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Gosling J, Maritz R, Laplante-Lévesque A, Sabariego C. Lessons learned from health system rehabilitation preparedness and response for disasters in LMICs: a scoping review. BMC Public Health 2024; 24:806. [PMID: 38486256 PMCID: PMC10938837 DOI: 10.1186/s12889-024-17992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/05/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION Disasters such as earthquakes, conflict, or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events. AIMS The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim was to summarize related recommendations identified in the gathered literature. METHODOLOGY A scoping review was conducted using the Arksey and O'Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search period was from 2010-2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks. RESULTS The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs. Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review found the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters to be: the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and response plans. CONCLUSION Findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMIC's, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of available evidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.
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Affiliation(s)
- Justine Gosling
- Center for Rehabilitation in Gobal Health Systems, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Roxanne Maritz
- Center for Rehabilitation in Gobal Health Systems, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Carla Sabariego
- Center for Rehabilitation in Gobal Health Systems, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Gök M, Melik MA. Clinical features and outcomes of orthopaedic injuries after the kahramanmaraş earthquake: a retrospective study from a hospital located in the affected region. Scand J Trauma Resusc Emerg Med 2024; 32:10. [PMID: 38291453 PMCID: PMC10829300 DOI: 10.1186/s13049-024-01181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The purpose of this retrospective, single-institutional study was to report the clinical features and outcomes of orthopaedic injuries after the Kahramanmaraş earthquake. METHODS An institutional database review was conducted to evaluate the results of patients who applied to our hospital's emergency department after the Kahramanmaraş earthquake. Trauma patients referred to orthopaedics and traumatology were identified. Patient records were checked for injury type, fracture site, treatment type (conservative or surgical), surgical technique, and outcome. Diagnosis with crush syndrome and the need for haemodialysis were also noted. Bedside fasciotomy was undertaken based on the urgency of the patient's condition, number of patients and the availability of the operating theatre. A team consisting of a trauma surgeon, a plastic surgeon, a board-certified physician in infectious disease, a reanimation specialist, a general surgeon and a nephrologist followed up with the patients. RESULTS Within the first 7 days following the earthquake, 265 patients were admitted to the emergency department, and 112 (42.2%) of them were referred to orthopaedics and traumatology. There were 32 (28.5%) patients diagnosed with acute compartment syndrome. Fasciotomy was performed on 43 extremities of 32 patients. Of these extremities, 5 (11.6%) were upper and 38 (88.4%) were lower extremities.The surgeries of 16 (50%) of the patients who underwent fasciotomy were performed in the emergency department. There was no significant difference in terms of complications and outcomes between performing the fasciotomy at the bedside or in the operating theatre (p = 0.456). CONCLUSIONS Fasciotomy appears to be a crucial surgical procedure for the care of earthquake causalities. Fasciotomy can be safely performed as a bedside procedure based on the urgency of the patient's condition as well as the availability of the operating theatre.
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Affiliation(s)
- Murat Gök
- Medicalpoint Gaziantep Hospital, Mücahitler 52063. Sk. No: 2,27584 Şehitkamil, 27100, Gaziantep, Turkey.
| | - Mehmet Ali Melik
- Medicalpoint Gaziantep Hospital, Mücahitler 52063. Sk. No: 2,27584 Şehitkamil, 27100, Gaziantep, Turkey
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Gök M, Melik MA, Doğan B, Durukan P. Hospital crisis management after a disaster: from the epicenter of 2023 Türkiye-Syria earthquake. ULUS TRAVMA ACIL CER 2023; 29:792-797. [PMID: 37409925 PMCID: PMC10405032 DOI: 10.14744/tjtes.2023.44449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/14/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND In such cases where sudden destruction and injury are very high, search and rescue teams and hospitals can be the most important determining factors between people's lives and deaths. METHODS This study was conducted retrospectively, after the two catastrophic earthquakes (Türkiye-Syria Earthquakes) by taking the records of the patients who admitted to our hospital. Patients' admission times, diagnoses, demographic data, triage codes, medical interventions, hemodialysis needs, crush syndrome and mortality rates were analyzed. RESULTS In the first 5 days after the earthquake, 247 earthquake-related patients were admitted to our hospital. The most intense period of admission to the emergency department was the first 24 h. The most intensive period of surgical procedures was 24-48 h. It was observed that Orthopedic surgical procedures were applied most frequently and the most common cause of mortality was crush syndrome. CONCLUSION In terms of preparations for earthquakes, especially in hospitals in the earthquake zone it will be beneficial for each hospital to make hospital disaster plans. For this reason, we thought it would be useful to share our experiences during this disaster.
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Affiliation(s)
- Murat Gök
- Department of Orthopedics and Traumatology, Medical Point Gaziantep Hospital, Gaziantep-Türkiye
| | - Mehmet Ali Melik
- Department of General Surgery, Medical Point Gaziantep Hospital, Gaziantep-Türkiye
| | - Baki Doğan
- Department of Emergency Medicine, Medical Point Gaziantep Hospital, Gaziantep-Türkiye
| | - Polat Durukan
- Department of Emergency Medicine, Medical Point Gaziantep Hospital, Gaziantep-Türkiye
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Maricot A, Dick E, Walravens A, Pluym B, Lathouwers E, De Pauw K, Verschueren J, Roelands B, Meeusen R, Tassignon B. Brain Neuroplasticity Related to Lateral Ankle Ligamentous Injuries: A Systematic Review. Sports Med 2023; 53:1423-1443. [PMID: 37155129 DOI: 10.1007/s40279-023-01834-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking. OBJECTIVE The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability. METHODS PubMed, Web of Science, Scopus, Embase, EBSCO-SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18 years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors' name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956. RESULTS Twenty articles were included, of which only one investigated individuals who experienced a lateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 who experienced a lateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability. DISCUSSION The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients' self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.
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Affiliation(s)
- Alexandre Maricot
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Emilie Dick
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Annemiek Walravens
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bert Pluym
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Elke Lathouwers
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Kevin De Pauw
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Jo Verschueren
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bart Roelands
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Romain Meeusen
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bruno Tassignon
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium.
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Traumatic Brain Injury-Related Pediatric Mortality and Morbidity in Low- and Middle-Income Countries: A Systematic Review. World Neurosurg 2021; 153:109-130.e23. [PMID: 34166832 DOI: 10.1016/j.wneu.2021.06.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The burden of pediatric traumatic brain injury (pTBI) in low- and middle-income countries (LMICs) is unknown. To fill this gap, we conducted a review that aimed to characterize the causes of pTBI in LMICs, and their reported associated mortality and morbidity. METHODS A systematic review was conducted. MEDLINE, Embase, Global Health, and Global Index Medicus were searched from January 2000 to May 2020. Observational or experimental studies on pTBI of individuals aged between 0 and 16 years in LMICs were included. The causes of pTBI and morbidity data were descriptively analyzed, and case fatality rates were calculated. PROSPERO ID CRD42020171276. RESULTS A total of 136 studies were included. Fifty-seven studies were at high risk of bias. Of the remaining studies, 170,224 cases of pTBI were reported in 32 LMICs. The odds of having a pTBI were 1.8 times higher (95% confidence interval, 1.6-2.0) in males. The odds of a pTBI being mild were 4.4 times higher (95% confidence interval, 1.9-6.8) than a pTBI being moderate or severe. Road traffic accidents were the most common cause (n = 16,275/41,979; 39%) of pTBIs. On discharge, 24% of patients (n = 4385/17,930) had a reduction in their normal mental or physical function. The median case fatality rate was 7.3 (interquartile range, 2.1-7.7). CONCLUSIONS Less than a quarter (n = 32) of all LMICs have published high-quality data on the volume and burden of pTBI. From the limited data available, young male children are at a high risk of pTBIs in LMICs, particularly after road traffic accidents.
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Rauch S, Borgato A, Gruber E, Leggieri C, Bock M, Seraglio PME. Case Report: Prevention of Rhabdomyolysis-Associated Acute Kidney Injury by Extracorporeal Blood Purification With Cytosorb ®. Front Pediatr 2021; 9:801807. [PMID: 35141180 PMCID: PMC8819180 DOI: 10.3389/fped.2021.801807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/29/2021] [Indexed: 01/06/2023] Open
Abstract
Acute kidney injury (AKI) is a severe complication of rhabdomyolysis. The pathophysiology of rhabdomyolysis-associated AKI is complex, but myoglobin related damage plays a major role. Extracorporeal removal of myoglobin is therefore an appealing target to prevent AKI, however, attempts to remove myoglobin with standard dialysis membranes have so far been disappointing. Here we report the case of a 12-year-old boy with severe trauma-related rhabdomyolysis where we successfully utilized continuous renal replacement therapy in combination with Cytosorb® to eliminate myoglobin and prevent AKI. The early use of extracorporeal myoglobin removal with Cytosorb® after severe rhabdomyolysis might be an option and should be further investigated as a tool to prevent the development of AKI.
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Affiliation(s)
- Simon Rauch
- Department of Anesthesia and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy.,Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Andrea Borgato
- Department of Anesthesia and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy
| | - Ewald Gruber
- Department of Surgery, "F. Tappeiner" Hospital, Merano, Italy
| | - Carlo Leggieri
- Department of Anesthesia and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy
| | - Matthias Bock
- Department of Anesthesia and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy.,Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
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Sever MS, Sever L, Vanholder R. Disasters, children and the kidneys. Pediatr Nephrol 2020; 35:1381-1393. [PMID: 31422466 DOI: 10.1007/s00467-019-04310-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 01/11/2023]
Abstract
Following disasters, children are physically, psychologically and socially more vulnerable than adults; consequently, their morbidity and mortality are higher. The risks are especially high for orphans and unaccompanied children who are separated from their families, making them frequently victims of human trafficking, slavery, drug addiction, crime or sexual exploitation. Education of children and families about disaster-related risks and providing special protection in disaster preparedness plans may mitigate these threats. Kidney disease patients, both paediatric and adult, are extra vulnerable during disasters, because their treatment is dependent on technology and functioning infrastructure. Acute kidney injury, chronic kidney disease patients not on dialysis and dialysis and transplant patients are faced with extensive problems. Overall, similar treatment principles apply both for adults and paediatric kidney patients, but management of children is more problematic, because of substantial medical and logistic difficulties. To minimize drawbacks, it is vital to be prepared for renal disasters. Preparedness plans should address not only medical professionals, but also patients and their families. If problems cannot be coped with locally, calling for national and/or international help is mandatory. This paper describes the spectrum of disaster-related problems in children and the specific features in treating acute and chronic kidney disease in disasters.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Millet Caddesi, 34093, Capa Istanbul, Turkey.
| | - Lale Sever
- Department of Paediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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Abstract
OBJECTIVES To date, we have only limited evidence of the determinants of earthquake inpatient mortality-related factors. This study is among the first to explore related factors of inpatient deaths using data from multiple hospitals and multiple earthquakes. METHODS We included and retrospectively analyzed data on 32,976 earthquake inpatients in the West China Earthquake Patients Database. Of these, we analyzed the records of 284 patients who died during hospitalization. We collected 12 dichotomous variables with reference to previous reports: patients' age (both ≤ 15 years and ≥ 65 years), gender, prehospital treatment, intensive care unit (ICU) admission, the presence of severe traumatic brain injury (TBI), trunk injury, severe poly-trauma, crush syndrome, multiple-system organ failure (MSOF), infection, and cardiac/respiratory disease. We performed multivariate logistic regression analysis to explore independent related factors of mortality. RESULTS Ultimately, we identified severe TBI, MSOF, old age (≥ 65 years), ICU admission, crush syndrome, and cardiac/respiratory disease as independent mortality-related factors. Severe TBI was the greatest risk factor of inpatient death (ods ratio [OR], 31.913, 95% confidence interval [CI], 20.484-49.720), followed by MSOF (OR 30.905, 95% CI, 21.733-43.947). CONCLUSION To reduce earthquake inpatient mortalities, the related factors analyzed in this study should be prioritized in future inpatient earthquake response strategies.
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Xi Y, Chen R, Gillespie AL, He Y, Jia C, Shi K, Yao Y, Ma X, Liu W, Chan EYY. Mental health workers perceptions of disaster response in China. BMC Public Health 2019; 19:11. [PMID: 30606149 PMCID: PMC6318987 DOI: 10.1186/s12889-018-6313-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Yingjun Xi
- The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Runsen Chen
- The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 China
- Department of Psychiatry, University of Oxford, Oxford, UK
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | | | - Yuyang He
- The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chihua Jia
- The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Kuo Shi
- The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 China
- Department of Psychology of China Rehabilitation Research Center, Beijing, China
| | - Yiming Yao
- The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xin Ma
- The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wei Liu
- The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088 China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN UK
- Francois-Xavier Bagnound Center for Health and Human Rights, Harvard University, Boston, MA 02138 USA
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Rodriguez-Llanes JM, Hellman L, Wu Q, van den Oever B, Pan L, Albela Miranda M, Chen G, Zhang DS, Guha-Sapir D, Von Schreeb J. Time to include burden of surgical injuries after disasters in the Global Surgery agenda? An assessment of DALYs and averted burden by surgery after the 2008 Wenchuan earthquake. BMJ Glob Health 2018; 3:e000909. [PMID: 30294459 PMCID: PMC6169667 DOI: 10.1136/bmjgh-2018-000909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023] Open
Abstract
Unlike other disasters, injury rates after earthquakes are still on the rise at a global scale. With an estimated one million people injured by earthquakes in the last decade, the burden of injury is considerable. Importantly, the surgical procedures carried out by healthcare facilities are capable to avert part of this burden. Yet both burdens remain unquantified using understandable metrics. We explored in this analysis a method to calculate them using disability-adjusted life years (DALYs), an internationally accepted measure expressing years of healthy life lost due to a health condition. We used data from a large standardised hospital database of earthquake-related injuries with complete information on International Classification of Diseases for injury and surgical procedures, sex and age information. DALYs and averted DALYs were calculated by injury types and per patient using disability weights available in the literature and expert opinion. We also suggested how DALYs might be further converted into an economic measure using approaches in the published literature. We estimated 10 397 DALYs as the earthquake surgical-injury burden produced in 1861 hospitalised patients treated in a single hospital (on average, 5.6 DALYs per patient). Our study also assessed that 4379 DALYs, or 2.4 DALYs per patient, were averted by surgery (42%). In economic terms, DALY losses amounted to US$36.1 million, from which US$15.2 million were averted by surgery in our case study. We urge to systematically estimate these impacts through improvements in the routine reporting of injury diagnoses and surgical procedures by health systems, potentially improving prevention policies and resource allocation to healthcare facilities.
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Affiliation(s)
- Jose Manuel Rodriguez-Llanes
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- European Commission, Joint Research Centre, Ispra, Italy
| | - Lina Hellman
- Centre for Research on Health Care in Disasters, Global Health-Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Qi Wu
- People’s Hospital of Deyang City, Deyang, China
| | - Barbara van den Oever
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Liang Pan
- People’s Hospital of Deyang City, Deyang, China
| | - Manuel Albela Miranda
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Gao Chen
- People’s Hospital of Deyang City, Deyang, China
| | | | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Johan Von Schreeb
- Centre for Research on Health Care in Disasters, Global Health-Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Profile and Management of Musculoskeletal Injuries Associated With the Lushan Earthquake in 2013. Disaster Med Public Health Prep 2018; 12:408-410. [PMID: 30084339 DOI: 10.1017/dmp.2016.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
On April 20, 2013, a 7.0-magnitude earthquake hit Lushan County, Ya'an City, Sichuan Province in southwest China. West China Hospital of Sichuan University, the largest and best hospital in Sichuan Province, is located in the city of Chengdu-about 100 km from the epicenter-and provided medical treatment to a total of 400 seismic patients. In this article, we retrospectively investigated 199 patients with musculoskeletal injuries who were treated in the Department of Orthopedics. Based on the seismic intensity distribution map, injury-occurring locations were divided into 5 grade-related areas: IX, VIII, VII, VI, and ≤V grade-area. The characteristics of seismic injuries were analyzed according to the geographic distribution of victims. We found that the constituent ratio of injury causes significantly differed in different earthquake areas according to the seismic intensity. (Disaster Med Public Health Preparedness. 2018; 12: 408-410).
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Li H, Nyland J, Kuban K, Givens J. Physical therapy needs for patients with physical function injuries post-earthquake disasters: A systematic review of Chinese and Western literature. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1714. [PMID: 29608038 DOI: 10.1002/pri.1714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/07/2017] [Accepted: 01/26/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Over the last 500 years, the most earthquakes with 10,000 or more fatalities and the most overall fatalities have occurred in China. Physical therapists must develop a better understanding of the patient and injury types that they are likely to treat post-earthquake disasters. This systematic review of Chinese and Western literature identified the primary patients treated by physical therapists post-earthquake disasters for injuries that negatively impacted physical function, activity, and participation. METHODS Comparisons were made between reports of earthquakes in China and reports from the rest of the world combined. RESULTS Sixty-seven studies of 71,986 patients (51.8% male) at 40.6 ± 15 years of age were included. Studies were mostly prospective (n = 48, 71.6%). Reports of earthquakes in China represented more recently occurring disasters (p = .003) and more prospective research designs (p = .003). Reports from China also had a higher median fracture number (p = .004). Studies from China used manual muscle testing (p = .02), visual analogue pain scales (p = .008), Barthel index or modified Barthel index (p < .0001), and joint motion assessment (p = .007) with greater frequencies. DISCUSSION Physical therapists from China are more likely to treat patients with a fracture; however, physical therapists from both regions are likely to treat patients with general injuries representing poly-trauma to multiple body regions, traumatic brain-closed head injuries, spinal cord injuries, peripheral nerve injuries, and soft tissue injuries. IMPLICATIONS ON PHYSIOTHERAPY PRACTICE These data can help improve earthquake disaster planning, infrastructure development, and resource needs assessment effectiveness. More prospective research study designs and more recent earthquake disasters in China are likely associated with greater explicit use of valid and reliable outcome measurements such as joint motion assessment, manual muscle testing, visual analogue pain scale, and the Barthel index or modified Barthel index.
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Affiliation(s)
- Hao Li
- Department of Disaster Rehabilitation, Sichuan University, Chengdu, China.,Institute for Disaster Management and Reconstruction, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - John Nyland
- Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - Katrina Kuban
- Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - Justin Givens
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
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Abstract
Introduction Earthquake-related trauma results in crush injuries and bony- and soft-tissue trauma. There are no systematic reviews analyzing the typical injury patterns and treatments in "Mega-Mass-Casualty" earthquakes. The characterization of an injury pattern specific to disaster type, be it natural or manmade, is imperative to build an effective disaster preparedness and response system. METHODS The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search strategy was developed to identify all publications relating to earthquakes and the orthopedic treatment in adult patients. The following databases were searched: PubMed (Medline; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Ovid (Ovid Technologies; New York, New York USA), Web of Science (Thomson Reuters; New York, New York USA), and The Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). RESULTS The searches identified 4,704 articles: 4,445 after duplicates were removed. The papers were screened for title and abstract and 65 out of those were selected for full-text analysis. The quality of data does not permit a standard-of-care (SOC) to be defined. Scarcity and poor quality of the data collected also may suggest a low level of accountability of the activity of the international hospital teams. Qualitatively, it is possible to define that there are more open fractures during daytime hours than at night. Excluding data about open and closed fractures, for all types of injuries, the results underline that the higher the impact of the earthquake, as measured by Richter Magnitude Scale (RMS), the higher is the number of injuries. Discussion Regarding orthopedic injuries during earthquakes, special attention must be paid to the management of the lower limbs most frequently injured. Spinal cord involvement following spine fractures is an important issue: this underlines how a neurosurgeon on a disaster team could be an important asset during the response. Conservative treatment for fractures, when possible, should be encouraged in a disaster setting. Regarding amputation, it is important to underline how the response and the quality of health care delivered is different from one team to another. This study shows how important it is to improve, and to require, the accountability of international disaster teams in terms of type and quality of health care delivered, and to standardize the data collection. Bortolin M , Morelli I , Voskanyan A , Joyce NR , Ciottone GR . Earthquake-related orthopedic injuries in adult population: a systematic review. Prehosp Disaster Med. 2017;32(2):201-208.
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Du F, Wu J, Fan J, Jiang R, Gu M, He X, Wang Z, He C. Injuries sustained by earthquake relief workers: a retrospective analysis of 207 relief workers during Nepal earthquake. Scand J Trauma Resusc Emerg Med 2016; 24:95. [PMID: 27456687 PMCID: PMC4960884 DOI: 10.1186/s13049-016-0286-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to analyse the injuries sustained by rescue workers in earthquake relief efforts in high altitude areas for improving the ways of how to effectively prevent the injuries. METHODS The clinical data of 207 relief workers from four military hospitals in Tibet, who were injured in the Tibetan disaster areas of China during '4.25' Nepal earthquake rescue period, was retrospectively analyzed. The demographic features, sites of injury and causes of injury were investigated. RESULTS The most frequently injured sites were the ankle-foot and hand-wrist (n = 61, 26.5 %), followed by injuries in leg-knee-calf (n = 22, 9.6 %), head-neck (4.87 %), thoracic and abdominal region (2.6 %) and lower back (3.9 %). The specific high-altitude environment increased the challenges associated with earthquake relief. DISCUSSION The specific plateau environment and climate increased the burden and challenge in earthquake relief. The injury distribution data shown in this study demonstrated that effective organization and personnel protection can reduce the injury occurrences. CONCLUSION Relief workers were prone to suffering various injuries and diseases under specific high-altitude environment.
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Affiliation(s)
- Feizhou Du
- Department of Radiology, Chengdu Military General Hospital, NO.270, Rongdu Avenue, Jinniu District, Chengdu, Sichuan, 610083, China
| | - Jialing Wu
- Department of Radiology, Chengdu Military General Hospital, NO.270, Rongdu Avenue, Jinniu District, Chengdu, Sichuan, 610083, China
| | - Jin Fan
- Department of Neurology, Chengdu Military General Hospital, Chengdu, 610083, China
| | - Rui Jiang
- Department of Radiology, Chengdu Military General Hospital, NO.270, Rongdu Avenue, Jinniu District, Chengdu, Sichuan, 610083, China
| | - Ming Gu
- Department of Radiology, Chengdu Military General Hospital, NO.270, Rongdu Avenue, Jinniu District, Chengdu, Sichuan, 610083, China
| | - Xiaowu He
- Department of Radiology, No. 8 Hospital of PLA, Shigatse, Tibet, 857000, China
| | - Zhiming Wang
- Department of Radiology, No. 41 Hospital of PLA, Shannan, Tibet, 856100, China
| | - Ci He
- Department of Radiology, Chengdu Military General Hospital, NO.270, Rongdu Avenue, Jinniu District, Chengdu, Sichuan, 610083, China.
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Landry MD, Raman SR, Kohrt BA. Disability as an Emerging Public Health Crisis in Postearthquake Nepal. Am J Public Health 2015; 105:1515-7. [PMID: 26066962 DOI: 10.2105/ajph.2015.302809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Michel D Landry
- Michel D. Landry BScPT, PhD is with the Doctor of Physical Therapy Division, School of Medicine, Duke University, Durham, NC. Sudha R. Raman is with the Duke Clinical Research Institute (DCRI), Duke University. Brandon A. Kohrt is with the Duke Global Health Institute, Duke University
| | - Sudha R Raman
- Michel D. Landry BScPT, PhD is with the Doctor of Physical Therapy Division, School of Medicine, Duke University, Durham, NC. Sudha R. Raman is with the Duke Clinical Research Institute (DCRI), Duke University. Brandon A. Kohrt is with the Duke Global Health Institute, Duke University
| | - Brandon A Kohrt
- Michel D. Landry BScPT, PhD is with the Doctor of Physical Therapy Division, School of Medicine, Duke University, Durham, NC. Sudha R. Raman is with the Duke Clinical Research Institute (DCRI), Duke University. Brandon A. Kohrt is with the Duke Global Health Institute, Duke University
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Qu J, Zong Z, Wang X, Zhou G, Feng P, Chen M, Wang B, Yang C, Yin W, Jin X, Kang Y, Lü X. Severe infections as the leading complication after the Lushan earthquake. Intensive Care Med 2015; 41:560-1. [PMID: 25619486 DOI: 10.1007/s00134-015-3644-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China
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