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Disaster-relief training and mental health.

The author describes a training program in diaster-relief agencies. The program is designed to improve their over-all understanding of disaster-relief work and to increase their sensitivity to the emotional needs of disaster victims. Based on the recommendations of a state task force report, it consists of a workshop that makes use of videotapes and learning exercises to help participants improve their listening skills, learn problem-solving techniques, become aware of behavioral signs that can alert them to victims' emotional reactions, and familiarize them with the work of other relief agencies.

Crisis Intervention↗

[The Red Cross and Scandinavian disaster aid].

In 1970, the League of Red Cross Societies drew up a plan for the training of delegates in international relief work. The main tasks of the delegates can be divided into: 1) disaster relief, 2) war-time relief work, 3) assistance in organising national Red Cross societies. Special training of certain categories, e. g. doctors, is now being considered. In many relief operations it would be of value to have a doctor as an administrative delegate. It should be easier for the doctor than for a non-medically trained person to decide where and when medical aid should be administered.

Disasters↗

[Voluntary helpers in hourly home care of patients with dementia. Intermediate term results of a prospective study and results of a retrospective survey].

Care of home-based dementia patients by trained part-time volunteer "helpers" is seen as a future-oriented, easily accessible and financially affordable means of relieving the burden on family carers. Qualitative interviews with 30 former or currently active helpers were conducted, and information gathered about their past experience. The additional, prospective part of the study, which is as yet uncompleted, has so far provided data on 33 individuals with regard to their motivation in wishing to become involved in this type of voluntary relief work. The most common characteristics of this group are previous experience in the care of old and sick people, either as private citizens or in a work situation, and previous periods engaged in voluntary work. Many volunteers had had what they perceived as unpleasant experiences when caring for dementia patients. Such experiences do not lead to the abandoning of the voluntary activity so long as an experienced professional is readily available to give support and advice when there are problems. If the kind of voluntary relief work described here is to succeed in its aims then, in addition to the professional support, volunteers will require thorough preparation for their task.

Adult↗

Getting your back back to work: pain relief--where to start?

Dental health care workers are vulnerable to back and neck pain resulting from poor occupational posture. While numerous choices exist for treatment, this article will provide them with a practical approach to seeking out appropriate care for this common malady. The McKenzie treatment approach is discussed and recommendations for its application are presented to provide the reader with a starting point for treatment. For the dental health care worker experiencing pain and dysfunction of the back and/or neck, as more than half will during their careers, this article will seek to provide an overview of potential causes while creating a roadmap for seeking the most appropriate conservative "antidote" for their care.

Back Pain↗

Overseas relief organizations: a guide for health care providers.

Spending time overseas providing health care to people in disaster or famine-related situations can be a very rewarding experience. This article presents lists of various organizations available for health care professionals who wish to spend time in relief work. The lists include qualifications and/or professional needs, locations, lengths of service, and focuses of the organizations. Some of these organizations provide a stipend for the relief worker. In others, the entire cost of the experience must be paid for by the volunteer. Guidelines are given to assist the prospective relief worker in looking for an appropriate agency, such as to obtain a complete job description; know the details of living arrangements; make sure you have compatible philosophies; ask about health concerns; find out if adequate health insurance is provided; and gain knowledge of the culture (e.g., especially about customs, relationships of nationals to relief workers, and religious beliefs). Interested health care providers can write to any of the organizations to obtain further information.

Disasters↗

Prevention of debris flow disasters on Chengdu-Kunming Railway.

Chengdu-Kunming Railway is an important transport line on southwestern China. However, this railway's safety is often threatened by debris flows. How to effectively forecast and alarm the debris flow disasters and reduce the losses is the aim to study the prevention system in this paper. The factors to cause or influence debris flow are divided into four parts--the basin environmental factors, the basin meteoric factors, the prevention work's elements and the flood-relief work's elements, and the prevention system is made up of three models--a judgment model to assess the debris flow gully's seriousness, a forecast model to predict the debris flow's occurrence and an alarm model to evaluate the debris flow's disaster. Afterwards, a concise structure chart is worked out and verified by the field data from Chengdu-Kunming Railway. This prevention system will provide beneficial reference for the debris flow's monitoring network to be executed on Chengdu-Kunming Railway.

China↗

From sentiment to science: children's relief organisations and the problem of malnutrition in inter-war Europe.

The transformation of the ethos of children's relief organisations from sentimentalism into science was reflected in the rise of nutritional science, eugenics, child psychology and child guidance. A related transition occurred in the organisational forms of child welfare organisations: with the rise of welfare states, government organisations took an increasing role. Internationally there was a move to expand the scope of charities relieving children in distress to broader strategies promoting child welfare. In this paper I consider these shifts in the case of international measures to relieve child starvation and to promote child welfare between the First and Second World Wars. I examine how health organisations had to move away from relief work and establish programmes seeking to relate the developing scientific understanding of nutrition to a range of factors affecting health.

Child Nutritional Physiological Phenomena↗

The 1980 earthquake in Southern Italy--morbidity and mortality.

The effects on health of the 1980 earthquake in southern Italy were surveyed retrospectively. The sample population includes 3619 people living in seven villages situated near the epicentre. Deaths were one hundred times and injury rates more than five times higher in trapped than in non-trapped victims. The possibility for escape was crucial for survival and depended on the type of building. Most of the rescue and relief work was carried out within a few days by unprepared local people who concentrated assistance on people sharing the same dwelling. The results suggest that the emergency phase for medical care was limited to the three to four days after impact. During the 18 months following the quake, mortality rates in injured (13.7%) and non-injured victims (15.8%) were similar. These results point to the need to establish, in each disaster prone area, a health evaluation system on which effective disaster relief and especially the preparedness of the community can be based.

Disaster Planning↗

Famine in southern Ethiopia 1985-6: population structure, nutritional state, and incidence of death among children.

OBJECTIVE: To assess the effects of drought on mortality in children. DESIGN: Prospective epidemiological study forming part of nutritional monitoring during famine relief work. SETTING: 24 Food distribution sites in Arero and Borana provinces in southern Ethiopia. PATIENTS: A monthly average of 14,173 and 5,334 children under 5 were examined in 1985 and 1986, respectively. Altogether 148,966 child months (105,872 for 1985 and 43,094 for 1986) were available for analysis. INTERVENTION: The families of all children were supplied with food each month. Basic medical care was also provided. MAIN OUTCOME MEASURE: Mortality in children under 5. RESULTS: A 40% increase in crude mortality was observed among children living in traditional and stable societies. The severe consequences were observed mainly among children living in relief shelters, where a threefold to fourfold increase in crude mortality was recorded among children. Increased childhood mortality was also associated with high prevalence of malnutrition, living in the most arid areas, and the dry season. A long period of food aid was needed to normalise the nutritional state, especially for children living in relief shelters. CONCLUSIONS: The most severe consequences of the widespread famine that occurred in the Arero and Borana provinces of southern Ethiopia during 1985-6 were seen among children living in relief shelters. Early food intervention may decrease the scale of migration and thus also reduce the severe consequences of a famine.

Altitude↗

Rapid assessment survey of earthquake affected Bhuj block of Kachchh District, Gujarat, India.

RESEARCH QUESTIONS: How much human loss would have caused by the earthquake in Bhuj block? What is the environmental sanitation status? OBJECTIVES: (1) To assess human loss and injuries after the earthquake in Bhuj block.(2) To study the status of some relief activities.(3) To study the environmental sanitation status of the earthquake affected Bhuj block. STUDY DESIGN: Cross-sectional study. SETTINGS: Bhuj block. PARTICIPANTS: All villages excluding Bhuj city of Bhuj block. STATISTICAL ANALYSIS: Proportions, chi-square test, chi-square for trend. RESULTS: Survey was done in 144 villages; there were total 541 deaths with death rate of 3.18 per 1000 population. Death rate was significantly associated with distance of village from epicenter (chi-square for trend significant, P < 0.001). Among victims, majority were children 171 (45.4%) and women 107 (28.4%). Relief work was significantly associated with accessibility of village (P < 0.001) and few interior pockets were deprived of help. Total 56 (38.9%) villages were entirely dependent on water tanker for water supply and in 61 (42.4%) villages drinking water was used without chlorination. In 142 (98.6%) villages open-air defecation was practiced. Diseases such as URTIs, diarrheal diseases, fever and conjunctivitis were commonly observed in the field area.

Adolescent↗

Medical support in the Tangshan earthquake: a review of the management of mass casualties and certain major injuries.

The Tangshan earthquake was probably the worst catastrophe in this century. It took a death toll of 242,769, with 164,851 injured in addition. This presentation describes the organization of disaster relief work after the earthquake, the rescue of buried victims, the organization of medical resources, and the sanitation work to forestall epidemics. It also presents the author's reflections on the management of three major injuries, namely, crush syndrome, fracture of pelvis, and traumatic paraplegia, by reviewing the available data pertaining to these injuries. The author concurs with the prevailing opinion that fasciotomy plays an important role in the successful management of crush injury. It not only prevented acute renal failure subsequent to intracompartmental increase of pressure, but also the occurrence of Volkmann's ischemic contracture as a late sequela. Herbs to induce catharsis and diuresis were used to alleviate intracompartmental pressure. For the management of pelvic fractures, two newly developed treatment techniques are described. On analysis of clinical data, it is the author's opinion that traumatic paraplegia should not be given the priority of early surgery in the circumstances of mass casualties. The primary concern should be the stability and restoration of normal curvature of the spine, especially in cases of complete paraplegia. Decompression of the spinal cord through an anterolateral approach gave promising results in hyperflexion type of spinal fracture.

China↗

Does the tube-compensation function of two modern mechanical ventilators provide effective work of breathing relief?

OBJECTIVE: An endotracheal tube (ETT) imposes work of breathing on mechanically ventilated patients. Using a bellows-in-a-box model lung, we compared the tube compensation (TC) performances of the Nellcor Puritan-Bennett 840 ventilator and of the Dräger Evita 4 ventilator. MEASUREMENTS AND RESULTS: Each ventilator was connected to the model lung. The respiratory rate of the model lung was set at 10 breaths/min with 1 s inspiratory time. Inspiratory flows were 30 or 60 l/min. A full-length 8 mm bore ETT was inserted between the ventilator circuit and the model lung. The TC was set at 0%, 10%, 50%, and 100% for both ventilators. Pressure was monitored at the airway, the trachea, and the pleura, and the data were recorded on a computer for later analysis of the delay time, of the inspiratory trigger pressure, and of the pressure-time product (PTP). The delay time was calculated as the time between the start of inspiration and minimum airway pressure, and the inspiratory trigger pressure was defined as the most negative pressure level. The same measurements were performed under pressure support ventilation of 4 and 8 cmH2O. The PTP increased according to the magnitude of inspiratory flow. Even with 100% TC, neither ventilator could completely compensate for the PTP imposed by the ETT. At 0% TC the PTP tended to be less with the Nellcor Puritan-Bennett 840 ventilator, while at 100% TC the PTP tended to be less with the Dräger Evita 4 ventilator. A small amount of pressure support can be equally effective to reduce the inspiratory effort compared with the TC. CONCLUSION: Although both ventilators provided effective TC, even when set to 100% TC they could not entirely compensate for a ventilator and ETT-imposed work of breathing. The effect of TC is less than that of pressure support ventilation. Physicians should be aware of this when using TC in weaning trials.

Humans↗

Spinal cord stimulation for treatment of meralgia paresthetica.

BACKGROUND: Meralgia paresthetica is a clinical syndrome of pain, dysesthesia or both, in the anterolateral thigh. It is associated with an entrapment mononeuropathy of the lateral femoral cutaneous nerve. Diagnosis of meralgia paresthetica is typically made clinically and is based on the characteristic location of pain or dysesthesia, sensory abnormality on exam, and absence of any other neurological abnormality in the leg. The majority of patients with meralgia paresthetica respond well to conservative treatment. OBJECTIVE: To present a case of intractable meralgia paresthetica in which conservative treatment options failed but which was successfully treated with a spinal cord stimulator. CASE REPORT: A 44-year-old woman presented to the pain clinic with a one-year history of bilateral anterolateral thigh pain. History, physical exam, and diagnostic work-up were consistent with meralgia paresthetica. Multiple medications, physical therapy, and chiropractic therapy were not successful for this patient. In addition, local anesthetic/steroid injection of the lateral femoral cutaneous nerve provided only short-term relief. Ultimately, a spinal cord stimulator was implanted after a successful temporary percutaneous trial. Two months after the implantation, she continued to have 100% pain relief, worked full-time, was physically active, and no longer required any pain medication including opioids. CONCLUSION: An implanted spinal cord stimulator may be an ideal treatment for intractable meralgia paresthetica after conservative treatments have failed because it is not destructive and can always be explanted without significant permanent adverse effects.

Journal Article↗