Global & Disaster Medicine

Archive for the ‘Documents’ Category

Rift Valley Fever: It’s even more dangerous to fetuses than Zika.

NYT

“…….Testing on human placental tissue revealed that, unlike the Zika virus, Rift Valley fever virus has a unique ability to infect a specialized layer of cells that supports the region of the placenta where nutrients flow in.

Zika must take the “side roads” into the placenta to infect a fetus, while the Rift Valley fever virus can take the “expressway,” Dr. Hartman said.

“The fetus is protected from hundreds of thousands of dangers that could affect it,” she added. “Only a few microbes can get past, and this is one of them.”…….”

Rift Valley Fever Distribution MapRift Valley Fever Distribution Map

Rift Valley Fever:  Document

Rift Valley fever virus induces fetal demise in Sprague-Dawley rats through direct placental infection

WHO: Psychological first aid: Guide for field workers

WHO

Overview

This guide (2011) covers psychological first aid which involves humane, supportive and practical help to fellow human beings suffering serious crisis events. It is written for people in a position to help others who have experienced an extremely distressing event. It gives a framework for supporting people in ways that respect their dignity, culture and abilities.

Endorsed by many international agencies, the guide reflects the emerging science and international consensus on how to support people in the immediate aftermath of extremely stressful events.

 


Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies.

World Health Organization and United Nations High Commissioner for Refugees. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Geneva: WHO, 2015.

The target group for WHO work on mental health and psychosocial support in emergencies is any population exposed to extreme stressors, such as refugees, internally displaced persons, disaster survivors and terrorism-, war- or genocide-exposed populations.

The WHO Department of Mental Health and Substance Abuse emphasizes that the number of persons exposed to extreme stressors is large and that exposure to extreme stressors is a risk factor for mental health and social problems. The Department’s work on mental health in emergencies focuses mostly on resource-poor countries, where most populations exposed to natural disasters and war live.

 

Management of physical health conditions in adults with severe mental disorders

Preventable physical health conditions lead to premature mortality in people with severe mental disorders, reducing their life span by 10-20 years. The majority of these premature deaths are due to physical health conditions.

The physical health of people with severe mental disorders is commonly overlooked, not only by themselves and people around them, but also by health systems, resulting in crucial physical health disparities and limited access to health services. Many lives can be saved by ensuring that people with severe mental disorders receive treatment.

WHO’s “Guidelines on management of physical health conditions in adults with severe mental disorders” provide evidence-based, up-to-date recommendations to practitioners on how to recognize and manage comorbid physical and mental health conditions.

 


WHO: Mental Health of Refugees and Migrants

WHO

Being a refugee or a migrant does not, in itself, make individuals significantly more vulnerable to mental disorders, but refugees and migrants can be exposed to various stress factors that influence their mental well-being.

Refugees and migrants have often faced war, persecution and hardship in their country of origin. Many will have experienced displacement and difficulties in transit countries and embarked on dangerous travels. Lack of information, uncertainty about immigration status, potential hostility, changing policies, and undignified and protracted detention all contribute to additional stress.

Furthermore, forced migration requires multiple adaptations in short periods of time, making them more vulnerable to abuse and neglect. Pre-existing social and mental health problems can thus be exacerbated.

Clinical Management of Mental, Neurological and Substance Use Conditions in Humanitarian Emergencies


WHO: Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration

WHO

Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration

Document

To achieve the vision of the 2030 Sustainable Development Goals – to leave no one behind – it is imperative that the health rights and needs of migrants be adequately addressed in the Global Compact for Safe, Orderly and Regular Migration (GCM). Despite health being a prerequisite for sustainable development, health is missing from the six thematic sessions of the modalities for development of the GCM, as well as from the 24 elements contained in Annex II of the New York Declaration for Refugees and Migrants. To address this, in its 140th session in January 2017, the WHO Executive Board requested that its Secretariat develop a framework of priorities and guiding principles to promote the health of refugees and migrants.

In May 2017, the World Health Assembly endorsed resolution 70.15 on ‘Promoting the health of refugees and migrants’. The resolution encourages Member States to use the Framework of priorities and guiding principles to promote the health of refugees and migrants at all levels and to ensure that health is adequately addressed both in the Global Compact for Refugees (GCR) and the GCM.

Based on the Framework, to further provide health resources for the development of the draft GCM, WHO in close cooperation with IOM, ILO, OHCHR, UNAIDS, and other stakeholders, developed the Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration. The document proposes eight actionable commitments and the means of implementation.


WHO: Addressing the health needs of refugees and migrants by 2030

WHO

Reports on situation analysis and practices in addressing the health needs of refugees and migrants

To achieve the vision of the 2030 Agenda and the Sustainable Development Goals, to leave no one behind, it is imperative that the health needs of refugees and migrants be adequately addressed. In its 140th session in January 2017, the Executive Board requested that its Secretariat develop a framework of priorities and guiding principles to promote the health of refugees and migrants. In May 2017, the World Health Assembly endorsed resolution 70.15 on Promoting the health of refugees and migrants. This resolution urges Member States to strengthen international cooperation regarding the health of refugees and migrants in line with the New York Declaration for Refugees and Migrants. It urged Member States to consider providing the necessary health-related assistance through bilateral and international cooperation to those countries hosting and receiving large populations of refugees and migrants, as well as using the Framework of priorities and guiding principles at all levels. In addition, the resolution requested the Director-General to conduct a situation analysis and identify best practices, experiences and lessons learned in order to contribute to the development of a global action plan for the Seventy-second World Health Assembly in 2019.

In alignment with World Health Assembly resolution 70.15, WHO made an online global call from August 2017 to January 2018 for contributions on evidence-based information, best practices, experiences and lessons learned in addressing the health needs of refugees and migrants. Between August 2017 and January 2018, 199 submissions were received, covering 85 countries, from 52 Member States and partners such as the Office of the United Nations High Commissioner for Refugees (UNHCR), the International Organization for Migration (IOM) and the International Labour Organization (ILO). The submissions included valuable information on the current situation of refugees and migrants, health challenges associated with migration and forced displacement, past and ongoing practices and interventions in promoting the health of refugees and migrants, legal frameworks in place for addressing the health needs of this population, lessons learned and recommendations for the future.

Reports

Practices


Trends in the Draw of Americans to Foreign Terrorist Organizations from 9/11 to Today

RAND

Williams, Heather J., Nathan Chandler, and Eric Robinson, Trends in the Draw of Americans to Foreign Terrorist Organizations from 9/11 to Today. Santa Monica, CA: RAND Corporation, 2018. https://www.rand.org/pubs/research_reports/RR2545.html. Also available in print form.

“……..Key Findings

Terrorist Recruits in the Present Day

  • The historic stereotype of a Muslim, Arab, immigrant male as the most vulnerable to extremism is not representative of many terrorist recruits today.
  • Recruits are more likely to be Caucasian/white or African American/black, and to have been born in the United States.
  • Recruits are more likely to be younger and less educated.
  • Recruits are more likely to have converted to Islam as part of their radicalization process.
  • Although they are still primarily male, recruits are increasingly likely to be female.
  • Perhaps most important, recruits are at present more likely to be drawn to or influenced by ISIL rather than al Qaeda or its affiliates during their process of radicalization and journey to terrorism.

Recommendations

  • A more thorough inquiry into this topic would benefit from the cooperation of law enforcement, and particularly the Federal Bureau of Investigation (FBI), which may be aware of additional cases that should be included and may have additional information regarding recruits’ conversion to Islam, educational background, and past criminal history. A research project done in collaboration with law enforcement could also gauge whether some of the increases or decreases in arrests could reflect a change in the posture or priorities of law enforcement.
  • A more precise inquiry into how FTOs inspire terrorist actions would also consider the date when an individual began radicalizing, or at least when a law enforcement investigation was opened; ideally, it would probe the sequencing of the radicalization process of individuals in fine biographical detail. Incorporating these dates and data points would better reflect events that inspired an individual to conduct a terrorist act.
  • Research efforts should consider whether to include the entire population of domestic terrorists inside the United States (e.g., individuals connected to white supremacists, sovereign citizens, militant environmentalists, revolutionary organizations, etc.). Doing so would require careful attention to definitions and coding criteria, as there is no universally set definition of terrorism.
  • Focusing more on the motivation of actors — and resisting the temptation to label an attack as terrorism simply because the individual involved may have been Muslim or had a Middle Eastern background — could help us better understand, and therefore combat, the threat of terrorism in the United States……..”

Marjory Stoneman Douglas High School: A state commission pointed to a range of failures on the part of school and law enforcement officials in the response to the shooting.

Draft Document:   

Marjory Stoneman Douglas High School

NYT

“……A total of 17 students and staff members lost their lives in an attack that spanned a full six minutes; 17 others were injured.….”

 


Portugal: First Case of Tularemia

Frontiers in PH

Case Report

Front. Public Health, 19 November 2018 |
First Case of Tularemia Reported in Portugal: Probably of Imported Origin
Isabel Lopes de Carvalho, Paula Nascimento, Maria Sofia Núncioand Miguel Toscano Rico

“……A previously healthy 47-years-old male developed abruptly malaise, high fever (40°C) and chills only 3 days after walking and sleeping in the countryside of the island of Bornholm (Denmark) during summer season. He also reported profuse night sweats, a small left infraclavicular non-painful cutaneous lesion. The patient did not report outdoor activities in the month before and did not recall any tick bite. Three days later the fever vanished and he was first observed in a hospital in Berlin. He was prescribed with amoxicillin/clavulanate 875mg/125mg twice-a-day for 7 days.

On the 15th day of disease, he was observed in Portugal because of ongoing malaise. During the observation he did not complain of respiratory symptoms nor headache.

He presented a non-pruritic macular erythematous rash of the trunk, a non-painful left infraclavicular cutaneous lesion covered with a black crust suggestive of a skin eschar and multiple small painless, non-adherent cervical, and axillar lymphadenopathies……”


Interim Updated Planning Guidance on Allocating and Targeting Pandemic Influenza Vaccine during an Influenza Pandemic

CDC

“Effective allocation and administration of pandemic influenza vaccine will play a critical role in preventing influenza and reducing its effects on health and society during a future pandemic. Although the timing and severity of a future pandemic and characteristics of the next pandemic influenza virus strain are not known, it is important to plan and prepare. The overarching aim of the national pandemic influenza vaccination program is to vaccinate all persons in the United States (U.S.) who choose to be vaccinated, prior to the peak of disease. The U.S. government’s  goal is to have sufficient pandemic influenza vaccine available for an effective domestic response within four months of a pandemic declaration. Additionally, plans are to have first doses available within 12 weeks of the President or the Secretary of Health and Human Services declaring a pandemic 1. To meet these timelines, the U.S. government is investing significant resources to create and evaluate new vaccine development approaches and production technologies. Pre-pandemic influenza vaccine stockpiles of bulk vaccine against viruses with pandemic potential are also being established and maintained.

Despite these investments, there are other issues to consider. Stockpiled pandemic vaccine availability will depend on the degree to which they match the circulating pandemic strain and other properties, and manufacturing capacity.  In a pandemic, a novel virus has not circulated in humans, and it is assumed that the majority of the population may not have immunity to the virus, causing more people to become ill. Rates of severe illness, complications, and death may be much higher than seasonal flu and more widely distributed. The greater frequency and severity of disease will increase the burden on the health care system, the risk of ongoing transmission in the community, and may increase rates of absenteeism and disruptions in the availability of critical products and services in health care and other sectors. Similarly, homeland and national security and critical infrastructure (e.g., transportation and power supply) could be threatened if illness among critical personnel reduces their capabilities.

Given that influenza vaccine supply will increase incrementally as vaccine is produced during a pandemic, targeting decisions may have to be made. Such decisions should be based on vaccine supply, pandemic severity and impact, potential for disruption of community critical infrastructure, operational considerations, and publicly articulated pandemic vaccination program objectives and principles. The overarching objectives guiding vaccine allocation and use during a pandemic are to reduce the impact of the pandemic on health and minimize disruption to society and the economy. Specifically, the targeting strategy aims to protect those who will: maintain homeland and national security, are essential to the pandemic response and provide care for persons who are ill, maintain essential community services, be at greater risk of infection due to their job, and those who are most medically vulnerable to severe illness such as young children and pregnant women.

Recognizing that demand may exceed supply at the onset of a pandemic, federal, state, tribal, and local governments, communities, and the private sector have asked for updated planning guidance on who should receive vaccination early in a pandemic.  This document uses pandemic severity categories based on the current CDC Pandemic Severity Assessment Framework1.  Several new elements have been incorporated into the 2018 guidelines to update and provide interim guidance for planning purposes, and to provide the rationale for a new vaccination program during a pandemic allowing for local adjustment where appropriate.  These guidelines replace the 2008 Guidance on Allocating and Targeting Pandemic Influenza Vaccine.”


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