseases can be influenced by psychological stress, suggesting a potential influence of current/recent disasters on atopic dermatitis (AD) patients. The aim of the study was to examine effects of the COVID-19 pandemic and Zagreb earthquake on the psychological stress level and disease condition of AD patients. SUBJECTS AND METHODS: This cross-sectional study included 150 AD patients (three groups with 50 patients): 1) those not exposed to either the COVID-19 pandemic or the earthquake; 2) those who only experienced the COVID-19 pandemic; and 3) those who experienced both the pandemic and the earthquake. Patients' data from the Perceived Stress Scale (PSS), on AD severity (SCORAD), and their answers from our newly designed questionnaire on disease-related behaviors and AD condition during the pandemic and quarantine were examined and statistically analyzed. RESULTS: The subjects who experienced both disasters had a greater PSS than those experiencing only the COVID-19 pandemic, especially women, and they also had higher disease severity (SCORAD) than those in the other two groups. Also, 59% of patients reported psychological stress during the pandemic, mostly caused by: the possibility of infection (31%), a changed work life and possible loss of income (23%), general pandemic-related conditions (17%), worry about physical survival (11%) and other (6%). Concerning the earthquake, the PSS significantly positively correlated with the psychological experience of the earthquake and with the intensity of sleep disturbances. CONCLUSION: To the best of our knowledge, this is the first study to specifically confirm that the COVID-19 pandemic influenced AD patients' stress levels and that stress from two disasters affected skin disease. Further research and therapeutic measures are needed.


Subject(s)
COVID-19 , Dermatitis, Atopic , Earthquakes , Cross-Sectional Studies , Dermatitis, Atopic/epidemiology , Female , Humans , Pandemics , SARS-CoV-2 , Stress, Psychological/epidemiology
13.
J Emerg Manag ; 19(7): 19-37, 2021.
Article in English | MEDLINE | ID: covidwho-1497654

ABSTRACT

The following article addresses the complexities of responding to the Magna, Utah earthquake under conditions of the global corona virus disease (COVID-19) pandemic. The article begins with a brief mention of the literature on complex disasters along with the research methods employed for the study. Contextual information about COVID-19 and the Magna earthquake are then provided along with general issues that had to be addressed in the public health emergency and after the seismic hazard occurred. The following two sections identify how COVID-19 benefited the response to the earthquake as well as how the virus complicated operations after the tremor. The article then discusses major lessons of this research and provides recommendations for future study and practice. Overall, this research reveals that the responses to these two simultaneous events witnessed successes as well as significant challenges. The appearance of COVID-19 may have limited injuries or the loss of life during the Magna earthquake, and it also enabled an early activation of the emergency operations center (EOC). However, COVID-19 presented unique challenges for evacuation, sheltering, and damage assessment functions. The pandemic also altered the nature of EOC operations, created the need for a virtual response, and had distinct implications for financial accounting and personnel workload.


Subject(s)
COVID-19 , Disasters , Earthquakes , Emergencies , Humans , Pandemics , SARS-CoV-2 , Utah
14.
Int J Environ Res Public Health ; 18(20)2021 10 15.
Article in English | MEDLINE | ID: covidwho-1480728

ABSTRACT

Resilience is an important issue in urban development, and community resilience (CR) is the most typical representative in building urban resilience, which has become the forefront of international resilience research. This paper presents a bibliometric and visual analysis of community resilience research collected from the WoS Core Collection database over the past two decades. H-index, citation frequency, centrality and starting year were adopted to analyze the research objects by bibliometric tools including CiteSpace, VOSviewer, and Gephi. The national and institutional characteristics of macro-geographical distribution and the characteristics of disciplines, journals, authors, and author cooperation of micro-knowledge network distribution were revealed. Finally, the potential research directions of community resilience in the future were discussed. The results show that there are three stages in community resilience research. Seven intellectual bases constitute the research background for community resilience, including social capital mechanism, the evolution of resilience knowledge, earthquake resistance and disaster mitigation, substance abuse, resilient development in rural communities, resilience-building in the least-developed countries, and emergency preparedness. Our analysis shows that the hottest community resilience research topics are the concept of resilience, climate resilience, the social capital mechanism, macro-environment and disaster-reduction policies, and an evaluation index system for community resilience.


Subject(s)
Civil Defense , Disasters , Earthquakes , Bibliometrics , Databases, Factual
16.
Int J Environ Res Public Health ; 18(19)2021 Oct 03.
Article in English | MEDLINE | ID: covidwho-1444224

ABSTRACT

Background: This practical report aims to publicize the ongoing disaster-related mental health interventions following the Great East Japan Earthquake during the COVID-19 pandemic. Methods: Disaster-related mental health interventions consisted of: (1) screening high-risk evacuees with high psychological distress (Kessler 6 score ≥ 13) or binge drinking; and (2) visiting selected high-risk individuals and providing them counseling through outreach in evacuee housing. These activity records were compiled from existing material in the Sendai City Office; therefore, no new interviews or questionnaire surveys were conducted. Results: During the COVID-19 pandemic, we introduced telephone counseling and shortened the time of support as a result of the restrictions. Counselors addressed issues of "loneliness" or "isolation" among evacuees, who had little connection with society due to the pandemic. Moreover, the procedure for obtaining COVID-19 special financial aid was explained to evacuees in financial difficulty. During this period, the suicide rates in the affected area did not increase significantly as compared to the national average. Conclusions: Our report may be instructive in terms of preventing suicide during the pandemic using high-risk approaches and counselors trained in disaster-related mental health interventions.


Subject(s)
COVID-19 , Disasters , Earthquakes , Suicide , Humans , Japan/epidemiology , Mental Health , Pandemics , SARS-CoV-2 , Suicide/prevention & control
17.
Oral Dis ; 27 Suppl 3: 688-693, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1434815

ABSTRACT

OBJECTIVE: To evaluate stress effect of COVID-19 pandemic and Zagreb earthquakes on symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: One hundred and two previously diagnosed TMD patients were contacted by email to participate in an online survey about impact of those events on current and/or new symptoms, perceived stress, anxiety and symptom intensity in time-points at the baseline, following pandemic and following earthquake. We compared data between earthquake-affected and non-affected respondents. RESULTS: Response rate was 79.4%. Effects stress had on deterioration of symptoms were significantly different between earthquake-affected and non-affected (p = .024). In earthquake-affected, numerical pain rating scale (NPRS) scores significantly increased between baseline and after COVID-19 (p > .001) and between baseline and after earthquakes (p > .05). However, scores insignificantly dropped from COVID-19 to after earthquakes time-points. In earthquake-affected, positive correlation was found between impact of COVID-19 on stress and NPRS (p < .001) and between earthquakes' impact on stress and NPRS (p < .001). Earthquake-affected respondents reported significantly more new behavioral habits when compared to non-affected (p = .048). CONCLUSIONS: A series of stressful events do not necessarily have a cumulative effect, but are likely to have a complex interaction (e.g., acute stress might trigger the protective mechanisms), which could have decreased pain scores after the earthquakes.


Subject(s)
COVID-19 , Earthquakes , Temporomandibular Joint Disorders , Humans , Pandemics , SARS-CoV-2 , Temporomandibular Joint Disorders/epidemiology , Temporomandibular Joint Disorders/etiology
19.
Environ Res ; 204(Pt B): 112079, 2022 03.
Article in English | MEDLINE | ID: covidwho-1433210

ABSTRACT

This paper is an analysis of complex crisis management and the importance of resilience on the example of co-occurring disasters. A resilience framework model was analyzed based on epidemiologic data and the interplay of several disasters; the COVID-19 pandemic and two 2020 Zagreb, Croatia earthquakes. A dose-response principle may be applied to a complex crisis scenario, within a resilience-vulnerability framework. The available data present the concept of balance between vulnerability and resilience of the population affected by complex crises as well as possible adaptation mechanisms. Multiple disasters that last for a prolonged period reduce the populations' resilience and increase the risk of the next crisis becoming a disaster as well. Such complex disasters should not be approached by multiple risk management protocols, but rather by a single, multilayered protocol. Health policies that predict the possible effects of complex disasters on health risk management need to provide measures to maintain and promote resilience instead of collapse. These is a clear need to adopt green environmental policies, reduce socioeconomic inequality, train volunteer managers during crises, introduce timely evidence-informed policies and transfer new research and innovations in society rapidly.


Subject(s)
COVID-19 , Disaster Planning , Disasters , Earthquakes , Croatia/epidemiology , Humans , Pandemics , SARS-CoV-2
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