The untold stories of the Sichuan earthquake

Quantifying Health Policy Uncertainty in China Using Newspapers: Text Mining Study

BACKGROUND

From the severe acute respiratory syndrome (SARS) outbreak in 2003 to the COVID-19 pandemic in 2019, a series of health measures and policies have been introduced from the central to the local level in China. However, no study has constructed an uncertainty index that can reflect the volatility, risk, and policy characteristics of the health environment.

OBJECTIVE

We used text mining analysis on mainstream newspapers to quantify the volume of reports about health policy and the total number of news articles and to construct a series of indexes that could reflect the uncertainty of health policy in China.

METHODS

Using the Wisenews database, 11 of the most influential newspapers in mainland China were selected to obtain the sample articles. The health policy uncertainty (HPU) index for each month from 2003 to 2022 was constructed by searching articles containing the specified keywords and calculating their frequency. Robustness tests were conducted through correlation analysis. The HPU index was plotted using STATA (version 16.0), and a comparative analysis of the China and US HPU indexes was then performed.

RESULTS

We retrieved 6482 sample articles from 7.49 million news articles in 11 newspapers. The China HPU index was constructed, and the robustness test showed a correlation coefficient greater than 0.74, which indicates good robustness. Key health events can cause index fluctuations. At the beginning of COVID-19 (May 2020), the HPU index climbed to 502.0. In December 2022, China's HPU index reached its highest value of 613.8 after the release of the "New Ten Rules" pandemic prevention and control policy. There were significant differences in HPU index fluctuations between China and the United States during SARS and COVID-19, as well as during the Affordable Care Act period.

CONCLUSIONS

National health policy is a guide for health development, and uncertainty in health policy can affect not only the implementation of policy by managers but also the health-seeking behavior of the people. Here, we conclude that changes in critical health policies, major national or international events, and infectious diseases with widespread impact can create significant uncertainty in China's health policies. The uncertainty of health policies in China and the United States is quite different due to different political systems and news environments. What is the same is that COVID-19 has brought great policy volatility to both countries. To the best of our knowledge, our work is the first systematic text mining study of HPU in China.

Operational considerations for the management of non-communicable diseases in humanitarian emergencies

Non-communicable diseases (NCD) represent an increasing global challenge with the majority of mortality occurring in low- and middle-income countries (LMICs). Concurrently, many humanitarian crises occur in these countries and the number of displaced persons, either refugees or internally displaced, has reached the highest level in history. Until recently NCDs in humanitarian contexts were a neglected issue, but this is changing. Humanitarian actors are now increasingly integrating NCD care in their activities and recognizing the need to harmonize and enhance NCD management in humanitarian crises. However, there is a lack of a standardized response during operations as well as a lack of evidence-based NCD management guidelines in humanitarian settings. An informal working group on NCDs in humanitarian settings, formed by members of the World Health Organization, Médecins Sans Frontières, the International Committee of the Red Cross, the International Federation of the Red Cross and others, and led by the United Nations High Commissioner for Refugees, teamed up with the University of Geneva and Geneva University Hospitals to develop operational considerations for NCDs in humanitarian settings. This paper presents these considerations, aiming at ensuring appropriate planning, management and care for NCD-affected persons during the different stages of humanitarian emergencies. Key components include access to treatment, continuity of care including referral pathways, therapeutic patient education/patient self-management, community engagement and health promotion. In order to implement these components, a standardized approach will support a consistent response, and should be based on an ethical foundation to ensure that the "do no harm" principle is upheld. Advocacy supported by evidence is important to generate visibility and resource allocation for NCDs. Only a collaborative approach of all actors involved in NCD management will allow the spectrum of needs and continuum of care for persons affected by NCDs to be properly addressed in humanitarian programmes.

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.

Adolescents' perspectives on the psychological effects of natural disasters in China and Nepal

Adolescents are disproportionately represented in nations vulnerable to humanitarian crises. The mental health effects of exposure to trauma are significant, but evidence concerning the experience of disaster-affected adolescents in Asia is limited. The current study aimed to investigate expressions of psychological distress and behavioral effects of exposure to natural disasters among adolescents in China and Nepal. Key informant interviews and focus group discussions were conducted with adolescents, caregivers, teachers and experts in disaster-affected districts of Yunnan Province, China (n = 79), and Kathmandu Valley, Nepal (n = 62). Open coding and thematic content analysis were employed to examine themes within the data. Indicators of distress were categorized in four domains that reflected expressions of anxiety and stress, mood difficulties, somatic complaints, and behavioral changes for adolescent disaster survivors. Differential reports of psychological concerns by gender were evident in Nepal but not China. Post-traumatic growth and strengthened connections between adolescents and their families were described in both settings. The findings complement similar reports from disaster-affected populations globally that have highlighted cross-cultural elements manifest in adolescents' descriptions of distress. Sustainable mental health services that are sensitive to adolescents' experiences of trauma and their unique capabilities will be a necessary component of long-term rehabilitation following disasters.

Scientific evidence on natural disasters and health emergency and disaster risk management in Asian rural-based area

INTRODUCTION

Disaster epidemiological studies indicate that Asia has the highest frequency of natural disasters. Rural communities are heavily impacted by natural disasters and have different healthcare needs to urban ones. Referencing Asian countries, this paper's objective is to provide an overview of health impacts and the current evidence for designing programmes and policies related to rural health emergency and disaster risk management (health-EDRM).

SOURCES OF DATA

This paper uses published English-only reports and papers retrieved from PubMed, Google Scholar, Embase, Medline and PsycINFO on rural disaster and emergency responses and relief, health impact and disease patterns in Asia (January 2000-January 2018).

AREAS OF AGREEMENT

Earthquakes are the most studied natural disasters in rural communities. The medical burden and health needs of rural communities were most commonly reported among populations of extreme age. Most of the existing research evidence for rural interventions was reported in China. There lacks published peer-reviewed reports of programme impacts on personal and community preparedness.

AREAS OF CONTROVERSY

There is a lack of evidence-based health-EDRM interventions to evaluate implementation effectiveness in rural areas despite vast volumes of health-related disaster literature.

GROWING POINTS

Climate change-related disasters are increasing in frequency and severity. Evidence is needed for disaster risk reduction interventions to address the health risks specific to rural populations.

AREAS TIMELY FOR DEVELOPING RESEARCH

To support global policy development, urgent evidence is needed on the intervention effectiveness, long-term health outcomes, local and cultural relevance as well as sustainability of health relief produced by Health-EDRM programmes in rural areas.

Mental health workers perceptions of disaster response in China

BACKGROUND

The post-disaster mental health crisis intervention (MHCI) system in China remains immature and unsystematic. We aim to report the perceptions of a large sample of MHCI workers and government administrators and provide recommendations for developing a national mental health disaster response management plan in China.

METHODS

An in-depth qualitative study was conducted, collecting data from 20 focus-group discussions and 25 key stakeholder interviews. These recruited participants who had been involved in different types of disaster rescue across 7 provinces/cities where disasters have recently occurred. We used thematic analysis to analyze the data and relevant findings were extracted for policy recommendation.

RESULTS

Mental health workers' perspectives were examined in detailed according to four core themes: forms of organization, intervention pathway, intervention strategy and technique, and public health information. Post-disaster MHCI should be approached in teams that are integrated with emergency medicine systems, and be led by unified command management. All levels of local health and family planning commission should prepare post-disaster MHCI work plans and build response teams/emergency centres. Future training for MHCI workers should focus on: building a sense of trust within the team; clarifying each member's role; strengthening the screening, assessment and referrals training for psychological professionals; and providing psychological intervention training for Chinese psychiatrists. It is necessary to set up guiding principles for disaster research ethics, mental health rehabilitation and media interaction.

CONCLUSIONS

Through exploring and analyzing the perceptions of current disaster response mental health workers and government administrators, our findings provide essential recommendations for developing a national to county level post-disaster MHCI emergency management plan and can guide the formulation of relevant laws and regulation in China.

A senior high school-based survey on the long-term impact of the Wenchuan earthquake on survivors' quality of life: PTSD as a mediator

Previous earthquake-related studies mostly focused on the prevalence and risk factors of post-traumatic stress disorder (PTSD), and there are only a few articles on the subsequent long-term outcomes of earthquakes. This study aimed to investigate the long-term impact of the Wenchuan earthquake on the quality of life (QOL) of surviving senior high school students 2-3 years post-disaster and to clarify whether PTSD was a mediator in the relationship of earthquake-related exposure and QOL. The study collected 1031 survivors' self-report questionnaires on socio-demographic data, earthquake-related experiences, PTSD symptoms (PCL-C), and QOL (WHOQOL-BREF). The results showed that earthquake-related exposure experiences were negatively associated with QOL scores, and the severity of PTSD symptoms was significantly and negatively related to QOL scores. Structural equation model (SEM) analysis showed that earthquake-related exposure was directly related to the severity of PTSD symptoms, while insignificantly directly related to QOL. Therefore, earthquake-related exposure was indirectly related to QOL (totally mediated by severity of PTSD symptoms). PTSD was a mediator in the relationship between earthquake-related exposure and QOL among adolescents: earthquake-related exposure affected the survivors' QOL mainly mediated by the PTSD symptoms that developed. Therefore, to improve the QOL of the survivors after an earthquake, more attention should be paid to survivors who have PTSD symptoms.

Assessment of the Public Health Risks and Impact of a Tornado in Funing, China, 23 June 2016: A Retrospective Analysis

(1) Background: Tornadoes are one of the deadliest disasters but their health impacts in China are poorly investigated. This study aimed to assess the public health risks and impact of an EF-4 tornado outbreak in Funing, China; (2) Methods: A retrospective analysis on the characteristics of tornado-related deaths and injuries was conducted based on the database from the Funing's Center for Disease Control and Prevention (CDC) and Funing People's Hospital. A change-point time-series analysis of weekly incidence for the period January 2010 to September 2016 was used to identify sensitive infectious diseases to the tornado; (3) Results: The 75 to 84 years old group was at the highest risk of both death (RR = 82.16; 95% CIs = 19.66, 343.33) and injury (RR = 31.80; 95% CI = 17.26, 58.61), and females were at 53% higher risk of death than males (RR = 1.53; 95% CIs = 1.02, 2.29). Of the 337 injuries, 274 injuries (81%) were minor. Most deaths occurred indoors (87%) and the head (74%) was the most frequent site of trauma during the tornado. Five diseases showed downward change-points; (4) Conclusions: The experience of the Funing tornado underscores the relative danger of being indoors during a tornado and is successful in avoiding epidemics post-tornado. Current international safety guidelines need modification when generalized to China.

Are older people more vulnerable to long-term impacts of disasters?

BACKGROUND

Despite the growing interest in the study of disasters, there is limited research addressing the elderly population that lead to prejudiced beliefs that older adults are more vulnerable to disasters than younger adults. This study aimed to compare positive mental health between elderly and young earthquake survivors.

METHOD

Data for this study, consisting of 324 earthquake survivors, were obtained from a population-based cross-sectional survey conducted in Iran, 2015. The long-term effect of earthquake was assessed using the Mental Health Continuum-Short Form questionnaire. A one-way multivariate analysis of covariance (MANCOVA) using SPSS (version 22) was used in data analysis.

RESULTS

Older adults scored significantly a higher level of overall positive mental health (mean [M]=34.31, standard deviation [SD]=10.52) than younger age group (M=27.48, SD=10.56, t=-4.41; P<0.001). Results of MANCOVA revealed a statistically significant difference between older and young adults on the combined positive mental health subscales (F_(3,317)=6.95; P<0.001), after controlling for marital status, sex, and employment status.

CONCLUSION

The present findings showing a higher level of positive mental health among elderly earthquake survivors compared with their younger counterparts in the wake of natural disasters suggest that advancing age per se does not contribute to increasing vulnerability.

Experiences in disaster-related mental health relief work: An exploratory model for the interprofessional training of psychological relief workers

The purpose of this study was to begin to generate an exploratory model of the disaster-related mental health education process associated with the training experiences of psychological relief workers active during the Sichuan earthquake in China. The data consisted of semi-structured interviews with 20 psychological relief workers from four different professions (social workers, psychiatric nurses, psychiatrists, and counsellors) regarding their experiences in training and ideas for improvement. The model explains the need to use a people-centred community interprofessional education approach, which focuses on role-modelling of the trainer, caring for relief workers, paying attention to the needs of the trainee, and building systematic interprofessional education strategies. The proposed model identifies areas for the comprehensive training of relief workers and aims to address the importance of people-centred mental health service provisions, ensure intentional and strategic training of relief workers using interprofessional concepts and strategies, and use culturally attuned and community-informed strategies in mental health training practices.

Lessons and Challenges of Disaster Relief Work in Rural China

Due to the disastrous Wenchuan earthquake that hit Sichuan, China, on May 12, 2008, approximately 70,000 people died, around 400,000 were injured, 18,467 were missing, and millions were left homeless due to the collapse of their homes. The substantial trauma and loss in the disaster area posed a challenge for disaster relief work focused on survivors’ psychological health. Many of the psychological interventions were based on Western or urban outpatient populations and were thus inappropriate for the uneducated, agriculturally based population of rural China, potentially limiting patient care and sensitivity during this postdisaster relief. This article discusses the therapeutic issues involved and finds that the collectivist nature of the rural Chinese culture and indigenized ways of working with the earthquake survivors are of paramount importance. It adds to the research literature by discussing the importance of relationships through the Chinese concept of Guanxi in the context of disaster relief work in rural China. Consistent with the concept of Guanxi, disaster relief volunteers must fully respect the world of the survivors while remaining flexible and creative in their work to build deeper connections and relationships.

Comparison of prosthetic outcomes between adolescent transtibial and transfemoral amputees after Sichuan earthquake using Step Activity Monitor and Prosthesis Evaluation Questionnaire

BACKGROUND

The devastating earthquake in Sichuan in 2008 has left many adolescent amputees. However, little research has been focused on the adolescent amputees who have high potential to return to premorbid activity level.

OBJECTIVES

To investigate daily step activities and prosthesis-related quality of life of the adolescent transtibial and transfemoral amputees after the earthquake.

STUDY DESIGN

A prospective and descriptive study.

METHODS

A total of 21 adolescent unilateral amputees (11 transtibial and 10 transfemoral amputees) were recruited. Step Activity Monitors and Prosthesis Evaluation Questionnaire were used to assess patients over a 3-month period.

RESULTS

The average number of steps per day was 4577 ± 849 and 2551 ± 693 in transtibial and transfemoral amputees, respectively. Transtibial amputees had significantly higher (p < 0.05) levels of step activity than transfemoral amputees in all Step Activity Monitors measures. Prosthetic compliance was good with daily wearing time of above 12 h/day in both groups. Prosthesis Evaluation Questionnaire scores showed no significant difference between two groups.

CONCLUSIONS

The subjective quality of life is similar for adolescent amputees across transtibial and transfemoral amputation levels. Higher levels of step activity of transtibial amputees suggest that they have had lower energy expenditure and more capacity for ambulation.

CLINICAL RELEVANCE

This article involves a unique subset of young amputees who have sustained traumatic amputations following a major natural disaster. It provides a better understanding on the daily activities and quality of life, and could assist in optimizing the prosthetic outcomes of this subset of populations.

Health education and promotion at the site of an emergency: experience from the Chinese Wenchuan earthquake response

Theories and strategies of social mobilization, capacity building, mass and interpersonal communication, as well as risk communication and behavioral change were used to develop health education and promotion campaigns to decrease and prevent injuries and infectious diseases among the survivors of the Wenchuan earthquake in May 2008. We evaluated the effectiveness of the campaigns and short-term interventions using mixed-methods. The earthquake survivors' health knowledge, skills, and practice improved significantly with respect to injury protection, food and water safety, environmental and personal hygiene, and disease prevention. No infectious disease outbreaks were reported after the earthquake, and the epidemic level was lower than before the earthquake. After a short-term intervention among the students of Leigu Township Primary and Junior School, the proportion of those with personal hygiene increased from 59.7% to 98.3% (p< 0.01). Of the sampled survivors from Wenchuan County, 92.3% reported to have improved their health knowledge and 54.9% improved their health practice (p< 0.01). Thus, health education and promotion during public health emergencies such as earthquakes play an important role in preventing injuries and infectious diseases among survivors.

The public health system response to the 2008 Sichuan province earthquake: a literature review and interviews

This paper describes and analyses the public health system response to the deadly earthquake in Sichuan province, China, in May 2008. Drawing on an experiential learning project consisting of a literature review and field research, including a series of interviews with medical and public health professionals, policy-makers and first responders, a conceptual framework was developed to describe the response. This approach emphasises the pre-existing preparedness level of the medical and public health systems, as well as social, economic and geo-political factors that had an impact on mitigation efforts. This framework was used to conduct post-disaster analyses addressing major response issues and examining methods employed during the public health response to the disaster. This framework could be used to describe and analyse the emergency response to other disasters.

Progress and challenges of disaster health management in China: a scoping review

Background

Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries.

Objective

This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity.

Design

A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims.

Results

The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue.

Conclusions

One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Epidemiological analysis of trauma patients following the Lushan earthquake

BACKGROUND

A 7.0-magnitude earthquake hit Lushan County in China's Sichuan province on April 20, 2013, resulting in 196 deaths and 11,470 injured. This study was designed to analyze the characteristics of the injuries and the treatment of the seismic victims.

METHODS

After the earthquake, an epidemiological survey of injured patients was conducted by the Health Department of Sichuan Province. Epidemiological survey tools included paper-and-pencil questionnaires and a data management system based on the Access Database. Questionnaires were completed based on the medical records of inpatients with earthquake-related injuries. Outpatients or non-seismic injured inpatients were excluded. A total of 2010 patients from 140 hospitals were included.

RESULTS

The most common type of injuries involved bone fractures (58.3%). Children younger than 10 years of age suffered fewer fractures and chest injuries, but more skin and soft -tissue injuries. Patients older than 80 years were more likely to suffer hip and thigh fractures, pelvis fractures, and chest injuries, whereas adult patients suffered more ankle and foot fractures. A total of 207 cases of calcaneal fracture were due to high falling injuries related to extreme panic. The most common type of infection in hospitalized patients was pulmonary infections. A total of 70.5% patients had limb dysfunction, and 60.1% of this group received rehabilitation. Most patients received rehabilitation within 1 week, and the median duration of rehabilitation was 3 weeks. The cause of death of all seven hospitalized patients who died was severe traumatic brain injuries; five of this group died within 24 h after the earthquake.

CONCLUSIONS

Injuries varied as a function of the age of the victim. As more injuries were indirectly caused by the Lushan earthquake, disaster education is urgently needed to avoid secondary injuries.

Moderating effects of a postdisaster intervention on risk and resilience factors associated with posttraumatic stress disorder in Chinese children

This study is an evaluation of a psychosocial intervention involving child and adolescent survivors of the 2008 Sichuan China earthquake. Sociodemographics, earthquake-related risk exposure, resilience using the Connor-Davidson Resilience Scale, and posttraumatic stress disorder (PTSD) using the UCLA-PTSD Index were collected from 1,988 intervention participants and 2,132 controls. Mean resilience scores and the odds of PTSD did not vary between groups. The independent factors for risk and resilience and the dependent variable, PTSD, in the measurement models between control and intervention groups were equivalent. The structural model of risk and 2 resilience factors on PTSD was examined and found to be unequivalent between groups. In contrast to controls, risk exposure (B = −0.32, p <.001) in the intervention group was negatively associated with PTSD. Rational thinking (B = −0.48, p < .001), a resilience factor, was more negatively associated with PTSD in the intervention group. The second resilience factor explored, self-awareness, was positively associated with PTSD in both groups (B = 0.46 for controls, p < .001, and B = 0.69 for intervention, p < .001). Results highlight the need for more cross-cultural research in resilience theory to develop culturally appropriate interventions and evaluation measures.

Developing a new perspective to study the health of survivors of Sichuan earthquakes in China: a study on the effect of post-earthquake rescue policies on survivors' health-related quality of life

Background

Sichuan is a province in China with an extensive history of earthquakes. Recent earthquakes, including the Lushan earthquake in 2013, have resulted in thousands of people losing their homes and their families. However, there is a research gap on the efficiency of government support policies. Therefore, this study develops a new perspective to study the health of earthquake survivors, based on the effect of post-earthquake rescue policies on health-related quality of life (HRQOL) of survivors of the Sichuan earthquake.

Methods

This study uses data from a survey conducted in five hard-hit counties (Wenchuan, Qingchuan, Mianzhu, Lushan, and Dujiangyan) in Sichuan in 2013. A total of 2,000 questionnaires were distributed, and 1,672 were returned; the response rate was 83.6%.

Results

Results of the rescue policies scale and Medical Outcomes Study Short Form 36 (SF-36) scale passed the reliability test. The confirmatory factor analysis model showed that the physical component summary (PCS) directly affected the mental component summary (MCS). The results of structural equation model regarding the effects of rescue policies on HRQOL showed that the path coefficients of six policies (education, orphans, employment, poverty, legal, and social rescue policies) to the PCS of survivors were all positive and passed the test of significance. Finally, although only the path coefficient of the educational rescue policy to the MCS of survivors was positive and passed the test of significance, the other five policies affected the MCS indirectly through the PCS.

Conclusions

The general HRQOL of survivors is not ideal; the survivors showed a low satisfaction with the post-earthquake rescue policies. Further, the six post-earthquake rescue policies significantly improved the HRQOL of survivors and directly affected the promotion of the PCS of survivors. Aside from the educational rescue policy, all other policies affected the MCS indirectly through the PCS. This finding indicates relatively large differences in the effects of different post-earthquake rescue policies on the HRQOL of survivors.

Lessons learned from the Wenchuan earthquake

OBJECTIVES

To conclude experience and lessons from emergency medical rescue after Wenchuan Earthquake from national and overall review for consideration on worldwide catastrophe rescue in the future.

METHODS

To systematically collect huge amount of primary data, and to make analysis, draw conclusions and lessons in terms of five aspects respectively as quake-damage conditions, command system, emergency medical rescue, prevention and control over infectious diseases as well as pairing-assistance for medical system and service reconstruction.

RESULTS

1. Numbers as of the death, injured and migrants made Wenchuan Earthquake ranked one of the top 9 catastrophes around the world during the past two decades. 2. Countermeasures such as four-level linkage by nation-province-city-county model, mutual assistance between military force and local forces, frontline commanding did effectively ensure the dispatch and cooperation among rescue forces. 3. Three-leveled medical transfers, "four concentrations" prevention and treatment besides whole-course rehabilitation at early stage managed to lower mortality and disability rate to minimum levels respectively. 4. "Four-keynote infectious disease control" under whole coverage and "five measures and four reinforcement measures" in settlements made rates as for those infectious diseases under the average level as those in the 3 pre-quake years. 5. Pairing-assistance in terms of talents, finance, materials as well as capacity building between other 18 provinces/municipalities and those 18 extremely-stricken/severely-stricken areas in Sichuan Province guaranteed efficient post-quake reconstruction, system reconstruction and long-term mechanism construction.

CONCLUSIONS

Successful experience from Wenchuan Earthquake could be summarized as: one goal as people-oriented life-rescuing. Two tasks as medical rescue for diseases of those injured and healthcare & anti-epidemic for safe and sound of those lives. Three strategies respectively as medical transfers after on-site triage, treatment for severe diseases in quake-hit areas and rehabilitation in non quake-hit areas for medical rescue, and quick post-quake evaluation, quick promotion for whole coverage and scientific regulation in long term for healthcare & anti-epidemic. Four measures as concentration for patients, experts, resources and treatment respectively for medical rescue, and key regions, key groups, key infectious diseases and key steps for healthcare & anti-epidemic. Five links as overall commanding, medical rescue, healthcare and anti-epidemic, physical/mental rehabilitation and post-quake reconstruction. And whole course surveillance as information guidance, policy guarantee, data collection, evidence producing, effectiveness evaluation, and academic communication.

Emergency medical rescue efforts after a major earthquake: lessons from the 2008 Wenchuan earthquake

Major earthquakes often result in incalculable environmental damage, loss of life, and threats to health. Tremendous progress has been made in response to many medical challenges resulting from earthquakes. However, emergency medical rescue is complicated, and great emphasis should be placed on its organisation to achieve the best results. The 2008 Wenchuan earthquake was one of the most devastating disasters in the past 10 years and caused more than 370,000 casualties. The lessons learnt from the medical disaster relief effort and the subsequent knowledge gained about the regulation and capabilities of medical and military back-up teams should be widely disseminated. In this Review we summarise and analyse the emergency medical rescue efforts after the Wenchuan earthquake. Establishment of a national disaster medical response system, an active and effective commanding system, successful coordination between rescue forces and government agencies, effective treatment, a moderate, timely and correct public health response, and long-term psychological support are all crucial to reduce mortality and morbidity and promote overall effectiveness of rescue efforts after a major earthquake.

Sichuan earthquake and emergency relief care for children: report from the firstly arrived pediatricians in the epicenter zone

OBJECTIVE

An 8.0-magnitude earthquake struck Sichuan province of China on May 12, 2008. Over the next 10 days, the firstly arrived uniformed pediatricians in the epicenter zone took part in emergency relief care for children. The investigations of major injuries and diseases in children were taken.

METHODS

Demographic data collected included (if possible) age, date of presentation, injury, disease, and surgery performed.

RESULTS

Total casualties were estimated to be more than 80,000, and much more were injured. Eight hundred eighty-two inpatients were treated by the relief team during the first 10 days. Of 882 inpatients, 192 (21.8%) were younger than 18 years. Children's ages were not evenly distributed. Twenty-seven patients were neonates, infants, and toddlers (14%), 105 were school-aged (55%), and were 60 adolescents (31%). The admitted children had 256 injuries. Limb (106 cases, 55.2%) and body surface (67 cases, 34.9%) were the majorly injured locations. One hundred twenty-seven cases (66.2%) had simple open injuries, and 106 (55.2% had fractures. The children's conditions were evaluated as mild (121 cases, 63.0%), moderate (56 cases, 29.7%), severe (8 cases, 4.2%), and fatal (7 cases, 3.7%).

CONCLUSIONS

More than 20% of patients requiring hospitalization were children. School-aged children were heavily injured. The increase in infectious diseases followed on. The data show that there is an immediate need for orthopedic and general surgery skills, and pediatricians should play an important role in early rescue and subsequent control of infectious diseases in a huge earthquake hazard.

Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor

The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic Society established the "Stand Tall" project to provide voluntary services to aid amputee victims in achieving total rehabilitation and social integration. This case report highlights the multidisciplinary rehabilitation of a girl who suffered thoracolumbar vertebral collapse and underwent bilateral transtibial amputation. The rehabilitation team was involved in all stages of the care process from the pre-operative phase, through amputation, into prosthetic training, and during her life thereafter. Despite this catastrophic event, early rehabilitation and specially designed bilateral prostheses allowed her a high level of functional ability. The joint efforts of the multidisciplinary team and the advancement of new technology have revolutionized the care process for amputees.

Case report of multidisciplinary management of a unilateral transhumeral amputee

Background

After the 12 May 2008 Sichuan disaster, thousands of injured survivors required intensive rehabilitation. Stand Tall project volunteered to help the earthquake victims with state-ofthe-art prosthesis and rehabilitation technology.

Content

This case report highlights the multidisciplinary rehabilitation module for a 9-year-old girl with unilateral transhumeral amputee. Early intervention for rehabilitation and multidisciplinary approach were the keys to her successful pathway. In pre-prosthetic phase, physical and activities of daily livings training, prosthesis fitting and motor training for myoelectric hand were essential.

Conclusions

Despite her young age, functional training for usage of prosthesis was successful and her rehabilitation outcome was satisfactory. The ultimate goal of rehabilitation in her case would be use of bilateral hands, psychological adjustment and social reintegration.

Are the elderly more vulnerable to psychological impact of natural disaster? A population-based survey of adult survivors of the 2008 Sichuan earthquake

BACKGROUND

The association between ages and psychological impact of natural disasters has not been well characterized. A population-based study was conducted 15 months after the 2008 Sichuan earthquake to assess whether elderly survivors were more likely to develop posttraumatic stress disorder (PTSD) and general psychiatric morbidity.

METHODS

A population-based survey of 327 survivors (152 elders, 175 younger adults) was conducted in severely affected areas by the earthquake, using a multi-stage systematic sampling design.

RESULTS

Compared with the younger adult survivors, the elderly were more likely to have symptoms of PTSD (22.5% vs. 8.0%, p = 0.001) and general psychiatric morbidity (42.0% vs. 25.4%, p = 0.003). Risk factors, such as being elderly, having been in serious danger, having lost family members, and having felt guilt concerning one's death or injury were significantly associated with developing PTSD; being elderly, having family members or friends seriously injured, and having felt guilt concerning one's death or injury were significantly associated with developing general psychiatric morbidity. Utilization of mental health services is strongly associated with the decreased risk for developing both of the symptoms.

CONCLUSION

Compared with the younger adults, the elderly survivors were more likely to develop PTSD and general psychiatric morbidity. More mental health services should be distributed to the elderly and groups at particular risk, to ensure their smooth mental health reconstruction after the earthquake.

Preparedness lessons from modern disasters and wars

Disasters come in all shapes and forms, and in varying magnitudes and intensities. Nevertheless, they offer many of the same lessons for critical care practitioners and responders. Among these, the most important is that well thought out risk assessment and focused planning are vital. Such assessment and planning require proper training for providers to recognize and treat injury from disaster, while maintaining safety for themselves and others. This article discusses risk assessment and planning in the context of disasters. The article also elaborates on the progress toward the creation of portable, credible, sustainable, and sophisticated critical care outside the walls of an intensive care unit. Finally, the article summarizes yields from military-civilian collaboration in disaster planning and response.

Dentists' role in treating facial injuries sustained in the 2008 earthquake in China: how dental professionals can contribute to emergency response

BACKGROUND

A major earthquake struck Sichuan province, China, on May 12, 2008, and the authors were involved in the medical response to the disaster in Jiangyou City, an area hard-hit by the quake. In this article, they analyze data about the earthquake-related facial injuries and assess dentistry's role in treating them.

METHODS

This descriptive study included review of medical records for 4,582 patients with earthquake-related trauma at eight hospitals in Jiangyou, a city severely affected by the earthquake, for the day of the disaster and the 14 days immediately afterward.

RESULTS

Of the 4,582 patients, 408 (8.9 percent) sustained a total of 482 facial injuries. The dental team treated patients with facial injuries and others who needed care.

CONCLUSIONS

Facial injuries constitute a significant portion of earthquake-related trauma, and dentists therefore are an important part of the medical team that deals with such trauma. Dentists are a reliable force in the medical response to earthquakes and other disasters.

CLINICAL IMPLICATIONS

The dental team should play an important role in disaster response. Establishing oral and maxillofacial surgeon (OMS)/dentist reserves and active leagues that use OMSs' and general dentists' offices as bases can help improve disaster response.