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The gross disparity between the routine attention paid to criminals and that paid to their victims led to the proposition that victims of major crime be treated as victims of disaster. The fresh appraisal might provide the impetus for appropriate services for them as a matter of social policy.
The healthcare landscape is littered with failed attempts by hospitals and physicians to manage insurance risk. This year's survey of managed-care plans shows 12 of 30 provider-owned HMOs lost money in 1997. And Modern Healthcare's news pages have chronicled recent losses at more than 20 provider-owned plans. With provider-sponsored organizations in the pipeline, the question is: Will they be a dream or are they a disaster in the making?
Effects, both specific and non-specific, were analysed of ionizing radiation in a comparative evaluation of medical sequels of the Chernobyl disaster and of the Semipalatinsk Range nuclear test. A hypothesis is advanced assuming that development of all major bodily morbid conditions is directly related to the dysfunction of certain complex of organs, the thyroid gland in the first place, the thymus gland known to be a central organ of systemic immunogenesis. A breach in the thymus link triggers harmful cascade reactions of neuroimmunoendocrinological regulation, appeared to be responsible for the pathogenesis of practically all pathologies disclosed.
This paper examines the cognitive and neuropsychological functioning of children who were in utero to age 15 months at the time of the Chornobyl disaster and were evacuated to Kyiv from the 30-kilometer zone surrounding the plant. Specifically, we compared 300 evacuee children at ages 10-12 with 300 non-evacuee Kyiv classmates on objective and subjective measures of attention, memory, and school performance. The evacuee children were not significantly different from their classmates on the objective measures (grades; Symbolic Relations subtest of the Detroit Test; forms 1 and 2 of the Visual Search and Attention Test; Benton Form A; Trails A; Underline the Words Test) or on most of the subjective measures (the attention subscale of the Child Behavior Checklist completed by mothers; the attention items of the Iowa Conners Teacher's Rating Scale; mother and child perceptions of school performance). The one exception was that 31.3% of evacuee mothers compared to 7.4% of classmate mothers indicated that their child had a memory problem. However, this subjective measure of memory problems was not significantly related to neuropsychological or school performance. No significant differences were found in comparisons of evacuees and classmates who were in utero at the time of the explosion, children from Pripyat vs. other villages in the 30-kilometer zone, and children manifesting greater generalized anxiety. For both groups, children with greater Chornobyl-focused anxiety performed significantly worse than children with less Chornobyl-focused anxiety on measures of attention. The results thus fail to confirm two previous reports that relatively more children from areas contaminated by radiation had cognitive deficits compared to controls. Possible reasons for the differences in findings among the studies are discussed.
It was attempted to assess the incidence of thyroid diseases in Polish children born between 1980-1986, who at the time of the Chernobyl nuclear disaster were 0-6 years old, or whose mothers were in the third trimester of pregnancy. 3071 children have been examined, 1772 girls and 1299 boys. The following were assessed in each child: the health status, the developmental level, the thyroid ultrasound examination, and the level of TSH, FT4, antithyroid antibodies ATM and ATGL in the blood serum. Disorders in thyroid morphology (abnormal echogenicity) have been found in 462 children (15%), almost twice as much in girls than in boys. Goiter has been recognized in 4.6% of all children, an abnormal echogenity in 5.4% and focal changes in 4.8%. 3.9% of children have been found to have a high level of ATM antibodies, and 8.7%--a high level of ATGL antibodies. Among 6 children, who had thyroidectomy, 2 children have been diagnosed to have ca papillary and 4 children--adenoma.
Relatively low morbidity of tuberculosis of the lung (2 per 1,500) and comparatively high morbidity of ling cancer were reported in 1995-1997 among the liquidators of Chernobyl nuclear power station disaster. Risk of malignant disease involved in X-ray check-ups of the chest has been identified. Low diagnostic value of photoroentgenography for lung tumors has been reported.
The possibility of a nuclear power plant disaster is small but not excluded: in its event, assistance to the affected population mainly depends on local practitioners. Already existing diseases have to be diagnosed and treated; moreover, these physicians are responsible for the early detection of those individuals exposed to radiation doses high enough to induce acute illness. Here we present the pathogenesis, clinical development and possible diagnostic and therapeutical problems related to acute radiation-induced diseases. The differentiation of persons according to therapy need and prognosis is done on the sole base of the clinical evidence and the peripheral blood count.
Comparative analysis of laparoscopic interventions was conducted as well as their results and the frequency of complications occurrence in patients, who were the Chernobyl power atomic station disaster survivors and those who were not exposed to radiation.
The control of food quality, using the analysis of essential and toxic element contents, assumes an urgent importance within the regions that suffered from the Chernobyl disaster. Instrumental neutron activation analysis was used to study contents of 17 chemical elements (calcium, chlorine, cobalt, chromium, cesium, iron, mercury, potassium, magnesium, manganese, sodium, rubidium, antimony, scandium, selenium, strontium, and zinc) in foods within the south and southwest territories of the Kaluga Region that was exposed to radionuclide contamination. The radionuclide contamination ranges up to 15 Ci/km2 there. Flesh and meat products, dairy products, bread, vegetables, legumes, roots, fruits, and mushrooms were analyzed. The concentration of essential and toxic elements in the different foods were in the normal ranges.
The Czernobyl disaster caused an extensive pollution in Europe due to the release into the environment thousands of tons of radioactive isotopes affecting the elevated cancer morbidity in the continent. The authors used the data set on radiation in Opole province, Poland, to model thyroid cancer incidence in the 1994-1998 quinquennium. An increase in thyroid cancer morbidity in females was observed within the 137 + 134Cs elevated concentration areas. The changes of the cancer incidence in males were found not significant for the distinguished radiation levels in the region. The statistical modeling was performed via the BUGS software.
Epidemiology, diagnostics and therapy of lung cancer in the aftermath of Chernobyl nuclear disaster are discussed on the basis of the data released by the Federal Expert Committee. Lung cancer appeared to be the main death-causing factor. The disease was far advanced (stage IIIb and IV) in 85% of cases. The effectiveness of diagnosis can be raised if such compulsory measures as annual bronchoscopic screenings and sputum counts are carried out. Atypical cell counts have to be run in the sputum samples from all the survivors who took part in the salvaging operations of 1986-1987 and are suffering acute and chronic respiratory diseases. Particular attention should be paid to those who were working under severe dust-pollution conditions in summer.
After the Twin Tower attack on 11 September 2001, much attention is being given to possible terrorist attacks on nuclear targets. However, most of this interest is in countries outside of the Netherlands. Iodine is a simple and effective means of preventing part of the radiation damage following a nuclear disaster. Non-radioactive (stable) iodine plays an important part in blocking the absorption of radioactive iodine by the thyroid gland, if it is administered as soon as possible after the nuclear accident has occurred. Prophylaxis with 100 mg non-radioactive iodide has a minimal toxic effect. Effective iodine prophylaxis is dependent on the government ensuring a well-regulated distribution. The government and hospitals should have thorough protocols that staff are sufficiently familiar with.
The authors record the contributions of dentistry to the identification of victims of one of the most significant disasters in aviation and U.S. military history--the December 1985 crash of a DC-8 charter airliner near Gander, Newfoundland (now known as Newfoundland and Labrador), Canada, which killed 248 Army personnel and 8 crewmembers. Most of the dental records of the military victims were destroyed in the crash, and, as a result, this loss hampered dental identification. Nevertheless, dental identification was the primary means of identification for many because a very high percentage of the bodies were severely burned and fragmented. Many phases of the U.S. identification efforts have been reported, but the dental-investigation aspects have been mentioned only in passing. Therefore, this article documents the dental team's organization, methodology, and a variety of remarkable problems that the team encountered.
Sept. 11, 2001, was a day of learning for the world. We learned oceans do not isolate the United States from acts of terrorism. Prior to hijackers flying commercial airplanes into the Pentagon and World Trade Center towers, forensic investigators had never dealt with a mass fatality incident of this magnitude on the mainland soil of the U.S. during non-wartime conditions. During the process of gearing up for the task of locating and identifying the victims, forensic dentists also learned a number of things. Established techniques for disaster management were tested to their extreme limits. Before and while this multi-functional effort was taking place, we familiarized ourselves with what techniques worked best under the immense pressure and tedious nature this job presented. Some of these accepted and now "tried and true" protocols are presented in this article.
OBJECTIVE: This study examined associations between alcohol use and PTSD symptoms among Red Cross workers who responded to the 9/11/2001 attacks. METHOD: Participants were 779 Red Cross paid and volunteer staff that responded during the first three months to the September 11, 2001, attacks against the United States. Women made up 64% of the sample. The American Red Cross provided a mailing list of all paid and volunteer staff (N = 6055 with valid addresses) that participated in the disaster relief operations in response to the September 11, 2001, attacks. Participants were randomly assigned to receive one of four questionnaire packets. The present study is based on the fourth group, which received the alcohol questionnaires. RESULTS: Overall, traumatic stress symptoms and alcohol use were low. Hyperarousal and intrusion symptoms on the Impact of Events Scale-Revised (IES-R) were associated with alcohol consumption, hazardous alcohol consumption, and change in alcohol consumption when controlling for age, gender, and worksite. Positive associations between Intrusion and Avoidance scores and hazardous consumption were stronger for younger participants. Individuals who reported increasing or decreasing alcohol use had higher IES-R scores than did those who maintained their normal rate of alcohol consumption, though effects were stronger for increasing alcohol use. Associations between alcohol variables and avoidance symptoms were minimal. CONCLUSIONS: The results suggest that there is a functional relation between posttraumatic stress symptoms and alcohol consumption. The study indicates that efforts to cope with traumatic stress symptoms may manifest in either increases or decreases in alcohol consumption.
On October 4, 1992 a cargo jet crashed in the Bijlmermeer district in Amsterdam, the Netherlands, killing 43 people and making hundreds homeless. Many years of confusion and prolonged media attention followed, including public debates and even a Parliamentary Inquiry as to the causes, exposure to various chemical, physical and biological risk factors, and related diseases. Two comprehensive large-scale medical investigations were carried out: a comparative epidemiological study analysing the long-term effects in involved and uninvolved care providers, and an individual medical examination of both residents and care providers with medical or psychological complaints. Later, an effects study was added analysing the effects of both medical investigations on the feelings of anxiety and the attribution of symptoms among the people involved. The epidemiological study revealed more physical and mental symptoms among the involved care providers. Blood, urine and saliva tests, however, revealed no differences. Although the studywas carried out with great care, the findings may have been biased to some extent by an evoked feeling of anxiety and by attention toward health problems brought about by the investigation itself. Another comment is the technical impossibility of stating, after so long a delay, that chemical exposure, e.g. to depleted uranium, could not have been a cause of adverse health effects. The effects study demonstrated that the medical investigations generally did not provide reassurance or decrease the anxiety about health problems. There was even a small increase in complaints. Residents with health problems that had been involved in the disaster still attribute their complaints to harmful chemical exposure.
This study examined treatment utilization in disaster workers deployed to the World Trade Center (WTC) during or after the terrorist attacks of September 11, 2001. Among 174 workers who accepted psychotherapy referrals following psychiatric screening for WTC-related symptoms, 74 (42.5%) attended at least one session, while 100 (57.5%) chose not to attend at all. The study assessed whether treatment utilization was associated with sociodemographic background, trauma history, psychiatric history, WTC attack exposure, diagnoses, or symptom severity. Analyses indicated that, of study variables, race/ethnicity and clinician-rated Post Traumatic Stress Disorder (PTSD) symptom severity distinguished workers who utilized treatment from those who did not. Implications for outreach and referral are discussed.
In the period of 2001-2004, frequency of cells bearing mutations at T-cell receptor (TCR) locus was assessed in 553 inhabitants of radiation polluted regions of the Russian Federation and 154 unexposed control persons. The inhabitants were divided into three groups according to age at the moment of the Chernobyl disaster and 137Cs pollution density: 1) in utero, 37-555 kBq/m2; 2) 0-14 years old, 20-555 kBq/m2; 3) 18 and more years old, highest 137Cs density (185 more than 555 kBq/m2). The most intense changes of the TCR-mutant cell frequency were observed in the group of persons exposed to ionizing radiation in utero. The mean frequency of the mutant cells was higher in the first group than in age-matched control group by about 1.5-fold: 4.0 x 10(-4) vs 2.7 x 10(-4) accordingly (p < 0.0001). Elevation in the mean TCR-mutant cell frequency was less expressed in group of inhabitants aged 0-14 years at the moment of irradiation start: 1.3-fold increase in comparison to age-matched control (3.8 x 10(-4) vs 2.9 x 10(-4), p = 0.0002). It was not found significant differences in mutant cell frequencies between control group and adults consisting in the third group (18 and more years old at the moment of the Chernobyl accident). The changes of the TCR-mutant cell frequency in persons exposed in pre- and postnatal periods differ not only quantitatively, but qualitatively. In the fist case all persons react to irradiation by increasing number of the TCR-mutant cells in some degree. In the second case - only a part of population. Proportion of reacting persons depends on age at the start of irradiation and, perhaps, on dose absorbed. The TCR-mutant frequency was significantly higher in persons with benign tumors of different localizations and nodules in thyroid gland than in persons without this pathology.