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BT 15.000 718.042 Td /F2 21.0 Tf  [(Non-Communicable Diseases in Emergencies: A Call to Action)] TJ ET
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BT 15.000 700.036 Td /F3 9.8 Tf  [(September 6, 2013)] TJ ET
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BT 26.250 635.283 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 615.329 Td /F1 9.8 Tf  [(Recent years have demonstrated the devastating health consequences of complex emergencies and natural disasters and )] TJ ET
BT 26.250 603.424 Td /F1 9.8 Tf  [(thereby highlighted the importance of comprehensive and collaborative approaches to humanitarian responses and risk )] TJ ET
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BT 26.250 579.615 Td /F1 9.8 Tf  [(and development; a threat that is magnified by and during emergencies.)] TJ ET
BT 26.250 560.210 Td /F1 9.8 Tf  [(Noncommunicable diseases, however, continue to receive little attention from humanitarian organisations in the acute phase of )] TJ ET
BT 26.250 548.305 Td /F1 9.8 Tf  [(disaster and emergency response.)] TJ ET
BT 26.250 528.900 Td /F1 9.8 Tf  [(This paper calls on all sectors to recognise and address the specific health challenges posed by noncommunicable diseases in )] TJ ET
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BT 26.250 461.877 Td /F1 9.8 Tf  [(� Incorporation of noncommunicable diseases into existing emergency-related policies, standards, and resources;)] TJ ET
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BT 26.250 377.655 Td /F4 12.0 Tf  [(Background)] TJ ET
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BT 64.197 361.589 Td /F1 8.7 Tf  [(st)] TJ ET
BT 70.940 357.701 Td /F1 9.8 Tf  [( century, we live in a world regularly affected by emergencies)] TJ ET
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BT 343.925 357.701 Td /F1 9.8 Tf  [(, often with severe local and regional health )] TJ ET
BT 26.250 345.796 Td /F1 9.8 Tf  [(consequences. Recent examples include the devastating hurricanes and floods in the US, Australia and Pakistan; earthquakes )] TJ ET
BT 26.250 333.891 Td /F1 9.8 Tf  [(in Haiti, Japan, and New Zealand; and the conflict in Syria. In the context of climate change and corrosive political instability in )] TJ ET
BT 26.250 321.987 Td /F1 9.8 Tf  [(many world regions, it is unlikely that we will see a reduction in disastfers)] TJ ET
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BT 350.159 321.987 Td /F1 9.8 Tf  [( or their resulting health impacts.)] TJ ET
BT 26.250 302.582 Td /F1 9.8 Tf  [(Simultaneously we are witnessing an increase in the burden of noncommunicable diseases \(NCDs\), including, but not limited to, )] TJ ET
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BT 26.250 278.772 Td /F1 9.8 Tf  [(too in younger populations secondary to the obesity epidemic and more sedentary lifestyles. Described by UN Secretary )] TJ ET
BT 26.250 266.868 Td /F1 9.8 Tf  [(General Ban Ki-Moon as a �public health emergency�, NCDs are already the world�s leading cause of death. The diseases are )] TJ ET
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BT 192.022 231.153 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 211.749 Td /F1 9.8 Tf  [(NCDs also act as a barrier to economic development and equity causing financial and social stress)] TJ ET
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BT 471.444 211.749 Td /F1 9.8 Tf  [(. In 2005, NCDs cost the )] TJ ET
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BT 181.170 187.939 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 168.534 Td /F1 9.8 Tf  [(While it is widely accepted that emergency situations render this vulnerable population increasingly susceptible to overcrowding, )] TJ ET
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BT 446.251 158.137 Td /F4 8.7 Tf  [(3)] TJ ET
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BT 26.250 144.725 Td /F1 9.8 Tf  [(specifically aimed to mitigate these effects. These factors can also interact synergistically to result in an increased incidence of )] TJ ET
BT 26.250 132.820 Td /F1 9.8 Tf  [(NCDs as well as progression of existing disease. In this light, NCDs are a poverty-cycle catalyst, exacerbated during a disaster.)] TJ ET
BT 26.250 113.415 Td /F1 9.8 Tf  [(During and following emergencies, there is often a fragmented approach to health intervention and coordination. Health )] TJ ET
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BT 150.838 89.606 Td /F1 9.8 Tf  [(. Health systems can be compromised and health policy formulation disrupted)] TJ ET
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BT 26.250 676.290 Td /F1 9.8 Tf  [(Demaio A, Jamieson J, Horn R, de Courten M, Tellier S. Non-Communicable Diseases in Emergencies: A Call to Action. PLOS )] TJ ET
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BT 26.250 635.283 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 615.329 Td /F1 9.8 Tf  [(Recent years have demonstrated the devastating health consequences of complex emergencies and natural disasters and )] TJ ET
BT 26.250 603.424 Td /F1 9.8 Tf  [(thereby highlighted the importance of comprehensive and collaborative approaches to humanitarian responses and risk )] TJ ET
BT 26.250 591.519 Td /F1 9.8 Tf  [(reduction. Simultaneously, noncommunicable diseases are now recognised as a real and growing threat to population health )] TJ ET
BT 26.250 579.615 Td /F1 9.8 Tf  [(and development; a threat that is magnified by and during emergencies.)] TJ ET
BT 26.250 560.210 Td /F1 9.8 Tf  [(Noncommunicable diseases, however, continue to receive little attention from humanitarian organisations in the acute phase of )] TJ ET
BT 26.250 548.305 Td /F1 9.8 Tf  [(disaster and emergency response.)] TJ ET
BT 26.250 528.900 Td /F1 9.8 Tf  [(This paper calls on all sectors to recognise and address the specific health challenges posed by noncommunicable diseases in )] TJ ET
BT 26.250 516.996 Td /F1 9.8 Tf  [(emergencies and disaster situations. This publication aims to highlight the need for:)] TJ ET
BT 26.250 497.591 Td /F1 9.8 Tf  [(� Increased research on morbidity and mortality patterns due to noncommunicable diseases during and following emergencies;)] TJ ET
BT 26.250 485.686 Td /F1 9.8 Tf  [(� Raised awareness through greater advocacy for the issue and challenges of noncommunicable diseases during and following )] TJ ET
BT 26.250 473.781 Td /F1 9.8 Tf  [(emergencies;)] TJ ET
BT 26.250 461.877 Td /F1 9.8 Tf  [(� Incorporation of noncommunicable diseases into existing emergency-related policies, standards, and resources;)] TJ ET
BT 26.250 449.972 Td /F1 9.8 Tf  [(� Development of technical guidelines on the clinical management of noncommunicable diseases in emergencies;)] TJ ET
BT 26.250 438.067 Td /F1 9.8 Tf  [(� Greater integration and coordination in health service provision during and following emergencies;)] TJ ET
BT 26.250 426.162 Td /F1 9.8 Tf  [(� Integrating noncommunicable diseases into practical and academic training of emergency workers and emergency-response )] TJ ET
BT 26.250 414.258 Td /F1 9.8 Tf  [(coordinators.)] TJ ET
BT 26.250 377.655 Td /F4 12.0 Tf  [(Background)] TJ ET
BT 26.250 357.701 Td /F1 9.8 Tf  [(In the 21)] TJ ET
BT 64.197 361.589 Td /F1 8.7 Tf  [(st)] TJ ET
BT 70.940 357.701 Td /F1 9.8 Tf  [( century, we live in a world regularly affected by emergencies)] TJ ET
BT 334.287 361.589 Td /F1 8.7 Tf  [([1])] TJ ET
BT 343.925 357.701 Td /F1 9.8 Tf  [(, often with severe local and regional health )] TJ ET
BT 26.250 345.796 Td /F1 9.8 Tf  [(consequences. Recent examples include the devastating hurricanes and floods in the US, Australia and Pakistan; earthquakes )] TJ ET
BT 26.250 333.891 Td /F1 9.8 Tf  [(in Haiti, Japan, and New Zealand; and the conflict in Syria. In the context of climate change and corrosive political instability in )] TJ ET
BT 26.250 321.987 Td /F1 9.8 Tf  [(many world regions, it is unlikely that we will see a reduction in disastfers)] TJ ET
BT 340.522 325.875 Td /F1 8.7 Tf  [([2])] TJ ET
BT 350.159 321.987 Td /F1 9.8 Tf  [( or their resulting health impacts.)] TJ ET
BT 26.250 302.582 Td /F1 9.8 Tf  [(Simultaneously we are witnessing an increase in the burden of noncommunicable diseases \(NCDs\), including, but not limited to, )] TJ ET
BT 26.250 290.677 Td /F1 9.8 Tf  [(heart disease, diabetes, cancers and chronic lung diseases. This phenomenon is not only visable in aging populations, but now )] TJ ET
BT 26.250 278.772 Td /F1 9.8 Tf  [(too in younger populations secondary to the obesity epidemic and more sedentary lifestyles. Described by UN Secretary )] TJ ET
BT 26.250 266.868 Td /F1 9.8 Tf  [(General Ban Ki-Moon as a �public health emergency�, NCDs are already the world�s leading cause of death. The diseases are )] TJ ET
BT 26.250 254.963 Td /F1 9.8 Tf  [(estimated to be responsible for over 60% of global mortality each year with 80% of these deaths occurring in low- and middle-)] TJ ET
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BT 98.802 243.058 Td /F1 9.8 Tf  [(. In addition, NCDs now contribute 54% of global Disability-Adjusted Life Years Lost with a majority of this )] TJ ET
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BT 192.022 231.153 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 211.749 Td /F1 9.8 Tf  [(NCDs also act as a barrier to economic development and equity causing financial and social stress)] TJ ET
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BT 471.444 211.749 Td /F1 9.8 Tf  [(. In 2005, NCDs cost the )] TJ ET
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BT 181.170 187.939 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 168.534 Td /F1 9.8 Tf  [(While it is widely accepted that emergency situations render this vulnerable population increasingly susceptible to overcrowding, )] TJ ET
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0.267 0.267 0.267 rg
BT 446.251 158.137 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 451.069 160.518 Td /F1 8.7 Tf  [(,)] TJ ET
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BT 26.250 144.725 Td /F1 9.8 Tf  [(specifically aimed to mitigate these effects. These factors can also interact synergistically to result in an increased incidence of )] TJ ET
BT 26.250 132.820 Td /F1 9.8 Tf  [(NCDs as well as progression of existing disease. In this light, NCDs are a poverty-cycle catalyst, exacerbated during a disaster.)] TJ ET
BT 26.250 113.415 Td /F1 9.8 Tf  [(During and following emergencies, there is often a fragmented approach to health intervention and coordination. Health )] TJ ET
BT 26.250 101.511 Td /F1 9.8 Tf  [(authorities may not have the capacity to monitor and evaluate efforts and there is no single agency with the tools, resources and )] TJ ET
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BT 146.019 91.113 Td /F4 8.7 Tf  [(9)] TJ ET
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BT 150.838 89.606 Td /F1 9.8 Tf  [(. Health systems can be compromised and health policy formulation disrupted)] TJ ET
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BT 492.949 91.113 Td /F4 8.7 Tf  [(10)] TJ ET
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BT 502.586 89.606 Td /F1 9.8 Tf  [(. Population )] TJ ET
BT 26.250 77.701 Td /F1 9.8 Tf  [(health needs escalate and humanitarian personnel enter the arena to provide essential services)] TJ ET
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BT 15.000 700.036 Td /F3 9.8 Tf  [(September 6, 2013)] TJ ET
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BT 26.250 635.283 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 615.329 Td /F1 9.8 Tf  [(Recent years have demonstrated the devastating health consequences of complex emergencies and natural disasters and )] TJ ET
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BT 26.250 377.655 Td /F4 12.0 Tf  [(Background)] TJ ET
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BT 70.940 357.701 Td /F1 9.8 Tf  [( century, we live in a world regularly affected by emergencies)] TJ ET
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BT 26.250 567.060 Td /F1 9.8 Tf  [(The outcome is greater morbidity resulting from a lack of evidence-based guidelines and a resulting healthcare gap for )] TJ ET
BT 26.250 555.155 Td /F1 9.8 Tf  [(populations with chronic diseases during and following emergencies. This gap, and the resulting morbidity, is yet to be )] TJ ET
BT 26.250 543.250 Td /F1 9.8 Tf  [(sufficiently quantified.)] TJ ET
BT 26.250 506.648 Td /F4 12.0 Tf  [(The Result of Noncommunicable Diseases in Emergencies)] TJ ET
BT 26.250 486.693 Td /F1 9.8 Tf  [(When considering NCDs and emergencies, the focus should be on the overall goals of the health response, particularly in the )] TJ ET
BT 26.250 474.789 Td /F1 9.8 Tf  [(acute phases of an emergency. Effective emergency action can avoid the escalation of an event into a disaster. Emergency )] TJ ET
BT 26.250 462.884 Td /F1 9.8 Tf  [(management involves plans and institutional arrangements to engage and guide the efforts of government, non-government, )] TJ ET
BT 26.250 450.979 Td /F1 9.8 Tf  [(voluntary and private agencies in comprehensive and coordinated ways to respond to the entire spectrum of emergency needs. )] TJ ET
BT 26.250 439.074 Td /F1 9.8 Tf  [(Its goal is directed towards avoiding excess morbidity and mortality \(UNISDR\).)] TJ ET
BT 26.250 419.670 Td /F1 9.8 Tf  [(There are several ways in which excess morbidity and mortality related to NCDs during emergencies and disasters might occur, )] TJ ET
BT 26.250 407.765 Td /F1 9.8 Tf  [(for example:)] TJ ET
BT 26.250 388.360 Td /F4 9.8 Tf  [(a\) )] TJ ET
BT 37.628 388.360 Td /F4 9.8 Tf  [(Persons with NCDs are more vulnerable in emergencies and disasters)] TJ ET
BT 26.250 368.955 Td /F1 9.8 Tf  [(For individuals with NCDs, their condition may deteriorate as a direct result of the emergency. They are less able to cope )] TJ ET
BT 26.250 357.051 Td /F1 9.8 Tf  [(without access to adequate nutrition, medications and follow-up)] TJ ET
0.267 0.267 0.267 rg
BT 299.923 358.558 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 304.741 360.939 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 307.151 358.558 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 316.788 360.939 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 319.197 358.558 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 328.835 357.051 Td /F1 9.8 Tf  [(. This includes individuals living with disabilities. For )] TJ ET
BT 26.250 345.146 Td /F1 9.8 Tf  [(example, people with diabetes may loose glucometers and insulin stock, lacking essential back-up supplies)] TJ ET
0.267 0.267 0.267 rg
BT 487.942 346.653 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 492.760 345.146 Td /F1 9.8 Tf  [(. Dialysis centres )] TJ ET
BT 26.250 333.241 Td /F1 9.8 Tf  [(may be destroyed and home healthcare services may not be operational)] TJ ET
0.267 0.267 0.267 rg
BT 338.396 334.748 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 348.034 333.241 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 313.836 Td /F4 9.8 Tf  [(b\) )] TJ ET
BT 38.165 313.836 Td /F4 9.8 Tf  [(Emergencies exacerbate NCDs leading to acute complications)] TJ ET
BT 26.250 294.432 Td /F1 9.8 Tf  [(Many NCDs require close and sustained interaction with health systems and providers. During and following an emergency, this )] TJ ET
BT 26.250 282.527 Td /F1 9.8 Tf  [(is often not possible. Due to interruptions in access to care and medications, acute exacerbations of NCDs can occur)] TJ ET
0.267 0.267 0.267 rg
BT 529.682 284.034 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 539.319 286.415 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 541.728 284.034 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 551.366 282.527 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 270.622 Td /F1 9.8 Tf  [(Common examples include exacerbations of chronic respiratory diseases and infectious ulcers in persons with diabetes mellitus)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 260.225 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 31.069 258.717 Td /F1 9.8 Tf  [(. Conditions that caused little or no impact on activities of daily living may deteriorate causing not only greater morbidity )] TJ ET
BT 26.250 246.813 Td /F1 9.8 Tf  [(through debilitating symptoms but also loss of income, security)] TJ ET
0.267 0.267 0.267 rg
BT 296.647 248.320 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 301.465 250.701 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 303.875 248.320 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 313.512 246.813 Td /F1 9.8 Tf  [(, limb or life.)] TJ ET
BT 26.250 227.408 Td /F4 9.8 Tf  [(c\) )] TJ ET
BT 37.628 227.408 Td /F4 9.8 Tf  [(Long-term implications of NCDs resulting from emergencies and their management)] TJ ET
BT 26.250 208.003 Td /F1 9.8 Tf  [(The morbidity and disability associated with NCDs is normally life-long. Therefore, suboptimal management during and after a )] TJ ET
BT 26.250 196.098 Td /F1 9.8 Tf  [(disaster not only has immediate health effects, but can also have lasting social and health ramifications. A lack of appropriate )] TJ ET
BT 26.250 184.194 Td /F1 9.8 Tf  [(care for even a short period can result in greater levels of chronic morbidity and suffering, as well as poverty entrenchment)] TJ ET
0.267 0.267 0.267 rg
BT 553.510 185.701 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 558.329 184.194 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 164.789 Td /F4 9.8 Tf  [(d\) The multifaceted impact of NCDs and emergencies)] TJ ET
BT 26.250 145.384 Td /F1 9.8 Tf  [(Developing countries are often disproportionately burdened by both NCDs and disasters in comparison to higher income )] TJ ET
BT 26.250 133.479 Td /F1 9.8 Tf  [(countries)] TJ ET
0.267 0.267 0.267 rg
BT 65.806 134.987 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 75.443 133.479 Td /F1 9.8 Tf  [(. Developing countries face the greatest burden from global and regional conflict as well as increased vulnerability to )] TJ ET
BT 26.250 121.575 Td /F1 9.8 Tf  [(the effects of climate change and natural disasters. Many of these situations are exacerbated by the increasing levels of )] TJ ET
BT 26.250 109.670 Td /F1 9.8 Tf  [(urbanisation and slum-populations. Additionally, the �double burden�)] TJ ET
0.267 0.267 0.267 rg
BT 320.515 111.177 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 330.152 109.670 Td /F1 9.8 Tf  [( of disease also contributes to the multifaceted impact of )] TJ ET
BT 26.250 97.765 Td /F1 9.8 Tf  [(NCDs and emergencies.)] TJ ET
BT 26.250 61.163 Td /F4 12.0 Tf  [(NCDs in Emergencies and Disasters: A Way Forward)] TJ ET
BT 26.250 41.208 Td /F1 9.8 Tf  [(In order to address the problem of NCDs in emergencies and minimise excess morbidity and mortality, the authors of this paper )] TJ ET
Q
q
15.000 26.923 577.500 750.077 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(long-term impacts and management of NCDs. There is a resulting paucity of NCDs in operational emergency guidelines and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(policies, for example:)] TJ ET
0.271 0.267 0.267 RG
40.337 739.134 m 
40.337 739.581 40.154 740.025 39.838 740.341 c
39.522 740.657 39.078 740.840 38.631 740.840 c
38.185 740.840 37.741 740.657 37.425 740.341 c
37.109 740.025 36.925 739.581 36.925 739.134 c
36.925 738.688 37.109 738.244 37.425 737.928 c
37.741 737.612 38.185 737.428 38.631 737.428 c
39.078 737.428 39.522 737.612 39.838 737.928 c
40.154 738.244 40.337 738.688 40.337 739.134 c f
BT 45.750 736.167 Td /F1 9.8 Tf  [(The Inter Agency Steering Committee \(IASC\) has no guidelines for NCDs, although there is a guideline on older persons )] TJ ET
BT 45.750 724.262 Td /F1 9.8 Tf  [(that mentions the need for medication for chronic diseases;)] TJ ET
40.337 711.575 m 
40.337 712.021 40.154 712.465 39.838 712.781 c
39.522 713.097 39.078 713.281 38.631 713.281 c
38.185 713.281 37.741 713.097 37.425 712.781 c
37.109 712.465 36.925 712.021 36.925 711.575 c
36.925 711.128 37.109 710.684 37.425 710.368 c
37.741 710.052 38.185 709.869 38.631 709.869 c
39.078 709.869 39.522 710.052 39.838 710.368 c
40.154 710.684 40.337 711.128 40.337 711.575 c f
BT 45.750 708.607 Td /F1 9.8 Tf  [(The Inter Agency Emergency Health Kit, coordinated by the WHO, contains limited medications for NCDs \(e.g. no insulin in )] TJ ET
BT 45.750 696.702 Td /F1 9.8 Tf  [(the current version\);)] TJ ET
0.267 0.267 0.267 rg
BT 132.447 698.210 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
40.337 684.015 m 
40.337 684.462 40.154 684.906 39.838 685.222 c
39.522 685.538 39.078 685.721 38.631 685.721 c
38.185 685.721 37.741 685.538 37.425 685.222 c
37.109 684.906 36.925 684.462 36.925 684.015 c
36.925 683.569 37.109 683.125 37.425 682.809 c
37.741 682.493 38.185 682.309 38.631 682.309 c
39.078 682.309 39.522 682.493 39.838 682.809 c
40.154 683.125 40.337 683.569 40.337 684.015 c f
BT 45.750 681.048 Td /F1 9.8 Tf  [(Although the WHO has invested in producing the Field Manual � Communicable Disease Control in Emergencies, it has not )] TJ ET
BT 45.750 669.143 Td /F1 9.8 Tf  [(produced a similar resource on NCDs)] TJ ET
0.267 0.267 0.267 rg
BT 208.292 670.650 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 217.930 669.143 Td /F1 9.8 Tf  [( � though the WHO will soon release new clinical guidelines on effective mental )] TJ ET
BT 45.750 657.238 Td /F1 9.8 Tf  [(health care for adults and children exposed to trauma and loss;)] TJ ET
0.267 0.267 0.267 rg
BT 317.804 658.745 Td /F4 8.7 Tf  [(28)] TJ ET
0.271 0.267 0.267 rg
40.337 644.551 m 
40.337 644.998 40.154 645.442 39.838 645.758 c
39.522 646.073 39.078 646.257 38.631 646.257 c
38.185 646.257 37.741 646.073 37.425 645.758 c
37.109 645.442 36.925 644.998 36.925 644.551 c
36.925 644.104 37.109 643.660 37.425 643.344 c
37.741 643.029 38.185 642.845 38.631 642.845 c
39.078 642.845 39.522 643.029 39.838 643.344 c
40.154 643.660 40.337 644.104 40.337 644.551 c f
BT 45.750 641.583 Td /F1 9.8 Tf  [(The 2012 UK Government report �Reducing Risks of Future Disasters� importantly mentions the �mental health damage� )] TJ ET
BT 45.750 629.679 Td /F1 9.8 Tf  [(associated with disasters as well as disability resulting from trauma, but provides no explicit direction on disaster risk )] TJ ET
BT 45.750 617.774 Td /F1 9.8 Tf  [(reduction with regards to concomitant chronic disease burden, or resulting morbidity associated with other NCDs; )] TJ ET
0.267 0.267 0.267 rg
BT 535.600 619.281 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
40.337 605.087 m 
40.337 605.533 40.154 605.977 39.838 606.293 c
39.522 606.609 39.078 606.793 38.631 606.793 c
38.185 606.793 37.741 606.609 37.425 606.293 c
37.109 605.977 36.925 605.533 36.925 605.087 c
36.925 604.640 37.109 604.196 37.425 603.880 c
37.741 603.564 38.185 603.380 38.631 603.380 c
39.078 603.380 39.522 603.564 39.838 603.880 c
40.154 604.196 40.337 604.640 40.337 605.087 c f
BT 45.750 602.119 Td /F1 9.8 Tf  [(The most recent edition of the Sphere Guidelines includes 40 pages on health, but only one of those paragraph refers to )] TJ ET
BT 45.750 590.214 Td /F1 9.8 Tf  [(NCDs.)] TJ ET
0.267 0.267 0.267 rg
BT 74.454 591.722 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 567.060 Td /F1 9.8 Tf  [(The outcome is greater morbidity resulting from a lack of evidence-based guidelines and a resulting healthcare gap for )] TJ ET
BT 26.250 555.155 Td /F1 9.8 Tf  [(populations with chronic diseases during and following emergencies. This gap, and the resulting morbidity, is yet to be )] TJ ET
BT 26.250 543.250 Td /F1 9.8 Tf  [(sufficiently quantified.)] TJ ET
BT 26.250 506.648 Td /F4 12.0 Tf  [(The Result of Noncommunicable Diseases in Emergencies)] TJ ET
BT 26.250 486.693 Td /F1 9.8 Tf  [(When considering NCDs and emergencies, the focus should be on the overall goals of the health response, particularly in the )] TJ ET
BT 26.250 474.789 Td /F1 9.8 Tf  [(acute phases of an emergency. Effective emergency action can avoid the escalation of an event into a disaster. Emergency )] TJ ET
BT 26.250 462.884 Td /F1 9.8 Tf  [(management involves plans and institutional arrangements to engage and guide the efforts of government, non-government, )] TJ ET
BT 26.250 450.979 Td /F1 9.8 Tf  [(voluntary and private agencies in comprehensive and coordinated ways to respond to the entire spectrum of emergency needs. )] TJ ET
BT 26.250 439.074 Td /F1 9.8 Tf  [(Its goal is directed towards avoiding excess morbidity and mortality \(UNISDR\).)] TJ ET
BT 26.250 419.670 Td /F1 9.8 Tf  [(There are several ways in which excess morbidity and mortality related to NCDs during emergencies and disasters might occur, )] TJ ET
BT 26.250 407.765 Td /F1 9.8 Tf  [(for example:)] TJ ET
BT 26.250 388.360 Td /F4 9.8 Tf  [(a\) )] TJ ET
BT 37.628 388.360 Td /F4 9.8 Tf  [(Persons with NCDs are more vulnerable in emergencies and disasters)] TJ ET
BT 26.250 368.955 Td /F1 9.8 Tf  [(For individuals with NCDs, their condition may deteriorate as a direct result of the emergency. They are less able to cope )] TJ ET
BT 26.250 357.051 Td /F1 9.8 Tf  [(without access to adequate nutrition, medications and follow-up)] TJ ET
0.267 0.267 0.267 rg
BT 299.923 358.558 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 304.741 360.939 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 307.151 358.558 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 316.788 360.939 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 319.197 358.558 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 328.835 357.051 Td /F1 9.8 Tf  [(. This includes individuals living with disabilities. For )] TJ ET
BT 26.250 345.146 Td /F1 9.8 Tf  [(example, people with diabetes may loose glucometers and insulin stock, lacking essential back-up supplies)] TJ ET
0.267 0.267 0.267 rg
BT 487.942 346.653 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 492.760 345.146 Td /F1 9.8 Tf  [(. Dialysis centres )] TJ ET
BT 26.250 333.241 Td /F1 9.8 Tf  [(may be destroyed and home healthcare services may not be operational)] TJ ET
0.267 0.267 0.267 rg
BT 338.396 334.748 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 348.034 333.241 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 313.836 Td /F4 9.8 Tf  [(b\) )] TJ ET
BT 38.165 313.836 Td /F4 9.8 Tf  [(Emergencies exacerbate NCDs leading to acute complications)] TJ ET
BT 26.250 294.432 Td /F1 9.8 Tf  [(Many NCDs require close and sustained interaction with health systems and providers. During and following an emergency, this )] TJ ET
BT 26.250 282.527 Td /F1 9.8 Tf  [(is often not possible. Due to interruptions in access to care and medications, acute exacerbations of NCDs can occur)] TJ ET
0.267 0.267 0.267 rg
BT 529.682 284.034 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 539.319 286.415 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 541.728 284.034 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 551.366 282.527 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 270.622 Td /F1 9.8 Tf  [(Common examples include exacerbations of chronic respiratory diseases and infectious ulcers in persons with diabetes mellitus)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 260.225 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 31.069 258.717 Td /F1 9.8 Tf  [(. Conditions that caused little or no impact on activities of daily living may deteriorate causing not only greater morbidity )] TJ ET
BT 26.250 246.813 Td /F1 9.8 Tf  [(through debilitating symptoms but also loss of income, security)] TJ ET
0.267 0.267 0.267 rg
BT 296.647 248.320 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 301.465 250.701 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 303.875 248.320 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 313.512 246.813 Td /F1 9.8 Tf  [(, limb or life.)] TJ ET
BT 26.250 227.408 Td /F4 9.8 Tf  [(c\) )] TJ ET
BT 37.628 227.408 Td /F4 9.8 Tf  [(Long-term implications of NCDs resulting from emergencies and their management)] TJ ET
BT 26.250 208.003 Td /F1 9.8 Tf  [(The morbidity and disability associated with NCDs is normally life-long. Therefore, suboptimal management during and after a )] TJ ET
BT 26.250 196.098 Td /F1 9.8 Tf  [(disaster not only has immediate health effects, but can also have lasting social and health ramifications. A lack of appropriate )] TJ ET
BT 26.250 184.194 Td /F1 9.8 Tf  [(care for even a short period can result in greater levels of chronic morbidity and suffering, as well as poverty entrenchment)] TJ ET
0.267 0.267 0.267 rg
BT 553.510 185.701 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 558.329 184.194 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 164.789 Td /F4 9.8 Tf  [(d\) The multifaceted impact of NCDs and emergencies)] TJ ET
BT 26.250 145.384 Td /F1 9.8 Tf  [(Developing countries are often disproportionately burdened by both NCDs and disasters in comparison to higher income )] TJ ET
BT 26.250 133.479 Td /F1 9.8 Tf  [(countries)] TJ ET
0.267 0.267 0.267 rg
BT 65.806 134.987 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 75.443 133.479 Td /F1 9.8 Tf  [(. Developing countries face the greatest burden from global and regional conflict as well as increased vulnerability to )] TJ ET
BT 26.250 121.575 Td /F1 9.8 Tf  [(the effects of climate change and natural disasters. Many of these situations are exacerbated by the increasing levels of )] TJ ET
BT 26.250 109.670 Td /F1 9.8 Tf  [(urbanisation and slum-populations. Additionally, the �double burden�)] TJ ET
0.267 0.267 0.267 rg
BT 320.515 111.177 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 330.152 109.670 Td /F1 9.8 Tf  [( of disease also contributes to the multifaceted impact of )] TJ ET
BT 26.250 97.765 Td /F1 9.8 Tf  [(NCDs and emergencies.)] TJ ET
BT 26.250 61.163 Td /F4 12.0 Tf  [(NCDs in Emergencies and Disasters: A Way Forward)] TJ ET
BT 26.250 41.208 Td /F1 9.8 Tf  [(In order to address the problem of NCDs in emergencies and minimise excess morbidity and mortality, the authors of this paper )] TJ ET
Q
q
15.000 26.923 577.500 750.077 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(long-term impacts and management of NCDs. There is a resulting paucity of NCDs in operational emergency guidelines and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(policies, for example:)] TJ ET
0.271 0.267 0.267 RG
40.337 739.134 m 
40.337 739.581 40.154 740.025 39.838 740.341 c
39.522 740.657 39.078 740.840 38.631 740.840 c
38.185 740.840 37.741 740.657 37.425 740.341 c
37.109 740.025 36.925 739.581 36.925 739.134 c
36.925 738.688 37.109 738.244 37.425 737.928 c
37.741 737.612 38.185 737.428 38.631 737.428 c
39.078 737.428 39.522 737.612 39.838 737.928 c
40.154 738.244 40.337 738.688 40.337 739.134 c f
BT 45.750 736.167 Td /F1 9.8 Tf  [(The Inter Agency Steering Committee \(IASC\) has no guidelines for NCDs, although there is a guideline on older persons )] TJ ET
BT 45.750 724.262 Td /F1 9.8 Tf  [(that mentions the need for medication for chronic diseases;)] TJ ET
40.337 711.575 m 
40.337 712.021 40.154 712.465 39.838 712.781 c
39.522 713.097 39.078 713.281 38.631 713.281 c
38.185 713.281 37.741 713.097 37.425 712.781 c
37.109 712.465 36.925 712.021 36.925 711.575 c
36.925 711.128 37.109 710.684 37.425 710.368 c
37.741 710.052 38.185 709.869 38.631 709.869 c
39.078 709.869 39.522 710.052 39.838 710.368 c
40.154 710.684 40.337 711.128 40.337 711.575 c f
BT 45.750 708.607 Td /F1 9.8 Tf  [(The Inter Agency Emergency Health Kit, coordinated by the WHO, contains limited medications for NCDs \(e.g. no insulin in )] TJ ET
BT 45.750 696.702 Td /F1 9.8 Tf  [(the current version\);)] TJ ET
0.267 0.267 0.267 rg
BT 132.447 698.210 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
40.337 684.015 m 
40.337 684.462 40.154 684.906 39.838 685.222 c
39.522 685.538 39.078 685.721 38.631 685.721 c
38.185 685.721 37.741 685.538 37.425 685.222 c
37.109 684.906 36.925 684.462 36.925 684.015 c
36.925 683.569 37.109 683.125 37.425 682.809 c
37.741 682.493 38.185 682.309 38.631 682.309 c
39.078 682.309 39.522 682.493 39.838 682.809 c
40.154 683.125 40.337 683.569 40.337 684.015 c f
BT 45.750 681.048 Td /F1 9.8 Tf  [(Although the WHO has invested in producing the Field Manual � Communicable Disease Control in Emergencies, it has not )] TJ ET
BT 45.750 669.143 Td /F1 9.8 Tf  [(produced a similar resource on NCDs)] TJ ET
0.267 0.267 0.267 rg
BT 208.292 670.650 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
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BT 26.250 767.476 Td /F1 9.8 Tf  [(suggest:)] TJ ET
BT 26.250 748.071 Td /F4 9.8 Tf  [(1. )] TJ ET
BT 37.092 748.071 Td /F4 9.8 Tf  [(Comprehensive review of the current scientific literature)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(A full and comprehensive review of the current global scientific literature relating to NCDs in emergencies and disaster )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(situations is needed in order to build evidence-based policies and guidelines. Existing research should be evaluated, allowing )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(for assessment of current interventions and identification of future interventional possibilities. In recent years, there have been )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(several efforts to try and coordinate information, needs assessments, and disaster response, such as the efforts by the )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Cochrane review with EvidenceAid. Although admirable, these efforts continue to exclude specific focus on management of )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(chronic diseases in disaster response at present.)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(Uniquely, a full assessment of evidenced-based practice in assessing and treating chronic disease in disaster may not be )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(plausible in the classical sense since this is more of a �modern era epidemic.� In decades past, chronic diseases did not affect )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(the sheer number of people that they do now, nor did they present as a pressing consideration during a disaster. As a result, it )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(will be vastly important to also collect and assess anecdotal evidence from first responders, humanitarian organisations, and )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(governements who have recently experienced a large scale disaster to be able to fully understand the scope of chronic )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(diseases in disaster and emergency settings.)] TJ ET
BT 26.250 570.810 Td /F4 9.8 Tf  [(2. )] TJ ET
BT 37.092 570.810 Td /F4 9.8 Tf  [(Increased awareness of the importance of NCDs in emergencies)] TJ ET
BT 26.250 551.405 Td /F1 9.8 Tf  [(Greater advocacy and awareness surrounding NCDs and emergencies is vital. Discussion of NCDs specific to emergency )] TJ ET
BT 26.250 539.500 Td /F1 9.8 Tf  [(response at the global level is imperative, as well as appropriate allocation of funding specific to chronic disease in disaster. )] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(Strides towards this have indeed been underway in venues such as the Geneva Health Forum, the American Public Health )] TJ ET
BT 26.250 515.691 Td /F1 9.8 Tf  [(Association, as well as organization specific fora such as the Red Cross Movement and Medecins sans frontieres. Over the last )] TJ ET
BT 26.250 503.786 Td /F1 9.8 Tf  [(couple of years the authors of this article have involved themselves in all of the above, supporting the discussions.)] TJ ET
BT 26.250 484.381 Td /F4 9.8 Tf  [(3. Increased research on morbidity and mortality patterns during and following an emergency)] TJ ET
BT 26.250 464.976 Td /F1 9.8 Tf  [(Further research is needed with regard to the patterns of morbidity and mortality related to NCDs in emergencies. Acute )] TJ ET
BT 26.250 453.072 Td /F1 9.8 Tf  [(complications, long-term complications and disease progression need to be qualified and quantified. Health outcome )] TJ ET
BT 26.250 441.167 Td /F1 9.8 Tf  [(assessments of disasters should incorporate NCDs as a factor impacting the current and potential health problems in a )] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(population affected by a disaster along the proposals made during the 15th World Congress on Disaster and Emergency )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(Medicine in Amsterdam \(2007\) regarding assessing the public health dimension of disasters.)] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(One viable option would be the establishment of a coordinated, international, open database focusing on the epidemiology of )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(NCDs during and following emergencies around the world. A platform for government, academic, NGO and IGO data, this could )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(serve as a timely, efficient and effective source of valuable evidence for policy and practice)] TJ ET
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BT 417.508 375.650 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 427.145 374.143 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 354.738 Td /F4 9.8 Tf  [(4. Incorporation of NCDs into existing emergency-related policies, standards, and resources)] TJ ET
BT 26.250 335.334 Td /F1 9.8 Tf  [(NCDs should be incorporated into publications and operational guidelines and resources including the Sphere Handbook )] TJ ET
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BT 549.211 336.841 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 558.848 335.334 Td /F1 9.8 Tf  [( and )] TJ ET
BT 26.250 323.429 Td /F1 9.8 Tf  [(the Interagency Emergency Health Kit )] TJ ET
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BT 193.160 324.936 Td /F4 8.7 Tf  [(14)] TJ ET
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BT 202.798 327.317 Td /F1 8.7 Tf  [(,)] TJ ET
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BT 214.844 327.317 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 217.254 324.936 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 226.891 323.429 Td /F1 9.8 Tf  [( . These must be readily available to those working within emergency situations.)] TJ ET
BT 26.250 304.024 Td /F1 9.8 Tf  [(Disaster risk reduction plans aiming to avoid, lessen or transfer the adverse effects of hazards through activities and measures )] TJ ET
BT 26.250 292.119 Td /F1 9.8 Tf  [(for prevention, mitigation and preparedness \(UNISDR\) should assess and integrate the role of NCDs as a factor increasing the )] TJ ET
BT 26.250 280.215 Td /F1 9.8 Tf  [(vulnerability of the population exposed. In this regard, the United Nations-endorsed Hyogo Framework for Action and the )] TJ ET
BT 26.250 268.310 Td /F1 9.8 Tf  [(International Strategy for Disaster Reduction \(ISDR\) should recognize NCDs as )] TJ ET
BT 371.410 268.310 Td /F5 9.8 Tf  [(a)] TJ ET
BT 376.831 268.310 Td /F1 9.8 Tf  [( threat to achieve their expected outcomes to )] TJ ET
BT 26.250 256.405 Td /F1 9.8 Tf  [(reduce losses related to disasters.)] TJ ET
BT 26.250 237.000 Td /F4 9.8 Tf  [(5. Development of technical guidelines on the clinical management of NCDs in emergencies and disaster situations)] TJ ET
BT 26.250 217.596 Td /F1 9.8 Tf  [(Guidelines, which take into account the practical problems associated with NCDs in emergencies are essential)] TJ ET
0.267 0.267 0.267 rg
BT 502.011 219.103 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 511.648 217.596 Td /F1 9.8 Tf  [(. These could )] TJ ET
BT 26.250 205.691 Td /F1 9.8 Tf  [(include partnerships and protocols for the supply of medications such as established by the International Diabetes Federation )] TJ ET
BT 26.250 193.786 Td /F1 9.8 Tf  [(on insulin supply during emergencies and disasters \(https://www.idf.org/insulin-diabetes-supplies/emergencies-and-disasters\).)] TJ ET
BT 26.250 174.381 Td /F4 9.8 Tf  [(6. Greater integration and coordination in health service provision during and following emergencies)] TJ ET
BT 26.250 154.977 Td /F1 9.8 Tf  [(The integration of NCDs into emergency healthcare provision during and following emergencies is imperative. Collaboration )] TJ ET
BT 26.250 143.072 Td /F1 9.8 Tf  [(between existing health infrastructure, the healthcare system and humanitarian assistance would improve the sustainability of )] TJ ET
BT 26.250 131.167 Td /F1 9.8 Tf  [(efforts)] TJ ET
0.267 0.267 0.267 rg
BT 53.345 132.674 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 62.983 131.167 Td /F1 9.8 Tf  [(. This does not require the duplication or reinventing of response efforts. Rather, an intelligent and collaborative )] TJ ET
BT 26.250 119.262 Td /F1 9.8 Tf  [(approach learning from experiences relating to communicable diseases)] TJ ET
0.267 0.267 0.267 rg
BT 334.038 120.770 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 343.675 119.262 Td /F1 9.8 Tf  [(. For example, health clinics and supply chains )] TJ ET
BT 26.250 107.358 Td /F1 9.8 Tf  [(created for the treatment of malaria or diarrhoeal diseases should be capitalised in their potential to simultaneously avert excess )] TJ ET
BT 26.250 95.453 Td /F1 9.8 Tf  [(suffering and disease from NCDs such as diabetes)] TJ ET
0.267 0.267 0.267 rg
BT 245.713 96.960 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 255.350 95.453 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 76.048 Td /F4 9.8 Tf  [(7. Integrating NCDs into practical and academic training of emergency workers and emergency-response coordinators)] TJ ET
BT 26.250 56.643 Td /F1 9.8 Tf  [(High-quality courses are required in order to build community-level, government and organisational capacity in the field of NCDs )] TJ ET
BT 26.250 44.739 Td /F1 9.8 Tf  [(during and following emergencies and for disaster risk reduction planning. These courses should be practical, evidence-based )] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(suggest:)] TJ ET
BT 26.250 748.071 Td /F4 9.8 Tf  [(1. )] TJ ET
BT 37.092 748.071 Td /F4 9.8 Tf  [(Comprehensive review of the current scientific literature)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(A full and comprehensive review of the current global scientific literature relating to NCDs in emergencies and disaster )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(situations is needed in order to build evidence-based policies and guidelines. Existing research should be evaluated, allowing )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(for assessment of current interventions and identification of future interventional possibilities. In recent years, there have been )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(several efforts to try and coordinate information, needs assessments, and disaster response, such as the efforts by the )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Cochrane review with EvidenceAid. Although admirable, these efforts continue to exclude specific focus on management of )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(chronic diseases in disaster response at present.)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(Uniquely, a full assessment of evidenced-based practice in assessing and treating chronic disease in disaster may not be )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(plausible in the classical sense since this is more of a �modern era epidemic.� In decades past, chronic diseases did not affect )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(the sheer number of people that they do now, nor did they present as a pressing consideration during a disaster. As a result, it )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(will be vastly important to also collect and assess anecdotal evidence from first responders, humanitarian organisations, and )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(governements who have recently experienced a large scale disaster to be able to fully understand the scope of chronic )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(diseases in disaster and emergency settings.)] TJ ET
BT 26.250 570.810 Td /F4 9.8 Tf  [(2. )] TJ ET
BT 37.092 570.810 Td /F4 9.8 Tf  [(Increased awareness of the importance of NCDs in emergencies)] TJ ET
BT 26.250 551.405 Td /F1 9.8 Tf  [(Greater advocacy and awareness surrounding NCDs and emergencies is vital. Discussion of NCDs specific to emergency )] TJ ET
BT 26.250 539.500 Td /F1 9.8 Tf  [(response at the global level is imperative, as well as appropriate allocation of funding specific to chronic disease in disaster. )] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(Strides towards this have indeed been underway in venues such as the Geneva Health Forum, the American Public Health )] TJ ET
BT 26.250 515.691 Td /F1 9.8 Tf  [(Association, as well as organization specific fora such as the Red Cross Movement and Medecins sans frontieres. Over the last )] TJ ET
BT 26.250 503.786 Td /F1 9.8 Tf  [(couple of years the authors of this article have involved themselves in all of the above, supporting the discussions.)] TJ ET
BT 26.250 484.381 Td /F4 9.8 Tf  [(3. Increased research on morbidity and mortality patterns during and following an emergency)] TJ ET
BT 26.250 464.976 Td /F1 9.8 Tf  [(Further research is needed with regard to the patterns of morbidity and mortality related to NCDs in emergencies. Acute )] TJ ET
BT 26.250 453.072 Td /F1 9.8 Tf  [(complications, long-term complications and disease progression need to be qualified and quantified. Health outcome )] TJ ET
BT 26.250 441.167 Td /F1 9.8 Tf  [(assessments of disasters should incorporate NCDs as a factor impacting the current and potential health problems in a )] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(population affected by a disaster along the proposals made during the 15th World Congress on Disaster and Emergency )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(Medicine in Amsterdam \(2007\) regarding assessing the public health dimension of disasters.)] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(One viable option would be the establishment of a coordinated, international, open database focusing on the epidemiology of )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(NCDs during and following emergencies around the world. A platform for government, academic, NGO and IGO data, this could )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(serve as a timely, efficient and effective source of valuable evidence for policy and practice)] TJ ET
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BT 417.508 375.650 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 427.145 374.143 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 354.738 Td /F4 9.8 Tf  [(4. Incorporation of NCDs into existing emergency-related policies, standards, and resources)] TJ ET
BT 26.250 335.334 Td /F1 9.8 Tf  [(NCDs should be incorporated into publications and operational guidelines and resources including the Sphere Handbook )] TJ ET
0.267 0.267 0.267 rg
BT 549.211 336.841 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 558.848 335.334 Td /F1 9.8 Tf  [( and )] TJ ET
BT 26.250 323.429 Td /F1 9.8 Tf  [(the Interagency Emergency Health Kit )] TJ ET
0.267 0.267 0.267 rg
BT 193.160 324.936 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 202.798 327.317 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 205.207 324.936 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 214.844 327.317 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 217.254 324.936 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 226.891 323.429 Td /F1 9.8 Tf  [( . These must be readily available to those working within emergency situations.)] TJ ET
BT 26.250 304.024 Td /F1 9.8 Tf  [(Disaster risk reduction plans aiming to avoid, lessen or transfer the adverse effects of hazards through activities and measures )] TJ ET
BT 26.250 292.119 Td /F1 9.8 Tf  [(for prevention, mitigation and preparedness \(UNISDR\) should assess and integrate the role of NCDs as a factor increasing the )] TJ ET
BT 26.250 280.215 Td /F1 9.8 Tf  [(vulnerability of the population exposed. In this regard, the United Nations-endorsed Hyogo Framework for Action and the )] TJ ET
BT 26.250 268.310 Td /F1 9.8 Tf  [(International Strategy for Disaster Reduction \(ISDR\) should recognize NCDs as )] TJ ET
BT 371.410 268.310 Td /F5 9.8 Tf  [(a)] TJ ET
BT 376.831 268.310 Td /F1 9.8 Tf  [( threat to achieve their expected outcomes to )] TJ ET
BT 26.250 256.405 Td /F1 9.8 Tf  [(reduce losses related to disasters.)] TJ ET
BT 26.250 237.000 Td /F4 9.8 Tf  [(5. Development of technical guidelines on the clinical management of NCDs in emergencies and disaster situations)] TJ ET
BT 26.250 217.596 Td /F1 9.8 Tf  [(Guidelines, which take into account the practical problems associated with NCDs in emergencies are essential)] TJ ET
0.267 0.267 0.267 rg
BT 502.011 219.103 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 511.648 217.596 Td /F1 9.8 Tf  [(. These could )] TJ ET
BT 26.250 205.691 Td /F1 9.8 Tf  [(include partnerships and protocols for the supply of medications such as established by the International Diabetes Federation )] TJ ET
BT 26.250 193.786 Td /F1 9.8 Tf  [(on insulin supply during emergencies and disasters \(https://www.idf.org/insulin-diabetes-supplies/emergencies-and-disasters\).)] TJ ET
BT 26.250 174.381 Td /F4 9.8 Tf  [(6. Greater integration and coordination in health service provision during and following emergencies)] TJ ET
BT 26.250 154.977 Td /F1 9.8 Tf  [(The integration of NCDs into emergency healthcare provision during and following emergencies is imperative. Collaboration )] TJ ET
BT 26.250 143.072 Td /F1 9.8 Tf  [(between existing health infrastructure, the healthcare system and humanitarian assistance would improve the sustainability of )] TJ ET
BT 26.250 131.167 Td /F1 9.8 Tf  [(efforts)] TJ ET
0.267 0.267 0.267 rg
BT 53.345 132.674 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 62.983 131.167 Td /F1 9.8 Tf  [(. This does not require the duplication or reinventing of response efforts. Rather, an intelligent and collaborative )] TJ ET
BT 26.250 119.262 Td /F1 9.8 Tf  [(approach learning from experiences relating to communicable diseases)] TJ ET
0.267 0.267 0.267 rg
BT 334.038 120.770 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 343.675 119.262 Td /F1 9.8 Tf  [(. For example, health clinics and supply chains )] TJ ET
BT 26.250 107.358 Td /F1 9.8 Tf  [(created for the treatment of malaria or diarrhoeal diseases should be capitalised in their potential to simultaneously avert excess )] TJ ET
BT 26.250 95.453 Td /F1 9.8 Tf  [(suffering and disease from NCDs such as diabetes)] TJ ET
0.267 0.267 0.267 rg
BT 245.713 96.960 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 255.350 95.453 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 76.048 Td /F4 9.8 Tf  [(7. Integrating NCDs into practical and academic training of emergency workers and emergency-response coordinators)] TJ ET
BT 26.250 56.643 Td /F1 9.8 Tf  [(High-quality courses are required in order to build community-level, government and organisational capacity in the field of NCDs )] TJ ET
BT 26.250 44.739 Td /F1 9.8 Tf  [(during and following emergencies and for disaster risk reduction planning. These courses should be practical, evidence-based )] TJ ET
Q
q
15.000 30.453 577.500 746.547 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(suggest:)] TJ ET
BT 26.250 748.071 Td /F4 9.8 Tf  [(1. )] TJ ET
BT 37.092 748.071 Td /F4 9.8 Tf  [(Comprehensive review of the current scientific literature)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(A full and comprehensive review of the current global scientific literature relating to NCDs in emergencies and disaster )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(situations is needed in order to build evidence-based policies and guidelines. Existing research should be evaluated, allowing )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(for assessment of current interventions and identification of future interventional possibilities. In recent years, there have been )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(several efforts to try and coordinate information, needs assessments, and disaster response, such as the efforts by the )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Cochrane review with EvidenceAid. Although admirable, these efforts continue to exclude specific focus on management of )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(chronic diseases in disaster response at present.)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(Uniquely, a full assessment of evidenced-based practice in assessing and treating chronic disease in disaster may not be )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(plausible in the classical sense since this is more of a �modern era epidemic.� In decades past, chronic diseases did not affect )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(the sheer number of people that they do now, nor did they present as a pressing consideration during a disaster. As a result, it )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(will be vastly important to also collect and assess anecdotal evidence from first responders, humanitarian organisations, and )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(governements who have recently experienced a large scale disaster to be able to fully understand the scope of chronic )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(diseases in disaster and emergency settings.)] TJ ET
BT 26.250 570.810 Td /F4 9.8 Tf  [(2. )] TJ ET
BT 37.092 570.810 Td /F4 9.8 Tf  [(Increased awareness of the importance of NCDs in emergencies)] TJ ET
BT 26.250 551.405 Td /F1 9.8 Tf  [(Greater advocacy and awareness surrounding NCDs and emergencies is vital. Discussion of NCDs specific to emergency )] TJ ET
BT 26.250 539.500 Td /F1 9.8 Tf  [(response at the global level is imperative, as well as appropriate allocation of funding specific to chronic disease in disaster. )] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(Strides towards this have indeed been underway in venues such as the Geneva Health Forum, the American Public Health )] TJ ET
BT 26.250 515.691 Td /F1 9.8 Tf  [(Association, as well as organization specific fora such as the Red Cross Movement and Medecins sans frontieres. Over the last )] TJ ET
BT 26.250 503.786 Td /F1 9.8 Tf  [(couple of years the authors of this article have involved themselves in all of the above, supporting the discussions.)] TJ ET
BT 26.250 484.381 Td /F4 9.8 Tf  [(3. Increased research on morbidity and mortality patterns during and following an emergency)] TJ ET
BT 26.250 464.976 Td /F1 9.8 Tf  [(Further research is needed with regard to the patterns of morbidity and mortality related to NCDs in emergencies. Acute )] TJ ET
BT 26.250 453.072 Td /F1 9.8 Tf  [(complications, long-term complications and disease progression need to be qualified and quantified. Health outcome )] TJ ET
BT 26.250 441.167 Td /F1 9.8 Tf  [(assessments of disasters should incorporate NCDs as a factor impacting the current and potential health problems in a )] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(population affected by a disaster along the proposals made during the 15th World Congress on Disaster and Emergency )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(Medicine in Amsterdam \(2007\) regarding assessing the public health dimension of disasters.)] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(One viable option would be the establishment of a coordinated, international, open database focusing on the epidemiology of )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(NCDs during and following emergencies around the world. A platform for government, academic, NGO and IGO data, this could )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(serve as a timely, efficient and effective source of valuable evidence for policy and practice)] TJ ET
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BT 417.508 375.650 Td /F4 8.7 Tf  [(26)] TJ ET
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BT 26.250 354.738 Td /F4 9.8 Tf  [(4. Incorporation of NCDs into existing emergency-related policies, standards, and resources)] TJ ET
BT 26.250 335.334 Td /F1 9.8 Tf  [(NCDs should be incorporated into publications and operational guidelines and resources including the Sphere Handbook )] TJ ET
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BT 26.250 323.429 Td /F1 9.8 Tf  [(the Interagency Emergency Health Kit )] TJ ET
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BT 26.250 304.024 Td /F1 9.8 Tf  [(Disaster risk reduction plans aiming to avoid, lessen or transfer the adverse effects of hazards through activities and measures )] TJ ET
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BT 371.410 268.310 Td /F5 9.8 Tf  [(a)] TJ ET
BT 376.831 268.310 Td /F1 9.8 Tf  [( threat to achieve their expected outcomes to )] TJ ET
BT 26.250 256.405 Td /F1 9.8 Tf  [(reduce losses related to disasters.)] TJ ET
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BT 26.250 217.596 Td /F1 9.8 Tf  [(Guidelines, which take into account the practical problems associated with NCDs in emergencies are essential)] TJ ET
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BT 26.250 193.786 Td /F1 9.8 Tf  [(on insulin supply during emergencies and disasters \(https://www.idf.org/insulin-diabetes-supplies/emergencies-and-disasters\).)] TJ ET
BT 26.250 174.381 Td /F4 9.8 Tf  [(6. Greater integration and coordination in health service provision during and following emergencies)] TJ ET
BT 26.250 154.977 Td /F1 9.8 Tf  [(The integration of NCDs into emergency healthcare provision during and following emergencies is imperative. Collaboration )] TJ ET
BT 26.250 143.072 Td /F1 9.8 Tf  [(between existing health infrastructure, the healthcare system and humanitarian assistance would improve the sustainability of )] TJ ET
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BT 26.250 95.453 Td /F1 9.8 Tf  [(suffering and disease from NCDs such as diabetes)] TJ ET
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BT 26.250 372.925 Td /F1 9.8 Tf  [(The authors of this paper declare no conflicts of interest.)] TJ ET
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BT 26.250 304.464 Td /F1 9.8 Tf  [(Slim Slama and Dr Carlos Grijalva.)] TJ ET
BT 26.250 275.361 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 247.907 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 247.907 Td /F1 9.8 Tf  [(Lozano, R., M. Naghavi, et al. \(2012\). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and )] TJ ET
BT 26.250 236.002 Td /F1 9.8 Tf  [(2010: a systematic analysis for the Global Burden of Disease Study 2010." Lancet 380\(9859\): 2095-2128.)] TJ ET
BT 26.250 216.597 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 216.597 Td /F1 9.8 Tf  [(Murray, C. J. L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., et al. \(2012\). Disability-adjusted life years )] TJ ET
BT 26.250 204.693 Td /F1 9.8 Tf  [(\(DALYs\) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study )] TJ ET
BT 26.250 192.788 Td /F1 9.8 Tf  [(2010. Lancet, 380\(9859\), 2197�2223. doi:10.1016/S0140-6736\(12\)61689-4)] TJ ET
BT 26.250 173.383 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 173.383 Td /F1 9.8 Tf  [(Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, Lincoln P, Mbanya JC, McKee M, Moodie R, Nishtar S, Piot P, Reddy KS, )] TJ ET
BT 26.250 161.478 Td /F1 9.8 Tf  [(Stuckler D. UN High-Level Meeting on Non-Communicable Diseases: addressing four questions. Lancet. 2011 Jul )] TJ ET
BT 26.250 149.574 Td /F1 9.8 Tf  [(30;378\(9789\):449-55. PubMed PMID:21665266.)] TJ ET
BT 26.250 130.169 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 130.169 Td /F1 9.8 Tf  [(World Economic Forum. Global Risks Report. Geneva: World Economic Forum2010 Contract No: 201209.)] TJ ET
BT 26.250 110.764 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 110.764 Td /F1 9.8 Tf  [(Mahal A, Karan A, Engelau M. The economic implications of noncommunicable disease for India. Washington: World )] TJ ET
BT 26.250 98.859 Td /F1 9.8 Tf  [(Bank2010.)] TJ ET
BT 26.250 79.455 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 79.455 Td /F1 9.8 Tf  [(World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health )] TJ ET
BT 26.250 67.550 Td /F1 9.8 Tf  [(Organization2011 Contract No.: ISBN: 978 92 4 156422 9.)] TJ ET
BT 26.250 48.145 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 48.145 Td /F1 9.8 Tf  [(Rath B, Donato J, Duggan A, Perrin K, Bronfin DR, Ratard R, VanDyke R, Magnus M. Adverse health outcomes after )] TJ ET
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BT 26.250 718.969 Td /F4 12.0 Tf  [(Our Call to Action)] TJ ET
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BT 26.250 667.705 Td /F1 9.8 Tf  [(We urge governments, non-government organisations and intergovernmental bodies to allocate specific resources for the )] TJ ET
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BT 26.250 643.896 Td /F1 9.8 Tf  [(reflects the magnitude of this health issue.)] TJ ET
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BT 26.250 612.586 Td /F1 9.8 Tf  [(disaster situations and produce evidence-based, global technical guidelines for the management of NCDs in emergencies and )] TJ ET
BT 26.250 600.681 Td /F1 9.8 Tf  [(disasters. NCDs should not have a token inclusion, but rather a meaningful and integrated one that addresses the care gap for )] TJ ET
BT 26.250 588.777 Td /F1 9.8 Tf  [(this vulnerable population.)] TJ ET
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BT 26.250 372.925 Td /F1 9.8 Tf  [(The authors of this paper declare no conflicts of interest.)] TJ ET
BT 26.250 336.323 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
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BT 26.250 304.464 Td /F1 9.8 Tf  [(Slim Slama and Dr Carlos Grijalva.)] TJ ET
BT 26.250 275.361 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 247.907 Td /F1 9.8 Tf  [(1.)] TJ ET
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BT 26.250 236.002 Td /F1 9.8 Tf  [(2010: a systematic analysis for the Global Burden of Disease Study 2010." Lancet 380\(9859\): 2095-2128.)] TJ ET
BT 26.250 216.597 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 216.597 Td /F1 9.8 Tf  [(Murray, C. J. L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., et al. \(2012\). Disability-adjusted life years )] TJ ET
BT 26.250 204.693 Td /F1 9.8 Tf  [(\(DALYs\) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study )] TJ ET
BT 26.250 192.788 Td /F1 9.8 Tf  [(2010. Lancet, 380\(9859\), 2197�2223. doi:10.1016/S0140-6736\(12\)61689-4)] TJ ET
BT 26.250 173.383 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 173.383 Td /F1 9.8 Tf  [(Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, Lincoln P, Mbanya JC, McKee M, Moodie R, Nishtar S, Piot P, Reddy KS, )] TJ ET
BT 26.250 161.478 Td /F1 9.8 Tf  [(Stuckler D. UN High-Level Meeting on Non-Communicable Diseases: addressing four questions. Lancet. 2011 Jul )] TJ ET
BT 26.250 149.574 Td /F1 9.8 Tf  [(30;378\(9789\):449-55. PubMed PMID:21665266.)] TJ ET
BT 26.250 130.169 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 130.169 Td /F1 9.8 Tf  [(World Economic Forum. Global Risks Report. Geneva: World Economic Forum2010 Contract No: 201209.)] TJ ET
BT 26.250 110.764 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 110.764 Td /F1 9.8 Tf  [(Mahal A, Karan A, Engelau M. The economic implications of noncommunicable disease for India. Washington: World )] TJ ET
BT 26.250 98.859 Td /F1 9.8 Tf  [(Bank2010.)] TJ ET
BT 26.250 79.455 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 79.455 Td /F1 9.8 Tf  [(World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health )] TJ ET
BT 26.250 67.550 Td /F1 9.8 Tf  [(Organization2011 Contract No.: ISBN: 978 92 4 156422 9.)] TJ ET
BT 26.250 48.145 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 48.145 Td /F1 9.8 Tf  [(Rath B, Donato J, Duggan A, Perrin K, Bronfin DR, Ratard R, VanDyke R, Magnus M. Adverse health outcomes after )] TJ ET
Q
q
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BT 26.250 767.476 Td /F1 9.8 Tf  [(and affordable to participants from every socio-economic background. Here again, several of the authors have been involved in )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(developing such training.)] TJ ET
BT 26.250 718.969 Td /F4 12.0 Tf  [(Our Call to Action)] TJ ET
BT 26.250 699.015 Td /F1 9.8 Tf  [(We call upon healthcare professionals, communities, organisations and governments to further understand and address the )] TJ ET
BT 26.250 687.110 Td /F1 9.8 Tf  [(structural determinants of NCDs in emergency and disaster situations.)] TJ ET
BT 26.250 667.705 Td /F1 9.8 Tf  [(We urge governments, non-government organisations and intergovernmental bodies to allocate specific resources for the )] TJ ET
BT 26.250 655.800 Td /F1 9.8 Tf  [(prevention and management of excess morbidity and mortality from NCDs in emergencies and disasters on a scale which )] TJ ET
BT 26.250 643.896 Td /F1 9.8 Tf  [(reflects the magnitude of this health issue.)] TJ ET
BT 26.250 624.491 Td /F1 9.8 Tf  [(We call on the international research, humanitarian and governing sectors to recognise and address NCDs in emergency and )] TJ ET
BT 26.250 612.586 Td /F1 9.8 Tf  [(disaster situations and produce evidence-based, global technical guidelines for the management of NCDs in emergencies and )] TJ ET
BT 26.250 600.681 Td /F1 9.8 Tf  [(disasters. NCDs should not have a token inclusion, but rather a meaningful and integrated one that addresses the care gap for )] TJ ET
BT 26.250 588.777 Td /F1 9.8 Tf  [(this vulnerable population.)] TJ ET
BT 26.250 552.174 Td /F4 12.0 Tf  [(Footnote)] TJ ET
BT 26.250 536.108 Td /F1 8.7 Tf  [([1])] TJ ET
BT 35.887 532.220 Td /F1 9.8 Tf  [(For the purposes on this publication, emergencies include natural disasters, conflicts and technological disasters, or a )] TJ ET
BT 26.250 520.315 Td /F1 9.8 Tf  [(combination, which result in major loss of life in a population and disruption to healthcare.)] TJ ET
BT 26.250 504.799 Td /F1 8.7 Tf  [([2])] TJ ET
BT 35.887 500.910 Td /F1 9.8 Tf  [(In this publication, disaster refers to a serious disruption of the functioning of a community or a society involving widespread )] TJ ET
BT 26.250 489.006 Td /F1 9.8 Tf  [(human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society )] TJ ET
BT 26.250 477.101 Td /F1 9.8 Tf  [(to cope using its own resources. Disasters are often described as a result of the combination of: the exposure to a hazard; the )] TJ ET
BT 26.250 465.196 Td /F1 9.8 Tf  [(conditions of vulnerability that are present; and insufficient capacity or measures to reduce or cope with the potential negative )] TJ ET
BT 26.250 453.291 Td /F1 9.8 Tf  [(consequences. Disaster impacts may include loss of life, injury, disease and other negative effects on human physical, mental )] TJ ET
BT 26.250 441.387 Td /F1 9.8 Tf  [(and social well-being, together with damage to property, destruction of assets, loss of services, social and economic disruption )] TJ ET
BT 26.250 429.482 Td /F1 9.8 Tf  [(and environmental degradation�)] TJ ET
0.267 0.267 0.267 rg
BT 163.900 430.989 Td /F4 8.7 Tf  [(25)] TJ ET
0.271 0.267 0.267 rg
BT 173.538 429.482 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 392.879 Td /F4 12.0 Tf  [(Competing Interests)] TJ ET
BT 26.250 372.925 Td /F1 9.8 Tf  [(The authors of this paper declare no conflicts of interest.)] TJ ET
BT 26.250 336.323 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 316.368 Td /F1 9.8 Tf  [(We would like to acknowledge the valuable support and contributions of Professor Ib Bygbjerg, A/Professor Peter Jensen, Dr )] TJ ET
BT 26.250 304.464 Td /F1 9.8 Tf  [(Slim Slama and Dr Carlos Grijalva.)] TJ ET
BT 26.250 275.361 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 247.907 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 247.907 Td /F1 9.8 Tf  [(Lozano, R., M. Naghavi, et al. \(2012\). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and )] TJ ET
BT 26.250 236.002 Td /F1 9.8 Tf  [(2010: a systematic analysis for the Global Burden of Disease Study 2010." Lancet 380\(9859\): 2095-2128.)] TJ ET
BT 26.250 216.597 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 216.597 Td /F1 9.8 Tf  [(Murray, C. J. L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., et al. \(2012\). Disability-adjusted life years )] TJ ET
BT 26.250 204.693 Td /F1 9.8 Tf  [(\(DALYs\) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study )] TJ ET
BT 26.250 192.788 Td /F1 9.8 Tf  [(2010. Lancet, 380\(9859\), 2197�2223. doi:10.1016/S0140-6736\(12\)61689-4)] TJ ET
BT 26.250 173.383 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 173.383 Td /F1 9.8 Tf  [(Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, Lincoln P, Mbanya JC, McKee M, Moodie R, Nishtar S, Piot P, Reddy KS, )] TJ ET
BT 26.250 161.478 Td /F1 9.8 Tf  [(Stuckler D. UN High-Level Meeting on Non-Communicable Diseases: addressing four questions. Lancet. 2011 Jul )] TJ ET
BT 26.250 149.574 Td /F1 9.8 Tf  [(30;378\(9789\):449-55. PubMed PMID:21665266.)] TJ ET
BT 26.250 130.169 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 130.169 Td /F1 9.8 Tf  [(World Economic Forum. Global Risks Report. Geneva: World Economic Forum2010 Contract No: 201209.)] TJ ET
BT 26.250 110.764 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 110.764 Td /F1 9.8 Tf  [(Mahal A, Karan A, Engelau M. The economic implications of noncommunicable disease for India. Washington: World )] TJ ET
BT 26.250 98.859 Td /F1 9.8 Tf  [(Bank2010.)] TJ ET
BT 26.250 79.455 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 79.455 Td /F1 9.8 Tf  [(World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health )] TJ ET
BT 26.250 67.550 Td /F1 9.8 Tf  [(Organization2011 Contract No.: ISBN: 978 92 4 156422 9.)] TJ ET
BT 26.250 48.145 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 48.145 Td /F1 9.8 Tf  [(Rath B, Donato J, Duggan A, Perrin K, Bronfin DR, Ratard R, VanDyke R, Magnus M. Adverse health outcomes after )] TJ ET
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BT 291.710 19.825 Td /F1 11.0 Tf  [(4)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 767.476 Td /F1 9.8 Tf  [(Hurricane Katrina among children and adolescents with chronic conditions. J Health Care Poor Underserved. 2007 )] TJ ET
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BT 26.250 736.167 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 736.167 Td /F1 9.8 Tf  [(Cefalu WT, Smith SR, Blonde L, Fonseca V. The Hurricane Katrina aftermath and its impact on diabetes care: observations )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(from "ground zero": lessons in disaster preparedness of people with diabetes. Diabetes Care. 2006 Jan;29\(1\):158-60. PubMed )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(PMID:16373918.)] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 692.952 Td /F1 9.8 Tf  [(Bornemizsa O, Sondorp E. Health Policy Formulation in Complex Political Emergencies and Post-Conflict Countries. London: )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(London School of Tropical Hygiene and Medicine 2002.)] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 661.643 Td /F1 9.8 Tf  [(Miller AC, Arquilla B. Chronic diseases and natural hazards: impact of disasters on diabetic, renal, and cardiac patients. )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(Prehosp Disaster Med. 2008 Mar-Apr;23\(2\):185-94. PubMed PMID:18557300.)] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 630.333 Td /F1 9.8 Tf  [(Chan EY, Kim J. Chronic health needs immediately after natural disasters in middle-income countries: the case of the 2008 )] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(Sichuan, China earthquake. Eur J Emerg Med. 2011 Apr;18\(2\):111-4. PubMed PMID:20679898.)] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 599.024 Td /F1 9.8 Tf  [(World Health Organization. A field manual � Communicable disease control in emergencies. Geneva: World Health )] TJ ET
BT 26.250 587.119 Td /F1 9.8 Tf  [(Organization, 2005)] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 567.714 Td /F1 9.8 Tf  [(Sphere Project. Sphere Handbook � Humanitarian Charter and Minimum Standards for Disaster Response. Geneva: )] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(Sphere, Humanitarian Charter and Minimum Standards in Disaster Response2011.)] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 536.405 Td /F1 9.8 Tf  [(World Health Organization \(2006\). The Interagency Emergency Health Kit. Geneva.)] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 517.000 Td /F1 9.8 Tf  [(Kjellstrom T, Butler AJ, Lucas RM, Bonita R. Public health impact of global heating due to climate change: potential effects )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(on chronic non-communicable diseases. Int J Public Health. 2010 Apr;55\(2\):97-103. PubMed PMID:19902143.)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 485.691 Td /F1 9.8 Tf  [(Fonseca VA, Smith H, Kuhadiya N, Leger SM, Yau CL, Reynolds K, Shi L, McDuffie RH, Thethi T, John-Kalarickal J. Impact )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(of a natural disaster on diabetes: exacerbation of disparities and long-term consequences. Diabetes Care. 2009 Sep;32\(9\):1632-)] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(8. PubMed PMID:19542210.)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 442.476 Td /F1 9.8 Tf  [(Inui A, Kitaoka H, Majima M, Takamiya S, Uemoto M, Yonenaga C, Honda M, Shirakawa K, Ueno N, Amano K, Morita S, )] TJ ET
BT 26.250 430.572 Td /F1 9.8 Tf  [(Kawara A, Yokono K, Kasuga M, Taniguchi H. Effect of the Kobe earthquake on stress and glycemic control in patients with )] TJ ET
BT 26.250 418.667 Td /F1 9.8 Tf  [(diabetes mellitus. Arch Intern Med. 1998 Feb 9;158\(3\):274-8. PubMed PMID:9472208.)] TJ ET
BT 26.250 399.262 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 399.262 Td /F1 9.8 Tf  [(Roy N, Thakkar P, Shah H. Developing-world disaster research: present evidence and future priorities. Disaster Med Public )] TJ ET
BT 26.250 387.357 Td /F1 9.8 Tf  [(Health Prep. 2011 Jun;5\(2\):112-6. PubMed PMID:21685306.)] TJ ET
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BT 43.553 293.429 Td /F1 9.8 Tf  [(Horn, R. Disaster Preparedness and the Aging Population: Discussion of a Novel Supplementary Unit for Chronic Disease )] TJ ET
BT 26.250 281.524 Td /F1 9.8 Tf  [(to the Interagency Emergency Health Kit.Johns Hopkins Bloomberg School of Public Health, CAPSTONE PAPER \(unpublished\))] TJ ET
BT 26.250 262.119 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 262.119 Td /F1 9.8 Tf  [(Pfeiffer J, Johnson W, Fort M, Shakow A, Hagopian A, Gloyd S, Gimbel-Sherr K. Strengthening health systems in poor )] TJ ET
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BT 26.250 238.310 Td /F1 9.8 Tf  [(PMID:18923125.)] TJ ET
BT 26.250 218.905 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 218.905 Td /F1 9.8 Tf  [(World Health Organization. Package of Essential Noncommunicable \(PEN\) Disease Interventions for Primary Health Care. )] TJ ET
BT 26.250 207.000 Td /F1 9.8 Tf  [(Geneva: World Health Organization, 2010.)] TJ ET
BT 26.250 187.596 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 187.596 Td /F1 9.8 Tf  [(Kheang S, Janssens B, Damme WV, Zachariah R. Delivering anti-retroviral treatment within the framework of a chronic )] TJ ET
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BT 43.553 144.381 Td /F1 9.8 Tf  [(United Nations International Strategy for Disaster Reduction. Accessed 15/11/12.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 135.895 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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BT 26.250 117.345 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 117.345 Td /F1 9.8 Tf  [(Edward J Mills. Sharing evidence on humanitarian relief. BMJ. 2005 Dec 24; 331\(7531\): 1485�1486.)] TJ ET
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BT 43.553 97.941 Td /F1 9.8 Tf  [(UK Government. Reducing Risks of Future Disasters. 2012. London: UK Government Office for Science.)] TJ ET
BT 26.250 78.536 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 78.536 Td /F1 9.8 Tf  [(World Health Organization. Mental Health Global Action Programme \(mhGAP\). Geneva: WHO. Accessed 08/08/13.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 70.050 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
Q
q
15.000 53.524 577.500 723.476 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Hurricane Katrina among children and adolescents with chronic conditions. J Health Care Poor Underserved. 2007 )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(May;18\(2\):405-17. PubMed PMID:17483568.)] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 736.167 Td /F1 9.8 Tf  [(Cefalu WT, Smith SR, Blonde L, Fonseca V. The Hurricane Katrina aftermath and its impact on diabetes care: observations )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(from "ground zero": lessons in disaster preparedness of people with diabetes. Diabetes Care. 2006 Jan;29\(1\):158-60. PubMed )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(PMID:16373918.)] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 692.952 Td /F1 9.8 Tf  [(Bornemizsa O, Sondorp E. Health Policy Formulation in Complex Political Emergencies and Post-Conflict Countries. London: )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(London School of Tropical Hygiene and Medicine 2002.)] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 661.643 Td /F1 9.8 Tf  [(Miller AC, Arquilla B. Chronic diseases and natural hazards: impact of disasters on diabetic, renal, and cardiac patients. )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(Prehosp Disaster Med. 2008 Mar-Apr;23\(2\):185-94. PubMed PMID:18557300.)] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 630.333 Td /F1 9.8 Tf  [(Chan EY, Kim J. Chronic health needs immediately after natural disasters in middle-income countries: the case of the 2008 )] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(Sichuan, China earthquake. Eur J Emerg Med. 2011 Apr;18\(2\):111-4. PubMed PMID:20679898.)] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 599.024 Td /F1 9.8 Tf  [(World Health Organization. A field manual � Communicable disease control in emergencies. Geneva: World Health )] TJ ET
BT 26.250 587.119 Td /F1 9.8 Tf  [(Organization, 2005)] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 567.714 Td /F1 9.8 Tf  [(Sphere Project. Sphere Handbook � Humanitarian Charter and Minimum Standards for Disaster Response. Geneva: )] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(Sphere, Humanitarian Charter and Minimum Standards in Disaster Response2011.)] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 536.405 Td /F1 9.8 Tf  [(World Health Organization \(2006\). The Interagency Emergency Health Kit. Geneva.)] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 517.000 Td /F1 9.8 Tf  [(Kjellstrom T, Butler AJ, Lucas RM, Bonita R. Public health impact of global heating due to climate change: potential effects )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(on chronic non-communicable diseases. Int J Public Health. 2010 Apr;55\(2\):97-103. PubMed PMID:19902143.)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 485.691 Td /F1 9.8 Tf  [(Fonseca VA, Smith H, Kuhadiya N, Leger SM, Yau CL, Reynolds K, Shi L, McDuffie RH, Thethi T, John-Kalarickal J. Impact )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(of a natural disaster on diabetes: exacerbation of disparities and long-term consequences. Diabetes Care. 2009 Sep;32\(9\):1632-)] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(8. PubMed PMID:19542210.)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 442.476 Td /F1 9.8 Tf  [(Inui A, Kitaoka H, Majima M, Takamiya S, Uemoto M, Yonenaga C, Honda M, Shirakawa K, Ueno N, Amano K, Morita S, )] TJ ET
BT 26.250 430.572 Td /F1 9.8 Tf  [(Kawara A, Yokono K, Kasuga M, Taniguchi H. Effect of the Kobe earthquake on stress and glycemic control in patients with )] TJ ET
BT 26.250 418.667 Td /F1 9.8 Tf  [(diabetes mellitus. Arch Intern Med. 1998 Feb 9;158\(3\):274-8. PubMed PMID:9472208.)] TJ ET
BT 26.250 399.262 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 399.262 Td /F1 9.8 Tf  [(Roy N, Thakkar P, Shah H. Developing-world disaster research: present evidence and future priorities. Disaster Med Public )] TJ ET
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