What can multiwave studies teach us about disaster research: an analysis of low-income Hurricane Katrina survivors

Previous research on natural disasters has been limited by a lack of predisaster data and statistical analyses that do not adequately predict change in psychological symptoms. In the current study, we addressed these limitations through analysis of 3 waves of data from a longitudinal investigation of 313 low-income, African American mothers who were exposed to Hurricane Katrina. Although postdisaster cross-sectional estimates of the impact of traumatic stress exposure and postdisaster social support on postdisaster psychological distress were somewhat inflated, the general trends persisted when controlling for predisaster data (B = 0.88 and -0.33, vs. B = 0.81 and -0.27, respectively). Hierarchical linear modeling of the 3 waves of data revealed that lower predisaster social support was associated with higher psychological distress at the time of the disaster (β = -.16), and that higher traumatic stress exposure was associated with greater increases in psychological distress after the storm (β = .86). Based on the results, we suggest that the impact of traumatic stress on psychological trajectories cannot be accounted for solely by preexisting risk, and recommend more complex research designs to further illuminate the complex, dynamic relationships between psychological distress, traumatic stress exposure, and social support.     

The effect of relocation after a natural disaster

Twenty-five women remaining in a city devastated by an earthquake were compared with 24 relocated survivors and 25 comparison women. The women were administered a structured PTSD interview, the Hamilton Depression Scale, and SCL-90-R. The women in both exposed groups showed significantly more symptoms of avoidance, arousal, and total PTSD than the comparison group. The women in the relocated city had significantly higher depression scores than the women in the earthquake city. On the SCL-90-R, relocated women were most symptomatic and comparison group women were least symptomatic. Relocation after a disaster appears to be associated more with risk for depression than with PTSD in situations where recovery is delayed following the trauma.     

Hylan G-F 20 tolerability with repeat treatment in a large orthopedic practice: a retrospective review

The objective of this study was to determine the incidence of local adverse events (AEs) with repeat treatment of hylan G-F 20 for osteoarthritis (OA) knee pain relief in the authors' practice. Prospectively collected patient data (5-year period) was retrospectively reviewed from patients who initiated multiple courses of three weekly hylan G-F 20 injections. All local AEs (knee pain and swelling) were qualitatively and quantitatively assessed. The incidence of treatment-related local AEs was 3.4% of patients (0.8% of injections) at course 1, 13.1% of patients (4.3% of injections) at course 2, and 17.3% of patients (5.4% of injections) at course 3. The majority of related local AEs were mild to moderate and persisted for < or = 48 hours. The number of patients who discontinued injections because of local AEs was low. While the incidence of local AEs with hylan G-F 20 tends to slightly increase with subsequent courses of therapy, physicians should educate patients regarding this possibility rather than preclude them from the benefit of continued OA pain relief with repeat hylan G-F 20 therapy.     

Outpatient orthopedic surgery: a retrospective study of 1996 patients

Outpatient surgical procedures performed at the Centre Hospitalier de l'Université Laval on 1996 patients (1091 men, 905 women) were studied retrospectively. Lower-limb surgery accounted for 66.5% of the procedures. The mean age of the 1996 patients was 40.7 years. General anesthesia was used in 91.5% of the cases. After surgery, the patients were discharged according to the criteria described by Wetchler and Kortilla. The unanticipated hospital admission rate was 6.3% and the complication rate was 1.3% with no life-threatening conditions. Proper selection and preparation of the patient and strict criteria for safe discharge after day surgery are mandatory for the patient's safety and satisfaction.     

Preparing for a burn disaster in Brazil: Geospatial modelling to inform a coordinated response

IntroductionTo optimize the early care of burned patients, protocols were developed that guide pre-hospital care and the need to transfer to a specialized burn treatment unit. Burn disasters are an important public health concern in developed and developing nations. Among the early steps in disaster preparedness is the understanding of geographic locations and capacity of burn care facilities. We aimed to map and classify medical facilities that provide burn care in Brazil and to undertake a location-allocation analysis to identify which could be targeted to increase capacity.MethodsA review of burn hospitalizations was conducted using Brazilian Ministry of Health data. Capacity was defined by number of burn patients admitted each year and bed type. Spatial population data per one-square kilometer were obtained from World Pop as a raster dataset. A road network dataset using Open Street Map data was created to conduct the drive time analysis. Location/allocation analysis was conducted to identify the proportion of Brazil’s population living within 2- and 6-hours’ drive time of a burn care capable hospital, stratified by the level of hospital capacity. Hospitals were ranked according to number of additional people served.ResultsWe found 26.471 burn admissions. Of these, 3.508(13,2 %) were ICU admissions. A total of 735(2,7 %) hospital deaths occurred under the selected burn codes. In all, 1.273 facilities admitted burn patients, and 263(20,7 %) reported ICU admissions of burn patients. Seventeen hospitals were classified as maximum capacity facilities. Additional 23 hospitals were identified as potential targets for capacity building. Most maximum capacity hospitals are clustered in the Southeast of Brazil. Currently, 40.8 % of the Brazilian population live within 2 h of a maximum capacity facility. A large part of the population lives farther than 6 h away from a maximum capacity hospital. Most of the potential targets for capacity building are located near the coast of Brazil.DiscussionWe mapped and classified facilities that provide public burn care in Brazil. We identified public facilities that could be targeted to increase capacity to improve access for patients in the event of a burn disaster. Mapping, planning, and coordinating response is key for optimal outcomes in Mass Casualties Incidents. Cataloging and understanding local resources is a crucial first step in disaster management. Inequality in profiles can determine specific regional needs. Specialized burn centers are rare in regions other than the southeast. Health equity should be considered when planning disaster preparedness initiatives. Location-allocation modelling may assist in universal and equitable burn care service offerings.ConclusionThis study proposes an initial step in the classification and mapping of available burn treatment centers and population coverage in Brazil.     

Predicting posttraumatic stress symptoms in children following Hurricane Katrina: a prospective analysis of the effect of parental distress and parenting practices

Research exhibits a robust relation between child hurricane exposure, parent distress, and child posttraumatic stress disorder (PTSD). This study explored parenting practices that could further explicate this association. Participants were 381 mothers and their children exposed to Hurricane Katrina. It was hypothesized that 3-7 months (T1) and 14-17 months (T2) post-Katrina: (a) hurricane exposure would predict child PTSD symptoms after controlling for history of violence exposure and (b) hurricane exposure would predict parent distress and negative parenting practices, which, in turn, would predict increased child PTSD symptoms. Hypotheses were partially supported. Hurricane exposure directly predicted child PTSD at T1 and indirectly at T2. Additionally, several significant paths emerged from hurricane exposure to parent distress and parenting practices, which were predictive of child PTSD.     

Improved trauma care after reorganisation: a retrospective analysis.

OBJECTIVE: To shorten the time to make a diagnosis and to begin definitive treatment of severely injured patients, thereby improving their medical care. DESIGN: Retrospective analysis. SETTING: Teaching hospital, Sweden. SUBJECTS: 61 patients who had sustained high-energy injuries, including head injury which required surgical intervention, and fracture of the femoral shaft before (1987-1988 n = 23) and after (1991-1993 n = 38) the reorganisation. INTERVENTION: Trauma care was reorganised during the year 1989-1990 and the concept of early multidisiplinary treatment with the general surgeon as trauma-leader was adopted. MAIN OUTCOME MEASURES: The time required to make a diagnosis and begin definitive treatment as well as the assessment of medical care taking account of the patient's general condition and other injuries. RESULT: The immediate medical care was classified as delayed or inappropriate in 9 of 23 patients before, and in 2 of 38 patients after, the reorganisation (p = 0.001). The time needed to make a diagnosis was less than 4 hours in all cases. The time needed to start definitive treatment of head injuries was less than four hours in 9 of 12 patients before, and in 18 of 21 patients after the reorganisation. The internal fixation of femoral fractures was started within four hours in 2 of 11 femoral fractures before, compared with 12 of 17, after the reorganisation. CONCLUSION: The time to beginning definitive treatment of severe injuries was shorter after the reorganisation, as a result of early participation of members of the trauma team.     

Parathyroidectomy after renal transplantation: a retrospective analysis of long-term outcome

Background: Advanced hyperparathyroidism refractory to active vitamin D continues to be a problem and frequently forces the nephrologist to resort to parathyroidectomy. One particular aspect is persisting advanced hyperparathyroidsim after renal transplantation. Published information on this point is fragmentary. Design: Retrospective analysis. Patients: Between 1983 and 1995 a total of 456 patients with renal secondary hyperparathyroidism were subjected to parathyroidectomy (PTX) of whom 103 were transplanted or had at least a history of renal transplantation. The present analysis concerns 37 patients who had a functional renal graft at the time of PTX and were followed for up to 13 years. PTX was performed after an average of 36.7 months after renal transplantation. Outcome: Thirteen patients experienced rejection and became dialysis-dependent. Twenty-four patients had stable function of the renal graft. Seven patients died during follow-up. Hypoparathyroidism post-PTX developed in 4/37 patients, but could be overcome by replantation of cryoconserved parathyroid tissue. Frequency estimate: A total of 2632 renal transplants were performed in the catchment area. As a minimum estimate 3.91% of patients with a functional graft required PTX. Recommendation: Parathyroidectomy should be considered early in cases with advanced secondary renal hyperparathyroidism, since renal transplantation does not necessarily guarantee reversibility of parathyroid overactivity.     

UKA after spontaneous osteonecrosis of the knee: a retrospective analysis

Purpose  

Safety and efficacy of unicompartmental knee arthroplasty (UKA) in unicompartmental osteoarthritis (OA) has been shown in large patient series. It has been matter of discussion whether or not spontaneous osteonecrosis of the knee (SONK) can successfully be treated with UKA.     

Refractures in cemented vertebrae after percutaneous vertebroplasty: a retrospective analysis

Percutaneous vertebroplasty is an efficient procedure to treat pain due to osteoporotic vertebral compression fractures. However, refracture of cemented vertebrae occurs occasionally after vertebroplasty. It is unclear whether such fractures are procedure-related or part of the natural course of osteoporosis. The effect of potentially important covariates on refracture risk in cemented vertebrae has not been evaluated previously. We retrospectively analyzed the incidence and possible causative mechanism of refracture in patients who had received only one vertebroplasty for a single level of vertebral compression fracture. We assessed the following covariates: age, sex, body weight, height, lumbar spine bone mineral density, treated vertebral level, pre-existing untreated vertebral compression fracture, and gas-containing vertebrae before treatment. Surgical variables, including surgical approach, cement injected, and anterior vertebral height restoration, were also analyzed. Anti-osteoporotic treatment after surgery was recorded. Multiple logistic regression analysis was used to determine the relative risk of refractures of cemented vertebrae. Over all, 98 patients were evaluated with a mean follow-up of 26.9 ± 12.4 months (range, 7–55 months). We identified 62 refractures and the mean loss of anterior vertebral height was 13.3% (range 3.2–40.3%). The greater the anterior vertebral height obtained from vertebroplasty, the greater the risk of refracture occurring (P < 0.01). Gas-containing vertebrae were also prone to refracture after the procedure (P = 0.01). Anti-osteoporotic treatment was of borderline significance between refractured and non-refractured vertebrae (P = 0.07). Only restoration of anterior vertebral height was positively associated with refracture during the follow-ups (P < 0.01). In conclusion, refractures of cemented vertebrae after vertebroplasty occurred in 63% of osteoporotic patients. Significant anterior vertebral height restoration increases the risk of subsequent fracture in cemented vertebrae.     

The flooding of Hat Yai: predictors of adverse emotional responses to a natural disaster

Background: A severe flood occurred in Hat Yai following a torrential downpour of rain in November 2000, killing at least 32 people, injuring about 1700, and causing severe damage to property. We have assessed the effect of this disaster on the mental health of the community and investigated predictors of adverse emotional responses. Method: A cross‐sectional survey using a structured questionnaire was carried out and Thai versions of the General Health Questionnaire (GHQ) and Impact of Event Scale (IES) were administered. Data on 590 respondents residing in four areas of the city and its environs were obtained. Results: Two hundred and thirty‐three (40 per cent) respondents had a positive GHQ score suggesting a mental health problem. There were significant associations between a positive GHQ and the subjects' perception of the severity of loss, the ability to collect possessions, and showing a ‘negative’ response to the flood. High IES scores were associated with indices of the severity of loss, lower socio‐economic status and minority religion. Conclusions: Natural disasters, such as floods, have a major impact on the mental health of a community. The impact is related to the perception of severity and loss, and is greater in lower socio‐economic and minority religious sub‐groups. Copyright © 2004 John Wiley & Sons, Ltd.     

Center practice drives variation in choice of US kidney transplant induction therapy: a retrospective analysis of contemporary practice

To assess factors that influence the choice of induction regimen in contemporary kidney transplantation, we examined center‐identified, national transplant registry data for 166 776 US recipients (2005–2014). Bilevel hierarchical models were constructed, wherein use of each regimen was compared pairwise with use of interleukin‐2 receptor blocking antibodies (IL2rAb). Overall, 82% of patients received induction, including thymoglobulin (TMG, 46%), IL2rAb (22%), alemtuzumab (ALEM, 13%), and other agents (1%). However, proportions of patients receiving induction varied widely across centers (0–100%). Recipients of living donor transplants and self‐pay patients were less likely to receive induction treatment. Clinical factors associated with use of TMG or ALEM (vs. IL2rAb) included age, black race, sensitization, retransplant status, nonstandard deceased donor, and delayed graft function. However, these characteristics explained only 10–33% of observed variation. Based on intraclass correlation analysis, “center effect” explained most of the variation in TMG (58%), ALEM (66%), other (51%), and no induction (58%) use. Median odds ratios generated from case‐factor adjusted models (7.66–11.19) also supported large differences in the likelihood of induction choices between centers. The wide variation in induction therapy choice across US transplant centers is not dominantly explained by differences in patient or donor characteristics; rather, it reflects center choice and practice.     

Acute kidney injury after major orthopedic surgery: A retrospective study of frequency and related risk factors

Objective:This study aimed to analyze the frequency of postoperative kidney injury, the related factors, and its effect on outcomes in major orthopedic surgery cases treated in the postanesthesia intensive care unit (PACU).Methods:Major orthopedic surgery cases treated in the PACU were included in this study retrospectively. Demographic, operation, and anesthesia characteristics, CCI, ASA risk classes, preoperative biochemistry, and hemogram results of the patients were recorded. Postoperative serum creatinine level, urine output, renal replacement therapy requirement, and hemoglobin levels were recorded. The kidney damage of the patients was evaluated with RIFLE and AKIN criteria. Postoperative complications were recorded.Results:The frequency of kidney injury in the early postoperative period was 7.1%. When only arthroplasty cases were taken, the frequency was 11%. It was determined that there was a correlation between preoperative ASA, CCI, BMI, K levels, lactate levels, and postoperative kidney damage (P  < 0.05). It was determined that the frequency and duration of inotropic use, the frequency and duration of noninvasive mechanical ventilation, and the duration of hospitalization increased in patients with postoperative kidney damage, and the frequency of pneumonia, wound infection, atelectasis, sepsis, arrhythmia, atrial fibrillation and mortality increased in the postoperative period (P  < 0.05).Conclusion:There is a need for further studies on the relationship between ASA, CCI, BMI, K, and lactate values and postoperative kidney damage. Postoperative kidney injury is associated with prolonged hospitalization and increased morbidity and mortality.Level of Evidence:Level IV, Therapeutic Study