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PubMed1993

The epidemiology of disasters and adverse reproductive outcomes: lessons learned.

A disaster has been defined as a disruption of human ecology that exceeds the capacity of the community to function normally. Little is known about the adverse effects of natural disasters on reproductive outcomes. Important lessons can be derived from several disasters caused by human factors, such as the Minamata Bay disaster. Adverse reproductive outcomes include infertility, early pregnancy loss, stillbirths, congenital malformations, and serious developmental disabilities such as cerebral palsy and mental retardation. Recent disasters like the Chernobyl and Bhopal explosions have provided important lessons on the need for accurate and sound information about the risk of prenatal exposures for adverse reproductive outcomes. To study questions of adverse reproductive outcomes and disasters requires a well-planned approach. It should include early development of surveillance for adverse reproductive outcomes, analytic studies on the risk of disasters from direct and indirect effects, sensitive methods to measure early pregnancy loss, and long-term follow-up programs to assess outcomes such as developmental disabilities.

Animals↗
PubMed1999

Emergency management of disasters involving livestock in developing countries.

Different disasters have similar consequence on the health and welfare of livestock. Numerous geophysical disasters can exacerbate epizootics, resulting in the deaths of many animals and the reduction of production efficiency. These disasters also present a considerable threat of spoilage of processed foods, endangering public health. Furthermore, large-scale disasters involving animals can modify the long-term stability of national economies, the environment and social structures. The authors discuss the vulnerability of the livestock industry to natural disasters and the impact of floods, droughts and transboundary diseases and pests on national economies. Examples are given on how some losses can be avoided, evaluated and compensated. The role of the veterinarian is presented in relation to work conducted by other relief organisations in cases of emergency. In developing countries, mitigation programmes should focus on strengthening global animal health services. Preparedness needs to be community based, with education provided in a timely manner. Effective recovery from disasters should be based on mitigation programmes, including international trade and mutual aid agreements between neighbouring countries to supply appropriate goods and environmentally and culturally appropriate breeds of livestock. Disaster relief for the care of livestock should be recognised as a form of humanitarian assistance, given the benefits to be derived for public health and the socio-economic implications of successful intervention.

Animal Diseases↗
PubMed2006

Hurricane Katrina: an environmental perspective.

On 29 August 2005, Hurricane Katrina hit the Gulf Coast of the USA to become one of the worst natural disasters in the country's history. The forecasts and official warnings of the event issued by the US National Hurricane Center up to 60 h ahead were excellent and largely based on an 'ensemble' of model and statistical guidance. The Met Office Global Model is highlighted as one of the best performers for Hurricane Katrina. The active 2005 Atlantic hurricane season has fuelled the debate on the impact of climate change on tropical cyclones. Some recent publications have suggested that this impact is already apparent, while others are more cautious. Inconsistencies remain among many of the theoretical, modelling and observational studies. Despite the excellent warnings, there was a tragic loss of life as a result of Hurricane Katrina which has led to political questions concerning complex socio-economic issues, the state of flood defences and how to coordinate the reaction to and mitigate the impact of such monumental natural hazards.

Disaster Planning↗
PubMed2006

Disaster planning for peritoneal dialysis programs.

Because of increased intensity of hurricanes in the Gulf Coast region of the United States, peritoneal dialysis (PD) programs have been disrupted and patients relocated temporarily following these catastrophic events. We describe the disaster planning, implementation, and follow-up that occurred in one such PD program in New Orleans following Hurricane Katrina. Each year at the beginning of the North American hurricane season, the PD program's disaster plan is reviewed by clinic staff and copies are distributed to patients. Patients are instructed to assemble a disaster kit and are provided with contact numbers for dialysis suppliers and for a PD program in their planned evacuation city. In July 2005, this disaster plan was tested when an early tropical storm and hurricane entered the Gulf and several patients briefly relocated or evacuated because of power loss and then returned without incident. However, when Hurricane Katrina, a category 5 storm, was predicted to strike the metropolitan area, patients were notified by telephone to evacuate, and contact information, including their evacuation city and telephone and cellular phone numbers, was obtained. Patients were also reminded to take all medications, bottled water, antibacterial soap, hand sanitizer, and 4-5 days of PD supplies. Following the storm, telephone and cellular phone services were severely disrupted. However, text messaging was available to contact patients to confirm safety and to provide further instructions. Arrangements with the major dialysis suppliers to ship emergency supplies to new locations were made by the PD nurse and the patients. Only 2 of 22 patients required hospitalization because of complications resulting from evacuation failure, contamination, and inability to perform dialysis for a prolonged period of time. Both of these patients were quickly released and have continued PD. Following the event, all patients remained on PD, and most have planned to return to their home PD program. Thorough preparation, planning, practice, and implementation and effective communication are necessary to prevent complications in PD patients who are affected by disasters. With advdnce preparation, maintenance of communication with health care providers, and planning for alternative sites of care, patients can be safely maintained on PD without complications following catastrophic natural disasters.

Communication↗
PubMed2003

Disasters and development in agricultural input markets: bean seed markets in Honduras after Hurricane Mitch.

The bulk of developing countries' populations and poor depend on agriculture for food and income. While rural economies and people are generally the most severely affected by natural disasters, little is known about how disasters and subsequent relief activities affect agricultural markets with differing levels of development. The article addresses this gap, drawing evidence from bean seed markets in Honduras after Hurricane Mitch. Case studies are used to address hypotheses about a disaster's effects on supply and demand in seed markets, farmers' responses and the performance of relief interventions in markets showing differing levels of development. The results show the importance of tailoring relief interventions to the markets that they will affect and to the specific effects of a disaster; the potential to use local and emerging seed distribution channels in a relief intervention; and opportunities for relief activities to strengthen community seed systems.

Agriculture↗
PubMed1992

A collaborative model of a county crisis intervention team: the Lake County experience.

A model is introduced for the classification of crisis intervention and disaster services as being clinic-based, ad hoc, school-oriented, disaster service based and integrative. An example is presented of an integrative-collaborative model that was developed in Lake County, Ohio to cope with situations of suicide, accidental death or natural disaster when they occur in rural areas and small towns. The Community Crisis Intervention Team (CCIT) was developed with characteristics specific to a collaborative model. The distinctive qualities of the CCIT are identified and discussed within the context of a case study of a postvention in a school setting following adolescent suicide.

Community Mental Health Services↗
PubMed1995

Special report. Mobile, Alabama, and New York City hospitals: meeting the new challenges of recurring disasters.

Unexpected disasters, natural and manmade, continue to occur and pose challenging situations for hospitals called on to treat casualties. Hospitals in Mobile, AL, which were tested by the Amtrak crash two years ago, faced another disaster in March when a fog caused numerous multi-vehicle collisions. Downtown New York City hospitals, which handled the over a thousand persons injured in the World Trade Center bombing in February 1993, faced another bombing emergency in December 1994 when a bomb exploded in a crowded subway train. How hospitals reacted to the new emergencies and the lessons they learned from the prior incidents are the subject of this report.

Accidents, Traffic↗
PubMed1996

Deaths related to Hurricane Andrew in Florida and Louisiana, 1992.

BACKGROUND: Information about circumstances leading to disaster-related deaths helps emergency response coordinators and other public health officials respond to the needs of disaster victims and develop policies for reducing the mortality and morbidity of future disasters. In this paper, we describe the decedent population, circumstances of death, and population-based mortality rates related to Hurricane Andrew, and propose recommendations for evaluating and reducing the public health impact of natural disasters. METHODS: To ascertain the number and circumstances of deaths attributed to Hurricane Andrew in Florida and Louisiana, we contacted medical examiners in 11 Florida counties and coroners in 36 Louisiana parishes. RESULTS: In Florida medical examiners attributed 44 deaths to the hurricane. The mortality rate for directly-related deaths was 4.4 per 1 000 000 population and that for indirectly-related deaths was 8.5 per 1 000 000 population. In Louisiana, coroners attributed 11 resident deaths to the hurricane. Mortality rates were 0.6 per 1000 000 population for deaths directly related to the storm and 2.8 for deaths indirectly related to the storm. Six additional deaths occurred among non-residents who drowned in international waters in the Gulf of Mexico. In both Florida and Louisiana, mortality rates generally increased with age and were higher among whites and males. CONCLUSIONS: In addition to encouraging people to follow existing recommendations, we recommend emphasizing safe driving practices during evacuation and clean-up, equipping shelters with basic medical needs for the population served, and modifying zoning and housing legislation. We also recommend developing and using a standard definition for disaster-related deaths, and using population-based statistics to describe the public health effectiveness of policies intended to reduce disaster-related mortality.

Adolescent↗
PubMed1997

The great Hanshin-Awaji earthquake aggravates blood pressure control in treated hypertensive patients.

A major earthquake (Hanshin-Awaji earthquake) struck Kobe on January 17, 1995. We had a unique opportunity to study the effect of tremendous psychological stress on blood pressure control in 221 hypertensive patients receiving antihypertensive medication. During the 4 weeks after earthquake, on average, the mean blood pressure increased significantly for both 105 patients who were exposed (living in the area of the very severe earthquake) and 116 patients who were not exposed (living in the surrounding area) (+4.2 +/- 1.0 mm Hg, P < .001, and +/- 2.4 +/- 0.7 mm Hg, P < .005, respectively). In the exposed group, the increase in mean blood pressure peaked in the first week (+6.7 +/- 1.6 mm Hg, P < .001), declined thereafter, and returned to the baseline within 6 weeks after the disaster. The earthquake related blood pressure elevation was, however, significantly attenuated (P < .02) in patients receiving beta-blockers compared with those receiving other drugs. The results indicate that acute psychological stress associated with a sudden natural disaster causes blood pressure elevation in treated hypertensive patients, and suggest the beneficial effect of beta-blockers on such a stress-associated high blood pressure.

Analysis of Variance↗
PubMed2001

The World Trade Center attack. Disaster preparedness: health care is ready, but is the bureaucracy?

When a disaster occurs, it is for governments to provide the leadership, civil defense, security, evacuation, and public welfare. The medical aspects of a disaster account for less than 10% of resource and personnel expenditure. Hospitals and health care provider teams respond to unexpected occurrences such as explosions, earthquakes, floods, fires, war, or the outbreak of an infectious epidemic. In some geographic locations where natural disasters are common, such as earthquakes in Japan, such disaster practice drills are common. In other locations, disaster drills become pro forma and have no similarity to real or even projected and predicted disasters. The World Trade Center disaster on 11 September 2001 provides new information, and points out new threats, new information systems, new communication opportunities, and new detection methodologies. It is time for leaders of medicine to re-examine their approaches to disaster preparedness.

Aircraft↗
PubMed1997

When mother and baby are refugees.

War and disaster strike everyone hard, but they strike the most vulnerable people hardest. Since the Second World War more than 21 million people, most of them women and children, have died in wars and other conflicts. Countless others have perished in natural disasters. Most of the world's 50 million refugees and displaced persons are women and children. The special feature in this issue of Safe Motherhood looks especially at mothers and infants in situations of war and disaster. It describes their plight as innocent victims, as society's most vulnerable members struggling to survive in hostile surroundings, and as lonely figures trying to rebuild their lives against all odds. It particularly focuses on motherhood among women refugees. Much can be done to improve the situation of these mothers and their infants. The special feature describes steps that can be taken to make sure that motherhood is safer--and infant health more secure--even when the situation seems to be desperate. Women refugees face all kinds of disadvantages and hardships. WHO is developing guidelines on women's reproductive health during conflict and displacement to address these problems. The feature in this newsletter is based on these guidelines.

Child Welfare↗
PubMedDate not supplied

Safe womanhood is not safe motherhood: policy implications.

The world continues to be unsafe for girls and women. Although natural disasters and man-made disasters make the world unsafe for all people, the gender divide further compromises safety of women. In addition to being at higher risk for violence, rape, trafficking, and abuse, women's injury and mortality increase because of the limited definition of the nature and type of work they do, the conditions that expose them to such infections as HIV/AIDS, the pregnancy and birthing cycles, as well as unsafe abortions, and because of the inadequacy and inaccessibility of health services. To enhance safe womanhood, not just safe motherhood for women, several urgent actions are outlined in this article.

Battered Women↗
PubMedDate not supplied

The concept of assisted management of large-scale disasters by horizontal organizations.

Management of large-scale disasters is impeded by inadequately designed organizational infrastructure. The vertical organizational structures of most agencies responding to disasters contribute to a poorly integrated response, especially when collaboration, information sharing, and coordination are required. Horizontal (or lateral) organizations have assisted traditionally vertical civilian and military agencies by enhancing their capacity to operate successfully in complex human emergencies and large-scale natural disasters. Because of the multiagency and highly technical multidisciplinary requirements for decision-making in chemical and biological disasters, similar horizontal management options must be considered.

Disaster Planning↗
PubMed2006

Emergency preparedness.

The Boy Scout motto is "be prepared," but can your home health agency abide by this standard? The post-9/11 days of 2001 and the natural disasters that have threatened people and plagued our home and countries abroad illustrate the heightened level of awareness and preparedness home healthcare agencies must achieve to satisfactorily meet emergency preparedness standards. Community-based nurses often are on the front line of response to a man-made, biological, or naturally occurring event. You may have been assigned to work on a plan for your agency's response or have had questions asked about preparedness by your clients and family members. Here are six Web sites to get you started on the answers to those questions and concerns.

Disaster Planning↗
PubMedDate not supplied

Sex ratio: a biological perspective of 'Sex and the City'.

The primary sex ratio in humans differs remarkably from the theoretically expected equality of 1:1, and may be as high as 170 males to 100 females. A number of environmental, physiological and genetic factors have been observed to impact on the primary sex ratio: sexual behaviour, variation in hormonal concentrations, natural disasters, environmental pollutants and timing of conception. Nevertheless, no biological mechanism or interaction of factors has suitably explained this phenomenon, or that of the prenatal vulnerability of the male, the suspected higher sex ratio in spontaneous abortion and the male excesses in adult diseases related to the intrauterine environment. Knowledge of the environmental effects and causes of natural variation in the primary sex ratio will make possible its manipulation, which will have public health implications as well as cultural and social consequences.

Blastocyst↗
PubMed2002

The trauma of profound childhood loss: a personal and professional perspective.

Profound loss in childhood as a precipitant for symptoms of posttraumatic stress disorder has been a largely neglected subject. There is now some literature to suggest that severe loss and the absence of care may be as predictive of psychological distress in children as events that are more frequently studied, such as exposure to natural disasters and physical or sexual abuse. This paper combines the author's personal experience as an orphaned child who was placed in foster care with a discussion of this emerging literature to examine the relationship between childhood loss and trauma symptoms. An awareness of the traumatic nature of severe losses in childhood could help caregivers and mental health professionals deal more effectively with such children.

Adolescent↗
PubMed2005

Cracking the code: the genesis, use and future of the Code of Conduct.

This paper reflects on the genesis of the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief, on the tenth anniversary of its adoption. The origins, usage and future of the code are examined with respect to three debates, current at the time of its inception, namely: the debate about the core content of humanitarianism; the debate about coherence and the consensual nature of the humanitarian community; and the debate about the need for, and the ability to demonstrate, accountability. The paper concludes that although the Code of Conduct was very much a product of its time, its content remains relevant today. However, its future application hinges on the capacity of those who purport to follow it to realise true accountability, and on proving that the code, written essentially for natural disasters, is relevant to contemporary complex emergencies.

Altruism↗
PubMed1983

The offerings from the Hyperboreans.

The ancient Greeks believed that the fruits of agriculture could be harvested only if one first appeased the spirit of the primitive avatars from which the edible crop had been evolved over the centuries through hybridization and cultivation. On occasion, this appeasement was secured through the sacrifice of a human victim, a person who for various reasons could be considered to represent a similar primitivism. By the classical age, this extreme form of sacrificial appeasement appears to have been reserved for times of unusual crisis, such as pestilence or natural disaster, for at such times, the resurgent forces of primitivism seemed to threaten the entire civilization with regression back to its wilder origins. Other forms of appeasement were ordinarily substituted for the actual offering of a human victim. Amongst these was the enactment of puberty rites, for the natural growth and maturation of an individual could be thought to symbolize this same evolutionary process. Each infant is born as a wild creature who must develop into a socialized adult through the metaphoric death of its former self as it assumes the responsibilities of civilized life in crossing the threshold to sexual maturity. A similar symbolic victim was customarily represented by the offering of first fruits. A portion of the cultivated crop was prematurely cut and consecrated to redeem and release the ripening harvest from the dangerous contamination with the spirits of its pre-agricultural precedents. On the island of Delos, a special version of this consecration was performed. Each year, the various Greek cities would send a sheaf of unripened grain to the sanctuary of the god Apollo and his twin sister Artemis. Amongst these annual offerings, there was one that was supposed to have originated from the Hyperboreans, a mythical people who were thought to live in the original homeland of the two gods. This special Hyperborean offering differed from the others, for it was said to contain a secret item hidden within the sheaf. The mythical traditions about these Hyperboreans recalled the Hellenic peoples' Indo-European origins, back in the time before the tribal migrations that brought them eventually into the Mediterranean lands, and the secret offering pertained to Apollo's more ancient religion in that pre-Greek Hyperborean context.(ABSTRACT TRUNCATED AT 400 WORDS)

Basidiomycota↗