What Ails the Bhopal Disaster Investigations? (And Is There a Cure?)

Abstract

A review of the health effects of the 1984 disaster in Bhopal, India, shows continuing morbidity of a multi-systemic nature in the exposed population. Scientific questions about epidemiologic issues are discussed with a view to understanding appropriate methods of investigation into the disaster. Other major chemical incidents were reviewed to note some of the common problems associated with public health investigations of disasters, which have included the lack of accident-related and toxicologic information, expertise, and funds. The complexity of the Bhopal crisis was underscored by the severe mortality and morbidity it entailed as well as its occurrence in a developing nation that had little experience in dealing with chemical disasters. Lessons learned from the disaster are discussed, with recommendations for disaster preparedness, long-term monitoring, rehabilitation, and treatment of the gas victims.     

Attention deficit disorder and hospitalization owing to intra- and interpersonal violence among children and young adolescents

PurposeTo investigate the associations between intra-and interpersonal violence and related injuries and the diagnosis of attention deficit disorder (ADD) among children and young adolescents.MethodsThis was a population-based epidemiological study that analyzed data routinely collected on hospitalized patients owing to injuries. Data were obtained from the routinely collected inpatient statistics. Information included patients’ demographics, diagnostic classifications of admitting problem, classification of external causes of injury, length of stay, and outcome of hospitalization. Patients with comorbidity of ADD were identified by the ICD-9CM diagnosis code. Data were analyzed univirately using Pearson Chi-square tests. Logistic regression analyses were also applied to calculate the adjusted odds ratio and their corresponding 95% confidence intervals.ResultsSignificant associations between suicide and self-harm, injuries owing to assault, and diagnosis of ADD were found. Patients diagnosed with ADD stayed in the hospital longer than others, disregarding the cause of their injury.ConclusionChildren and adolescents with ADD are at risk of being victims of assaults, as well as suicide and self harm. Assessment for ADD can be considered as part of school-age childhood screening programs.     

How the 2018 Japan Floods Impacted Nursing Home Admissions for Older Persons: A Longitudinal Study Using the Long-Term Care Insurance Comprehensive Database

ObjectivesAs disasters become more frequent because of global warming, countries across the world are seeking ways to protect vulnerable older populations. Although these conditions may increase nursing home admission (NHA) rates for older persons, we know of no studies that have directly tested this hypothesis.DesignThis was a retrospective cohort study.Setting and ParticipantsWe analyzed data from long-term care insurance (LTCI) users in 3 Japanese prefectures that incurred heavy damage from the 2018 Japan Floods, which is the largest recorded flooding disaster in national history. Specifically, we extracted NHA data from the LTCI comprehensive database, both for disaster-affected and unaffected individuals.MethodsWe employed the Cox proportional hazards model to calculate multivariate-adjusted hazard ratios (HRs) for NHAs within a 6-month period following the 2018 Japan Floods, with adjustments for potential confounding factors.ResultsOf the 187,861 individuals who used LTCI services during the investigated period, we identified 2156 (1.1%) as disaster affected. The HR for NHA was significantly higher for disaster-affected (vs unaffected) individuals (adjusted HR 3.23: 95% CI 2.88?3.64), and also higher than the HRs for older age (90-94 years vs 65-69 years: 2.29, CI 1.93?2.70), cognitive impairment (severe impairment vs normal: 1.40, CI 1.25?1.57), and physical function (bedridden vs independent: 2.27, CI 1.83?2.70). According to our subgroup analyses, the adjusted HR for disaster-affected individuals unable to feed themselves was 6.00 (CI 3.68?9.79), with a significant interaction between the 2 variables (P = .01).Conclusions and ImplicationsNatural disasters increase the risk of NHA for older persons, especially those who are unable to feed themselves. Health care providers and policymakers should understand and prepare for this emerging risk factor.     

High agreement of self-report and physician-diagnosed somatic conditions yields limited bias in examining mental–physical comorbidity

ObjectiveTo quantify the misclassification bias of self-reported somatic diseases and its impact on the estimation of comorbidity with mental disorders.Study Design and SettingData were drawn from the German National Health Interview and Examination Survey (N = 7,124), which assessed both self-reported and physician-diagnosed somatic diseases. Eight chronic diseases were examined: coronary heart disease, heart failure, asthma, chronic bronchitis, diabetes, cancer, arthrosis, and arthritis. Mental disorders were assessed by means of the Munich-Composite International Interview.ResultsThe agreement of case ascertainment by patient self-report and physician diagnosis was high (kappa: 0.74–0.92), except for arthritis (0.53). False-positive and false-negative disease statuses were partly associated with age, sex, socioeconomic status, somatic comorbidities, marital status, and mood and anxiety disorders. In most conditions, the odds ratios (ORs) of comorbid mental disorders based on self-reported diseases were slightly overestimated with regard to mood disorders (relative OR: 0.91–1.38), whereas there proved to be no such trend regarding anxiety disorders (0.82–1.05). Substance disorders were partly biased without showing an interpretable trend across diseases (0.49–2.58).ConclusionsEvaluation of mental–physical comorbidity based on self-reported and physician-diagnosed physical conditions yielded similar results, with modestly inflated ORs for mood disorders for several self-reported physical conditions.     

Nonsteroidal Anti-Inflammatory Drug (NSAID) Use and Sarcopenia in Older People: Results From the ilSIRENTE Study

BackgroundRecently, a great deal of attention has been paid to the role of inflammatory processes in the pathophysiology of sarcopenia. The aim of the present study was to examine the relationship between NSAID use and sarcopenia in a large sample of community-dwelling elderly people aged 80 years or older.MethodsData are from the baseline evaluation of 354 individuals enrolled in the ilSIRENTE Study. Following the recommendations of the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia was established on the basis of low muscle mass plus either low muscle strength or low physical performance. The relationship between NSAID use and sarcopenia was estimated by deriving odds ratios (ORs) from multiple logistic regression models considering sarcopenia as the dependent variable.ResultsNearly 12% (n = 44) of the study sample used NSAIDs. Using the EWGSOP-suggested algorithm, 103 individuals (29.1%) with sarcopenia were identified. Ninety-nine (31.9%) participants were affected by sarcopenia among non-NSAID users compared with 4 participants (9.1%) among NSAID users (P < .001). Compared with all nonusers, NSAID users had a nearly 80% lower risk of being affected by sarcopenia (OR 0.21, 95% CI 0.07–0.61). After adjusting for potential confounders, NSAID users had a lower risk of sarcopenia compared with nonusers (OR 0.26, 95% CI: 0.08–0.81).ConclusionsThe results are consistent with the hypothesis that long-term NSAID use might have a protective effect against the loss of muscle mass and function. Interventions able to reduce inflammation-related adverse outcomes at muscle level may be warranted.     

Does disaster affect immigrant victims more than non-immigrant victims in Dutch general practice: a matched cohort study

Background  In the literature, immigrant victims appear to be more vulnerable to health effects of a disaster than indigenous victims. Most of these studies were performed without pre-disaster measurement and without using a control group. Aim  The objective of the study is to monitor differences between two groups of victims, Turkish immigrants and indigenous Dutch, in utilization and morbidity as presented in general practice after a man-made disaster. Methods  A matched cohort study was performed with pre-disaster (1 year) and post-disaster (4 years) measurements of patients from 30 general practices in Enschede. Turkish victims (N = 303) and Dutch victims (N = 606), matched on age, gender and socioeconomic status, were included. Main outcome measures were psychological problems and physical symptoms as recorded by the general practitioner, using the International Classification of Primary Care (ICPC). Results  The Turkish victims showed higher utilization than the Dutch victims prior to the disaster. In the 1st post-disaster year, both groups of victims showed an increase in utilization, but the increases did not differ significantly. The Turkish group showed no significantly greater increase than the Dutch group in the five most prevalent clusters of health problems (psychological, respiratory, skin, musculoskeletal, and digestive). Conclusion  The Turkish victims in general practice were as vulnerable as the Dutch victims for the effects on their health of this man-made disaster. Differences between Turkish and native Dutch victims of this man-made disaster can largely be explained by the differences that existed already before the disaster.     

Underrecognition and undertreatment of dementia in italian nursing homes

ObjectiveTo determine the prevalence of dementia diagnoses and the use of antidementia drugs in a cohort of Italian older nursing home (NH) residents.DesignCross-sectional study.SettingThe NH residents participating in 2 studies: the U.L.I.S.S.E. study and the Umbria Region survey.ParticipantsA total of 2215 nursing home residents.MeasurementEach resident underwent a comprehensive geriatric assessment at baseline by means of the RAI MDS 2.0. Dementia diagnosis was based on ICD-9 codes.ResultsThe prevalence of dementia diagnosis according to ICD-9 codes was 50.7% (n = 1123), whereas 312 subjects had cognitive impairment with a cognitive performance scale score ≥3 without a diagnosis of dementia. Only 56 NH residents were treated (5% of the sample) and the main drugs used were cholinesterase inhibitor, whereas only 1 subject was treated with memantine. Limiting our analysis to patients with mild to moderate Alzheimer's disease, who are those reimbursed by the public health care system for receiving antidementia drugs, the percentage rose to 11.3%.ConclusionThese findings demonstrate a high rate of underdiagnosis and undertreatment of dementia in Italian NH residents. Potential explanations include the lack of systematic assessment of cognitive functions, the limitations to antidementia drug reimbursement, the complexity of the reimbursement procedure itself, and the high prevalence of patients with severe dementia. Older NH residents still lack proper access to state-of-the-art diagnosis and treatment for a devastating condition such as dementia.     

重大自然灾害后心理危机干预机制的构建

分析了国内外重大灾难后心理危机干预的现状及发展趋势,明确了心理危机干预的领域、形式及方法,探讨构建我国重大灾难后的心理危机干预机制.重大自然灾害后,应使用心理危机干预的专业方法,利用心理危机快速反应专家服务组,给受灾者带来常规社会救援所不能解决的紧急心理救护和进一步的心理援助,使不幸的人们在绝望中鼓起勇气、获得希望.面对灾难,危机干预是利国利民的重要事务,是政府对灾难后受灾人群进行人文关怀和构建和谐社会的直接体现.     

Post-nuclear disaster evacuation and survival amongst elderly people in Fukushima: A comparative analysis between evacuees and non-evacuees

BackgroundConsidering the health impacts of evacuation is fundamental to disaster planning especially for vulnerable elderly populations; however, evacuation-related mortality risks have not been well-investigated. We conducted an analysis to compare survival of evacuated and non-evacuated residents of elderly care facilities, following the Great East Japan Earthquake and subsequent Fukushima Dai-ichi nuclear power plant incident on 11th March 2011.ObjectiveTo assess associations between evacuation and mortality after the Fukushima nuclear incident; and to present discussion points on disaster planning, with reference to vulnerable elderly populations.MethodsThe study population comprised 1,215 residents admitted to seven elderly care facilities located 20–40 km from the nuclear plant in the five years before the incident. Demographic and clinical characteristics were obtained from medical records. Evacuation histories were tracked until mid 2013. Main outcome measures are hazard ratios in evacuees versus non-evacuees using random-effects Cox proportional hazards models, and pre- and post-disaster survival probabilities and relative mortality incidence.ResultsExperiencing the disasters did not have a significant influence on mortality (hazard ratio 1.10, 95% confidence interval: 0.84–1.43). Evacuation was associated with 1.82 times higher mortality (95% confidence interval: 1.22–2.70) after adjusting for confounders, with the initial evacuation from the original facility associated with 3.37 times higher mortality risk (95% confidence interval: 1.66–6.81) than non evacuation.ConclusionsThe government should consider updating its requirements for emergency planning for elderly facilities and ensure that, in a disaster setting, these facilities have the capacity and support to shelter in place for at least sufficient time to adequately prepare initial evacuation.