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The author describes problems facing Armenia in reorganization of the structure of science in the post-socialist era with the aim of utilizing limited state resources more efficiently by reducing the number of separate scientific institutes, concentrating on essential core subjects required by the nation and encouraging all other projects to compete in the international arena for grant sponsorship.
Aquatic macrophytes are unchangeable biological filters and they carry out purification of the water bodies by accumulating dissolved metals and toxins in their tissue. In view of their potential to entrap several toxic heavy metals, 45 macrophytes belonging to 8 families collected from two different physiographic locations (36 from Sevan Lake, Armenia; 9 from Carambolim Lake, Old Goa, India) were studied for estimation of 14 heavy metals. The study was aimed at understanding the importance of these macrophytes in accumulation of toxic metals and controlling the heavy metal pollution and suggesting the remedial measures, if any, for the preservation and restoration of lake ecosystem. Inductively Coupled Plasma-Atomic Emission Spectrometric (ICP-AES) analyses of these aquatic macrophytes have shown the importance of aquatic macrophytes in accumulation of heavy metals and maintaining the clarity of water bodies beside their role in trophic systems. Accumulation of most of the heavy metals was higher in root system. The representative macrophytes from two different physiographic locations show similar trends and order in accumulating different metals generally. Of the 14 metals investigated, 9 (Ca, Fe, Al, Cr, Cu, Ba, Ti, Co and Pb) showed higher rates of accumulation in the root whereas 3 (Mn, Zn and Mg) showed more accumulation in stem and 1 (Ca) showed higher accumulation in the leaves. In most of the samples Cu was accumulated more in the roots (50+/-47.15 microg/g) and less in flowers (9.52+/-3.97 microg/g). Occurrence of heavy metal was much higher in macrophytes of Sevan Lake than that of the Carambolim Lake. The accumulation of 14 elements was in order of Ca>Mg>Fe>Al>Mn>Ba>Zn>Ti>Cu>Cr>Co>Ni>Pb>Cd. The present study revealed that the aquatic macrophytes play a very significant role in removing the different metals from the ambient environments. They probably play a major role in reducing the effect of high concentration of heavy metals. Therefore, the macrophyte community of the Sevan Lake area needs to be protected and restored on a priority basis. Accumulation of highly toxic metals like--Cr, Cd, Pb and Ni was lower as compared to the essential metals like Ca, Fe and Mn in all the macrophytes from both the lake systems, consequently high metal concentrations observed in both the areas may not directly reflect on the pollution level.
This pilot study of sources of lead exposure in residential settings was conducted in a mining and smelting district in northern Armenia. Samples of exterior soil and dust and interior house dust were collected in and around apartment buildings in Alaverdi where the country's largest polymetallic smelter is located, and in nearby mining towns of Aghtala and Shamlugh. The NITON XL-723 Multi-Element XRF analyzer was used for lead testing. Lead levels in samples from Alaverdi were higher than those in Shamlugh and Aghtala. In all three towns, the highest lead levels were found in loose exterior dust samples, and lead concentrations in yard soil were higher than those in garden soil. Many soil samples (34%) and the majority of loose dust samples (77%) in Alaverdi exceeded the US Environmental Protection Agency standard of 400 mg/kg for bare soil in children's play areas. In addition, 36% of floor dust samples from apartments in Alaverdi exceeded the US Environmental Protection Agency standard of 40 microg/ft(2) for lead loading in residential floor dust. The Armenian Ministry of Health and other interested agencies are being informed about the findings of the study so that they can consider and develop educational and preventive programs including blood lead screening among sensitive populations.
The genotoxicity of ground water from four bore-holes of different depths (40-120m) in the Ararat valley (Armenia) used both for drinking and irrigation was investigated. The frequency of recessive somatic mutations was determined using the Tradescantia-stamen-hair-mutation (Trad-SHM) test. The Tradescantia clone 02 was used. The pink mutation events (PMEs) were increased by 3.18-6.81-fold in comparison with the control depending both on the depth of subterranean water location and the increase of Na(+) ion concentration in these water samples. The peak frequency was found in water from the 40-45m depth. The deeper the bore-holes, the lower the mutagenicity of water and the concentration of Na(+) ions. Different types of mutant sector arrangements and their frequencies changed depending on the subterranean water depth.
OBJECTIVE: To study the relationship of post-traumatic stress disorder (PTSD) to severity of the disaster experience. METHOD: A sample of 1785 adult participants of an epidemiological study initiated in the immediate aftermath of the 1988 earthquake in Armenia were interviewed about 2 years following the disaster based on the NIMH DIS-Disaster Supplement. All 154 cases of pure PTSD were compared with 583 controls without symptoms satisfying psychiatric diagnoses of interest. RESULTS: PTSD cases included more persons from areas with the worst destruction. Having the highest level of education compared to lowest (OR 0.6 [95% CI 0.4-0.9]), being accompanied at the moment of the earthquake (OR 0.6 [95% CI 0.4-0.9]) and making new friends after the earthquake (OR 0.6 [95% CI 0.5-0.8]) were protective for PTSD. PTSD risk increased with the total amount of loss to the family (OR for highest level of loss 4.1 [95% CI 2.3-7.5]). CONCLUSION: Based on this large population sample, we believe that early support to survivors with high levels of loss may reduce PTSD following earthquakes.
A severe earthquake in December 1988 in Armenia, resulted in a large number of spinal cord injuries. A rehabilitation facility was urgently established in Yerevan by the Red Cross with volunteers from various countries outside the then Soviet Union. A programme of training of Armenian doctors, nurses and therapists was established, and a new purpose built spinal unit planned. The new unit was opened in August 1992 and should serve as a model for similar units throughout the Commonwealth of Independent States.
BACKGROUND: This is the first population-based study of earthquake injuries and deaths that uses a cohort approach to identify factors of high risk. As part of a special project that collected data about the population in the aftermath of the earthquake that hit Northern Armenia on 7 December 1988, employees of the Ministry of Health working in the earthquake zone on 7 December 1988, and their families, were studied as a cohort to assess the short and long term impact of the disaster. The current analysis assesses short term outcomes of injuries and deaths as a direct result of the earthquake. METHODS: From an unduplicated list of 9017 employees, it was possible to contact and interview 7016 employees or their families over a period extending from April 1990 to December 1992. The current analysis presents the determinants of 831 deaths and 1454 injuries that resulted directly from the earthquake in our study population of 32,743 people (employees and their families). RESULTS: Geographical location, being inside a building during the earthquake, height of the building, and location within the upper floors of the building were risk factors for injury and death in the univariate analyses. However, multivariate analyses, using different models, revealed that being in the Spitak region (odds ratio [OR] = 80.9, 95% confidence interval [CI]: 55.5-118.1) and in the city of Gumri (OR = 30.7, 95% CI: 21.4-44.2) and inside a building at the moment of the earthquake (OR = 10.1, 95% CI: 6.5-15.9) were the strongest predictors for death. Although of smaller magnitude, the same factors had significant OR for injuries. Building height was more important as a factor in predicting death than the location of the individual on various floors of the building except for being on the ground floor of the building which was protective. CONCLUSIONS: Considering that most of the high rise buildings destroyed in this earthquake were built using standard techniques, the most effective preventive effort for this disaster would have been appropriate structural approaches prior to the earthquake.
To assess the relation of increased mortality and morbidity to personal loss and damage following the 1988 earthquake in Armenia, the authors conducted a prospective study of mortality and a nested case-control analysis of incident morbidity. Employees of the Armenian Ministry of Health and their immediate families (n = 35,043) who survived the disaster formed the study population. Two sets of interviews with the employees, carried out over a period of 4 years of follow-up, were used as the primary source of data for this study. The highest numbers of deaths from all causes and from heart disease were observed within the first 6 months following the earthquake. The nested case-control analysis of 483 cases of newly reported heart disease and 482 matched non-heart-disease controls revealed that people with increasing levels of loss of material possessions and family members had significant increases in heart disease risk (odds ratios for "loss scores" of 1, 2, and 3 were 1.3, 1.8, and 2.6, respectively). The findings were similar with regard to the relation of damage and loss to newly reported hypertension, diabetes mellitus, and arthritis. The findings of this study support the hypothesis that longer term increased rates of heart disease and chronic disease morbidity following an earthquake are related to the intensity of exposure to disaster-related damage and losses. People sustaining such losses should be closely monitored for increased long term morbidity.
OBJECTIVE: To determine current rates of posttraumatic stress disorder (PTSD), depressive disorder, and separation anxiety disorder (SAD) among children 1 1/2 years after the 1988 earthquake in Armenia; to determine current rates of comorbid PTSD and depressive disorder; and to assess the contribution of exposure, gender, loss of family members, and loss of residence. METHOD: Two hundred eighteen school-age children from three cities at increasing distances from the epicenter were evaluated using the Child Posttraumatic Stress Disorder Reaction Index, the Depression Self-Rating Scale, and the section on SAD from the Diagnostic Interview for Children and Adolescents. RESULTS: On the basis of these evaluations, high rates of current PTSD, depressive disorder, and their co-occurrence were found among victims residing in the two heavily impacted cities. SAD was comparatively less frequent, although symptoms of SAD had been pervasive throughout the region. Severity of posttraumatic stress and depressive reactions were highly correlated. Extent of loss of family members was independently correlated with each. CONCLUSION: After a catastrophic natural disaster, children are at risk for comorbid PTSD and secondary depression. Based on the findings, an interactive model is proposed of postdisaster psychopathology. Early clinical intervention is recommended to prevent chronic posttraumatic stress reactions and secondary depression.
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.
Strain S, a spotted fever group (SFG) rickettsia isolated from Rhipicephalus sanguineus ticks collected in Armenia, was identified. Microimmunofluorescence, sodium dodecyl sulfate-polyacrylamide gel protein electrophoresis and Western immunoblotting, PCR and then restriction fragment length polymorphism analysis, pulsed-field gel electrophoresis, and 16S rRNA gene sequencing were used to compare strain S with reference isolates. Strain S was found to possess proteinic, antigenic, and genomic patterns which were unique among SFG rickettsiae. Strain S is characterized by its high degree of pathogenicity for experimental animals, but its role as a potential human pathogen should be determined. The role of R. sanguineus ticks in the epidemiology of SFG rickettsiae is discussed.
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.
OBJECTIVE: This study evaluated basal salivary cortisol, 3-methoxy-4-hydroxyphenylglycol (MHPG), and cortisol suppression following dexamethasone administration in adolescents exposed to two levels of earthquake-related trauma. METHOD: Five years after the 1988 earthquake, saliva samples were obtained from 37 adolescents from two cities in Armenia at different distances from the epicenter. Baseline saliva samples were obtained at 8:00 a.m., 4:00 p.m., and 11:00 p.m., following which 0.5 mg of dexamethasone was administered. Nine and 17 hours later, saliva samples were again obtained. Subjects were evaluated for posttraumatic stress and depressive reactions through use of self-report instruments. RESULTS: Significantly lower mean baseline 8:00 a.m. cortisol levels and greater day 24:00 p.m. cortisol suppression following dexamethasone were observed in the more symptomatic adolescents living in the city closer to the epicenter. Of the three symptom categories of posttraumatic stress disorder (PTSD), only intrusion (category B) symptoms were significantly correlated with basal morning cortisol levels and percent suppression by dexamethasone. The more highly exposed adolescents also exhibited a more rapid decline in MHPG levels over the course of day 1. CONCLUSIONS: The findings indicate that chronic posttraumatic stress reactions among adolescents exposed to catastrophic disaster are associated with hypothalamic-pituitary-adrenal (HPA) axis alterations. The findings are congruent with those previously described in adults with chronic PTSD. Persistent intrusion (category B) symptoms may constitute continued episodes of distress and evoke repeated physiological stress responses, which, over time, alter HPA axis function. The MHPG findings suggest that there may be diurnal changes associated with severity of posttraumatic stress symptoms.
BACKGROUND: Physicians can play an important role in smoking prevention and control. This study will identify smoking prevalence among physicians in Yerevan, Armenia. It will also explore how the smoking behaviors of physicians, their perceived ability to influence patient smoking behavior, and their knowledge about health outcomes related to smoking influence their interaction with patients. METHODS: A cross-sectional, self-administered, anonymous survey was conducted in July, 2004, among 12 healthcare facilities in Yerevan. Analyses are based on responses from 240 physicians, representing a 70% response rate. RESULTS: The percentage of current smokers was significantly higher in men than women (48.5% vs. 12.8% regular and 6.8% vs. 4.5% occasional). Among current smokers, 52.7% of men compared with 13.0% of women had previously smoked in the presence of patients. Only 35.3% felt well prepared to assist patients to quit smoking. Physicians who smoke are less likely to ask their patients about their smoking behavior or believe their example is likely to influence their patients. Level of perceived preparedness to assist patients to quit smoking was positively associated with knowledge about known health risks associated with smoking. CONCLUSION: Smoking prevalence is high among physicians in the 12 healthcare facilities in Yerevan, and a large percentage of physician smoke in the presence of their patients. Physician smoking behavior and knowledge of smoking related health outcomes in Yerevan influences whether they counsel patients regarding smoking.
BACKGROUND: Mortality rates in Western Europe have fallen significantly over the last 50 years. Maternal mortality now averages 10 maternal deaths per 100,000 live births but in some of the Newly Independent States of the former Soviet Union, the ratio is nearly 4 times higher. The availability of skilled attendants to prevent, detect and manage major obstetric complications may be the single most important factor in preventing maternal deaths. A modern, multidisciplinary, scenario and model based training programme has been established in the UK (Managing Obstetric Emergencies and Trauma (MOET)) and allows specialist obstetricians to learn or revise the undertaking of procedures using models, and to have their skills tested in scenarios. METHODS: Given the success of the MOET course in the UK, the organisers were keen to evaluate it in another setting (Armenia). Pre-course knowledge and practice questionnaires were administered. In an exploratory analysis, post-course results were compared to pre-course answers obtained by the same interviewer. RESULTS: All candidates showed an improvement in post-course scores. The range was far narrower afterwards (167-188) than before (85-129.5). In the individual score analysis only two scenarios showed a non-significant change (cord prolapse and breech delivery). CONCLUSION: This paper demonstrates the reliability of the model based scenarios, with a highly significant improvement in obstetric emergency management. However, clinical audit will be required to measure the full impact of training by longer term follow up. Audit of delays, specific obstetric complications, referrals and near misses may all be amenable to review.
On 7 December 1988, a severe earthquake hit in Armenia, a former republic of the Soviet Union (USSR); on 11 September 2001, a manmade attack of similar impact hit New York City. These events share similar implications for the role of the uninjured survivor. With basic training, the uninjured survivors could save lives without tools or resuscitation equipment. This article makes the case for teaching life-supporting first aid to the public in the hope that one day, should another such incident occur, they would be able to preserve injured victims until formal rescue occurs.
An international mental health relief programme for children and adults was implemented in Soviet Armenia after the 7 December 1988 Spitak earthquake. This paper presents: (a) the steps considered essential in the selection, preparation and support of mental health workers for the relief work; (b) a method which facilitated the screening and treating of large numbers of students in their classrooms; (c) the rate of post-traumatic stress disorder (74%) and major depressive disorder (22%) of 582 victims clinically evaluated before entering treatment three to six months after the earthquake; (d) clinical observations of significant psychological problems that may be overlooked in brief crisis-orientated psychotherapy; (e) multiple severe post-earthquake adversities (such as the collapse of the social network, the recurrence of after-shocks, the delay of reconstruction and the ongoing political turmoil) which contributed to the psychological problems of the victims and delayed their recovery; (f) the extension of the outreach programme beyond its traditional therapeutic role to an advisory one to other relief organisations.
This article provides a description of the eight phases of the Mental Health Outreach Program (MHOP) cofounded by the author to address the needs of the surviving community following the 1988 earthquake in Armenia. For the purposes of the MHOP, the nursing process was expanded from five to eight phases: 1) preassessment, 2) assessment, 3) analysis, 4) community diagnosis, 5) planning, 6) implementation, 7) evaluation, and 8) remodification. A framework for assessing the level of trauma in an unfamiliar community (with its mnemonic acronym COPE), which was formulated by the author to expedite the assessment and implementation phases, is described. The article concludes with a set of recommendations for psychiatric mental health nurses in mitigating the negative impact and consequences of disasters.