Dry eye disease (DED) affects visual function and quality of life. In Gaza, conflict, displacement, environmental exposure, and psychological distress may increase risk, but evidence is limited. This study estimated DED symptom prevalence among adults aged ≥40 years and examined associated factors.

A community-based cross-sectional convenience sample of 296 adults aged ≥40 years living in houses, shelters, or tents in Gaza was surveyed face-to-face. Arabic OSDI assessed symptoms (≥13) and severe symptoms (≥33). Psychological distress was measured using the Arabic DASS-8. Exploratory analyses examined continuous OSDI scores, housing type, geographic/displacement context, and the OSDI environmental-trigger domain. Adjusted associations were evaluated using regression models with robust standard errors.

Overall, 97.3% of participants had DED symptoms. Living in tents (PR 1.05, 95% CI 1.01-1.10; P = 0.024) and age ≥70 years (PR 1.05, 95% CI 1.00-1.09; P = 0.028) were associated with slightly higher prevalence. Higher DASS-8 scores were associated with greater continuous OSDI scores and more severe symptoms. Participants in the South/displaced group had greater symptom burden than those surveyed in the North.

DED symptoms were nearly universal in this convenience sample. Greater symptom burden was associated with psychological distress and displacement context, although specific environmental exposures were not measured directly.

Disaster response requires a diverse set of skills, yet there is no universally agreed definition of the specific competences needed. Therefore, this study aimed to explore how disaster responders acquire competence.

A qualitative study using inductive thematic analysis. Individual interviews with disaster responders who had worked in a leading position.

The study included 14 participants from 7 nationalities, all of whom were experienced disaster responders from different professions. From the analysis, four themes arose describing different ways of acquiring the competences and skills required to function as a disaster responder. Previous background, formal training, mental preparedness, and personal traits all had a role in how competences and skills were acquired among disaster responders.

Formal training alone cannot fully prepare disaster responders for the reality of a disaster but needs to be combined with personal experiences from both disasters and other contexts as well as mental preparation. Personal traits also play a role for acquisition of competence. When designing training programs, technical disaster-specific skills should serve as the core, but equal emphasis should be placed on non-technical skills, especially teamwork, leadership, mentoring, and gender awareness within response teams. These elements contribute to developing capable and well-prepared responders.

To examine the associations between various hurricane-related exposures and psychiatric and substance use disorders among Puerto Rican adults following Hurricane Maria and to identify disaster-related exposures that may contribute to psychiatric morbidity in hurricane- and typhoon-prone settings.

Hurricane-related exposures were grouped into personal, property, utility/resource losses, and unsanitary/hazardous exposures. Logistic regression models were run to examine the associations between the number of hurricane-related exposures and disorders.

Each additional hurricane-related exposure was associated with a 1.1 percentage-point increase in the probability of any mood disorder (P < 0.001), a 1.3 percentage-point increase in the probability of any anxiety disorder (P < 0.001), and a 2.0 percentage-point increase in the probability of any disorder (P < 0.001). Each additional utility/resource loss exposure was associated with a 2.3 percentage-point increase in the probability of any anxiety disorder (P = 0.001). Each additional unsanitary/hazardous exposure was associated with a 1.9 percentage-point increase in the probability of any mood disorder (P = 0.017). Findings varied when individual disorders were examined. No associations were found between exposures and substance use disorders.

Utility/resource losses and unsanitary/hazardous conditions emerged as important correlates of post-disaster psychiatric disorders, suggesting that these often-overlooked exposures should be incorporated into disaster assessments and recovery planning.

The aim of this research is to explore and report on factors that define and impact resource availability and the decision-making space regarding scarce health resources in humanitarian response settings.

This research was conducted with an exploratory qualitative design. Clinicians and managers with relevant experience were identified and purposively recruited to include broad perspectives. Semi-structured interviews were conducted remotely to produce transcripts of participant narrative which were analyzed using an inductive thematic analysis approach to allow themes to arise from the data.

Seventeen interviews were conducted, contributing 887 minutes of data. Five themes framing decision-making were identified: scope; relationships; adaptation; power; and security. Each theme influences resource availability and the experience of health resource allocation decisions in humanitarian contexts. Collectively, the themes informed the development of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) ScRAPS Model.

The findings of this research articulate several pertinent factors that shape resource allocation decision-making in humanitarian health responses. In consolidating these factors, the resulting ScRAPS Model provides a conceptualization and analytical framework for considering humanitarian health responses. Finally, this research illuminates a potential path for future research and communicating learned lessons through a proposed common language.

As flood disasters increase with climate change, elementary school children require consideration due to their developing self-protection capacities. However, their specific challenges and support needs during flood evacuation remain inadequately investigated. This study identified challenges faced by elementary school children and their families during flood evacuation and elucidated needed support.

A qualitative study was conducted using semi-structured interviews with 8 parents of 9 elementary school children using maximum variation sampling. Following the COREQ guidelines, interviews focused on the flood evacuation process from onset to shelter arrival. Data were analyzed using Braun and Clarke’s reflexive thematic analysis with an inductive analytical framework.

Five major themes were identified from 111 codes (percentages indicate the proportion of total codes): Disaster preparedness (22.5%), Evacuation support (16.2%), Material support at evacuation sites (22.5%), Environmental support at evacuation sites (22.5%), and Disaster response (16.2%). The findings revealed multifaceted challenges and required support systems during flood disasters.

Children’s and their families’ safety during flood disasters may require enhanced community awareness, family evacuation plans, child-friendly shelters, effective information systems, and collaboration among schools, families, and communities. These findings emphasize considering their unique needs in disaster planning and evacuation shelter management. Future research should develop practical intervention programs with diverse samples to enhance resilience.

In mass-casualty incidents, inaccurate pretriage labeling at Advanced Medical Post (AMP) arrival, whether due to undertriage or clinical deterioration before arrival, may affect downstream workflow processes and delay recognition of critically injured patients. Although triage accuracy has been widely studied, the operational impact of inaccurate pretriage labelling at AMP entry on time-critical care processes within AMP systems remains poorly understood.

To evaluate the impact of inaccurate pretriage labeling at AMP entry on downstream time-critical care processes in simulated red-category patients.

Prospective, pilot simulation-based study conducted during 2 full-scale AMP exercises. The AMP reflected the real-world operational structure, personnel, and logistics of an AMP deployed during the World Economic Forum (WEF) 2026. Each simulation included 18 standardized patients; 10 met predefined red-triage criteria and constituted the analytic cohort. The primary objective was to compare time to predefined first critical action between correctly labeled and mislabeled patients.

Mislabeled at AMP entry, defined as red patients entering the AMP undertriaged with a lower-acuity pretriage label (yellow instead of red).

The primary outcome was time from AMP entry to first predefined critical action. Secondary outcomes included reaching predefined case-specific deterioration or death thresholds prior to intervention and time to correction of triage category. Outcomes were analyzed descriptively using within-patient paired comparisons across simulation runs.

Across 2 simulation runs, 6 paired observations were analyzed. In 4 of 5 comparisons in which a predefined critical action was performed, mislabeling was associated with longer time to predefined critical action, with delays ranging from 5 to 24 minutes. In 2 cases, these delays resulted in crossing of case-specific deterioration thresholds. In 1 additional mislabeled patient, the predefined critical action was not performed before the deterioration threshold was reached, and the patient subsequently progressed to the scripted death threshold. No correctly labelled red patient reached deterioration or death. Early correction of triage status mitigated delays, whereas delayed correction was associated with adverse progression.

In this pilot full-scale simulation study, inaccurate pretriage labeling at AMP entry was associated with delays in time-critical interventions. These findings highlight the importance of early and continuous structured reassessment and timely correction of triage categorization within AMP workflows. The results are hypothesis-generating and require confirmation in further simulation or real-world studies.

This study aimed to describe the epidemiological, clinical, and operational characteristics of violence-related emergency medical services (EMS) encounters recorded on the Anatolian side of Istanbul from 2019 to 2023, to conduct secondary descriptive comparisons by sex, and to identify factors associated with confirmed prehospital death status.

We conducted a retrospective observational registry-based analysis of records coded as “Violence & Assault.” Clinical, operational, and demographic variables were analyzed. Comparisons by sex and confirmed death status were conducted using nonparametric and categorical-data tests. In a secondary exploratory analysis, Firth-penalized multivariable logistic regression was used to estimate adjusted associations with confirmed prehospital death status.

The sample comprised 29,335 violence-related EMS encounters; most involved young adult males and occurred in urban districts. Most recorded clinical findings were normal or preserved, although a small subgroup showed physiological instability. Several sex-based differences were statistically significant, but their effect sizes were generally small. Confirmed prehospital death was recorded in 132 encounters (0.45%). In the exploratory Firth model, severe respiratory status (aOR 56.02, 95% CI 8.62-364.05), altered consciousness (aOR 10.71, 95% CI 1.67-68.67), and cyanotic skin (aOR 4.24, 95% CI 2.67-6.73) were associated with the highest adjusted odds ratios for confirmed prehospital death.

Violence-related EMS encounters were concentrated among young adult males, and most did not meet the confirmed-death definition. Nevertheless, a clinically important subgroup presented with physiological instability. In the exploratory analysis, confirmed prehospital death was most strongly associated with acute physiological compromise; operational intervals should be interpreted cautiously as potential markers of case complexity and EMS workflow rather than as causal determinants.

Trench foot develops after prolonged exposure of the feet to cold, wet conditions (e.g., during floods in cold climates), causing pain, swelling, and impaired gait. It can be prevented by maintaining dry feet and changing socks whenever they become wet. However, sock shortages are common in disaster settings. A practical alternative is cloth footwrapping. This study evaluated footwrap skill acquisition across different age groups and assessed the feasibility of footwraps as sock substitutes.

A total of 100 laypersons from four age groups completed 10 footwrapping trials. Subsequently, participants performed walking trials wearing shoes, with one foot wrapped and the other unwrapped. Technique acquisition and sock-substitution outcomes were analyzed statistically. Stability, shoe tightness, and acceptability were summarized as frequencies.

Achieving optimal footwrap tightness was the most challenging aspect of the technique. Participants aged ≥70 years required more trials and time to acquire the technique. Footwraps showed favorable results across most sock-substitution measures, except for friction-related pain reduction. Among the participants, 17 experienced loosening within 30 min, 2 reported shoe tightness, and all indicated a willingness to use footwraps as sock substitutes in shelters.

Footwraps may be practical sock alternatives in resource-limited environments; however, age-related differences in skill acquisition warrant tailored instruction.

The COVID-19 pandemic may have shaped health care workers’ (HCWs’) perceptions of emerging infectious threats and willingness to adopt new vaccines. This study examined whether COVID-19-related experiences and psychological factors were associated with Mpox vaccine acceptance among HCWs in Central Asia.

In this cross-sectional study, 3,054 HCWs from Kazakhstan, Kyrgyzstan, and Uzbekistan completed an online survey between July and November 2022. Mpox vaccine acceptance was assessed using a single 5-point Likert-scale item and analyzed as a continuous outcome. Measures included COVID-19-related experiences, fear of COVID-19 and Mpox, DASS-21, and occupational burnout. Analyses included comparative tests, multivariable linear regression, and exploratory mediation models.

Overall, 1,868 HCWs (61.2%) reported some willingness to receive Mpox vaccination, whereas 1,186 (38.8%) reported none. In bivariate analyses, acceptance varied by country and was higher among HCWs with COVID-19 frontline experience or living with high-risk individuals. In multivariable regression, fear of Mpox was the strongest correlate of acceptance, while burnout was inversely associated. Mediation analyses indicated indirect associations through fear- and distress-related pathways.

Mpox vaccine acceptance among Central Asian HCWs was associated with pandemic experience and psychological responses to infectious disease risk. Strategies should combine risk communication with burnout reduction and HCW well-being support.

To describe nursing workforce arrangements, training exposure, educational needs, and support needs for nuclear emergency medical care among Nuclear Emergency Core Hospitals (NECHs) in Japan.

This facility-level cross-sectional survey targeted all 51 NECHs. Questionnaire items were developed and reviewed for content validity through internal consensus by 3 study-team nurses or public health nurses; no pilot testing or recruitment reminders were conducted. Facility proportions included exact Clopper-Pearson 95% confidence intervals, and free-text responses underwent qualitative content analysis.

Twenty-two facilities responded (43.1%; exact 95% CI, 29.3-57.8%). Emergency departments (19/22, 86.4%) and DMAT membership (20/22, 90.9%) were common, while certified nurse specialists in radiation nursing were reported by 5 facilities (22.7%). Radiation basics and PPE donning/doffing practice were each selected by 21 facilities (95.5%). Free-text responses yielded 43 meaning units across 5 categories emphasizing recurrent training, workforce maintenance, organizational and financial support, and clearer staffing standards.

Among responding NECHs, nuclear emergency nursing preparedness relied heavily on emergency/disaster nursing infrastructure, while radiation-specific advanced nursing expertise was reported less frequently. Sustainable preparedness may benefit from recurrent practical training, broader access to radiation nursing expertise, organizational support, and policy-level staffing discussion.

This study aimed to examine the relationships between post-earthquake trauma, anxiety, stress, and stress coping strategies among university students who survived the Kahramanmaraş earthquakes.

This cross-sectional study included 384 university students who survived the Kahramanmaraş earthquakes. Data were collected using a personal information form and standardized scales assessing post-earthquake trauma, anxiety, stress, and stress coping strategies. Descriptive statistics, group comparisons, and correlation analyses were performed.

Among the participants, 35.7% had lost a relative, 47.8% had lost a friend, 10.0% reported that their homes were destroyed, 54.0% reported home damage, and 3.1% had been trapped under rubble. A strong positive correlation was found between post-earthquake trauma and anxiety scores (r = 0.714). Participants who had lost a family member, relative, or friend had significantly higher trauma and anxiety scores than those who had not. Trauma scores were also significantly higher among those who were injured, trapped under rubble, or involved in rescue efforts. Significant relationships were found between post-earthquake trauma, anxiety, stress, and stress coping strategies.

Earthquake-related experiences were associated with increased trauma, anxiety, and stress and with stress coping strategies. Early psychological assessment and psychosocial support may help reduce the psychological effects of earthquakes on university students.