Use of hyperbaric oxygen therapy in severe earthquake injuries.

BACKGROUND: Earthquakes are natural disasters that can often cause severe injuries and traumatic situations. These injuries can include crush injuries, fractures, tissue damage, and blood circulation problems. Hyperbaric oxygen therapy (HBOT) has recently become a frequently used treatment modality for individuals suffering from severe injuries. HBOT is a form of treatment that involves administering pure oxygen to the patient under high pressure. This treatment aims to promote tissue healing by increasing cellular oxygenation. It is thought to have a positive effect on factors such as accelerating tissue healing, reducing inflammation, and controlling infection in severe post-earthquake injuries, particularly crush injuries. This study aimed to retrospectively evaluate the clinical effects, contributions to the healing process, and potential advantages of HBOT in 35 patients with severe injuries after the Kahramanmaras earthquake that occurred on 06.02.2023 and to contribute to the development of emergency intervention strategies. METHODS: This study was carried out after ethics committee approval. In the study, the data of patients with a MESS Score between 7-14 who were admitted as earthquake victims and treated in the HBOT Unit due to severe earthquake-related injuries were obtained from records and retrospectively analyzed. Demographic information, general distribution of patient data, mean values, number of HBOT sessions, and functional outcomes were recorded. RESULTS: The gender distribution of the 35 patients who received HBOT was 31.4% male and 68.6% female. 45.7% of patients were aged 18 years or younger, and 54.3% were aged 19 years or older. The most common injuries in the treated patients were observed in the lower extremities. After HBOT, sensory recovery (54.3%) and functional recovery (51.4%) were achieved in the majority of patients. The minor amputation rate was 20.0% and the major amputation rate was 11.4% after HBOT. CONCLUSION: This study evaluated the possible effects of HBOT on patients with severe earthquake injuries in Türkiye, and the results showed that HBOT may have a beneficial effect on critical factors such as sensory recovery, functional recovery, and amputation rates in this particular group of patients, and that this benefit may be more pronounced in those who started treatment early.

Assessment of Nutritional Composition of Turkish Red Crescent Menus After the M7.8 and M7.6 Earthquakes in Kahramanmaras, Türkiye.

OBJECTIVE: This study aims to evaluate the nutritional content and quality of the Turkish Red Crescent (TRC) menus delivered to earthquake victims after the 2023 earthquakes in Kahramanmaras, Türkiye. METHODS: The menus of general, search-rescue, diabetes, and celiac were obtained from the TRC following the magnitudes of 7.8 and 7.6 Kahramanmaras earthquakes. The nutrient content of the menus was evaluated with the Nutrient Rich Food (NRF20.3) score. In addition, the menus' energy, macronutrient, and micronutrient contents were compared with the dietary reference intake values of the Türkiye Dietary Guideline-2022, European Food Safety Authority, and Food and Drug Administration. RESULTS: The general menu was insufficient to meet the daily requirements of vitamin D, vitamin K, vitamin C, calcium, and potassium for earthquake victims. The sodium, phosphorous, and omega-6/omega-3 ratios were much higher than the recommended intakes. The NRF20.3 score of the diabetes menu was significantly higher than the search-rescue and celiac menus (P < 0.05). The energy content of the search-rescue menu was significantly higher than that of other menus (P < 0.05). CONCLUSION: The several nutritional risks were determined in TRC menus for earthquake victims who suffered from the Kahramanmaras earthquakes. Several supplementation programs can be applied to the earthquake regions to obtain strength immunity and effectively challenge posttraumatic stress symptoms.

Influence of earthquake on radon exhalation law at the beach of the uranium tailing reservoir under high temperature environment.

In this paper, the influence of an earthquake on radon exhalation rate of uranium tailings reservoir beach under high temperature environment is studied by using a self-made integrated simulation test device for natural disasters, and a scale model test based on similarity and dimensional laws. The results show that, (1)When the peak acceleration reaches 0.6g, the radon exhalation rate increases sharply with the increase of peak acceleration, and tends to be gentle after 1.0g. (2)Under the action of high temperature, the radon exhalation rate increases rapidly with the increase of high temperature time, and gradually becomes flat after the 4th hour. (3)Compared with loading the earthquake condition only, the coupling effect of high temperatures and earthquakes causes a greater degree of damage to the beach surface of a uranium tailings reservoir under the same acceleration conditions, and the fissure rate and radon exhalation rate of the beach surface are substantially increased.

Nutritional status among earthquake survivors: a systematic review and meta-analysis.

OBJECTIVE: Earthquakes, as one of the most devastating natural disasters, have many consequences, including the collapse of buildings where food is produced, stored, and distributed, which can ensue with numerous nutritional problems. This study was to investigate the nutritional status of earthquake survivors. STUDY DESIGN: This was a systematic review and meta-analysis study. METHODS: The present review was conducted according to the PRISMA guideline. The data were collected by searching the data resources of PubMed, Scopus, Web of Science, Science Direct, Google Scholar, MagIran, and Scientific Information Database. Meta-analysis was conducted using the random effects model, and the I2 index was used to assess heterogeneity among studies. Publication bias was assessed using Begg's test. RESULTS: In this study, 342 studies were identified in the primary literature search, and after removing duplicates, 14 of which were finally selected for meta-analysis. Based on the results of the meta-analysis, the overall prevalence was obtained: 4.19% for wasting, 16.78% for stunting, 12.59% for underweight, and 28.06% for anemia after the earthquake. CONCLUSION: The results indicated that earthquake survivors are exposed to malnutrition. Therefore, it is recommended that adequate food and nutritional supplements are provided to all earthquake survivors.

Development of disaster nursing in Nepal: Opportunities and challenges for advanced practice.

AIM: This article discusses the evolution of the field of disaster nursing in Nepal and its challenges and ways to protect the health and well-being of the community during disasters. It also discusses the alignment of field activities with the International Council of Nurses' (ICN) competencies in disaster nursing. BACKGROUND: Disaster nursing has become increasingly important due to the increasing frequency and impact of disasters on health. In Nepal, disaster nursing is a relatively new field, but it has grown over the years with nurses playing a vital role in providing holistic care during disasters, emergencies, and crises. SOURCES OF EVIDENCE: Literature review and experience from the field. DISCUSSION: Following the Nepal earthquake, the concept of the "epidemiology nurse" evolved in Nepal which trained local nurses with disaster nursing knowledge and skills using the digital information, communication, and technology (ICT) toolkit for collecting real-time information. Nurses monitored the environment, conducted physical and mental health assessments, identified the needs of vulnerable populations, provided basic aid, offered mental health support, and shared data with authorities. However, their competencies are not yet enough to fully align with those given by ICN nursing standards. CONCLUSION: Recognizing the valuable contributions of Nepalese nurses in the field, their initiatives can serve as a foundation for advancing their roles in disaster nursing. It is essential to implement national disaster plans and invest in specialized university courses for disaster nursing training. IMPLICATIONS FOR NURSING POLICY: The field experiences of disaster nursing reflected in this article can contribute to the development of policies and practices related to disaster management in adherence to the ICN' guidelines.

Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week following rescue.

Crush syndrome due to traumatic rhabdomyolysis is one of the most significant problems to occur following earthquakes. On February 6, 2023, millions of people in Turkey were affected by two consecutive Kahramanmaras earthquakes. The present study reports the analysis of clinical and laboratory findings of crush syndrome in pediatric earthquake victims admitted to our hospital from our region where the earthquake had a devastating effect. Clinical and laboratory findings concerning earthquake victims with crush syndrome were analyzed within the first week to determine what factors are predictive of kidney replacement therapy (KRT). The data of patients were retrospectively collected from medical records. A total of 310 children were admitted as earthquake victims to the pediatric emergency department. Ninety-seven (31%) of these patients had crush syndrome. Fifty-three (55%) of those with crush syndrome were female. The mean age was 10.9 ± 4.7 years, and the mean time under the rubble was 30.6 ± 23.8 h. Twenty-two patients (23%) required KRT. Hemodialysis was applied to 16 (73%) of them, and hemodiafiltration was applied to the other six (27%) in the pediatric intensive care unit. Regarding creatine kinase (CK) levels, the area under the receiver operating characteristic (ROC) curve (AUC) for predicting KRT was 0.905 (95% confidence interval [CI] 0.848-0.963; p < 0.001). The optimal cut-off value was 40,000 U/L with a sensitivity of 86% and a specificity of 83%. In terms of the percentage of body area crushed, the AUC for predicting KRT was 0.907 (95% CI 0.838-0.976; p < 0.001). The optimal cut-off value was 30% with a sensitivity of 86% and a specificity of 88%. Multiple logistic regression analysis showed that each 10% increase in body area crushed (OR 4.16, 95% CI 1.58-10.93, p = 0.004) and 1 mg/dl increase in the serum phosphorus level (OR 4.19, 95% CI 1.71-10.28, p = 0.002) were significant risk factors for dialysis treatment. CONCLUSIONS: Crush syndrome and kidney problems are common following disasters like earthquakes. Clinical and laboratory findings at admission can predict dialysis requirement in earthquake victims. While CK elevation, body area crushed percentage, and increased phosphorus level were predictive of dialysis treatment, time under the rubble was not. Even if the patients were under the rubble for a short time, acute kidney injury (AKI) may develop as a result of severe hypovolemia due to crush injuries, and patients may need KRT. WHAT IS KNOWN: •Crush syndrome after earthquakes needs to be treated carefully in victims and can cause AKI and mortality when not treated timely and appropriately. WHAT IS NEW: •CK level elevation, body area crushed percentage, and increased phosphorus level are predictive of dialysis treatment. •The time under the rubble may not be predictive of dialysis requirement.

A comprehensive assessment of mechanical and environmental properties of green concretes produced using recycled concrete aggregates and supplementary cementitious material.

This study aims to present a multi-perspective evaluation of green concretes produced using supplementary cementitious material and recycled concrete aggregates and to balance the reduction in compressive strength values caused by using recycled concrete aggregates with silica fume. For these purposes, statistical analyses were performed on the response surface method using the data of 9 reference and 27 green concrete series mixtures, and mathematical models were developed to predict the compressive strength with high accuracy. Then, energy consumption, global warming potential, and waste generation were taken into account from the environmental impact categories, and the environmental impact scores obtained were compared in detail to examine the impact of the use of silica fume and recycled concrete aggregates on sustainable development. Significant reductions in energy consumption and global warming potential values with the use of silica fume and waste generation values with the use of recycled concrete aggregates were achieved, and it was seen that supplementary cementitious material and recycled concrete aggregates are of great importance in terms of sustainable development. It was seen that these waste materials could be utilized, especially in regions with high earthquake risk, and that these waste materials are of great importance.

Analysis of wound types and wound care methods after the 2023 Kahramanmaras earthquake.

OBJECTIVES: This study aims to investigate the types of wounds and wound care in earthquake victims rescued from collapsed buildings after the 2023 Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 8th, 2023 and March 1st, 2023, a total of 94 patients (46 males, 48 females; mean age: 40.2±15.5 years; range, 16 to 77 years) with earthquake-related wounds who were trapped under rubble were retrospectively analyzed. Data including age, sex, duration of being trapped under rubble, type and location of the wound, bacterial cultures from deep tissue, and wound care methods used were recorded. RESULTS: The mean duration of being trapped under rubble was 58±38.1 h. Wounds were most commonly located on the lower extremities, followed by the upper extremities. The most common type of wounds were abrasions, followed by necrotic wounds due to crushing. Wound and skin antiseptics, debridement and negative pressure wound therapy (NPWT) were the most common wound care methods used. CONCLUSION: Various types of injuries and wounds may occur after natural disasters. Chronic wound care is as important as the management of life-threatening acute pathologies. Preparations should be made properly for the long-term treatment of patients after disasters. Methods such as NPWT, debridement creams containing collagenase, wound and skin antiseptics, and hyperbaric oxygen therapy can provide satisfactory short-term results. A broader and more intense application of these treatments is thought to be beneficial, particularly in crush injuries.

Hyperbaric oxygen therapy does not change the amputation level in patients with fasciotomy after an earthquake: Our single-center experience after 2023 Kahramanmaras earthquake.

OBJECTIVES: This study aims to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the amputation level in patients undergoing fasciotomy with a Mangled Extremity Severity Score (MESS) score of ≥7 after 2023 Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and March 10th, 2023, a total of 23 patients (14 males, 9 females; mean age: 36.8±13.2 years; range, 17 to 64 years) who needed amputation with a MESS score of ≥7 and refused amputation were included in the study. All fasciotomies were performed in an external center, and five of them was incomplete. First, incomplete fasciotomies were completed with debridement due to deep muscle necrosis. Daily two HBOT sessions were performed for the first three days. In the following days, daily one HBOT session was performed. The HBOT was terminated for the patients who were decided by the council that they did not benefit from HBOT treatment. RESULTS: Six (26.08%) of the patients had a bone fracture (n=2 forearm, n=1 femur, n=2 tibia, and n=1 ankle fracture). The mean number of HBOT session was 13.24±5.4 (range, 7 to 30) and the mean duration of HBOT was 26.5±10.8 (range, 14 to 60) h. The mean MESS score was 9.96±1.36 (range, 7 to 12). All of the patients were trapped under the rubble with a mean time of 12.3±5.4 (range, 6 to 23) h. All fasciotomies were performed within the first 30 h. Twenty-two of the patients were amputated at the level previously determined by the experienced trauma surgeons. The amputation level changed in only one patient. After 38 h of HBOT, transradial amputation was performed to the patient in whom transhumeral amputation level was determined previously. None of the patients had any adverse event related to HBOT. CONCLUSION: Our study results suggest that the MESS is a useful scoring system for amputation decision after a high-energy trauma, such as an earthquake, with a high accuracy rate. The outcomes of HBOT are not satisfactory for high-energy traumas, such as earthquakes, in those requiring fasciotomy having more muscle necrosis and a MESS score of ≥7.

Effects of acupuncture on earthquake survivors with major psychiatric disorders and related symptoms: A scoping review of clinical studies.

BACKGROUND: This scoping review aimed to determine the current research status of acupuncture for major psychiatric disorder (MPD) in earthquake survivors. METHOD: We followed the scoping review process described previously. A literature search on 14 electronic databases was conducted from inception to November 29, 2022. Data from the included studies were collected and descriptively analyzed to address our research question. Extracted data were collated, synthesized, and summarized the according to the analytical framework of a scoping review. RESULT: This scoping review included nine clinical studies: four randomized controlled trials (RCTs) and five before-after studies. The most frequent MPD type among the included acupuncture studies was posttraumatic stress disorder (PTSD; 6/9, 66.67%). The most frequent acupuncture type was scalp electro-acupuncture (4/9, 44.44%), followed by manual acupuncture and ear acupressure/ear acupuncture (3/9, 33.33%). Studies using scalp electro-acupuncture all used common acupoints, including GB20, GV20, GV24, and EX-HN1. In general, the treatment period lasted between 4 and 12 weeks. Validated assessment tools for PTSD severity and accompanying symptoms were used for patients with PTSD, while the corresponding evaluation tools were used for patients with other diagnoses or clinical symptoms. Acupuncture-related adverse events were generally mild and temporary, such as mild bleeding and hematoma, and syncope was a rare but potentially serious adverse event (1/48 patients and 1/864 sessions over a treatment period of 4 weeks). CONCLUSION: Acupuncture studies for MPD after an earthquake mainly focused on PTSD. RCTs accounted for around half of the included studies. Scalp electro-acupuncture was the most common acupuncture type, and EX-HN1 and GV24 were the most important acupoints in the acupuncture procedures for MPD. The included studies mostly used validated symptom assessment tools, though some did not. Clinical studies in this field need to be further expanded regardless of the study type. PROTOCOL REGISTRATION: https://osf.io/wfru7/.

Effect of acupuncture on patients with major psychiatric disorder and related symptoms caused by earthquake exposure: Protocol for a scoping review of clinical studies.

Earthquakes have the greatest destructive effect among all natural disasters. Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and anxiety disorder (AD) are major psychiatric disorders (MPD) that can be triggered by exposure to earthquakes. Conventional treatments such as pharmacological treatments have several limitations. Acupuncture therapy as a complementary integrative medicine may be an effective alternative treatment for these limitations. This study aimed to identify the status of the clinical evidence regarding acupuncture therapy for earthquake survivors with MPD. We will follow the scoping review process as previously described. The study question is as follows: "Which types of clinical research designs, study types, study durations, adverse events, and clinical outcomes have been reported regarding acupuncture therapy for MPD in earthquake survivors?" Medline, Excerpta Medica dataBASE, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycArticles databases, and Chinese, Korean, and Japanese databases will be comprehensively searched electronically from their inception to November 2022. Data from the included studies will be collected and descriptively analyzed in relation to our research question. We will collate, synthesize, and summarize the extracted data according to the analytical framework of a scoping review. The protocol will conform with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions of Scoping Reviews to ensure the clarity and completeness of our reporting in the whole phase of the scoping review (Protocol registration: https://osf.io/wfru7/). The findings of this scoping review will provide fundamental data that will help researchers identify appropriate research questions and design further studies on the use of acupuncture for MPD management in earthquake survivors. These results will be helpful for developing disaster site-specific research protocols for future clinical trials on this topic.

Pathways to post-traumatic growth and post-traumatic stress following the Canterbury earthquakes in a cohort of 40-year-olds.

OBJECTIVE: To report on post-traumatic growth and post-traumatic stress following the Canterbury earthquakes and to quantify the relationships between exposure to the earthquakes, post-traumatic growth and post-traumatic stress. METHOD: The Christchurch Health and Development Study is a longitudinal birth cohort study of New Zealanders aged 40 years at the time of latest assessment in 2017. A total of 455 participants were exposed to the Canterbury earthquakes and assessed in 2012 and 2017. Post-traumatic growth was measured in 2017 using the Post-traumatic Growth Inventory. Earthquake-related post-traumatic stress was measured in 2012 using post-traumatic stress disorder items from the Diagnostic Interview Schedule. Post-traumatic growth and post-traumatic stress were modelled using measures of earthquake impact and subjective measures of earthquake consequences (peri-traumatic stress and disruption distress). RESULTS: There was an indirect relationship between earthquake impact and post-traumatic growth. This was mediated via disruption distress. There was also an indirect relationship between earthquake impact and post-traumatic stress. This was mediated via peri-traumatic stress and disruption distress. Post-traumatic growth and post-traumatic stress were not significantly related. CONCLUSIONS: Measurement of post-traumatic growth and post-traumatic stress is required for a holistic understanding of disaster consequences. Subjective assessment of distress following disasters is required to predict their psychological effects.

Effect of simulated earthquake loading on radon exhalation from uranium tailings dam.

Uranium tailings sand will continuously release radon-222. When the external condition changes, the exhalation of radon will also change. Thus, radon is being recommended as a tracer for dam damage assessment. When an earthquake is simulated on the uranium tailings dam with a shaking table test and the change in radon concentration is measured, it is observed that the earthquake causes micro-fissures in the uranium tailings dam, which aggregate to form fractures. During the process, the radon concentration will climb dramatically, as will the radon exhalation rate. To verify that the radon monitoring date is accurate, the acceleration response, surface displacement, and interior displacement are all monitored. The results show that radon can be utilized as a tracer to evaluate uranium tailings dam damage.

A holistic assessment of the use of emerging recycled concrete aggregates after a destructive earthquake: Mechanical, economic and environmental.

This study aims to examine the mechanical, environmental, and economic properties of recycled aggregate concretes produced using emerged recycled concrete aggregates from the buildings that were demolished in a controlled way after the 24 January 2020, Elazig-Sivrice earthquake. For this purpose, 24 series of recycled aggregate concretes were produced, water-to-cement ratios of 0.30-0.35-0.40-0.45-0.50, and cement dosages were chosen as 320-370-420 kg/m3. 100% recycled concrete aggregate was used in the prepared concrete mixtures. Analyses were made on the response surface method using the mixture ratios and test results of 24 series. The effectiveness of the developed models was examined on 6 Control recycled aggregate concrete. Then, Energy Consumption, Global Warming Potential, Waste Generation, and Abiotic Depletion were considered to assess the environmental impacts of recycled aggregate concretes. In order to make environmental and economic comparisons of recycled aggregate concretes and natural aggregate concretes according to these impact categories, 4 different scenarios were developed. Then, a detailed feasibility analysis was made for 4 different scenarios, and the economic results of recycled aggregate concretes and natural aggregate concretes were evaluated. Regarding the arisen millions of tons of waste materials and newly constructed buildings after the earthquake, recycling waste materials is considered crucial. Therefore, a holistic assessment was taken with this study, and the usability of recycled concrete aggregates was examined in detail.

Effectiveness of an Integrated Nutrition Rehabilitation on Growth and Development of Children under Five Post 2018 Earthquake in East Lombok, Indonesia.

BACKGROUND: In August 2018 Lombok Island in Indonesia was hit by a 7 Richter scale earthquake. This study aimed to assess the effectiveness of comprehensive nutrition disaster rehabilitation, based on the holistic integrated early child development concept, on the growth and development of children under five. METHODS: A community-based intervention was performed in the East Lombok district; four villages in two sub-districts were randomly allocated into intervention or control groups. Mothers of 6-49-month-old children in the intervention group (n = 240) attended parenting classes (twice weekly) and received shredded fish/liver/anchovy and optimized complementary feeding/food-based recommendations, developed using linear programming. Health staff from the public health center and teachers from early childhood education (ECE) centers delivered parenting sessions on health-nutrition and care-education. The control group (n = 240) received existing health services. Indicators measured at baseline and the end line point were weight, length/height, hemoglobin, feeding practices, psychosocial care (HOME) and maternal stress (SRQ). At the end line point, child development was assessed using BSID-III. RESULTS: At the end line point, maternal stress and child morbidity (cough) were lower and dietary diversity (+1) in 6-23-month-old children, and weight-for-age Z-score (+0.26) and social emotional score (+10 points) in ≥24-month-old children were higher in the intervention group. CONCLUSIONS: The nutrition rehabilitation intervention delivered through ECE centers has a positive effect on the growth and development of children under five in post-disaster conditions.

Understanding Suffering and Emotion in Chinese Earthquake Survivors: Environment, Society, Body-Mind, and Spirituality.

Research on posttraumatic experiences has focused heavily on emotional experiences based on predetermined psychopathological standards. In contrast, victims' subjective experiences-especially of indigenous populations-are scarcely discussed. This study used a narrative approach to examine the experiences of 22 Sichuan earthquake survivors who were diagnosed with posttraumatic stress disorder. Victims completed semistructured interviews regarding their overall experiences, and analysis of narrative was employed to analyze the data. The current study found that the earthquake brought significant changes to participant lives regarding their (i) environment, (ii) society, (iii) body-mind, and (iv) spiritual dynamics. Each of these key themes and its practical and theoretical implications are discussed along with suggestions for further development and practices of culturally sensitive mental health services for earthquake survivors in China.

Revising "Nutritional Reference Values for Feeding at Evacuation Shelters" According to Nutrition Assistance by Public Health Dietitians Based on Past Major Natural Disasters in Japan: A Qualitative Study.

It is important to provide nutritionally adequate food in shelters to maintain the health of evacuees. Since the Great East Japan Earthquake in 2011, Japan's Ministry of Health, Labour and Welfare has released the "Nutritional Reference Values for Evacuation Shelters" (Reference Values) after every major natural disaster. There is clear evidence, however, that the Reference Values have only been used infrequently. This study aims to revise these guidelines to include the actual situation in the affected areas and the feasibility of the endeavor. This qualitative study uses group interviews with local government dietitians to propose revisions to Japan's Reference Values. These revisions include the following: issuing Reference Values within 1 week of a disaster, showing one type of values for meal planning for each age group, showing the minimum values of vitamins, upgrading salt to basic components, creating three phases of nutrition (Day 1, Days 1-3, and After Day 4), stipulating food amounts rather than nutrient values, and creating a manual. Local government officials could use the Reference Values as guidelines for choosing food reserves, and dietitians could use them while formulating supplementary nutrition strategies for a model menu in preparation for disasters.

The hypothalamic-pituitary-adrenal and -thyroid axes activation lasting one year after an earthquake swarm: results from a big data analysis.

PURPOSE: To cope physical and/or psychological threats, the human body activates multiple processes, mediated by a close interconnection among brain, endocrine and inflammatory systems. The aim of the study was to assess the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes involvement after an acute stressful event (Emilia Romagna earthquake swarm) with a big data approach. METHODS: A retrospective, observational trial was performed, collecting all biochemical examinations regarding HPA and HPT axes performed in the same laboratory the year before and the year after the earthquake swarm (20-29 May 2012). RESULTS: Comparing 2576 pre-earthquake to 3021 post-earthquake measurements, a cortisol serum level increase was observed (p < 0.001). Similar increase was evident for urinary free cortisol (p = 0.016), but not for adrenocorticotropic hormone (p = 0.222). The biochemical hypercortisolism incidence increased from 7.6 to 10.3% after earthquakes (p = 0.001). Comparing 68,456 pre-earthquake to 116,521 post-earthquake measurements, a reduction in thyroid-stimulating hormone (TSH) levels was evident (p = 0.018), together with an increase in free triiodothyronine and free thyroxine levels (p < 0.001 and p < 0.001). Moreover, a significant increase in altered TSH after earthquakes was registered considering the epicenter-nearest measurements (p < 0.001). No clinically relevant alterations were observed considering thyroid-specific autoantibodies. CONCLUSION: A long-term HPA axis activation in the inhabitants of the earthquake-affected areas was highlighted for the first time. Moreover, an increased incidence of biochemical hypercortisolism emerged after earthquakes. We confirmed a recruitment of HPT axis after stressful events, together with increased incidence of altered TSH in the. Our big data study allowed to increase knowledge about the connection between external stressors and endocrine regulation.

Dislocation, Social Isolation, and the Politics of Recovery in Post-Disaster Japan.

What happens when temporary shelters become permanent homes? What are the psychosocial impacts of prolonged dislocation, and how might these effects be mitigated through grassroots community activities? Based on fieldwork and interviews with residents in temporary housing and volunteer support groups in northeastern Japan conducted from 2014-2018, this article analyzes the ongoing challenges of delayed recovery, chronic dislocation, and social isolation among survivors of the March 11, 2011 disaster in Japan, with a particular focus on the residents of temporary facilities in Natori City, Miyagi Prefecture. I examine how the complexity of the disaster-recovery process within the local politics of the region has produced new tensions, creating a particular "zoned liminality" for displaced residents while undermining the social nexus of community relations. Then I reflect on certain challenges in treating the psychosocial trauma among survivors, and how their particular needs are addressed through new citizen-based volunteer movements offering holistic activities. These grassroots activities do not necessarily solve the breakdown of social bonds nor improve residents' prospects of returning home. However, by alleviating survivors' sense of social isolation and loneliness, this "humanistic" approach highlights the possibilities of participatory-style psychosocial support that goes beyond conventional biomedical services and top-down, state-driven policies.　.

Health-Related Rehabilitation after the 2008 Great Wenchuan Earthquake in China: A Ten Year Retrospective Systematic Review.

Being one of the world's seismically hazard-prone countries, the People's Republic of China (PRC) witnessed an 8.0-magnitude earthquake on May 12th 2008-which was reported as one of the most destructive disasters since its founding. Following this earthquake, rehabilitation was greatly required for survivors to enable them to achieve and maintain optimal independence; functioning; full physical, mental and social ability; inclusion; and participation in all aspects of life and environments. We conducted a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to retrospectively identify, in five English databases/sources, the existing evidence about the Health-Related Rehabilitation (HRR) that was rendered to the survivors of the 2008 Wenchuan earthquake between 2008 and 2018. Only 11 studies out of 828 initial studies retrieved were included in our study and reported the survivors of the 2008 Wenchuan earthquake to have been aged between 10.5 and 55.7, and predominantly diagnosed with posttraumatic stress disorders. Their HRR was mainly premised on physical and physiological therapies, as well as traditional Chinese medicine and digital technologies. Although all HRR interventions used were reported to be effective, none was identified as much more effective than the others in the post-earthquake era -which calls for more robust research to build upon our systematic review.