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At least 613 records · Page 34Linked to original sources
PubMedDate not supplied

Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care.

OBJECTIVE: Epidemiologic studies have linked exposure to severe environmental stress, such as natural disasters and combat operations, to the onset of specific psychiatric disorders. Some research also suggests that these exposures may be associated with the onset of chronic diseases as well. However, these chronic disease outcome studies often have been obscured by bias and confounding. METHOD: The medical histories of 1399 male Vietnam veterans approximately 20 years after combat exposure (mean years = 17) were analyzed by lifetime posttraumatic stress disorder (PTSD) status (lifetime PTSD = 332 cases). These men were included in a national, random in-person study of United States Army veterans of the Vietnam War (study completion rate = 65%). RESULTS: After controlling for preservice, in-service, and postservice factors (including intelligence, race, region of birth, enlistment status, volunteer status, Army marital status, Army medical profile, hypochondriasis, age, smoking history, substance abuse, education, and income), associations were found for reported circulatory [odds ratio (OR) = 1.62, p = .007], digestive (OR = 1.47, p = .036), musculoskeletal (OR = 1.78, p = .008), endocrine-nutritional-metabolic (OR = 1.58, p = .10), nervous system (OR = 2.47, p < .001), respiratory (OR = 1.54, p = .042), and nonsexually transmitted infectious diseases (OR = 2.14, p < .004) after military service. CONCLUSION: Although this study has some limitations, it suggests that there is a direct link between severe stress exposures and a broad spectrum of human diseases. In the future, medical researchers and clinicians should focus more on the medical consequences of exposure to severe environmental stress and seek to better integrate psychobiologic models of disease pathogenesis.

Adult↗
PubMed1999

Lightning strikes at a mass gathering.

Among natural disasters, lightning is a leading cause of morbidity and mortality throughout the world. A well-informed bystander and an astute physician can make the difference between an outcome of death or lifelong disability versus complete or near-complete recovery. What is done in the first few minutes after such an event is the predominant predictor of success. This case report describes a young woman who was struck by lightning while talking on a cellular telephone at a mass gathering in an outdoor stadium. The discussion that follows the case centers on the pathophysiology of being struck by lightning and on issues unique to being struck in a stadium full of people.

Adult↗
PubMedDate not supplied

A comprehensive Laboratory Services Survey of State Public Health Laboratories.

In November 2004, the Association of Public Health Laboratories (APHL) conducted a Comprehensive Laboratory Services Survey of State Public Health Laboratories (SPHLs) in order to establish the baseline data necessary for Healthy People 2010 Objective 23-13. This objective aims to measure the increase in the proportion of health agencies that provide or assure access to comprehensive laboratory services to support essential public health services. This assessment addressed only SPHLs and served as a baseline to periodically evaluate the level of improvement in the provision of laboratory services over the decade ending 2010. The 2004 survey used selected questions that were identified as key indicators of provision of comprehensive laboratory services. The survey was developed in consultation with the Centers for Disease Control and Prevention National Center for Health Statistics, based on newly developed data sources. Forty-seven states and one territory responded to the survey. The survey was based on the 11 core functions of SPHLs as previously defined by APHL. The range of performance among individual laboratories for the 11 core functions (subobjectives) reflects the challenging issues that have confronted SPHLs in the first half of this decade. APHL is now working on a coordinated effort with other stakeholders to create seamless state and national systems for the provision of laboratory services in support of public health programs. These services are necessary to help face the threats raised by the specter of terrorism, emerging infections, and natural disasters.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Burn specialty teams.

Natural disasters have always been a threat. human-caused disasters, especially terrorist acts, are increasing in frequency. Burn centers and providers have an important contribution to make in caring for those injured in these incidents. The most effective way to make a contribution is to act in cooperation with the Federal Disaster Response, which is organized by the Department of Homeland Security and the Federal Emergency Management Agency. It appears that this can be most effectively accomplished through participation in the Burn Specialty Team Program, which has been developed to rapidly augment emergency medical teams with burn expertise.

Burn Units↗
PubMed2005

Long-term follow-up of psychological distress following earthquake experiences among working Italian males: a cross-sectional analysis.

This report details relationships between earthquake exposures in 1980 and 1983 to 1984 and psychological distress reported in 1994. Participants are 555 Italian male factory workers from Naples, Italy. Those men who experienced damage from the 1980 quake reported higher levels of psychological distress (across several dimensions of the Symptom Checklist) than those without damage; additionally, 30% of these men reported symptoms of posttraumatic stress disorder (PTSD). While men evacuated as a result of the 1983 to 1984 Bradyseism earthquakes did not report higher distress levels (Symptom Checklist) than their nonevacuated colleagues, they did report more PTSD-like symptoms than those not evacuated. Financial loss from the Bradyseism quakes was associated with higher distress across all measures (seven Symptom Checklist dimensions and presence of PTSD symptoms). Additionally, social network disruptions following 1983 to 1984 evacuation were associated with greater distress (not all measures). These findings suggest that psychological distress from natural disasters may be very long lasting.

Adult↗
PubMed2006

Hurricanes Katrina and Rita: evacuee healthcare efforts remote from hurricane affected areas.

Hurricanes Katrina and Rita produced the largest evacuation due to a natural disaster in United States history. Many people were evacuated or rescued from New Orleans and the Gulf Coast, resulting in a need for mass disaster shelters and medical care for months following the storms. The shelter healthcare system that was successfully developed in the Shreveport-Bossier City, Louisiana area was accomplished with little support from customary sources. This report is written after much discussion and introspection of community leaders involved "on the ground," who organized and provided medical services to evacuees of south Louisiana. Its purpose is to compile "lessons learned" in preparation for the next disaster recovery effort that might affect this or any other region of our country.

Community Health Services↗
PubMed2006

Inclusive trauma systems: do they improve triage or outcomes of the severely injured?

BACKGROUND: Trauma systems decrease injury-related mortality, but not all systems have the same configuration. In some systems, nearly all acute care hospitals participate to the extent that their resources allow (inclusive systems), whereas in others, relatively few high-level centers participate (exclusive systems). We postulate that inclusive systems assure that severely injured patients are more likely to be triaged to a level I or II regional trauma center, and this greater degree of participation would lead to lower mortality. METHODS: We used administrative discharge data for 2001 in 24 states with formal systems, and we included all urgently hospitalized adults with an Injury Severity Score>or=16. We categorized states by trauma system configuration ("exclusive", "more inclusive", "most inclusive") based on the proportion of all hospitals designated as a Level I through V trauma center (0-13%, 14-37%, 38-100%, respectively). We compared the rates of triage to a regional trauma center and inpatient death in inclusive states relative to exclusive states, while adjusting for patient- and state-level factors. RESULTS: Out of 61,496 patients, 40,706 (66.2%) were hospitalized at regional trauma centers. Inpatient mortality was 14.7%. After adjusting for patient age, primary payer status, and system maturity, the odds of triage to a regional trauma center were similar in inclusive and exclusive systems. After adjusting for primary payer status, mechanism of injury, and system maturity, the odds of death were similar in more inclusive and exclusive systems (odds ratio, 0.93; 95% confidence interval, 0.80-1.08) but were significantly lower in the most inclusive systems (odds ratio, 0.77; 95% confidence interval, 0.60-0.99). CONCLUSIONS: Severely injured trauma patients have greater inpatient survival in inclusive trauma systems even though they are no more likely to be hospitalized at a regional trauma center. Consideration should be given to continuing implementation of systems with an inclusive configuration, especially in light of other theoretical benefits of these systems, such as better dispersing of trauma care resources in the event of natural disasters or terrorist events.

Adult↗
PubMed2002

Floods in a changing climate: a review.

This paper begins with an analysis of flooding as a natural disaster for which the solutions to the environmental, social and economic problems are essentially those of identifying and overcoming hazards and vulnerability, reducing risk and damaging consequences. Long-term solutions to flooding problems, especially in a changing climate, should be sought in the wider context of developing more sustainable social organization, economics and technology. Then, developments are described of how scientific understanding, supported by practical modelling, is leading to predictions of how human-induced changes to climatic and geological conditions are likely to influence flooding over at least the next 300 years, through their influences on evaporation, precipitation, run-off, wind storm and sea-level rise. Some of the outstanding scientific questions raised by these problems are highlighted, such as the statistical and deterministic prediction of extreme events, the understanding and modelling of mechanisms that operate on varying length- and time-scales, and the complex interactions between biological, ecological and physical problems. Some options for reducing the impact of flooding by new technology include both improved prediction and monitoring with computer models, and remote sensing, flexible and focused warning systems, and permanent and temporary flood-reduction systems.

Climate↗
PubMed2005

Inland and coastal flooding: developments in prediction and prevention.

We review the scientific and engineering understanding of various types of inland and coastal flooding by considering the different causes and dynamic processes involved, especially in extreme events. Clear progress has been made in the accuracy of numerical modelling of meteorological causes of floods, hydraulics of flood water movement and coastal wind-wave-surge. Probabilistic estimates from ensemble predictions and the simultaneous use of several models are recent techniques in meteorological prediction that could be considered for hydraulic and oceanographic modelling. The contribution of remotely sensed data from aircraft and satellites is also considered. The need to compare and combine statistical and computational modelling methodologies for long range forecasts and extreme events is emphasized, because this has become possible with the aid of kilometre scale computations and network grid facilities to simulate and analyse time-series and extreme events. It is noted that despite the adverse effects of climatic trends on flooding, appropriate planning of rapidly growing urban areas could mitigate some of the worst effects. However, resources for flood prevention, including research, have to be considered in relation to those for other natural disasters. Policies have to be relevant to the differing geology, meteorology and cultures of the countries affected.

Computer Simulation↗
PubMed2006

Extreme natural hazards: population growth, globalization and environmental change.

Mankind is becoming ever more susceptible to natural disasters, largely as a consequence of population growth and globalization. It is likely that in the future, we will experience several disasters per year that kill more than 10,000 people. A calamity with a million casualties is just a matter of time. This situation is mainly a consequence of increased vulnerability. Climate change may also be affecting the frequency of extreme weather events as well as the vulnerability of coastal areas due to sea-level rise. Disastrous outcomes can only increase unless better ways are found to mitigate the effects through improved forecasting and warning, together with more community preparedness and resilience. There are particular difficulties with extreme events, which can affect several countries, while the largest events can have global consequences. The hazards of supervolcanic eruptions and asteroid impacts could cause global disaster with threats to civilization and deaths of billions of people. Although these are very rare events, they will happen and require consideration. More frequent and smaller events in the wrong place at the wrong time could have very large human, environmental and economic effects. A sustained effort is needed to identify places at risk and take steps to apply science before the events occur.

Disaster Planning↗
PubMed2006

The effects and consequences of very large explosive volcanic eruptions.

Every now and again Earth experiences tremendous explosive volcanic eruptions, considerably bigger than the largest witnessed in historic times. Those yielding more than 450km3 of magma have been called super-eruptions. The record of such eruptions is incomplete; the most recent known example occurred 26000 years ago. It is more likely that the Earth will next experience a super-eruption than an impact from a large meteorite greater than 1km in diameter. Depending on where the volcano is located, the effects will be felt globally or at least by a whole hemisphere. Large areas will be devastated by pyroclastic flow deposits, and the more widely dispersed ash falls will be laid down over continent-sized areas. The most widespread effects will be derived from volcanic gases, sulphur gases being particularly important. This gas is converted into sulphuric acid aerosols in the stratosphere and layers of aerosol can cover the global atmosphere within a few weeks to months. These remain for several years and affect atmospheric circulation causing surface temperature to fall in many regions. Effects include temporary reductions in light levels and severe and unseasonable weather (including cool summers and colder-than-normal winters). Some aspects of the understanding and prediction of super-eruptions are problematic because they are well outside modern experience. Our global society is now very different to that affected by past, modest-sized volcanic activity and is highly vulnerable to catastrophic damage of infrastructure by natural disasters. Major disruption of services that society depends upon can be expected for periods of months to, perhaps, years after the next very large explosive eruption and the cost to global financial markets will be high and sustained.

Disaster Planning↗
PubMed2000

Matching response to context in complex political emergencies: 'relief', 'development', 'peace-building' or something in-between?

There is an ongoing debate over the value and pitfalls of the policy and practice of 'linking relief and development' or 'developmental relief' in aid responses to complex political emergencies (CPEs). Driven by concerns about relief creating dependence, sometimes doing harm and failing to address root causes of emergencies despite its high cost, pursuit of both relief and development has become a dominant paradigm among international aid agencies in CPEs as in 'natural' disasters. In CPEs a third objective of 'peace-building' has emerged, along with the logic that development can itself help prevent or resolve conflict and sustain peace. However, this broadening of relief objectives in ongoing CPEs has recently been criticised on a number of counts, central concerns being that it leads to a dilution of commitment to core humanitarian principles and is overly optimistic. This paper addresses these issues in the light of two of the CPEs studied by the COPE project: Eritrea and Somalia/Somaliland. It is argued that the debate has so far suffered from lack of clarity about what we mean by 'relief', 'development' and, for that matter, 'rehabilitation' and 'peace-building'. The wide spectrum of possible aid outcomes does not divide neatly into these categories. The relief-development divide is not always as clear-cut, technically or politically, as the critics claim. Moreover such distinctions, constructed from the point of view of aid programmers, are often of little relevance to the concerns of intended beneficiaries. Second, there has been insufficient attention to context: rather than attempting to generalise within and across CPE cases, a more productive approach would be to examine more closely the conditions under which forms of aid other than basic life support can fruitfully be pursued. This leads to consideration of collective agency capacity to respond effectively to diverse needs in different and changing circumstances.

Africa, Eastern↗
PubMed2000

Rehabilitation: strategic, proactive, flexible, risky?

Rehabilitation after armed conflict is a direct intellectual descendant of thinking about rehabilitation after natural calamity. It is related, generally, to poverty reduction and, operationally, to associated action at the micro level. This history has limited its strategic conceptualisation and, in particular, its links with reconciliation and state re-legitimation and also with macro-economic stabilisation and renewed growth. In post-war--or more generally, a lull in conflict with the potential to become permanent--a country's rapid, focused, prioritised action within a strategic framework is urgent. It is not risk-free for political and natural disasters as well as for those with economic and social bases. Flexibility, learning from initial experience and asking intended household beneficiaries about their needs in advance can reduce risk as can pre-positioning of contingency or standby resources to avert post-war calamities (for example, drought, flood) and catastrophes (renewed violence) from delaying and discrediting rehabilitation efforts.

Africa, Eastern↗
PubMed2001

Negative emotions and coronary heart disease: causally related or merely coexistent? A review.

Negative emotions have been claimed to be a cause of coronary heart disease (CHD) as well as a consequence of cardiovascular disorders. Early case studies of cardiac disorders of soldiers in battle drew attention to the possibility that strong negative emotional states could cause CHD. Subsequent reports of reactions to natural disasters supported the notion that intense negative emotions could precipitate somatic disorders such as CHD. Since then, numerous studies have investigated relations between negative emotions and CHD. Over the years, retrospective studies have found, for example, that negative emotions are often present before the occurrence of CHD. Cross-sectional studies have indicated that symptoms of depression and anxiety are often present in CHD patients. Prospective studies have shown that the likelihood of CHD tends to be higher for people with negative emotions than for those without them. The main symptoms of negative emotional states that seem to be most closely associated with CHD are nervousness, getting easily upset, feeling fatigue, being indecisive, having sleep disturbances, being usually worried about something, and feeling that others would be better off if oneself were dead. Although the findings appear to support the notion of causal connections between negative emotions and CHD, they fail to provide conclusive proof of such relations. An alternative explanation that could also account for the findings is simply that negative emotions and CHD often coexist.

Affective Symptoms↗
PubMed2003

Risk modeling, assessment, and management of lahar flow threat.

The 1991 eruption of Mount Pinatubo in the Philippines is considered one of the most violent and destructive volcanic activities in the 20th century. Lahar is the Indonesian term for volcanic ash, and lahar flows resulting from the massive amount of volcanic materials deposited on the mountain's slope posed continued post-eruption threats to the surrounding areas, destroying lives, homes, agricultural products, and infrastructures. Risks of lahar flows were identified immediately after the eruption, with scientific data provided by the Philippine Institute of Volcanology, the U.S. Geological Survey, and other research institutions. However, competing political, economic, and social agendas subordinated the importance of scientific information to policy making. Using systemic risk analysis and management, this article addresses the issues of multiple objectives and the effective integration of scientific techniques into the decision-making process. It provides a modeling framework for identifying, prioritizing, and evaluating policies for managing risk. The major considerations are: (1) applying a holistic approach to risk analysis through hierarchical holographic modeling, (2) applying statistical methods to gain insight into the problem of uncertainty in risk assessment, (3) using multiobjective trade-off analysis to address the issue of multiple decisionmakers and stakeholders in the decision-making process, (4) using the conditional expected value of extreme events to complement and supplement the expected value in quantifying risk, and (5) assessing the impacts of multistage decisions. Numerical examples based on ex post data are formulated to illustrate applications to various problems. The resulting framework from this study can serve as a general baseline model for assessing and managing risks of natural disasters, which the Philippines' lead agency-the National Disaster Coordinating Council (NDCC)-and other related organizations can use for their decision-making processes.

Journal Article↗
PubMed2004

Risk management for Leontief-based interdependent systems.

When stricken by a terrorist attack, a war, or a natural disaster, an economic unit or a critical infrastructure may suffer significant loss of productivity. More importantly, due to interdependency or interconnectedness, this initial loss may propagate into other systems and eventually lead to much greater derivative loss. This belongs to what is known as a cascading effect. It is demonstrated in this article that the cascading effect and the derivative loss can be significantly reduced by effective risk management. This is accomplished by deliberately distributing the initial inoperability to other systems so that the total loss (or inoperability) is minimized. The optimal distribution strategy is found by a linear programming technique. The same risk management can also be applied to situations where objectives need to be prioritized. A case study featuring 12 economic sectors illustrates the theory. The result suggests that using the same amount of resources, minimizing risk (inoperability) of infrastructures will generally give rise to highest payoff, whereas overlooking it may result in greatest total loss. The framework developed in this work uses a steady-state approach that applies primarily to managing situations where the attack is catastrophic resulting in very long recovery time.

Journal Article↗
PubMed2006

Mainstreaming risk reduction in urban planning and housing: a challenge for international aid organisations.

The effects of 'natural' disasters in cities can be worse than in other environments, with poor and marginalised urban communities in the developing world being most at risk. To avoid post-disaster destruction and the forced eviction of these communities, proactive and preventive urban planning, including housing, is required. This paper examines current perceptions and practices within international aid organisations regarding the existing and potential roles of urban planning as a tool for reducing disaster risk. It reveals that urban planning confronts many of the generic challenges to mainstreaming risk reduction in development planning. However, it faces additional barriers. The main reasons for the identified lack of integration of urban planning and risk reduction are, first, the marginal position of both fields within international aid organisations, and second, an incompatibility between the respective professional disciplines. To achieve better integration, a conceptual shift from conventional to non-traditional urban planning is proposed. This paper suggests related operative measures and initiatives to achieve this change.

City Planning↗
PubMedDate not supplied

Fathers clubs to improve child health in rural Haiti.

OBJECTIVES: This paper describes an innovative public health nursing strategy, village-based fathers clubs, to improve child and family health in rural Haiti. It discusses related nursing implications in Haiti and other parts of the world. DESIGN: Relevant current literature was reviewed and evaluated with respect to child health in Haiti and the development of the fathers clubs. Program participants and organizers were consulted. SAMPLE: The fathers clubs in remote areas of Jeremie Haiti, participants and program directors, provided input for this description. RESULTS: Public health practitioners continually face grave challenges when addressing the health care needs in less developed countries. One such case is Haiti, where crushing poverty, poor infrastructure, a failing economy, natural disasters, and chaotic sociopolitical conditions compound these challenges. Public health practitioners, including nurses, must seek creative, culturally-appropriate, low technologic approaches to improve the health of the children and families in the remote villages of Haiti. The institution and support of village fathers clubs is one approach that has been ongoing since 1994. Fathers meet together on a regular basis for health education, support, and community building activities. The curriculum is health-based and facilitated by nurses, with participation by young and old men alike. CONCLUSIONS: Participants and organizers believe that family and child health is improved as a result of the groups.

Child↗