Environmental influences on pregnancy outcomes after Hurricane Michael

自然界和人类的影响共同作用，造成了重大灾难之后的破坏。 像飓风这样的灾难。尽管许多研究已经考察了影响的广泛模式 灾难发生后的妊娠结局，不良结局的原因并不总是很清楚，因为 是否与环境污染物暴露、心理压力源和缺乏健康有关？ 关心。不了解灾难暴露的哪些方面是最大的促成因素 不利的后果，将不可能建立有效针对 最重要的因素。此应用程序的目标是检查以下各项的效果 环境(有害藻华、一氧化碳)暴露和普遍遭遇的灾难 暴露(停电、暴风雨损害)对妊娠相关结局的影响。我们的中心假设是 严重暴露于这些应激源中的任何一种(由强度和持续时间定义)将是 与更糟糕的结果相关。我们的具体目标是1)考察两者之间的关系 环境暴露(HAB和CO)与出生结局；2)评估一般情况下 与灾害有关的暴露(损害程度、医疗保健关闭)和出生结果；3) 确定哪些与灾难相关的暴露最能预测出生结果，以及 环境和一般灾害暴露的影响；4)聘请初级保健从业者 通过开发有关HAB和CO的CME内容，建立EOH知识和技能。我们将实现这些目标 通过将暴露于这些环境预测因素的地区的出生结果与 未曝光的区域和时间。我们将根据生态采样和 基于卫星的估计(HAB)、一氧化碳监测数据和毒物控制中心数据，以及 飓风损失报告(最先进的卫星测量、灾害声明、电力 停电数据、卫生设施关闭)和物理影响测量(风暴潮淹没、 风速、土地覆盖变化)。将在暴露于以下物质的地区和范围内进行比较 不同程度的环境污染物，以及飓风后的情况。为了促进 翻译和传播，我们将开发针对潜在风险不利的继续医学教育内容 与暴露于HAB和CO有关的妊娠和出生结局。在项目结束时， 我们的预期结果是已经确定了飓风迈克尔最相关的方面 不良的分娩结局。拟议的研究代表了一个三管齐下的创新设计- 概念上，通过确定两个综合曝露领域的潜在累积风险- 环境污染物与传统灾难；方法论上，使用合成孔径 雷达数据，以检查人类在怀孕期间暴露于HAB；以及3)翻译，由 利用对时间敏感的灾害相关环境健康调查结果进行一线继续医学教育。

The natural world and human influences work together to create the devastation that follows a major disaster such as a hurricane. Although many studies have examined broad patterns of effects on pregnancy outcomes after disasters, the causes of adverse outcomes are not always clear, as there are interrelated environmental pollutant exposures, psychological stressors, and lack of health care. Without understanding which aspects of disaster exposure are the strongest contributors to adverse outcomes, it will not be possible to establish disaster responses that efficiently target the most important factors. The objective of this application is to examine effects of environmental (harmful algal bloom, carbon monoxide) exposures and generally encountered disaster exposures (power outages, storm damage) on pregnancy-related outcomes. Our central hypothesis is that severe exposure (defined by both magnitude and duration) to any of these stressors will be associated with worse outcomes. Our specific aims are to 1) Examine the relationship between environmental exposures (HAB and CO) and birth outcomes; 2) Assess the relationship between general disaster-related exposures (extent of damage, health care closings) and birth outcomes; 3) Determine which disaster- related exposures most strongly predict birth outcomes, and the combined effect of environmental and general disaster exposure; 4) Engage primary care practitioners to build EOH knowledge and skills by developing CME content on HAB and CO. We will accomplish these specific aims by comparing birth outcomes in areas exposed to these environmental predictors to areas and times that are unexposed. We will map exposure patterns based on ecological sampling and satellite-based estimates (HAB), CO surveillance data and poison control centers data, and hurricane damage reports (state of the art satellite measurements, disaster declarations, power outage data, health facility closing) and physical impacts measurements (storm surge inundation, wind speed, land cover change). Comparisons will be made across and within areas exposed to different levels of environmental contaminants, as well as pre-post hurricane. To promote translation and dissemination, we will develop CME content targeting the potential risks adverse pregnancy and birth outcomes associated with exposures to HAB and CO. At the end of the project, our expected outcome is to have identified the aspects of Hurricane Michael most associated with adverse birth outcomes. The proposed research represents a three-pronged innovative design- conceptually, by determining the potential cumulative risk of two integrated exposure domains - environmental contaminants and traditional disaster; methodologically, by using Synthetic Aperture Radar data to examine exposures to HAB during pregnancy in humans; and 3) translational, by utilizing time sensitive disaster-related environmental health findings for frontline CME.