Climate Change, Environmental Disasters, and Health Inequities: The Underlying Role of Structural Inequalities.

PURPOSE OF REVIEW: We review and analyze recent literature in public health, urban planning, and disaster management to better understand the relationships between climate change, natural disasters, and root causes of health disparities in the USA. RECENT FINDINGS: Existing scholarship establishes clear linkages between climate change and increasing occurrences and severity of natural disasters across the USA. The frequency and types of disasters vary by region and impact both short and long-term health outcomes. Current research highlights health inequities affecting lower income and minoritized communities disproportionately, but data-driven studies critically examining the role of structural inequalities in climate-induced health disparities are sparse. Adding to the body of knowledge, our conceptual framework maps how long-standing structural inequalities in policy, practice, and funding shape vulnerability of lower-income, racially and ethnically marginalized individuals. Vulnerability follows three common pathways: disparities in "exposure", "sensitivity", and "resiliency" before, during, and after a climate disaster. We recommend that future research, policy, and practice shift towards solutions that unearth and address the structural biases that cause environmental disaster and health inequities.

Compression regimes after endovenous ablation for superficial venous insufficiency--A survey of members of the Vascular Society of Great Britain and Ireland.

INTRODUCTION: The optimal compression regime following ultrasound guided foam sclerotherapy (UGFS), radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) for varicose veins is not known. The aim of this study was to document current practice. METHODS: Postal questionnaire sent to 348 consultant members of the Vascular Society of Great Britain and Ireland. RESULTS: Valid replies were received from 41% (n = 141) surgeons representing at least 68 (61%) vascular units. UGFS was used by 74% surgeons, RFA by 70% and EVLA by 32%, but fewer patients received UGFS (median 30) annually, than endothermal treatment (median 50)--P = 0.019. All surgeons prescribed compression: following UGFS for median seven days (range two days to three months) and after endothermal ablation for 10 days (range two days to six weeks)--P = 0.298. Seven different combinations of bandages, pads and compression stockings were reported following UGFS and four after endothermal ablation. Some surgeons advised changing from bandages to stockings from five days (range 1­14) after UGFS. Following endothermal ablation, 71% used bandages only, followed by compression stockings after two days (range 1­14). The majority of surgeons (87%) also treated varicose tributaries: 65% used phlebectomy, the majority (65%) synchronously with endothermal ablation. Concordance of compression regimes between surgeons within vascular units was uncommon. Only seven units using UGFS and six units using endothermal ablation had consistent compression regimes. CONCLUSION: Compression regimes after treatments for varicose veins vary significantly: more evidence is needed to guide practice.