Impact of a technological disaster on young children: a five-year postdisaster multiinformant study.

Children exposed to a technological disaster during an understudied part of the lifespan, preschool age and early middle childhood, were assessed in a 5-year follow-up regarding mental health problems, anxiety disorder symptoms, depressive symptoms, physical symptoms, and posttraumatic stress symptoms. Exposed children and their parents (n = 264) reported significantly more problems than controls (n = 515). The differences were greater for conduct problems (including hyperactivity) and physical symptoms, than for anxiety and depression. The long-term effects of a technological disaster on children of pre-school age at exposure appear to differ from those in children, who were victimized at a later age. This may reflect interference with completion of specific developmental tasks.

The influence of news events on health after disaster: a longitudinal study in general practice.

This study investigates the influence of local and international news events on utilization of health services resources and health complaints as presented by victims of a fireworks depot disaster. It was hypothesized that victims (N = 2,854) will show more utilization and health complaints to their general practitioner (GP) in the week after 11 local news reports of events relating to the specific index trauma and 6 unrelated disasters reported in international print news, than the week before. Health data of victims and matched controls were extracted from electronic medical records, covering 4-years postdisaster. Especially local news events concerning the cause of the disaster were associated in both victims and controls with an increase of GP utilization and health complaints, including medically unexplained physical symptoms, chronic diseases, and psychological problems. No difference between victims and controls were found.

Emotional reasoning and parent-based reasoning in non-clinical children, and their prospective relationships with anxiety symptoms.

Emotional and parent-based reasoning refer to the tendency to rely on personal or parental anxiety response information rather than on objective danger information when estimating the dangerousness of a situation. This study investigated the prospective relationships of emotional and parent-based reasoning with anxiety symptoms in a sample of non-clinical children aged 8-14 years (n = 122). Children completed the anxiety subscales of the Revised Children's Anxiety and Depression Scale (Muris et al. Clin Psychol Psychother 9:430-442, 2002) and provided danger ratings of scenarios that systematically combined objective danger and objective safety information with anxiety-response and positive-response information. These measurements were repeated 10 months later (range 8-11 months). Emotional and parent-based reasoning effects emerged on both occasions. In addition, both effects were modestly stable, but only in case of objective safety. Evidence was found that initial anxiety levels were positively related to emotional reasoning 10 months later. In addition, initial levels of emotional reasoning were positively related to anxiety at a later time, but only when age was taken into account. That is, this relationship changed with increasing age from positive to negative. No significant prospective relationships emerged between anxiety and parent-based reasoning. As yet the clinical implications of these findings are limited, although preliminary evidence indicates that interpretation bias can be modified to decrease anxiety.

The influence of a disaster on the health of rescue workers: a longitudinal study.

BACKGROUND: Rescue workers strive, after disasters, to help victims and restrict damage, often in dangerous circumstances. We examined the effect of a disaster on the physical and psychological health of rescue workers (firefighters, police officers and medical emergency services personnel) who provided assistance after the explosion of a fireworks depot in the Netherlands in May 2000. METHODS: We carried out a 4-year longitudinal study of 1403 rescue workers employed in or near the affected neighbourhood (the study group) and a control group of 1650 uninvolved rescue workers (from another city of similar size and urbanization). Health outcomes were measured as prevalence, incidence (both measured as the percent of workers who took sick leave), frequency of the absences and number of sick days (both per 100 workers), and duration (mean length of sickness absences, in days). RESULTS: Sick leave among the study workers increased substantially during the 18 months after the explosion. For example, the prevalence of absences attributed to psychological problems increased from 2.5% of workers during the 6 months before the disaster to 4.6% during the first 6-month period after the explosion and 5.1% during the second. That for respiratory problems rose from 5.4% predisaster to 14.9% 6-12 months afterward. In comparison with controls, immediate increases occurred in musculoskeletal, psychological, respiratory and nonspecific ill health (e.g., malaise, fatigue) during the first year postdisaster. Rates of sick leave for musculoskeletal and respiratory reasons remained elevated until 3 years postdisaster, whereas leave for psychological problems and other ill health had returned to predisaster levels by then. Neurological problems increased after a 1-year delay. No significant increase in gastrointestinal problems was observed among the study workers, in comparison with controls. INTERPRETATION: Many health problems arise immediately after a disaster and may persist for years. Health care workers should realize, however, that some disaster-related effects may not emerge until a year or more after the event.

Perceived genetic knowledge, attitudes towards genetic testing, and the relationship between these among patients with a chronic disease.

OBJECTIVE: Genetics increasingly permeate everyday medicine. When patients want to make informed decisions about genetic testing, they require genetic knowledge. This study examined the genetic knowledge and attitudes of patients with chronic diseases, and the relationship between both. In addition, patients were asked about their preferred source of genetic information. METHODS: Questionnaires were mailed to participants of a nationwide representative sample of patients with chronic diseases in the Netherlands (n = 1916). RESULTS: The response rate was 82% (n = 1496). Perceived genetic knowledge was low, particularly among older and lower educated patients. Attitudes towards genetics were rather positive, especially among younger and higher educated patients. Some concerns were also documented, mainly about the consequences of genetic testing for employment and taking insurance. Patients who perceived to have little knowledge found it difficult to formulate an opinion about genetic testing. Higher levels of genetic knowledge were associated with a more favourable attitude towards genetics. Chronic patients prefer to receive genetic information from their GP. CONCLUSION: Chronic patients are ill prepared when they require genetic knowledge to make decisions regarding the treatment of their disease. This seems to result from a knowledge deficiency rather than from disagreement with the genetic developments. PRACTICE IMPLICATIONS: When chronic patients are in need of information about genetics or genetic testing, their general practitioner should provide this.

Use of mental health services among disaster survivors: predisposing factors.

BACKGROUND: Given the high prevalence of mental health problems after disasters it is important to study health services utilization. This study examines predictors for mental health services (MHS) utilization among survivors of a man-made disaster in the Netherlands (May 2000). METHODS: Electronic records of survivors (n = 339; over 18 years and older) registered in a mental health service (MHS) were linked with general practice based electronic medical records (EMRs) of survivors and data obtained in surveys. EMR data were available from 16 months pre-disaster until 3 years post-disaster. Symptoms and diagnoses in the EMRs were coded according to the International Classification of Primary Care (ICPC). Surveys were carried out 2-3 weeks and 18 months post-disaster, and included validated questionnaires on psychological distress, post-traumatic stress reactions and social functioning. Demographic and disaster-related variables were available. Predisposing factors for MHS utilization 0-18 months and 18-36 months post-disaster were examined using multiple logistic regression models. RESULTS: In multiple logistic models, adjusting for demographic and disaster related variables, MHS utilization was predicted by demographic variables (young age, immigrant, public health insurance, unemployment), disaster-related exposure (relocation and injuries), self-reported psychological problems and pre- and post-disaster physician diagnosed health problems (chronic diseases, musculoskeletal problems). After controlling for all health variables, disaster intrusions and avoidance reactions (OR:2.86; CI:1.48-5.53), hostility (OR:2.04; CI:1.28-3.25), pre-disaster chronic diseases (OR:1.82; CI:1.25-2.65), injuries as a result of the disaster (OR:1.80;CI:1.13-2.86), social functioning problems (OR:1.61;CI:1.05-2.44) and younger age (OR:0.98;CI:0.96-0.99) predicted MHS utilization within 18 months post-disaster. Furthermore, disaster intrusions and avoidance reactions (OR:2.29;CI:1.04-5.07) and hostility (OR:3.77;CI:1.51-9.40) predicted MHS utilization following 18 months post-disaster. CONCLUSION: This study showed that several demographic and disaster-related variables and self-reported and physician diagnosed health problems predicted post-disaster MHS-use. The most important factors to predict post-disaster MHS utilization were disaster intrusions and avoidance reactions and symptoms of hostility (which can be identified as symptoms of PTSD) and pre-disaster chronic diseases.

The health of volunteer firefighters three years after a technological disaster.

On May 13, 2000, a firework depot exploded in a residential area of the city of Enschede, The Netherlands. Many disaster workers responded, including volunteer firefighters, a group that has received little attention in disaster research. This study examined the presence of health problems in volunteer firefighters who were involved in disaster work, three years after the disaster. Furthermore, it was investigated whether demographic characteristics and disaster exposure predicted health problems. The study population consisted of 246 volunteer firefighters who were deployed in disaster work and 71 non-deployed controls. These firefighters completed a questionnaire which inquired about their perceived health and health change, physical symptoms, post-traumatic stress, mental health problems, and health care utilization. Three years after the disaster, no health differences emerged between deployed and non-deployed firefighters. Good health and health improvement over the previous year were reported. Respondents who encountered more distressing experiences during disaster work or carried out more direct disaster-related recovery tasks reported more mental health problems and health care utilization. However, the most reliable predictors of health problems were distressing experiences unrelated to the disaster in personal life or during work. Three years after the disaster, the health of volunteer firefighters involved in the disaster work was not much impaired, possibly because aftercare was available and utilized. Nevertheless, disaster exposure was associated with elevated post-traumatic stress symptoms and mental health care utilization. Health care workers should direct specific attention to the treatment and prevention of post-traumatic stress symptoms in cases of major accidents or disasters.

Anger and hostility in adolescents: relationships with self-reported attachment style and perceived parental rearing styles.

OBJECTIVE: To examine relationships between self-reported attachment style and parental rearing behaviors, on the one hand, and anger/hostility, on the other hand, in a sample of nonclinical adolescents (N=441). METHOD: Participants completed (a) a single-item measure of attachment style; (b) a questionnaire measuring perceptions of parental rearing behaviors; and (c) two scales assessing anger and hostility. RESULTS: Self-reported attachment style was related to anger/hostility. That is, adolescents who defined themselves as avoidantly or ambivalently attached displayed higher levels of anger/hostility than adolescents who classified themselves as securely attached. Furthermore, perceived parental rearing was also related to anger/hostility. More specifically, low levels of emotional warmth and high levels of rejection, control, and inconsistency were accompanied by high levels of anger/hostility. Finally, regression analyses showed that both attachment status and parental rearing behaviors accounted for a unique and significant proportion of the variance in anger/hostility. CONCLUSION: These findings are in keeping with the notion that family environment factors such as attachment style and parental rearing are involved in the development of anger/hostility in youths.

Compliance with momentary pain measurement using electronic diaries: a systematic review.

Electronic diaries are increasingly used to assess daily pain in many different forms and populations. This systematic review aims to survey the characteristics of studies using electronic pain diaries and to examine how these characteristics affect compliance. A literature search of 11 electronic databases was conducted. Studies were evaluated on the basis of predetermined inclusion criteria by two independent reviewers. Study characteristics were grouped into four categories: general, population, electronic diary, and sampling procedure (i.e., response, attrition, and compliance rates) including strategies to enhance compliance. The 62 included publications reported from 43 different datasets. Papers were usually written in English and published as from 2000. Samples mostly consisted of female chronic pain patients aged 19-65 years from western countries. Most diaries held less than 20 items and were completed up to 6 times daily at fixed or prompted times for 1 month at most. Less than 25% of the studies reported both response and attrition rates; however, a majority reported compliance. Compliance was generally high, and positively associated with shorter diaries, age, having a user's manual, financial compensation and using an alarm. It is important that the various study characteristics are catalogued carefully, especially response and attrition rates, because they can affect compliance. Measures of momentary pain are often developed for the purpose of a certain study; standardisation and validation of these measures is recommended. Finally, authors should mention whether they report on data that has also been used in previous studies.

Knowledge and attitudes towards genetic testing: a two year follow-up study in patients with asthma, diabetes mellitus and cardiovascular disease.

Adequate knowledge and personal attitudes towards DNA-testing are major determinants of optimal utilization of genetic testing. This study aims to (1) assess the genetic knowledge and attitude towards genetic testing of patients with asthma, diabetes mellitus type II and cardiovascular diseases, (2) determine whether their knowledge or attitude changed since 2002, and (3) investigate the predictive role of knowledge on attitude. Data were collected within the Panel of Patients with Chronic Diseases in 2002 and 2004, resulting in 398 data-pairs. Results show that factual knowledge mainly relates to associations between genes and diseases, less is known on associations between genes, chromosomes, cells and body. The perceived knowledge on DNA-testing has not increased since 2002. The attitude towards genetic testing also appeared to be rather consistent. Less perceived medical genetic knowledge and more perceived social genetic knowledge were found predictive for a more reserved attitude towards genetic testing. In conclusion, advanced developments in the field of genetics are not accompanied by increased knowledge of patients with common multi-factorial diseases. The finding that more perceived social genetic knowledge results in more reluctance can be considered an indicator for the necessity of social debates on genetic testing.

Emotional reasoning and parent-based reasoning in normal children.

A previous study by Muris, Merckelbach, and Van Spauwen demonstrated that children display emotional reasoning irrespective of their anxiety levels. That is, when estimating whether a situation is dangerous, children not only rely on objective danger information but also on their own anxiety-response. The present study further examined emotional reasoning in children aged 7-13 years (N = 508). In addition, it was investigated whether children also show parent-based reasoning, which can be defined as the tendency to rely on anxiety-responses that can be observed in parents. Children completed self-report questionnaires of anxiety, depression, and emotional and parent-based reasoning. Evidence was found for both emotional and parent-based reasoning effects. More specifically, children's danger ratings were not only affected by objective danger information, but also by anxiety-response information in both objective danger and safety stories. High levels of anxiety and depression were significantly associated with the tendency to rely on anxiety-response information, but only in the case of safety scripts.