Patterns of psychiatric admissions across two major health crises: L' Aquila earthquake and COVID-19 pandemic lockdown.

BACKGROUND: This study examined psychiatric hospitalisation patterns in San Salvatore Hospital in L' Aquila (Italy), during two major crises: the 2009 earthquake and the COVID-19 pandemic lockdown. The investigation spans two four-year periods, from 2008 to 2011 and from 2019 to 2022, with a focus on the trimester around the earthquake and the first wave/lockdown of the pandemic. METHODS: We analysed weekly psychiatric unit admissions of adults diagnosed with schizophrenia spectrum disorder, major depression, bipolar disorder, and alcohol/substance use disorder. Four-year periods around the Earthquake and COVID-19 Lockdown were divided into sixteen trimesters, and Generalised linear models were used to analyse the relationship between weekly hospitalisation frequency and trimesters by diagnosis using a Poisson distribution. RESULTS: A total of 1195 and 1085 patients were admitted to the psychiatric ward in the 2008-2011 and 2019-2022 periods, respectively. Weekly hospitalisations in the earthquake trimester were lower than during the previous one for all diagnoses (schizophrenia spectrum: -41.9%, p = 0.040; major depression: -56.7%, p = 0.046; bipolar disorder: -69.1%, p = 0.011; alcohol/substance use disorder: -92.3%, p = 0.013). This reduction persisted for 21, 18, and 33 months after the earthquake for schizophrenia spectrum, bipolar, and alcohol/substance use disorders, respectively. Contrarily, patterns of weekly admissions around the COVID-19 lockdown remained substantially stable in the short term. However, a consistent long-term hospitalisation increase for all diagnoses characterised the first half of 2022 (the cessation of anti-COVID-19 measures; schizophrenia spectrum: +68.6%, p = 0.014; major depression: +133.3%, p = 0.033; bipolar disorder: +180.0%, p = 0.034; alcohol/substance use disorder: +475.0%, p = 0.001). CONCLUSIONS: The present study indicated that exposure to major health crises can have both short- and long-term effects on psychiatric ward admission, holding significant implications for current and future major health emergency management strategies.

Exposure to Multiple Natural Disasters and Externalising and Internalising Behavior: A Longitudinal Study of Adolescents.

PURPOSE: As natural disasters become more frequent and more severe, there is a corresponding need to understand their relationship with child and adolescent mental health, and in particular, to understand exposure to multiple natural disasters. This study assesses the relationship between exposure to both single and multiple disasters and adolescent internalising and externalising behavior. METHODS: The study used five waves of a nationally representative longitudinal Australian dataset. Exposure to sudden-onset (fires, floods, storms) and slow-onset (drought) disasters was collected across five waves. Adolescent internalising and externalising behavior collected in the final three waves using the self-reported Strengths and Difficulties Questionnaire. Random effects regressions assessed sudden- and slow-onset disasters and multiple disaster exposure, controlling for geographic and socioeconomic variables. RESULTS: Exposure to multiple disasters was associated with adverse adolescent outcomes. Two or more sudden- and slow-onset disaster exposures in the last 12 months was related to more conduct problems. Exposure to multiple sudden-onset disasters in the current and previous waves was related to increased problems with peers. A single exposure to either sudden- or slow-onset disasters was not associated with Strengths and Difficulties Questionnaire outcomes. DISCUSSION: The study findings suggest that multiple exposure to disasters has a negative association with adolescent wellbeing. These findings suggest that, rather than adapting to disasters, youth exposed to multiple disasters suffer more than their peers, including peers exposed to a single disaster.

Psychological resilience, resilient coping, and health behaviors among adults in Puerto Rico after multiple adverse events.

Objective: Residents of Puerto Rico have recently experienced multiple adverse events, including hurricanes, earthquakes, and political unrest. Such adversity is associated with worse mental and physical health. Psychological resilience and effective coping may mitigate these relations by fostering positive health behaviors, like consuming a high-quality diet and being physically active. However, empirical evidence for these relationships is limited. Methods: We assessed psychological resilience, resilient coping, and health behaviors among two groups of adults in Puerto Rico, before and during the pandemic, in 2019-2023 (total N = 1,342). Resilience and resilient coping were assessed using the Brief Resilience Scale and Brief Resilient Coping Scale. Diet quality was defined by the Alternate Healthy Eating Index from a food frequency questionnaire. We collected data on sleep, physical activity, alcohol intake, and tobacco use using validated questionnaires. Results: Adjusting for confounders, higher resilience z-scores were associated with being in the highest category of diet quality [OR: 1.25, 95 % CI: 1.04, 1.50]; getting 7-8 h of sleep per night [OR: 1.15, 95 % CI: 1.02,1.30]; and reporting moderate or heavy physical activity (vs. light or sedentary) [OR: 1.17, 95 % CI: 1.02,1.34]. The same patterns were observed for higher resilient coping z-scores, and for categorical measures of resilience and resilient coping. These relationships were stronger among participants interviewed during (vs. before) the COVID-19 pandemic, suggesting that resilience and resilient coping may be particularly relevant during an ongoing stressor. Conclusion: Identifying supportive strategies to cultivate resilience and effective coping mechanisms may contribute to healthier behaviors, particularly in a vulnerable population.

Hispanic Cancer Survivors Exposed to Multiple Natural Disasters: Pre-Post-Disaster Changes in Anxiety, Depression, PTSD, Perceived Stress, and Physical Symptom Burden.

BACKGROUND: Studies evaluating the effects of natural disasters on cancer outcomes are scarce, especially among USA ethnic minority groups, and none have focused on the effects of concurrent natural disasters and the COVID-19 pandemic. The goal of this secondary data analysis is to explore the impact of concurrent exposure to COVID-19 and earthquakes on psychological distress and symptom burden among Puerto Rican cancer survivors. METHODS: This secondary data analysis (n = 101) was part of a longitudinal case-control cohort study (n = 402) aimed at describing unmet psychological needs among Puerto Rican cancer patients and non-cancer subjects previously exposed to Hurricane María in 2017. The research team pooled data from participants (cancer survivors and non-cancer group) from their baseline assessments and from follow-up assessments conducted during January-July 2020 (earthquake and the lockdown period). A descriptive, paired t-test, non-parametric mean rank test, and two-sided Pearson correlation analyses were performed. RESULTS: Psychological distress and cancer symptom burden diminished over time. Resilience was significantly correlated with all the psychological and symptom burden variables during both pre- and post-earthquake and COVID-19 assessment periods. CONCLUSIONS: The results support the role of resilience, social support, and post-traumatic growth as potential protective factors preventing psychological distress and diminishing cancer symptom burden among cancer survivors exposed to natural disasters and the COVID-19 pandemic.

Academy of Breastfeeding Medicine Position Statement: Breastfeeding in Emergencies.

Background: During emergencies, including natural disasters and armed conflict, breastfeeding is critically important. Breastfeeding provides reliable nutrition and protection against infectious diseases, without the need for clean water, feeding implements, electricity, or external supplies. Key Information: Protection, promotion, and support of breastfeeding should be an integral part of all emergency preparedness plans. Breastfeeding specialists should be part of plan development. Emergency protocols should include breastfeeding specialists among emergency relief personnel, provide culturally sensitive environments for breastfeeding, and prioritize caregivers of infants in food/water distribution. Emergency relief personnel should be aware that dehydration and missed feedings can impact milk production, but stress alone does not. Emergency support should focus on keeping mothers and infants together and providing private and/or protected spaces for mothers to breastfeed or express milk. Emergency support should also focus on rapidly identifying mothers with breastfeeding difficulties and breastfeeding mothers and infants who are separated, so their needs can be prioritized. Breastfeeding support should be available to all women experiencing difficulties, including those needing reassurance. Nonbreastfed infants should be identified as a priority group requiring support. Relactation, wet-nursing, and donor milk should be considered for nonbreastfed infants. No donations of commercial milk formula (CMF), feeding bottles or teats, or breast pumps should be accepted in emergencies. The distribution of CMF must be highly controlled, provided only when infants cannot be breastfed and accompanied by a comprehensive package of support. Recommendations: Protecting, promoting, and supporting breastfeeding should be included in all emergency preparedness planning and in training of personnel.

Enhancing geotechnical damage detection with deep learning: a convolutional neural network approach.

Most natural disasters result from geodynamic events such as landslides and slope collapse. These failures cause catastrophes that directly impact the environment and cause financial and human losses. Visual inspection is the primary method for detecting failures in geotechnical structures, but on-site visits can be risky due to unstable soil. In addition, the body design and hostile and remote installation conditions make monitoring these structures inviable. When a fast and secure evaluation is required, analysis by computational methods becomes feasible. In this study, a convolutional neural network (CNN) approach to computer vision is applied to identify defects in the surface of geotechnical structures aided by unmanned aerial vehicle (UAV) and mobile devices, aiming to reduce the reliance on human-led on-site inspections. However, studies in computer vision algorithms still need to be explored in this field due to particularities of geotechnical engineering, such as limited public datasets and redundant images. Thus, this study obtained images of surface failure indicators from slopes near a Brazilian national road, assisted by UAV and mobile devices. We then proposed a custom CNN and low complexity model architecture to build a binary classifier image-aided to detect faults in geotechnical surfaces. The model achieved a satisfactory average accuracy rate of 94.26%. An AUC metric score of 0.99 from the receiver operator characteristic (ROC) curve and matrix confusion with a testing dataset show satisfactory results. The results suggest that the capability of the model to distinguish between the classes 'damage' and 'intact' is excellent. It enables the identification of failure indicators. Early failure indicator detection on the surface of slopes can facilitate proper maintenance and alarms and prevent disasters, as the integrity of the soil directly affects the structures built around and above it.

Experiences Accessing Health and Social Services during and after Natural Disasters among People Who Use Drugs in Houston, Texas.

People who use drugs (PWUD) disproportionately experience health-related and social vulnerabilities, which may affect service needs and access during and after natural disasters. We conducted qualitative interviews with N = 18 PWUD recruited via a syringe services program in Houston, Texas. We assessed their health and social service needs, as well as related service access experiences, during and after natural disasters using a combined inductive-deductive approach. Participants described a range of service-related needs related to illicit drug use, poverty, neighborhood disadvantage, acute and chronic health problems, and housing insecurity. They endorsed decreased access to medical and substance-related services and difficulty accessing disaster relief aid. Interviews highlighted the importance of mutual aid for sharing harm reduction supplies and meeting practical needs. Results suggest that some PWUD experience disproportionate vulnerability after natural disasters related to multiple marginalized identities that intersect with illicit drug use.

A Scoping Review of Factors Associated with HIV Acquisition in the Context of Humanitarian Crises.

Humanitarian crises-natural or human-made events that can threaten communities' health, safety, security, and well-being-may affect the HIV epidemic dynamics. Common aspects of humanitarian crises such as poverty, powerlessness, disruptions to the health systems, and social instability can contribute to a person's vulnerability to HIV infection through increased risk behaviors and limited access to health services. Guided by the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, we conducted a scoping review of literature published in English between January 1990 and March 2022 to characterize the global evidence of modifiable and non-modifiable factors for HIV acquisition in the context of humanitarian crises. We systematically searched, screened, and synthesized literature from MEDLINE, Embase, Global Health (all accessed via Ovid), and Scopus, and also grey literature through websites of humanitarian agencies and relevant non-government organizations, the International AIDS Society's abstract databases, and Google Scholar. We considered studies presenting empirical data on HIV prevalence, incidence, or risk factors in humanitarian crises-affected populations, including refugees, asylum seekers, and internally displaced persons. Forty-nine studies met the inclusion criteria. The majority of studies were quantitative (n = 43, 87.8%) and cross-sectional (n = 37, 75.5%) in design. Most were single-country studies (n = 43, 87.8%) and conducted in Sub-Saharan Africa (n = 31, 63.3%). We identified 5 non-modifiable factors for HIV acquisition (i.e., age, gender, location, place of birth or origin, and ethnicity) and 60 modifiable factors that we further classified into five categories, namely 18 policy and structural, 9 sociocultural, 11 health and mental health, 16 sexual practice, and 6 humanitarian crisis-related traumatic event factors. Within the modifiable categories, factors that were most often investigated were education level, marital status, sexually transmitted infection diagnosis, condom use, and experience of rape or sexual trauma, respectively. Informed by the findings, we applied the social-ecological model to map the identified multidimensional factors associated with HIV acquisition at the levels of individual, social and sexual networks, community, public policy, and the context of humanitarian crises. The current review provides a comprehensive, global analysis of the available evidence on HIV prevalence, incidence, and risk factors in humanitarian crises and implications for potential programs and research. Future research is warranted to further understand the directionality of the non-modifiable and modifiable factors affecting HIV acquisition, and the multilevel barriers and facilitators to the uptake of HIV prevention strategies in the context of humanitarian crises. Such research can generate actionable evidence to inform the development of ethical, trauma-informed, and culturally appropriate HIV prevention interventions in humanitarian settings.

RESUMEN: Las crisis humanitarias (eventos naturales o provocados por el hombre que pueden amenazar la salud, la seguridad y el bienestar de las comunidades) pueden afectar la dinámica de la epidemia del VIH. Los aspectos comunes de las crisis humanitarias como la pobreza, la impotencia, las perturbaciones de los sistemas de salud y la inestabilidad social pueden contribuir a la vulnerabilidad de una persona a la infección por VIH a través del aumento de comportamientos de riesgo y el acceso limitado a los servicios de salud. Guiados por la metodología del Instituto Joanna Briggs para las revisiones de alcance y la extensión de las directrices para la presentación de elementos de informe preferidos para revisiones sistemáticas y metaanálisis para revisiones de alcance (PRISMA-ScR), llevamos a cabo una revisión de alcance de la literatura publicada en inglés entre enero de 1990 y marzo de 2022 para caracterizar la evidencia global de factores modificables y no modificables para la adquisición del VIH en el contexto de crisis humanitarias. Buscamos, seleccionamos y sintetizamos sistemáticamente literatura de MEDLINE, Embase, Global Health (todas accedidas a través de Ovid) y Scopus y literatura gris a través de sitios web de agencias humanitarias y organizaciones no gubernamentales relevantes, las bases de datos de resúmenes de la Sociedad Internacional del SIDA y Google Académico. Consideramos estudios que presentaban datos empíricos sobre la prevalencia, incidencia o factores de riesgo del VIH en poblaciones afectadas por crisis humanitarias, incluyendo las personas refugiadas, solicitantes de asilo y desplazadas internamente. Cuarenta y nueve estudios cumplieron los criterios de inclusión. La mayoría de los estudios fueron de diseño cuantitativo (n = 43, 87.8%) y transversal (n = 37, 75.5%). La mayoría fueron estudios de un solo país (n = 43, 87.8%) y realizados en África subsahariana (n = 31, 63.3%). Identificamos cinco factores no modificables para la adquisición del VIH (es decir, edad, género, ubicación geográfica, lugar de nacimiento u origen y grupo étnico) y 60 factores modificables que clasificamos en cinco categorías, a saber 18 políticos y estructurales, 9 socioculturales, 11 factores de salud y salud mental, 16 de práctica sexual y 6 de eventos traumáticos relacionados con crisis humanitarias. Dentro de las categorías modificables, los factores que se investigaron con mayor frecuencia fueron el nivel educativo, el estado civil, el diagnóstico de infecciones de transmisión sexual, el uso de condón y la experiencia de violación o trauma sexual, respectivamente. Informados por los hallazgos, aplicamos el modelo socioecológico para asignar los factores multidimensionales asociados con la adquisición del VIH identificados a los niveles individual, de redes sociales y sexuales, comunidad, políticas públicas y contexto de crisis humanitaria. La revisión presente proporciona un análisis integral y global de la evidencia disponible sobre la prevalencia, la incidencia y los factores de riesgo del VIH en crisis humanitarias y sus implicaciones para posibles programas e investigaciones. Se necesitan más investigaciones para comprender mejor la direccionalidad de los factores modificables y no modificables que afectan la adquisición de VIH, y las barreras y facilitadores multinivel para el uso de estrategias para la prevención del VIH en el contexto de las crisis humanitarias. Dicha investigación puede generar evidencia accionable para informar el desarrollo de intervenciones para la prevención del VIH que sean éticas, informadas sobre el trauma, y culturalmente apropiadas en entornos humanitarios.

Modeling interdependence between climatic factors, commodities, and financial markets.

This paper introduces a comprehensive approach to studying the impact of climate-related factors on commodity and financial markets using network analysis. We utilize a Bayesian network Vector Autoregressive model to investigate whether climate risk significantly influ-ences commodity prices and financial market returns. Our findings provide evidence of a climate effect on major commodities and global financial markets. Specifically, we identify Crude oil, Cotton, and Sugar as the commodities most affected by climate risk, with Gold demonstrating the least susceptibility. Additionally, we observe that climate-related risk on commodities is likely propagated by patterns such as PNA, NN1, and AO. In terms of financial markets, we find that stock markets in Hong Kong, India, and Spain are the most susceptible to climate risk, while Switzerland's market appears to be the least affected. Furthermore, we document evidence that climate-related risk capable of altering financial markets is likely propagated by factors like ENP, NN1, and WH. Overall, our study underscores the intricate relationship between climate factors and market dynamics, highlighting the importance of considering climate risk in assessing market behavior and performance.

The efficacy of a cellular approach to resilience-oriented operation of distribution grids based on eigenvectors of the Laplacian matrix.

This study aims to address the following research query: In the event of an imminent disaster poised to impact distribution grids, what constitutes the optimal course of action for the distribution system operators to keep the lights on? To address this challenge, we propose a cost-efficient cellular model for enhancing the resilience of smart distribution grids. This model prioritizes resilience in the face of natural disasters or other disruptions that could impact service delivery. This method benefits both grid operators and consumers by ensuring reliable power supply while minimizing energy costs. Furthermore, the model's scalability allows it to be applied to distribution systems of varying sizes. The proposed method utilizes an innovative approach to form optimal cellular network configurations within the grid. As the first step in the formation of cellular topology for the grid, the eigenvectors of the Laplacian matrix of the grid will be used to decide on the optimal configurations. Subsequently, a bi-level mixed-integer linear programming model is proposed to decrease the network costs while simultaneously consider potential power transfer scenarios between the cells and the upstream network during both normal and emergency conditions. The researchers validated the effectiveness of the proposed method through simulations on an IEEE 33-bus test system. The results demonstrate outstanding performance, with a significant increase in the resilience index (96 %) and a substantial reduction in load-shedding costs (80 %), making the network considerably more robust.

Strengthening Maternal and Infant Health Resilience Before Weather and Climate Disasters: Preparedness Resources from CDC's Division of Reproductive Health.

This report describes opportunities to address emergency preparedness to incorporate the needs of pregnant and postpartum populations. This report briefly summarizes data on the impacts of weather and climate disasters on maternal and infant health and outlines opportunities for individuals, health care providers, and public health practitioners to increase capacity to prepare for these occurrences, which are becoming more frequent and costly. Specific resources from the U.S. Centers for Disease Control and Prevention's Division of Reproductive Health are shared to support individual preparedness, communication of disaster safety messages, and emergency preparedness planning capacity among health care providers and health departments.

Hurricanes and Health: A Scoping Review of Recent Developments in Physical Injuries, Mental Health, and Emergency Interventions.

Hurricanes, as one of the most devastating natural disasters, significantly impact the public's health, causing both physical injuries and long-lasting mental health issues. Although substantial research has focused on hurricane-related injuries, this study aims to synthesize findings from recent literature, specifically evaluating the 10 most recent hurricanes, to identify research gaps and inform future studies. This scoping review, conducted in accordance with PRISMA-Scr guidelines, assessed studies from PubMed, CINAHL, Cochrane databases, and Medline as of February 2024. Eligibility criteria focused on studies examining physical and mental health impacts, COVID-19 effects, and emergency medical services (EMS) interventions related to Hurricanes Ian, Nicholas, Ida, Zeta, Delta, Sally, Laura, Isaias, Hanna, and Dorian. Twenty articles met the inclusion criteria. The studies were categorized into four themes: physical injuries and fatalities, mental health impacts, hurricane-COVID-19 interplay, and EMS interventions. Findings revealed varied mechanisms of injuries and deaths, significant mental health challenges, compounded crises due to COVID-19, and diverse EMS strategies, including AI utilization and strategic planning for medical care delivery. Addressing the social determinants of health and evaluating hurricane readiness initiatives were two gaps in the literature identified. Future research should focus on the mental health impacts and concurrent crisis challenges to develop comprehensive disaster management practices that enhance community resilience against future hurricanes and public health crises.

Resist and recover: Introducing a spring theory for modeling disaster resilience.

This paper presents a new approach for quantitatively modeling the resilience of a system that has been disrupted by a sudden-impact event. It introduces a new theoretical model that explicitly incorporates representations of the enabling and inhibiting forces that are inherent within postdisruption recovery behavior. Based on a new, more comprehensive measure of resilience that is able to capture both negative and positive deviations in performance, a generic mass-spring system is then used to illustrate the applicability of the theoretical model. The interplay between the enabling and inhibiting forces that is revealed by the new model provides a new theoretical basis for understanding the complexity of resilience and disaster recovery. With the addition of the new resilience measure, it lends support for defining and characterizing a new type of resilient behavior: unstable resilience.

Factors related to the disaster preparedness of patients on haemodialysis from Sichuan, China, during COVID-19: A cross-sectional study.

AIM: This study aimed to investigate personal preparedness among patients on haemodialysis (HD) and to examine the relationship among sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours during natural disaster incidents. DESIGN: A cross-sectional survey was conducted. METHODS: A convenience sampling method was used. A total of 446 participants from six areas of Sichuan province completed the online questionnaire study from February 27 to March 13, 2022. Sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours were measured. Descriptive statistics were used to analyse sociodemographic characteristics and attitudes toward disaster preparedness. The relationship among sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours were assessed using ordinal regression. Statistical significance was defined as p < 0.05. RESULTS: A total of 446 participants completed the survey. Of these, 42.15% (N = 188) were poorly prepared, 26.23% (N = 117) were moderately prepared and 31.61% (N = 141) were highly prepared. Ordinal regression showed that knowing about disaster preparedness (Odds Ratio (OR) = 1.691, 95% Confidence Interval (CI) = 1.081-2.644, p = 0.021), participating in disaster evacuation exercises (OR = 2.519, 95% CI = 1.595-3.977, p < 0.001) and learning about disaster preparedness (OR = 2.421, 95% CI = 1.542-3.802, p < 0.001) were associated with high preparedness. Compared to patients with a university degree or higher, patients with a junior high school education or lower (OR = 3.491, 95% CI = 1.760-6.925, p < 0.001) and senior high school degree (OR = 2.052, 95% CI = 1.038-4.057, p = 0.039) were associated with high preparedness. Patients who felt very confident and could deal with all their needs (OR = 3.878, 95% CI = 2.904-7.181, p < 0.001) or patients who felt confident and could meet some of their needs (OR = 1.949, 95% CI = 1.124-3.379, p = 0.017) had higher preparedness than those who felt less confident and were not well prepared to take care of their needs. PATIENT OR PUBLIC CONTRIBUTION: After obtaining each participant's consent, they filled out the online questionnaire using their own or a relative's cell phone while undergoing HD. IMPLICATION FOR PRACTICE: It is essential that patients should be educated not only on medical specialty topics, but also on general disaster preparedness. Medical institutions should improve and reinforce preparation training among targeted populations. The low level of preparedness is partly due to the lack of participation of patients in disaster preparedness programs. Dialysis center managers should be urged to implement such programs at their centers.

Risk and protective factors associated with substance use among Puerto Rican youths after Hurricane María: a cross-sectional study.

BACKGROUND: Identifying factors associated with post-disaster youth substance use is a crucial element of developing evidence-based prevention and intervention efforts. Hurricane María struck Puerto Rico in September of 2017 and the wide-spread impact from this disaster, including exposure to trauma, displacement, and disrupted social supports had the potential to negatively impact levels of substance use among youth across the archipelago. However, post-disaster substance use remains under-investigated in this context. The current study sought to identify risk and protective factors associated with substance use among Puerto Rican youth in the aftermath of Hurricane Maria. METHODS: Cross-sectional, secondary data analyses were conducted using school-based survey data collected at all schools in Puerto Rico between February 1 and June 29, 2018 (5-9 months after Hurricane María). Social supports, substance use, and trauma symptoms were assessed. An ordinal regression analysis was conducted to identify student factors associated with greater likelihood of post-disaster substance use. RESULTS: A total of 36,485 participants (50.7% female, grades 7-12), were included in an ordinal regression analysis that compared the likelihood of respondents endorsing high, low, or no substance use after Hurricane María based on reported adult social support, counselor/teacher social support, peer social support, ptsd symptomatology, and gender. Findings showed that, when compared to students that endorsed low or no substance use, those who reported having adult social support demonstrated a 58% reduction in odds (OR = 0.42, 95% CI: 0.34-0.53) of reporting high substance use after Hurricane María, while students who reported having teacher/counselor social support demonstrated a 21% reduction in odds (OR = 0.79, 95% CI: 0.69-0.89) of reporting high substance use. Additionally, those that reported having peer social support demonstrated a 31% increase in odds (OR = 1.31, 95% CI: 1.10 to 1.58) of reporting higher substance use, compared to those that reported low or no substance use. CONCLUSIONS: While social support was generally protective, prevention efforts to build positive family and community connections may be indicated. Evidence-based school screenings of substance use and trauma may help direct intervention to those most at risk for co-occurring issues.

Implementation of medication for opioid use disorder treatment during a natural disaster: The PROUD-LA study.

BACKGROUND: The impacts of climate change-related extreme weather events (EWEs) on Medication for Opioid Use Disorders (MOUD) implementation for Medicaid beneficiaries are relatively unknown. Such information is critical to disaster planning and other implementation strategies. In this study we examined implementation determinants and strategies for MOUD during EWEs. METHODS: The Louisiana-based Community Resilience Learning Collaborative and Research Network (C-LEARN) utilized Rapid Assessment Procedures-Informed Community Ethnography (RAPICE), involving community leaders in study design, execution, and data analysis. We conducted qualitative semi-structured interviews with 42 individuals, including MOUD Medicaid member patients and their caregivers, healthcare providers and administrators, and public health officials with experience with climate-related disasters. We mapped key themes onto updated Consolidated Framework for Implementation Research domains. RESULTS: MOUD use is limited during EWEs by pharmacy closures, challenges to medication prescription and access across state lines, hospital and clinic service limits, overcrowded emergency departments, and disrupted communications with providers. MOUD demand simultaneously increases due to the stress associated with displacement, resource loss, the COVID-19 pandemic, and social determinants of health. Effective implementation strategies include healthcare system disaster plans with protocols for clear and regular patient-provider communication, community outreach, additional staffing, and virtual delivery of services. Providers can also increase MOUD access by having remote access to EHRs, laptops and contact information, resource lists, collaborative networks, and contact with patients via call centers and social media. Patients can retain access to MOUD via online patient portals, health apps, call centers, and provider calls and texts. The impact of EWEs on MOUD access and use is also influenced by individual characteristics of both patients and providers. CONCLUSIONS: The increasing frequency and severity of climate-related EWEs poses a serious threat to MOUD for Medicaid beneficiaries. MOUD-specific disaster planning and use of telehealth for maintaining contact and providing care are effective strategies for MOUD implementation during EWEs. Potential considerations for policies and practices of Medicaid, providers, and others to benefit members during hurricanes or major community stressors, include changes in Medicaid policies to enable access to MOUD by interstate evacuees, improvement of medication refill flexibilities, and incentivization of telehealth services for more systematic use.

The Perceptions and Experiences of Older People Living in the Aftermath of Lombok Earthquakes, Indonesia: A Qualitative Study.

INTRODUCTION: Despite the growing knowledge of people's vulnerability following natural disasters, the perspective of older people has received limited attention. This study aimed to explore the perceptions and experiences of older people encountering the 2018 Lombok earthquakes. METHODS: This exploratory qualitative study involved 16 older people living in one of the villages most affected by the 2018 earthquakes in Lombok Island, Nusa Tenggara Barat, Indonesia. The data were collected in June 2019 using semi-structured interviews. Participants' responses were digitally recorded and transcribed verbatim for analysis. The data were analysed using qualitative content analysis managed in NVivo. RESULTS: From older people's perspectives, three themes were generated: surviving the disaster, dealing with life changes and navigating through challenges and hope. Each theme comprised two categories, which reflected the journey of older people from the early to the later phase of the disaster. CONCLUSIONS: Older people experienced critical conditions and difficulties both physically and mentally. They also experienced various emotional responses before accepting living situations following a disaster. Nurses should play a role in fulfilling the physical and mental health needs of older people in post-disaster conditions. IMPLICATIONS FOR PRACTICE: This study can inform nurses and other key stakeholders about the needs of older people during and after natural disasters. Nurses need to be equipped with the skills and abilities to identify and meet the needs of older people in difficult situations and with limited resources.

Comprehensive risk assessment for identifying suitable residential zones in Manavgat, Mediterranean Region.

The absence of comprehensive risk analysis in residential development within certain regions often leads to substantial human and material losses during natural disasters. The Mediterranean region, particularly susceptible to the impacts of climate change, is projected to witness an upsurge in the frequency of natural calamities like floods, landslides, and forest fires. Consequently, meticulous risk assessment during the selection of residential areas becomes paramount in this context. This study is dedicated to the evaluation of suitable residential zones in Manavgat, a pivotal location in the Mediterranean region with a progressively growing population. The findings indicate that approximately 4.26 % of the research area is deemed appropriate for residential establishment. The identification of these locations is crucial for ensuring human and material safety, as well as enhancing overall biocomfort. Moreover, this study provides a foundation for long-term planning initiatives within the region and makes a significant contribution to the international evaluation literature by demonstrating the application of integrated risk assessment methodologies in urban planning.

Unveiling the heart of disaster nursing: A qualitative study on motivations, challenges, and lessons from the devastating 2023 Turkey earthquakes.

BACKGROUND: Turkey has faced a notable escalation in earthquake disasters in the last two decades. Despite initiating a health and disaster management system, nurses' pivotal roles and experiences in handling such crises have been disregarded. AIM: This qualitative study analyzed nurses' experiences before, during, and after deployment in response to the 2023 Turkey earthquakes to enhance disaster-response efforts. METHODS: This descriptive qualitative study was conducted between March and May 2023 using semistructured interviews with 15 nurses purposively  sampled among those who volunteered to work in the earthquake zone. The MIRACLE and COREQ guidelines were followed for reporting qualitative research. FINDINGS: The analysis exposed five main themes for pre-tasking: moral obligation, motivation, insufficient experience, balancing responsibilities, and preparation challenges. The peri-task themes include responsibilities, skills, bravery and characteristics, workload management, teamwork, and outcomes. Post-tasking has three themes: competence assessment, career goals and aspirations, and support. Training and coping with anxiety and stress are common themes for all phases. CONCLUSIONS: Disaster relief requires a comprehensive and coordinated response from healthcare organizations, government agencies, and support systems. Providing adequate training, ensuring safety protocols, offering mental health support, and fostering a fair and supportive work environment are crucial steps in mitigating the adverse effects on nurses and, by extension, the patient care process in earthquake-affected areas. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse training in disaster preparedness should cover various response methods and involve multiple disciplines. Managers can help by arranging drills, simulations, online courses, and workshops and promoting partnerships for improved collaboration. Psychological support should be included to address emotional challenges. Regularly updating response policies based on past experiences is crucial for preparedness and efficiency.

Abstruse Side of Climate Change, Impact on Malaria: A Systematic Evidence Review Comparing Iran versus Globally.

Background: Infectious outbreaks due to disrupted social and environmental conditions after climate change-induced events complicate disasters. This research aimed to determine the contentions of bioclimatic variables and extreme events on the prevalence of the most common Climate-Sensitive Infectious Disease (CSID); Malaria in Iran. Methods: The present narrative systematic review study was conducted on the bioclimatic variable impact on the prevalence of malaria, as a common CSID. The search was conducted in 3 sections: global climate change-related studies, disaster related, and studies that were conducted in Iran. The literature search was focused on papers published in English and Persian from Mar 2000 to Dec 2021, using electronic databases; Scopus, Web of Science, PubMed, Google Scholar, SID, Magiran, and IranDoc. Results: Overall, 41 studies met the inclusion criteria. The various types of climatic variables including; Temperature, rainfall, relative humidity, and hydrological events including; flood, drought, and cyclones has been reported as a predictor of malaria. The results of studies, inappropriately and often were inconsistent in both Iran and other parts of the world. Conclusion: Identifying malaria outbreak risks is essential to assess vulnerability, and a starting point to identify where the health system is required to reduce the vulnerability and exposure of the population. The finding of most related studies is not congruent to achieve reliable information, more extensive studies in all climates and regions of the country, by climatic models and high accuracy risk map, using the long period of bioclimatic variables and malaria trend is recommended.