Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Cities”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 595 records · Page 33Linked to original sources
PubMed2005

Inner City Asthma Study: relationships among sensitivity, allergen exposure, and asthma morbidity.

BACKGROUND: Asthma-associated morbidity is rising, especially in inner city children. OBJECTIVE: We evaluated the allergen sensitivities, allergen exposures, and associated morbidity for participants in the Inner City Asthma Study. We also determined geographic variations of indoor allergen levels. METHODS: Nine hundred thirty-seven inner city children 5 to 11 years old with moderate to severe asthma underwent allergen skin testing. Bedroom dust samples were evaluated for Der p 1, Der f 1, Bla g 1, Fel d 1, and Can f 1. RESULTS: Skin test sensitivities to cockroach (69%), dust mites (62%), and molds (50%) predominated, with marked study site-specific differences. Cockroach sensitivity was highest in the Bronx, New York, and Dallas (81.2%, 78.7%, and 78.5%, respectively), and dust mite sensitivity was highest in Dallas and Seattle (83.7% and 78.0%, respectively). A majority of homes in Chicago, New York, and the Bronx had cockroach allergen levels greater than 2 U/g, and a majority of those in Dallas and Seattle had dust mite allergen levels greater than 2 microg/g. Levels of both of these allergens were influenced by housing type. Cockroach allergen levels were highest in high-rise apartments, whereas dust mite allergen levels were highest in detached homes. Children who were both sensitive and exposed to cockroach allergen had significantly more asthma symptom days, more caretaker interrupted sleep, and more school days missed than children who were not sensitive or exposed. CONCLUSION: Geographic differences in allergen exposure and sensitivity exist among inner city children. Cockroach exposure and sensitivity predominate in the Northeast, whereas dust mite exposure and sensitivity are highest in the South and Northwest. Cockroach allergen appears to have a greater effect on asthma morbidity than dust mite or pet allergen in these children.

Air Pollution, Indoor↗
PubMed2005

Allergen sensitization evaluation and allergen avoidance education in an inner-city adult cohort with persistent asthma.

BACKGROUND: Asthma morbidity, mortality, and health services utilization are highest among inner-city populations. The National Asthma Education and Prevention Program Expert Panel recommends that all patients with moderate and severe persistent asthma be evaluated for sensitization to environmental allergens. OBJECTIVE: This study examined whether a cohort of inner-city adults hospitalized with asthma had been evaluated for allergen sensitization, received avoidance counseling, and followed through on these recommendations. METHODS: One hundred sixty-nine eligible patients who were part of a prospective cohort of all adults hospitalized in an inner-city hospital over a consecutive 12-month period completed a questionnaire to assess allergen sensitization evaluation, avoidance education, and adherence. RESULTS: Overall, 60% of patients had ever been evaluated for allergen sensitization. Among those who were evaluated, 94.0% were sensitized to at least one antigen: 91.5% to dust mites, 90.5% to outdoor allergens, 77.9% to cats, 69.5% to dogs, 68.4% to molds, and 61% to cockroaches. Approximately half of the patients sensitized to dust mite (55.1%) or mold (52.8%) were given any avoidance-abatement advice. Patient adherence to this advice was highly variable. Allergen sensitization evaluation was more likely among women (odds ratio, 3.05; CI, 1.64-8.64) and those who use oral steroids most or all of the time (odds ratio, 7.14; CI, 2.25-22.56) and less likely among smokers (odds ratio, 0.26; CI, 0.11-0.61). CONCLUSION: In this population of inner-city adults hospitalized with asthma, the quality of allergen sensitization evaluation, avoidance education, and patient adherence with these recommendations was suboptimal.

Adult↗
PubMed2006

The epidemiology of illness and injury at the alpine venues during the Salt Lake City 2002 Winter Olympic Games.

The Emergency Medicine literature has described levels of medical care for mass gatherings in the United States, including for the Los Angeles 1984 Summer and Calgary 1988 Winter Olympic Games. However, there are limited data to describe the type and number of illness or injury that may occur during mass gatherings in an alpine winter environment. To describe the epidemiology of illness and injury seen among spectators at the alpine and snowboarding venues during the Salt Lake City 2002 Winter Olympic Games, we conducted a retrospective review of the Salt Lake City 2002 Olympic Medical Care database for all patient encounters during the operational period of the Games at the alpine and snowboarding venues. The three venues included were: Deer Valley Resort (DVR), Park City Mountain Resort (PCM), and Snowbasin Resort (SBA). Each venue had a medical clinic located on site for spectators and another for athletes. Physicians, nurses, emergency medical technicians, and therapists staffed the clinics. The database was created by Inter-mountain Health Care (IHC) in conjunction with Salt Lake City 2002 Winter Olympic staff and consisted of descriptive reports of all patient encounters from all venues including demographic, epidemiology, and outcome information. IHC maintains the database, and was the sole medical provider for the Games. Each venue had at least 6 days of competition events. Over the 19 days of the Olympiad, a total of 410,160 spectators and 3,961 competitive athletes attended the three venues. There were 841 spectators evaluated and treated at the venue clinics, and mobile medical staff treated 262 spectators. The top five spectator clinic diagnostic categories were: sprain/strain (n=108), miscellaneous trauma (n=103), respiratory (n=88), miscellaneous medical (n=69), and digestive (n=52). Fifty spectators required transport to a hospital for additional care: 27 required transfer by ground ambulance and the remainder were transported by private vehicle. The overall spectator medical utilization rate was 26.9. In conclusion, the rate and acuity of patients seen at the alpine venues during the 2002 Winter Olympic Games was low. Nevertheless, we recommend full on-site physician and nurse staffing with advanced trauma and cardiac life support available during similar events.

Anniversaries and Special Events↗
PubMed2004

Level of knowledge and attitude of primary care physicians in Eastern Anatolian cities in relation to child abuse and neglect.

BACKGROUND: Child abuse and neglect is not a new phenomenon. It has always existed in every nation and culture in one form or another. The aim of this study was to determine the level of knowledge and attitude toward child abuse and neglect of primary care physicians serving in eastern Turkish cities. METHODS: The study was done in four Eastern Turkish cities involving Elazig, Tunceli, Malatya, and Bingol. All the primary care physicians serving in these cities were contacted. Of 266 primary care physicians, 175 replied (65.8% reply rate) and participated in the study. RESULTS: Most of the participated primary care physicians did not have adequate knowledge about physical assessment of suspected child abuse and neglect. Those physicians serving in primary care centers had better knowledge than those serving in Mother-Child Health and Family Planning Centers. CONCLUSIONS: Results from this study indicate that primary care physicians working in the eastern cities of Turkey do not have adequate knowledge and proper attitudes toward the identification and reporting of suspected child abuse. There is a need for educational programs to primary care physicians and other health personals working with child abuse and neglect to increase their knowledge and skills in detection, assessment, reporting, treatment, and prevention of child abuse and neglect.

Adult↗
PubMed2006

Mammography use among older women of seven Latin American and Caribbean cities.

BACKGROUND: To describe the prevalence of mammography use, and to estimate its association with sociodemographics. METHODS: A sample of 6207 women aged 60 and older from the first interview of Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE) in seven cities (Buenos Aires, Bridgetown, Havana, Mexico, Montevideo, Santiago, and Sao Paulo). The outcome was reporting a mammogram within the last 2 years. RESULTS: Prevalence of mammography use ranged from 9.8% in Havana to 34.4% in Sao Paulo. Independent predictors of mammography use across cities were older age (lowest odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.89-0.95), higher education (highest OR = 1.14, 95% CI 1.08-1.20), public health insurance (lowest OR = 0.28, 95% CI 0.11-0.76), or no insurance (lowest OR = 0.08, 95% CI 0.02-0.34) compared with private insurance. In a combined sample of six cities, higher education was associated with higher mammography use, but older age and insurance (public: OR = 0.54, 95% CI 0.45-0.65; no insurance: OR = 0.30, 95% CI 0.23-0.40; compared with private insurance) were associated with lower mammography use. CONCLUSIONS: Prevalence of mammography use across cities was lower than that reported for Hispanic populations in the US. In the overall sample, mammography use was increased in highly educated people and decreased in people without insurance.

Aged↗
PubMed2003

Fluoride profiles in premolars after different durations of water fluoridation in Ho Chi Minh City, Vietnam.

In order to evaluate the uptake of fluoride (F) into tooth structures following water fluoridation in Ho Chi Minh City, F concentrations were measured from the enamel surface through the enamel-dentine junction (EDJ) to dentine close to the pulp in premolars. Calcification had been completed in all the teeth before fluoridation. Samples were obtained from fluoridated areas of the City ([F]: 0.7 parts/10(6)) after 3 years (eight samples), 6 years (eight samples) and 8 years (nine samples). Samples were also taken from regions outside the fluoridated water supply of the City in 1998 after 8 years of water fluoridation. An abrasive microsampling method was used to determine the profiles of fluoride and phosphorus concentrations. In enamel surfaces, F concentrations tended to increase with increasing periods of fluoridation. In dentine close to the pulp, F concentrations also increased statistically significantly with the increasing duration of fluoridation of water (between 6 and 3 years: P=0.006; between 8 and 3 years: P=0.001; between 8 years and 8 years without F: P=0.0001). It was concluded that F concentrations in enamel and dentine had tended to increase gradually with the duration of water fluoridation in Ho Chi Minh City. The increase was most obvious in dentine near the junction with the pulp.

Adolescent↗
PubMed1989

Studies on schistosomiasis in the Niger Delta: Schistosoma intercalatum in the urban city of Port Harcourt, Nigeria.

Ova of S. intercalatum have been found in the urban city of Port Harcourt in the Niger Delta area of Nigeria, following examination of stool and urine samples from 1,709 persons (5-15 years of age) resident in various parts of the city. The ova occurred only in urine, with prevalence ranging from 1.0% to 9.8% with an overall prevalence of 5.7%. The intensity of the infection was low. Most infected individuals had counts of less than 500 ova in total bladder content. There was no significant difference in either the prevalence or intensity of the infection among the sexes (Male; prevalence 6.1%, intensity 527.3 vs Female; prevalence 5.4%, intensity 500.9). No case of infection with either S. haematobium or S. mansoni was encountered in the study. Malacological surveys in the gutters, creeks, streams and stagnant waterbodies within the city showed the presence of Lymnaea natalensis, Bulinus forskalii, Pila ovata, Melanoides tuberculata, Physa sp., Lanistes ovum and Segmentorbis sp. B. forskalii is indicated as the probable vector of S. intercalatum in the city. The growing problem of urban schistosomiasis in tropical Africa is discussed. Further studies on urban transmission and epidemiology of schistosomiasis in the Niger Delta area of Nigeria is also indicated.

Adolescent↗
PubMed2003

Social class, family, and life-style factors associated with overweight and obesity among adults in Peruvian cities.

BACKGROUND: Overweight and obesity have reached epidemic proportions in Latin America. OBJECTIVE: The purpose of this study was to explore social and behavioral factors associated with obesity in Peruvian cities. DESIGN: Between 1998 and 2000 health examination surveys were conducted among adults in 1176 families identified in six cities. Stratified by social class, multistaged random sampling was used. Using body mass index (weight (kg)/height (m)(2)), men and women were classified into normal weight (BMI <25), overweight (BMI 25-29), or obese (BMI > or =30); abdominal circumference (> or =94 cm in men and > or =84 cm in women) further identified morbidity risk. Several demographic, social, and behavioral variables were collected following standardized procedures. RESULTS: Adjusting for age, 37% of women were categorized as normal weight, 40% overweight, and 23% obese; corresponding figures for men were 40, 44, and 16%. More developed cities, e.g., Lima, Arequipa, and Ica, had the largest prevalence of overweight and obesity for both men and women. Adjusted logistic models showed that BMI > or =25 was positively correlated with age; whereas, education was negatively associated, only among women. Other significant associated factors of overweight included city of residence, television viewing > or =4 h daily in women, and underestimation of body weight status. CONCLUSIONS: The study showed elevated rates of overweight across the income level spectrum. Factors such as urban development stage, income, education, and gender posed differential relationships with the risk of overweight and must be considered in designing future public health interventions. Underestimation of body weight status and sedentary behavior may also constitute specific areas of intervention.

Adult↗
PubMedDate not supplied

Prevalence of skin reactivity to coccidioidin and associated risks factors in subjects living in a northern city of Mexico.

BACKGROUND: Coccidioidomycosis is a reemerging fungal disease seen mainly in the states located at the Mexican-U.S. border. The finding of advanced cases of the disease are now more frequent. METHODS: A cross-sectional study was conducted to determine the prevalence of skin reactivity to coccidioidin in the city of Torreón, Coahuila, Mexico, located in the northern region of the country. A multifactorial association of environmental, social, and health conditions was analyzed. A total of 1,653 coccidioidin skin tests was applied in male and female subjects older than 8 years of age. RESULTS: The overall rate of positive reactivity in this city was 40.2%, with a 95% confidence interval of 37.8-42.5. This was related to time/life exposure risk and to the habitat of unpaved streets. No statistically significant difference regarding gender, socioeconomic level, and working activities was found. The highest reactivity was observed in subjects between 30 and 65 years of age. CONCLUSIONS: Positive results were related to exposure risk and habitat, principally in the southeast region of the city. These results were applied both to residents and outsiders with no differences between the groups. Of the total, 87.5% were considered high-risk subjects. It is recommended that future surveys be carried out in other northern cities of Mexico to obtain more useful data concerning the extent of the infection and mainly to establish preventive measures, such as appropriate reforestation and urbanization procedures.

Coccidioidin↗
PubMedDate not supplied

[Social inequalities in health in the city of Málaga].

Social inequalities and health inequalities are closely related, and their reduction is the goal of international organizations and governments as well. In order to better understand the territorial distribution of social inequalities in the city of Málaga (Spain) and compare them with measured health differences, a descriptive study was done using different sources of information. Using the city's neighbourhoods as the unit of analysis, a cluster analysis was carried out based on a set of demographic, socioeconomic and standard of living indicators. This led to the configuration of six social areas within the city. In these areas, as defined by socially homogeneous criteria, diverse health indicators have been measured, leading the verification of important health differences among them. For example, clear differences in mortality rates between Area IV (socioeconomically deprived) and Area III (with a higher standard of living) are observed: the ratio between their respective "years of potential life lost" was 1.79, and between standardized mortality rates, 1.42. A similar disadvantage in low birth weight was confirmed notably so in adolescent pregnancies (five times higher). In conclusion, those areas of the city with a lower socio-economic status also had the lowest health levels.

Cluster Analysis↗
PubMed1997

The hierarchical diffusion of AIDS and violent crime among U.S. metropolitan regions: inner-city decay, stochastic resonance and reversal of the mortality transition.

Census data on migration within and between the 25 largest U.S. metropolitan areas-containing more than 113 million people-permit construction of a probability-of-contact matrix corresponding to a particular Markov process dominated by the nation's largest cities, a hierarchical structure. Regression models based on vectors associated with that process find the large-scale diffusion of AIDS in the U.S.A. depends strongly on national patterns of contact with the original AIDS outbreaks in New York City and San Francisco as modulated by the violent crime rate, a local index of social disintegration resulting from the marginalization of minority ethnic urban communities. Violent crime is itself undergoing a recognizably similar hierarchical diffusion from the largest U.S. cities into smaller metropolitan regions. Further analysis suggests that continuation of public policies of "benign neglect" and "planned shrinkage" directed against marginalized urban populations may trigger a strong stochastic resonance which can significantly degrade public health and public order for much of the three-quarters of the U.S. population living in or near cities, in effect reversing the mortality transition of the last century.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Seroepidemiologic survey of Dirofilaria immitis infection among domestic dogs in Taipei City and mountain aboriginal districts in Taiwan (1998-1999).

To estimate the seroprevalence of Dirofilaria immitis infection in domestic dogs in Taiwan, we utilized a commercial ELISA kit (Snap, IDEXX, USA) for detecting circulating antigens released by adult female worms. Serum specimens of 664 domestic dogs sampled from Taipei City in northern Taiwan and 14 mountain aboriginal districts in eastern Taiwan were screened for D. immitis antigens. Multivariate-adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) were estimated by multiple logistic regression analysis. A total of 89 subjects were antigen-positive, giving a seroprevalence of 13.4%, of which the seroprevalence in Taipei City and mountain aboriginal districts were 13.8 and 12.1%, respectively. The mean overall seropositive rates were 6.3% in 1-3-year-old age group, 14.1% in 3-6-year-old age group and 23.7% in the > or =6-year-old age group. The older the age, the higher the seroprevalence (OR=4.6, 95% CI=2.4-9.0 for the > or =6-year-old age group versus 1-3-year-old age group, P<0.001) for all the dogs in the present study. Moreover, seroprevalence was not different between female and male dogs in either Taipei City or mountain aboriginal districts (P>0.05). Also, no significant difference in seroprevalence among dogs between the two geographical areas was found (P>0.05). In the logistic regression analysis, the seroprevalence of D. immitis remained significantly increased with age after multivariate adjustment in the present study. To our knowledge, this is the first report on the status of D. immitis infection in domestic dogs in Taipei City and mountain aboriginal districts in Taiwan to date.

Age Factors↗
PubMed2002

Flea species from dogs in three cities of Chile.

The purpose of this study was to establish the pattern of flea infestation in dogs in the cities of Santiago (33 degrees latitude south, 70 degrees longitude west), Concepción (36 degrees latitude south, 73 degrees longitude west) and Osorno (40 degrees latitude south, 73 degrees longitude west), located in different parts of Chile. The only species of fleas found on dogs from the three cities were Ctenocephalides felis felis (41.8%), Ctenocephalides canis (39.4%) and Pulex irritans (18.8%). Although the three species were found in the three cities, differences regarding their frequencies were detected (p<0.05). C. felis was the predominant species found on dogs in Santiago (80.5%). In Concepción, their frequencies followed a similar trend. However in Osorno, the most southern city, the predominant species was C. canis (78.7%).

Animals↗
PubMed1997

The inner city and drug use: initial findings from an epidemiological study.

Although scientific and policy statements regarding drugs often suggest that there are grave problems of drug use within America's inner cities, the evidence that supports these statements is often based on anecdotal or incomplete data. This study of African-American adults from the Woodlawn study followed longitudinally partially fills that gap, at least for learning more about those who spend some or all of their childhood within an inner city neighborhood. We found few differences between the lifetime prevalence of drug use and a national representative sample of adults of the same age range. Furthermore, a national household survey of African-Americans of similar age living in six central cities also reported low lifetime rates of illicit drug use. Nevertheless, those from the Woodlawn cohort had higher rates of use of illicit drugs in the past year than the national sample, especially those still living in areas with high rates of poverty. Additionally, reports of heavy drug trafficking were much greater in the inner city areas than in the suburbs.

Adult↗
PubMed2002

African-American children are at risk of a measles outbreak in an inner-city community of Chicago, 2000.

BACKGROUND: Since the measles resurgence of 1989-1991, which affected predominantly inner-city preschoolers, national vaccination rates have risen to record-high levels, but rates among inner-city, preschool-aged, African-American children lag behind national rates. The threat of measles importations from abroad exists and may be particularly important in large U.S. cities. To stop epidemic transmission, measles vaccination coverage should be at least 80%. OBJECTIVE: To determine measles vaccination rates and predictors for having received a dose of measles-containing vaccine by age 19 to 35 months among children in an inner-city community of Chicago. METHODS: We used a cross-sectional survey with probability proportional to size cluster sampling. Immunization histories from parent-held records and providers were combined to establish a complete vaccination history. RESULTS: A total of 2545 households were contacted, and 170 included a resident child aged 12 to 35 months. Of these, 97% (N=165 children) agreed to participate. Immunization history from a parent or provider was not available for 20 children. Among children aged 19 to 35 months with available immunization histories, 74% received measles vaccine (n=100); of these, 84% received the vaccine as recommended at ages 12 to 15 months. However, when including children without immunization histories, measles coverage levels among children aged 19 to 35 months were 64% (n=114). Among children with records, predictors for receipt of measles vaccine by age 19 to 35 months were possessing a hand-held immunization card (odds ratio [OR]=16.8; 95% confidence interval [CI]=4.2-67.1); utilizing a public health department provider for a usual source of care (OR=8.9; 95% CI=1.6-47.2); and being up-to-date for vaccines at 3 months of age (OR=5.0; 95% CI=1.8-14.1). CONCLUSIONS: Optimistically assuming that children without immunization histories are as well immunized as children with immunization histories, the measles vaccination rate among Englewood's children aged 19 to 35 months is too low to maintain immunity (74%). Measles coverage levels lagged behind coverage reported in a national survey in Chicago (86%) and the nation as a whole (92%). Efforts to raise and sustain coverage should be undertaken.

Black or African American↗
PubMed2005

Prevalence of methadone injection in three Swiss cities.

OBJECTIVE: Intravenous methadone is associated with increased risk of morbidity and mortality. A previous report from a methadone center in Fribourg, Switzerland, found a high prevalence (43%) of patients who injected oral methadone. We therefore wished to assess the prevalence of methadone injection among patients in oral methadone programs in 3 other Swiss cities--Lausanne, Geneva, and La Chaux-de-Fonds. METHOD: Subjects were randomly selected and interviewed by assistant psychologists who were not on the staff of the study centers. Participation was voluntary and anonymous. RESULTS: 164 patients participated in the study (n = 58 in Lausanne, 52 in Geneva, and 54 in La Chaux-de-Fonds). The prevalence of methadone injection was low (5%) and did not differ significantly between the cities. DISCUSSION: Less liberal policies cannot explain the lower prevalence of methadone injection in these three centers than in Fribourg. The high prevalence of methadone injection there is probably related to its separate methadone injection program: patients in oral methadone programs may be more likely to injection methadone when other patients authorized to do so. IN CONCLUSION: Although the 5% prevalence of methadone injection found in the 3 cities surveyed is low, it is not negligible. These results suggest that information on the risks associated with injection of methadone syrup should be provided to all methadone maintenance. This information is especially necessary when maintenance therapy is provided in the same center, or city as injectable methadone maintenance.

Adolescent↗
PubMed1996

Coronary heart disease mortality, morbidity, and case fatality in five east and west German cities 1985-1989. Acute Myocardial Infarction Register Teams of Augsburg, Bremen, Chemnitz, Erfurt, and Zwickau.

Cardiovascular mortality (CVD; International Classification of Diseases [ICD] 390-458) is higher in East than in West Germany, but the differences in official coronary heart disease mortality (CHD; ICD 410-414) are not so pronounced. The aim of this study was to validate the official mortality statistics based on the five German AMI registers and to analyze whether these mortality differences are due to differences in the attack rates of acute myocardial infarction (AMI) or to differences in the 28-day case fatality rates. This comparison includes the MONICA study cities of Augsburg and Bremen, both in West Germany, as well as the cities of Chemnitz, Erfurt, and Zwickau in East Germany (former the German Democratic Republic). The rates were calculated on the basis of all MONICA cases of definite AMI or coronary death aged 35 to 64 years occurring in the respective study populations between 1985 and 1989. All study populations except women in Augsburg showed higher coronary death rates compared to the rates based on the official cause of death statistics (ICD 410-414), but this difference was significant only for men in Chemnitz. In men there were no significant differences in the register-based coronary death rates between these urban areas (160/100,000 in Zwickau to 170/100,000 in Chemnitz) nor in the AMI attack rates (327/100,000 in Augsburg to 363/100,000 in Chemnitz), and consequently no significant center differences in the overall 28-day case fatality. However, the prehospital case fatality was significantly higher in Erfurt (34%) than in Bremen (27%). There were no significant differences in the AMI attack rates in women as well (60/100,000 in Chemnitz to 70/100,000 in Bremen and Erfurt), but the overall 28-day case fatality showed a clear gradient from the East (61-71%) to the West German cities (48-56%) and therefore also the register-based coronary death rates (38-50/100,000 and 34-38/100,000, respectively). However, the higher 28-day case fatality in women found in the MONICA registers in East compared to West Germany is not reflected in the CHD mortality statistics because of a stronger underestimation of the official mortality rates and in East than in West Germany, in particular in women. Nevertheless, the total mortality rates and in most cases also the CVD mortality rates were in women significantly higher in the East German compared to the West German cities. The East German official preunification CHD mortality data cannot be used for national and international comparisons. The results of the MONICA AMI registers in East and West Germany indicate, furthermore, the need to improve coronary care in women in the eastern part of the country. Nevertheless, because of the relatively high AMI attack rate in both parts of Germany primary prevention must generally be intensified.

Adult↗
PubMed1996

Sadness, tragedy and mass disaster in Oklahoma City: providing critical incident stress debriefings to a community in crisis.

Shortly after 09:00 h on 19 April 1995, the Alfred P. Murrah Federal Building, located in downtown Oklahoma City, was devastated with a bomb blast of such gigantic proportions that it was heard 60 miles away in neighbouring Norman, Oklahoma. Oklahomans routinely commuting to work on that sunny Wednesday morning went about their business as usual. A crude bomb chemically comprised of various organic compounds, chemical fertilizer, ammonium nitrate and diesel fuel, weighing an estimated 4800 pounds or more, was transported in a vehicle the size of a truck. It blew open a crater 6-8 ft deep in the street floor. The Murrah Federal Building was impacted immediately; floors, windows, communication equipment and almost all the innocent victims inside were razed to the ground. Outside the building, as far as 10 blocks away or more, hundreds of victims lay hurt, seriously injured or dead from shards of glass that flew from office windows hundreds of feet above the street floor. Without warning, the initial impact of the bomb immediately devastated the entire city. People were in a state of shock, disbelief and denial; acute symptoms of post traumatic stress disorder (PTSD) were commonplace. Oklahomans, 'numb' from the impact of the critical incident and ill-equipped to handle the chaos of such catastrophic proportions, struggled to regain control of their lives as friends, family and loved ones went unaccounted for or were found critically injured, dying or already dead. The critical incident on 19 April demanded the immediate attention of the nation, to come to the aid of the Oklahomans who were in desperate need. By 1 June, the exhaustive investigations revealed that 30 office buildings in downtown Oklahoma City had to be condemned, and as many as 300 others were damaged. In addition, 168 people had been found dead including 19 children and one nurse working as an emergency services rescue worker. Approximately 490 other victims had been reported injured from the blast. Countless others have been traumatised by the critical event and will need professional attention and care for weeks, months and years to come. The final extent of the impact on Oklahoma City is yet unknown and may never realistically be estimated in terms of personal trauma, loss and grief.

Crisis Intervention↗