Health Impact of Hurricanes Irma and Maria on St Thomas and St John, US Virgin Islands, 2017-2018.

Objectives. To assess the health impact of Hurricane Irma and Hurricane Maria on St Thomas, US Virgin Islands.Methods. We collected data from interviews conducted 6 and 9 months after the hurricanes, a review of 597 randomly selected emergency department (ED) encounters, and administrative records from 10 716 ED visits 3 months before, between, and 3 months after the hurricanes.Results. Informants described damaged hospital infrastructure, including flooding, structural damage, and lost staff. The greatest public health impact was on the elderly and persons with chronic diseases. In the setting of loss of the electronic medical record system, ED chart reviews were limited by problems with missing data. ED administrative data demonstrated that posthurricane patients, compared with prehurricane patients, were older and had less severe complaints. There was a significant increase in patients being seen for diabetes-related and respiratory complaints, especially asthma. Suboptimal recordkeeping for medical evacuees limited the ability to assess outcomes for patients with severe illnesses.Conclusions. Hurricanes Irma and Maria caused major disruptions to health care on St Thomas. Emphasis should be given to building a resilient health care system that will optimally respond to future hurricanes.

Repeated Dietary Exposure to Low Levels of Domoic Acid and Problems with Everyday Memory: Research to Public Health Outreach.

Domoic Acid (DA) is a marine-based neurotoxin. Dietary exposure to high levels of DA via shellfish consumption has been associated with Amnesic Shellfish Poisoning, with milder memory decrements found in Native Americans (NAs) with repetitive, lower level exposures. Despite its importance for protective action, the clinical relevance of these milder memory problems remains unknown. The purpose of this study was to determine whether repeated, lower-level exposures to DA impact everyday memory (EM), i.e., the frequency of memory failures in everyday life. A cross-sectional sample of 60 NA men and women from the Pacific NW was studied with measures of dietary exposure to DA via razor clam (RC) consumption and EM. Findings indicated an association between problems with EM and elevated consumption of RCs with low levels of DA throughout the previous week and past year after controlling for age, sex, and education. NAs who eat a lot of RCs with presumably safe levels of DA are at risk for clinically significant memory problems. Public health outreach to minimize repetitive exposures are now in place and were facilitated by the use of community-based participatory research methods, with active involvement of state regulatory agencies, tribe leaders, and local physicians.

Perception of risk for Domoic Acid related health problems: A Cross-cultural study.

Risk perception is a complex process that refers to the way people approach, think about and interpret risks in their environment. An important element of risk perception is that it is culturally situated. Since HAB's can present a health risk in many places around the world, looking at cultural parameters for understanding and interpreting risks are important. This study examined how two different groups of people perceive the potential health risks of low level exposure to domoic acid (DA) through razor clam consumption. The risk perceptions of Washington State, USA coastal dwelling Native American nations (NA) were compared to that of a community sample of recreational razor clam harvesters (CRH). Overall, the findings support the hypothesis that cultural and community specific contexts impact the perception of risk of a DA related illness. Specifically, the NA sample was distinguished by worrying more about ocean pollution, attributing DA risks to climate change, expressing concerns about the potential impact of DA on future generations, and feeling better informed than the CRH group. The CRH group were more likely to attribute the DA problem to anthropogenic or industrial causes; and view the risk of health problems as lower than that associated with smoking, high cholesterol, anxiety or depression, alcoholism, high blood pressure or obesity. The CRH group was also more likely to turn to the media for DA related information. Both groups trust the decisions of state and tribe health and natural resources officials and demonstrated a complex pattern of findings that involved gender. It was recommended that risk communication and outreach activities are designed to take into consideration factors that specifically apply to each cultural community.

Perception of risk for domoic acid related health problems: A cross-cultural study.

Risk perception is a complex process that refers to the way people approach, think about, and interpret risks in their environment. An important element of risk perception is that it is culturally situated. Since HABs can present a health risk in many places around the world, looking at cultural parameters for understanding and interpreting risks is important. This study examined how two different groups of people perceive the potential health risks of low-level exposure to domoic acid (DA) through razor clam consumption. The risk perceptions of Washington State, USA coastal dwelling Native American nations (NA) were compared to that of a community sample of recreational razor clam harvesters (CRH). Overall, the findings support the hypothesis that cultural and community specific contexts impact the perception of risk of a DA related illness. Specifically, the NA sample was distinguished from the CRH group in particular, by their worries about ocean pollution, attribution of DA risks to climate change, concerns about the potential impact of DA on future generations, and feeling of being better informed than the CRH group. The CRH group was more likely to attribute the DA problem to anthropogenic or industrial causes and view the risk of health problems from DA as lower than those associated with smoking, high cholesterol, anxiety or depression, alcoholism, high blood pressure or obesity. The CRH group was also more likely to turn to the media for DA-related information. Both groups trusted the decisions of state and tribe health and natural resources officials, and demonstrated a complex pattern of findings that involved gender. In summary, risk communication and outreach activities should be designed to take into consideration the specific factors that are unique to each cultural community.