The course of post-disaster health problems of victims with pre-disaster psychological problems as presented in general practice

Clinical value of the emergency department in screening and diagnosis of COVID-19 in China

Since the global outbreak of severe acute respiratory syndrome (SARS) in 2003, China has gradually built a robust prevention and control system for sudden infectious diseases. All large hospitals have a fever clinic that isolates patients with all kinds of acute communicable diseases as the first line of medical defense. The emergency department, as the second line of medical defense in hospitals, is constantly shouldering the heavy responsibility of screening communicable diseases while also treating all kinds of other non-communicable acute and critical diseases (Zhang et al., 2012; Zhu et al., 2015; Wang et al., 2017; Feng et al., 2018; Lu, 2018; Xu and Lu, 2019). An outbreak of pneumonia of unknown etiology that began in Wuhan city (China) has spread rapidly in China since December 2019 (Huang et al., 2020; WHO, 2020; Zhu et al., 2020). In February 2020, the National Health Commission of China named the disease a novel coronavirus pneumonia (NCP); then, it was formally named the coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) on Feb. 11, 2020. The Coronavirus Study Group of the International Committee on Taxonomy of Viruses designated this causative virus as SARS coronavirus 2 (SARS-CoV-2). SARS-CoV-2 belongs to the β coronavirus genus, and its pathogenic mechanism has not been clarified, which requires further study. To better understand the clinical characteristics of COVID-19 and more effectively prevent and control this disease, we retrospectively analyzed four representative cases of COVID-19 that had recently been screened and diagnosed in our emergency department.

Psychological health and resilience: the impact of significant earthquake events on tertiary level professional students. A cross-sectional study

BACKGROUND

The effect of natural disasters internationally is linked to intensity and duration and the impact of these events for tertiary level professional students is not clearly understood. Following a 7.1 magnitude earthquake in New Zealand in 2010 (with aftershocks lasting 27 months) a number of tertiary nursing students experienced significant disruption to their studies.

AIM

To compare the psychological health, resilience and the impact on learning for three cohorts of students engaged in tertiary nursing education during this time.

METHOD

A cross-sectional survey design and convenience sampling was used for three cohorts of learners. An online survey was completed (n = 290) and included: Depression Anxiety and Stress Scale; PTSD Checklist; Work and Social Adjustment Scale; Connor-Davidson Resilience Scale.

RESULTS

Statistically significant differences were found across the psychometric scales with regard to relationship status. Whilst an increase in self-reported physical and mental health issues prior to and following the earthquakes were noted, mitigating factors were also identified.

CONCLUSIONS

In order to support psychological health amongst nursing students, tertiary education systems need to plan for sustainable learning. The importance of facilitating future orientation within organisations is necessary to develop resilience amongst staff and students, which, in turn, will enable on-going education during significant disaster events.

Opportunities for general practitioners to enhance disaster preparedness among vulnerable patients

Disasters occur frequently in Australia and will become more unpredictable and severe due to climate change. Some members of the Australian population, such as the elderly, the chronically ill and the socially isolated, are less likely to be prepared and more likely to be adversely affected by disasters. Although general practitioners (GPs) view the delivery of preventive health care as a priority, few preventive services focus on patients' resilience and ability to cope with unexpected stressors. This paper focuses on the individuals most vulnerable to disasters and the opportunities for GPs to facilitate the enhancement of disaster preparedness among these groups. General practitioners are ideally placed to identify vulnerable patients and refer them to services that may assist them in enhancing their disaster resilience. To reduce the burden on individual GPs, adjustments can be made to practice software systems that will use patient records to identify vulnerable individuals.

The impact of the San Diego wildfires on a general mental health population residing in evacuation areas

San Diego County Mental Health system clients completed a questionnaire after the October 2007 wildfires. As compared to those not in an evacuation area, those residing in an evacuation area reported significantly more impact of the fires. Clients who evacuated were most affected, followed by those in an evacuation area who did not evacuate. Evacuation strongly impacted client-reported emotional effects of the fire, confusion about whether to evacuate, and ability to obtain medications. Gender and clinical diagnosis interacted with evacuation status for some fire impact variables. Loss of control and disruption of routine are discussed as possibly related factors.

Health problems among low-income parents in the aftermath of Hurricane Katrina

OBJECTIVE

Although the mental health consequences of disasters have been well documented, relatively less is known about their effects on survivors' physical health. Disaster studies have also generally lacked predisaster data, limiting researchers' ability to determine whether postdisaster physical health problems were influenced by disaster exposure, or whether they would have emerged even if the disaster had not occurred. The current study aimed to fill this gap.

METHOD

Participants were low-income, primarily non-Hispanic Black mothers (N = 334) who survived Hurricane Katrina and completed 4 survey assessments, 2 predisaster and 2 postdisaster. In each assessment, participants reported on whether they had experienced 3 common health problems (frequent headaches or migraines, back problems, and digestive problems) and completed 2 mental health measure (the K6 scale, the Perceived Stress Scale).

RESULTS

The descriptive results suggested that the hurricane led to at least short-term increases in the 3 health outcomes. Fixed effects modeling was conducted to explore how changes in various predictor variables related to changes in each health condition over the study. Bereavement and increases in psychological distress were significant predictors of increases in health problems.

CONCLUSIONS

Based on these results, further research that explores the processes through which disasters lead to both physical and mental health problems, postdisaster screenings for common health conditions and psychological distress, and interventions that boost survivors' stress management skills are suggested.

Healthcare utilization of bereaved family members following the 1999 Chi-chi earthquake: evidence from administrative data

OBJECTIVE

Strong earthquakes not only cause death and property damage, but also have continuous repercussions on the survivors' health. This study investigates the impact of the 1999 Chi-chi earthquake to understand how an earthquake disaster affects healthcare utilization differently between individuals who lost co-resident family members (victims) and those who did not (non-victims).

METHODS

We utilize the household registration records from the Ministry of the Interior as well as claim data from the Bureau of National Health Insurance in Taiwan from 1998 to 2000. Such datasets enable us to identify the relationship of the survivors with the dead and contain the residents' detailed healthcare utilization records. The difference-in-differences method is used to explore the changes in healthcare utilization.

RESULTS

Our results indicate that the victims had a higher probability of using inpatient care than the non-victims; and the victims who lost their parents tended to use more inpatient services than the other victims. As for the changes in outpatient utilization, the difference between victims and non-victims, and among victims who lost different family members appears to be statistically insignificant.

CONCLUSION

Compared to non-victims, victims were more likely to use inpatient care after the Earthquake, particularly the victims who lost parents. However, the impacts of the Earthquake on outpatient care are statistically indifferent between victims and non-victims. One possible explanation is that the abundance of primary care and social support services provided by emergency medical assistance teams and/or non-governmental organizations after the Earthquake had substituted for regular outpatient utilization.

Variations in Disaster Preparedness by Mental Health, Perceived General Health, and Disability Status

Objectives:Chronic medical and mental illness and disability increase vulnerability to disasters. National efforts have focused on preparing people with disabilities, and studies find them to be increasingly prepared, but less is known about people with chronic mental and medical illnesses. We examined the relation between health status (mental health, perceived general health, and disability) and disaster preparedness (home disaster supplies and family communication plan).

Methods:A random-digit-dial telephone survey of the Los Angeles County population was conducted October 2004 to January 2005 in 6 languages. Separate multivariate regressions modeled determinants of disaster preparedness, adjusting for sociodemographic covariates then sociodemographic variables and health status variables.

Results:Only 40.7% of people who rated their health as fair/poor have disaster supplies compared with 53.1% of those who rate their health as excellent (P< 0.001). Only 34.8% of people who rated their health as fair/poor have an emergency plan compared with 44.8% of those who rate their health as excellent (P< 0.01). Only 29.5% of people who have a serious mental illness have disaster supplies compared with 49.2% of those who do not have a serious mental illness (P< 0.001). People with fair/poor health remained less likely to have disaster supplies (adjusted odds ratio [AOR] 0.69, 95% confidence interval [CI] 0.50–0.96) and less likely to have an emergency plan (AOR 0.68, 95% CI 0.51–0.92) compared with those who rate their health as excellent, after adjusting for the sociodemographic covariates. People with serious mental illness remained less likely to have disaster supplies after adjusting for the sociodemographic covariates (AOR 0.67, 95% CI 0.48–0.93). Disability status was not associated with lower rates of disaster supplies or emergency communication plans in bivariate or multivariate analyses. Finally, adjusting for the sociodemographic and other health variables, people with fair/poor health remained less likely to have an emergency plan (AOR 0.66, 95% CI 0.48–0.92) and people with serious mental illness remained less likely to have disaster supplies (AOR 0.67, 95% CI 0.47–0.95).

Conclusions:People who report fair/poor general health and probable serious mental illness are less likely to report household disaster preparedness and an emergency communication plan. Our results could add to our understanding of why people with preexisting health problems suffer disproportionately from disasters. Public health may consider collaborating with community partners and health services providers to improve preparedness among people with chronic illness and people who are mentally ill. (Disaster Med Public Health Preparedness. 2009;3:33–41)

Epidemiological surveillance linked to an outreach psychological support program after the Xynthia storm in Charente-Maritime, France, 2010

INTRODUCTION

Following the Xynthia storm of February 2010 in France, an outreach program was initiated by the regional health authorities during the post-emergency phase to improve access to mental health care for the population exposed to the floods. The program was designed to complement routine health and social care services. It relied on a special telephone service and outreach consultations located in the town halls of the five most affected cities. The objective of this outreach service was to provide initial psychological counseling free of charge and without appointment. Another objective was to refer persons for appropriate treatment and follow-up by routine health care services. A surveillance program was developed to monitor the use of mental health services by first-time users, describe outreach service users with psychological manifestations, and provide timely information to decision makers.

METHODS

Health providers working in affected towns were asked to complete an individual record sheet for each person who displayed psychological manifestations directly or indirectly linked with the storm on their first visit, and to send it to the regional health office. Participation was voluntary. Data analysis was performed monthly during the six-month surveillance period.

RESULTS

Only mental health providers participated in the surveillance. A total of 227 individual files were sent from April 7 through September 19, 2010. New cases were mainly female adults, and one fifth had a past history of psychiatric illness. Depressive signs and anxiety were the most commonly reported symptoms, followed by signs of post-traumatic stress disorder. A total of five feedback reports were produced for surveillance participants (informants) and authorities.

CONCLUSION

With initiation in the post-emergency phase of a disaster and timely regular feedback, the surveillance program enabled the authors to describe the occurrence of psychological distress, monitor mental health service use by first-time users, and provide guidance to health authorities. This research showed the advantages of integrating epidemiology in the development of strategy for mental health and psychosocial support in the aftermath of natural catastrophes.

A Phenomenological Analysis of Disaster-Related Experiences in Fire and Emergency Medical Services Personnel

This article explores the experiences of fire and Emergency Medical Services (EMS) personnel during and immediately after a technological event using a phenomenological approach. Personnel engaged in the rescue operations during and immediately after the Ghislenghien gas explosion reflected upon their experiences in their responses to a specially designed, self-reporting questionnaire that included open-ended questions. Firefighters reported more perceived threat and direct exposure to death than did EMS personnel. Qualitative analysis indicates that the central characteristics of this potentially traumatizing event were the suddenness and massiveness of the impact, and the fact that it involved young victims and/or multiple deaths. With regard to emotions, powerlessness, horror, fear, a sense of apocalypse, and grief were experienced by both firefighters and EMS personnel. Firefighters noted that the death of colleagues, the involvement of friends and family, the massive impact, and exposure to the burned victims were most shocking. Emergency Medical Services personnel and in-hospital staff reported the impact, the confrontation with death, the involvement of friends and family, and the pain, suffering, and screaming of burned victims as the most shocking aspects of this event. Qualitative differences in the lived experiences of firefighters, EMS personnel, and in-hospital staff might be explained by differences in life threat, contact with death, and various degrees of training.

De Soir E, Knarren M, Zech E, Mylle J, Kleber R, Van der Hart O. A phenomenological analysis of disaster-related experiences in fire and Emergency Medical Services personnel. Prehosp Disaster Med. 2012;27(2):1-8.

Symptom attribution and presentation in general practice after an extreme life event

BACKGROUND

A serious life event is likely to shape attributions relating to symptoms experienced afterwards. While they may play an important role in prognosis and seeking care, such perceptions have hardly been studied among survivors of a disaster.

OBJECTIVE

To investigate the association between self-reported health problems that have been attributed to an extreme life event and the symptoms presented to GPs.

METHODS

A two-wave longitudinal survey (2-3 weeks and 18 months) among survivors of a fireworks disaster was combined with a continuous morbidity surveillance in general practice. Symptoms attributed to the disaster reported in an open-ended question in the two waves were analysed using descriptive statistics. Differences in presented symptoms over time were analysed using logistic multilevel analysis.

RESULTS

More than half of the respondents reported health problems, which were, in their opinion, related to the disaster. Psychological problems were most frequently reported in association with the disaster, and in contrast to physical attributed symptoms, presentation of these problems in general practice decreased over time. In the total sample, musculoskeletal symptoms were less frequently presented in the longer term. Survivors who attributed symptoms to the disaster at both waves or after 18 months only most often presented such symptoms to the GP.

CONCLUSION

Survivors attributed psychological problems and physical symptoms to the disaster at short-term and midterm post-disaster. Most of these survivors presented such symptoms to the GP. Attribution of symptoms to an extreme life event such as a disaster may therefore require special attention from the GP.

Medium-term post-Katrina health sequelae among New Orleans residents: predictors of poor mental and physical health

AIMS

To assess the medium-term post-Katrina mental and physical health of New Orleans residents and to determine demographic, social and environmental factors that predict poor mental and physical health.

BACKGROUND

Major disasters can have a negative impact on the health of survivors for prolonged periods. Although the initial and short-term impacts of Hurricane Katrina have been well described, the medium-term impacts have not been studied as thoroughly.

DESIGN

Cross-sectional survey.

METHODS

A convenience sample (n = 222) of residents in Gentilly area of New Orleans completed questionnaires between 16 and 18 December 2006. Multivariate logistic regression and multiple regression models were employed to determine predictors of poor mental and physical health.

RESULTS

Poor mental health was reported by 52% of the respondents. Pre-Katrina depression [odds ratio (OR) = 19.1], post-Katrina depression (OR = 7.2), poor physical health (OR = 5.6), feeling unsafe from crime (OR = 4.3) and female gender (OR = 2.6) were significant predictor variables of poor mental health. Twenty-four percent of the variance in number of days of poor mental health was explained by the independent variables (R(2) = 0.24; p < 0.001). Poor physical health was reported by 48% of the respondents. Poor mental health (OR = 3.9), lack of money to buy food (OR = 2.7) and pre-Katrina arthritis (OR = 2.6) were significant predictor variables of poor physical health. Twenty-three percent of the variance in number of days of poor physical health was explained by the independent variables (R(2) = 0.23; p < 0.001).

CONCLUSIONS

Approximately half of the New Orleans residents continue to experience poor mental and physical health 15 months after Katrina. The results support focusing post-Katrina efforts to protect residents from crime, improve mental health services to the depressed and improve food supply to the poor.

RELEVANCE TO CLINICAL PRACTICE

Identifying predictors of poor mental and physical health may help clinicians and policy makers to focus their efforts in ameliorating the post-disaster health sequelae.

Changes in the pattern of service utilisation and health problems of women, men and various age groups following a destructive disaster: a matched cohort study with a pre-disaster assessment

Objectives

Female gender and young age are known risk factors for psychological morbidity after a disaster, but this conclusion is based on studies without a pre-disaster assessment. The aim of this study in family practice was to investigate if these supposed risk factors would still occur in a study design with a pre-disaster measurement.

Methods

A matched cohort study with pre-disaster (one year) and post-disaster (five years) data. Community controls (N = 3164) were matched with affected residents (N = 3164) on gender, age and socioeconomic status. Main outcome measures were utilization rates measured by family practice attendances and psychological, musculoskeletal and digestive health problems as registered by the family practitioner using the International Classification of Primary Care (ICPC).

Results

Affected residents of female and male gender and in five age groups all showed increases in utilization rates in the first post-disaster year and in psychological problems when compared to their pre-disaster baseline levels. The increases showed no statistically significant changes, however, between women and men and between all age groups.

Conclusion

Gender and age did not appear to be disaster-related risk factors in this study in family practice with a pre-disaster base line assessment, a comparison group and using existing registries. Family practitioners should not focus specifically on these risk groups.

The SMILE study: a study of medical information and lifestyles in Eindhoven, the rationale and contents of a large prospective dynamic cohort study

Background

Health problems, health behavior, and the consequences of bad health are often intertwined. There is a growing need among physicians, researchers and policy makers to obtain a comprehensive insight into the mutual influences of different health related, institutional and environmental concepts and their collective developmental processes over time.

Methods/Design

SMILE is a large prospective cohort study, focusing on a broad range of aspects of disease, health and lifestyles of people living in Eindhoven, the Netherlands. This study is unique in its kind, because two data collection strategies are combined: first data on morbidity, mortality, medication prescriptions, and use of care facilities are continuously registered using electronic medical records in nine primary health care centers. Data are extracted regularly on an anonymous basis. Secondly, information about lifestyles and the determinants of (ill) health, sociodemographic, psychological and sociological characteristics and consequences of chronic disease are gathered on a regular basis by means of extensive patient questionnaires. The target population consisted of over 30,000 patients aged 12 years and older enrolled in the participating primary health care centers.

Discussion

Despite our relatively low response rates, we trust that, because of the longitudinal character of the study and the high absolute number of participants, our database contains a valuable set of information.

SMILE is a longitudinal cohort with a long follow-up period (15 years). The long follow-up and the unique combination of the two data collection strategies will enable us to disentangle causal relationships. Furthermore, patient-reported characteristics can be related to self-reported health, as well as to more validated physician registered morbidity. Finally, this population can be used as a sampling frame for intervention studies. Sampling can either be based on the presence of certain diseases, or on specific lifestyles or other patient characteristics.