How do you solve a problem like Maria? The politics of disaster response in Puerto Rico, Florida and Texas.
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ABSTRACT:
SUBMITTER: Willison CE
PROVIDER: S-EPMC9545961 | biostudies-literature | 2022 Sep
REPOSITORIES: biostudies-literature
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How do you solve a problem like Maria? The politics of disaster response in Puerto Rico, Florida and Texas.
Willison Charley E CE Singer Phillip M PM Creary Melissa S MS Vaziri Soha S Stott Jerry J Greer Scott L SL
World medical & health policy 20211017 3
COVID-19 is not the first, nor the last, public health challenge the US political system has faced. Understanding drivers of governmental responses to public health emergencies is important for policy decision-making, planning, health and social outcomes, and advocacy. We use federal political disaster-aid debates to examine political factors related to variations in outcomes for Puerto Rico, Texas, and Florida after the 2017 hurricane season. Despite the comparable need and unprecedented mortal ...[more]
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Project description:BACKGROUND:Hurricanes are among the most devastating natural disasters, playing a significant role in public health. Currently, the epidemiology of fall-related injuries after the occurrence of a tropical storm is not well described. This study aims to compare the demographical patterns, clinical profile, hospital course, and costs of patients admitted to the Puerto Rico Trauma Hospital before and after Hurricane Maria. METHODS:A retrospective study was performed to compare fall-related injuries after the hurricane (September 20, 2017 - January 20, 2018) with a control period (same period in 2014-2016). Comparison between the groups was done using chi-square, Mann-Whitney test, and logistical regression. RESULTS:After the hurricane, there was an increase in the proportion of fall-related admissions in subjects aged 40-64?years (39.2% vs. 50.6%) and a decrease among those aged 18-39?years (16.0% vs. 5.9%), when compared with the previous years. A greater proportion of patients presented with work related injuries (3.9% vs. 9.4%). No significant differences were identified for sex, Glasgow Coma Scale, Injury Severity Score, and hospital outcomes (hospital and intensive care unit days, mechanical ventilation, and mortality). Intracranial injuries were marginally higher post-Maria (p?=?0.06). In multivariate analysis, during the post-Maria period, an increased risk of fall-related injuries was observed among subjects ?40?years (OR: 3.20) and injuries related to recovery work (OR: 2.64) (p?<?0.05). CONCLUSIONS:Our study shows that there is an increased risk of fall-related injuries among middle-aged individuals after a hurricane, causing significant changes in epidemiology. This study helps to elucidate the health consequences of falls and, in doing so, improves healthcare preparedness, interventions, and planning for future natural disasters.
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Project description:Population displacement may occur after natural disasters, permanently altering the demographic composition of the affected regions. Measuring this displacement is vital for both optimal postdisaster resource allocation and calculation of measures of public health interest such as mortality estimates. Here, we analyzed data generated by mobile phones and social media to estimate the weekly island-wide population at risk and within-island geographic heterogeneity of migration in Puerto Rico after Hurricane Maria. We compared these two data sources with population estimates derived from air travel records and census data. We observed a loss of population across all data sources throughout the study period; however, the magnitude and dynamics differ by the data source. Census data predict a population loss of just over 129,000 from July 2017 to July 2018, a 4% decrease; air travel data predict a population loss of 168,295 for the same period, a 5% decrease; mobile phone-based estimates predict a loss of 235,375 from July 2017 to May 2018, an 8% decrease; and social media-based estimates predict a loss of 476,779 from August 2017 to August 2018, a 17% decrease. On average, municipalities with a smaller population size lost a bigger proportion of their population. Moreover, we infer that these municipalities experienced greater infrastructure damage as measured by the proportion of unknown locations stemming from these regions. Finally, our analysis measures a general shift of population from rural to urban centers within the island. Passively collected data provide a promising supplement to current at-risk population estimation procedures; however, each data source has its own biases and limitations.
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Project description:ObjectivesOnly few studies evaluated whether hurricane preparedness impacts health. The PREPARE study addresses this gap.MethodsWe recruited participants who had pertinent pre-hurricane data from the San Juan Overweight Adults Longitudinal Study (SOALS: n=364) and 125 patients with diabetes from Federally Qualified Health Center (COSSMA) in Puerto Rico. Participants aged 42-75 years completed interviews 20-34 months after Hurricanes Irma and Maria. We evaluated associations between self-reported hurricane preparedness and health and other related associations using logistic regression controlling for age, location, education and interview date.ResultsOnly 41% of participants reported high pre-hurricane preparedness; 25% reported gaps (moderate/low availability) in information and 48% reported gaps in resources for hurricane preparedness. Participants reporting lower pre-hurricane preparedness had higher reported hurricane-related detrimental health impact (OR=1.96; 95% CI: 1.31, 2.95) and higher odds (OR=2.07; 95% CI: 0.92, 4.68) of developing new non-communicable disease (NCD) compared to others. Post-hurricane drinking water disruption for ≥ 3 months versus none or less (OR=2.76; 95% CI: 1.39, 5.47) and similarly diet changes due to cooking/refrigeration access (OR=1.96; 95% CI: 1.24, 3.07), and diet changes for ≥ 20 months due to finances/access to shops (OR=2.83; 95% CI: 1.85, 4.32) were also associated with detrimental health impact.ConclusionLower preparedness was associated with higher detrimental impact of the hurricanes on overall health, and marginally significant impact on NCD. Future preparedness efforts could especially target means of coping with disruption of water services and regular diet, as these were also associated with detrimental health impact.
| S-EPMC8754401 | biostudies-literature
Project description:A real-time understanding of the distribution and duration of power outages after a major disaster is a precursor to minimizing their harmful consequences. Here, we develop an approach for using daily satellite nighttime lights data to create spatially disaggregated power outage estimates, tracking electricity restoration efforts after disasters strike. In contrast to existing utility data, these estimates are independent, open, and publicly-available, consistently measured across regions that may be serviced by several different power companies, and inclusive of distributed power supply (off-grid systems). We apply the methodology in Puerto Rico following Hurricane Maria, which caused the longest blackout in US history. Within all of the island's settlements, we track outages and recovery times, and link these measures to census-based demographic characteristics of residents. Our results show an 80% decrease in lights, in total, immediately after Hurricane Maria. During the recovery, a disproportionate share of long-duration power failures (> 120 days) occurred in rural municipalities (41% of rural municipalities vs. 29% of urban municipalities), and in the northern and eastern districts. Unexpectedly, we also identify large disparities in electricity recovery between neighborhoods within the same urban area, based primarily on the density of housing. For many urban areas, poor residents, the most vulnerable to increased mortality and morbidity risks from power losses, shouldered the longest outages because they lived in less dense, detached housing where electricity restoration lagged. The approach developed in this study demonstrates the potential of satellite-based estimates of power recovery to improve the real-time monitoring of disaster impacts, globally, at a spatial resolution that is actionable for the disaster response community.
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Project description:ImportanceAs public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico.ObjectiveTo estimate the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria in 2017.Design, setting, and participantsThis cross-sectional study used data from 2 previous cross-sectional studies, including the pre-Hurricane Maria Puerto Rico Assessment on Diet, Lifestyles and Disease (PRADLAD) study, conducted in 2015, and the post-Hurricane Maria Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT), conducted in 2019. Participants included adults aged 30 to 75 years residing in Puerto Rico. Data were analyzed from April to October 2020.ExposuresSelf-reported data were obtained on sociodemographic, lifestyle, and psychosocial factors and medically diagnosed conditions using validated questionnaires. Anthropometrics were measured in triplicate.Main outcomes and measuresData were obtained using similar protocols in both studies. Characteristics were contrasted for all participants across studies and for 87 PRADLAD participants who returned to PROSPECT.ResultsA total of 825 participants from both cohorts were included, with 380 PRADLAD participants and 532 PROSPECT participants. In the 2019 PROSPECT study, the mean (SD) age was 53.7 (10.8) years, and 363 participants (68.2%) were assigned female at birth and 169 participants (31.8%) were assigned male at birth. In the 2019 cohort, 360 participants (67.7%) had college education or higher, 205 participants (38.5%) reported annual income greater than $20 001, and 263 participants (49.5%) were employed. Most sociodemographic variables were similar between studies, except for higher income and employment after the hurricane. In the main analysis, participants in 2019, compared with participants in 2015, had higher abdominal obesity (389 participants [73.2%] vs 233 participants [61.3%]), sedentarism (236 participants [44.4%] vs 136 participants [35.8%]), binge drinking (95 participants [17.9%] vs 46 participants [12.1%]), and social support (mean [SD] score, 26.9 [7.2] vs 24.7 [7.1]) but lower depressive symptoms (169 participants [31.7%] vs 200 participants [52.6%]) and perceived stress (mean [SD] score, 19.3 [9.5] vs 21.7 [7.7]). In 2019, compared with 2015, there were higher rates of hypertension (252 participants [47.3%] vs 149 participants [39.2%]), arthritis (172 participants [32.3%] vs 97 participants [25.6%]), high cholesterol (194 participants [36.4%] vs 90 participants [23.8%]), high triglycerides (123 participants [23.1%] vs 56 participants [14.7%]), eye disease (94 participants [17.6%] vs 48 participants [12.7%]), fatty liver disease (68 participants [12.8%] vs 29 participants [7.5%]), and osteoporosis (74 participants [13.9%] vs 20 participants [5.2%]). Secondary analysis for the 87 returning participants showed similar results.Conclusions and relevanceIn this cross-sectional study, a higher prevalence of unhealthy behaviors and chronic conditions was noted among adults in Puerto Rico after Hurricane Maria, warranting long-term studies. Psychosocial factors were better, but still need attention. As natural disasters intensify, efforts should focus on continuous surveillance of health outcomes and promoting healthy behaviors, positive emotional health, and disease control, particularly in populations with higher risk for poor health.
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Project description:We compared occupancy in local assemblages of birds in forested areas across Puerto Rico during a winter before (2015) and shortly after (2018) the passage of hurricanes Irma and Maria. Using dynamic community models analyzed within a Bayesian framework, we found significant changes in detectability, with some species becoming more readily detected after the storms and others becoming more difficult to detect during surveys. Changes in occupancy were equally mixed. Five species-mostly granivores and omnivores, but also Black-whiskered Vireo (Vireo altiloquus), a migratory insectivore-occupied more sites in 2018 than in 2015. Twelve species were less common after the hurricanes, including all of the obligate frugivores. Declines in site-occupancy rates were not only more common than increases, but tended to be of greater magnitude. Our results support the general conclusions that bird species respond largely independently to changes in forest structure caused by hurricanes, but that some dietary guilds, notably frugivores, are more sensitive and more likely to show changes in abundance or occupancy following strong storms.
| S-EPMC6559628 | biostudies-literature
Project description:ImportanceOn September 20, 2017, one of the most destructive hurricanes in US history made landfall in Puerto Rico. Anecdotal reports suggest that many persons with kidney failure left Puerto Rico after Hurricane Maria; however, empirical estimates of migration and health outcomes for this population are scarce.ObjectiveTo assess the changes in migration and mortality among patients with kidney failure in need of dialysis treatment in Puerto Rico after Hurricane Maria.Design, setting, and participantsThis cross-sectional study used an interrupted time-series design of 6-month mortality rates and migration of 11 652 patients who received hemodialysis or peritoneal dialysis care in Puerto Rico before Hurricane Maria (before October 1, 2017) and/or during and after Hurricane Maria (on/after October 1, 2017). Data analyses were performed from February 12, 2019, to June 16, 2022..Main outcomes and measuresNumber of unique persons dialyzed in Puerto Rico per quarter; receipt of dialysis treatment outside Puerto Rico per quarter; and 6-month mortality rate per person-quarter for all persons undergoing dialysis.ExposuresHurricane Maria.ResultsThe entire study sample comprised 11 652 unique persons (mean [SD] age, 59 [14.7] years; 7157 [61.6%] men and 4465 [38.4%] women; 10 675 [91.9%] Hispanic individuals). There were 9022 patients with kidney failure and dialysis treatment before and 5397 patients after Hurricane Maria. Before the hurricane, the mean quarterly number of unique persons dialyzed in Puerto Rico was 2834 per quarter (95% CI, 2771-2897); afterwards it dropped to 261 (95% CI, -348 to -175; relative change, 9.2%). The percentage of persons who had 1 or more dialysis sessions outside of Puerto Rico in the next quarter following a previous dialysis in Puerto Rico was 7.1% before Hurricane Maria (95% CI, 4.8 to 9.3). There was a significant increase of 5.8 percentage points immediately after the hurricane (95% CI, 2.7 to 9.0). The 6-month mortality rate per person-quarter was 0.08 (95% CI, 0.08 to 0.09), and there was a nonsignificant increase in level of mortality rates and a nonsignificant decreasing trend in mortality rates.Conclusions and relevanceThe findings of this cross-sectional study suggest there was a significant increase in the number of people receiving dialysis outside of Puerto Rico after Hurricane Maria. However, no significant differences in mortality rates before and after the hurricane were found, which may reflect disaster emergency preparedness among dialysis facilities and the population with kidney failure, as well as efforts from other stakeholders.
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Project description:Violence is a public health concern faced on a daily basis by transgender women. Literature has documented how it adversely affects quality of life and health and in some instances leads to homicide. Considering the lack of research documenting the experiences of violence among transgender women, the objective of this article was to explore manifestations of violence among this population in Puerto Rico. The data presented in this article are part of a larger study on transgender/transsexual health in Puerto Rico. For the purpose of this article we focus on the quantitative data analysis. Participants (N = 59 transgender women) were recruited via respondent driven sampling. Implications and specific recommendations are discussed in light of these findings.
| S-EPMC5546874 | biostudies-other