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Drawover anesthesia. A review of equipment, capabilities, and utility under austere conditions.

Anesthesia care may be required under austere conditions during military operations and natural disasters. Drawover anesthesia devices that provide inhalational anesthetic agents in air or an air/oxygen mixture are useful in these circumstances. This equipment must be portable, rugged, lightweight, and capable of functioning with an absolute requirement for compressed gas supplies. The historical experience, available equipment and literature on this subject are reviewed.

Anesthesia, Inhalation↗

Giving LTC residents that secure feeling. Risk management and loss prevention techniques.

Nursing homes today are promoting the physical, emotional, and psychosocial security of their residents while involving them and their families in the ultimate decision making. These efforts, however, do not minimize nursing homes' responsibility to ensure a secure environment through good risk management and loss prevention techniques. Facility managers should annually evaluate policies and procedures to ensure that department standards are realistic and reflect the accepted standard of care owed to residents. Technological and functional developments in healthcare make continuous staff training programs a necessity. Involving patients and their families in care planning and treatment decisions can enhance residents' feelings of security. These feelings are further bolstered by a safe environment. Staff should also be alert to changes in residents' behavior. When a resident is admitted to a nursing home, managers should obtain signed consent forms for potential future medical treatment and resident trips. Managers' responsibilities also extend to situations beyond their control. All long-term care facilities must have practical plans in case of natural disasters.

Accident Prevention↗

Legal notice. Plant closing law covers healthcare facilities, too.

Many healthcare facilities and other not-for-profit organizations employ enough people to be covered by the new Worker Adjustment and Retraining Notification Act, which requires businesses to give 60 days' notice of a shutdown or mass layoffs. Leaders of these organizations should be aware of the law's terms. The law requires that any business enterprise that employs 100 full-time workers give 60 days' notice of a closing or mass layoffs. It also covers businesses that employ 100 or more workers, both full time and part time, who work at least a total of 4,000 hours per week. It defines employer as any "business enterprise" that employs the required number of persons. Interim interpretive rules include not-for-profit organizations in this definition, and the final rules are not likely to change this. The organization must give notice in writing to "each representative of the affected employees" or to each employee. In addition, it must notify in writing the state dislocated worker unit and the local government to which the business paid the highest taxes in the previous year. Notice is not required if it would prevent the organization from obtaining capital or business necessary to continue operations, if the shutdown is due to "natural disaster," or if the shutdown was unforeseeable. The law also allows exceptions for strikes, lockouts, and temporary jobs.

Employment↗

What's eating you? Pediculus humanus (head louse and body louse).

Head lice remain a common problem worldwide. As resistance to available therapeutic agents can emerge rapidly, there is a need for continued research to find new and better agents. Until better agents are available, clinicians may find that rotational therapy, using different agents, may help to slow the emergence of resistance. Physical modalities, such as mechanical nit and louse removal and occlusive agents to asphyxiate the lice, should not be ignored, especially in light of our limited therapeutic armamentarium. All therapeutic agents are doomed to failure if infestation is allowed to recur. Classmates, playmates, and family members of infested children should be inspected for head lice. Efforts should be directed at fomite control and nit removal. Louse infestation must be addressed as a community-wide problem. Body lice remain important vectors of disease. War, natural disaster, and poverty favor the spread of body lice. As we work to solve these seemingly eternal problems, we must develop better agents to treat infestation and prevent the spread of body lice.

Adult↗

Lessons on humanitarian assistance.

Conflict almost completely destroyed Rwanda's infrastructure in 1994. Natural disasters, as well as disasters caused by humans, have severely challenged humanitarian aid available within the country. In this study, we have analysed the experiences of nongovernmental organizations since the summer of 1994 to evaluate how these difficulties may be overcome. One of the problems identified has been restrictions on the ability to introduce effective health planning due to the poor quality of available local information. The implementation of effective plans that show due consideration to the environment and society is clearly necessary. Effective monitoring and detailed observation are identified as being essential to the continuity of existing humanitarian assistance.

Altruism↗

Adolescent suicide: a review of the literature.

This article reviews the literature on the risk factors related to teen suicide in the United States and Puerto Rico. Findings indicate the interplay of multifactors including depression, homosexuality--due to the hostility that is often experienced by the person--, sexual abuse, lack of coping, social and problem-solving skills stemming from family dysfunction, feelings of isolation and helplessness, contagion, gender differences, alcohol and drug abuse, psychiatric disorders, biological factors, as well as natural disasters. Included in this report are some statistics on the prevalence of suicide among teens and in the military.

Adaptation, Psychological↗

Increased acute myocardial infarction mortality following the 1995 Great Hanshin-Awaji earthquake in Japan.

BACKGROUND: This study examined the factors affecting mortality from acute myocardial infarction (AMI) following the 1995 Great Hanshin-Awaji earthquake. METHODS: We examined the death certificates of all decedents between January 1994 and December 1996 in 16 municipalities, which covered most of the area affected by the 1995 Great Hanshin-Awaji earthquake. We analysed the extent and duration of the increased mortality from AMI. The standardized mortality ratio (SMR) of AMI was calculated weekly after the earthquake, taking the number of AMI deaths during the same period in 1994 as a reference. The main outcome measures were the number of deaths from AMI (ICD-9 410; ICD-10 I21, I22) in the study area before and after the earthquake, and the weekly SMR after the earthquake. RESULTS: A significant increase in mortality from AMI in the study area as a whole continued for about 8 weeks after the earthquake. There was wide variation amongst the regions with respect to the extent and duration of the increased mortality from AMI. The SMR of AMI showed a positive relationship with the percentage of houses which were completely destroyed, and was almost significant (r = 0.530, P = 0.062). CONCLUSIONS: The duration of increased cardiac mortality after the 1995 Great Hanshin-Awaji earthquake was longer than seen with previous earthquakes. Further analysis to identify the factors affecting cardiac mortality is needed so that we may reduce adverse health effects during the recovery stage following natural disaster.

Adult↗

The impact of the monetary crisis and the development of a health and social safety-net with a special note on donor participation--real life experiences on the role of health services in public health.

South-East Asia (i.e. Indonesia) has enjoyed economic boom and rapid unbridled growth for the last decade. This rapid expansion was fuelled by cheap labour, foreign and local investments and the extensive development of the oil and non-oil sector. Dark clouds, however, loomed on the economic and financial horizons of these rapidly developing 'tiger' economies. Indonesia was not only affected by various facts-of-life elements which contributed to these grave forecasts but also by a wave of natural disasters on an unprecedented scale, with devastating social and economic effects on the poor and susceptible groups. Although economic recovery will take time, the most pressing and practical measure remains the need to create a health and social safety net to maintain the health, social and nutritional status of the "population-at-risk". This paper is an exposure of "lessons learnt" and the invaluable role of health services and public health to the negative impact of the monetary crisis experienced by various inter-sectors, which the authors believe can be used as a long-term investment measure in other countries.

Delivery of Health Care↗

El Niño and human health.

The El Niño-Southern Oscillation (ENSO) is the best known example of quasi-periodic natural climate variability on the interannual time scale. It comprises changes in sea temperature in the Pacific Ocean (El Niño) and changes in atmospheric pressure across the Pacific Basin (the Southern Oscillation), together with resultant effects on world weather. El Niño events occur at intervals of 2-7 years. In certain countries around the Pacific and beyond, El Niño is associated with extreme weather conditions that can cause floods and drought. Globally it is linked to an increased impact of natural disasters. There is evidence that ENSO is associated with a heightened risk of certain vector-borne diseases in specific geographical areas where weather patterns are linked with the ENSO cycle and disease control is limited. This is particularly true for malaria, but associations are also suggested in respect of epidemics of other mosquito-borne and rodent-borne diseases that can be triggered by extreme weather conditions. Seasonal climate forecasts, predicting the likelihood of weather patterns several months in advance, can be used to provide early indicators of epidemic risk, particularly for malaria. Interdisciplinary research and cooperation are required in order to reduce vulnerability to climate variability and weather extremes.

Climate↗

Coccidioidomycosis in travelers returning from Mexico--Pennsylvania, 2000.

Coccidioidomycosis (CM), a fungal disease caused by Coccidioides immitis, is endemic in the southwestern United States and parts of Central and South America. The disease is acquired by inhaling the arthroconidia of C. immitis present in the soil. Outbreaks of CM occur when susceptible persons are exposed to airborne arthroconidia from dust storms, natural disasters, and earth excavation (1,2). Persons who travel to areas where the disease is endemic may become infected and develop symptoms after returning home (3,4). This report describes an outbreak of CM among travelers returning to Pennsylvania from a trip to Mexico.

Adult↗

[Post-traumatic stress disorder. After the flood in Saguenay].

OBJECTIVE: To measure the prevalence of posttraumatic stress disorder and emotional distress among victims of the Saguenay flood compared with those who were not affected by the flood. DESIGN: Cross-sectional study using a telephone survey of victims and a control group. SETTING: Chicoutimi, Que. PARTICIPANTS: Sixty-two adults in a flooded area and a control group of 79 volunteers chosen randomly from an adjacent area. MAIN OUTCOME MEASURES: Diagnostic criteria for posttraumatic stress disorder measured using the Post-traumatic Stress Disorder Reaction Index and high scores on the Self-Reporting Questionnaire on emotional distress. RESULTS: Socially and demographically, study group and control group were comparable. Prevalence of posttraumatic stress disorder in the study group was close to 20% (odds ratio [OR] 6.08; 95% confidence interval [CI] 1.63 to 22.64). Prevalence of emotional distress in the study group was 29% (OR 2.42; 95% CI 1.04 to 5.61). CONCLUSION: The Saguenay flood caused psychological distress that was measurable 4 months later. Health care professionals should be aware of the psychological effects of natural disasters.

Adolescent↗

Emotional reactions to the sudden death of a child: the challenge to emergency care providers.

The death of a child has the potential to traumatize everyone involved. Child deaths caused by auto crashes, suicides, murders, gun accidents, drowning, fires, natural disasters, sudden illness, and other events trigger painful and profound emotional grief reactions in family members, and, at times, for emergency care providers. What grief reactions do family members experience when their child dies suddenly? What emotional struggles take place with siblings? How do emergency care providers cope with the tragic and painful deaths of children? We are guided by the literature and by our own experiences in pediatric emergency departments in trying to supply answers to the questions posed.

Adaptation, Psychological↗

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

Adolescent↗

[Post-traumatic stress, post-traumatic depression and major depressive episode: literature].

Although they are likely to add their effects, physical and psychic traumata (or traumas) can provoke in different ways the appearance of depressive symptoms sometimes common. Post-traumatic depression, reactional depression, major depressive disorder and post-traumatic stress disorder represent different clinical and nosographic disorders in despite of their occasionally common symptomatic core. Historically, it is interesting to note during the XXth century the true semantic change of the terms of trauma from the somatic field to the psychic sphere. Physical traumatism is often represented by a material shock for the subject and by its organic consequences. It is defined as an event that leaves its mark which itself inflicts and handicaps the vital trajectory of the subject. It primarily comprises brain and rachis injuries, whose evolution is frequently characterized by the occurrence/appearance of a depressive disorder, whose genesis rests on psychological but also neurobiologic and physical arguments. Thus major depressive disorders are often present in the course of various physical traumatisms mainly related to nervous system. In accordance with several studies, the prevalence of major depressive disorders ranges from 25% to 50%. These mood disorders occur in the year which follows the accidental event. Their average time of revelation is estimated at four months and their average duration lies between three and six months. Lastly, although these depressive illnesses present clinical symptoms comparable with those observed in other contexts, some nuances can be raised. Nonetheless, they confine sometimes with true clinical forms depending on the intensity, the form, the circumstances or the consequences of the trauma. Psychic traumatism doesn't have the same profile and rests for much dedicated with the reexperiencing. Thus for some authors, depression illness represents a disorder that occurs after a traumatic event whereas others see a differential diagnosis which exludes or which represents a comorbidity with post-traumatic stress disorder. The review of the literature allows us to emphasize the complexity of the links as well as the clinical and epidemiologic differences between stress disorder and major depressive disorder. From the clinical point of view, the major features of PTSD are articulated around a triad of symptoms. They include the reexperiencing symptoms of the traumatic event such as intrusive memories and recurrent nightmares, the protective reactions such as avoidance of the stimuli associated with the trauma and emotional numbing, and the arousal symptoms such as the startled response and hypervigilance. The complexity of this syndrom is due to the frequent combination of these symptoms with other nonspecific ones. As far as the mood is concerned (the mood symptoms are concerned), the regrouping of some of these symptoms allows the clinician to sometimes releave a depressive symptomatology without being able to assess the DSM diagnosis of major depressive disorder. Epidemiologic studies dealing with the risk of installation of a PTSD after a traumatic event reveal differences in the prevalence depending on the nature of the traumatic events: ranging from 1% in general population to 80% following some situations of extreme and durable psychic suffering. Between both poles, one finds a prevalence ranging between 20 and 50% following other events such as serious accidents, natural disasters or criminal assaults. The clinical features of depressive episodes comorbid or associated with PTSD have some characteristics making it possible to individualize various clinical forms as a function of traumatic event type: asthenic, characterial or with somatic symptoms. According to the majority of authors, the co-occurrence of post-traumatic stress disorder and major depressive disorder is high although differential diagnosis is sometimes difficult. However, conceptual differences remain and two conceptions are distinguished. For some authors, like Bleich and Shalev, there would not be true chronological evolution from PTSD to MDD. Moreover the presence of symptoms considered as pertaining to the mood register within the criteria of PTSD would be clearly predictive of the occurrence and the severity of the diagnosis but not of the chronicity. For others, there would be a continuity between post-traumatic stress disorder and major depressive disorder. It is the case in many studies of veterans but also for civilian traumatic events. It is also the case for the American national study of comorbidity in which Kessler concludes that for 78% of the subjects who present a comorbidity PTSD/MDD (comorbidity raised for 48% of the 5,877 subjects included), the mood disorder is secondary to PTSD. (ABSTRACT TRUNCATED)

Comorbidity↗

[Drinking habits and characteristics of urban male residents with high alcohol intake--analysis of temporary housing residents after the Great Hanshin Earthquake].

In December 1996, a health survey was conducted of 49,033 temporary housing residents of Kobe City, who were victims of the Great Hanshin Earthquake on Tuesday, January 17, 1995. A total of 33,414 residents (68.1% of those requested) filled in self-administered questionnaires. This study focused on males over 20 years old and examined factors related to increase in alcohol intake. A total of 14,179 men were analyzed, 67.4% of whom reported habitual drinking, and 32.1% an increase in their alcohol intake. The factors related to elevated alcohol intake were a low Breslow's health practice index, a high nervous complaint score and a low living score. In addition, the health practice index demonstrated an inverse link. There are many drinkers among urban residents and drinking related problems are easily evoked when living conditions worsen, as in the case of a natural disaster. Logistic regression analyses were used to predict which persons are likely to increase their alcohol intake. Significant predictors identified were the smoking habit, sleep disturbance, nervous complaints and the health practice index. It is important to ensure that this latter remains high to prevent the alcohol-related problems in urban residents.

Adult↗

Psychological disturbance in Darwin evacuees following cyclone Tracy.

The incidence and course of psychological reactions following natural disasters has been based on clinical impressions in the past. In the present study, 67 survivors of cyclone Tracy who had been evacuated to Sydney were studied by an objective test, the General Health Questionnaire, which has been found to be a reliable and valid instrument in determining non-psychotic psychological disturbance. Fifty-eight per cent of these Darwin evacuees scored as "probable psychiatric cases" when tested five to eight days after the cyclone. Psychological disturbance increased with age and was more pronounced in females.

Adolescent↗

[An analytic study of medical records in Sam-Kuk-Sa-Ki].

In Sam-Kuk-Sa-Ki there are several types of records which are associated with medicine. They are of the plagues, delivery of twins, drugs in use of the time, religious healing and names of some diseases. Records of plagues are most frequently described and they are described associated with climate and natural disasters. Those who delivered twins were awarded by the nation. Because at that time when population was not so large, the population was the power of the nation. As Buddhism was the ruling religion of the time, records of religious healing were mostly associated with the Buddhism. Medical records in Sam-Kuk-Sa-Ki gives us valuable clues to the understanding of the medicine of the time, the ancient Koreans' concept of diseases and the way how they confronted them.

Disease↗

The Highlands and Islands Medical Service: precursor of a state funded medical care system?

The Highlands and Islands of Scotland cover a large area of the country and are sparsely populated. A series of man-made and natural disasters ensured that, early in the nineteenth century, they were also poverty stricken. It was gradually recognised that the degree of social deprivation was too severe for self-help and could only be alleviated from outside the area. This paper traces the use of State funds to support a medical service, from the first payments under the new Poor Law until the outbreak of war in 1939. Improvement was at first very slow but a turning point came with the establishment in 1913 of the Highlands and Islands Medical Service Committee. The committee was given a free hand to expand or retain its annual grant as it saw fit; the way in which the money was used to develop first a comprehensive primary care service and then the nucleus of an integrated hospital service is revealed in the annual reports. The success of this local scheme may have made easier the later introduction of a national health service.

Comprehensive Health Care↗