[Health administration of emergencies in natural disasters].
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OBJECTIVES: A prospective study of children examined both before and after a flood disaster in Bangladesh is used to test the hypothesis that stressful events play a causal role in the development of behavioral disorders in children. METHODS: Six months before the disaster, structured measures of selected behavioral problems were made during an epidemiological study of disability among 2- to 9-year-old children. Five months after the disaster, a representative sample of 162 surviving children was reevaluated. RESULTS: Between the pre- and postflood assessments, the prevalence of aggressive behavior increased from zero to nearly 10%, and 45 of the 134 children who had bladder control before the flood (34%) developed enuresis. CONCLUSIONS: These results help define what may be considered symptoms of posttraumatic distress in childhood; they also contribute to mounting evidence of the need to develop and evaluate interventions aimed at ameliorating the behavioral and psychological consequences of children's exposure to extreme and traumatic situations.
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This article provides a description of the eight phases of the Mental Health Outreach Program (MHOP) cofounded by the author to address the needs of the surviving community following the 1988 earthquake in Armenia. For the purposes of the MHOP, the nursing process was expanded from five to eight phases: 1) preassessment, 2) assessment, 3) analysis, 4) community diagnosis, 5) planning, 6) implementation, 7) evaluation, and 8) remodification. A framework for assessing the level of trauma in an unfamiliar community (with its mnemonic acronym COPE), which was formulated by the author to expedite the assessment and implementation phases, is described. The article concludes with a set of recommendations for psychiatric mental health nurses in mitigating the negative impact and consequences of disasters.
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A survey of the health and psychosocial problems of all victims of the 1983 South Australian Ash Wednesday Bushfires was carried out 12 months after the disaster. A total of 1526 victims completed an extensive questionnaire that included the 28-item General Health Questionnaire and a self-reporting check-list of specific health problems. The data received indicated a significant increase in stress-related conditions, including hypertension, gastrointestinal disorders, diabetes, and mental illness, while the prevalence of nonstress-related conditions such as cancer or urological disease were not increased significantly. Health problems increased during the 12 months following the bushfire and diminished toward the end of that period, but a large number of difficulties remained. Certain disaster experiences, particularly the type of loss suffered, were found to be significantly related to health.
The traumatic experience of bereavement affects people in many different ways and may produce bodily symptoms of distress which prompt the bereaved to consult their doctor. A general practitioner who is familiar and comfortable with the expression of intense emotions, and aware of the grieving process and of risk factors which may complicate healing, can have a key role in preventing significant morbidity and mortality in the bereaved population. In this article the authors provide some guidelines from their clinical experience over the past 16 years and suggest further reading which may help doctors to be more effective in providing appropriate support.
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BACKGROUND: A three month relief operation for the 25,303 people living in the municipal area of Villanueva, Nicaragua, hit by Hurricane Mitch, was carried out jointly by the staff of an international non-government organization and an Italian Regional Hospital's staff. METHODS: Health Mobile Teams joined the local health facilities (Health Centers and Health Posts) in responding to the people's urgent health problems. From their files the thirty-day post-disaster incidence of acute diarrheas (AD), respiratory tract infectious diseases (ARD), and malaria were estimated and compared with off-crisis data. New cases of leptospirosis were searched, but no control group was available. RESULTS: The incidence of AD and ARD increased significantly in comparison with pre-disaster data (6,798 vs. 2,849 per 100,000 inhabitants (p < 0.01) and 1,205 vs. 295 per 100,000 inhabitants (p < 0.01)). The increase in incidence of malaria was not explicit. Only three cases of leptospirosis were ascertained. The relief operators used the gathered data to make decisions to allocate the poorly available resources. CONCLUSIONS: The feasibility of the infectious disease surveillance and the reliability of the results under such conditions may change according to the setting. In this case study the infectious disease surveillance was feasible, and the gathered data were reliable and of some help to the relief operators in order to allocate the resources efficiently.