The Impact of Hurricane Maria on Individuals Living with Non-Communicable Disease in Puerto Rico: The experience of 10 communities

Abstract Background Coinciding with the rising non-communicable disease (NCD) prevalence worldwide is the increasing frequency and severity of natural hazards. Protecting populations with NCDs against natural hazards is ever more pressing given their increased risk of morbidity and mortality in disaster contexts. Methods This investigation examined Hurricane Maria’s impact across 10 communities in Puerto Rico to determine whether and how disaster impact and community attributes affected NCD management. We conducted 40 qualitative interviews with mayors, first responders, faith leaders, community leaders, and municipal employees, with 4 interviews per selected municipality. Using QSR NVivo software, we coded interview transcripts and created categorical community-level impact variables based on participant responses. We undertook thematic analysis to characterize community-level impact and consequences for NCD management, and to identify convergent and divergent themes. Using a matrix coding query, we compared NCD management experiences across communities by impact variables and community attributes. Results The delivery of healthcare, pharmacy, and dialysis services was compromised due to facility structural damage and ineffective contingencies for electrical power and water supply. The challenges resulting from power outages were immediate, and individuals who were reliant on life-sustaining medical equipment, dialysis, or the refrigeration of medications were most vulnerable. Inaccessible roadways and the need to travel greater distances to locate operational health services were major impediments to transporting patients in need of NCD care, with those requiring dialysis and living in remote, mountainous communities at highest risk due to landslides and lengthy roadway obstruction. These barriers were compounded by limited communication to locate services and coordinate care. Two weeks post-hurricane, emerging challenges to NCD management included widespread diesel fuel shortages for generators, and shortages in medications, oxygen, and medical supplies. In the weeks to months post-hurricane, the emergence or exacerbation of mental health disorders was characterized as a pressing health concern. Conclusions Study findings identify contributors to morbidity and mortality among individuals with NCDs following Hurricane Maria. The degree to which these impacts were experienced across communities with different characteristics is discussed, offering important lessons regarding the impact of catastrophic disasters on NCD management for improve community disaster resilience.

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Large-scale application of the flood damage model RAilway Infrastructure Loss (RAIL)

Natural Hazards and Earth System Science ◽

10.5194/nhess-16-2357-2016 ◽

2016 ◽

Vol 16 (11) ◽

pp. 2357-2371 ◽

Cited By ~ 11

Author(s):

Patric Kellermann ◽

Christine Schönberger ◽

Annegret H. Thieken

Keyword(s):

Risk Management ◽

Risk Aversion ◽

Flood Risk ◽

Structural Damage ◽

Large Scale ◽

Damage Model ◽

Flood Damage ◽

Railway Infrastructure ◽

Increased Risk ◽

The Impact

Abstract. Experience has shown that river floods can significantly hamper the reliability of railway networks and cause extensive structural damage and disruption. As a result, the national railway operator in Austria had to cope with financial losses of more than EUR 100 million due to flooding in recent years. Comprehensive information on potential flood risk hot spots as well as on expected flood damage in Austria is therefore needed for strategic flood risk management. In view of this, the flood damage model RAIL (RAilway Infrastructure Loss) was applied to estimate (1) the expected structural flood damage and (2) the resulting repair costs of railway infrastructure due to a 30-, 100- and 300-year flood in the Austrian Mur River catchment. The results were then used to calculate the expected annual damage of the railway subnetwork and subsequently analysed in terms of their sensitivity to key model assumptions. Additionally, the impact of risk aversion on the estimates was investigated, and the overall results were briefly discussed against the background of climate change and possibly resulting changes in flood risk. The findings indicate that the RAIL model is capable of supporting decision-making in risk management by providing comprehensive risk information on the catchment level. It is furthermore demonstrated that an increased risk aversion of the railway operator has a marked influence on flood damage estimates for the study area and, hence, should be considered with regard to the development of risk management strategies.

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Is health coaching the next panacea in healthcare reform?

Practice Nursing ◽

10.12968/pnur.2021.32.8.323 ◽

2021 ◽

Vol 32 (8) ◽

pp. 323-326

Author(s):

Catherine Best

Keyword(s):

Chronic Disease ◽

Healthcare Reform ◽

Healthy Lifestyle ◽

Communicable Disease ◽

Essential Element ◽

Health Coaching ◽

Health Conditions ◽

The Impact ◽

Non Communicable Disease

Health coaching aims to empower patients to self-manage their long-term health conditions. Catherine Best explores the effect health coaching can have on patients and the shifts that are required to deliver it Non-communicable diseases now account for the vast majority of deaths globally. It is recognised that personalised care is key to managing non-communicable disease and health coaching is considered an essential element. Health coaching is a developing field of practice that encourages patients to adopt healthy lifestyle behaviours that can avert the impact of chronic disease. This article explores the effect health coaching can have on patients and the shifts that are required to deliver it.

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The Impact of Natural Hazards on Older Adult Health: Lessons Learned From Hurricane Maria in Puerto Rico

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.305 ◽

2021 ◽

pp. 1-8

Author(s):

Elizabeth L. Andrade ◽

Megan Jula ◽

Carlos E. Rodriguez-Diaz ◽

Lauren Lapointe ◽

Mark C. Edberg ◽

...

Keyword(s):

Older Adults ◽

Puerto Rico ◽

Natural Hazards ◽

Older Adult ◽

Natural Hazard ◽

Emotional Health ◽

Well Being ◽

Adult Health ◽

Preparedness Planning ◽

The Impact

Abstract Objective: With natural hazards increasing in frequency and severity and global population aging, preparedness efforts must evolve to address older adults’ risks in disasters. This study elucidates potential contributors to the elevated older adult mortality risk following Hurricane Maria in Puerto Rico through an examination of community stakeholder preparedness, response, and recovery experiences. Methods: In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities. Interview transcripts were deductively and inductively coded and analyzed to identify salient topics and themes representing participant response patterns. Results: The hurricane’s detrimental impact on older adult health emerged as a prominent finding. Through 6 months post-hurricane, many older adults experienced unmet needs that contributed to declining physical and emotional health, inadequate non-communicable disease management, social isolation, financial strain, and excess morbidity and mortality. These needs were predominantly consequences of lengthy public service gaps, unsafe living conditions, interrupted health care, and the incongruence between preparedness and event severity. Conclusions: In a landscape of increasing natural hazard frequency and magnitude, a pattern of older adult risk has become increasingly clear. Study findings compel practitioners to engage in natural hazard preparedness planning, research, and policy-making that considers the multiple facets of older adult well-being.

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Sex differences in the impact of a community-based program for non-communicable disease prevention: The Isfahan Healthy Heart Program (IHHP)

Journal of Public Health ◽

10.1007/s10389-008-0240-7 ◽

2009 ◽

Vol 17 (4) ◽

pp. 257-263

Author(s):

Nizal Sarrafzadegan ◽

Masoumeh Sadeghi ◽

Aliakbar Tavassoli ◽

Masood Mohseni ◽

Hasan Alikhasi ◽

...

Keyword(s):

Sex Differences ◽

Disease Prevention ◽

Communicable Disease ◽

Community Based ◽

The Impact ◽

Non Communicable Disease

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Large-scale application of the flood damage model Railway Infrastructure Loss (RAIL)

10.5194/nhess-2016-259 ◽

2016 ◽

Cited By ~ 1

Author(s):

Patric Kellermann ◽

Christine Schönberger ◽

Annegret H. Thieken

Keyword(s):

Risk Management ◽

Risk Aversion ◽

Flood Risk ◽

Structural Damage ◽

Large Scale ◽

Damage Model ◽

Flood Damage ◽

Railway Infrastructure ◽

Increased Risk ◽

The Impact

Abstract. Experience has shown that river floods can significantly hamper the reliability of railway networks and cause extensive structural damage and disruption. As a result, the national railway operator in Austria had to cope with financial losses of more than one hundred million euros due to flooding in recent years. Comprehensive information on potential flood risk hot spots as well as on expected flood damage in Austria is therefore needed for strategic flood risk management. In view of this, the flood damage model RAIL (RAilway Infrastructure Loss) was applied to estimate 1) the expected structural flood damage, and 2) the resulting repair costs of railway infrastructure due to a 30-year, 100-year and 300-year flood in the Austrian Mur River catchment. The results were then used to calculate the expected annual damage of the railway subnetwork and subsequently analysed in terms of their sensitivity to key model assumptions. Additionally, the impact of risk aversion on the estimates was investigated, and the overall results were briefly discussed against the background of climate change and possibly resulting changes in flood risk. The findings indicate that the RAIL model is capable of supporting decision-making in risk management by providing comprehensive risk information on the catchment level. It is furthermore demonstrated that an increased risk aversion of the railway operator has a marked influence on flood damage estimates for the study area and, hence, should be considered with regard to the development of risk management strategies.

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Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study

Health Policy and Planning ◽

10.1093/heapol/czaa050 ◽

2020 ◽

Vol 35 (8) ◽

pp. 931-940

Author(s):

Éimhín Ansbro ◽

Sylvia Garry ◽

Veena Karir ◽

Amulya Reddy ◽

Kiran Jobanputra ◽

...

Keyword(s):

Low Income ◽

Care Delivery ◽

Communicable Disease ◽

Host Population ◽

Syrian Refugees ◽

Task Sharing ◽

Primary Level ◽

Costing Study ◽

The Impact ◽

Non Communicable Disease

Abstract The Syrian conflict has caused enormous displacement of a population with a high non-communicable disease (NCD) burden into surrounding countries, overwhelming health systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the response. Cost data, which are currently lacking, may support programme adaptation and system scale up of such NCD services. This descriptive costing study from the provider perspective explored financial costs of the MSF NCD programme. We estimated annual total, per patient and per consultation costs for 2015–17 using a combined ingredients-based and step-down allocation approach. Data were collected via programme budgets, facility records, direct observation and informal interviews. Scenario analyses explored the impact of varying procurement processes, consultation frequency and task sharing. Total annual programme cost ranged from 4 to 6 million International Dollars (INT$), increasing annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to 1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209 to 253 (2015–17). Annual cost increases reflected growing patient load and increasing service complexity throughout 2015–17. A scenario importing all medications cut total costs by 31%, while negotiating importation of high-cost items offered 13% savings. Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more sensitive to reducing clinical review frequency than to task sharing review to nurses. Over 1000 extra patients could be enrolled without additional staffing cost if care delivery was restructured. Total costs significantly exceeded costs reported for NCD care in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or restructuring consultation models could confer cost savings or facilitate cohort expansion. Cost effectiveness studies of adapted models are recommended.

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Identifying ‘at risk’ women and the impact of maternal obesity on National Health Service maternity services

Proceedings of The Nutrition Society ◽

10.1017/s0029665111001625 ◽

2011 ◽

Vol 70 (4) ◽

pp. 439-449 ◽

Cited By ~ 19

Author(s):

Nicola Heslehurst

Keyword(s):

Maternal Obesity ◽

Perinatal Care ◽

Epidemiological Data ◽

Health Concern ◽

Individual Choice ◽

National Guidelines ◽

Maternity Services ◽

Published Evidence ◽

Increased Risk ◽

The Impact

Obesity is a public health concern worldwide, arising from multifaceted and complex causes that relate to individual choice and lifestyle, and the influences of wider society. In addition to a long-standing focus on both childhood and adult obesity, there has been more recent concern relating to maternal obesity. This review explores the published evidence relating to maternal obesity incidence and associated inequalities, the impact of obesity on maternity services, and associated guidelines. Epidemiological data comprising three national maternal obesity datasets within the UK have identified a significant increase in maternal obesity in recent years, and reflect broad socio-demographic inequalities particularly deprivation, ethnicity and unemployment. Obese pregnancies present increased risk of complications that require more resource intensive antenatal and perinatal care, such as caesarean deliveries, gestational diabetes, haemorrhage, infections and congenital anomalies. Healthcare professionals also face difficulties when managing the care of women in pregnancy as obesity is an emotive and stigmatising topic. There is a lack of good-quality evidence for effective interventions to tackle maternal obesity. Recently published national guidelines for the clinical management and weight management of maternal obesity offer advice for professionals, but acknowledge the limitations of the evidence base. The consequence of these difficulties is an absence of support services available for women. Further evaluative research is thus required to assess the effectiveness of interventions with women before, during and after pregnancy. Qualitative work with women will also be needed to help inform the development of more sensitive risk communication and women-centred services.

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Nutrient Dense, Low-Cost Foods Can Improve the Affordability and Quality of the New Zealand Diet—A Substitution Modeling Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157950 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7950

Author(s):

Carlene S. Starck ◽

Michelle Blumfield ◽

Tim Keighley ◽

Skye Marshall ◽

Peter Petocz ◽

...

Keyword(s):

New Zealand ◽

Diet Quality ◽

Communicable Disease ◽

Low Cost ◽

Cost Ratio ◽

Processing Level ◽

Nutrient Density ◽

Increased Risk ◽

Adults And Children ◽

The Impact

The high prevalence of non-communicable disease in New Zealand (NZ) is driven in part by unhealthy diet selections, with food costs contributing to an increased risk for vulnerable population groups. This study aimed to: (i) identify the nutrient density-to-cost ratio of NZ foods; (ii) model the impact of substituting foods with a lower nutrient density-to-cost ratio with those with a higher nutrient density-to-cost ratio on diet quality and affordability in representative NZ population samples for low and medium socioeconomic status (SES) households by ethnicity; and (iii) evaluate food processing level. Foods were categorized, coded for processing level and discretionary status, analyzed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods were 56% unprocessed (vegetables, fruit, porridge, pasta, rice, nuts/seeds), 31% ultra-processed (vegetable dishes, fortified bread, breakfast cereals unfortified <15 g sugars/100 g and fortified 15–30 g sugars/100 g), 6% processed (fruit juice), and 6% culinary processed (oils). Using substitution modeling, diet quality improved by 59% and 71% for adults and children, respectively, and affordability increased by 20–24%, depending on ethnicity and SES. The NZ diet can be made healthier and more affordable when nutritious, low-cost foods are selected. Processing levels in the healthier, modeled diet suggest that some non-discretionary ultra-processed foods may provide a valuable source of low-cost nutrition for food insecure populations.

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Estrogen and neuroprotection: from clinical observations to molecular mechanisms

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2002.4.2/ddubal ◽

2002 ◽

Vol 4 (2) ◽

pp. 149-161 ◽

Cited By ~ 3

Keyword(s):

Molecular Mechanisms ◽

Science Studies ◽

Adult Brain ◽

Health Concern ◽

Past Century ◽

Clinical Observations ◽

Protective Actions ◽

Increased Risk ◽

The Impact

We now appreciate that estrogen is a pleiotropic gonadal steroid that exerts profound effects on the plasticity and cell survival of the adult brain. Over the past century, the life span of women has increased, but the age of the menopause remains constant. This means that women may now live over one third of their lives in a hypoestrogenic, postmenopausal state. The impact of prolonged hypoestrogenicity on the brain is now a critical health concern as we realize that these women may suffer an increased risk of cognitive dysfunction and neurodegeneration due to a variety of diseases. Accumulating evidence from both clinical and basic science studies indicates that estrogen exerts critical protective actions against neurodegenerative conditions such as Alzheimer's disease and stroke. Here, we review the discoveries that comprise our current understanding of estrogen action against neurodegeneration. These findings carry far-reaching possibilities for improving the quality of life in our aging population.

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A retrospective observational study of the impact of Tigecycline in treating multidrug resistant pneumonia

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20172541 ◽

2017 ◽

Vol 4 (3) ◽

pp. 122

Author(s):

John Paul ◽

Cherish Paul

Keyword(s):

Critically Ill ◽

Meta Analysis ◽

Multidrug Resistant ◽

Health Concern ◽

P Value ◽

Global Public Health ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

Background: Few antimicrobials are currently active to treat extensively drug resistant (XDR) gram-negative bacilli infections. This represents a serious global public health concern. Critically ill patients face the brunt of majority of these infections. Tigecycline has coverage for a majority of these XDR infections (with the exception of Pseudomonas aeruginosa), but is not currently approved for hospital-acquired pneumonia. Nevertheless it is being commonly used for this indication though many meta-analysis have suggested an increased risk of death in patients receiving this antibiotic. Methods: In this retrospective analysis we compared the mortality rates between a Tigecycline based and a non Tigecycline based therapy for XDR infections in the critically ill over a period of 12 months. A total of 93 patients were included in the study.Results: Tigecycline group had significantly increased risk for in hospital mortality with an odds ratio of 6.0 and 95% CI of 1.37 to 26.12 with a p value of 0.01. But such a difference was not evident in 14 day mortality. Conclusions: Initiation of Tigecycline for multidrug resistant, pneumonia needs to be re-thought. Only a small percentage of patients with pneumonia with in-vitro sensitivity having low minimum inhibitory concentration (MIC) would benefit from the drug. Even in this group the risk of increased mortality needs to be carefully considered before Initiation of therapy.

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