Surveying mental health stressors of emergency management professionals: Factors in recruiting and retaining emergency managers in an era of disasters and pandemics.

Emergency managers are responsible for managing crises and disasters, and while their work is essential, it can be stressful and impact their mental health, particularly during the COVID-19 pandemic. This study aimed to examine the mental health of professional emergency managers and factors associated with their intent to leave the field before and during the COVID-19 pandemic. A total of 903 respondents completed an online survey assessing their secondary traumatic stress, emergency reaction strategies, organizational culture, age, length of time in primary position, the highest level of education as well as other metrics. The Secondary Traumatic Stress Scale (STSS) was used to determine scores of secondary traumatic stress symptoms, and the Emergency Reaction Questionnaire (ERQ) index was used to evaluate levels of predominant personality types and its tendency towards "fight or flight" reactions in emergency situations. Results revealed significant differences among respondents who reported considering leaving the field before or during the COVID-19 pandemic in terms of secondary traumatic stress scores, ERQ levels, perceived organizational culture (OC), age category, length of time in primary position, and the highest level of education (p < 0.05). Logistic regression analysis indicated that respondents with higher secondary traumatic stress scores, poorer organizational culture, younger age, less experience, and a bachelor's degree had nearly three times the odds of reporting considering leaving the field (p < 0.05). Additionally, respondents with a graduate degree had nearly four times the odds of reporting leaving the field (p < 0.05), while those who had directly managed between three and five disasters had nearly two times the odds of reporting and considering leaving the field (p < 0.05). These findings underscore the importance of addressing secondary traumatic stress, promoting positive organizational culture, and providing support for emergency managers now and in the future. By addressing the factors identified in this study, such as secondary traumatic stress symptoms, promoting positive organizational culture, and providing adequate support, emergency management organizations can improve the mental health and well-being of their personnel, reduce attrition rates, and ensure that they are better equipped to respond to future crises.

Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic.

The COVID-19 pandemic profoundly affected physical, mental, and economic well-being across the globe and has disproportionately affected certain vulnerable groups. This paper provides a scoping review of literature on the impact of the COVID-19 pandemic on sex workers, published between December 2019 and December 2022. Six databases were systematically searched, identifying 1009 citations; 63 studies were included in the review. Thematic analysis revealed eight main themes: financial issues; exposure to harm; alternate ways of working; COVID-19 knowledge, protective behaviors, fear, and risk; well-being, mental health, and coping; access to support; access to health care; and the impact of COVID-19 on research with sex workers. COVID-associated restrictions led to reduced work and income, leaving many sex workers struggling to cover basic needs; additionally, government protections excluded those working in the informal economy. Fearing the loss of their already reduced number of clients, many felt compelled to compromise both prices and protective measures. Although some engaged in online sex work, this raised concerns about visibility and was impossible for those without technological access or skills. Many feared COVID-19, but felt pressure to continue working, often with clients who refused to wear masks or share exposure history. Other negative impacts on well-being related to the pandemic included reduced access to financial support or health care. Marginalized populations (and especially those in professions which require close contact like sex workers) need further support and capacity-building within the community to recover from the impact of COVID-19.

Chemical, biological, radiological, nuclear, and explosives (CBRNEs) preparedness for sporting event mass gatherings: A systematic review of the literature.

OBJECTIVE: Sporting events often constitute mass gatherings (MGs) featuring large crowds of spectators and participants. Our objective is to understand the current state of emergency preparedness for sporting events by examining past MG sporting events to evaluate mitigation, preparedness, response, and recovery against chemical, biological, radiological, nuclear, and explosive (CBRNE) events. METHODS: In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was carried out among 10 literature databases. The quality and risk of bias in each reviewed publication was assessed using the Mixed Methods Appraisal Tool. RESULTS: A total of 5,597 publications were identified. Of these, 81 papers were selected for full text reads and 25 publications were accepted. The included articles documented sporting events worldwide, ranging from incidents occurring from 1972 to 2020. Cross-cutting themes found in best practices and recommendations were strategic communication, surveillance, planning and preparedness, and training and response. CONCLUSION: More evidence-based guidelines are needed to ensure best practices in response and recovery for CBRNE incidents at sporting events. Public health risks as well as implementation barriers and opportunities to prepare for potential CBRNE threats at sporting event MGs require further investigation.

Strategies to Counter Disinformation for Healthcare Practitioners and Policymakers.

Medical disinformation has interfered with healthcare workers' ability to communicate with the general population in a wide variety of public health contexts globally. This has limited the effectiveness of evidence-based medicine and healthcare capacity. Disinformation campaigns often try to integrate or co-opt healthcare workers in their practices which hinders effective health communication. We describe a critical overview of issues health practitioners and communicators have experienced when dealing with medical disinformation online and offline as well as best practices to overcome these issues when disseminating health information. This article lists disinformation techniques that have yet to be used against the medical community but need to be considered in future communication planning as they may be highly effective. We also present broad policy recommendations and considerations designed to mitigate the effectiveness of medical disinformation campaigns.

La desinformación médica ha interferido con la capacidad de los trabajadores de la salud para comunicarse con la población en general en una amplia variedad de contextos de salud pública a nivel mundial. Esto ha limitado la eficacia de la medicina basada en la evidencia y la capacidad sanitaria. Las campañas de desinformación a menudo intentan integrar o cooptar a los trabajadores de la salud en sus prácticas, lo que dificulta la comunicación efectiva de la salud. Describimos una descripción general crítica de los problemas que los profesionales de la salud y los comunicadores han experimentado al lidiar con la desinformación médica en línea y fuera de línea, así como las mejores prácticas para superar estos problemas al difundir información de salud. Este artículo enumera las técnicas de desinformación que aún no se han utilizado contra la comunidad médica, pero que deben tenerse en cuenta en la planificación de comunicaciones futuras, ya que pueden ser muy efectivas. También presentamos amplias recomendaciones y consideraciones de políticas diseñadas para mitigar la efectividad de las campañas de desinformación médica.

The new humanitarian crisis in Ukraine: Coping with the public health impact of hybrid warfare, mass migration, and mental health trauma.

One of the largest mass movements of displaced people from their homelands in recent history must be recognized and assisted by the Free World. The unprovoked Russian attacks on Ukraine during February-March 2022 will leave long-lasting devastating effects on millions of innocent victims. Nations worldwide, especially NATO member countries, will need to intervene to ameliorate the situation. This letter describes major public health issues apart from the COVID-19 pandemic that are emerging concerns, such as shortages of healthcare professionals, chronic care treatments and health prevention services, disinformation communication campaigns affecting the healthcare infrastructure, and the generational impact of the conflict on people's mental health. A global response and public health support need immediate action including humanitarian assistance, food security, clean water supplies, adequate shelter, and safe transportation out of the active military zones.

Psychological Consequences of the Flint Water Crisis: A Scoping Review.

OBJECTIVE: To summarize existing literature on the mental health impact of the Flint Water Crisis. METHODS: In March 2020, we searched 5 databases for literature exploring the psychological consequences of the crisis. Main findings were extracted. RESULTS: 132 citations were screened and 11 included in the review. Results suggest a negative psychological effect caused by the water crisis, including anxiety and health worries, exacerbated by lowered trust in public health officials, uncertainty about the long-term impacts of the crisis, financial hardships, stigma, and difficulties seeking help. There was evidence that concerns about tap water continued even after the state of emergency was lifted. CONCLUSIONS: With a possible compound effect to residents of Flint with the recent COVID-19 pandemic, the results highlight the need for more resources for psychological health interventions in Flint as well as a need for local governments and health authorities to regain the trust of those affected by the Flint Water Crisis.

Corruption and disasters in the built environment: a literature review.

This paper presents the findings of a review of academic literature concerning the degree to which corruption worsens disasters triggered by natural hazards in the built environment. The research employed a 'systematic literature review' methodology to analyse leading academic databases, resulting in a detailed analysis of 59 peer-reviewed, published papers. It found that while much of the literature focuses on earthquakes (relating to building and infrastructure collapse), the quality of governance, and the drivers of corruption, there is presently very limited scholarship on the general scope, reach, and scale with respect to how disasters are worsened by corruption. It is notable that the Sendai Framework for Disaster Risk Reduction 2015-2030 and a number of other high-level reports fail to mention corruption. The paper argues that this serious gap in understanding and expressing how corruption increases vulnerability in the built environment within disaster studies perversely supports the furtherance of corruption in worsening disasters.

When disaster management agencies create disaster risk: a case study of the US's Federal Emergency Management Agency.

PURPOSE: Disaster management agencies are mandated to reduce risk for the populations that they serve. Yet, inequities in how they function may result in their activities creating disaster risk, particularly for already vulnerable and marginalized populations. In this article, how disaster management agencies create disaster risk for vulnerable and marginalized groups is examined, seeking to show the ways existing policies affect communities, and provide recommendations on policy and future research. DESIGN/METHODOLOGY/APPROACH: The authors undertook a systematic review of the US disaster management agency, Federal Emergency Management Agency (FEMA), examining its programs through a lens of equity to understand how they shape disaster risk. FINDINGS: Despite a growing commitment to equity within FEMA, procedural, distributive, and contextual inequities result in interventions that perpetuate and amplify disaster risk for vulnerable and marginalized populations. Some of these inequities could be remediated by shifting toward a more bottom-up approach to disaster management, such as community-based disaster risk reduction approaches. PRACTICAL IMPLICATIONS: Disaster management agencies and other organizations can use the results of this study to better understand how to devise interventions in ways that limit risk creation for vulnerable populations, including through community-based approaches. ORIGINALITY/VALUE: This study is the first to examine disaster risk creation from an organizational perspective, and the first to focus explicitly on how disaster management agencies can shape risk creation. This helps understand the linkages between disaster risk creation, equity and organizations.

Delivering the Promise of Sendai Framework for Disaster Risk Reduction in Fragile and Conflict-Affected Contexts (FCAC): A Case Study of the NGO GOAL's Response to the Syria Conflict.

The Sendai Framework for Disaster Risk Reduction (SFDRR) has helped to reduce global disaster risk, but there has been a lack of progress in disaster risk reduction (DRR) for people living in fragile and conflict affected contexts (FCAC). Given the mounting evidence that DRR cannot be implemented through conventional approaches in FCAC, serious efforts must be made to understand how to meet SFDRR's goals. This paper offers a case study of international non-governmental organization GOAL's programming that responds to the protracted crisis in Syria, with critical discussion on SFDRR and how to adapt humanitarian relief and disaster resilience.

Converging Impact of the Ongoing Conflict and COVID-19 Pandemic on Mental Health and Substance Use Disorders in Ukraine.

Since the Russian annexation of the Autonomous Republic of Crimea and the subsequent occupation of parts of the Donetsk and Luhansk regions, Ukraine has been facing increasing security and healthcare challenges. The seven-year war in East Ukraine has led to a rise in substance and alcohol use and increasing addiction rates among veterans, internally displaced persons, and civilian survivors. This article examines the combined impact of the ongoing Russo-Ukrainian conflict and COVID-19 pandemic on substance use in Ukraine. It also gives an overview of the institutions in place to monitor and improve mental health in the country. The article highlights the urgent need for further funding and research on substance and alcohol addiction, with vulnerable populations affected by the conflict during the COVID-19 pandemic. Frontline healthcare workers in this region should anticipate an increased burden of patients suffering from substance use disorders who are in need of emergency management intervention and proper behavioral health referrals.

Practitioner Approaches to Measuring Community Resilience: The Analysis of the Resilience of Communities to Disasters Toolkit.

To be useful for operational programs, measures of resilience must not just be valid, but be easy to use and useful. Unfortunately, while resilience measurement techniques have progressed tremendously over the past decade, most progress has been on improving validity rather than utility and ease of use. In this article we present a new tool for measuring community resilience that incorporates issues of utility and ease of use, the Analysis of Resilience of Communities to Disasters (ARC-D) toolkit. The toolkit was developed over the course of ten years by the international humanitarian and development organization GOAL to enable aid organizations to measure community resilience in a way that supports resilience building interventions. It offers an approach to measurement that is cognizant of the resilience policy landscape, including the Sendai Framework, approaches to data collection and measurement uses relevant to aid agencies. We first present the core tenants of community resilience measurement before describing the toolkit, which consists of 30 measures, a guidebook, and an online platform. To illustrate its use, we a case study of a resilience building program in Tegucigalpa, Honduras. By developing one of the first resilience toolkits focused beyond validity and providing a description of how such an assessment works, this article has implications for resilience researchers and practitioners.

The Conflict in East Ukraine: A Growing Need for Addiction Research and Substance Use Intervention for Vulnerable Populations.

Security and trauma challenges in Ukraine have been constantly evolving since the 2014 Russian military incursion of Crimea and War in Donbass. One long-term consequence of the conflict in East Ukraine is the toll of substance and alcohol use and addictions that may have been triggered by the conflict among the veterans, internally displaced peoples, and civilian survivors. Further funding and research on substance and alcohol addiction with these vulnerable populations affected by the ongoing Ukrainian conflict should be examined. Are people from fragile states and conflict zones more susceptible to co-morbidity with substance abuse and addiction?

Incorporating Issues of Elderly Loneliness into the Coronavirus Disease-2019 Public Health Response.

As the systems that people depend on are increasingly strained by the coronavirus disease-2019 (COVID-19) outbreak, public health impacts are manifesting in different ways beyond morbidity and mortality for elderly populations. Loneliness is already a chief public health concern that is being made worse by COVID-19. Agencies should recognize the prevalence of loneliness among elderly populations and the impacts that their interventions have on loneliness. This letter describes several ways that loneliness can be addressed to build resilience for elderly populations as part of the public health response to COVID-19.

"Emerging Technologies and Medical Countermeasures to Chemical, Biological, Radiological, and Nuclear (CBRN) Agents in East Ukraine".

Since 2014, Ukraine has been beset by an armed conflict with international and internal dimensions. The nature of this conflict is multidimensional, and disaster preparedness and response in this context must be as well. Health experts from Ukraine, the United States of America, United Kingdom, Czech Republic, and Norway convened for an educational event in Dnipro, East Ukraine on November 11-15, 2019. At the event, "Emerging Technologies and Countermeasures to CBRN Agents: Advanced Training Response to Conflict and Security Challenges in East Ukraine," over 1,000 participants participated in panel discussions, didactic lectures, and an advanced training on various dimensions of disaster response. This report provides an overview of the key discussions and outcomes of the event.

Research fatigue in COVID-19 pandemic and post-disaster research: Causes, consequences and recommendations.

PURPOSE: Research fatigue occurs when an individual or population of interest tires of engaging with research, consequently avoiding further participation. This paper considers research fatigue in the context of the current COVID-19 pandemic, to identify contributory factors and possible solutions for future post-disaster research. METHODOLOGY: We draw on examples from the literature and our own observations from the recruitment and data collection phases of qualitative and quantitative studies, to provide an overview of possible research fatigue in the current COVID-19 pandemic, with implications for future post-disaster research. FINDINGS: People affected by disasters sometimes receive multiple requests for study participation by separate teams who may not necessarily be coordinating their work. Not keeping participants informed of the research process or outcomes can lead to disillusionment. Being overburdened with too many research requests and failing to see any subsequent changes following participation may cause individuals to experience research fatigue. ORIGINALITY: Guidelines for researchers wishing to reduce the occurrence of research fatigue include ensuring greater transparency within research; sharing of results; and using oversight or gatekeeper bodies to aid coordination. Failure to restrict the number of times that people are asked to participate in studies risks poor participation rates. This can subsequently affect the quality of information with which to inform policy-makers and protect the health of the public during the COVID-19 pandemic or other public health disasters/emergencies.

Technological advancements to address elderly loneliness: Practical considerations and community resilience implications for COVID-19 pandemic.

PURPOSE: Loneliness has been a known severe public health concern among the elderly population during the COVID-19 pandemic. The aim of this paper is to discuss the practicalities of using emerging technologies to address elderly loneliness and its implications and adaptations to the outbreak of coronavirus disease-2019. DESIGN/METHODOLOGY/APPROACH: The authors draw on examples from the literature and their own observations from working with older adults, to provide an overview of possible ways technology could help this population in the current COVID-19 pandemic. FINDINGS: Technological advancements have offered remarkable opportunities to deliver care and maintain connections despite the need to stay physically separated. These tools can be integrated into crisis communications, public health responses, and care programs to address loneliness among the elderly. However, it must be done strategically and informed by the type of loneliness at play, environmental factors, socioeconomics, and technological literacy. ORIGINALITY: Technological advancements can be a valuable tool in addressing known public health concerns, such as loneliness among the elderly populations. However, the use of this tool should be governed by the specific situation at hand, taking into consideration individual needs and environmental factors, especially the compounded effects caused by the coronavirus pandemic. Different technological programs and approaches are appropriate for different types of loneliness. For example, online therapy such as internet-based cognitive behavior therapy may mitigate loneliness caused by fear; online interaction such as videoconferencing may relieve loneliness caused by lack of social engagement. PRACTICAL IMPLICATIONS: Care-providing organizations and policy makers should consider the risk of loneliness while responding to COVID-19 outbreak, particularly within elderly populations. As part of a broader plan, technological solutions as well as low-tech approaches can make a difference in mitigating loneliness. Solutions should be accessible to and usable by older adults. Provision of equipment, training, and guidance may be necessary to execute a technology-centric plan; for some communities and individuals, approaches that do not rely on advanced technology may be more effective.

The Landscape of Disinformation on Health Crisis Communication During the COVID-19 Pandemic in Ukraine: Hybrid Warfare Tactics, Fake Media News and Review of Evidence.

The COVID-19 pandemic has impacted the world in ways not seen since the 1918-1920 Spanish Flu. Disinformation campaigns targeting health crisis communication during this pandemic seek to cripple the medical response to the novel coronavirus and instrumentalize the pandemic for political purposes. Propaganda from Russia and other factions is increasingly infiltrating public and social media in Ukraine. Still, scientific literature has only a limited amount of evidence of hybrid attacks and disinformation campaigns focusing on COVID-19 in Ukraine. We conducted a review to retrospectively examine reports of disinformation surrounding health crisis communication in Ukraine during the COVID-19 response. Based on the themes that emerged in the literature, our recommendations are twofold: 1) increase transparency with verified health crisis messaging and, 2) address the leadership gap in reliable regional information about COVID-19 resources and support in Ukraine.

What Do We Mean by 'Community Resilience'? A Systematic Literature Review of How It Is Defined in the Literature.

BACKGROUND: Government, industry and charitable organisations have an increasing focus on programs intended to support community resilience to disasters. But has consensus been reached as to what defines 'community resilience' and what its core characteristics are? METHODS: We undertook a systematic literature review of definitions of community resilience related to disasters. We conducted an inductive thematic analysis of the definitions and descriptions that we identified, in order to determine the proposed characteristics of community resilience prior to, during and after a disaster. RESULTS: We identified 80 relevant papers. There was no evidence of a common, agreed definition of community resilience. In spite of this, evidence was found of nine core elements of community resilience that were common among the definitions. The core elements were: local knowledge, community networks and relationships, communication, health, governance and leadership, resources, economic investment, preparedness, and mental outlook. Within these core elements, we identified 19 sub-elements linked to community resilience. CONCLUSION: Our findings show that community resilience remains an amorphous concept that is understood and applied differently by different research groups. Yet in spite of the differences in conception and application, there are well-understood elements that are widely proposed as important for a resilient community. A focus on these individual elements may be more productive than attempting to define and study community resilience as a distinct concept.