Responding to Catastrophes: A Public Health Perspective

From a public health perspective, it is difficult to define exactly what a catastrophe is. Catastrophes can be of sudden onset or they can develop slowly; they can be the result of natural causes, such as hurricanes, droughts, or earthquakes, or they can be man-made, a consequence of war or of terrorist acts. Some would say that the distinction between these is not totally clear-even in earthquakes, for example, mortality rates are predictably higher among the poor, those who live in housing that does not conform to local construction standards. The Indian Ocean tsunami of December 2004 did not spare anyone on the basis of socioeconomic status, but those with means were able to rebuild, rehabilitate, and reconstruct their lives much more rapidly and more completely than those who had only minimal assets. Finally, the plight of the poor left behind in the wake of Hurricane Katrina, one of the world\u27s most recent major catastrophes, was visible on televisions around the world. The blurriness of the lines between these categories, acute versus slow onset and natural versus man-made disaster, has led some to coin the term complex emergency. The global response to complex emergencies has become a subject of relatively recent study and many of its medical, engineering, and even legal ramifications are still being refined. Unfortunately, there is no universally accepted definition of exactly what constitutes a complex emergency. One common description, initially promulgated by the Centers for Disease Control and Prevention, the lead public health agency of the United States government, contends that complex emergencies are situations affecting large civilian populations that usually involve a combination of factors including war or civil strife, food shortages, and population displacement, resulting in significant excess mortality. This definition is obviously imprecise, but it is clear that events such as the outpouring of hundreds of thousands of Hutus into neighboring Tanzania and Zaire (now the Democratic Republic of Congo) in the wake of the 1994 genocide in Rwanda generally fit the definition. The displacement of villagers in the Darfur region of Sudan, fleeing both to more southern parts of that country and over the border to Chad, is another clear-cut example of a complex emergency. [CONT

A survey of physician receptivity to molecular diagnostic testing and readiness to act on results for early-stage colon cancer patients.

BACKGROUND: We sought to assess physician interest in molecular prognosic testing for patients with early stage colon cancer, and identify factors associated with the likelihood of test adoption. METHODS: We identified physicians who care for patients with early-stage (pN0) colon cancer patients, mailed them a survey, and analyzed survey responses to assess clinician receptivity to the use of a new molecular test (GUCY2C) that identifies patients at risk for recurrence, and clinician readiness to act on abnormal test results. RESULTS: Of 104 eligible potential respondents, 41 completed and returned the survey. Among responding physicians, 56 % were receptive to using the new prognostic test. Multivariable analyses showed that physicians in academic medical centers were significantly more receptive to molecular test use than those in non-academic settings. Forty-one percent of respondents were ready to act on abnormal molecular test results. Physicians who viewed current staging methods as inaccurate and were confident in their capacity to incorporate molecular testing in practice were more likely to say they would act on abnormal test results. CONCLUSIONS: Physician receptivity to molecular diagnostic testing for early-stage colon cancer patients is likely to be influenced by practice setting and perceptions related to delivering quality care to patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01972737

Impact of Type Ia Supernova Ejecta on a Helium-star Binary Companion

The impact of Type Ia supernova ejecta on a helium-star companion is investigated via high-resolution, two-dimensional hydrodynamic simulations. For a range of helium-star models and initial binary separations it is found that the mass unbound in the interaction, $\delta M_{\rm ub}$, is related to the initial binary separation, $a$, by a power law of the form $\delta M_{\rm ub} \propto a^{m}$. This power-law index is found to vary from -3.1 to -4.0, depending on the mass of the helium star. The small range of this index brackets values found previously for hydrogen-rich companions, suggesting that the dependence of the unbound mass on orbital separation is not strongly sensitive to the nature of the binary companion. The kick velocity is also related to the initial binary separation by a power law with an index in a range from -2.7 to -3.3, but the power-law index differs from those found in previous studies for hydrogen-rich companions. The space motion of the companion after the supernova is dominated by its orbital velocity in the pre-supernova binary system. The level of Ni/Fe contamination of the companion resulting from the passage of the supernova ejecta is difficult to estimate, but an upper limit on the mass of bound nickel is found to be $\sim 5\times 10^{-4}\ M_\odot$.Comment: Accepted in ApJ, 9 pages, 9 figure

COVID-19 control in low-income settings and displaced populations: what can realistically be done?

COVID-19 prevention strategies in resource limited settings, modelled on the earlier response in high income countries, have thus far focused on draconian containment strategies, which impose movement restrictions on a wide scale. These restrictions are unlikely to prevent cases from surging well beyond existing hospitalisation capacity; not withstanding their likely severe social and economic costs in the long term. We suggest that in low-income countries, time limited movement restrictions should be considered primarily as an opportunity to develop sustainable and resource appropriate mitigation strategies. These mitigation strategies, if focused on reducing COVID-19 transmission through a triad of prevention activities, have the potential to mitigate bed demand and mortality by a considerable extent. This triade is based on a combination of high-uptake of community led shielding of high-risk individuals, self-isolation of mild to moderately symptomatic cases, and moderate physical distancing in the community. We outline a set of principles for communities to consider how to support the protection of the most vulnerable, by shielding them from infection within and outside their homes. We further suggest three potential shielding options, with their likely applicability to different settings, for communities to consider and that would enable them to provide access to transmission-shielded arrangements for the highest risk community members. Importantly, any shielding strategy would need to be predicated on sound, locally informed behavioural science and monitored for effectiveness and evaluating its potential under realistic modelling assumptions. Perhaps, most importantly, it is essential that these strategies not be perceived as oppressive measures and be community led in their design and implementation. This is in order that they can be sustained for an extended period of time, until COVID-19 can be controlled or vaccine and treatment options become available

Ariel - Volume 8 Number 2

Executive Editor James W. Lockard , Jr. Issue Editor Doug Hiller Business Manager Neeraj K. Kanwal University News Richard J. Perry World News Doug Hiller Opinions Elizabeth A. McGuire Features Patrick P. Sokas Sports Desk Shahab S. Minassian Managing Editor Edward H. Jasper Managing Associate Brenda Peterson Photography Editor Robert D. Lehman, Jr. Graphics Christine M. Kuhnl

Gender, Social Support, and Posttraumatic Stress in Postwar Kosovo

The effects of social support and traumatic experiences on mental health in conflict situations may be different by gender. The Kosovo Emergency Department Study was conducted in July and August 2001 to assess mental health 2 years after the end of the war in Kosovo. Of 306 emergency department patients (87.7% response rate), all were ethnic Albanian, 97.4% had experienced traumatic events, and 89.5% had posttraumatic stress symptoms. Women and persons who experienced more traumatic events had higher posttraumatic stress scores. Persons with social support had lower posttraumatic stress scores. In a final model, social support had a greater protective effect for women, whereas traumatic events had a greater detrimental effect on men. Two years after the war in Kosovo, there remained a high prevalence of posttraumatic stress symptoms, particularly among women with low social support. Interventions targeting social support may be important public health efforts in the postwar context.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40288/2/Ahern_Gender, Social Support, and Posttraumatic Stress_2004.pd

Mental Health Status Among Ethnic Albanians Seeking Medical Care in an Emergency Department Two Years After the War in Kosovo: A Pilot Project

Study objective: The long-term psychological effects of war are underappreciated in clinical settings. Describing the postwar psychosocial burden on medical care can help direct public health interventions. We performed an emergency department (ED)–based assessment of the mental health status of ethnic Albanian patients 2 years after the North Atlantic Treaty Organization–led bombing of Serbia and Kosovo in 1999. Methods: This study was conducted July 30, 2001, to August 30, 2001, in the ED of a hospital in Pristina, Kosovo. Investigators collected data through systematic sampling of every sixth nonacute ED patient presenting for care; 87.7% of patients agreed to participate. Respondents completed a structured questionnaire, including demographic characteristics, the Short Form-36, and the Harvard Trauma Questionnaire. Results: All 306 respondents were ethnic Albanians; mean age was 39 years (SD 17.9 years). Of respondents, 58% had become refugees during the war. Two hundred ninety-six (97%) reported experiencing at least one traumatic event during the war; the average number of traumatic events encountered by participants was 6.6. Fortythree (14%) reported symptoms that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for posttraumatic stress disorder; mean Short Form- 36 Mental Component Summary score was 42.1 (SD 12.5). Separate multivariable linear regression models confirmed our belief that older age, female sex, less than a high school education, and having experienced a greater number of traumatic events would be associated with more posttraumatic stress disorder symptoms and lower Mental Component Summary scores. Conclusion: Mental health problems among ED patients in Kosovo, particularly among specific vulnerable populations, are a significant public health concern 2 years after the conflict.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40378/2/Fernandez_Mental Health Status Among Ethnic Albanians_2004.pd

Investigating the delivery of health and nutrition interventions for women and children in conflict settings: a collection of case studies from the BRANCH Consortium.

Globally, the number of people affected by conflict is the highest in history, and continues to steadily increase. There is currently a pressing need to better understand how to deliver critical health interventions to women and children affected by conflict. The compendium of articles presented in this Conflict and Health Collection brings together a range of case studies recently undertaken by the BRANCH Consortium (Bridging Research & Action in Conflict Settings for the Health of Women and Children). These case studies describe how humanitarian actors navigate and negotiate the multiple obstacles and forces that challenge the delivery of health and nutrition interventions for women, children and adolescents in conflict-affected settings, and to ultimately provide some insight into how service delivery can be improved