Mapping study for health emergency and disaster risk management competencies and curricula: literature review and cross-sectional survey.

BACKGROUND: With the increasing threat of hazardous events at local, national, and global levels, an effective workforce for health emergency and disaster risk management (Health EDRM) in local, national, and international communities is urgently needed. However, there are no universally accepted competencies and curricula for Health EDRM. This study aimed to identify Health EDRM competencies and curricula worldwide using literature reviews and a cross-sectional survey. METHODS: Literature reviews in English and Japanese languages were performed. We searched MEDLINE, EMBASE, CINAHL (English), and the ICHUSHI (Japanese) databases for journal articles published between 1990 and 2020. Subsequently, a cross-sectional survey was sent to WHO Health EDRM Research Network members and other recommended experts in October 2021 to identify competency models and curricula not specified in the literature search. RESULTS: Nineteen studies from the searches were found to be relevant to Health EDRM competencies and curricula. Most of the competency models and curricula were from the US. The domains included knowledge and skills, emergency response systems (including incident management principles), communications, critical thinking, ethical and legal aspects, and managerial and leadership skills. The cross-sectional survey received 65 responses with an estimated response rate of 25%. Twenty-one competency models and 20 curricula for managers and frontline personnel were analyzed; managers' decision-making and leadership skills were considered essential. CONCLUSION: An increased focus on decision-making and leadership skills should be included in Health EDRM competencies and curricula to strengthen the health workforce.

Lessons learned from practices during the initial response to COVID-19 on the cruise ship Diamond Princess.

The battle against coronavirus disease 2019 (COVID-19) still continues three years after the onset of the pandemic, but there are concerns about the next emerging infectious disease. This study reports the practices during the initial response to COVID-19 on the cruise ship Diamond Princess and lessons learned from a nursing perspective. During these practices, one of the authors dealt with a sample collection team from the Self-Defense Forces and collaborated with the Disaster Medical Assistance Team (DMAT), Disaster Psychiatric Assistance Team (DPAT), and other teams. They mentioned the passengers' state and the distress and fatigue of the personnel assisting them. This revealed the specifics of emerging infectious diseases and their commonalities, regardless of the disaster. Results identified three crucial points: i) predicting the impact of lifestyle changes on health due to isolation and implementing preventive measures, ii) protecting individual human rights and dignity even in health emergencies, and iii) support for personnel providing assistance.

Health Emergency and Disaster Risk Management Workforce Development Strategies: Delphi Consensus Study.

INTRODUCTION: Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM). STUDY OBJECTIVE: The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC). METHODS: A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking. RESULTS: In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were "Human Resources" (n = 15), "Planning and Coordination" (n = 7), and "Community Capacities for Health EDRM" (n = 6) in the LMIC group. "Policies, Strategies, and Legislation" (n = 7) and "Human Resources" (n = 7) were the components with the most recommendations for the HIC group. CONCLUSION: The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.

Long-term participation in community-based group resistance exercises delays the transition from robustness to frailty in older adults: a retrospective cohort study.

BACKGROUND: How community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises. METHODS: We analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0-3, 4-7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: <3 times, short-term participation group; 4-6 times; mid-term participation group; and 7-13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51). RESULTS: The participants' mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (p<0.001) and changed by - 0.93 points for long-term participate group (p<0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (p=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (p<0.001) and mid-term (p=0.002) participation groups. CONCLUSION: Participation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline.

Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults.

BACKGROUND: The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. METHODS: We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test's participate. RESULTS: A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. DISCUSSION: Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. CONCLUSION: Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations.

The Sendai Framework for Disaster Risk Reduction 2015-2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster risk management across prevention, preparedness, readiness, response, and recovery to improve the resilience and health security of communities, countries, and health systems. Evidence-based Health EDRM workforce development is vital. However, there are still significant gaps in the evidence identifying common competencies for training and education programmes, and the clarification of strategies for workforce retention, motivation, deployment, and coordination. Initiated in June 2020, this project includes literature reviews, case studies, and an expert consensus (modified Delphi) study. Literature reviews in English, Japanese, and Chinese aim to identify research gaps and explore core competencies for Health EDRM workforce training. Thirteen Health EDRM related case studies from six WHO regions will illustrate best practices (and pitfalls) and inform the consensus study. Consensus will be sought from global experts in emergency and disaster medicine, nursing, public health and related disciplines. Recommendations for developing effective health workforce strategies for low- and middle-income countries and high-income countries will then be disseminated.

Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study.

BACKGROUND: The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. METHODS: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. RESULTS: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. CONCLUSIONS: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

A Literature Review on Psychosocial Support for Disaster Responders: Qualitative Synthesis with Recommended Actions for Protecting and Promoting the Mental Health of Responders.

Little scientific evidence exists on ways to decrease the psychological stress experienced by disaster responders, or how to maintain and improve their mental health. In an effort to grasp the current state of research, we examined research papers, agency reports, the manuals of aid organisations, and educational materials, in both English and Japanese. Using MEDLINE, Ichushi-Web (Japanese search engine), Google Scholar, websites of the United Nations agencies, and the database of the Grants System for Japan's Ministry of Health, Labour, and Welfare, 71 pertinent materials were identified, 49 of which were analysed. As a result, 55 actions were extracted that could potentially protect and improve the mental health of disaster responders, leading to specific recommendations. These include (1) during the pre-activity phase, enabling responders to anticipate stressful situations at a disaster site and preparing them to monitor their stress level; (2) during the activity phase, engaging in preventive measures against on-site stress; (3) using external professional support when the level of stress is excessive; and (4) after the disaster response, getting back to routines, sharing of experiences, and long-term follow-up. Our results highlighted the need to offer psychological support to disaster responders throughout the various phases of their duties.

Psychosocial Management Before, During, and After Emergencies and Disasters-Results from the Kobe Expert Meeting.

Emergencies and disasters typically affect entire communities, cause substantial losses and disruption, and result in a significant and persistent mental health burden. There is currently a paucity of evidence on safe and effective individual- and community-level strategies for improving mental health before, during, and after such events. In October 2018, the World Health Organization (WHO) Centre for Health Development (WHO Kobe Centre) convened a meeting bringing together leading Asia Pacific and international disaster research experts. The expert meeting identified key research needs in five major areas, one being "Psychosocial management before, during, and after emergencies and disasters". Experts for this research area identified critical gaps in observational research (i.e., the monitoring of long-term psychological consequences) and interventional research (i.e., the development and evaluation of individual- and community-level interventions). Three key research issues were identified. First, experts underscored the need for a standardized and psychometrically robust instrument that classified the mental health/psychosocial risk of people within both a clinical and community setting. Then, the need for a standardization of methods for prevention, screening, diagnosis, and treatment for affected people was highlighted. Finally, experts called for a better identification of before, during, and after emergency or disaster assets associated with greater community resilience.