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PubMedDate not supplied

Primary health care and the Midwest flood disaster.

The Midwest flood disaster of 1993 ravaged communities across a 9-State area. Homes were destroyed, roads closed, and services disrupted. Economic costs, including loss of revenue from farming and loss of jobs, are estimated at more than $1 billion. Even as people continue to rebuild their lives 1 year later, renewed flooding has occurred in some areas. A community-based primary health care system can be described as a system of services that (a) offers all members of a family continuous, comprehensive, quality health services throughout their lives; (b) includes case management and coordinated referrals to other related services when necessary; (c) is usually provided by family practitioners, general internists, general pediatricians, obstetricians-gynecologists, nurse practitioners, certified nurse midwives, and physician assistants; and (d) has community involvement in the development and management of the system to assure that it meets the changing needs and the diversity of the people it is designed to serve. This paper uses the floods to describe the impact of a disaster on primary health care services and primary health care systems. This includes changes in the demand for services (as evidenced by the frequency and type of patient visits) and the ability of the system to respond to these changes. The effect of a disaster on access to primary health care is discussed.

Community Health Services↗
PubMed1994

An analysis of the value of forensic odontology in ten mass disasters.

The results of dental identification in ten mass disasters, in which British forensic odontologists undertook the dental identification procedures, are reported. These ten disasters indicate the difficulties associated with this method and draw attention to the need for national dental associations to deal with the problem of inadequate dental records and unmarked dentures. It is suggested that, through the FDI World Dental Federation, each member country should appoint dentists, responsible for providing advice and assistance, to forensic odontologists in other countries, when nationals of the country are victims of an international disaster.

Accidents↗
PubMed1993

[Military medical doctrine and the development of the concept of disaster medicine].

On the basis of their own experience and literature concerning liquidation of the disaster consequences the authors analyse limitations in the disaster health care system. The article shows the trends towards the improvement of medical aid during catastrophes of peaceful period, taking into account various aspects of military doctrine and, especially, the casualty care staging system. It is stressed that the disaster health care procedures will depend on the structure of sanitary losses, characteristic features of the scene of an accident and the dynamics of medical environment.

Disasters↗
PubMedDate not supplied

Disaster preparedness for the ICN: evolution and testing of one unit's plan.

A plan for the care of technology-dependent premature and critically ill children during a disaster or other emergency requires more guidance than a generic hospital disaster plan can offer. An intensive care nursery (ICN) devised disaster and emergency preparedness policies and procedures specific to its patient population. Staff responses to events such as loss of power, loss of medical gases, and partial evacuation are described.

Disaster Planning↗
PubMed1996

A modified cluster-sampling method for post-disaster rapid assessment of needs.

The cluster-sampling method can be used to conduct rapid assessment of health and other needs in communities affected by natural disasters. It is modelled on WHO's Expanded Programme on Immunization method of estimating immunization coverage, but has been modified to provide (1) estimates of the population remaining in an area, and (2) estimates of the number of people in the post-disaster area with specific needs. This approach differs from that used previously in other disasters where rapid needs assessments only estimated the proportion of the population with specific needs. We propose a modified n x k survey design to estimate the remaining population, severity of damage, the proportion and number of people with specific needs, the number of damaged or destroyed and remaining housing units, and the changes in these estimates over a period of time as part of the survey.

Cluster Analysis↗
PubMed1998

Understanding the needs of children following large-scale disasters and the role of government.

No one who experiences a disaster is untouched by it. Children and their families are often among the most affected. This article explains how mental health and medical professionals can assist families and communities in dealing with common disaster-related stress reactions in children. An overview of disaster research and examples of special concerns about children are given. In addition, an overview of the role of local, state, and federal governments, as well as other organizations, is provided.

Adolescent↗
PubMed2005

Stress and Well-Being in the Aftermath of the World Trade Center Attack: the Continuing Effects of a Communitywide Disaster.

In this study, we examine the relationship between exposure to the World Trade Center disaster (WTCD) and the well-being of adults living in New York City (NYC) at the time of the attacks by using a stress process model. One year after the attacks, we conducted a telephone survey of a cross-sectional random sample of city residents with an oversample of residents who had received mental health treatment since the attacks (N = 2,368). The survey gathered information about respondents' demographic characteristics, exposure to the WTCD, other stressful events, and social psychological resources. The dependent variable (health status) was measured by using the Short Form-12 (SF-12) mental health and physical health scales. Overall, the greater the exposure to the events surrounding the WTCD, the poorer the person's psychological well-being, even after controlling for demographic characteristics, other stressors, and social psychological resources. Exposure was only weakly related to physical well-being, once other factors were taken into account. The findings clearly show that individuals who experienced greater exposure to the WTCD have more psychological problems than those who had less exposure 1 year after the attacks. Exposure did not seem to have such severe consequences for physical well-being. Thus, our study supports the continuation of mental health services to survivors of a community disaster well beyond the first year post disaster.

Journal Article↗
PubMed2005

Disparities in mental health treatment following the World Trade Center Disaster: implications for mental health care and health services research.

To assess disparities in mental health treatment in New York City (NYC) after the World Trade Center Disaster (WTCD) reported previously related to care access, we conducted analyses among a cross-sectional survey of adults who had posttraumatic stress disorder (PTSD) or major depression (N = 473) one year after the event. The dependent variables examined were use of mental health services, in general, and use of mental health services related to the WTCD. Similar dependent variables were developed for medication usage. Although a number of bivariate results were statistically significant for postdisaster mental health visits, in a multivariate logistic regression model, only WTCD exposure remained significant. For service utilization related to the WTCD, the multivariate results indicated that African Americans were less likely to have had these visits compared to Whites, while those with a regular doctor, who had greater exposure to WTCD events, and those who had a perievent panic attack were more likely to have had such visits. In terms of medication use, multivariate results suggested that African Americans were less likely to use postdisaster medications, whereas persons 45 + years old and those with a regular doctor, were more likely to use them. For WTCD-related medication use, multivariate models indicated that African Americans were less likely to use medications, relative to Whites, while those between 45 and 64 years old, those with a regular doctor, those exposed to more WTCD events, and those who had a perievent panic attack, were more likely to have taken medications related to the disaster. The primary reason respondents gave for not seeking treatment (55% of subsample) was that they did not believe that they had a problem (73%). Other reasons were that they wanted to solve the problem on their own (5%), had problems accessing services (6%), had financial problems (4%), or had a fear of treatment (4%). Despite the availability of free mental health services offered in a supportive and potentially less stigmatizing environment post disaster, there still appeared to be barriers to receiving postdisaster services among those presumably in need of care.

Health Services Needs and Demand↗
PubMed1999

Disasters of endoscopic surgery and how to avoid them: error analysis.

For every innovation there are two sides to consider. For endoscopic surgery the positive side is more comfort for the patient, and the negative side is new complications, even disasters, such as injuries to organs (e.g., the bowel), vessels, and the common bile duct. These disasters are rare and seldom reported in the scientific world, as at conferences, at symposiums, and in publications. Today there are many methods for testing an innovation (controlled clinical trials, consensus conferences, audits, and confidential inquiries). Reporting "complications," however, does not help to avoid them. We need real methods for avoiding negative failures. The failure analysis is the method of choice in industry. If an airplane crashes, error analysis starts immediately. Humans make errors, and making errors means punishment. Failure analysis means rigorously and objectively investigating a clinical situation to find clinical relevant information for avoiding these negative events in the future. Error analysis has four important steps: (1) What was the clinical situation? (2) What has happened? (3) Most important: Why did it happen? (4) How do we avoid the negative event or disaster in the future. Error analysis has decisive advantages. It is easy to perform; it supplies clinically relevant information to help avoid it; and there is no need for money. It can be done everywhere; and the information is available in a short time. The other side of the coin is that error analysis is of course retrospective, it may not be objective, and most important it will probably have legal consequences. To be more effective in medicine and surgery we must handle our errors using a different approach. According to Sir Karl Popper: "The consituation is that we have to learn from our errors. To cover up failure is therefore the biggest intellectual sin.

Clinical Trials as Topic↗
PubMed2007

Chernobyl disaster sequelae in recent immigrants to the United States from the former Soviet Union (FSU).

Long-term mental health sequelae of the 1986 Chernobyl disaster have been documented for exposed populations who remained in the former Soviet Union (FSU) (Havenaar et al., 1997), and in a cohort migrated to Israel (Cwikel et al., 1997). This paper reports on Chernobyl disaster sequelae in émigrés (n = 321) to the United States. Demographic characteristics, migration factors, and self-reported physical health were considered. Both geographical proximity to the 1986 disaster, and perception of radiation risk stood as long-term indicators of current psychological distress. Proximity was related to poor self-perceived physical health, as well as current symptoms of depression (p<.05), anxiety (p<.01), and Chernobyl-related trauma distress (p<.001) on standardized measures. Environmental contamination as a reason for migration was also associated with greater mental health symptomatology.

Adult↗
PubMed1991

The lesson of the Chernobyl disaster.

On April 26, 1986 a major nuclear disaster took place at 1 h 24 min local time, destroying the fourth reactor of the Chernobyl plant. Five years later the consequences of the disaster are still not fully known. Nevertheless the long term future of nuclear energy in the world is uncertain. Questions need to be answered by observing hard facts if emotional attitudes are not to prevail over reality. The reactor and its core were destroyed by an explosion, causing two radioactive jet emissions of iodine 131, followed by caesium 137. Both elements are mainly incorporated in the body via food. The Chernobyl disaster was a consequence of inadequate safety regulations and human error. Enforcement of strict regulations are likely to be highly effective in preventing a further catastrophe. However, governments should consider another possibility. What would be the consequences for public health if a terroristic act deliberately destroyed a nuclear power station?

Accidents↗
PubMed2004

The relations of PTSD symptoms to alcohol use and coping drinking in volunteers who responded to the Swissair Flight 111 airline disaster.

We investigated the effects of the 1998 Swissair Flight 111 (SA 111) disaster on a variety of indices of alcohol use among volunteer responders. We retrospectively administered standardized questionnaires and a semi-structured interview to 13 volunteer disaster workers recruited from the community. According to the interview, 54% of the volunteers were exposed to human remains. According to Modified Post-Traumatic Stress Disorder (PTSD) Symptoms Scale responses, 46% met DSM-IV criteria for PTSD. Frequency and severity of PTSD symptoms, but not human remains exposure, per se, were positively correlated with coping-motivated drinking (but not social or mood enhancement drinking) and with alcohol use to forget. The re-experiencing and hyper-arousal PTSD symptom dimensions showed the strongest and most consistent correlations with the alcohol use indices. We discuss ways in which the information gleaned from this sample can be used to improve disaster response planning to minimize the probability of maladaptive coping drinking among volunteers.

Accidents, Aviation↗
PubMed2002

Ethical and methodological issues in academic mental health research in populations affected by disasters: the Oklahoma City experience relevant to September 11, 2001.

Empirical data from research studies are vital to guiding mental health interventions following disasters. However, few data are available for this purpose. Important advances in policy and procedures for the conduct of organized research emerged from the Oklahoma City bombing, yielding cooperative working relationships among researchers and culminating in the ethical attainment of informative research data. However, the academic community was again caught off guard after the September 11, 2001, terrorist attacks. Suggestions to surmount these obstacles include incorporating research infrastructures into disaster preparedness plans in advance; organizing the community of researchers; and working closely with major funding organizations. Methodological issues pertaining to measurement of psychopathology include the importance of obtaining diagnostic data; interpreting the meaning of symptoms in the absence of a psychiatric disorder; differentiating preexisting symptoms from those that emerged after the disaster, and optimal timing of postdisaster assessment.

Journal Article↗
PubMed1988

The phenomenology of posttraumatic stress disorders following a natural disaster.

This study examined the utility of the DSM-III diagnostic criteria for posttraumatic stress disorder (PTSD) in a high-risk group of 50 firefighters who had had an intense exposure to a natural disaster 8 months before being interviewed. Follow-up over the next 3 years allowed examination of the ability of these diagnostic criteria to predict a pattern of chronic posttraumatic morbidity. They predicted a pattern of chronic disorder, demonstrated by the finding that eight of the 15 subjects who had definite or borderline PTSD at 8 months remained symptomatic 3 years later. A disturbance of attention and concentration appeared to be the best predictor of chronic PTSD. The longitudinal course of posttraumatic morbidity in these 50 firefighters was compared with a matched group of 96 uninterviewed subjects 11 and 29 months after the disaster. Although the interview provoked an emotional catharsis in a number of firefighters, the long-term morbidity in the two groups was comparable. Fourteen subjects who did not have PTSD continued to experience intense imagery 8 months after the disaster. This observation raises questions about whether such thoughts and feelings have adequate specificity as diagnostic criteria for PTSD in a group that has recently been exposed to a traumatic event.

Anxiety Disorders↗
PubMed2006

Are male disaster workers with Vietnam military service at greater risk for ptsd than peers without combat history?

This study examined whether male disaster workers with Vietnam service histories were at risk for posttraumatic stress disorder when compared with colleagues following duties at Ground Zero. The study compared participants from ongoing psychiatric screening of disaster workers: those with Vietnam service (Vietnam veteran; N = 125), those without trauma history (no trauma; N = 116); and those with childhood physical abuse but no combat history (physical abuse; N = 57). ANOVA indicated the trauma groups differed significantly in clinician-rated posttraumatic stress disorder severity (p < 0.005). However, post hoc analyses revealed the Vietnam veteran group did not differ significantly from the no trauma group; both had significantly lower severity compared with the physical abuse group. It should be noted that veterans in this sample, unlike in many studies, were in the workforce. Research with different veteran groups is warranted to clarify further the relation of combat experience and symptoms in disaster workers.

Combat Disorders↗
PubMed2004

Health and environmental consequences of the world trade center disaster.

The attack on the World Trade Center (WTC) created an acute environmental disaster of enormous magnitude. This study characterizes the environmental exposures resulting from destruction of the WTC and assesses their effects on health. Methods include ambient air sampling; analyses of outdoor and indoor settled dust; high-altitude imaging and modeling of the atmospheric plume; inhalation studies of WTC dust in mice; and clinical examinations, community surveys, and prospective epidemiologic studies of exposed populations. WTC dust was found to consist predominantly (95%) of coarse particles and contained pulverized cement, glass fibers, asbestos, lead, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), and polychlorinated furans and dioxins. Airborne particulate levels were highest immediately after the attack and declined thereafter. Particulate levels decreased sharply with distance from the WTC. Dust pH was highly alkaline (pH 9.0-11.0). Mice exposed to WTC dust showed only moderate pulmonary inflammation but marked bronchial hyperreactivity. Evaluation of 10,116 firefighters showed exposure-related increases in cough and bronchial hyperreactivity. Evaluation of 183 cleanup workers showed new-onset cough (33%), wheeze (18%), and phlegm production (24%). Increased frequency of new-onset cough, wheeze, and shortness of breath were also observed in community residents. Follow-up of 182 pregnant women who were either inside or near the WTC on 11 September showed a 2-fold increase in small-for-gestational-age (SGA) infants. In summary, environmental exposures after the WTC disaster were associated with significant adverse effects on health. The high alkalinity of WTC dust produced bronchial hyperreactivity, persistent cough, and increased risk of asthma. Plausible causes of the observed increase in SGA infants include maternal exposures to PAH and particulates. Future risk of mesothelioma may be increased, particularly among workers and volunteers exposed occupationally to asbestos. Continuing follow-up of all exposed populations is required to document the long-term consequences of the disaster.

Adult↗
PubMed1997

Molecular changes in the offspring of liquidators who emigrated to Israel from the Chernobyl disaster area.

The primary goal of this research was to reveal de novo mutations in the liquidators (cleanup personnel) who emigrated to Israel from the Chernobyl disaster area. We used genome fingerprinting simple sequence repeat-anchored polymerase chain reaction (PCR) amplification and random amplified polymorphic DNA PCR (RAPD PCR). The methodology involved a combination of RAPD PCR, polyacrylamide gel electrophoresis, and silver staining, with arbitrarily primed PCR. Use of microsatellite markers appears to be the most promising technique for high sensitivity analysis. The analysis involved DNA isolated from the blood of experimental and control subjects (involving both offspring who were born before or after the disaster and their parents). Our studies have reproducibly detected new bands that appeared in the children born after the disaster. No such bands appeared in the children born in the same family before the accident or in the children of control families who had not been exposed to radiation.

Adult↗
PubMed2005

The Oklahoma City bombing study and methodological issues in longitudinal disaster mental health research.

Several methodological issues may affect the findings of studies of the mental health effects of disasters over time. These issues include analysis of the course of individual disorders over time that may be lost when they are presented embedded in general summary statistics, consideration of assessment of psychiatric disorders versus symptoms, adherence to established criteria in assigning psychiatric diagnoses, and orientation of mental health issues to the type of disaster exposure of the sample. This report will explore these methodological issues in a review of disaster literature and in data obtained from study of survivors of the Oklahoma City bombing. Clinical implications of the data obtained from the Oklahoma City bombing study of survivors of the direct bomb blast are presented in the context of these methodological concerns.

Chronic Disease↗