Lessons from Katrina – What Went Wrong, What Was Learned, Who’s Most Vulnerable

If humans did not occupy the planet, disasters would never occur. Massive climatic events, earthquakes, volcanic eruptions, and tsunamis would be regular occurrences, of course, and the earth would look like a dynamic cauldron of natural activity, changing the look and the balance of nature and natural events continuously and randomly. What morphs these natural phenomenon into catastrophic events we call “disasters” is simply the presence of human beings who by choice, chance, or necessity find themselves in harm’s way. The “human factors” may be straightforward and benign. For instance, people making their livelihood from the sea are at risk from coastal storms and tsunamis. Similarly, people are found living in areas at considerable risk for mudslides and volcanoes. It could even be said that living in New Orleans, a coastal city actually below sea level, is a gamble, as was so dramatically emphasized by the storms and subsequent flooding of August and September 2005

Prevalence and Predictors of Mental Health Distress Post-Katrina: Findings From the Gulf Coast Child and Family Health Study

Background: Catastrophic disasters often are associated with massive structural, economic, and population devastation; less understood are the long-term mental health consequences. This study measures the prevalence and predictors of mental health distress and disability of hurricane survivors over an extended period of recovery in a postdisaster setting. Methods: A representative sample of 1077 displaced or greatly affected households was drawn in 2006 using a stratified cluster sampling of federally subsidized emergency housing settings in Louisiana and Mississippi, and of Mississippi census tracts designated as having experienced major damage from Hurricane Katrina in 2005. Two rounds of data collection were conducted: a baseline face-to-face interview at 6 to 12 months post-Katrina, and a telephone follow-up at 20 to 23 months after the disaster. Mental health disability was measured using the Medical Outcome Study Short Form 12, version 2 mental component summary score. Bivariate and multivariate analyses were conducted examining socioeconomic, demographic, situational, and attitudinal factors associated with mental health distress and disability. Results: More than half of the cohort at both baseline and follow-up reported significant mental health distress. Self-reported poor health and safety concerns were persistently associated with poorer mental health. Nearly 2 years after the disaster, the greatest predictors of poor mental health included situational characteristics such as greater numbers of children in a household and attitudinal characteristics such as fatalistic sentiments and poor self-efficacy. Informal social support networks were associated significantly with better mental health status. Housing and economic circumstances were not independently associated with poorer mental health. Conclusions: Mental health distress and disability are pervasive issues among the US Gulf Coast adults and children who experienced long-term displacement or other serious effects as a result of Hurricanes Katrina and Rita. As time progresses postdisaster, social and psychological factors may play greater roles in accelerating or impeding recovery among affected populations. Efforts to expand disaster recovery and preparedness policies to include long-term social re-engagement efforts postdisaster should be considered as a means of reducing mental health sequelae

Prevalence and Predictors of Mental Health Distress Post-Katrina: Findings From the Gulf Coast Child and Family Health Study

Background: Catastrophic disasters often are associated with massive structural, economic, and population devastation; less understood are the long-term mental health consequences. This study measures the prevalence and predictors of mental health distress and disability of hurricane survivors over an extended period of recovery in a postdisaster setting. Methods: A representative sample of 1077 displaced or greatly affected households was drawn in 2006 using a stratified cluster sampling of federally subsidized emergency housing settings in Louisiana and Mississippi, and of Mississippi census tracts designated as having experienced major damage from Hurricane Katrina in 2005. Two rounds of data collection were conducted: a baseline face-to-face interview at 6 to 12 months post-Katrina, and a telephone follow-up at 20 to 23 months after the disaster. Mental health disability was measured using the Medical Outcome Study Short Form 12, version 2 mental component summary score. Bivariate and multivariate analyses were conducted examining socioeconomic, demographic, situational, and attitudinal factors associated with mental health distress and disability. Results: More than half of the cohort at both baseline and follow-up reported significant mental health distress. Self-reported poor health and safety concerns were persistently associated with poorer mental health. Nearly 2 years after the disaster, the greatest predictors of poor mental health included situational characteristics such as greater numbers of children in a household and attitudinal characteristics such as fatalistic sentiments and poor self-efficacy. Informal social support networks were associated significantly with better mental health status. Housing and economic circumstances were not independently associated with poorer mental health. Conclusions: Mental health distress and disability are pervasive issues among the US Gulf Coast adults and children who experienced long-term displacement or other serious effects as a result of Hurricanes Katrina and Rita. As time progresses postdisaster, social and psychological factors may play greater roles in accelerating or impeding recovery among affected populations. Efforts to expand disaster recovery and preparedness policies to include long-term social re-engagement efforts postdisaster should be considered as a means of reducing mental health sequelae

On the Edge: Children and Families Displaced by Hurricanes Katrina and Rita Face a Looming Medical and Mental Health Crisis

The individuals and families who were displaced by Hurricanes Katrina and Rita and who have ended up in FEMA-subsidized community housing in Louisiana are facing a second crisis, one in which untreated and undertreated chronic medical problems and incipient mental health issues will overwhelm patients and providers. Among the displaced, children may be particularly vulnerable. In New Orleans alone, approximately 110,000 children under age eighteen — 85% of the pre-Katrina pediatric population — have not returned to the city since the hurricanes. These children, and others from outside of New Orleans, have been scattered throughout the Gulf Coast and across the fifty states. Louisiana's school enrollment dropped by 70,000 students, many of whom have resettled in other states, some who have not yet returned to school in Louisiana. The Louisiana Child & Family Health Study focused on the displaced population living in FEMA-subsidized housing in Louisiana, and who may be among the most needy. According to interviews with adults in 665 randomly selected households at trailer communities and hotels throughout the state, this displaced group of children and families suffers from a constellation of serious medical and mental health problems. Parents report high rates of asthma, behavioral problems, and learning disabilities among their children. Despite that, access to continuous medical care, appropriate mental health care, medications, specialized medical equipment, and specialty medical care, is either fragmented at best, or absent altogether. The medical and mental health needs documented in this report may be regarded as the consequence of inadequately treated chronic diseases, psychological and emotional traumas secondary to the chaos and despair of a massive dislocation, and the social deprivations of the chronically-poor and the newly-impoverished. At a deeper level, though, the problems relate to the loss of stability in people's lives: families that are increasingly fragile, children who are disengaged from schools, and the wholesale loss of community, workplace, and health care providers and institutions

Mental Health Services in Louisiana School-Based Health Centers Post-Hurricanes Katrina and Rita

Following Hurricanes Katrina and Rita, Louisiana school-based health centers (SBHCs) were called on to respond to a sharp increase in mental health needs, especially for displaced students coping with grief, loss, trauma, and uncertainty. To assess the impact of the hurricanes on the students and the needs of SBHC mental health providers (MHPs), we surveyed MHPs in each of the SBHCs under the auspices of the Louisiana Department of Health and Hospitals, Office of Public Health. SBHC practitioners from around the state reported that mental health service utilization rose during the 2005–2006 school year, but utilization of services increased most significantly in schools receiving the majority of displaced students. Anxiety and adjustment problems were noted as increasing the most following the hurricanes. A multitude of other conditions was also reported. By the time of this survey in April 2006, the reported prevalence of most symptoms had declined, but all remained above their pre-hurricane levels. Selfreported needs of SBHC MHPs are also discussed in light of the major natural disasters

On the Edge: Children and Families Displaced by Hurricanes Katrina andRita Face a Looming Medical and Mental Health Crisis: Executive Summary

The individuals and families who were displaced by Hurricanes Katrina and Rita and who have ended up in FEMA-subsidized community housing in Louisiana are facing a second crisis, one in which untreated and undertreated chronic medical problems and incipient mental health issues will overwhelm patients and providers. Among the displaced, children may be particularly vulnerable. In New Orleans alone, approximately 110,000 children under age eighteen — 85% of the pre-Katrina pediatric population — have not returned to the city since the hurricanes. These children, and others from outside of New Orleans, have been scattered throughout the Gulf Coast and across the fifty states. Louisiana's school enrollment dropped by 70,000 students, many of whom have resettled in other states, some who have not yet returned to school in Louisiana. The Louisiana Child & Family Health Study focused on the displaced population living in FEMA-subsidized housing in Louisiana, and who may be among the most needy. According to interviews with adults in 665 randomly selected households at trailer communities and hotels throughout the state, this displaced group of children and families suffers from a constellation of serious medical and mental health problems. Parents report high rates of asthma, behavioral problems, and learning disabilities among their children. Despite that, access to continuous medical care, appropriate mental health care, medications, specialized medical equipment, and specialty medical care, is either fragmented at best, or absent altogether. The medical and mental health needs documented in this report may be regarded as the consequence of inadequately treated chronic diseases, psychological and emotional traumas secondary to the chaos and despair of a massive dislocation, and the social deprivations of the chronically-poor and the newly-impoverished. At a deeper level, though, the problems relate to the loss of stability in people's lives: families that are increasingly fragile, children who are disengaged from schools, and the wholesale loss of community, workplace, and health care providers and institutions

The Recovery Divide: Poverty and the Widening Gap Among Mississippi Children and Families Affected by Hurricane Katrina

Six months after Hurricane Katrina hit the Gulf Coast, a Columbia-led research team conducted a random household survey of people who had been displaced by the disaster in Louisiana. Mental health disability and psychological strain were rampant, people’s lives were chaotic, and their futures were uncertain. The children who had been displaced were often socially and medically adrift – many of them were disengaged from schools, without medical homes, and living among very fragile families1. One year after the hurricane, we replicated the study among residents of Mississippi’s Gulf Coast who had been heavily impacted or displaced by the hurricane. Based on interviews conducted with randomly sampled residents, it appears that the situation remains dire or is worsening for a number of people. Furthermore, there is evidence of an economic determinism at work, in that those who had been struggling to maintain their financial footing at the time of the hurricane – particularly the working class and the working poor – have been forced back down the socioeconomic ladder towards impoverishment and dependency. The first wave of research on populations affected by Katrina reflected the impact of the initial response – consequences of evacuation, displacement, and massive economic and social loss2. One year out from the hurricane, circumstances are driven by the opportunities for long-term recovery, or by the boundaries of how far people can recover. Recovery has become a test of resilience – who will bounce back, both in terms of people and in terms of geography? The premise of much recovery policy is to invest in geographically-based recovery – the bricks and mortar of critical infrastructure, housing, and markets – with the notion that once a place has recovered, the population’s recovery will follow as well. Findings from the Mississippi Child & Family Health (M-CAFH) study suggest that the population recovery – particularly among the most economically and socially vulnerable – may be lagging significantly behind that of other infrastructure recovery

Linear and Non-linear associations between vitamin D and grip strength: a Mendelian Randomisation study in UK Biobank

BACKGROUND: Low vitamin D status is a widespread phenomenon. Similarly, muscle weakness, often indicated by low grip strength, is another public health concern; however, the vitamin D-grip strength relationship is equivocal. It is important to understand whether variation in vitamin D status causally influences muscle strength to elucidate whether supplementation may help prevent/treat muscle weakness. METHODS: UK Biobank participants, aged 37-73 years, with valid data on Vitamin D status (circulating 25-hydroxyvitamin D (25(OH)D) concentration) and maximum grip strength were included (N=368,890). We examined sex-specific cross-sectional associations between 25(OH)D and grip strength. Using Mendelian randomisation (MR), we estimated the strength of the 25(OH)D-grip strength associations using genetic instruments for 25(OH)D as our exposure. Crucially, because potential effects of vitamin D supplementation on strength could vary by underlying 25(OH)D status, we allowed for non-linear relationships between 25(OH)D and strength in all analyses. RESULTS: Mean(SD) of 25(OH)D was 50(21)nmol/L in males and females. In cross-sectional analyses there was evidence of non-linear associations between 25(OH)D and strength: e.g., compared to males with 50nmol/L circulating 25(OH)D, males with 75nmol/L had 0.36kg (0.31,0.40) stronger grip; males with 25nmol/L had 1.01kg (95% CI: 0.93,1.08) weaker grip. In MR analyses, linear and non-linear models fitted the data similarly well: e.g., 25nmol/L higher circulating 25(OH)D in males was associated with 0.25kg (-0.05,0.55) greater grip (regardless of initial 25(OH)D status). Results were similar, albeit weaker, for females. CONCLUSIONS: Using two different methods to triangulate evidence, our findings suggest moderate to small causal links between circulating 25(OH)D and grip strength

Choice of Moisturiser for Eczema Treatment (COMET):feasibility study of a randomised controlled parallel group trial in children recruited from primary care

OBJECTIVES: To determine the feasibility of a randomised controlled trial of ‘leave on’ emollients for children with eczema. DESIGN: Single-centre, pragmatic, 4-arm, observer-blinded, parallel, randomised feasibility trial. SETTING: General practices in the UK. PARTICIPANTS: Children with eczema aged 1 month to <5 years. OUTCOME MEASURES: Primary outcome—proportion of parents who reported use of the allocated study emollient every day for the duration of follow-up (12 weeks). Other feasibility outcomes—participant recruitment and retention, data collection and completeness and blinding of observers to allocation. INTERVENTIONS: Aveeno lotion, Diprobase cream, Doublebase gel, Hydromol ointment. RESULTS: 197 children were recruited—107 by self-referral (mainly via practice mail-outs) and 90 by inconsultation (clinician consenting and randomising) pathways. Participants recruited inconsultation were younger, had more severe Patient-Oriented Eczema Measure scores and were more likely to withdraw than self-referrals. Parents of 20 (10%) of all the randomised participants reported using the allocated emollient daily for 84 days. The use of other non-study emollients was common. Completeness of data collected by parent-held daily diaries and at monthly study visits was good. Daily diaries were liked (81%) but mainly completed on paper rather than via electronic (‘app’) form. Major costs drivers were general practitioner consultations and eczema-related prescriptions. Observer unblinding was infrequent, and occurred at the baseline or first follow-up visit through accidental disclosure. CONCLUSIONS: It is feasible in a primary care setting to recruit and randomise young children with eczema to emollients, follow them up and collect relevant trial data, while keeping observers blinded to their allocation. However, reported use of emollients (study and others) has design implications for future trials. TRIAL REGISTRATION NUMBER: ISRCTN21828118/EudraCT2013-003001-26