javad aghazadeh-attari

Non-communicable diseases are of the major health challenges and the leading cause of death in Iran and at the global level. Moreover, Iran is a disaster-prone country and considering the exacerbation of diabetes and chronic respiratory diseases in natural disasters, its healthcare system is facing challenges. This study was designed to explore challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during disasters in Iran.
The conventional content analysis is used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 of stakeholders were experienced and had theoretical knowledge. Participants’ selection started by means of purposive sampling and continued to the point of data saturation. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method.
Based on participants’ experiences, four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management (with three subcategories: control and supervision, patient data management, volunteer management), physical, psychosocial health (with three subcategories: psychological impacts, exacerbation of signs and symptoms, special patient characteristics), health literacy and the behavior (with three subcategories: risk perception, values and beliefs, education and awareness) and barriers to healthcare delivery (with three subcategories: facilities and human resources, financial and living problems and insurances, accessibilities and geographic access).
Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters, and potentially promote health outcomes during and after disasters.

Iran’s health care system faces significant challenges in managing the growing burden of non-communicable diseases, and these are exacerbated during the frequent natural disasters. The current study was designed to understand challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during such crisis periods.

The conventional content analysis was used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 stakeholders with knowledge and experience in disasters. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method.

Four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management, physical, psychosocial health, health literacy and the behavior and barriers to healthcare delivery.

Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters.

In disasters, patients with chronic diseases, such as diabetes and chronic respiratory diseases, are considered to be a vulnerable population. This study aimed to examine the natural disaster preparedness knowledge of patients with chronic diseases in Iran with a focus on diabetic patients and those with Chronic Obstructive Pulmonary Disease (COPD) admitted to Masih Daneshvari Hospital in Tehran, Iran.

This cross-sectional survey was administered from August 2020 to April 2021. A disaster preparedness knowledge questionnaire was devised and validated, subsequently. A total of 86 eligible patients were selected using the census method and completed the questionnaire. The questionnaire included items on patients’ knowledge of disasters (n=7), personal preparedness of patients in disasters (n=8), and family and community preparedness in disasters (n=4).

A total of 86 patients were included in this survey, including 44 (51.2%) males. In total, 64% (n=55), 34.9% (n=30), and 1.2% (n=1) of patients had diabetes, COPD, and both, respectively. Two-thirds of patients reported that they had no good knowledge of disaster and emergency awareness and preparedness.

Based on the obtained results and due to the low readiness of patients, it is necessary to make decisions to improve the patients’ readiness. Therefore, it is possible to help promote the level of knowledge and preparedness of patients with diabetes and COPD to improve the health results during and after disasters through the adoption of required strategies and comprehensive plans in different areas of public health.

Volunteers' presence, as a critical issue in hospital response to disasters and emergencies, helps to readiness and quick response to the phenomena, preventing deaths caused by such incidences. This study aimed to determine the main factors affecting popular volunteers' presence in hospital response to disasters and emergencies in Iran.

This qualitative study, conducted on 31 semi-structured interviews during the years 2019 and 2020, concerningemergency specialist working in various health organization nationwide between June 2019 and April 2020. The non-structured and semi-structured interviews were adopted to gather concept code and analyzed using Graneheim recommendation method.

Four main categories, identified as effective factors on volunteers' presence in hospital response to disasters and emergencies, includingnine subcategories: (1) organizing and managing volunteers (with two sub-categories: (a) calling and registering volunteers, and (b) identifying volunteers' ability); (2) organizational structure (with two sub-categories: (a) operational planning and (b) coordination and communication); (3) training (with two sub-categories: (a) training in disasters and (b) volunteer training); and (4) volunteer challenges (with three sub-categories: (a) volunteer interaction with organizations, (b) volunteer logistics, and (c)volunteering culture).

Exploring effective factors as regards volunteers' presence in hospital response phase in disasters to adopt a policy based on the experiences of managers and heads of health can help planners to provide effective design and implementation. It can scientifically contribute to disaster risk management and hospital emergency response in Iran.

Patients with non-communicable diseases are vulnerable to disasters. This is a systematic review describing the impact of disasters on non-communicable diseases.

A systematic review was conducted using PRISMA standards. Relevant articles published from 1997 to 2019 collected by searching the Scopus, PubMed, Science Direct, databases. We specifically examined reports describing NCDs and including the key words “non-communicable disease and Disasters”. NCDs included cardiovascular, respiratory, diabetes, cancer and mental health diseases.

Of the 663 studies identified, only 48 articles met all the eligibility criteria. Most studies have shown the impact of all natural disasters on non-communicable diseases (39.8% n=19). The largest study was the effect of earthquakes on non-communicable diseases (29.2% n=14). For the NCDs targeted by this research, most of the included studies were a combination of four diseases: cardiovascular disease, respiratory disease, diabetes and cancer (44% n=21). Followed by cardiovascular disease (14.6% n=7), chronic respiratory disease (12.5% n=6), diabetes and cancer (6.2% n=3) and mental health (12.5% n=6).

The incidence of disasters affects the management of treatment and care for patients with NCDs. Specific measures include a multi-part approach to ensuring that patients with non-communicable diseases have access to life-saving services during and after disasters. The approach of the health system should be expanded from traditional approaches to disasters and requires comprehensive planning of health care by policy makers and health professionals to develop effective strategies to enable patients to access medical, therapeutic and diagnostic services in natural disasters.

NCDs require an ongoing management for optimal outcomes, which is challenging in emergency settings, because natural disasters increase the risk of acute NCD exacerbations and lead to health systems’ inability to respond. This study aims to develop a protocol for a systematic review on non-communicable diseases in natural disaster settings.

This systematic review protocol is submitted to the International Prospective Register of Systematic Reviews (Registration No. CRD42020164032). The electronic databases to be used in this study include: Medline, Scopus, Web of Science, Clinical Key, CINAHL, EBSCO, Ovid, EMBASE, ProQuest, Google Scholar, Cochrane Library (Cochrane database of systematic reviews; Cochrane central Register of controlled Trials). Records from 1997 to 2019 are subject to this investigation. Three independent researchers will review the titles, abstracts, and full texts of articles eligible for inclusion, and if not matched, they will be reviewed by a final fourth reviewer. The proposed systematic review will be reported in accordance with the reporting guideline provided in the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. We select studies based on: PICOs (Participants, Interventions, Comparators, and Outcomes).

This systematic review identifies any impacts of natural disasters on patients with NCDs in three stages i.e. before, during and in the aftermath of natural disasters.

A comprehensive response to NCD management in natural disasters is an important but neglected aspect of non-communicable disease control and humanitarian response, which can significantly reduce the potential risk of morbidity and mortality associated with natural disasters.