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Extreme weather events in developing countries and related injuries and mental health disorders - a systematic review

1 , 2 , , 3 , 4 , 5

BMC Public Health

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      BackgroundDue to climate change, extreme weather events have an incremental impact on human health. Injuries and mental health disorders are a particular burden of disease, which is broadly investigated in high income countries. Most distressed populations are, however, those in developing countries. Therefore, this study investigates mental and physical health impacts arising from extreme weather events in these populations.MethodPost-traumatic Stress Disorder (PTSD), injury [primary outcomes], anxiety and depressive disorders [secondary outcomes], caused by weather extremes were systematically analyzed in people of developing countries. A systematic review of observational studies was conducted searching six databases, complemented by hand search, and utilizing two search engines. Review processing was done independently by two reviewers. Prevalence rates were analyzed in a pre/post design; an additional semi-structured search was conducted, to provide reference data for studies not incorporating reference values.ResultsAll 17 identified studies (70,842 individuals) indicate a disease increase, compared to the reference data. Increase ranges from 0.7–52.6 % for PTSD, and from 0.3–37.3 % for injury. No studies on droughts and heatwaves were identified. All studies were conducted in South America and Asia.ConclusionThere is an increased burden of psychological diseases and injury. This finding needs to be incorporated into activities of prevention, preparedness and general health care of those developing countries increasingly experiencing extreme weather events. There is also a gap in research in Africa (in quantity and quality) of studies in this field and a predominant heterogeneity of health assessment tools.PROSPERO registration no.: CRD42014009109Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3692-7) contains supplementary material, which is available to authorized users.

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          The development of instruments to measure the work disability assessment behaviour of insurance physicians

          Background Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants. Methods Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items. Results Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour. The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'. Conclusions The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.

            Author and article information

            [1 ]Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, TU Dresden, Germany
            [2 ]Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
            [3 ]Institute and Policlinic of Occupational and Social Medicine, University Hospital Carl Gustav Carus, TU Dresden, Germany
            [4 ]Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
            [5 ]Institute and Outpatient Clinics of Psychotherapy and Psychosomatic, University Hospital Carl Gustav Carus, TU Dresden, Germany
            +49 (351) 3177-453 ,
            BMC Public Health
            BMC Public Health
            BMC Public Health
            BioMed Central (London )
            29 September 2016
            29 September 2016
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            © The Author(s). 2016

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