Thunderstorm asthma: a review, risks for Aotearoa New Zealand, and health emergency management considerations.

AIM: To provide an up-to-date review of thunderstorm asthma (TA), identifying causative factors, and to discuss implications for management of TA in New Zealand. METHODS: A literature search was carried out to identify articles that investigate the characteristics and causative factors of TA. Nine electronic databases were searched, yielding 372 articles, reduced to 30 articles after screening for duplication and relevance. RESULTS: TA is globally rare, with 29 reported events since 1983, but is expected to increase in frequency as Earth warms. Triggers include both pollen (particularly ryegrass pollen) and fungal spores. Individual risk factors include outdoor exposure, sensitivity to triggering allergens and history of seasonal allergic rhinitis. History of asthma is not a strong risk factor but is associated with severity of outcome. Limited data on demographic characteristics suggests that individuals aged between 20 and 60 and (in Australasia) of Asian/Indian ethnicity are at higher risk. A single TA event has been reported in New Zealand to date, but much of New Zealand may be at risk of future events given that ryegrass pastures are widely distributed, and summer thunderstorms can occur anywhere. CONCLUSIONS: We recommend developing rapidly deployable public messaging to support the health emergency management response to future TA events, together with the instigation of routine aeroallergen monitoring.

Strategies for Implementing a One Welfare Framework into Emergency Management.

Responding to emergencies requires many different individuals and organisations to work well together under extraordinary circumstances. Unfortunately, the management of animal welfare in emergencies remains largely disconnected from emergency management overall. This is due predominately to professional silos and a failure to understand the importance of human-animal-environment (h-a-e) interdependencies. One Welfare (OW) is a concept with these interrelationships at its core. This paper argues that by adopting an OW framework it will be possible to achieve a transdisciplinary approach to emergency management in which all stakeholders acknowledge the importance of the h-a-e interdependencies and work to implement a framework to support this. Acknowledging that such a transformational change will not be easy, this paper proposes several strategies to overcome the challenges and optimise the outcomes for animal welfare emergency management (AWEM). These include legislation and policy changes including h-a-e interface interactions as business as usual, improving knowledge through interprofessional education and training, incorporating One Welfare champions, and recognising the role of animals as vital conduits into communities.

When Childhood Cancer Becomes a Family Affair, It Really Hits Home.

In this article, a father and son describe the experience of childhood leukemia treatment and its aftermath with the unique perspective of a parent who is also a pediatric oncologist. An illness that began with an apparently favorable prognosis was transformed by an early relapse, followed by unexpected complications and difficult treatment decisions. Despite unfavorable statistics, the son is a long-term survivor with an overall excellent quality of life, despite several late events and effects. His father, in the meantime, gained insights that now inform his own practice.

Health emergency management in Aotearoa New Zealand: Making sense of professional development.

OBJECTIVE: To explore how health emergency management (HEM) personnel make sense of professional development, such as education and training, in their everyday roles and responsibilities within an increasingly complex emergency management and disaster field. DESIGN: This in-depth qualitative study comprised of semistructured interviews with 10 Aotearoa New Zealand HEM personnel from a range of healthcare professions, including emergency managers, nurses, clinical support, and paramedics. The thematic, data-driven approach was exploratory. The research identified inductively significant thematic concepts relating to professional development from the health emergency personnel's talk about their roles and responsibilities. RESULTS: The authors identified four themes relating to professional development in the participants' talk: test yourself under pressure; selling what we do; under the pump; and real stuff that actually makes a difference. These themes represent shared sense-making about how the participants negotiated their professional development needs and the needs of others while performing their everyday roles and responsibilities. CONCLUSIONS: Our findings support the production of local and contextually driven knowledge that highlights how HEM personnel discuss professional development as strengths, tensions, challenges, and knowledge gaps. These insights contribute to a broader understanding of what needs to be taken into account when developing competencies, skill sets, and training programs to promote professional development in an increasingly complex emergency management and disaster field.

Behavioral Response in the Immediate Aftermath of Shaking: Earthquakes in Christchurch and Wellington, New Zealand, and Hitachi, Japan.

This study examines people's response actions in the first 30 min after shaking stopped following earthquakes in Christchurch and Wellington, New Zealand, and Hitachi, Japan. Data collected from 257 respondents in Christchurch, 332 respondents in Hitachi, and 204 respondents in Wellington revealed notable similarities in some response actions immediately after the shaking stopped. In all four events, people were most likely to contact family members and seek additional information about the situation. However, there were notable differences among events in the frequency of resuming previous activities. Actions taken in the first 30 min were weakly related to: demographic variables, earthquake experience, contextual variables, and actions taken during the shaking, but were significantly related to perceived shaking intensity, risk perception and affective responses to the shaking, and damage/infrastructure disruption. These results have important implications for future research and practice because they identify promising avenues for emergency managers to communicate seismic risks and appropriate responses to risk area populations.

Health Hazards Associated with Consumption of Roof-Collected Rainwater in Urban Areas in Emergency Situations.

The greater Wellington region, New Zealand, is highly vulnerable to large earthquakes because it is cut by active faults. Bulk water supply pipelines cross the Wellington Fault at several different locations, and there is considerable concern about severe disruption of the provision of reticulated water supplies to households and businesses in the aftermath of a large earthquake. A number of policy initiatives have been launched encouraging householders to install rainwater tanks to increase post-disaster resilience. However, little attention has been paid to potential health hazards associated with consumption of these supplies. To assess health hazards for householders in emergency situations, six 200-litre emergency water tanks were installed at properties across the Wellington region, with five tanks being allowed to fill with roof-collected rainwater and one tank being filled with municipal tapwater as a control. Such tanks are predominantly set aside for water storage and, once filled, feature limited drawdown and recharge. Sampling from these tanks was carried out fortnightly for one year, and samples were analysed for E. coli, pH, conductivity, a range of major and trace elements, and organic compounds, enabling an assessment of the evolution of water chemistry in water storage tanks over time. Key findings were that the overall rate of E. coli detections in the rain-fed tanks was 17.7%, which is low in relation to other studies. We propose that low incidences of may be due to biocidal effects of high zinc concentrations in tanks, originating from unpainted galvanised steel roof cladding. Lead concentrations were high compared to other studies, with 69% of rain-fed tank samples exceeding the World Health Organisation's health-based guideline of 0.01 mg/L. Further work is required to determine risks of short-term consumption of this water in emergency situations.

Improving the Impact and Implementation of Disaster Education: Programs for Children Through Theory-Based Evaluation.

A main weakness in the evaluation of disaster education programs for children is evaluators' propensity to judge program effectiveness based on changes in children's knowledge. Few studies have articulated an explicit program theory of how children's education would achieve desired outcomes and impacts related to disaster risk reduction in households and communities. This article describes the advantages of constructing program theory models for the purpose of evaluating disaster education programs for children. Following a review of some potential frameworks for program theory development, including the logic model, the program theory matrix, and the stage step model, the article provides working examples of these frameworks. The first example is the development of a program theory matrix used in an evaluation of ShakeOut, an earthquake drill practiced in two Washington State school districts. The model illustrates a theory of action; specifically, the effectiveness of school earthquake drills in preventing injuries and deaths during disasters. The second example is the development of a stage step model used for a process evaluation of What's the Plan Stan?, a voluntary teaching resource distributed to all New Zealand primary schools for curricular integration of disaster education. The model illustrates a theory of use; specifically, expanding the reach of disaster education for children through increased promotion of the resource. The process of developing the program theory models for the purpose of evaluation planning is discussed, as well as the advantages and shortcomings of the theory-based approaches.

Immediate behavioural responses to earthquakes in Christchurch, New Zealand, and Hitachi, Japan.

This study examines people's immediate responses to earthquakes in Christchurch, New Zealand, and Hitachi, Japan. Data collected from 257 respondents in Christchurch and 332 respondents in Hitachi revealed notable similarities between the two cities in people's emotional reactions, risk perceptions, and immediate protective actions during the events. Respondents' physical, household, and social contexts were quite similar, but Hitachi residents reported somewhat higher levels of emotional reaction and risk perception than did Christchurch residents. Contrary to the recommendations of emergency officials, the most frequent response of residents in both cities was to freeze. Christchurch residents were more likely than Hitachi residents to drop to the ground and take cover, whereas Hitachi residents were more likely than Christchurch residents to evacuate immediately the building in which they were situated. There were relatively small correlations between immediate behavioural responses and demographic characteristics, earthquake experience, and physical, social, or household context.

Nurse Perspectives on the Practical, Emotional, and Professional Impacts of Living and Working in Post-earthquake Canterbury, New Zealand.

INTRODUCTION: This report explores nurses' perspectives following the Canterbury (New Zealand) 2010-2011 earthquake sequence and the subsequent recovery process. Problem Little is known about the experiences of health care professionals during a disaster recovery process, and this research generates insights about the challenges faced. METHODS: Qualitative semi-structured interviews were undertaken with 11 nurses from the Christchurch (New Zealand) area to explore the challenges faced by the nurses during and following the earthquakes. The interviews took place three years after the start of the earthquake experience to enable exploration of longer term aspects of the recovery process. The interview transcripts were analyzed and coded using a grounded theory approach. RESULTS: The data analysis identified that the nurses had faced a number of challenges and these were characterized as practical, emotional, and professional. While some of the challenges were short-lived in the aftermath of the earthquakes, some were long-lasting due to the extended nature of the recovery process. Dealing with house damage, insurance negotiations, and working in damaged environments had a negative impact on the nurses. The nurses experienced a range of emotions, both negative and positive, after the disaster, though many had needed time to elapse before feeling able to reflect on their experiences. DISCUSSION: The findings suggest that secondary stressors have a negative impact on the psychosocial recovery process. The nurses recognized that they received support from others and were also required to focus on others. Keeping busy appeared to be the most common coping strategy. This lack of reflection on their experiences may have resulted in delayed emotional responses. Some of the nurses changed their work role, hours, and responsibilities suggesting that working in this environment was having a detrimental impact. CONCLUSION: The research indicates the challenges faced by nurses in the initial impact of the earthquakes and during the longer term recovery process. There is a need to consider the psychosocial impact of working and living in a post-disaster context and to develop support packages to ensure the health and well-being of nurses in this environment.

Disaster preparedness for children and families: a critical review.

Preparedness for disasters is universally low; children and families are particularly vulnerable groups. Against this backdrop, research on disaster preparedness for children and families is reviewed, with a focus on disaster preparedness and prevention education programs. Following definitions and theory/rationale, research is critically analyzed. While findings indicate a large growth in research in the past 15 years and largely positive findings, significant challenges remain. These challenges include issues related to methodological rigor, long-term effectiveness, and implementation. Recent research reflecting these important challenges is reviewed. At the same time, other recent research documents real potential for these programs, including findings which suggest that increased attention to incorporating theory- and evidence-supported components can enhance outcomes. Thus, despite some important limitations and challenges, research done to date signals promise for these programs in reducing risk and increasing resilience to disasters for children, families, and the households and communities in which they live.

Salient beliefs about earthquake hazards and household preparedness.

Prior research has found little or no direct link between beliefs about earthquake risk and household preparedness. Furthermore, only limited work has been conducted on how people's beliefs influence the nature and number of preparedness measures adopted. To address this gap, 48 qualitative interviews were undertaken with residents in three urban locations in New Zealand subject to seismic risk. The study aimed to identify the diverse hazard and preparedness-related beliefs people hold and to articulate how these are influenced by public education to encourage preparedness. The study also explored how beliefs and competencies at personal, social, and environmental levels interact to influence people's risk management choices. Three main categories of beliefs were found: hazard beliefs; preparedness beliefs; and personal beliefs. Several salient beliefs found previously to influence the preparedness process were confirmed by this study, including beliefs related to earthquakes being an inevitable and imminent threat, self-efficacy, outcome expectancy, personal responsibility, responsibility for others, and beliefs related to denial, fatalism, normalization bias, and optimistic bias. New salient beliefs were also identified (e.g., preparedness being a "way of life"), as well as insight into how some of these beliefs interact within the wider informational and societal context.

The impact of the 2004 tsunami on coastal Thai communities: assessing adaptive capacity.

The suddenness and scale of the 26 December 2004 tsunami and the challenges posed to affected communities highlighted the benefits of their members having a capacity to confront and adapt to the consequences of such a disaster. Research into adaptive capacity or resilience has been conducted almost exclusively with Western populations. This paper describes an exploratory study of the potential of a measure of collective efficacy developed for Western populations to predict the capacity of members of a collective society, Thai citizens affected by the 2004 tsunami, to confront effectively the recovery demands associated with this disaster. Following a demonstration that this measure could predict adaptive capacity, the role of religious affiliation, ethnicity and place of residence in sustaining collective efficacy is discussed. The implications of the findings for future research on, and intervention to develop, adaptive capacity among Thai citizens in particular and collectivist societies in general are discussed.

Serum neopterin, an immune activation marker, independently predicts disease progression in advanced HIV-1 infection.

BACKGROUND: CD4+ T lymphocyte (CD4) counts and plasma human immunodeficiency virus (HIV) type 1 RNA concentrations predict clinical outcome in HIV-1 infection. Our objective was to assess the independent prognostic value for disease progression of soluble markers of immune system activation. METHODS: This retrospective marker-validation study utilized previously obtained clinical and laboratory data, including CD4+ cell counts, and made use of stored frozen serum samples to assay for levels of beta2-microglobulin, neopterin, endogenous interferon, triglycerides, interleukin-6, soluble tumor necrosis factor- alpha receptor II, and HIV-1 RNA, and to determine HIV genotypic reverse-transcriptase inhibitor resistance. The 152 patients who participated in this study represented a subsample of participants in AIDS Clinical Trials Group (ACTG) 116B/117, a randomized trial that demonstrated the clinical benefit of didanosine over zidovudine monotherapy in persons with advanced HIV-1 infection. Marker data were analyzed in relation to protocol-defined clinical disease progression, using Cox proportional hazards models. RESULTS: The median duration of follow-up was 344 days. Elevated baseline values for neopterin (P=.0009), endogenous interferon (P=.00039) and interleukin-6 (P=.0007) were each associated with greater subsequent risk of clinical disease progression. In a head-to-head comparison that was adjusted for CD4+ cell count (P=.0165) and HIV-1 RNA level (P=.1220), we found that elevated values for neopterin (P=.0002) and, to a lesser extent, endogenous interferon (P=.0053) were the strongest predictors of increased risk of clinical disease progression 6 months later. CONCLUSIONS: Soluble markers of immune activation add prognostic information to CD4 counts and viral load for risk of disease progression in advanced HIV-1 infection. The robust performance of neopterin, an inexpensive and reliably measured serum marker, supports its potential suitability for patient monitoring, particularly in resource-limited settings.

Hazards education for youth: a quasi-experimental investigation.

No experimental research has examined the hypothesized benefits of hazards education programs for youth in helping to increase community resilience. This preliminary study followed on from correlational studies and examined the role these programs play in helping increase child and family problem- and emotion-focused coping. Children (n= 219) were randomly assigned, based on classroom, to a condition. The "usual condition" consisted of a reading and discussion program. The "emergency management" condition consisted of the usual condition combined with emergency-management-focused teaching and increased interaction between youth and home. Factors assessed included both problem- and emotion-focused factors: knowledge of mitigation and emergency response activities, family and home hazard adjustments, hazard-related fears, emotion-focused coping ability, and perceptions of parents' hazard-related fears. Overall, the results supported the role for hazards education programs in increasing resilience in youth and at home. In particular, large intervention produced effect sizes were seen for both child- and parent-reported hazard adjustments. Significant interactions provided additional support for the role of an emergency management focus in the problem-focused areas of (1) both child- and parent-reported hazard adjustments and (2) increased hazards-based knowledge in the youth. These initial findings provide a continuing foundation for further research in this emerging area. Discussion considers the role for such programs in the future.