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PubMed1999

Mental health services for children in the first two years after the 1995 Oklahoma City terrorist bombing.

Nineteen infants and children were killed in the 1995 terrorist bombing in Oklahoma City, and many were injured. More than 200 children lost one or both parents. These casualties focused attention on children in the disaster response efforts. This paper describes the development and implementation of a school-based mental health program that provided accessible services to children affected by the bombing, with an emphasis on normalization. A clinical needs assessment of all children in the Oklahoma City public school system was carried out, and clinicians provided emergency and crisis services, counseling, and support groups.

Adolescent↗
PubMed2005

Clinical review: communication and logistics in the response to the 1998 terrorist bombing in Omagh, Northern Ireland.

The Omagh bombing in August 1998 produced many of the problems documented in other major incidents. An initial imbalance between the demand and supply of clinical resources at the local hospital, poor information due to telecommunication problems, the need to triage victims and the need to transport the most severely injured significant distances were the most serious issues. The Royal Group Hospitals Trust (RGHT) received 30 severely injured secondary transfers over a 5-hour period, which stressed the hospital's systems even with the presence of extra staff that arrived voluntarily before the hospital's major incident plan was activated. Many patients were transferred to the RGHT by helicopter, but much of the time the gained advantage was lost due to lack of a helipad within the RGHT site. Identifying patients and tracking them through the hospital system was problematic. While the major incident plan ensured that communication with the relatives and the media was effective and timely, communication between the key clinical and managerial staff was hampered by the need to be mobile and by the limitations of the internal telephone system. The use of mobile anaesthetic teams helped maintain the flow of patients between the Emergency Department and radiology, operating theatres or the intensive care unit (ICU). The mobile anaesthetic teams were also responsible for efficient and timely resupply of the Emergency Department, which worked well. In the days that followed many victims required further surgical procedures. Coordination of the multidisciplinary teams required for many of these procedures was difficult. Although only seven patients required admission to adult general intensive care, no ICU beds were available for other admissions over the following 5 days. A total of 165 days of adult ICU treatment were required for the victims of the bombing.

Adult↗
PubMed2004

Post-traumatic stress after terrorist attack: psychological reactions following the US embassy bombing in Nairobi: Naturalistic study.

BACKGROUND: Most studies of post-traumatic stress disorder following terrorist attacks are of small samples in industrialised nations and take place months or years after the incident. AIMS: To describe reactions following the US embassy bombing in Nairobi and the characteristic features of and risk factors for post-traumatic stress symptoms in a large, non-Western sample soon after the attack. METHOD: A self-report questionnaire which assessed potential risk factors and identified symptoms matching DSM-IV criteria for post-traumatic stress disorder was answered by 2883 Kenyans, 1-3 months after the bombing. RESULTS: Symptoms approximating to the criteria for post-traumatic stress disorder occurred in 35%. Factors associated with post-traumatic stress included female gender, unmarried status, lack of college education, seeing the blast, injury, not recovering from injury, not confiding in a friend, bereavement and financial difficulty since the blast. Many other factors were not significant. CONCLUSIONS: Specific factors often cited to predict marked short-term post-traumatic stress were confirmed in this large, non-Western sample.

Blast Injuries↗
PubMed2005

Long-term prognosis of thyroid nodule cases compared with nodule-free controls in atomic bomb survivors.

CONTEXT: Radiation exposure is associated with development of thyroid nodules. The long-term risk of thyroid cancer development in irradiated people with thyroid nodules, however, has not been clarified. OBJECTIVE: The objective of this study was to assess the long-term risk of cancer development in irradiated individuals with thyroid nodules. DESIGN, SETTING, AND PARTICIPANTS: This prospective study comprised 2637 atomic bomb survivors (mean age, 59 yr; 1071 men and 1566 women) who participated in the baseline thyroid study of the Nagasaki Radiation Effects Research Foundation from 1984 through 1987. The participants were divided into three groups at baseline by ultrasound findings: 82 cases of solid thyroid nodules other than cancer, 121 cases of thyroid cysts, and 2434 thyroid nodule-free controls. Both the solid nodule and the cyst groups included postoperative cases. In the solid nodule group, 68 cases had ultrasound-detected solid nodules, including 31 cases diagnosed as benign by cytological or histological examination. They were followed for an average of 13.3 yr. MAIN OUTCOME MEASURE: Incident thyroid cancer was measured during an average 13.3-yr follow-up period. RESULTS: During the follow-up period, six thyroid cancer cases (7.3%) were found in the solid nodule group, seven cases in the controls (0.3%), and one case (0.8%) in the cyst group. In 31 cases with solid nodules diagnosed as benign, three cases (9.7%) developed thyroid cancer. The hazard ratio (HR) for cancer development was significantly high at 23.6 [95% confidence interval (CI), 7.6-72.8] in the solid nodule group (HR, 40.2; 95% CI, 9.4-173.0 in 31 people with solid nodules diagnosed as benign) but not in the cyst group (HR, 2.7; 95% CI, 0.3-22.2), after controlling for age and sex. Sex, age, TSH level, thyroglobulin level, radiation dose, nodule volume, and increase in nodule volume did not predict cancer development in the solid nodule group. CONCLUSIONS: Risk of thyroid cancer development is high in atomic bomb survivors with solid thyroid nodules, suggesting the need for careful observation of irradiated individuals with such nodules.

Aged↗
PubMed1986

The Beirut terrorist bombing.

The Beirut terrorist bombing on October 23, 1983, caused 234 immediate deaths and injured at least 112 survivors. Military medical records were available for each casualty; postmortem examination reports were available for each immediate fatality. This represented a unique opportunity to assess type, incidence, treatment, and outcome of neurological injuries suffered in a mass casualty terrorist bombing situation. Three categories of neurological injuries are described: head injuries, spine and spinal cord injuries, and peripheral nerve injuries. The following types and numbers of injuries occurred among the 112 immediate survivors of the explosion: 37 head injuries--28 concussions, 20 scalp lacerations, 13 skull fractures, 6 facial bone fractures, 4 cerebral contusions, 5 dural lacerations, 2 cerebrospinal fluid fistulas, and 2 intracerebral hematomas; 2 spine or spinal cord injuries--1 cervical and 1 thoracolumbar spine fracture associated with neurological deficit; and 9 peripheral nerve injuries--1 facial nerve palsy, 2 brachial plexus palsies, 1 median and 1 radial nerve palsy, and 4 peroneal nerve palsies. Among 234 immediate fatalities, the types and numbers of neurological injuries were: 167 head injuries--93 scalp lacerations, 85 skull fractures, and 24 facial bone fractures; and 22 spine and spinal cord injuries--15 cervical and 7 thoracolumbar fractures. Seven of the 112 immediate survivors died; 4 of these deaths were related to severe head injuries. The treatment and outcome of survivors with neurological injuries is briefly described. One-third of the immediate survivors who suffered either a scalp laceration or a concussion had a concomitant skull fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Blast Injuries↗
PubMed1998

Delta-Notch signalling and the patterning of sensory cell differentiation in the zebrafish ear: evidence from the mind bomb mutant.

Mechanosensory hair cells in the sensory patches of the vertebrate ear are interspersed among supporting cells, forming a fine-grained pattern of alternating cell types. Analogies with Drosophila mechanosensory bristle development suggest that this pattern could be generated through lateral inhibition mediated by Notch signalling. In the zebrafish ear rudiment, homologues of Notch are widely expressed, while the Delta homologues deltaA, deltaB and deltaD, coding for Notch ligands, are expressed in small numbers of cells in regions where hair cells are soon to differentiate. This suggests that the delta-expressing cells are nascent hair cells, in agreement with findings for Delta1 in the chick. According to the lateral inhibition hypothesis, the nascent hair cells, by expressing Delta protein, would inhibit their neighbours from becoming hair cells, forcing them to be supporting cells instead. The zebrafish mind bomb mutant has abnormalities in the central nervous system, somites, and elsewhere, diagnostic of a failure of Delta-Notch signalling: in the CNS, it shows a neurogenic phenotype accompanied by misregulated delta gene expression. Similar misregulation of delta ; genes is seen in the ear, along with misregulation of a Serrate homologue, serrateB, coding for an alternative Notch ligand. Most dramatically, the sensory patches in the mind bomb ear consist solely of hair cells, which are produced in great excess and prematurely; at 36 hours post fertilization, there are more than ten times as many as normal, while supporting cells are absent. A twofold increase is seen in the number of otic neurons also. The findings are strong evidence that lateral inhibition mediated by Delta-Notch signalling controls the pattern of sensory cell differentiation in the ear.

Animals↗
PubMed1990

Determination of specific activity of cobalt (60Co/Co) in steel samples exposed to the atomic bomb in Hiroshima.

Specific activity 60Co/Co in two steel samples taken at 687m S and 1295m NNW from the hypocenter was measured by gamma-ray spectrometry and neutron activation analysis. The results were, respectively, (2.64 +/- 0.38) x 10(1) and (3.09 +/- 0.48) x 10(-1) dpm/mg Co at the time of bombing, which are consistent with previous data by Hashizume et al. for steel rings on the surface of roofs of buildings. The present data are expected to serve as verification of the bomb neutron transport calculations. Content of nickel and copper in the samples, determined by colorimetric and neutron activation methods, respectively, was too small to account for any significant 60Co production by the (n,p) and (n, alpha) reactions.

Cobalt Radioisotopes↗
PubMed1991

Recent uses of biological data for the evaluation of A-bomb radiation dosimetry.

Random errors in the DS86 radiation dose estimates used in the analysis of A-bomb survivor data are recognized to have an important impact upon estimates of the risk of late effects such as cancer. Little however is known for certain concerning the distribution of such random errors. This paper gives an overview of recent work at the Radiation Effects Research Foundation (RERF) using multivariate analysis of biological data, including acute effects of radiation exposure, late effects (eg leukemia mortality) and stable chromosome aberrations, for the purpose of evaluating the extent of random error in the estimation of individual doses using DS86. The emphasis here is on analyses of apparent association between biological endpoints, in light of a dosimetry error model framework proposed recently by Pierce et al. Analyses performed to date appear to be consistent with the view that lognormal random dosimetry errors with a standard deviation of 40% or greater of true dose may exist in DS86. Association between radiogenic outcomes in A-bomb survivors, after adjustment for DS86 estimated dose level, has been detected for such widely varying pairs of outcomes as mutant T-cell frequencies and chromosome aberrations, epilation and leukemia mortality, and epilation and chromosome aberrations. The motivation for examining association between pairs of biological endpoints has usually been to determine the extent to which radiation sensitivity varies between individual survivors. Recognizing, however, that random error in dose estimates results in apparent association between biological outcomes is crucial to interpreting studies, such as these, which use data on multiple biological endpoints. To go one step further, in situations where there is a prior knowledge about the biological plausibility of such associations in outcome data the amount of association between radiogenic outcomes (remaining after adjustment for estimated dose), to the extent that they are greater than that assumed to be reasonable, is an important potential source of information concerning the magnitude of random errors in the DS86 dose estimates.

Chromosome Aberrations↗
PubMed1991

Medical X-ray doses' contributions to the ionizing radiation exposures of atomic-bomb survivors.

Doses from diagnostic radiological examinations were measured in order to evaluate the radiation risks of atomic-bomb survivors in Hiroshima and Nagasaki. Using a phantom human, doses to the active bone marrow, gonads, salivary glands, thyroid gland, lung, breast, stomach and colon were determined by type of examination and by examination site. The results of this dosimetry program will aid in estimating the diagnostic exposure doses received by each participant in the Adult Health Study of the Radiation Effects Research Foundation. The current results of these dosimetry studies also indicate that the effects of A-bomb exposure cannot be reliably assessed unless medical X-ray doses are carefully incorporated into these long-term evaluations.

Humans↗
PubMed1991

The LD50 associated with exposure to the atomic bombing of Hiroshima and Nagasaki.

Numerous attempts have been made to estimate the distance at which 50% of the individuals exposed to the A-bombing of Hiroshima and Nagasaki died, ostensibly from their exposure to ionizing radiation. It is difficult to convert most of these distance estimates to a dose-related LD50, since radiation shielding was ignored. The recent reassessment of the atomic bomb radiation dosimetry has provided an opportunity for the estimation of the bone marrow LD50. There is a surprising concordance in the various estimates that have been made given the different groups of survivors involved and the methods used to estimate the LD50/60.

Humans↗
PubMed1991

Atomic bomb and leukemia.

Characteristic features of leukemia among atomic bomb survivors were studied. The ratio of a single leukemia type to all leukemias was highest for CML in Hiroshima, and the occurrence of CML was thought to be most characteristic for atomic bomb radiation induced leukemia. In the distribution of AML subtypes of FAB classification, there was no M3 cases in 1Gy or more group, although several atypical AML cases of survivors were observed. Chromosome study was conducted using colony forming cells induced by hemopoietic stem cells of peripheral blood of proximal survivors. Same chromosome aberrations were observed in colony forming cells and peripheral blood of proximal survivors.

Humans↗
PubMed1991

A review of forty-five years study of Hiroshima and Nagasaki atomic bomb survivors. Thyroid cancer: reports up to date and a review.

Evidence to date from a number of studies, indicates that there is an increased incidence of thyroid cancer among A-bomb survivors, and that the incidence rises with increase of dose and is especially predominant in females exposed at younger ages. Although 45 years have elapsed since A-bomb exposure, there are still some questions about the development of thyroid cancer: 1) Is the incidence now decreasing? 2) What factors, other than radiation exposure, are involved? 3) What is the incidence of multiple cancer, including thyroid cancer? With these questions in mind, it is apparent that studies in this field must continue for some time to come.

Female↗
PubMed1991

Parathyroid tumors in atomic bomb survivors in Hiroshima: a review.

Parathyroid tumors in A-bomb survivors in Hiroshima have been studied. Thirteen cases of parathyroid tumor were confirmed from 4,136 autopsy cases between 1961 to 1977, and an elevated incidence of tumor with increase of dose (T65D) was demonstrated (P less than 0.01). A high proportion of 42.9%, 6 out of 14 parathyroid tumors extirpated at Hiroshima University Hospital between 1956 and 1988, were atomic bomb survivors exposed within 4.1 km from the hypocenter. From an epidemiological study using 23 parathyroid tumor cases detected in Hiroshima Prefecture between 1974 and 1987, an elevated incidence of parathyroid tumors with increase of dose (proximally exposed, other exposed and control nonexposed) was demonstrated (P less than 0.001).

Humans↗
PubMed1991

A review of forty-five years study of Hiroshima and Nagasaki atomic bomb survivors. Cancer risk among in utero-exposed survivors.

The Radiation Effects Research Foundation (RERF) continues to conduct a follow-up study initiated some years ago of cancer mortality and incidence among the survivors of the atomic bombing of Hiroshima and Nagasaki exposed in utero. Although only 18 incident cases of cancer were identified in the years 1950-1984 (of which 5 cases were in the 0 dose group), cancer risk appears to increase significantly as maternal uterine dose increases. Only two cases of childhood cancer were observed among these individuals in the first 14 years of life; both had been exposed to greater than or equal to 0.30 Gy. All other cases developed cancer in adulthood, and the cancers they developed are, in the main, the ones known to be elevated in frequency among the postnatally exposed survivors. The estimated relative risk for cancer at 1 Gy (uterine dose) is 3.77. The results suggest that the in utero group may have a higher risk than that seen among exposed adults because the individuals exposed in utero have not reached the major cancer prone age. However, since the observed cases are too few to allow a site-specific review, further follow-up studies are required to determine if the observed increased cancer risk can definitely be attributed to A-bomb radiation, although there appears to be a significant dose-related cancer response.

Child↗
PubMed1991

A review of forty-five years study of Hiroshima and Nagasaki atomic bomb survivors. Tumor registries and cancer incidence studies.

A tumor registry is essential in the systematic collection and analysis of tumor data in a defined population. Population-based tumor registries have been in operation for more than 30 years in Hiroshima and Nagasaki. While the tumor registry data have previously been used for many site-specific cancer studies in atomic bomb survivors, overall analysis of tumor registry based cancer incidence data among the atomic bomb survivors has not been undertaken for some time. However, a recent improvement in the tumor registries has made it possible to analyze most recent cancer incidence data among the Life Span Study population. Preliminary analysis under way indicates a potential power of the data. There are a few methodological problems associated with the use of the incidence data, especially relating to consistency of data and migration. Several measures taken to resolve such problems are discussed.

Female↗
PubMed1991

A review of forty-five years study of Hiroshima and Nagasaki atomic bomb survivors. Hyperparathyroidism.

An epidemiological survey on hyperparathyroidism (HPT) among A-bomb survivors in Hiroshima has been conducted since August 1986. The results are summarized based on proceedings of meetings. The survey demonstrated that the prevalence rate of HPT increased with A-bomb radiation dose. Further analysis is now under way on the relationship between HPT prevalence and radiation dose, sex and age, the results of which will be published in the near future.

Humans↗
PubMed1991

A review of forty-five years study of Hiroshima and Nagasaki atomic bomb survivors. Radiation cataract.

This report reviews the relationship of ionizing radiation to the occurrence of cataracts (posterior lenticular opacities) among the A-bomb survivors in Hiroshima and Nagasaki. The new DS86 doses are available for 1,983 (93.4%) of the 2,124 A-bomb survivors analyzed in 1982. The DS86 kerma neutron component for Hiroshima is much smaller than its comparable T65DR component, but still 4.2 fold higher (0.38 Gy at 6 Gy) than that in Nagasaki (0.09 Gy at 6 Gy). Thus, if the eye is especially sensitive to neutrons, there may yet be some useful information on their effects, particularly in Hiroshima. Under the best fitting dose-response model, an L(gamma)-L(neutron) with two thresholds, both the gamma and neutron regression coefficients of the occurrence of cataracts on dose are positive and highly significant for the DS86 eye organ doses. The DS86 gamma coefficient is almost the same as that associated with the T65DR gamma dose, the ratio of the two coefficients being 1.1 (95% confidence limits: 0.5-2.3) for DS86 kerma in the individual dose data, and if the risks based on the DS86 eye organ dose and DS86 kerma are compared, the ratio is 1.3 (0.6-2.8). However, the risk estimates associated with neutron exposure are 6.4 (2.2-19.2) fold higher for the DS86 kerma than the T65DR kerma and 1.6 (0.5-2.3) fold higher for the DS86 eye organ dose than for the DS86 kerma.

Cataract↗
PubMed1991

X-ray sensitivity of fibroblast cell strains derived from atomic bomb survivors with and without breast cancer.

Fibroblasts were established in vitro from skin biopsies obtained from 55 women and 1 man with or without breast cancer and with or without exposure to radiations from the atomic bomb (A-bomb) explosion in Hiroshima. The radiosensitivity of these cells was evaluated by clonogenic assays after exposure to X-rays. Dose-response curves were fitted to a multitarget model, S/S0 = A[1-(1-e-D/D0)N]. There was no difference in the means or variances of radiosensitivity between exposed and nonexposed groups, or between groups with and without breast cancer.

Breast Neoplasms↗