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PubMed1996

Received and perceived social support in times of stress: a test of the social support deterioration deterrence model.

The authors evaluated the impact of receiving social support on subsequent levels of perceived social support and psychological distress in 2 independent samples of victims of severe natural disasters: Hurricane Hugo (n = 498) and Hurricane Andrew (n = 404). A social support deterioration deterrence model was proposed that stipulated that postdisaster mobilization of received support counteracts the deterioration in expectations of support often experienced by victims of major life events. LISREL analyses of data collected 12 and 24 months after Hugo and 6 and 28 months after Andrew provided strong evidence for the hypothesized model: Perceived support mediated the long-term effects on distress of both scope of disaster exposure and postdisaster received support. Theoretical and application issues of social support are discussed.

Adaptation, Psychological↗
PubMed2000

Age and emotional response to the Northridge earthquake: a longitudinal analysis.

Cross-sectional studies have found older adults to have lower levels of emotional distress after natural disasters. The maturation hypothesis suggests that older adults are less reactive to stress events, whereas the inoculation hypothesis argues that prior experience with disaster is protective. One hundred and sixty-six adults aged 30 to 102 were interviewed regarding the 1994 Northridge earthquake. Longitudinal data were available on depressed mood before and after the earthquake. The maturation hypothesis was generally not supported. The young-old were least depressed; however, this age difference was present prior to the earthquake. The old-old showed lowest levels of earthquake-specific rumination, but age did not buffer the relationship between damage exposure and rumination. The inoculation hypothesis was supported for depressed mood. Prior earthquake experience was related to lower postearthquake depression scores.

Adult↗
PubMed2002

Preparing for bioterrorism at the state level: report of an informal survey.

Members of 18 states' departments of mental health were interviewed about their plans for managing the psychosocial impacts of a bioterrorism event. Questions were developed from recommendations of an international conference on planning for bioterrorism ("Planning for bioterrorism," 2000). Information derived from the survey highlights the need for, and the importance of, mental health consultation to the state's planning process. Familiarity with the unique psychological and behavioral consequences of a bioterrorism event in contrast to natural disasters is essential. Realistic training scenarios that incorporate likely psychosocial impacts and appropriate mental health response must be developed.

Bioterrorism↗
PubMed2002

Comparison of three pyrethroid treatments of top-sheets for malaria control in emergencies: entomological and user acceptance studies in an Afghan refugee camp in Pakistan.

Insecticide-treated bedding materials (sheets and blankets) could be protective against vectors of malaria and leishmaniasis--especially in complex emergencies, epidemics and natural disasters where people are more likely to sleep in exposed situations. Comparison of cotton top-sheets impregnated with different pyrethroids (permethrin 500 mg/m2, deltamethrin 25 mg/m2 or alphacypermethrin 25 mg/m2) for effectiveness against mosquitoes (Diptera: Culicidae) was undertaken in a refugee camp in Pakistan. Predominant species encountered were Anopheles stephensi Liston, An. pulcherrimus Theobald, An. nigerrimus Giles, Culex quinquefasciatus Say, Cx. tritaeniorhynchus Giles and other culicine mosquitoes. All three pyrethroid treatments performed significantly better than the untreated sheets in deterrence and killing of mosquitoes. No significant differences were found between the three insecticides tested in terms of entomological effect. Washing of the treated sheets greatly reduced their effectiveness. In a user acceptance study conducted among 88 families (divided into four groups), six families complained of irritation of the skin and mucous membranes. Of these reports, one was from the placebo group (using untreated sheets) and the other five (5/22=23%) from families using deltamethrin-treated sheets. All families allocated to permethrin and alphacypermethrin groups declared an appreciation for the intervention and reported no side-effects. Ten of the placebo group disliked the intervention, citing no prevention of mosquito biting as the reason. Side-effects associated with deltamethrin indicate that alphacypermethrin and permethrin are more appropriate first choice insecticides for treatment of sheets and blankets.

Afghanistan↗
PubMed1994

Effects of new brochures on blood donor recruitment and retention.

BACKGROUND: Currently, donors may arrive at blood collection sites without prior knowledge of eligibility and deferral criteria. STUDY DESIGN AND METHODS: The effects of distributing newly developed recruitment brochures 2 weeks in advance of blood drives and the provision of brochures on temporary deferral at the taking of health history were examined in four southeastern regional blood collection centers. Twenty-four similar pairs of worksites, with employee-only recruitment, were randomly assigned to a control (C) or experimental (E) group. Information about sponsor recruitment strategies, worksite factors, and first-time, repeat, and temporarily deferred donors was obtained at three collection drives per site over a 1-year period. Drive 1 was used as a baseline. Two weeks before Drives 2 and 3, the recruitment brochures were distributed to all Group E employees, with temporary deferral brochures provided as needed when the health history was taken. RESULTS: No significant differences between groups or drives were found in the total percentage of employees recruited or returning as a result of recruitment or deferral brochure distribution (Wilcoxon's signed rank test and t test). Substantiating previous observations by donor recruiters, the study results showed decreased donations during vacation periods and busier times at the workplace. Loudspeaker announcements led to decreased donations; increased donations followed special appeals in relation to a specific patient, an accident, or a natural disaster. CONCLUSION: The brochures may have encouraged previous donors to return, but their use did not significantly increase the recruitment of new donors or the return of temporarily deferred donors.

Blood Donors↗
PubMed2001

Emergency medicine in Ecuador.

Emergency medical care in Ecuador is limited by geographic, economic, political, and infrastructural barriers. Afflictions of the developing world (eg, tropical infections and natural disasters) combine with ailments of the developed world (eg, trauma and cardiovascular disease) to mandate improved emergency medical systems. The nation has recently initiated FASBASE, a program dedicated to the enhancement of both prehospital and emergency department (ED) services. Furthermore, a dedicated residency program in Emergency and Disaster Medicine recently graduated its first class. Although more programs and funding are necessary to sustain the effort, Ecuador has begun to develop a modern emergency medical system.

Disasters↗
PubMed2002

Acute psychosocial stress and cardiovascular events.

Stressful life events can trigger acute myocardial infarction and sudden cardiac death. Victims of natural disasters, such as earthquakes and other conditions of extreme stress should be evaluated for physical injuries as well as for cardiac disease.

Acute Disease↗
PubMed1990

Excess mortality in Harlem.

In recent decades mortality rates have declined for both white and nonwhite Americans, but national averages obscure the extremely high mortality rates in many inner-city communities. Using data from the 1980 census and from death certificates in 1979, 1980, and 1981, we examined mortality rates in New York City's Central Harlem health district, where 96 percent of the inhabitants are black and 41 percent live below the poverty line. For Harlem, the age-adjusted rate of mortality from all causes was the highest in New York City, more than double that of U.S. whites and 50 percent higher than that of U.S. blacks. Almost all the excess mortality was among those less than 65 years old. With rates for the white population as the basis for comparison, the standardized (adjusted for age) mortality ratios (SMRs) for deaths under the age of 65 in Harlem were 2.91 for male residents and 2.70 for female residents. The highest ratios were for women 25 to 34 years old (SMR, 6.13) and men 35 to 44 years old (SMR, 5.98). The chief causes of this excess mortality were cardiovascular disease (23.5 percent of the excess deaths; SMR, 2.23), cirrhosis (17.9 percent; SMR, 10.5), homicide (14.9 percent; SMR, 14.2), and neoplasms (12.6 percent; SMR, 1.77). Survival analysis showed that black men in Harlem were less likely to reach the age of 65 than men in Bangladesh. Of the 353 health areas in New York, 54 (with a total population of 650,000) had mortality rates for persons under 65 years old that were at lest twice the expected rate. All but one of these areas of high mortality were predominantly black or Hispanic. We conclude that Harlem and probably other inner-city areas with largely black populations have extremely high mortality rates that justify special consideration analogous to that given to natural-disaster areas.

Adolescent↗
PubMed1994

Dealing with the flood crisis of 1993. A medical center's account.

On Saturday, 10 July 1993, Iowans were assaulted by the greatest natural disaster in the state's history when virtually all rain-swollen rivers and creeks in the Midwest spilled over their banks. In Des Moines, the Iowa Methodist Medical Center was suddenly surrounded by flood waters and stripped of power, water, computer, and telephone communication. Striving to deliver quality patient care in the face of the crisis, medical staff, administrators, and employees at the center achieved recovery in record time.

Communication↗
PubMed1991

Antecedents of posttraumatic stress disorder: wasn't being raped enough? A brief communication.

Many rape victims, like those traumatized by war, accidents, and natural disasters, are able to recover from their ordeal with supportive, crisis-oriented treatment. For others, however, symptoms may persist and require more intensive treatment. Hypnosis allows a modulated re-experiencing and abreaction of the traumatic event that can help to provide the victim with a relieving sense of mastery, and it fosters a receptive context for reassurance and interpretation regarding the irrational or exaggerated thoughts and feelings involved. 2 case examples are presented in which earlier conflicts appeared to play a role in perpetuating the patients' symptoms. Detecting and addressing these antecedents resulted in complete alleviation of long-standing problems through relatively brief treatment using hypnosis.

Adult↗
PubMed1992

Hepatitis A, B, C, D, and E. Update on testing and treatment.

Five major types of viral hepatitis have been identified. Hepatitis A is an acute, usually self-limited illness. Prophylaxis with immune globulin (Gamastan, Gammar) is effective in household and sexual contacts of infected patients. Hepatitis B has both acute and chronic forms. Treatment trials for chronic hepatitis B with interferon alfa-2b have shown promise. Hepatitis C is the name now given to non-A non-B hepatitis. Interferon alfa-2b (Intron A) has been approved for treatment of chronic hepatitis C. Hepatitis D occurs only in patients with hepatitis B. The only treatment for hepatitis D is prevention of hepatitis B. Hepatitis E is seen after natural disasters in developing regions of the world. Further advances in serologic testing and treatment of viral hepatitis can be expected.

Hepatitis A↗
PubMedDate not supplied

Adolescents in a therapeutic community: treatment implications for teen survivors of traumatic experiences.

This article describes an adolescent with a history of severe traumatic experiences and treatment in a residential program for chemically dependent, severely emotionally disturbed youths between the ages of 12 and 18. It begins with a description of the long-term treatment program, the types of clients admitted, and the treatment activities provided. Basic findings from an outcome study conducted within the program made predictions regarding the length of time of residential treatment for drug addicted, severely emotionally disturbed adolescents regardless of trauma history. Pretreatment psychiatric functioning was addressed by utilizing GAF scores from the DSM-III-R for each of the participants in the study. Of 102 participants in the study, 34 were survivors of sexual abuse, physical abuse, or devastating natural disasters. A clinical case of a traumatized adolescent is presented in relation to adolescent identity, the distinction between adolescent and adult treatment, and a variety of treatment strategies that can influence an abused adolescent's long-term recovery from both addiction and trauma, including retention in treatment, the developmental stage of adolescence, identification and diagnosis of trauma during adolescence, building a working alliance, individual psychotherapy, psychopharmacology as an aid to psychotherapy, psychological debriefing, and group psychotherapy.

Adolescent↗
PubMed2000

Protection of the young child's brain: personal observations and thoughts in postwar stress syndrome and in natural catastrophes. The Nils Rosén von Rosenstein Lecture at Uppsala University, 6 May 1999.

This paper calls attention to the plight of children exposed to various traumas associated with wars and other natural disasters around the world. Little systematic attention has been paid to the mental health needs of child survivors of armed conflict. Our observations since 1968 and experiences around the world suggest that there are significant differences in the degree to which children have been prepared in anticipation of exposure to violence and in interventions applied after their exposure. It is the author's impression that prevention and intervention can be quite powerful when employed in these situations.

Bangladesh↗
PubMed2004

High-sodium diets in Japanese evacuation centers increase blood pressures of evacuees.

AIMS: High blood pressure after a natural disaster is tentatively considered to be due to elevation of sympathetic nerve activity. A volcano in Japan erupted on March 31, 2000, and people living in the vicinity of the volcano were evacuated to safe shelters. We found that many evacuees developed high blood pressure while staying at evacuation centers. The aim of this study was to investigate why their blood pressures stayed elevated. METHODS AND SUBJECTS: Sixty-five evacuees, who were staying evacuation centers for 4 months, were examined for blood pressure, urinary sodium excretion, urinary potassium excretion, and plasma and urinary catecholamines. RESULTS: Associations were found between systolic blood pressure and sodium excretion (r = 0.311, p < 0.05) and between systolic blood pressure and the ratio of urinary sodium to urinary potassium (r = 0.320, p < 0.05). However, no association was found between blood pressure and plasma and urinary catecholamines (NE, DHPG and MHPG). CONCLUSION: High sodium consumption was thought to be an important factor in the elevation of blood pressure of the evacuees after acute phase reactions.

Aged↗
PubMed2004

Impact of multiple traumatic experiences on the persistence of depressive symptoms--a population-based study.

The objective of this population-based study was to determine whether traumatic experiences in general, and multiple traumatic experiences in particular, are associated with persistent self-rated depressive symptoms in adult Finnish subjects over 2 years of follow-up. The study sample included 1405 subjects aged 25-64 years. Subjects (n = 217) who were depressed both at baseline in 1999 and on follow-up 2 years later in 2001 (having persistent depressive symptoms) were compared with subjects (n = 987) having no depressive symptoms either at baseline or on follow-up. All six categories of traumatic experiences (wartime experience, natural disaster, life-threatening accident, victim of violent crime, domestic violence and childhood sexual abuse) pertained to the respondents' whole life span. Odds ratios, adjusted for significant covariates, were obtained from multiple logistic regression models that estimated the likelihood of persistent depressive symptoms in different trauma categories. Persistent depressive symptoms had a significant positive graded relationship with the number of traumatic experiences. The adjusted odds of persistent depression was 6.05 (95% CI 1.76-20.7) for men and 6.99 (95% CI 2.69-18.2) for women in those with three or more traumatic experiences compared with those with no such experiences at all. Multiple traumatic experiences substantially increase the likelihood of persistent depressive symptoms. Mental health intervention, as early as possible, may serve to prevent the chronicity of depressive reactions among victims of multiple traumas.

Adult↗
PubMedDate not supplied

Nepal mental health country profile.

The Kingdom of Nepal is situated in the heart of Asia, between its two big neighbours China and India. Nepal is home to several ethnic groups. The majority of the 23 million population reside in the countryside. Although figures on many of the health and socio-economic indicators are non-existing, some existing ones show gradual improvement over the years. However the figures for illiteracy and infant mortality are still one of the highest in the world. As per GDP, and population living below the poverty line and per capita income, Nepal still remains one of the poorest countries in the world. Despite this, it provides shelter to thousands of Bhutanese refugees in its land. Frequent natural disasters and recent violent conflicts in Nepal have further added hardship to life. Less than 3% of the national budget is allocated to the health sector. Mental health receives insignificant attention. The Government spends about 1% of the health budget on mental health. There is no mental health act and the National Mental Health Policy formulated in 1997 is yet to be fully operational. Mental ill health is not much talked about because of the stigma attached. The roles of the legal and insurance systems are almost negligible. The financial burden rests upon the family. The traditional/religious healing methods still remain actively practiced, specifically in the field of mental health. The service, comprising little more than two-dozen psychiatrists along with a few psychiatric nurses and clinical psychologists (mainly practicing in modern health care facilities) has started showing its impact--however this is limited to specific urban areas. The majority of the modern health care facilities across the country are devoid of a mental health facility. The main contextual challenges for mental health in Nepal are the provision of adequate manpower, spreading the services across the country, increasing public awareness and formulating and implementing an adequate policy.

Attitude to Health↗
PubMed2006

Mental health and psychosocial support after the tsunami: observations across affected nations.

The countries affected by the tsunami responded to the natural disaster promptly but with different results and outcomes. The reasons for this varied response were many. The outcome depended upon a number of factors, including the extent of the damage to property and lives, accessibility of the areas and existing disaster plans. In this paper we present the overall observations and suggest the way forward.

Asia↗
PubMed2006

Do all children need intervention after exposure to tsunami?

Children are uniquely vulnerable in the context of a major natural disaster like tsunami. Post disaster intervention studies in children are few, especially from developing countries like India. An intervention programme for children was developed and conducted at Srinivasapuram, a coastal hamlet in Chennai, a year after tsunami. Sixty-five children who participated in all the six intervention modules were compared to 70 children who did not participate in the intervention. All the children were assessed before and after intervention using the Youth Self Report (YSR) form of Child Behaviour Check List (CBCL) in addition to PTSD symptoms. Children in the two groups were comparable in socio-demographic factors and exposure to tsunami. Prevalence of family psychopathology was more in the intervention group. Only hyperactivity problems were significantly reduced after intervention (z = 2.41 p = 0.016). Children in the intervention group appreciated expression of positive emotions (F = 8.044 p = 0.005) and were also more likely to desist from smoking (F = 6.102 p = 0.003) compared to the control group. The majority of the children are likely to be resilient and only children with pre-existing vulnerability require specific and specialized interventions.

Child↗