Perceptions of Resilience and Physical Health Symptom Improvement Following Post Disaster Integrated Health Services.

OBJECTIVE: Theorists and researchers have linked resilience with a host of positive psychological and physical health outcomes. This paper examines perceptions of resilience and physical health symptoms in a sample of individuals exposed to multiple community disasters following involvement in integrated mental health services. METHODS: A multiwave naturalistic design was used to follow 762 adult clinic patients (72% female; 28% minority status), ages 18-92 years (mean age=40 years), who were evaluated for resilience and physical health symptoms prior to receiving services and at 1, 3, and 6 months' follow-up. RESULTS: Data indicated increases in perceptions of resilience and decreased physical health symptoms reported over time. Results also indicated that resilience predicted physical health symptoms, such that resilience and physical health symptoms were negatively associated (ie, improved resilience was associated with decreases in physical health symptoms). These effects were primarily observed for those individuals with previous exposure to natural disasters. CONCLUSIONS: Findings provide correlational evidence for behavioral health treatment provided as part of a stepped-care, collaborative model in reducing physical health symptoms and increasing resilience post-disaster. Controlled trials are warranted. (Disaster Med Public Health Preparedness. 2019;13:223-229).

Identifying trajectories of change to improve understanding of integrated health care outcomes on PTSD symptoms post disaster.

INTRODUCTION: Addressing life stressors is an important function for integrated care, especially for health care homes located in disaster prone environments. This study evaluated trajectories of change for patients with postdisaster posttraumatic stress disorder (PTSD) who were seen in integrated care. In addition to describing the results, this article provides the methods of subgroup analyses as this may be useful for others working in real-world practice. METHOD: Patients (N = 340) receiving services at 5 rural health clinics self-reported PTSD symptoms as part of an ongoing evaluation to study the effectiveness of integrated health. Analysis of variance was used to assess differences overtime and trajectories were identified with cluster analyses. Disaster and trauma related factors associated with these trajectories were assessed using logistic regression. RESULTS: Significant overall decreases in PTSD symptoms overtime were found; individual trajectories were identified and include stable low, steep declines, stable high symptoms, and increasing symptoms. Stress related to disaster and the number of other traumas patients experienced correctly classified trajectory membership. DISCUSSION: Trajectories indicate that patients have differing treatment needs and cluster analysis as an evaluation technique may be useful in identifying what treatment works and for whom. The present study addresses a major concern for health care providers serving disaster prone communities and emphasizes the importance of identifying pre incident and disaster related risk vulnerabilities that contribute to mental health outcomes. Subgroup analyses are a useful tool for developing more targeted treatment within integrated care and may be an accessible research strategy for others working in such settings. (PsycINFO Database Record

Fire disaster caused by LPG tanker explosion at Lice in Diyarbakir (Turkey): July 21, 2014.

A disaster can be defined as a situation where the affected society cannot overcome its own resources. Our aim was to present the case of a fire disaster caused by a liquefied petroleum gas (LPG) tanker-based explosion on the Diyarbakir-Bingöl road in Lice to determine the various kinds of challenges and patient groups that an emergency department faces and to discuss more effective interventions for similar disasters. This is a retrospective cross-sectional study. To find out the factors that affected mortality, we investigated the patient conditions presented at the time of admission. Among 69 patients included in the study, 62 were male (89.9%) and seven were female (10.1%). The average age of patients was 32.10±14.01 years, and the burn percentage was 51.1±32.2. One patient died during the first response, and a total of 34 patients (49.3%) died during the patient follow-up. Factors statistically related to mortality were determined to be inclusion in the severe burn group, presence of inhalation injuries, use of central venous catheter on patients, application of fasciotomy, presence of a tracheostomy opening, use of endotracheal intubation and sedoanalgesia, and transfer to centers outside the city (p-values <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, 0.001, and 0.003, respectively). In conclusion, although fire disasters caused by LPG tanker explosions are rare, the frequency of such disasters will increase with the increase in LPG use. The factors affecting mortality should be determined to decrease mortality. We recommend that all personnel members who engage in work related to LPG from production to use, in addition to rescue and first-response personnel, be trained comprehensively and that advanced technological fire equipment be used to prevent such disasters.

Fire risk reduction through a community-based risk assessment: reflections from Makola Market, Accra, Ghana.

This paper explores the level of vulnerability to the hazard of fire that exists in Makola Market in Accra, Ghana, and assesses how this threat can be reduced through a community-based risk assessment. It examines the perceptions of both market-stall occupants and primary stakeholders regarding the hazard of fire, and analyses the availability of local assets (coping strategies) with which to address the challenge. Through an evaluation of past instances of fire, as well as in-depth key stakeholder interviews, field visits, and observations, the study produces a detailed hazard map of the market. It goes on to recommend that policymakers consider short-to-long-term interventions to reduce the degree of risk. By foregrounding the essence of holistic and integrated planning, the paper calls for the incorporation of disaster mitigation measures in the overall urban planning process and for the strict enforcement of relevant building and fire safety codes by responsible public agencies.

Petroleum pipeline explosions in sub-Saharan Africa: a comprehensive systematic review of the academic and lay literature.

BACKGROUND: Experience indicates that the frequency and impact of petroleum pipeline fires and explosions in sub-Saharan Africa (SSA) is presently under-represented in the academic literature. MATERIALS AND METHODS: Using adapted PRISMA guidelines, the authors reviewed both PubMed and the LexisNexis Academic news database, which includes periodicals, news transcripts and online reports. Country-by-country searches were conducted for petroleum pipeline fires and explosions in SSA occurring between June 1, 2004 and May 31, 2014. RESULTS: Initial search yielded 5730 articles from LexisNexis Academic and 3 from PubMed. On further review, a total of 28 separate petroleum pipeline-related incidents causing injuries and/or deaths were identified, 16 of which had not been previously reported in the academic literature. The events occurred in Nigeria (23), Kenya (2), Ghana (1), Sierra Leone (1), and Tanzania (1). A total of 1756 deaths were reported across all events. The most common cause of the original leak was intentional, either from theft or vandalism (13/20, 65%), or by militia activity (2/20, 10%). CONCLUSIONS: Fire disasters related to scavenging fuel from petroleum pipelines are common in SSA and cause significant morbidity and mortality. These events require better reporting tools and intervention strategies overall. Furthermore, our study demonstrates that non-academic sources can effectively supplement gaps in the academic literature.

Holistic approach to community in crisis.

This report emphasizes the belief that whatever the type and scale of disaster, the period of transition from relief to recovery is the most critical. Following the severe earthquake that struck Kachchh, Gurjarat, India on 26 January 2001, emotions spanned grief over the lives lost; anxiety over property and other economic losses; profound feelings of isolation, helplessness, and guilt; and panic in the face of problematic communications from authorities. In an attempt to manage this vast array of psychosocial problems, a large cadre of volunteers was rapidly trained and supervised by experts to work as grass-roots counselors for the community.

Fire disaster following LPG tanker explosion at Chala in Kannur (Kerala, India): August 27, 2012.

A fire disaster following LPG tanker explosion occurred at Chala bypass, Kannur, Kerala, India on August 27, 2012. The three chambered tanker with total 16tonnes (162.57 quintal) LPG collided with a road divider and exploded thrice. A total of 41 people became victims during first blast; out of which 20 died in various hospitals. Five people remained inside the house after first blast and escaped unhurt from the zone of accident before second blast. All the victims were transferred to various hospitals; of these, six were transferred to the burns unit of the Kasturba Hospital, Manipal (320km from Chala). Five (5/6) were transferred within 1-5 days at our burns unit suffered 31-72% total body surface area (TBSA) burn, none had external injuries. One (1/6) was transferred on 20th day as a follow up case of 15% TBSA burn with 4% residual raw area and diabetes mellitus. Except one, all were managed conservatively using Limited access dressings (LAD; Negative Pressure Wound Therapy). One of the patient wound bed prepared under LAD and on 41 post burn day underwent split skin grafting under LAD. Out of the six patients admitted at the burns unit, two (2/6) admitted patients expired (one due to inhalation injury and another due to sepsis with multiple organ failure). One survivor (1/4) developed sepsis related liver dysfunction with hepatomegaly but recovered well. The total hospital stay of survivors at the burns unit varied from 8 to 60 days (mean hospital stay 36.5 days). All the victims who developed psychological symptoms were treated by psychiatrists and counselled before discharge. Three of survivors developed psychological symptoms. Two of them (2/3) developed mixed anxiety-depression disorder (ICD 10 code F41.8) and one of these two showed grief reaction too (ICD 10 code F43.23). One victim (1/3) developed non-organic insomnia (ICD 10 code F51.0) and responded to counselling. The article describes the incident, mechanism of the incident, injuries sustained, author, explanations on pattern of burn and suggestions in relation to future safety measures.

Preventable disasters in the offshore oil industry: from Piper Alpha to Deepwater Horizon.

This article compares two industrial disasters in the offshore oil industry, the explosion and fire on Piper Alpha off the coast of Scotland in 1988, the world's worst offshore disaster, and the blowout and explosions on Deepwater Horizon in the Gulf of Mexico in 2010. It attempts to answer a simple question: Given the enormity of the first tragedy and the careful analysis of its circumstances and causes, why were the lessons of previous failure not learned by this globally organized industry, in the very heartland in the United States? The answer tells us much about the ability of corporate capital to configure regulatory regimes in its own interests and to do so in a manner that continues to threaten the safety and well-being of its employees and the wider environment.

Suicidal intention and negative spiritual coping one year after the earthquake of L'Aquila (Italy).

BACKGROUND: This study investigated the rate of suicidal intention and its relationship with the features of religious involvement in a non-clinical sample of the adult population exposed to the L'Aquila earthquake. METHODS: The study population was composed of 426 people who had experienced the earthquake (188 males and 238 females). For comparison, 522 people were recruited from nearby unaffected areas. The sample was investigated for suicidal intention screening, distinguishing Suicidal Screen-Negative (SSN) subjects from Positive (SSP) subjects. Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and Impact of Event Scale (IES) assessments were administered. RESULTS: More SSP subjects were observed in the population exposed to the earthquake (Odds Ratio 3.54). A higher proportion of females showed suicidal ideation. Multivariate analysis showed overall significance for the between-subject factor. Univariate F tests for each BMMRS variable that contributed to significant overall effect showed that negative spiritual coping was significantly different. No differences were observed for IES scores between the two groups, but correlations with negative spiritual coping were found. LIMITATIONS: The samples are relatively small and data are based on self-reports. CONCLUSIONS: Negative religious coping such as expression of conflict and doubt regarding matters of faith, as well as a feeling of being punished or abandoned by God, can prevail in response to prolonged stress without relief, as was experienced by the population exposed to the earthquake. These features are more associated with suicide ideation. Degree of religious affiliation and commitment examination by mental health practitioners can be useful when suicidal ideation is investigated.

Remodelling reparation: changes in the compensation of victims of natural catastrophes in Belgium and the Netherlands.

The paper presents a comparative analysis of the development and present state of compensation for victims of catastrophes in Belgium and the Netherlands. These two neighbouring countries have both seen legislative changes in this field in recent years, albeit with different outcomes. The paper thus analyses to what extent the two compensation scheme structures allow for conclusions as to the comparative benefits of a comprehensive insurance scheme for natural disasters. From the perspective of law and economics, the evolution of private insurance and public intervention through compensation funds, the preference for private or public solutions and the actual financing of these are examined. Drawing on practical experience, such as the case of flood risks, the solutions are tested in view of incentive-based financing. The paper concludes that the private insurance market is more developed in Belgium than it is in the Netherlands, where the reform process has not yet ended.

Accidental hazardous material releases with human impacts in the United States: exploration of geographical distribution and temporal trends.

OBJECTIVE: To investigate the circumstances and geographic and temporal distributions of hazardous material releases and resulting human impacts in the United States. METHOD: Releases with fatalities, injuries, and evacuations were identified from reports to the National Response Center between 1990 and 2008, correcting for data quality issues identified in previous studies. RESULTS: From more than 550,000 reports, 861 deaths, 16,348 injuries and 741,427 evacuations were identified. Injuries from releases of chemicals at fixed facilities and natural gas from pipelines have decreased whereas evacuations from petroleum releases at fixed facilities have increased. CONCLUSION: Results confirm recent advances in chemical and pipeline safety and suggest directions for further improvement including targeted training and inspections and adoption of inherently safer design principles.