Impact of the earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia / 中华创伤杂志(英文版)

PURPOSE@#To determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia.@*METHODS@#A case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3.@*RESULTS@#We identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = -2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis.@*CONCLUSION@#It is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.

La educación antisísmica con estudiantes de medicina a través de un proyecto comunitario / Anti-seismic education of medical students through a community project

La prevención ante los desastres acaecidos por sismos constituye una problemática en determinadas regiones vulnerables en Cuba, y una prioridad en la formación de estudiantes de medicina. En este trabajo, las opiniones de los autores se fundamentan en la influencia que tiene un proyecto comunitario, para actuar ante situaciones sísmicas, en la preparación de los estudiantes de medicina, pues favorece una mayor calidad profesional y contribuye a enriquecer su labor preventiva con la población. Como parte del proceso, participaron 46 estudiantes de cuarto año de la Facultad de medicina No. 1, de Santiago de Cuba, en el período comprendido entre septiembre de 2016 a febrero de 2018(AU)

Prevention of earthquake disasters is a problem in certain vulnerable regions of Cuba, and a priority in the training of medical students. In this work, the authors' opinions are based on the influence that a community project has, to act in seismic situations, in the preparation of medical students, since it favours a higher professional quality and contributes to enriching their preventive work with population. As part of the process, 46 fourth-year students from the Faculty of Medicine No. 1, Santiago de Cuba, participated in the period from September 2016 to February 2018(AU)

Percepción de funcionarios sobre la gestión del Sistema de Salud de Chone, ante el terremoto de Pedernales / Perception of officials on the management of the Chone Health System, in the face of the Pedernales earthquake

INTRODUCCIÓN. En abril de 2016 ocurrió en la provincia de Manabí-Ecuador un terremoto de 7,6 grados, escala de Richter. Afectó la gestión de entidades de salud de dicha provincia. El país viene implementando políticas para alcanzar acceso universal de atención de salud, pero, el sistema mantiene debilidades en el modelo de atención primaria. OBJETIVO. Describir los efectos del terremoto en la gestión del sistema de salud en el Distrito de Chone, en base a las percepciones de los funcionarios de salud. MATERIALES Y MÉTODOS. Estudio cualitativo. Se describió el evento desde la perspectiva de 11 funcionarios seleccionados de diferentes niveles de gestión técnica en el sistema de salud, que laboraron durante el terremoto. Datos obtenidos por una encuesta semiestructurada sobre las tres funciones del sistema de salud: Rectoría, Provisión de Servicios y Financiamiento. RESULTADOS. El terremoto profundizó las debilidades que ya existían, afectó la ejecución de los programas de salud. La gestión del nivel central del Ministerio de Salud Pública sobrecargó el trabajo del personal local y la asignación de recursos fue insuficiente. DISCUSIÓN. A pesar que la evidencia demostró que una adecuada atención primaria con suficiente personal de salud, mejora la respuesta ante desastres, sin embargo, esto no se dio y los efectos negativos del desastre se mantienen años después. CONCLUSIÓN. Las deficiencias en la atención primaria de salud, así como insuficiente preparación para la gestión adecuada ante un desastre natural, influyeron en la calidad de la respuesta del sistema de salud.

INTRODUCTION. In april 2016, an earthquake of 7.6 degrees, on the Richter scale, occurred in the province of Manabí-Ecuador. It affected the management of health entities in said province. The country has been implementing policies to achieve universal access to health care, but the system maintains weaknesses in the primary care model. OBJECTIVE. Describe the effects of the earthquake on the management of the health system in the Chone District, based on the perceptions of health officials. MATERIALS AND METHODS. Qualitative study. The event was described from the perspective of 11 officials selected from different levels of technical management in the health system, who worked during the earthquake. Data obtained by a semi-structured survey on the three functions of the health system: Stewardship, Provision of Services and Financing. RESULTS. The earthquake deepened the weaknesses that already existed, affected the execution of health programs. Management at the central level of the Ministry of Public Health overloaded the work of local staff and the allocation of resources was insufficient. DISCUSSION. Although the evidence showed that adequate primary care with sufficient health personnel improves the response to disasters, however, this did not occur and the negative effects of the disaster continue years later. CONCLUSION. Deficiencies in primary health care, as well as insufficient preparation to properly manage a natural disaster, influenced the quality of the health system response.

El terremoto de 1746 y su impacto en la salud en la ciudad de Lima / The earthquake of 1746 and its impact on health in the city of Lima

RESUMEN Durante el siglo XVIII la ciudad de Lima fue afectada por una serie de desastres de origen natural y de epidemias que mermaron tanto la población como la producción agrícola. A continuación, analizaremos el caso del terremoto producido en Lima el 28 de octubre de 1746 y su impacto en el sistema de salud de la ciudad. Dada la magnitud de su destrucción en la infraestructura y el alto número de muertes, marcó un hito en la sociedad limeña de la época.

ABSTRACT During the 18th century, the city of Lima was affected by a series of natural disasters and epidemics that depleted both the population and agricultural production. Next, we will analyze the case of the earth quake in Lima on October 28, 1746 and its impact on the city's health system, given the magnitude of the destruction of infrastructure and the high number of deaths it marked a milestone in Lima's society at the time.

A Structural Equation Model of Factors Influencing Posttraumatic Growth of Earthquake Victims

PURPOSE: The purpose of this study is to construct and test a structural equation model of posttraumatic growth (PTG) of earthquake victims based on Tedeschi and Calhoun's model (2004). METHODS: Data were collected from 195 earthquake victims living in K. City. The exogenous variables include distress perception, resilience, and social support, and the endogenous variables include intrusive rumination, deliberate rumination, and posttraumatic growth. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed. RESULTS: The modified model showed a good fitness to the data. Moreover, 6 of the 9 paths of the final model were statistically significant, which include PTG affected by deliberate rumination (β=.58, p<.001), resilience (γ=.18, p=.001), and distress perception (γ=.20, p=.002). These predictors explain 51.8% of variance in posttraumatic growth. CONCLUSION: Based on the results of this study, it is necessary to develop and disseminate preventive intervention programs to increase the resilience of earthquake-prone communities. In addition, after exposure to a community-scale traumatic event such as earthquake, we should provide social supports to alleviate distress perception and transition from intrusive rumination to deliberate rumination so that we can seek new meaning from the earthquake and facilitate posttraumatic growth.

Disaster preparedness for earthquakes in hemodialysis units in Gyeongju and Pohang, South Korea

In 2016 and 2017, there were earthquakes greater than 5.0 in magnitude on the Korean Peninsula, which has previously been considered an earthquake-free zone. Patients with chronic kidney disease are particularly vulnerable to earthquakes, as the term “renal disaster” suggests. In the event of a major earthquake, patients on hemodialysis face the risk of losing maintenance dialysis due to infrastructure disruption. In this review, we share the experience of an earthquake in Pohang that posed a serious risk to patients on hemodialysis. We review the disaster response system in Japan and propose a disaster preparedness plan with respect to hemodialysis. Korean nephrologists and staff in dialysis facilities should be trained in emergency response to mitigate risk from natural disasters. Dialysis staff should be familiar with the action plan for natural disaster events that disrupt hemodialysis, such as outages and water treatment system failures caused by earthquakes. Patients on hemodialysis also need to be educated about disaster preparedness. In the event of a disaster situation that results in dialysis failure, patients need to know what to do. At the local and national government level, long-term preparations should be made to handle renal disaster and patient safety logistics. Moreover, Korean nephrologists should also be prepared to manage cardiovascular disease and diabetes in disaster situations. Further evaluation and management of social and national disaster preparedness of hemodialysis units to earthquakes in Korea are needed.

19S: la respuesta en salud del gobierno del estado de Morelos / S19: Morelos State government's response in health

Resumen El pasado 19 de septiembre de 2017 se registró un sismo, de magnitud de 7.1 grados Richter al sureste de Axochiapan, en Morelos. Lo anterior implicó un total de 74 fallecimientos, más 20 000 viviendas afectadas, así como la evacuación de 18 hospitales y 281 unidades de primer nivel de atención médica. Dos meses después, las acciones de atención por parte del sector salud a la población damnificada continúan. Esta población pasó de 3 173 personas pernoctantes, concentradas en 49 refugios en el pico máximo, a un total de 1 512 personas, en 23 refugios temporales. Se implementaron acciones en materia de salud pública, como protección a riesgos sanitarios, vigilancia epidemiológica, promoción a la salud, prevención de enfermedades, atención en salud y rehabilitación. El presente artículo describe las acciones realizadas durante y después del sismo por parte del sector salud, con el fin de proveer un panorama en materia de salud pública basado en evidencia para situaciones de emergencia.

Abstract On September 19th, 2017, an earthquake of magnitude 7.1 degrees on the Richter scale was recorded to the Southeast of Axochiapan in Morelos, Mexico. The seism left a total of 74 deaths, more than 20 000 households affected, and produced the evacuation of 18 hospitals and 281 primary health care units. Two months later, actions by the Health Sector regarding the assistance of the affected population continued. The numbers went from 3 173 people concentrated in 49 temporary shelters at its maximum peak, to a total of 1 512 people in 23 temporary shelters, with the implementation of public health actions such as: sanitary risks protection, epidemiological surveillance, health promotion, disease prevention, health attention and rehabilitation. This article describes the Health Sector's response during and after the earthquake, with the purpose of providing an evidence-based public health perspective for emergency situations.

Nuestros terremotos / Our earthquakes

Resumen El terremoto de septiembre de 2017 sirvió para mostrar el rostro de la sociedad y la cara del Estado. El terremoto dividió en dos a México; uno de ellos, el de la ciudadanía, mostró su solidaridad; el del poder, rezagado e inoperante, quedó relegado ante la fuerza y entrega de la gente. La estructura social permite a las personas crear redes y difundir información que puede ser útil para manejar y confrontar desastres. Las bondades del capital social son vastas. Las experiencias previas y la nuestra enaltecen el papel de la comunidad y la trascendencia de la solidaridad, la empatía y del compromiso de quienes la ejercen.

Abstract September 2017 earthquake served us to reveal the face of society and the role of the State. The earthquake divided Mexico in two: one where citizens demonstrated their solidarity; and the other, an ineffective government which fell behind, displaced by the power and commitment of the people. Social structure allows people to create networks and share information that helps to manage and confront disasters. Social capital benefits are immense. Ours and previous experiences in earthquakes exalt the role of community and the transcendence of solidarity, empathy and of the commitment of those who exercise it.

Terremotos y salud: lecciones y recomendaciones / Earthquakes and health: lessons and recommendations

Resumen Los terremotos, además de los múltiples efectos que producen, ponen en evidencia la vulnerabilidad de los sistemas de salud y crean la necesidad de adoptar una política de Estado que ponga en práctica un plan de contención y mitigación de daños a la salud. Asimismo, el comportamiento de las personas durante un terremoto es un factor importante de predicción de su supervivencia, por lo tanto, la educación de la comunidad acerca de cómo comportase durante un evento es primordial. Por consiguiente, la preparación es necesaria a nivel comunitario, organizacional y de política pública, particularmente de los servicios sanitarios, para mitigar los efectos adversos para salud y para el sistema de respuesta del Estado. Dentro de los factores de riesgo, los niños menores, los adultos mayores y las personas con problemas de movilidad presentan una mayor vulnerabilidad. Esto debe ser tomado en cuenta por los Estados en sus fases de prevención y preparación previas a un terremoto. Desde el punto de vista epidemiológico, la morbilidad y la mortalidad están relacionadas con lesiones traumáticas, las cuales demandan, muchas veces, niveles de atención médica especializada en un periodo corto, para lo cual en muchas ocasiones los Estado no se encuentran preparados. Además de las víctimas de traumatismos relacionados con el terremoto, los servicios de emergencia y los hospitales también deberían prepararse para responder a otras necesidades de salud como enfermedades cardiovasculares, enfermedades infectocontagiosas y desórdenes de estrés postraumático. Los terremotos generados en México en septiembre de 2017 generaron una respuesta social organizada que debe de ser documentada, para qué, con base en las lecciones aprendidas, se enfrenten con mayor eficacia los nuevos fenómenos naturales.

Abstract Earthquakes, in addition to the multiple effects they produce, highlight the vulnerability of health systems and create the need to adopt a State policy that implements a plan to contain and mitigate health damages. Likewise, the behavior of people during an earthquake is an important factor in predicting their survival. Therefore, educating the community about how to behave during an event is paramount. Therefore, preparation is necessary at the community, organizational and public policy levels, particularly in health services to mitigate adverse effects for health and for the State response system. Among the risk factors, younger children, the elderly and people with mobility problems are more vulnerable. This must be taken into account by the States in their phases of prevention and preparation prior to an earthquake. From the epidemiological point of view, morbidity and mortality are related to traumatic injuries, which often demand levels of specialized medical attention in a short period, which in many cases States are not prepared to offer it. In addition to victims of earthquake-related injuries, emergency services and hospitals should also be prepared to respond to other health needs such as cardiovascular diseases, infectious diseases and post-traumatic stress disorder. The earthquakes suffered in Mexico in September 2017, generated an organized social response that must be documented, so that based on the lessons learned, the new natural phenomena will be faced with greater efficiency.

Terremoto en México: la respuesta en salud del gobierno de la Ciudad de México / Earthquake in Mexico: Mexico City governmentʼs health response

Resumen Ante el evento telúrico del 19 de septiembre de 2017, la Secretaría de Salud de la Ciudad de México (Sedesa) y las instituciones sectorizadas a ella instrumentaron intervenciones en lo inmediato: cada unidad en la red hospitalaria de la Sedesa se preparó para la recepción masiva de pacientes. Se suspendieron las cirugías programadas, se trasladó a los pacientes de urgencias a hospitalización o terapia intensiva y se egresó a aquéllos que pudieran continuar en sus casas, para recibir pacientes con prioridad roja y amarilla. Con la declaratoria de emergencia publicada por el jefe de gobierno la Sedesa, en coordinación con otras dependencias del gobierno de la CDMX, instituciones federales, paraestatales, organizaciones de la sociedad civil e instituciones privadas se instrumentaron los planes, protocolos y acciones definidos exprofeso.

Abstract Before earthquake event of September 19, 2017, the Health Ministery of Mexico City and the institutions sectored to it, immediately implemented interventions: To receive patients with red and yellow priority, each unit in the hospital network of Sedesa, was prepared for massive reception of patients; scheduled surgeries were suspended, emergency patients were transferred to hospitalization or intensive therapy and those who could continue in their homes were discharged. With declaration of emergency, published by the head of government, the Ministery of Health, in coordination with other agencies of CDMX Government; federal institutions, parastatals, civil society organizations and private institutions, implemented the plans, protocols and actions defined exprofeso.

Experiencia de un equipo médico de emergencia del IMSS durante el sismo en México en setiembre de 2017 / The experience of a medical emergency team belonging to the Mexican Social Security Institute during the earthquake in Mexico in September 2017 / Experiência de uma equipe médica de emergência do IMSS no terremoto do México em setembro de 2017

RESUMEN El objetivo de este trabajo es describir las acciones desarrolladas por el equipo médico de emergencia (EMT por sus siglas en inglés) del Instituto Mexicano del Seguro Social (IMSS) durante la emergencia derivada del sismo del 7 de setiembre de 2017, el cual tuvo una magnitud de 8,2 grados con epicentro a 133 km al suroeste de Pijijiapan, Chiapas, México. Una vez realizada la evaluación inicial intersectorial de la emergencia, se activó el sector salud. Dentro de esta respuesta, y una vez determinado un número elevado de lesionados y un riesgo alto para la salud pública de la población afectada, el IMSS desplegó en la región un EMT capacitado y entrenado para apoyar en la respuesta de atención médica y quirúrgica de lesionados. Las acciones del EMT, conformado por especialistas en urgencias médico-quirúrgicas y desastres, incluyeron la atención médica de 252 pacientes, la gestión del traslado de 57 pacientes y la colaboración en la habilitación de un hospital provisorio. Para mejorar la respuesta en situaciones de desastres, se requiere seguir el proceso de integración, registro y capacitación de los EMT a nivel nacional e internacional.(AU)

ABSTRACT The objective of this article is to describe the actions undertaken by the emergency medical team (EMT) of the Mexican Social Security Institute (MSSI) during the emergency caused by the earthquake of September 7, 2017 (magnitude 8.2; epicenter 133 km southwest of Pijijiapan, Chiapas, Mexico). After the initial intersectoral assessment of the emergency had been conducted, the health sector stepped in. As part of this response effort, and once it was determined that a large number of people had been injured and that the health risks facing the affected population were substantial, the MSSI deployed an EMT equipped and trained to provide support in the medical and surgical treatment of injured people. The actions of the EMT, composed of specialists in medical and surgical emergencies and disaster situations, included providing medical care to 252 patients, managing the transfer of 57 patients, and helping to set up an emergency hospital. To improve response efforts during disaster situations, it is necessary to follow the process of forming, registering, and training EMTs at the national and international levels.(AU)

RESUMO O propósito deste artigo é descrever as ações empreendidas pela equipe médica de emergência (EMT) do Instituto Mexicano de Seguro Social (IMSS, instituição pública que presta serviços de saúde) na crise de emergência causada pelo terremoto de 7 de setembro de 2017, com magnitude de 8,2 graus e epicentro a 133 km a sudoeste de Pijijiapan, Chiapas, México. Após a avaliação intersetorial inicial de emergência, o setor da saúde foi ativado. Como parte da resposta, diante do elevado número de feridos e alto risco para a saúde pública da população afetada, o IMSS mobilizou uma EMT na região, capacitada e treinada para dar apoio à resposta de atendimento médica e cirúrgica das vítimas. A EMT, formada por especialistas em emergências médico-cirúrgicas e desastres, prestou atendimento médico a 252 pacientes, coordenou a transferência de 57 pacientes e também colaborou na preparação de um hospital provisório. A fim de melhorar a resposta a desastres, é necessário prosseguir com o processo de integração, cadastramento e capacitação das EMT ao nível nacional e internacional.(AU)

China Medical Team: Medical rescue for "4.25" Nepal earthquake / 中华创伤杂志(英文版)

In recent years, global natural disasters have been frequent and resulted in great casualties and property loss. Since Wenchuan earthquake, the disaster emergency rescue system of China has obtained considerable development in various aspects including team construction, task scheduling, personnel training, facilities and equipments, logistics, etc. On April 25, 2015, an earthquake that measured 8.1 on the Richter scale attacked Nepal. Chinese government firstly organized a medical team, named China Medical Team, and sent it to the attacked region in Nepal to implement medical rescue. The medical team completed the rescue mission successfully and creatively based on their experiences.

La solidaridad, valor innegable del ser humano

El 16 de abril de 2016 Ecuador sufrió uno de los desastres naturales más grandes de la historia de este país; un terremoto de 7,8 grados sacudió al país dejando una enorme estela de muertos, heridos, daños económicos, sociales y psicológicos. La ayuda nacional e internacional no se hizo esperar. En este trabajo mostramos, de forma gráfica, como un grupo de trabajadores de la Universidad Nacional de Chimborazo, mediante una brigada de apoyo, brindan su aporte solidario en áreas afectadas por el sismo a solo pocos días de haber sucedido esta tragedia.

On April 16, 2016 Ecuador suffered one of the biggest natural disasters in the history of this country; 7.8-magnitude earthquake struck the country leaving a huge trail of dead, wounded, economic, social and psychological damage. National and international aid did not wait. In this paper we show, graphically, as a group of workers of the National University of Chimborazo, by a brigade support, provide the solidarity contribution in areas affected by the earthquake just a few days after this tragedy happened.

Tularemia and plague survey in rodents in an earthquake zone in southeastern Iran / 한국역학회지

OBJECTIVES: Earthquakes are one the most common natural disasters that lead to increased mortality and morbidity from transmissible diseases, partially because the rodents displaced by an earthquake can lead to an increased rate of disease transmission. The aim of this study was to evaluate the prevalence of plague and tularemia in rodents in the earthquake zones in southeastern Iran. METHODS: In April 2013, a research team was dispatched to explore the possible presence of diseases in rodents displaced by a recent earthquake magnitude 7.7 around the cities of Khash and Saravan in Sistan and Baluchestan Province. Rodents were trapped near and in the earthquake zone, in a location where an outbreak of tularemia was reported in 2007. Rodent serums were tested for a serological survey using an enzyme-linked immunosorbent assay. RESULTS: In the 13 areas that were studied, nine rodents were caught over a total of 200 trap-days. Forty-eight fleas and 10 ticks were obtained from the rodents. The ticks were from the Hyalomma genus and the fleas were from the Xenopsylla genus. All the trapped rodents were Tatera indica. Serological results were negative for plague, but the serum agglutination test was positive for tularemia in one of the rodents. Tatera indica has never been previously documented to be involved in the transmission of tularemia. CONCLUSIONS: No evidence of the plague cycle was found in the rodents of the area, but evidence was found of tularemia infection in rodents, as demonstrated by a positive serological test for tularemia in one rodent.

Screening de trastornos de estrés postraumático en población afectada por el terremoto chileno de 2010 / Screening for posttraumatic stress disorder in people affected by the 2010 earthquake in Chile / Triagem para transtorno de estresse pós-traumático em pessoas afetadas pelo terremoto chileno de 2010

Se analizó un screening de trastornos de estrés postraumático en habitantes chilenos, como consecuencia del terremoto de febrero de 2010; a partir de una Encuesta Post Terremoto con una muestra multietápica de 24.982 personas mayores de 18 años, a quienes se aplicó la Escala de Trauma de Davidson. La prevalencia de screening positivo para los trastornos de estrés postraumático fue del 11% en el país, pero a menor nivel de desagregación llegaron a observarse prevalencias del 30%. El modelo de regresión logística para la estimación de la variable trastornos de estrés postraumático identificó como factores de riesgo el hecho de pertenecer un hogar pobre, haber sufrido daños en la vivienda, haber tenido algún problema de salud en el último mes y ser mujer (p<0,05). También se encontró que el afrontamiento del sismo en familia resultó como un factor protector, en relación a afrontarlo con otros colectivos sociales (vecinos), la mayor cantidad de años de educación formal también fue identificada como un factor de protección (p<0,05). Se observaron claras desigualdades sociales en las personas que presentaron un screening positivo.

The authors conducted an assessment of post-traumatic stress disorder screening in the Chilean population following the February 2010 earthquake, based on the Post Earthquake Survey with a multistage sample of 24,982 individuals over 18 years of age, applying the Davidson Trauma Scale. Multivariate analysis was performed with significance set at p<0.05. Prevalence of positive screening for post-traumatic stress disorder was 11% for the country as a whole, but reached 30% at lower-level disaggregation. The logistic regression model for post-traumatic stress disorder identified the following risk factors: belonging to a low-income family, having suffered damage to the household, a history of health problems in the previous month, and female gender (p<0.05). Family coping with the earthquake proved to be a protective factor as compared to other social or neighborhood groups, and more years of schooling were also protective (p<0.05). Positive screening for posttraumatic stress disorders revealed clear social inequalities.

Foram analisados dados associados a transtornos de estresse pós-traumáticos apresentados por uma população do Chile, após o terremoto de fevereiro de 2010, a partir de uma pesquisa pós-terremoto (EPT 2010, Chile) com uma amostra multiestágio de 24.982 pessoas de mais de 18 anos, com aplicação da Escala de Trauma Davidson. A prevalência de casos positivos de screening para transtornos avaliados foi de 11% no país, mas em um nível inferior de desagregação, a prevalência observada atingiu 30%. O modelo de regressão logística para estimar a variável transtornos de estresse pós-traumático identificou como fatores de risco o fato de pertencer a uma família pobre, ter sofrido danos em seu domicílio, ter problemas de saúde no último mês e ser do sexo feminino (p<0,05). Também se encontrou que enfrentar o terremoto em família resultou como um fator de proteção em comparação com outros grupos sociais ou vizinhos, o maior número de anos de educação formal também foi identificado como um fator de proteção (p<0,05). Foram observadas claras desigualdades sociais em pessoas que tiveram screening positivo.

Factores que influyen la comorbilidad entre trastorno de pánico y estrés postraumático después de terremotos / Factors that influence comorbidity from panic disorder and PTSD after earthquakes

Objetivo Después del terremoto y tsunami de Chile (27-F), estudiamosel efecto de factores socio-demográficos, de exposición al evento y de ayuda estatal recibida en la comorbilidad entre trastorno de pánico (CAP) y estrés postraumático (TEPT). Método Encuestas que incluían la Escala de Trauma de Davidson(DTS)a 246 habitantes. Resultados Se encontró19,1% de comorbilidad (r=,583; R2=,340; p<,01). Quienes tienen mayor riesgo de sufrir CAP y TEPT son las mujeresdueñas de casa. La ayuda estatal se asocia amás casos de CAP. Conclusiones Diseñamos perfiles de riesgo/resistencia anteterremotos/tsunamis y uninstrumento (EP-TEPT) para detectar casos en riesgo de TEPT. Sugerimos pautas para que el Estado mejore su rol después de desastres.(AU)

Objective After the earthquake and tsunami in Chile (F-27), we studied the effect of socio-demographic factors, exposure to the event, and state aid received on comorbidity from panic disorder (PD) and posttraumatic stress disorder (PTSD). Method Surveys that include the administration of the Davidson Trauma Scale (DTS) to 246 inhabitants. Results 19.1 % comorbidity was found (r=.583, R2=.340, p<.01). Females homeowners have a higher risk of PD and PTSD. State aid is associated with more cases of PD. Conclusions We designed risk/resistance profilesagainst earthquakes/tsunamis and an instrument to detect cases at risk of PTSD. We suggest guidelines so that the government can improve its role after disasters.(AU)

Traumatic brain injury in Ya'an earthquake: a report of 69 cases / 中华创伤杂志

Objective To analyze the clinical features of patients with traumatic brain injury in the Ya' an earthquake and discuss the treatment experiences.Methods Medical records of 69 patients admitted from April 2013 to May 2013 because of traumatic brain injury in the Ya' an earthquake were collected.Retrospective review was performed for age,gender,causes of injury,time from injury to hospitalization,types of injury,associated injury,treatment methods and outcomes.Results There were 47 males and 22 females.Forty-two patients (61％) were injured from falling objects.Fifty-eight patients (84％) were sent to the West China Hospital within 72 hours postinjury.Twenty-two cases (32％) sustained associated injuries.Twenty-nine patients (42％) were critically injured.Twenty-four patients underwent operation at the local hospital and twelve patients had operation at our hospital.Outcome measure using GOS one month after treatment showed 55 favorable recovery,5 moderate disability,4 severe disability,and 5 coma.Conclusions Main cause of injury is hit by falling objects during the Ya' an earthquake.Majority of the patients obtained effective treatment in the time window.GCS in combination with patients' general condition used in casualty triage and critical patients charged by neurosurgeons and treated with the cooperation of multiple disciplinary teams are helpful to successful treatment.

Sintomas de estresse pós-traumático em profissionais durante ajuda humanitária no Haiti, após o terremoto de 2010 / Post-traumatic stress disorder symptoms among professionals during humanitarian aid in Haiti after the earthquake in 2010

O artigo tem por objetivo rastrear sintomatologia de transtorno de estresse pós-traumático (TEPT) em profissionais que prestaram ajuda humanitária à população haitiana, após o terremoto de 2010. Estudo transversal. A sintomatologia de TEPT foi avaliada pela Escala Impacto do Evento - Revisada (IES-R). Os participantes foram 32 brasileiros (idade m = 37.58 +/- 7.01), 22 estadosunidenses (idade m = 33.67 +/- 8.03) e 12 equatorianos (idade m = 44.80 +/- 15.88) e não apresentaram sintomatologia de TEPT. A relação entre as variáveis experiência prévia em situação de desastre e escore total da IES-R [F(2) = 4.34, p = 0.017] bem como experiência prévia em situação de desastre e subescala intrusão [F(2) = 3.94, p = 0.024] foram significantes nos modelos de regressão linear. Experiência prévia se mostrou preditor significante para escore total da IES-R (p < 0,05). Os resultados demonstraram que vivências atuais podem ser potencializadas pelas memórias de experiências anteriores, aumentando a probabilidade de desenvolvimento de TEPT. Portanto, o cuidado com a saúde mental dos profissionais deve favorecer a precoce identificação do fator de risco experiência prévia, não permitindo que a iniciativa voluntária se sobreponha aos critérios seletivos e aos cuidados específicos.

The scope of this article is to screen the symptoms of Post-Traumatic Stress Disorder (PTSD) among the professionals who provided humanitarian aid for the Haitian population after the 2010 earthquake. It involvess a cross-sectional study. The Impact of Event Scale - Revised (IES-R) was used for screening symptoms of PTSD. The participants included 32 Brazilians (mean age = 37.58 +/-7.01), 22 Americans (mean age =33.67 +/-8.03) and 12 Ecuadorians (mean age = 44.80 +/- 15.88). The professionals did not have PTSD symptoms. The relationship between prior experience variables in disaster situations and the total score of the IES-R (F (2) = 4.34, p = 0.017), as well as prior experience in disaster situations and the intrusion subscale (F (2) = 3.94, p = 0.024) were significant in linear regression models. The number of prior experiences was revealed as a significant predictor for the total score of IES (p < 0.05). The results showed that current experiences can be exacerbated by memories of prior experiences, increasing the likelihood of developing PTSD. Therefore the mental health care of the professionals should foster the early identification of prior experience risk factors, thereby not permitting voluntary initiative to transcend selective criteria and specific care.

Terremoto en Chile: estrés agudo y estrés post-traumático en mujeres en tratamiento por depresión grave / Earthquake in Chile: acute stress and post traumatic stress disorder among women in treatment for severe depression

Background: Depression is a risk factorfor developing secondary post-traumatic stress disorder. The earthquake on February 27th, 2010, destroyed the Hospital of Curicó. Despite the prevailing chaos, patients in treatment for severe depression actively maintained their treatment from the first post-earthquake workingday Aim: To determine prevalence of acute stress (AS) and post-traumatic stress disorder (PTSD) after the earthquake amongwomen in treatment for severe depression. Material and Methods: Seventy five women aged 20 to 73 years in treatment for depression for at least six months before the oceurrence of the earthquake, who continued in follow up after the event, were studied. According to the Tenth International Classification ofDiseases, thefrequency ofAS was assessed duringthe consultation oceurring one month after the event and thefrequency ofPTSD was assessed during the consultation oceurring six months after the event. Results: Fifty nine percent of women hadAS symptoms at thefirst month and 53.3% had PTSD, six months later. AS was signifi cantly associated with a low educational level. PTSD was significantly associated with prior oceurrence of AS and a history of childhood trauma history. Conclusions: A high frequeney ofPTSD was observed in thisgroup of depressive patients, which was significantly associated with a history ofprevious AS and childhood trauma.

Standardized early medical care of Lushan earthquake victims in army hospitals / 中华创伤杂志

Objective To summarize the experiences with early treatment of the wounded associated with 4 · 20 Lushan earthquake in army hospitals.Methods Emergency response programs were started and tent hospitals were set up.According to the basic principle of wartime wound treatment regulation,emergency triage,emergency medical care,transferring,specialized treatment and evacuation were performed for the wounded in this earthquake.Results After the earthquake,the emergency rescue programs were started in the hospital.Twenty minutes later,emergence medical team with full equipment were set out for the epicenter and the tent hospitals were set up.A total of 181 earthquake cases were admitted within two weeks,of which 68 (37.6％) were transferred from the scene of earthquake and 113 (62.4％) were transferred after the primary treatment (including cases evacuating from other hospitals).Forty-nine surgeries had been done,including 30 emergence ones.Thirty-four cases (including 14 severe wounded) were evacuated to superior hospitals as their vital signs turned stable.There was no death or surgical wound infection.Conclusions Peacetime complete emergence programs and materials reserves,unified and well-organized command as well as normative grading treatment system in army hospitals assure the standardized medical care with high efficiency and high quality for earthquake victims.However,more researches are needed over diagnosis methods and standards for wound severity,equipment improvement and standards for casualty evacuation.