Active-Duty Physicians' Perceptions and Satisfaction with Humanitarian Assistance and Disaster Relief Missions: Implications for the Field

Background

The United States Department of Defense participates in more than 500 missions every year, including humanitarian assistance and disaster relief, as part of medical stability operations. This study assessed perceptions of active-duty physicians regarding these activities and related these findings to the retention and overall satisfaction of healthcare professionals.

Methods and Findings

An Internet-based survey was developed and validated. Of the 667 physicians who responded to the survey, 47% had participated in at least one mission. On a 7-point, Likert-type response scale, physicians reported favorable overall satisfaction with their participation in these missions (mean  = 5.74). Perceived benefit was greatest for the United States (mean  = 5.56) and self (mean  = 5.39) compared to the target population (mean  = 4.82). These perceptions were related to participants'' intentions to extend their military medical service (total model R ²  = .37), with the strongest predictors being perceived benefit to self (β = .21, p<.01), the U.S. (β = .19, p<.01), and satisfaction (β = .18, p<.05). In addition, Air Force physicians reported higher levels of satisfaction (mean  = 6.10) than either Army (mean  = 5.27, Cohen''s d = 0.75, p<.001) or Navy (mean  = 5.60, Cohen''s d  = 0.46, p<.01) physicians.

Conclusions

Military physicians are largely satisfied with humanitarian missions, reporting the greatest benefit of such activities for themselves and the United States. Elucidation of factors that may increase the perceived benefit to the target populations is warranted. Satisfaction and perceived benefits of humanitarian missions were positively correlated with intentions to extend time in service. These findings could inform the larger humanitarian community as well as military medical practices for both recruiting and retaining medical professionals.     

Pre-Positioning Disaster Response Facilities and Relief Items

ABSTRACT

Large-scale disasters cause enormous damage to people living in the affected areas. Providing relief quickly to the affected is a critical issue in recovering the effects of a disaster. Pre-disaster planning has an important role on reducing the arrival time of relief items to the affected areas and efficiently allocating them. In this study, a mixed integer programming model is proposed in order to pre-position warehouses throughout a potential affected area and determine the amount of relief items to be held in those warehouses. Time between the strike of the disaster and arrival of relief items at the affected areas is aimed to be minimized. In addition, using probabilistic constraints, the model ensures that relief items arrive at affected areas within a certain time window with certain reliability. Considering instable fault lines on which Istanbul is located, the proposed model is applied to the Istanbul case for pre-positioning warehouses a priori to the possible expected large-scale earthquake.     

Factors Influencing Collaborative Activities between Non-Professional Disaster Volunteers and Victims of Earthquake Disasters

Background

Assistance from non-professional disaster volunteers (hereinafter, volunteers) is essential for disaster victims to recover physically and rebuild their lives; however, disaster victims in some areas are reluctant to accept assistance from volunteers. This study explored factors that may influence collaborative activities between volunteers and victims of earthquake disasters.

Methods

From July to September 2008, a self-reporting questionnaire survey was conducted with all 302 leaders of neighborhood associations in a city within Niigata Prefecture at the time of the Niigataken Chuetsu-oki Earthquake in 2007. Each factor was determined based on the Health Belief Model. Multiple regression analysis was conducted, using collaborative activities as the objective variable.

Results

From 261 valid responses received (response rate 86.4%), 41.3% of leaders collaborated with volunteers, and 60.2% of associations had residents who collaborated with volunteers. Collaboration with volunteers was significantly and positively related to perceived severity of an earthquake disaster (standardized partial regression coefficient β = 0.224, p<0.001) and neighborhood association activities during the earthquake disaster (β = 0.539, p<0.001). A positive and marginally significant relation was found between such collaboration and sense of coherence within a community (β = 0.137, p = 0.06), social capital (β = 0.119, p = 0.08), and perceived benefits (β = 0.116, p = 0.09).

Conclusion

Collaboration between disaster victims and volunteers during the response to an earthquake may require the preemptive estimation of damage by residents during normal times and the enhancement of neighborhood association activities during a disaster. For residents to have such estimation abilities, public institutions should provide information related to anticipated disaster damage and appropriate disaster prevention training and education. In addition, residents should create a disaster prevention map with other residents. Lastly, promoting neighborhood association activities may require the participation of many residents in disaster drills and education as well as a preemptive discussion of neighborhood activities during a disaster.     

Famine Crimes: Politics and the Disaster Relief Industry in Africa

Famine Crimes: Politics and the Disaster Relief Industry in Africa. Alex de Waal. Bloomington: Indiana University Press, 1997.238 pp.     

Two Glycogen Synthase Activities Associated with Proteoglycogen in Retina

Glycogen synthase of bovine retina was found associated with the acid-insoluble and acid-soluble proteoglycogen fractions. The synthase associated with the acid-insoluble proteoglycogen precursor showed an 8-fold lower Km for UDP-glucose than the synthase associated with the acid-soluble fraction, and was inhibited by detergent. A short digestion with pronase resulted in conversion of the acid insoluble fraction into acid-soluble. The results lead us to postulate that the acid-insolubility of the proteoglycogen fraction and the association with retina membrane proposed before, is caused by glycogen synthase strongly associated to its polysaccharide moiety. The enlargement of the polysaccharide moiety during proteoglycogen biosynthesis, from glycogenin linked to a few 11 to 12 glucose units to the acid-insoluble proteoglycogen precursor (Mr 470,000) would be carried out, together with the branching enzyme, by the glycogen synthase showing a low Km for UDP-glucose. The glycogen synthase with the highest Km for UDP-glucose would participate in conversion of the precursor into mature acid-soluble proteoglycogen.     

Anti-protease and Immunomodulatory Activities of Bacteria Associated with Caribbean Sponges

Marine sponges and their associated bacteria have been proven to be a rich source of novel secondary metabolites with therapeutic usefulness in cancer, infection, and autoimmunity. In this study, 79 strains belonging to 20 genera of the order Actinomycetales and seven strains belonging to two genera of the order Sphingomonadales were cultivated from 18 different Caribbean sponges and identified by 16S rRNA gene sequencing. Seven of these strains are likely to represent novel species. Crude extracts from selected strains were found to exhibit protease inhibition against cathepsins B and L, rhodesain, and falcipain-2 as well as immunomodulatory activities such as induction of cytokine release by human peripheral blood mononuclear cells. These results highlight the significance of marine sponge-associated bacteria to produce bioactive secondary metabolites with therapeutic potential in the treatment of infectious diseases and disorders of the immune system.     

Factors Associated with Weight Control in Older Adults

Dieting behaviors in a sample of 183 overweight older adults were studied to assess how they were influenced by six cognitive, behavioral, emotional, and social variables. Membership in a weight control program was also evaluated to assess whether it affected these relationships. Responses indicated that reports of high quality dieting behaviors were associated with higher levels of depression and less effective coping skills. Dieting behaviors among subjects who were participants in weight loss programs were not as strongly associated with less effective coping skills, but were associated with external health locus-of-control. The degree of social support had a limited impact on dieting behaviors, while measures of optimism and health status were unrelated to dieting behaviors. We concluded that older adults, especially those who diet independently, are likely to experience significant stress associated with weight loss efforts. Weight loss programs for older adults might produce better outcomes if they focus on reducing depression and stress associated with dieting.     

Several Galactosyltransferase Activities Are Associated with Mouse Chromosome 17

Indirect evidence suggests that some major histocompatibility complex (MHC) proteins are glycosyltransferases. No sequence or mapping information is available for transferases, although ganglioside variations in mice are linked to the H-2 complex on chromosome 17, and one galactosyltransferase activity on mouse sperm varies with T/t complex genotypes, also on chromosome 17. In the present experiments, diploid and trisomy 17 mouse embryos were assayed for four different galactosyltransferase activities. The same preparations were assayed for isocitrate dehydrogenase (Id-1, chromosome 1) and glyoxalase-1 (Glo-1, chromosome 17). Galactosyltransferase specific activities in trisomy 17 embryos are almost 1.5 times higher than in diploid embryos. The correlation between galactosyltransferase activities and chromosome 17 dosage indicates that the structural or regulatory gene for these enzymes are located on chromosome 17.     

Reduced APOBEC3H Variant Anti-Viral Activities Are Associated with Altered RNA Binding Activities

APOBEC3H (A3H) is a member of the APOBEC3 family of proteins with varying activities against retroviruses and retrotransposons. The A3H gene contains several single nucleotide polymorphisms and up to seven haplotypes have been detected in humans. Although variations in anti-viral function among A3H haplotypes are not fully understood, only 15N105R-containing A3H variants are known to have potent activities against Vif-deficient HIV-1. Unique motif RLYY(F/Y)W of APOBEC3G (A3G) and APOBEC3F (A3F) required for 7SL RNA binding and HIV-1 incorporation is also conserved in all A3H variants. Like A3G, A3H HapII also demonstrated high binding affinity to host small RNAs such as 7SL and Y RNAs. Mutation of a critical amino acid, W115A resulted in reduced expression level, decreased affinity for 7SL RNA, impairment of virion packaging and reduced anti-viral activity. By comparison, A3H HapI had lower binding affinities to host small RNAs and reduced efficiency of virion incorporation, resulting in significantly reduced anti-viral activity. The SNP ΔN15 commonly found in A3H HapIII and HapIV abolished their abilities to associate with RNAs, and A3H HapIIΔ15N failed to package into HIV-1 virions or exhibited any anti-viral activity. Finally, we showed that A3H variants had distinct cellular localization patterns, which correlated with their different RNA binding affinities. Thus, Pol-III RNA such as 7SL RNA binding is a conserved feature of potent anti-HIV human APOBEC3 cytidine deaminases.     

Protein Kinase Activities Associated with Actin Cytoskeleton in Xenopus laevis Oocytes and Eggs

Protein phosphorylation with specific protein kinases plays the key role in the regulation of meiotic maturation of oocytes. However, little is known about the contribution of kinases to the temporal and positional regulation of the cytoskeleton rearrangement in maturing oocytes, including the actin cytoskeleton. In order to study a relationship between the kinase activities and actin cytoskeleton rearrangement, we analyzed protein phosphorylation in the isolated actin cytoskeleton of Xenopus laevis oocytes. Analysis of the full grown oocytes and eggs injected with [-³²P]ATP has revealed phosphorylation of many proteins associated with the actin cytoskeleton and shown the appearance of three additional major phosphoproteins, 20, 43, and 69 kDa, during oocyte maturation. A significant number of these phosphoproteins were also found after incubation of the isolated cytoskeleton with [-³²P]ATP in vitro, thus confirming that the kinases modifying these substrates are also specifically associated with actin. The in vivo and in vitro kinase activities were also stimulated during maturation. Analysis of kinase self-phosphorylation in situ and protein phosphorylation in solutions and substrate containing gels revealed a set of actin-associated kinases, including cAMP- and Ca²⁺-dependent kinases, as well as MAP, p34^cdc2, and tyrosine kinase activities. Their level was the highest in the eggs. The involvement of kinases in the actin cytoskeleton rearrangement during oocyte maturation is discussed.     

Unhealthy Aid: Food Security Programming and Disaster Responses to Cyclone Pam in Vanuatu

ABSTRACT

In this paper, I examine the disconnect between government and NGO responses to Cyclone Pam, and previous healthy food initiatives in Port Vila, Vanuatu. Decades of nutrition education programs across Vanuatu have urged families to limit their consumption of tinned meat and imported food in favour of locally grown fruits and vegetables. These dietary guidelines call on families to watch their food consumption in order to raise healthy children and avoid serious non-communicable diseases such as hypertension and diabetes. In spite of these guidelines, the food aid offered after Cyclone Pam, on which many ni-Vanuatu depended, consisted primarily of imported white rice, tinned meat, and instant noodles – foods previously labelled unhealthy in nutrition education campaigns. Humanitarian agencies often envision disaster relief as a short-term intervention. However, the cyclone exacerbated inequality across Port Vila, magnifying socioeconomic disparities and associated food insecurity that existed before the cyclone, forcing many families to rely reluctantly on unhealthy food aid. Drawing on research conducted over several fieldwork trips from 2010 to 2016, I discuss food security and nutrition programs in Vanuatu and how ni-Vanuatu families interpreted disaster relief efforts in the context of existing nutrition programming. I argue that disaster preparedness has not accounted for the values promoted in nutrition education programs, the health needs of the community, or food preferences. I conclude with a call for the creation of culturally appropriate responses to natural disaster relief efforts so as to promote sustainable food security measures.     

Electronic Games and Environmental Factors Associated with Childhood Obesity in Switzerland

Objective: Environmental factors and behaviors associated with obesity have not been well described in children living in Europe. Although television watching has been repeatedly associated with obesity, it is unclear whether other sedentary activities, such as use of electronic games, are independently associated with obesity in children. The hypothesis was that various types of sedentary activities are associated with obesity in children living in Switzerland. Research Methods and Procedures: This was a cross‐sectional study of children (grades one to three) from four communities in the Greater Zurich Area (Switzerland). Obesity was defined as a combination of overweight (BMI) and overfat (skinfold thicknesses). Environmental factors were assessed by questionnaire. The children's physical activity was estimated by their teacher (scale 0 to 10). Results: Of 922 eligible subjects, 872 (94.6%) took part in the study. Use of electronic games [odds ratio (OR) = 2.03 per hour per day, 95% confidence interval (CI): 1.57 to 2.61, p < 0.001], television (OR = 2.83 per hour per day, 95% CI: 2.08 to 3.86, p < 0.001), physical activity (OR = 0.80 per unit, 95% CI: 0.72 to 0.88, p < 0.001), maternal work (OR = 1.93, 95% CI: 1.13 to 3.29, p = 0.02), and paternal smoking (OR = 1.78, 95% CI: 1.07 to 2.96, p = 0.03) were independently associated with obesity. Further adjustment for socioeconomic status, when available, did not change these results. Discussion: In this sample of children living in Switzerland, the use of electronic games was significantly associated with obesity, independently of confounding factors. The association of obesity with television use and lack of physical activity confirms results from other populations and points to potential strategies for obesity prevention.     

Peptidasic Activities Associated with Acetylcholinesterase Are Due to Contaminating Enzymes

The esterasic and peptidasic activities of two different sources of acetylcholinesterase purified from electric eel were examined. Hydrolyses of leucine-enkephalin and neurotensin indicated that both sources exhibited exopeptidasic and tryptic-like activities. However, the enzyme preparation which appeared 10-fold enriched with regard to the esterasic activity was found to display a 50- and 185-fold lower tryptic-like and exopeptidasic function, respectively. This lack of parallelism in the enrichment of the various activities seemed to indicate that they were not co-purified. Immunoprecipitation experiments performed with monoclonal antibodies directed towards the catalytic subunit of globular or asymmetric forms of electric eel acetylcholinesterase allowed the physical dissociation of esterasic and peptidasic functions and therefore confirmed that the ability of acetylcholinesterase to hydrolyze various neuropeptides was likely due to contaminating peptidases.     

Dietary and Non-dietary Factors Associated with Serum Zinc in Indian Women

Women in low-income settings, common in India, are at risk of inadequate zinc intake due to poor diet quality and low consumption of flesh foods rich in zinc. The aims of this study were to assess the prevalence of zinc status of non-pregnant rural and tribal women living in central India and to identify dietary and non-dietary factors associated with the biochemical zinc status of these women. Rural and tribal non-pregnant women 18–30 years of age were selected using proportion to population sampling near Nagpur, Maharashtra, India. Sociodemographic, biochemical (serum zinc), clinical, and dietary data (1-day interactive 24-h recall) were collected. The mean age of women (n?=?109; rural?=?52; tribal?=?56) was 23.2 years and mean BMI was 17.9 kg/m². The majority of the participants identified as being non-vegetarian (72 %). The mean?±?SD serum zinc concentration was 10.8?±?1.6 μmol/L, and 52 % of participants had a low serum zinc concentration according to the International Zinc Nutrition Consultative Group (IZiNCG). The median (first and third quartile) energy, zinc intake, and phytate/zinc molar ratio was 5.4 (4.2, 6.7)?MJ/day, 5.3 (3.8, 7.0)?mg/day, and 26 (22, 28), respectively. Zinc intakes were well below IZiNCG recommendations for dietary zinc of 9 mg/day for non-pregnant women aged 14–18 years and 7 mg/day for non-pregnant women aged ≥19 years. Using linear regression analysis to identify non-dietary and dietary factors associated with serum zinc, a significant association was only found for current lactation (p?=?0.012) and energy intake (p?相似文献   

Long-Term Spatiotemporal Dynamics and Factors Associated with Trends in Bare-Nosed Wombats

Geographically widespread species present challenges for conservation assessment. We used long-term spotlight surveys to assess spatiotemporal dynamics of bare-nosed wombats (Vombatus ursinus), encompassing 34 years of surveys for the Tasmanian mainland sub-species (V. u. tasmaniensis, 1985–2018) and 25 years for the Flinders Island sub-species (V. u. ursinus, 1994–2018). Wombat populations increased on the Tasmanian mainland by 2.59 times and on Flinders Island by 3.51 times ( = 1.05 and 1.1 times increase/yr, respectively). At smaller spatial scales on mainland Tasmania, increases in wombat counts generally occurred within meteorological regions and regional zones, except for the Central North (West Tamar) region where a decrease in wombats is linked to a sarcoptic mange disease epizootic. We used generalized additive models to assess relationships between variables and wombat counts. The most supported variables at the mainland Tasmania scale were (in order of importance) year, positive associations with time-lagged minimum temperature, Tasmanian devil (Sarcophilus harrisii) counts, and moonlight, and a negative association with time-lagged rainfall. Among meteorological regions, variables associated with wombat counts exhibited some heterogeneity, with temperature and rainfall the most frequently associated variables. Our long-term, large-scale, and ecologically diverse analysis of bare-nosed wombats supports spotlight monitoring as a valuable, relatively simple, and affordable survey method in Tasmania and beyond. © 2021 The Wildlife Society.     

Respiratory Activities Associated with Mesosomal Vesicles and Protoplast Membranes of Staphylococcus aureus

Analysis of oxidase and dehydrogenase activities, cytochrome content of mesosomal vesicles, and protoplast membranes showed that the respiratory chain in Staphylococcus aureus is associated predominantly with the protoplast membranes.     

Psychological Distress, Depression, Anxiety, and Burnout among International Humanitarian Aid Workers: A Longitudinal Study

Background

International humanitarian aid workers providing care in emergencies are subjected to numerous chronic and traumatic stressors.

Objectives

To examine consequences of such experiences on aid workers'' mental health and how the impact is influenced by moderating variables.

Methodology

We conducted a longitudinal study in a sample of international non-governmental organizations. Study outcomes included anxiety, depression, burnout, and life and job satisfaction. We performed bivariate regression analyses at three time points. We fitted generalized estimating equation multivariable regression models for the longitudinal analyses.

Results

Study participants from 19 NGOs were assessed at three time points: 212 participated at pre-deployment; 169 (80%) post-deployment; and 154 (73%) within 3–6 months after deployment. Prior to deployment, 12 (3.8%) participants reported anxiety symptoms, compared to 20 (11.8%) at post-deployment (p = 0·0027); 22 (10.4%) reported depression symptoms, compared to 33 (19.5%) at post-deployment (p = 0·0117) and 31 (20.1%) at follow-up (p = .00083). History of mental illness (adjusted odds ratio [AOR] 4.2; 95% confidence interval [CI] 1·45–12·50) contributed to an increased risk for anxiety. The experience of extraordinary stress was a contributor to increased risk for burnout depersonalization (AOR 1.5; 95% CI 1.17–1.83). Higher levels of chronic stress exposure during deployment were contributors to an increased risk for depression (AOR 1·1; 95% CI 1·02–1.20) comparing post- versus pre-deployment, and increased risk for burnout emotional exhaustion (AOR 1.1; 95% CI 1.04–1.19). Social support was associated with lower levels of depression (AOR 0·9; 95% CI 0·84–0·95), psychological distress (AOR = 0.9; [CI] 0.85–0.97), burnout lack of personal accomplishment (AOR 0·95; 95% CI 0·91–0·98), and greater life satisfaction (p = 0.0213).

Conclusions

When recruiting and preparing aid workers for deployment, organizations should consider history of mental illness and take steps to decrease chronic stressors, and strengthen social support networks.