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PubMedDate not supplied

Morbidity on Kauai before and after Hurricane Iniki.

BACKGROUND: On September 11, 1992, Hurricane Iniki, a Class III/IV storm, passed directly over Kauai. This study is the first attempt to measure increases in injuries and other health outcomes among an entire population in the impact zone of a hurricane. METHODS: Medical chart data were abstracted from all facilities providing primary and emergency care on Kauai. Incidence of injury, cardiovascular disease, and asthma for the 2-week period following Hurricane Iniki were compared to those for the 2-week period preceding Iniki. RESULTS: A total of 1,584 injuries were treated in the post-Iniki period compared with 231 injuries treated in the pre-Iniki period (relative risk = 6.86, 95% confidence interval 5.98-7.87). Open wounds constituted over half of these injuries. Physician visits for asthma and cardiovascular disease were also significantly increased in the post-Iniki period (relative risks, respectively: 2.81, 95% confidence interval 1.93-4.09; 2.73, 95% confidence interval 1.51-4.94). CONCLUSIONS: Significant increases in the incidence of injuries, asthma, and cardiovascular disease occurred following Hurricane Iniki. Although no changes occurred in the proportion of patients needing hospitalization, additional injuries and illnesses after a natural disaster can burden existing medical facilities in a rural community with limited resources. Disaster preparedness plans need to include methods to increase services and supplies at existing medical facilities.

Adolescent↗
PubMedDate not supplied

Necrotizing lesions of soft tissues: a review.

Necrotizing lesions of the soft tissues are grave entities not infrequently seen in daily surgical practice. They may occur with epidemic proportions after natural disasters, representing a serious challenge to the surgeon since they are characteristically associated with high mortality rates unless an early diagnosis is made and prompt aggressive surgical management is initiated. Necrotizing fasciitis is the currently accepted generic term to encompass into a single category the diverse syndromes of progressive gangrenous infections of the skin and subcutaneous tissues. Necrotizing fasciitis must be viewed as a clinical entity rather than a specific type of infection: it is a clinical infection most commonly caused by a mixed aerobic/anaerobic synergistic polymicrobial combination. Zygomycetes may appear as major causal organisms (mucormycosis) and they should be actively searched for. Initial diagnosis of necrotizing fasciitis is established through the characteristic physical signs. Gram stain, and, in some doubtful cases, through frozen-section tissue biopsy. Aggressive and urgent radical debridement is the key to survival, combined with wide-spectrum antibiotic therapy.

Fasciitis↗
PubMedDate not supplied

Necrotizing soft tissue lesions after a volcanic cataclysm.

A volcanic cataclysm of major proportions, the fourth largest in terms of total casualties in the history of mankind, wiped out the town of Armero, Colombia, in 1985 resulting in over 23,000 deaths and 4,500 wounded. Among the hundreds of survivors who were transferred to hospitals in the capital city of Bogotá, there was as overwhelming number who developed necrotizing fasciitis. These patients constitute, perhaps, the single largest group of this type of lesions in the recorded literature. Thirty-eight patients with well established necrotizing fasciitis were identified at 4 selected hospitals in Bogotá; 8 of them presented with zygomycetic infection (mucormycosis), a highly lethal entity. Many additional cases were treated at other hospitals in Bogotá and several cities in Colombia. The main clinical features of these 38 patients affected by necrotizing fasciitis are reviewed, with special emphasis on the patients with mucormycosis. Patients with necrotizing fasciitis had an overall mortality rate of 47.7%; patients with mucormycosis, 80%. A plea is made for an early diagnosis, utilizing tissue sampling and microbiological studies, so that prompt and radical treatment can be instituted. This is especially pertinent in situations of natural disasters resulting in massive numbers of casualties and seriously injured survivors.

Amputation, Surgical↗
PubMed1994

Psychological distress of adolescents exposed to Hurricane Hugo.

To ascertain the effects of a natural disaster on adolescents, 1482 South Carolina high school students who were exposed to Hurricane Hugo were surveyed 1 year after the disaster. Subjects completed a self-administered questionnaire measuring Hugo exposure, nonviolent and violent life events, social support, self-efficacy, and psychological distress. Results showed that the students reported minimal exposure to the hurricane and psychological distress variables approximated national norms. As exposure increased, adolescents reported increased symptoms of psychological distress; i.e., anger, depression, anxiety, and global mental distress. Females and white students experienced higher levels of distress. In most cases, other stressful life events were at least as strong a predictor of psychological distress as was exposure to the hurricane. Self-efficacy and social support were protective.

Adolescent↗
PubMed1996

Psychiatric morbidity following Hurricane Andrew.

The nature of psychiatric morbidity in previously non-ill subjects from the area most affected by Hurricane Andrew was investigated at 6-12 months posthurricane. Preliminary associations of morbidity with personal and event-related risk factors were also determined. Fifty one percent (31/61) met criteria for a new-onset disorder, including posttraumatic stress disorder (PTSD) in 36%, major depression (MD) in 30%, and other anxiety disorders in 20%. Thirty four subjects (56%) had significant symptoms persisting beyond 6 months. Having sustained "severe damage" was the risk factor most strongly associated with outcome. Our data underscore the range of psychiatric morbidity related to a natural disaster, and suggest a relationship to chronic stressors.

Adult↗
PubMed2003

Prevalence of psychiatric disorder following the 1988 Yun Nan (China) earthquake--the first 5-month period.

BACKGROUND: There is a continuing need to examine the psychiatric impact of natural disasters for the development of an understanding of the determinants of morbid outcomes. The study of culturally distinct groups provides evidence as to the robustness of psychopathology emerging in the context of traumatic exposures. METHOD: In this study, 1294 people were examined at 5 months after the 1988 Yun Nan earthquake in order to explore the psychiatric impact of this disaster. They were assessed with a number of instruments, including the General Health Questionnaire (28-item version), the Life Event Inventory, and the Post-traumatic Stress Disorder section of the Diagnostic Interview Schedule. Three groups were examined according to their distance from the epicenter of the quake. Their responses were compared with an additional sample of 908 people from a general population living 520 kilometers away from the epicenter. RESULTS: GHQ 'caseness' in the three disaster groups, from those closest to those more distant from the epicenter, were 60.4, 48.2 and 44.0%. These rates were significantly higher than the non-exposed control group (36.2). Among the three disaster groups, taking those who achieved GHQ 'caseness' criteria, the PTSD prevalence was 23, 13 and 16%, respectively. For the overall population experiencing the earthquake (the combined disaster group), a conservative estimate of disaster-related PTSD prevalence was 8.9%. CONCLUSION: The varied rate of morbidity (both general and PTSD-specific) could be attributed to the relative impact of the earthquake as represented by epicenter proximity and as measured by the rate of property damage and loss in the three earthquake-affected areas.

Adolescent↗
PubMed1999

Effects of negative life experiences on phobia onset.

BACKGROUND: Conditioning theories, stress theories and social psychological theories each suggest that negative life experiences should influence phobia onset, though the patterns of effects suggested by each type of theory are different. Few previous studies have estimated the effects of a broad enough range of life experiences on onset of multiple types of phobia to evaluate patterns of effects. METHODS: Retrospective data on life experiences and history of phobia from a representative sample of persons 15-54 years old from the US population (the National Comorbidity Survey) are analyzed using discrete-time event history methods. RESULTS: The effects of 12 negative life events and ten chronic childhood adversities on onset of agoraphobia, specific phobia, and social phobia are presented. Three discrete events have unique effects on agoraphobia onset: life threatening accidents, combat in war (for men), and a fire/flood or other natural disaster. Two chronic experiences during childhood have unique effects on specific phobia onset: violence at the hands of one or more adults, and verbal aggression between parents. Sexual assault by a relative and verbal aggression between parents have unique effects on social phobia onset. The effect of sexual assault by a relative on social phobia is confined to women, and to phobias beginning before age 12. CONCLUSIONS: Unpredictable and uncontrollable events that threaten or result in physical harm influence agoraphobia onset. Potentially predictable but difficult to control childhood experiences (e.g., chronic parental violence) influence specific phobia onset. Blame is a likely mediator of the effect of sexual abuse on social phobia. No data on perceptions of predictability and controllability of life experiences, or of blame, were available for analysis. These conclusions are therefore based on speculations about social psychological processes that have been supported by previous research and theory.

Adolescent↗
PubMed2001

Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective.

BACKGROUND: Whereas natural disasters more commonly occur in low-income countries, almost all studies on psychological consequences have been conducted in the Western world. In countries where resources are poor it is of importance to know which groups should be targeted for early intervention after a disaster. The study aims at assessing the prevalence of post-traumatic stress disorder PTSD and of post-traumatic symptoms among people afflicted by hurricane Mitch in Nicaragua and at identifying risk factors for PTSD symptoms 6 months following a disaster. METHOD: At four primary health care centres, 496 consecutive adult patients were interviewed 6 months after hurricane Mitch regarding PTSD symptoms (Harvard Trauma Questionnaire, HTQ), disaster experiences and post-disaster help-seeking. RESULTS: All individuals resident in the area during Mitch were judged to have experienced a trauma fulfilling A criteria for PTSD. Regarding more specific traumas, 39% reported a close relative to be dead or seriously injured and 72% had their house partly or completely destroyed. Prevalence of PTSD ranged from 9.0% in the worst afflicted area to 4.5% in a less damaged area. From a dimensional perspective, PTSD symptoms according to HTQ 6 months after the disaster were significantly associated with the death of a relative (beta-coefficient 0.257, P = 0.000), a house destroyed (beta-coefficient 0.148, P = 0.001), female sex (beta-coefficient 0.139, P = 0.001), previous mental health problems (beta-coefficient 0.109, P = 0.009) and illiteracy (beta-coefficient 0.110, P = 0.009). Those with previous mental health problems (OR = 4.84; 95% CI = 3.04-7.66) were more likely than others to seek from help, any source whereas the opposite was true for illiterate people (OR = 0.38; 95% CI = 0.21-0.69). Of all respondents, 8.5% reported that they had thought of taking their lives, and illiterates (OR 2.84; 95% CI = 1.12-4.37) and those with previous mental health problems (OR 2.84; 95% CI = 1.12-4.57) were at particular risk for suicidal problems. One year after Mitch, half of those identified as PTSD cases at 6 months still fulfilled the criteria for a PTSD diagnosis. CONCLUSION: PTSD represents a serious mental health problem after a disaster. Those with illiteracy, females and those with previous mental health problems should be targets for early post-disaster intervention.

Adolescent↗
PubMed2006

Applying gap analysis and a comparison index to evaluate protected areas in Thailand.

Protected areas in Thailand were first established 40 years ago. The total area of existing protected areas covers 18.2% of the country's land area and the Class 1 Watershed, another form of protection, encompasses 18.1%. The government of Thailand intends to increase protected area systems to 25% of the country in 2006 and 30% in 2016. There are always questions arising about how much is enough protected areas to effectively protect biodiversity. The objective of this article is to assess the representation of ecosystems in the protected area network. This article also recommends which underrepresented ecosystems should be added to fill the gaps in representativeness. The research applies a gap analysis and a comparison index to assess the representation of ecosystems within the protected area network. The spatial analyses were applied to measure three aspects of representativeness, namely forest type, altitude, and natural land system. The analyses indicate that the existing protected area system covers 24.4% of the country's land area, nearly meeting the 25% target proposed by the National Forest Policy; and 83.8% of these areas are under forest cover. Most protected areas are situated in high altitudes, where biological diversity is less than in lowlands. Mangrove forest and riparian floodplain are extremely underrepresented in the existing system. Peat swamp forest, dry dipterocarp forest, and beach forest are relatively well represented. In addition, these five ecosystems are threatened by human pressures and natural disasters; therefore, they should be targeted as high priorities for the selection of new reserves. Future research should incorporate aquatic and marine ecosystems, as well as animal distributions, which were not included in this research due to data unavailabilities.

Environmental Health↗
PubMed2006

Improvements on flood alleviation in Germany: lessons learned from the Elbe flood in August 2002.

The increase in damage due to natural disasters is directly related to the number of people who live and work in hazardous areas and continuously accumulate assets. Therefore, land use planning authorities have to manage effectively the establishment and development of settlements in flood-prone areas in order to avoid the further increase of vulnerable assets. Germany faced major destruction during the flood in August 2002 in the Elbe and Danube catchments, and many changes have been suggested in the existing German water and planning regulations. This article presents some findings of a "Lessons Learned" study that was carried out in the aftermath of the flood and discusses the following topics: 1) the establishment of comprehensive hazard maps and flood protection concepts, 2) the harmonization of regulations of flood protection at the federal level, 3) the communication of the flood hazard and awareness strategies, and 4) how damage potential can be minimized through measures of area precaution such as resettlement and risk-adapted land use. Although attempts towards a coordinated and harmonized creation of flood hazard maps and concepts have been made, there is still no uniform strategy at all planning levels and for all states (Laender) of the Federal Republic of Germany. The development and communication of possible mitigation strategies for "unthinkable extreme events" beyond the common safety level of a 100-year flood are needed. In order to establish a sustainable and integrated flood risk management, interdisciplinary and catchment-based approaches are needed.

Disaster Planning↗
PubMed2006

Parent refugee status, immigration stressors, and Southeast Asian youth violence.

PURPOSE: To assess the effects of parents' experience of traumatic events on violence among Southeast Asian and Chinese youth. The study examines independent effects of parents' refugee camp experiences and immigration stress on serious or family/partner violence among youth. Findings contribute evidence on the intergenerational effects of community-level trauma that can help policy makers better integrate family and community strategies to reduce youth violence. METHODS: Obtained cross-sectional, face-to-face interview data including peer delinquency, parental engagement, parental discipline, serious violence, and family/partner violence from a sample of 329 Chinese and Southeast Asian adolescents. Measures of socioeconomic status, refugee status, and immigration stressors were collected from their respective parents. Data were analyzed using LISREL 8.54 for structural equation modeling. RESULTS: Findings show that parents' refugee status facilitated serious violence, and was fully mediated by peer delinquency and parental engagement, but for Vietnamese only. Parents' refugee status was also significantly related to family/partner violence, and mediated by peer delinquency. This relationship was not observed among the other Asian ethnic groups. The immigration stress variable had no significant effects on either serious violence or family/partner violence. CONCLUSIONS: Refugee communities may not transform easily into stereotypical immigrant Asian communities characterized by little youth violence. Results suggest that the refugee process, as experienced second-hand through the children of refugees, has a strong effect on externally oriented violence (serious violence) and on family/partner violence for particular subgroups. Therefore, community-oriented policy makers should join social workers in developing programs to address youth violence in Southeast Asian families and communities. Findings have implications for other forms of community trauma such as natural disasters.

Adolescent↗
PubMed2007

Depressive symptoms among firefighters and related factors after the response to Hurricane Katrina.

The National Institute for Occupational Safety and Health conducted an evaluation regarding physical and psychological health symptoms among New Orleans firefighters 13 weeks after Hurricane Katrina struck the U.S. Gulf Coast on August 29, 2005. This report examines associations between depressive symptoms and concurrent comorbidity. Depressive symptoms were twice as likely among those with either lower respiratory symptoms or skin rash. Firefighters housed with their families were less likely to report depressive symptoms compared to those not living with their families. Perceived low supervisor support was associated with depressive symptoms, whereas participating in group counseling was not. The results underscore the need for the incorporation of physical and psychological health follow-up of emergency responders after natural disasters to better understand, monitor, and treat their health conditions.

Adult↗
PubMed1985

The nurse as a survivor: delayed post-traumatic stress reaction and cumulative trauma in nursing.

As opposed to studies on the immediate psychological impact of traumatic nursing experiences, little attention has been directed to the persistence of certain long-standing hidden symptoms of trauma in some nurses. Since psychological reactions to trauma are claimed to be similar, irrespective of the source of trauma, it is postulated that findings from recent studies on delayed post-traumatic stress reaction in Vietnam veterans, victims of natural disaster, and survivors of the holocaust, delineate symptoms which are also found in stress-prone nurses utilizing maladaptive coping strategies in response to hospital-related traumatic episodes. While some observations are conjectural and speculative, an integrated review is presented of areas of research hitherto unrelated, which serves to deepen our understanding of trauma and its impact upon the mental health of nurses.

Adaptation, Psychological↗
PubMed1988

Earthquakes, influenza and cycles of Indian kala-azar.

It is suggested that previous data indicate 3 major epidemics of kala-azar in Assam between 1875 and 1950, with inter-epidemic periods of 30-45 and 20 years. This deviates from the popular view of regular cycles with a 10-20 year period. A deterministic mathematical model of kala-azar is used to find the simplest explanation for the timing of the 3 epidemics, paying particular attention to the role of extrinsic (drugs, natural disasters, other infectious diseases) versus intrinsic (host and vector dynamics, birth and death rates, immunity) processes in provoking the second. We conclude that, whilst widespread influenza in 1918-1919 may have magnified the second epidemic, intrinsic population processes provide the simplest explanation for its timing and synchrony throughout Assam. The model also shows that the second inter-epidemic period is expected to be shorter than the first, even in the absence of extrinsic agents, and highlights the importance of a small fraction of patients becoming chronically infectious (with post kala-azar dermal leishmaniasis) after treatment during an epidemic.

Disasters↗
PubMed1991

Survival of classic cholera in Bangladesh.

During the present cholera pandemic the El Tor biotype of Vibrio cholerae has completely displaced the classic biotype, except in Bangladesh. We studied the distribution of these two biotypes in twenty-four rural districts during epidemics in 1988-89; there was clustering of the classic biotype in the southern region and of the El Tor biotype in all other regions. These findings suggest that the southern coastal region is now (and may always have been) the habitat of classic cholera. The selective distribution of V cholerae O1 biotypes in Bangladesh may have been affected by ecological changes occurring in the country.

Bangladesh↗
PubMed1993

The geographical inequalities of mortality in China.

The Chinese population accounts for one-fifth of the world's total, so any change in Chinese mortality will have a great influence on the change of the world population. Before 1949, Chinese population mortality was 25-33%, the high year was 40%, and infant mortality even reached over 250 per 1000 live births. After 1949, the mortality had a rapid decline: it was 20% in 1949, and 14-18% in 1950-1964. But in 1960, mortality went up to 25.43% because of the natural disasters. Since 1965 it has been under 10%. Chinese mortality was 6.58% in 1988. The lowest proportion was 4.95% in Heilongjiang Province. The highest was 7.13% in Yunnan Province. Urban mortality has always been lower than that of the countryside. The urban mortality was 7% in 1965, but it was not until 1978, that countryside mortality had just reached this level. It probably related to the economics, culture, environment, health care and etc. It is worth noting that urban mortality has increased in China since 1981. It was 6.44% in Shanghai in 1981, but it went up to 6.80% in 1988. This condition has been attributed to an aging population and environmental pollution. As family planning has been practised in China, it can be estimated that the Chinese population will be at its height in 2004, and will begin to decrease in 2005.

Adolescent↗
PubMed1994

Social stress and state-to-state differences in smoking and smoking related mortality in the United States.

This paper reports on the relationship between the stressfulness of the social environment, smoking and mortality rates for malignant neoplasms of the respiratory system and chronic obstructive pulmonary disease (COPD). A macro-social approach was employed with the 50 states of the United States serving as the units of analysis. A 'State Stress Index' was computed using stressful events in 15 categories (divorce rate, business failures, natural disasters, etc.). Smoking behavior was measured by percentage smokers and the average cigarette sales per capita. Mortality rates for lung cancer and COPD were standardized by age. The percent population living in metropolitan areas, black, below poverty line, and with less than high school education were included as controls in the multiple regression analysis. The results show that populations that experience higher levels of stressful events smoke more heavily and eventually experience higher mortality from lung cancer and COPD. These relationships are robust: they are replicated for different time periods, for different measures of the independent and dependent variables, and with different analytic methods. The pattern of findings is consistent with a 'health behavior' model of stress in which populations under stress engage in behavior which is extremely inimical to health.

Aged↗
PubMed2004

Consensus statement on crush injury and crush syndrome.

Crush syndrome remains rare in European practice. It is, however, common in areas of civil disorder and where the normal structures of society have given way to civil war or natural disaster. Western doctors are becoming increasingly involved in such situations and there is no reason to believe that instances due to more conventional causes, such as collapse in the elderly or road traffic accidents will cease. For all these reasons it is important that clinicians who deal infrequently with crush syndrome have access to appropriate guidelines. This consensus report seeks to provide such advice.

Adult↗