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Highlight and copy the desired format. Emerging Infectious Diseases, 23 Abstract Humanitarian emergencies, including complex emergencies associated with fragile states or areas of conflict, affect millions of persons worldwide.
Such emergencies threaten global health security and have complicated but predictable effects on public health. Responses were conducted across the world and in collaboration with national and international partners. Lessons from this work include the need to develop epidemiologic tools for use in resource-limited contexts, build local capacity for response and health systems recovery, and adapt responses to changing public health threats in fragile states.
The number of persons affected by humanitarian emergencies worldwide is unprecedented; inthe United Nations Office for the Coordination of Humanitarian Affairs estimated that million persons needed humanitarian assistance 1.
More than half of these, Among these are Displaced persons might settle in temporary shelters or camps in resource-limited or politically unstable areas, straining local capacity to provide services.
The effects of humanitarian emergencies can be exacerbated by political instability and weak governance associated with fragile states or areas of conflict 3and this instability directly undermines global health security.
In such unstable settings, the humanitarian community calls these crises complex emergencies CEs Table 4. Although the underlying causes of humanitarian emergencies and CEs specifically are highly varied, the population displacement and health systems destabilization associated with emergencies have predictable public health consequences.
Historically, the cause of the high morbidity and mortality rates have been infectious disease outbreaks; exacerbation of endemic infectious diseases; and acute malnutrition, often in high-density settlements with inadequate water, sanitation, shelter, and access to food 37 — Increased availability of interventions for these conditions, coupled with a rise in conflicts in higher-income countries, have led to an increasing burden from chronic conditions such as tuberculosis, cardiovascular disease, and diabetes 389.
Conflict-affected populations also have an elevated risk for injury from violence, including sexual and gender-based violence, and mental health conditions are common 39.
Most displaced persons live in host communities, rather than in separate camps, contributing to poor or uncoordinated access to healthcare services 9. This inconsistent access continues to be problematic in protracted emergencies, during which public health services might be strained for years.
Responding to the wide-ranging public health effects of CEs requires expertise in diverse sectors, such as vaccine-preventable and other infectious diseases; water, sanitation, and hygiene WASH ; nutrition; noncommunicable diseases; injury; sexual and reproductive health; and mental health.
Equally varied are the epidemiologic approaches needed to effectively respond to CEs, including development of novel epidemiologic methods, rapid needs assessments, surveillance implementation and evaluation, outbreak investigations, and capacity building, often in resource-restricted and insecure environments.
The Centers for Disease Control and Prevention CDC has long been a leader in developing and understanding the epidemiology and public health effects of humanitarian emergencies and CEs specifically.
CDC published a compendium of disease control and public health surveillance programs used among Khmer refugees from Kampuchea Cambodia in Thailand during — 13followed by a synthesis of accumulated knowledge about public health issues in CEs InToole and Waldman, among the first CDC staff dedicated to studying the epidemiology of CEs, published a paper on mortality rates among displaced populations, which established the use of a crude mortality rate CMR threshold to quantitatively define CEs InCDC staff, as part of the Goma Epidemiology Group, conducted rapid cluster sample population surveys to document the unprecedented mortality rate among Rwanda refugees in Goma, Zaire now Democratic Republic of the Congo 68.
After a systematic review of nutritional surveys in Somalia during the — famine, CDC staff provided recommendations for standardizing nutritional assessments in CEs In the s and s, CDC staff emphasized the burden of chronic diseases in CEs 19 and documented adverse mental health outcomes and social functioning among refugee and CE-affected populations 20 — 23 and, later, among national and international aid workers 24 — In all activities, CDC worked to address the unique characteristics of humanitarian emergencies through development of epidemiologic methods, strengthening local capacity, improvement of surveillance, and evaluation of interventions.
Staff members work with the international humanitarian community to apply public health and epidemiologic science, develop tools and methods to understand health needs, and build the capacity and resilience of public health systems within these fragile settings.
To ensure the completeness of this dataset, we compared it with a previously compiled comprehensive database of all emergencies worldwide, including CEs and natural disasters, for the same period A.
Culver, Emory University, pers. Sources for natural disasters were the Center for Research on the Epidemiology of Disasters international disaster database http: To compile emergency responses for andwe abstracted data from branch administrative and travel records. Of 14 selected emergencies over the past 10 years, nearly two thirds were CEs; the rest were natural and human-made disasters Technical Appendix Table.
Responses were conducted in Africa, Asia, Latin America and the Caribbean, Europe, and the Middle East; activities included providing technical assistance or directly conducting assessments and investigations, implementing and evaluating surveillance systems, developing guidelines, providing trainings, and coordinating interventions.
All responses featured extensive collaboration with a variety of partners, including the US government, UN agencies, governmental health entities, and both national and international nongovernmental organizations NGOs. The quake also created 1 million IDPs and massively disrupted public health and other basic services within an already fragile state.
ERRB staff worked with the Pan American Health Agency and the Haiti Ministry of Public Health and Population to establish sentinel site surveillance for epidemic-prone infectious diseases at 51 health facilities across the country and in IDP camp clinics; these systems were instrumental in detecting the cholera outbreak that began in October 27 The cholera epidemic was also the basis for a series of ERRB activities focused on improving access to clean water and proper sanitation in Haiti.
Nearly 1 million Somali refugees fled to camps in Kenya and Ethiopia, and an additional 1. Staff review of demographic profiles of outbreak cases led to an expansion of the target age group for vaccination from 6 months—14 years of age to 6 months—30 years of age 33 UntilERRB supported the Somalia communicable disease reporting surveillance system, designed to optimize early warning of outbreaks, by providing analysis and training; this system identified an outbreak of polio inenabling swift intervention For ERRB, the response to the Horn of Africa famine and displacement indicated the value of enhancing public health information quality, thereby guiding the allocation of humanitarian resources.
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Pediatr Res. ;69(5 pt 1)– doi: RES week 5 Learning Team Assignment: Final Conclusions Memo • Compute the confidence intervals of your data from the Week 4 Learning Team paper. • Based on your confidence intervals, determine if you would change the conclusions given in your Week 4 Learning Team paper.
Clinical signs of pain following declawing include a “guarding” posture, reluctance to bear weight on the declawed limb(s), and reluctance to move.
2,42 Nine of (%) declawed cats were non-weight-bearing on the affected limbs for one day after the operation, and . Possible responses include: not anxious, slightly anxious, fairly anxious, very anxious, and extremely anxious.
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RES week 4 Res Learning Team Assignment: Descriptive Statistics Paper • Write and submit a 1,,word paper, adding to your Week Three paper, examining the data you have collected.