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PubMed1998

The impact of trauma and disaster on young children.

In the past few decades, the study of the impact of trauma and disaster on children has grown; however, information about the effects on very young children is still scarce in the literature. In some regards, the characteristics of stress in young children are similar to those of older children and adults; in other ways, their reactions are unique. These characteristics, as well as mediating factors and interventions with young children, are discussed. Suggestions for future research are offered.

Adult↗
PubMed1995

Mass disasters: rapid molecular screening of human remains by means of short tandem repeats typing.

Human remains identification represents a challenging situation and constitutes a difficult task associated with mass disasters. The only highly efficient means for individual and family group reconstruction is that based on DNA typing. On July 18, 1994 an explosion destroyed the A.M.I.A. (Argentine Israeli Association). Over 100 people died; however, the exact number of victims is still being investigated. Our Service received over 70 remains to be characterized by DNA typing in order to determine the number of victims and to try to reconstruct the family groups to which they belonged. DNA was extracted by a cetyltrimethylammonium bromide (CTAB) based protocol, a rapid molecular screening of all samples was carried out by multiplex STR amplifications including HUMTH01, HUMFABP, HUMHPRTB, HUMRENA4, HUMVWA, HUMFES/FPS and Y27H39LR. Samples with identical genotypes were HaeIII-digested. Southern blotted and probed with YNH-24 (D2S44). PH-30 (D4S139). LH-1 (D5S110) and MS-1 (D1S7) for variable number of tandem repeats (VNTR) evaluation. The minisatellite variant repeat (MVR) approach was used in those cases in which band or profile shift were detected in Southern blot assays. Kinship between victims and putative relatives was initially evaluated by comparison of short tandem repeat (STR) profiles and then confirmed by VNTR with the above probes. The high identification efficiency attained in this case is, in part, supported by a previous experience, the DNA-based molecular characterization of human remains caused by the explosion of the Israeli Embassy in Buenos Aires, March 1992.

Blotting, Southern↗
PubMed2005

Secondary traumatic stress among disaster mental health workers responding to the September 11 attacks.

Relationships between secondary traumatic stress (STS) symptoms and therapist characteristics and assignment variables were examined for 81 disaster mental health (DMH) workers who responded to the terrorist attacks of September 11, 2001. Higher STS was associated with therapist variables of heavier prior trauma caseload, less professional experience, youth, and therapist's discussion of his or her own trauma or trauma work in his or her own therapy. Therapist gender and personal trauma history were not significantly related to STS. Assignment variables associated with higher STS included longer length of assignment and more time spent with child clients, firefighters (who suffered great losses in the tragedy), or clients who discussed morbid material. Recommendations for practice include informing DMH recruits of therapist risk factors and assigning at-risk DMH workers to lower-risk assignments.

Adult↗
PubMed2005

Disaster-related posttraumatic stress symptoms and sustained attention: evaluation of depressive symptomatology and sleep disturbances as mediators.

Research about attentional functioning following trauma has almost exclusively been performed in patient populations with combat-related posttraumatic stress disorder (PTSD). In this study the relationship between sustained attention and PTSD symptoms was examined in a community sample of survivors of a major disaster using the Paced Auditory Serial Addition Task (PASAT) and the Self-Rating Scale for PTSD (SRS-PTSD) 2-3 years postdisaster. Analyses revealed low but significant partial correlations between PTSD symptoms and the least difficult subtests, ruling out the effects of age, education, depressive symptomatology, and sleep disturbances. These results demonstrate that PTSD symptoms link to attentional dysfunction 2-3 years postdisaster.

Adult↗
PubMed2006

Predictors of responses to psychotherapy referral of WTC utility disaster workers.

This study examined male utility disaster workers' responses to referral for trauma-specific psychotherapy. Among 328 workers offered referral for symptoms related to the World Trade Center (WTC) attacks during psychological screening, approximately 48% chose to accept, 28% chose to consider only, and 24% chose to decline. Analyses examined predisposing factors, i.e., age, race/ethnicity, marital status, education, previous mental health treatment, and previous disorder; as well as illness level; i.e., posttraumatic stress disorder (PTSD), depression, and general psychiatric distress; current treatment; and time of referral as predictors of referral response. PTSD (specifically reexperiencing and hyperarousal symptoms), depressive symptoms, and previous mental health treatment were positively associated with workers' accepting referral. Implications and limitations of these findings are discussed.

Humans↗
PubMed2006

Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to Ground Zero.

The present study compared rates of posttraumatic stress disorder (PTSD) in relief workers at the World Trade Center collapse from two sources: direct exposure to the disaster site and indirect exposure through survivor narratives. Standardized clinical interviews for PTSD were conducted with 109 relief workers 6-8 months after the September 11th terrorist attacks. Rates of acute PTSD from direct and indirect exposure to traumatic stressors were 6.4% and 4.6%, respectively. The findings suggest that indirect exposures can lead to PTSD even when Criterion A1 of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR; American Psychiatric Association, 2000, p. 463), i.e., "experienced by a family member or other close associate" is not met. Further research is necessary to define precisely the parameters of indirect traumatic exposure that may be linked to the development of PTSD.

Adult↗
PubMed2004

A prospective study of thyroid nodular disease in children and adolescents in western Poland from 1996 to 2000 and the incidence of thyroid carcinoma relative to iodine deficiency and the Chernobyl disaster.

BACKGROUND: In Poland, where soil is deficient in iodine, supplementation of iodine was introduced in 1935, discontinued in 1980, and then re-introduced in 1997. One of the effects of inadequate iodine intake, prior to 1997, was an increase in the prevalence of thyroid nodular disease (TND) in children. Chernobyl, located in the neighbouring country of Ukraine, suffered a catastrophic nuclear explosion in April 1986. PROCEDURE: A total of 411 children with TND (an incidence of 7.53/100,000) were diagnosed and registered in western Poland between 1996 and 2000 and further evaluated as a population-based study. RESULTS: Based on the patient's clinical status, ultrasound examination, scintiscan, laboratory tests, cytology and the family history, many of the patients qualified for surgery and, as a result, histopathologic data were obtained from 155 of the 411 patients operated on to date (37.7% of all TND). Thyroid carcinoma was detected in 37 of the operated children, i.e. 23.9% or 9.0% of all children with TND with a median incidence of 0.68/100,000. Papillary carcinoma was the predominant histologic type (26-70.3%) compared to follicular carcinoma (10-27.0%) and medullary carcinoma (1-2.7%). Retrospective analysis of the figures for the 23 years (1972-1995) showed that in that period a total of 23 thyroid carcinomas were registered. However, only 12 of these were detected in the 20-year period between 1972 and 1991, none in the years 1992-1993 and, significantly, 11 from 1994 to 1995. CONCLUSIONS: Thyroid carcinoma appears to be an ongoing and increasing problem in the children and adolescents of our region, and it is developing more intensively when compared, both to other parts of Poland and to previous statistics (2000 vs. 1985; P<0.002). Iodine deficiency and radiation resulting from the Chernobyl disaster might be important risk factors in the development of thyroid carcinoma in the young population analysed in our region in the period since 1994. The high percentage of follicular carcinoma and follicular adenoma with an undetermined prognosis (19 out of 46) indicates that the long-term iodine deficiency in our region may be more significant in the pathogenesis of malignant transformation than has previously been postulated.

Adenocarcinoma, Follicular↗
PubMed1995

Odontological identification of the victims of flight AI. IT 5148 air disaster Lyon-Strasbourg 20.01.1992.

The authors report on the contribution of odontological identification of the flight AI. IT 5148 air disaster victims, which occurred on 20th January 1992. The identification procedure was difficult due to large numbers of bodies and mutilations and required the involvement of multidisciplinary teams composed of odontologists, forensic pathologists, radiologists and biologists. The authors set up a simple, discriminant classification which was easy to handle by a multidisciplinary team. Four groups were defined according to the matching characteristics between ante and post mortem data. Perfect matching characteristics between ante and post mortem data were achieved in only 44 cases (Group A). Partial matching characteristics between ante and post mortem data were achieved in 12 cases (Group B). In 29 cases, the insufficiency or absence of odontological data (Group C and D) did not enable the victim to be identified. The results of the investigations showed that the dental examination alone enabled 17 victims to be identified and by including a morphological examination the figure reached 33. By the end of the investigations, 85 of the 87 victims were positively identified. Odontological identification is an essential, accurate and rapid method with allows a body to be identified from its dental characteristics. This anthropometrical method of identification is included with the descriptive and the biological methods. The authors present their experience in performing a formal identification of 44 victims in less than 15 days.

Accidents, Aviation↗
PubMed1992

Accident analysis of large-scale technological disasters applied to an anaesthetic complication.

The occurrence of serious accidents in complex industrial systems such as at Three Mile Island and Bhopal has prompted development of new models of causation and investigation of disasters. These analytical models have potential relevance in anaesthesia. We therefore applied one of the previously described systems to the investigation of an anaesthetic accident. The model chosen describes two kinds of failures, both of which must be sought. The first group, active failures, consists of mistakes made by practitioners in the provision of care. The second group, latent failures, represents flaws in the administrative and productive system. The model emphasizes the search for latent failures and shows that prevention of active failures alone is insufficient to avoid further accidents if latent failures persist unchanged. These key features and the utility of this model are illustrated by application to a case of aspiration of gastric contents. While four active failures were recognized, an equal number of latent failures also became apparent. The identification of both types of failures permitted the formulation of recommendations to avoid further occurrences. Thus this model of accident causation can provide a useful mechanism to investigate and possibly prevent anaesthetic accidents.

Accidents↗
PubMed2002

Penetrating axillary trauma in a survivor of the World Trade Center disaster.

Penetrating axillary trauma is classically associated with gunshot wounds or stab wounds, and it is a cause for concern because of the high risk of vascular injury. We report a case of penetrating axillary trauma to a victim of the World Trade Center disaster. In this case report, we discuss the CT and angiographic findings of both blunt and penetrating axillary injury, and present a diagnostic algorithm.

Journal Article↗
PubMed2002

PACS disaster recovery procedures--evaluation in a clinical environment.

Failures of picture archiving communication systems are not a common event and are even less commonly documented. Planning in advance for such an event can have an enormous effect on the overall impact on clinical operations. This report provides insight into the planning required for disaster recovery and how the impact on clinical operations can be minimized if this planning takes place in advance.

Equipment Failure↗
PubMed1994

Britain's regional mortality: a legacy from disaster in the Celtic periphery?

Are the differences in Britain's contemporary regional mortality partly a legacy from the disasters which befell nineteenth-century peasant populations? The rise of Britain's industrial cities was linked with recruitment from populous but vulnerable peasant economies in the (largely Celtic) north and west of the British Isles, and in Glasgow this was linked with exceptionally high mortality. Three ways of accounting for the first of these linkages, between industrial cities and peasant migration, are considered, drawing on analyses of rural Malthusian pressures, of the industrial labour market, and of cultural divisions on the Celtic periphery. These accounts all predict a particular urban and regional geography of mortality which is confirmed in nineteenth-century data. Different accounts also suggest somewhat different durations for this pattern, and preliminary exploration of readily available data on secular change in relevant areas up to 1971 show that Malthusian explanations are unlikely to account for much of the effect, while the economic and cultural structures described are worth exploring further. Alternative explanations of regional or ethnic mortality cannot all be ruled out at this stage but discussions of contemporary regional mortality differences need to take into account the history of the peasant populations in the former British Isles as a whole.

Adolescent↗
PubMed1988

Flame burns disasters from kerosene appliance explosions in Lagos, Nigeria.

A study of 55 cases of burns admitted to the Lagos University Teaching Hospital in the month of March 1984 revealed that 96 per cent were caused by flame burns due to explosions that occurred during the use of kerosene appliances for cooking and lighting. Thirty-four (62 per cent) were children, while 21 (38 per cent) were adults. In each of seven families, two or more people were affected. The overall mortality was 44 per cent, of which the larger contribution of 30 per cent was in children. By comparison, in the two preceding months there was a total of 17 and 20 burns admissions respectively. The mortality rate was 16 per cent while in March 1983 there was no death among the six paediatric admissions. Investigations showed that the explosions occurred due to petrol contamination of the kerosene before delivery to the domestic users. Appropriate precautions by kerosene suppliers and users, and health education can help prevent similar disasters in the future.

Accidents, Home↗
PubMed1990

Bashkirian train-gas pipeline disaster: the American military response.

The United States Army Institute of Surgical Research was asked to provide burn care assistance in June 1989 following the explosion of leaking methane/propane gas in the Central Soviet Union, which destroyed two passenger trains and injured 800 passengers. A 17-member burn team flew from San Antonio, Texas, to Ufa, USSR and assisted in the management of 150 burn patients in a general medical-surgical hospital. Early problems included heavily colonized burn wounds, with a microbial flora that demonstrated broad antibiotic resistance. As wound complications were controlled, 28 operative procedures were performed to excise and graft the burn wounds. The recommendations for burn disaster management, based on our experience in Ufa, should be of assistance to other groups that may be asked to provide similar assistance in the future.

Bashkiria↗
PubMed1990

Burned children from the Bashkir train-gas pipeline disaster. I. Acute management at Children's Hospital 9, Moscow.

Following the Bashkir train-gas pipeline disaster of 4 June 1989, US surgeons and nurses had an opportunity to join their Soviet counterparts at the Burn Unit at Children's Hospital 9 in Moscow in caring for the children. As a result of the joint effort, both the Soviet and US professionals came to understand the strengths and limits of each system of burn care. Joining strengths through mutual willingness to listen and cooperate left an elevated level of burn care at Children's Hospital 9.

Adolescent↗
PubMed1995

Identification of bodies from the scene of a mass disaster using DNA amplification of short tandem repeat (STR) loci.

The accompanying paper in this issue describes work conducted during a collaborative effort to identify the victims of a mass disaster that occurred on the 19th of April 1993 near Waco, Texas. The DNA identification programme was also used partly as an exercise to further investigate the robustness and reliability of a recently developed STR quadruplex. The preceding paper provides details of the loci used and also deals with efforts to assess the applicability of STR profiling and its suitability for forensic investigations of this nature. In this paper, we present the results obtained from 61 Waco bodies. Using reference blood samples and family trees 26 positive identifications were made using a 'paternity style' analytical approach. Worked examples, representing a range of casework situations, are used to illustrate the kind of approach taken in interpretation of the data and highlight factors which affected its success. Additionally, we report on the successful application of a PCR-based gender test to 24 of the Waco bodies.

Child↗
PubMed1992

Unrecognized constipation in patients with advanced cancer: a recipe for therapeutic disaster.

Morphine-induced constipation can lead to therapeutic disasters by several mechanisms. It can be readily prevented by administration of appropriate laxatives, but the importance of this simple intervention is often overlooked. Problems resulting from uncontrolled constipation include not only fecal impaction and spurious diarrhea, but also pseudoobstruction of bowel causing abdominal pain, nausea and vomiting, and serious interference with drug administration and absorption. Cancer pain may also be exacerbated. All of these contribute unnecessarily to morbidity and costs of health care. A case that exemplifies many of these problems is presented and discussed.

Aged↗