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Relocation after a disaster: posttraumatic stress disorder in Armenia after the earthquake.

OBJECTIVE: To explore the relationship between exposure to the earthquake in Armenia on December 7, 1988, and relocation from the disaster zone, and the subsequent development of posttraumatic stress disorder (PTSD), depression, and behavioral difficulties in children. METHOD: The PTSD module of the Diagnostic Interview for Children and Adolescents-Revised and the Depression Self-Rating Scale were administered to 25 children, aged 11 through 13 years, who had high exposure to the earthquake and remained in the earthquake city. They were compared with a demographically similar group of 24 children exposed to the earthquake who were relocated to another city after the earthquake and 25 nonexposed children. For each child the mothers responded to the Child Behavior Checklist and the teachers responded to the Teacher's Report Form. RESULTS: The hypothesis that relocated children would present with less PTSD, depression, and behavioral problems was not confirmed. Both groups of children with high exposure to the earthquake, one remaining in the earthquake city and one relocating, demonstrated significantly higher rates of PTSD, depression, and behavioral difficulties than the comparison group. There were no differences between the relocated children and those who remained in the earthquake zone. CONCLUSION: Children who were relocated after a natural disaster did no worse than children who remained in the disaster zone. Relocation should be considered as an alternative after catastrophic natural disasters in situations where resources are so limited that rebuilding cannot take place for an indefinite period of time.

Adolescent↗

Coping strategies in an ethnic minority group: the Aeta of Mount Pinatubo.

The particular problems arising in the aftermath of natural disasters in indigenous societies in the Third World, especially in ethnic or cultural minorities, have until now received only little attention in social scientific research. The potential of such indigenous groups to use their traditional knowledge and behaviour patterns in coping with natural disasters has been badly neglected. The example of the Aeta in Zambales, Philippines, a marginal group who were hit directly by the eruption of Mt Pinatubo in 1991, shows how traditional economic and social behaviour can in some measure determine their various survival strategies.

Cultural Characteristics↗

Bioterrorism and mass casualty preparedness in hospitals: United States, 2003.

OBJECTIVES: This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity. METHODS: The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an annual survey of a probability sample of approximately 500 non-Federal general and short-stay hospitals in the United States. A Bioterrorism and Mass Casualty Supplement was included in the 2003 survey and provided the data for this analysis. RESULTS: Almost all hospitals have plans for responding to natural disasters (97.3 percent). Most have plans for responding to chemical (85.5 percent), biological (84.8 percent), nuclear or radiological (77.2 percent), and explosive incidents (76.9 percent). About three-quarters of hospitals were integrated into community-wide disaster plans (76.4 percent), and 75.9 percent specifically reported a cooperative planning process with other local health care facilities. Despite these plans, only 46.1 percent reported written memoranda of understanding with these facilities to accept inpatients during a declared disaster. Hospitals varied widely in their plans for re-arranging schedules and space in the event of a disaster. Training for hospital incident command and smallpox, anthrax, chemical, and radiological exposures was ahead of training for other infectious diseases. The percentage of hospitals training their staff in any exposure varied from 92.1 percent for nurses to 49.2 percent for medical residents. Drills for natural disasters occurred more often than those for chemical, biological, explosive, nuclear, and epidemic incidents. More hospitals staged drills for biological attacks than for severe epidemics. Despite explosions being the most common form of terrorism, drills for these were staged by only one-fifth of hospitals. Hospitals collaborated on drills most often with emergency medical services, fire departments, and law enforcement agencies.

Bioterrorism↗

An integrated program to train local health care providers to meet post-disaster mental health needs.

This paper describes a post-disaster mental health training program developed by the International Section of the Department of Psychiatry at Dalhousie University (Halifax, Canada) and delivered in Grenada after Hurricane Ivan struck the country in September 2004. This train-the-trainer program used an integrated community health model to help local health care providers develop the necessary skills for the identification and evidenced-based treatment of mental disorders occurring after a natural disaster. The approach also provided for ongoing, sustainable mental health care delivered in the community setting, as advocated by the World Health Organization and the Pan American Health Organization. This approach is in contrast to the largely ineffective and costly vertical whole-population psychosocial counseling activities that have often been used in the Caribbean following natural disasters.

Caribbean Region↗

Successful coupling of community attachment of health science students with relief work for drought victims.

CONTEXT: Recurrent drought is a major disaster affecting many countries. As a result of poor rain fall a major drought was forecast for Ethiopia in 2003. The country appealed for support to avert drought-related health problems. University of Gondar decided to respond to the appeal by sending students and staff to selected drought-affected areas. OBJECTIVES: To illustrate how an institution has turned the response to a natural disaster into a service-learning educational opportunity while maintaining equilibrium between the two. METHODS: The drought relief response of the institute was twined with the regular team-training programme and academic schedule of senior health science students and 190 of them were transferred to deployment sites. FINDINGS: Students provided support for the national effort of reducing drought-related morbidity and mortality by participating in multifaceted public health and relief activities, and fulfilled their regular learning objectives at the same time. DISCUSSION: This project demonstrated the use of a natural disaster as a learning method to expose students to a more realistic array of health problems and human conditions. It also demonstrated the feasibility of addressing social responsibility, while fulfilling academic responsibility through community-based approach. CONCLUSION: Service-learning is a valuable learning method. Balancing the service and teaching objectives and maintaining the quality of both can be attained through careful twining of the objectives of both components.

Community-Institutional Relations↗

CMC external fixator.

PURPOSE OF THE STUDY: Imobilisation of wounded extremity decreases pain and shock, diminishes the possibilities of soft tissue, vessels and nerves injury with bone fragments, that influences the volume and success of surgical debridement of the wound. Optimal external fixator for war purposes must be rigid in construction, have to be simple to master, allow simple approach to wound during the whole period of fixation, have to be in sterile package with all its necessary part and should not be too expensive. DESIGN OF THE STUDY: Prof. Korzinek in correspondence with "Instrumentarija" from Zagreb developed a new type of external fixateur applicable in war situation and natural disasters. It was named CMC (Croatian Medical Corps) external fixateur, and it ensures imobilisation of extremity during transport to area of final treatment and it could also ensure conditions for definitive fixation. CMC is compound of bar, clamps and Schanz screws. Standard packing are CMC-30 and CMC-40. CONCLUSION: CMC external fixator is the applicable device in war and natural disaster situations. It is simple to master even for less experienced surgeons, it's low volume allows appropriate wound treatment, it could be resterilised and reused and it has acceptable price.

Croatia↗

Chronic disease in health emergencies: in the eye of the hurricane.

INTRODUCTION: Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response to natural disasters. An estimate of the possible numbers of people who may require treatment for chronic diseases should help in planning a response, but such information for local areas is not easily accessible. We explored how a current surveillance system could be used to provide estimates of the potential needs for emergency treatment of chronic diseases in the wake of a natural disaster. METHODS: We used data from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2004 to estimate the prevalence and numbers of people with diabetes, heart disease, stroke, hypertension, and current asthma who lived in the New Orleans-Metairie-Kenner, La, metropolitan statistical area. RESULTS: About 9.0% of participants had diabetes, 4.6% had angina or coronary heart disease, 3.0% had had a myocardial infarction, 2.0% had had a stroke, and 6.3% had current asthma. About 25.4% adults had at least one of the above conditions. CONCLUSION: A surveillance system such as the BRFSS can provide potentially useful baseline information about the numbers of people with chronic diseases and the treatment that they receive; this information can assist the medical and public health community in assessing the needs of people with chronic diseases after disasters and in planning relief efforts.

Adolescent↗

Sovereign cat bonds and infrastructure project financing.

We examine the opportunities for using catastrophe-linked securities (or equivalent forms of nondebt contingent capital) to reduce the total costs of funding infrastructure projects in emerging economies. Our objective is to elaborate on methods to reduce the necessity for unanticipated (emergency) project funding immediately after a natural disaster. We also place the existing explanations of sovereign-level contingent capital into a catastrophic risk management framework. In doing so, we address the following questions. (1) Why might catastrophe-linked securities be useful to a sovereign nation, over and above their usefulness for insurers and reinsurers? (2) Why are such financial instruments ideally suited for protecting infrastructure projects in emerging economies, under third-party sponsorship, from low-probability, high-consequence events that occur as a result of natural disasters? (3) How can the willingness to pay of a sovereign government in an emerging economy (or its external project sponsor), who values timely completion of infrastructure projects, for such instruments be calculated? To supplement our treatment of these questions, we use a multilayer spreadsheet-based model (in Microsoft Excel format) to calculate the overall cost reductions possible through the judicious use of catastrophe-based financial tools. We also report on numerical comparative statics on the value of contingent-capital financing to avoid project disruption based on varying costs of capital, probability and consequences of disasters, the feasibility of strategies for mid-stage project abandonment, and the timing of capital commitments to the infrastructure investment. We use these results to identify high-priority applications of catastrophe-linked securities so that maximal protection can be realized if the total number of catastrophe instruments is initially limited. The article concludes with potential extensions to our model and opportunities for future research.

Journal Article↗

Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia.

OBJECTIVE: This study was undertaken 1 1/2 years after the 1988 earthquake in Armenia to assess the frequency and severity of posttraumatic stress reactions among elderly and younger adult victims and to assess the relation of exposure, age, sex, and death of a family member to these reactions. METHOD: One hundred seventy-nine subjects of both sexes were evaluated with the Posttraumatic Stress Disorder (PTSD) Reaction Index. A subgroup of 60 individuals were also assessed for PTSD with the DSM-III-R criteria. RESULTS: There was a strong association between the presence of severe symptoms on the index and a DSM-III-R diagnosis of PTSD. Elderly and younger adult victims in cities closer to the epicenter (higher exposure) had significantly higher index scores than elderly and adult victims in more distant locations. In comparison with previous studies of natural disasters, much greater rates of chronic severe posttraumatic stress reactions were found among the highly exposed individuals. Although there was no difference in total mean score on the Posttraumatic Stress Disorder Reaction Index, a significant difference in symptom profile was found between the elderly and younger adults; the elderly scored higher on arousal symptoms and lower on intrusive symptoms. There was a positive correlation between loss of family members and severity of posttraumatic stress reaction. CONCLUSIONS: These findings indicate that after a major natural disaster with subsequent multiple adversities, a substantial proportion of the adult population may experience severe and chronic posttraumatic stress reactions. The risk factors identified in this study may prove useful in screening exposed individuals for appropriate treatment.

Adolescent↗

Psychological effects of chronic injury in elite athletes.

Many athletes train in a constant state of pain or injury while meeting the demands of an elite level program. It is hypothesized that the emotional distress experienced by athletes with chronic injuries is not inconsequential. A self-report battery, the Impact of Event Scale, was administered to 280 inter-collegiate athletes at a division I institution in an attempt to examine their response to chronic injury. Of the 280, 134 (48%) had been injured by study definition, with 117 (42%) meeting the criteria for chronic injury. Athletes with chronic injury scored on the Intrusion subscale of the Impact of Event Scale in the range of those who had experienced natural disasters, but scored higher (P < .05) on the Avoidance/Denial subscale. Their Avoidance subscale scores were similar to those of a group of orthopedic patients who required hospital admission with surgical fixation. Female athletes' Avoidance scores were significantly higher than those of their male peers (P < .05), but no gender differences were seen in intrusive thoughts. Subsets of athletes defined by the duration of injury showed no significant differences on subscale scores. It appears extraordinary that athletes should score in the realm of groups traumatized by natural disasters in intrusive thought and higher in avoidance thought when referring to their chronic injury. Although some attention has been focused on psychiatric intervention for acutely injured athletes or those who have undergone surgical treatment, the psychological needs of athletes struggling with chronic "minor" injuries also appear to merit consideration.

Adult↗

Positive and negative postdisaster psychological adjustment among adult survivors of the Southeast Asian earthquake-tsunami.

OBJECTIVE: This study explored psychosocial factors associated with psychological adjustment among survivors of a severe natural disaster. METHODS: Two hundred sixty-seven adult Thai survivors of the 2004 Southeast Asian earthquake-tsunami were surveyed. RESULTS: At 6 months following the disaster, percentages of survivors who reported positive and negative adjustment were 34% and 40%, respectively. For positive adjustment, best predictors were predisaster employment, increased arousal, and frequent support seeking. Support seeking also partially mediated the association between arousal and positive adjustment. For negative adjustment, infrequent support seeking and increased intrusion and arousal were the best predictors. Arousal was a partial mediator between intrusion and negative adjustment, and support seeking also partially mediated the influence of intrusion and arousal on negative adjustment. CONCLUSION: Mental health programs for survivors of natural disasters should focus on promoting active coping strategies such as support seeking, strengthening of support networks, and management of posttraumatic stress symptoms to facilitate adjustment.

Adaptation, Psychological↗

The Armenian earthquake of 1988: a milestone in the evolution of nephrology.

A dreadful earthquake struck a densely populated region of Armenia on December 7, 1988. All principal determinants of structural damage and crush injury converged to magnify the dreadful outcomes of this otherwise modest earthquake, which registered 6.9 on the Richter scale. Two circumstantial events focused unprecedented world attention on this natural disaster. First, the news media, assembled to cover the historic visit of Mikhail Gorbachev to the United States, were suddenly deprived of the news they had gathered to cover when Gorbachev interrupted his visit to examine the disaster personally. As a result, the world news media channeled their collective force on covering the tragic events in Armenia. Second, an official Soviet request for dialysis assistance was delivered at the opening session of the annual meeting of the American Society of Nephrology in San Antonio on Sunday, December 11, 1988. As a result, the entire nephrology community was suddenly engulfed in the mounting worldwide enthusiasm to provide humanitarian aid. The subsequent efforts of the National Kidney Foundation and the International Society of Nephrology prompted the discipline to examine, evaluate, and establish a role for nephrologists in preparedness and response to natural disasters.

Acute Kidney Injury↗

Psychosocial and health correlates of types of traumatic event exposures among U.S. military personnel.

The prevalence of lifetime exposure to violence, natural disaster, or major accidents involving injuries or fatalities was examined in the largest population-based epidemiologic survey of U.S. military personnel to date. The psychosocial and health effects of types of exposure experience (witness only, victim/survivor, relief worker), gender differences, and social support were also evaluated. Over 15,000 active duty U.S. military personnel from stratified random samples of active duty U.S. personnel from all services responded to either mail questionnaires and/or worksite surveys. The lifetime exposure to one or more traumatic events was 65%; the most prevalent trauma for men was witnessing a major accident, and for women, witnessing a natural disaster. Victims of any traumatic event were at twice the risk of having two or more physical and mental health problems than nonexposed controls. Health outcomes of trauma exposure vary by type of traumatic event: type of exposure experience, rank, and gender.

Adult↗

Earthquake and coronary heart disease risk factors: a longitudinal study.

The longitudinal association between a number of coronary heart disease risk factors and the experience of a natural disaster (earthquake) was analyzed in a group of workers participating in a longitudinal epidemiologic investigation. The 5-year follow-up examination was interrupted by a major earthquake, and examinations were resumed 2 weeks after the quake. Participants screened after the quake had, on average, higher heart rates, serum cholesterol, and triglycerides than participants examined before the quake; these differences were independent from the coronary heart disease risk factor values measured 5 years previously during the baseline examination. The data collected during the 12-year examination indicated that the observed short-term increase in serum lipids and heart rate was not present long-term (7 years after the quake). These longitudinal data indicate that exposure to a natural disaster can be associated with short-term increases in heart rate, serum cholesterol, and triglycerides but that there is no apparent long-term effect on these coronary heart disease risk factors.

Adult↗

[Migration and health].

In the last decades of this century we are witnesses of frequent crises in different parts of the world produced by internal disturbance and wars. These crises, together with natural disasters, poverty and hunger, follow the history of mankind often forcing huge population groups to leave their homes. The harmful health consequences are among negative effects of migrations. While stable populations have well-tried routines for maintaining health, migrations mean abandoning such support systems. The increased exposure to harmful factors contributes more to the bad health condition of the migrant population. Setting of newcomers and local people together in the same homes, reduction in food and heating resources, drug shortage as well as importation of new infectious agents, may also endanger health of the native population. These observations have also been confirmed by Yugoslav experience. Depending on the fact whether a migration is elemental or organized i.e. dependent on its place in the large scale between these two extreme endpoints, the size of risk is also dependent on the consequences and degree of their difficulty. Mass health disturbances occur during migrations of the population from war regions, migrations from areas of natural disasters, mass pilgrimage, migrations of seasonal workers and migrations of armies during wars. However, even in these difficult times and conditions, a good organization can contribute to the mitigation of harmful consequences caused by these migrations. For instance, in 1942 there was an epidemic of typhus fever in Bosnia when many refugees crossed the Drina river on the way to Serbia escaping from Ustasha terrorism. At the Serbian side there were checkpoints where the refugees could taka a bath and where their laundry and clothing were depediculated with dry air, and after a two-week quarantine they could continue to Serbian provinces without making new foci of typhus fever. The most vulnerable and numerous group of refugees is usually composed of women, children and old persons. One of the largest migrations took place over the period from 1991 to 1995, when about 1,500,000 people left the war areas of the former Yugoslavia, Bosnia-Herzegovina and Croatia. Of that number, about 700.000 refugees came to Yugoslavia. In August 1995 during an unprecedented exile from the Kninska krajina region (Croatia) over 200,000 people left their homes. During the arrival of refugees and expelled persons health teams offered first aid to these unlucky persons at reception points: drinking water, food, emergency care and indispensable clothing. The next step in their task was to move refugees into families i.e. into collective camps and centres. As in similar situations, this migration had also its negative effects on health of the refugees. At this time, however, the situation was aggravated by international economic sanctions imposed to Yugoslavia although Yugoslavia has accepted and received more refugees than all European countries together. In 1992 a special refugees Law was promulgated in Yugoslavia. In this Law, among other things, it was stated that "the organized reception, temporary lodging, nutrition, appropriate health care, material and other sort of help" will be secured to refugees. The increased infant mortality rate in Yugoslavia may be ascribed to migrations. After several years of decrease it was in constant rise over the period from 1991 to 1995 (Table 1). Disturbed mental balance, loosing of ethic norms, feeling of hopelessness and despair, and underestimation of the risk of infections among refugees, contributed to the rise of promiscuity and increase in sexually transmitted diseases. Thus, the number of registered cases of symphills in the period 1991-1995 was six times greater than in previous years. The number of gonorrhea cases was twice greater in this period than before that time. At the same time, it should be emphasized that the number of recorded cases was smaller than it w

Aged↗

Assessment of health-related needs after Hurricanes Katrina and Rita--Orleans and Jefferson Parishes, New Orleans area, Louisiana, October 17-22, 2005.

Residents returning home after natural disasters face numerous physical, mental, and social challenges. Seven weeks after Hurricane Katrina struck the New Orleans area in Louisiana, causing levees to break and large sections of the city to flood, local authorities had reopened most of Jefferson Parish and much of Orleans Parish to residents. To identify health-related needs among returning parish residents, state and local public health and mental health agencies and CDC conducted an assessment of living conditions, access to basic services, and physical and mental health status. This report describes the results of that assessment, which determined that, approximately 7 weeks after Hurricane Katrina made landfall, 20.2% of housing units lacked water, 24.5% had no electricity, 43.2% had no telephone service, and 55.7% of households contained one or more members with a chronic health condition. In addition, 49.8% of adults exhibited levels of emotional distress, indicating a potential need for mental health services. As a result of these findings, the Louisiana Office of Mental Health established a crisis-counseling program to provide interventions and support to hurricane survivors. Community assessments after natural disasters can identify health-related needs and guide public health interventions.

Disasters↗

UNICEF's rich history in emergency response.

When conflict erupts or natural disasters strike, UNICEF's challenge is to provide for the emergency needs of civilians, especially women and children, who are caught in the crossfire or plagued by the drought or swept away by the flood. When emergency situations arise, threatening to derail UNICEF's ongoing work in a country, the challenge is to adapt programmes to better address the changing needs of the affected population. UNICEF's goal in all countries undergoing emergencies is to build on the work already done to lay the foundation for long-term peace and progress. In most emergency cases, certain core interventions are applied to meet basic needs, including health (UNICEF's largest activity in emergencies), water supply and sanitation, education, nutrition, community development, advocacy and initiatives addressing the special needs of women and children. Specific programmes for unaccompanied children, women's reproductive health, child soldiers, land-mine awareness and child prisoners are also employed in many emergency situations. UNICEF works towards the day when children and women no longer face acute threats to their survival and development; but until such time as natural disasters and man-made conflict no longer pose threats to them, UNICEF remains committed to the range of activities required to ensure their protection and well-being.

Child↗

Effect of stress on atopic dermatitis: investigation in patients after the great hanshin earthquake.

BACKGROUND: Although a variety of factors are responsible for atopic dermatitis (AD), very little is known about the effect of stress caused by a natural disaster on AD symptoms. OBJECTIVE: This study was conducted to assess the effect of stress or trauma on the symptoms of AD. METHODS: One thousand four hundred fifty-seven patients with AD (745 males and 712 females), diagnosed by using the criteria of the Japanese Dermatology Association, were enrolled in the study. The data were obtained from a self-administered questionnaire given to patients with AD after experiencing the Great Hanshin Earthquake. The data were analyzed by multivariate logistic regression analysis. Patients were divided into 3 groups: area A, severe damage to buildings and houses; area B, mild damage; and control area, no damage. RESULTS: Exacerbation of skin symptoms was found in 38% and 34% of patients in areas A and B, respectively, whereas similar exacerbation was seen in 7% of control patients. Nine percent and 5% of the patients in areas A and B, respectively, showed improvement in their symptoms compared with 1% in the control group. The earthquake caused stress in 63% and 48% of the patients in areas A and B, respectively, but fewer patients felt stress in undamaged areas (19%). Multiple logistic regression analysis revealed that of the factors examined here, subjective distress is the factor that is most responsible for the exacerbation of skin symptoms (odds ratio, 2.98; 95% confidence interval, 2.25-3.96). CONCLUSION: The results presented here strongly suggest that stress caused by a natural disaster influences AD symptoms.

Adolescent↗