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Douedari Y, Alhaffar M, Khanshor A, Alrashid Alhiraki O, Marzouk M, Howard N. ' COVID-19 is just another way to die…': a qualitative longitudinal study of frontline COVID-19 response governance across Syria. BMJ Glob Health 2023; 8:e013199. [PMID: 38084479 PMCID: PMC10711850 DOI: 10.1136/bmjgh-2023-013199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Governance of COVID-19 responses has been challenging for all countries. Syria has been particularly challenged due to protracted multiparty conflict and debilitated health systems fragmented across different areas of control. To improve response governance, better understanding of frontline response policy implementation across the country is needed. This study thus explored perspectives of COVID-19 response governance among frontline healthcare providers over time and across major areas of control. METHODS We used a qualitative longitudinal study design, conducting five rounds of remote semistructured interviews in Arabic (ie, approximately eight interviews each in March 2020, July 2020, September 2020, December 2020 and September 2021) with 14 purposively sampled public and private healthcare providers in the three main areas of control (ie, opposition-controlled area, Autonomous Administration-controlled area and al-Assad government-controlled area (GCA)). We conducted integrative thematic analysis in Arabic within and across geography and time. RESULTS Almost all participants across all areas and rounds expressed distrust of local health authorities and dissatisfaction with COVID-19 response governance. This was most apparent in initial rounds and in GCA. Response planning was identified as insufficient, non-participatory and non-transparent. Limited infrastructure and resources were the main challenges across time, though anticipated rapid virus spread and health systems' collapse did not occur and participant optimism increased over time. Public adherence to prevention measures varied-initially weak due to general scepticism, increasing after first cases were confirmed and then fluctuating with case numbers and challenges of insecurity and misinformation. Perceptions of COVID-19 vaccination varied, with low uptake and hesitancy attributed to misinformation, disinformation and disinterest. Suggested improvements to COVID-19 response governance focused on strengthening health systems' capacity and coordination. CONCLUSION This is a unique longitudinal study of COVID-19 responses. Addressing transparency and misinformation should be a first step to improving public engagement and trust and thus response governance for health emergencies in Syria.
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Affiliation(s)
- Yazan Douedari
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Free Aleppo University, Azaz, Syria
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Mervat Alhaffar
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Ahmad Khanshor
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Omar Alrashid Alhiraki
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
- Acute Medicine Department, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Manar Marzouk
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Darker CD, O'Connell N, Dempster M, Graham CD, O'Connor C, Zgaga L, Nolan A, Tobin K, Brennan N, Nicolson G, Burke E, Mather L, Crowley P, Scally G, Barry J. Study protocol for the COvid-19 Toolbox for All IslaNd (CONTAIN) project: A cross-border analysis in Ireland to disentangle psychological, behavioural, media and governmental responses to COVID-19. HRB Open Res 2021; 3:48. [PMID: 33659855 PMCID: PMC7898359 DOI: 10.12688/hrbopenres.13105.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/03/2023] Open
Abstract
COVID-19 represents a serious challenge to governments and healthcare systems. In addition to testing/contact tracing, behavioural and social responses such as handwashing and social distancing or cocooning are effective tools for mitigating the spread of the disease. Psychological (e.g., risk perceptions, self-efficacy) and contextual factors (government, public health messaging, etc.) are likely to drive these behaviours. Collated real-time information of these indicators strengthens local, national and international public health advice and messaging. Further, understanding how well public health and government messages and measures are understood, communicated via (social) media and adhered to is vital. There are two governments and public health jurisdictions on the island of Ireland, the Republic of Ireland (ROI) and Northern Ireland (NI). This represents an opportunity to explore implications of differing measures and messaging across these two jurisdictions as they relate to COVID-19 on two similar populations. The expert research team are drawn from a range of disciplines in the two countries. This project has four nested studies: Assessment of key behavioural, social and psychological factors through a large, prospective representative telephone survey of individuals aged over-18 on a weekly basis over eight weeks (n=3072); and conduct qualitative focus groups over the same period.Interrogation of social media messaging and formal media responses in both jurisdictions to investigate the spread of (mis)information.Modelling data from Studies 1 and 2, plotting the psychosocial/behavioural and media messaging information with international, ROI and NI incidence and mortality data. Conducting an assessment of health policy transfer in an attempt to incorporate the most significant public health and political insights from each jurisdiction. The CONTAIN project will develop an evidence-based toolbox for targeting public health messaging and political leadership and will be created for use for the anticipated second wave of COVID-19, and subsequently for future epidemics/pandemics.
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Affiliation(s)
- Catherine D. Darker
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Nicola O'Connell
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Martin Dempster
- School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - Christopher D. Graham
- School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - Cliodhna O'Connor
- School of Psychology, University College Dublin, Newman Building, Belfield, D04 V1W8, Ireland
| | - Lina Zgaga
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Ann Nolan
- Trinity Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin, D02 K104, Ireland
| | - Katy Tobin
- Trinity Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin, D02 PN40, Ireland
| | - Niamh Brennan
- Trinity College Library, Trinity College Dublin, Dublin, D02 PN40, Ireland
| | - Gail Nicolson
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Emma Burke
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Luke Mather
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Philip Crowley
- Quality Improvement, Health Service Executive, Dr Steevens’ Hospital, Dublin, D08 W2A8, Ireland
| | - Gabriel Scally
- School of Medicine, University of Bristol, Bristol, Tyndall Venue, BS8 1TH, UK
| | - Joseph Barry
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
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Darker CD, O'Connell N, Dempster M, Graham CD, O'Connor C, Zgaga L, Nolan A, Tobin K, Brennan N, Nicolson G, Burke E, Mather L, Crowley P, Scally G, Barry J. Study protocol for the COvid-19 Toolbox for All IslaNd (CONTAIN) project: A cross-border analysis in Ireland to disentangle psychological, behavioural, media and governmental responses to COVID-19. HRB Open Res 2021; 3:48. [PMID: 33659855 PMCID: PMC7898359 DOI: 10.12688/hrbopenres.13105.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
COVID-19 represents a serious challenge to governments and healthcare systems. In addition to testing/contact tracing, behavioural and social responses such as handwashing and social distancing or cocooning are effective tools for mitigating the spread of the disease. Psychological (e.g., risk perceptions, self-efficacy) and contextual factors (government, public health messaging, etc.) are likely to drive these behaviours. Collated real-time information of these indicators strengthens local, national and international public health advice and messaging. Further, understanding how well public health and government messages and measures are understood, communicated via (social) media and adhered to is vital. There are two governments and public health jurisdictions on the island of Ireland, the Republic of Ireland (ROI) and Northern Ireland (NI). This represents an opportunity to explore implications of differing measures and messaging across these two jurisdictions as they relate to COVID-19 on two similar populations. The expert research team are drawn from a range of disciplines in the two countries. This project has four nested studies:
Assessment of key behavioural, social and psychological factors through a large, prospective representative telephone survey of individuals aged over-18 on a weekly basis over eight weeks (n=3072); and conduct qualitative focus groups over the same period. Interrogation of social media messaging and formal media responses in both jurisdictions to investigate the spread of (mis)information. Modelling data from Studies 1 and 2, plotting the psychosocial/behavioural and media messaging information with international, ROI and NI incidence and mortality data. Conducting an assessment of health policy transfer in an attempt to incorporate the most significant public health and political insights from each jurisdiction. The CONTAIN project will develop an evidence-based toolbox for targeting public health messaging and political leadership and will be created for use for the anticipated second wave of COVID-19, and subsequently for future epidemics/pandemics.
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Affiliation(s)
- Catherine D Darker
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Nicola O'Connell
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Martin Dempster
- School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - Christopher D Graham
- School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - Cliodhna O'Connor
- School of Psychology, University College Dublin, Newman Building, Belfield, D04 V1W8, Ireland
| | - Lina Zgaga
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Ann Nolan
- Trinity Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin, D02 K104, Ireland
| | - Katy Tobin
- Trinity Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin, D02 PN40, Ireland
| | - Niamh Brennan
- Trinity College Library, Trinity College Dublin, Dublin, D02 PN40, Ireland
| | - Gail Nicolson
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Emma Burke
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Luke Mather
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
| | - Philip Crowley
- Quality Improvement, Health Service Executive, Dr Steevens' Hospital, Dublin, D08 W2A8, Ireland
| | - Gabriel Scally
- School of Medicine, University of Bristol, Bristol, Tyndall Venue, BS8 1TH, UK
| | - Joseph Barry
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland, D24 DH74, Ireland
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Abstract
Disasters are complex events that challenge the coping abilities of individuals and communities. This article reviews the likely impact of such events and factors that compromise the ability of survivors to cope with that impact. The principles of early intervention are also considered, particularly with regard to the role of a mental health adviser. This role is an important and demanding one, and its aims and principles of professional conduct should be carefully scrutinised.
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Shao X, Li X, Ma X, Zhu F. Long-term prediction of dynamic distribution of passive contaminant in complex recirculating ventilation system. BUILDING AND ENVIRONMENT 2017; 121:49-66. [PMID: 32287971 PMCID: PMC7126526 DOI: 10.1016/j.buildenv.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/27/2017] [Accepted: 05/08/2017] [Indexed: 06/11/2023]
Abstract
Recirculating ventilation systems may act as carriers of hazardous substances. The long-term prediction of the dynamic distribution of contaminants in this type of system is crucial for the evaluation of pollution and further design of more efficient ventilation systems. However, few convenient methods can predict the dynamic distribution of contaminants, because the dynamic supply air concentrations resulting from air recirculation are unknown, especially over long time periods, such as months or years. In this study, a novel method is proposed to predict the dynamic distribution of contaminants over a long time period in a complex recirculating ventilation system, where an algebraic expression based on the indices of the response coefficient is applied to account for the relationship between the contaminant distribution inside the room and various boundary conditions. The method is established by obtaining comprehensive mathematical descriptions of the relationships between concentrations of contaminants in the air handling units, supply air inlets, return air outlets, and fresh air. Hourly supply air concentrations can be easily obtained by solving a matrix, and the dynamic distribution of contaminants is then calculated using an expression based on the response coefficient. The reliability of the proposed method is analyzed by both experimental and numerical methods. A simplified method is suggested to accelerate the time-consuming calculation of the response coefficient. The proposed method is beneficial for predicting three-dimensional dynamic distribution of contaminants in complex ventilation systems with an acceptable accuracy and time cost.
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Affiliation(s)
- Xiaoliang Shao
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Xianting Li
- Department of Building Science, School of Architecture, Tsinghua University, Beijing 100084, China
| | - Xiaojun Ma
- College of Biochemical Engineering, Beijing Union University, Beijing 100023, China
| | - Fenfei Zhu
- Department of Building Science, School of Architecture, Tsinghua University, Beijing 100084, China
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6
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Katz AR, Nekorchuk DM, Holck PS, Hendrickson LA, Imrie AA, Effler PV. Bioterrorism Preparedness Survey of Hawaii Mental Health Professionals. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411350101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alan R. Katz
- a Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu
| | - Dawn M. Nekorchuk
- b Bioterrorism Preparedness Food Safety Coordinator, Disease Outbreak Control Division, Hawaii State Department of Health, , Honolulu
| | - Peter S. Holck
- a Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu
| | - Lisa A. Hendrickson
- c Medical Epidemiologist, Disease Outbreak Control Division, Hawaii State Department of Health, , Honolulu
| | - Allison A. Imrie
- a Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu
| | - Paul V. Effler
- d Disease Outbreak Control Division, Hawaii State Department of Health, , Honolulu
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7
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Gouweloos J, Dückers M, te Brake H, Kleber R, Drogendijk A. Psychosocial care to affected citizens and communities in case of CBRN incidents: a systematic review. ENVIRONMENT INTERNATIONAL 2014; 72:46-65. [PMID: 24684819 DOI: 10.1016/j.envint.2014.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/14/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in various recommendations and general guidelines. However, as CBRN (chemical, biological, radiological, nuclear) events form a distinctive theme in emergency planning and disaster preparedness, it is important to systematically explore their implications for psychosocial care. The aim of this study is to answer two questions: 1). To what extent does psychosocial care in the case of CBRN events differ from other types of events? 2). How strong is the scientific evidence for the effectiveness of psychosocial care interventions in the context of a CBRN event? A systematic literature review was conducted. Searches were performed in Medline, PsychINFO, Embase and PILOTS. Studies since January 2000 were included and evaluated by independent reviewers. The 39 included studies contain recommendations, primarily based on unsystematic literature reviews, qualitative research and expert opinions. Recommendations address: 1) public risk- and crisis communication, 2) training, education and exercise of responders, 3) support, and 4) psychosocial counselling and care to citizens and responders. Although none of the studies meet the design criteria for effectiveness research, a substantial amount of consensus exists on aspects relevant to CBRN related psychosocial care. Recommendations are similar or complementary to general post-disaster psychosocial care guidelines. Notable differences are the emphasis on risk communication and specific preparation needs. Relevant recurring topics are uncertainty about contamination and health effects, how people will overwhelm health care systems, and the possibility that professionals are less likely to respond. However, the lack of evidence on effectiveness makes it necessary to be careful with recommendations. More evaluation research is absolutely needed.
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Affiliation(s)
- Juul Gouweloos
- National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
| | - Michel Dückers
- National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
| | - Hans te Brake
- National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
| | - Rolf Kleber
- Utrecht University, Department of Clinical & Health Psychology, PO Box 80140, 3508 TC, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
| | - Annelieke Drogendijk
- National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
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Greenberg N, Langston V, Jones N. Trauma risk management (TRiM) in the UK Armed Forces. J ROY ARMY MED CORPS 2008; 154:124-7. [PMID: 19043994 DOI: 10.1136/jramc-154-02-11] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Trauma Risk Management (TRiM) is a novel system of post incident management which intend to allow commanders to provide appropriate support to their subordinates in the aftermath of traumatic events. Given the current very considerable operational tempo being experienced by the majority of the UK Armed Forces, it is perhaps not surprising that TRiM has been in use in both Iraq and Afghanistan. Although TRiM originated from within the Royal Marines, it is now widely used in both the Royal Navy and Army; there are also plans to introduce it into specific components of the Royal Air Force such as for the RAF Regiment. This paper aims to explore the basis behind the TRiM system and to explore the evidence for its growing popularity within hierarchical organisations such as the military.
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Affiliation(s)
- N Greenberg
- Academic Centre for Defence Mental Health, King's College London
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Jones E, Everitt B, Ironside S, Palmer I, Wessely S. Psychological effects of chemical weapons: a follow-up study of First World War veterans. Psychol Med 2008; 38:1419-1426. [PMID: 18237455 DOI: 10.1017/s003329170800278x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chemical weapons exercise an enduring and often powerful psychological effect. This had been recognized during the First World War when it was shown that the symptoms of stress mimicked those of mild exposure to gas. Debate about long-term effects followed the suggestion that gassing triggered latent tuberculosis. METHOD A random sample of 103 First World War servicemen awarded a war pension for the effects of gas, but without evidence of chronic respiratory pathology, were subjected to cluster analysis using 25 common symptoms. The consistency of symptom reporting was also investigated across repeated follow-ups. RESULTS Cluster analysis identified four groups: one (n=56) with a range of somatic symptoms, a second (n=30) with a focus on the respiratory system, a third (n=12) with a predominance of neuropsychiatric symptoms, and a fourth (n=5) with a narrow band of symptoms related to the throat and breathing difficulties. Veterans from the neuropsychiatric cluster had multiple diagnoses including neurasthenia and disordered action of the heart, and reported many more symptoms than those in the three somatic clusters. CONCLUSIONS Mild or intermittent respiratory disorders in the post-war period supported beliefs about the damaging effects of gas in the three somatic clusters. By contrast, the neuropsychiatric group did not report new respiratory illnesses. For this cluster, the experience of gassing in a context of extreme danger may have been responsible for the intensity of their symptoms, which showed no sign of diminution over the 12-year follow-up.
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Affiliation(s)
- E Jones
- Institute of Psychiatry and King's Centre for Military Health Research, Weston Education Centre, London, UK.
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Isukapalli SS, Lioy PJ, Georgopoulos PG. Mechanistic modeling of emergency events: assessing the impact of hypothetical releases of anthrax. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2008; 28:723-40. [PMID: 18643828 PMCID: PMC3066661 DOI: 10.1111/j.1539-6924.2008.01055.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A modular system for source-to-dose-to-effect modeling analysis has been developed based on the modeling environment for total risk studies (MENTOR),((1)) and applied to study the impacts of hypothetical atmospheric releases of anthrax spores. The system, MENTOR-2E (MENTOR for Emergency Events), provides mechanistically consistent analysis of inhalation exposures for various release scenarios, while allowing consideration of specific susceptible subpopulations (such as the elderly) at the resolution of individual census tracts. The MENTOR-2E application presented here includes atmospheric dispersion modeling, statistically representative samples of individuals along with corresponding activity patterns, and population-based dosimetry modeling that accounts for activity and physiological variability. Two hypothetical release scenarios were simulated: a 100 g release of weaponized B. anthracis over a period of (a) one hour and (b) 10 hours, and the impact of these releases on population in the State of New Jersey was studied. Results were compared with those from simplified modeling of population dynamics (location, activities, etc.), and atmospheric dispersion of anthrax spores. The comparisons showed that in the two release scenarios simulated, each major approximation resulted in an overestimation of the number of probable infections by a factor of 5 to 10; these overestimations can have significant public health implications when preparing for and responding effectively to an actual release. This is in addition to uncertainties in dose-response modeling, which result in an additional factor of 5 to 10 variation in estimated casualties. The MENTOR-2E system has been developed in a modular fashion so that improvements in individual modules can be readily made without impacting the other modules, and provides a first step toward the development of models that can be used in supporting real-time decision making.
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Affiliation(s)
- S S Isukapalli
- Environmental and Occupational Health Sciences Institute, NJ 08854, USA.
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Abstract
OBJECTIVES To discover the content of enduring beliefs held by first world war veterans about their experience of having been gassed. DESIGN Collection and thematic analysis of written and reported statements from a sample of veterans about gassing. SUBJECTS 103 veterans with a war pension. RESULTS Twelve themes were identified, which were related to individual statements. The systemic nature of chemical weapons played a key part in ideas and beliefs about their capacity to cause enduring harm to health. Unlike shrapnel or a bullet that had a defined physical presence, gas had unseen effects within the body, while its capacity to cause damage was apparent from vesicant effects to skin and eyes. The terror inspired by chemical weapons also served to maintain memories of being gassed, while anti-gas measures were themselves disconcerting or a source of discomfort. CONCLUSIONS Chronic symptoms and work difficulties maintained beliefs about the potency of chemical weapons. In the period after the war, gas continued to inspire popular revulsion and was associated with a sense of unfairness.
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Affiliation(s)
- Edgar Jones
- Institute of Psychiatry and King's Centre for Military Health Research, Weston Education Centre, London SE5 9RJ.
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12
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Abstract
Children and families are now in the front line of war, conflict and terrorism as a consequence of the paradigm shift in the nature of warfare and the growth of terror as a weapon. They are as vulnerable as are adults to the traumatizing effects of violence and mass violence. Furthermore, employing children as soldiers is not new, but it is continuing and young people are also perpetrators of other forms of violence. This paper summarizes a selection of the literature showing the direct and indirect psychosocial impacts on minors of their exposure to single incident (event) and recurrent or repetitive (process) violence. Additionally, children's psychosocial and physical development may be affected by their engagement with violence as victims or perpetrators. Several studies point to positive learning from certain experiences in particular communities while many others show the potential for lasting negative effects that may result in children being more vulnerable as adults. The spectrum of response is very wide. This paper focuses on resilience but also provides access to several frameworks for planning, delivering and assuring the quality of community and family-orientated and culture-sensitive responses to people's psychosocial needs in the aftermath of disasters of all kinds including those in which children and young people have been involved in mass violence.
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Kirk MA, Deaton ML. Bringing Order Out of Chaos: Effective Strategies for Medical Response to Mass Chemical Exposure. Emerg Med Clin North Am 2007; 25:527-48; abstract xi. [PMID: 17482031 DOI: 10.1016/j.emc.2007.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An accident or a deliberate terrorism attack releasing hazardous chemicals will create chaos, confusion, and seeming unpredictability that complicates the emergency response. Clinicians are challenged to urgently treat patients needing care, even before a chemical is confirmed. Emergency response planning that focuses on preparing for predictable challenges to the health care system and applies basic toxicologic principles to clinical decision-making can bring a sense of order to the chaos and provide medical care that will be best for the most victims of an incident.
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Affiliation(s)
- Mark A Kirk
- Blue Ridge Poison Center, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908-0774, USA.
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14
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Tsao JCI, Dobalian A, Wiens BA, Gylys JA, Evans GD. Posttraumatic stress disorder in rural primary care: improving care for mental health following bioterrorism. J Rural Health 2006; 22:78-82. [PMID: 16441340 DOI: 10.1111/j.1748-0361.2006.00006.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors. PURPOSE Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. METHODS We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities. FINDINGS AND CONCLUSIONS Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
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Abstract
A national survey of 1,001 Australians found that most were concerned about a bioterrorist attack and were ill-informed about smallpox prevention and response. Since general practitioners were commonly identified as the initial point of care, they should become a focus of bioterrorism response planning in Australia.
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Affiliation(s)
- David N Durrheim
- Hunter New England Population Health, Newcastle, New South Wales, Australia.
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16
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Alexander DA, Klein S. The psychological aspects of terrorism: from denial to hyperbole. J R Soc Med 2005. [PMID: 16319440 DOI: 10.1258/jrsm.98.12.557] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- David A Alexander
- School of Medicine and Life Sciences, University of Aberdeen, Aberdeen AB25 2ZH, Scotland, UK.
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17
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Affiliation(s)
- David A Alexander
- School of Medicine and Life Sciences, University of Aberdeen, Aberdeen AB25 2ZH, Scotland, UK.
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18
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Abstract
Perceived poisoning may manifest in numerous ways; however, all cases share certain characteristics. All are fostered by the wide availability of unreliable information about chemical safety, poor understanding of scientific principles, and ineffective risk communication. Although this problem is still incompletely understood, some approaches have been demonstrated to be useful, such as education about risk, appropriate reassurance, and empathy on the part of the practitioner. Successful management may curtail the spread or exacerbation of symptoms, whereas unsuccessful treatment may cause the problems to escalate, with detrimental effects on both society and patient.
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Affiliation(s)
- Kristine A Nañagas
- Division of Medical Toxicology, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206-1367, USA.
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19
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Vasterman P, Yzermans CJ, Dirkzwager AJE. The role of the media and media hypes in the aftermath of disasters. Epidemiol Rev 2005; 27:107-14. [PMID: 15958431 DOI: 10.1093/epirev/mxi002] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter Vasterman
- Faculty of Humanities, Department of Media Studies, University of Amsterdam, The Netherlands
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20
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Abstract
The possibility of bioterrorism has been met by significant financial outlays to map out public health responses. These have included comprehensive audits of potential agents, as well as exploring mechanisms for counteracting their impact. Psychological intervention and communication have been identified as key areas requiring further work, as fear of infection could pose a greater strain on social resources than the pathogens themselves. Bioterrorism provides a powerful metaphor for élite fears of social corrosion from within. Accordingly, a broader historical and cultural perspective is required to understand why individuals and societies feel so vulnerable to what remain largely speculative scenarios.
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Affiliation(s)
- Bill Durodié
- International Centre for Security Analysis, King's College London, 138-142 Strand, London WC2R 2LS, United Kingdom.
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21
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Stein BD, Tanielian TL, Eisenman DP, Keyser DJ, Burnam MA, Pincus HA. Emotional and behavioral consequences of bioterrorism: planning a public health response. Milbank Q 2004; 82:413-55, table of contents. [PMID: 15330972 PMCID: PMC2690224 DOI: 10.1111/j.0887-378x.2004.00317.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Millions of dollars have been spent improving the public health system's bioterrorism response capabilities. Yet relatively little attention has been paid to precisely how the public will respond to bioterrorism and how emotional and behavioral responses might complicate an otherwise successful response. This article synthesizes the available evidence about the likely emotional and behavioral consequences of bioterrorism to suggest what decision makers can do now to improve that response. It examines the emotional and behavioral impact of previous "bioterrorism-like" events and summarizes interviews with experts who have responded to such events or conducted research on the effects of community-wide disasters. The article concludes by reflecting on the evidence and experts' perspectives to suggest actions to be taken now and future policy and research priorities.
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Affiliation(s)
- Bradley D Stein
- RAND Corporation, 1700 Main Street, Santa Monica, CA 90407, USA.
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22
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Chong MY, Wang WC, Hsieh WC, Lee CY, Chiu NM, Yeh WC, Huang OL, Wen JK, Chen CL. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry 2004; 185:127-33. [PMID: 15286063 DOI: 10.1192/bjp.185.2.127] [Citation(s) in RCA: 441] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The sudden emergence of severe acute respiratory syndrome (SARS) caused international anxiety owing to its highly contagious and pandemic transmission. Health workers are vulnerable and are at high risk of infection. AIMS To assess SARS-related stress and its immediate psychological impact and responses among health workers. METHOD Health workers in a tertiary hospital affected by SARS were invited to complete a questionnaire designed to evaluate exposure experience, psychological impact and psychiatric morbidity. The risk and rates of psychiatric morbidity were estimated for exposure experience. RESULTS Altogether, 1257 health workers successfully completed the survey. In the initial phase of the outbreak, when the infection was spreading rapidly, feelings of extreme vulnerability, uncertainty and threat to life were perceived, dominated by somatic and cognitive symptoms of anxiety. During the 'repair' phase, when the infection was being brought under control, depression and avoidance were evident. The estimated prevalence of psychiatric morbidity measured by the Chinese Health Questionnaire was about 75%. CONCLUSIONS The outbreak of SARS could be regarded as an acute episode of a bio-disaster, leading to a significantly high rate of psychiatric morbidity.
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Affiliation(s)
- Mian-Yoon Chong
- Chairman, Department of Psychiatry, Chang Gung Memorial Hospital in Kaohsiung, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung County 83342, Taiwan.
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