Tourism as a Tool in Nature-Based Mental Health: Progress and Prospects Post-Pandemic.

The healthcare sector recognises the role of nature in mental health. The tourism sector is equipped to take people to national parks. The conservation sector gains support from visitors. Theoretical frameworks for mental health benefits from nature tourism include: tourism destinations and activities; tourist personalities and life histories; sensory and emotional components of tourist experiences; and intensity and duration of memories. Mental health deteriorated worldwide during the COVID-19 pandemic. Recovery of global economic productivity requires immediate, accessible, affordable mental health measures at national scales, and nature-based approaches provide the best option. Different countries have adopted a variety of public, private, or voluntary mechanisms. Some focus on design of activities, others on provision of facilities. Costs and implementation depend on key research questions: marginal benefits of nature tour guides or psychologists compared to self-guided nature experiences; comparisons between repeated brief visits and one-off nature holidays; effects of biodiversity, flagship species, and scenic or wilderness quality; and differences between individuals, depending on personalities, life histories, and mental health status and symptoms.

Post electrical or lightning injury syndrome: a proposal for an American Psychiatric Association's Diagnostic and Statistical Manual formulation with implications for treatment.

In the past, victims of electrical and lightning injuries have been assessed in a manner lacking a systematic formulation, and against ad hoc criteria, particularly in the area of neuropsychological disability. In this manner patients have, for example, only been partially treated, been poorly or incorrectly diagnosed, and have been denied the full benefit of compensation for their injuries. This paper contains a proposal for diagnostic criteria particularly for the neuropsychological aspects of the post injury syndrome. It pays attention to widely published consistent descriptions of the syndrome, and a new cluster analysis of post electrical injury patients. It formulates a proposal which could be incorporated into future editions of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM). The major neuropsychological consequences include neurocognitive dysfunction, and memory subgroup dysfunction, with ongoing consequences, and sometimes including progressive or delayed psychiatric, cognitive, and/or neurological symptoms. The proposed diagnostic criteria insist on a demonstrated context for the injury, both specifying the shock circumstance, and also physical consequences. It allows for a certain delay in onset of symptoms. It recognizes exclusory conditions. The outcome is a proposal for a DSM classification for the post electrical or lightning injury syndrome. This proposal is considered important for grounding patient treatment, and for further treatment trials. Options for treatment in electrical or lightning injury are summarised, and future trials are foreshadowed.

The Most Effective Methods for Delivering Severe Weather Early Warnings to Fishermen on Lake Victoria.

Introduction: It is estimated that five thousand people die on Lake Victoria every year by drowning which is triggered by severe weather hazards like lightning. Objectives:  In order to improve predictability of severe weather conditions on Lake Victoria, there is need to deliver timely and effective Severe Weather Early Warning Systems (SWEWS) to those at risk. On Lake Victoria, previous SWEW service trials ceased with the end of the funding grants. This study therefore assessed the possibility of sustaining the SWEW service by assessing willingness to pay.   Methods: An assessment was conducted between March and May 2015 to determine the SWEW service improvements desired by the population. A convenience sample of respondents was gathered and interviewed during impromptu visits to landing sites on Lake Victoria. The respondents were also among community members that had earlier participated in a pilot assessing the feasibility of mobile phones is delivering SWEW alerts.  Semi-structured questionnaires were administered to fishermen and fisher folks at the landing site to gather suggestions/strategies for (i) better design and implementation of SWEW service, (ii) use of smart phones, and (iii) their ability and willingness to pay for a SWEW service. Results were presented as frequencies. Results: Two hundred fifteen respondents from fourteen landing sites (communities) were interviewed. Over 50% of the respondents (113/215) were aware about at least one community member who had been injured due to lightening on the lake in the past year. Ninety two percent (198/215) of the respondents reported using mobile phones as their main tool of communication but only 4% had smart phones that could receive early warning weather alerts through internet connectivity. Seventy five percent of respondents said they would welcome a system that could deliver commercial weather alerts and 65% were willing to pay for such a service.   Conclusions: A SWEW service is feasible in this community but must be accompanied with public education on risk, a design that can fit the basic phone functionality and a system that the community majority will be willing to pay for on a continuing basis as a sustainability plan/strategy for an early warning system. This will enable timely dissemination of severe weather alerts and reduce risk of drowning on lakes among fishing communities.

A follow-up study of a large group of children struck by lightning.

BACKGROUND: On 11 November 1994, 26 preadolescent girls, 2 adult supervisors and 7 dogs were sleeping in a tent in rural South Africa when the tent was struck by lightning. Four of the girls and 4 of the dogs were killed. The 2 adults were unharmed, but all but 3 of the children suffered significant injuries. An article in 2002 detailed the event and examined the medical and psychological changes in the surviving girls. OBJECTIVE: To understand the medical and psychological changes secondary to lightning strike years after injury. METHODS: An online questionnaire was prepared that included a checklist of physical and psychological symptoms. Participants were asked to report on both initial and current symptoms. Eleven of the 22 survivors were contacted, and 10 completed the survey. RESULTS: Participants reported that initial physical symptoms generally resolved over time, with ~10 - 20% continuing to experience physical symptoms. Vision problems persisted in 50% of respondents. Psychological symptoms, overall, had a later onset and were more likely to be chronic or currently experienced. Depression and anxiety, specifically, were higher among the survivors than the reported incidence in South Africa. CONCLUSIONS: Initial and current/chronic physical and psychological symptoms following lightning strike are reported, adding to the body of literature on the long-term after-effects of lightning strike on survivors. A brief discussion on post-traumatic stress disorder symptomatology and post-lightning shock syndrome is provided.

National Athletic Trainers' Association position statement: lightning safety for athletics and recreation.

OBJECTIVE: To present recommendations for the education, prevention, and management of lightning injuries for those involved in athletics or recreation. BACKGROUND: Lightning is the most common severe-storm activity encountered annually in the United States. The majority of lightning injuries can be prevented through an aggressive educational campaign, vacating outdoor activities before the lightning threat, and an understanding of the attributes of a safe place from the hazard. RECOMMENDATIONS: This position statement is focused on supplying information specific to lightning safety and prevention and treatment of lightning injury and providing lightning-safety recommendations for the certified athletic trainer and those who are involved in athletics and recreation.

Psychiatric morbidity following electrical injury and its effects on cognitive functioning.

OBJECTIVE: This study examines the prevalence of psychiatric morbidity in a large sample of electrical injury (EI) patients in three phases of recovery and its effects on cognitive functioning. METHODS: Eight-six self-referred EI patients received psychiatric and neuropsychological evaluations. Descriptive statistics were conducted to examine the prevalence of psychiatric morbidity. Polytomous logistic regression was used to identify predictors of psychiatric diagnosis. Between-subjects analysis of variances (ANOVA) was conducted to examine the effects of psychiatric morbidity on cognitive functioning. RESULTS: Seventy-eight percent of subjects warranted a psychiatric diagnosis. Long-term patients compared to acute patients were more likely to be diagnosed with two diagnoses than not having any diagnosis (OR=14.30, 95% CI 1.40-38.71). Patients with two diagnoses performed worse than both patients with a single or no diagnosis on all cognitive outcome measures (P<.05). Voltage level, chronic pain and litigation status did not predict psychiatric morbidity. CONCLUSIONS: Psychiatric difficulties commonly emerge and persist following EI. EI patients with psychiatric conditions exhibited poorer cognitive performance as compared to EI patients with no post-injury psychiatric difficulties. Health care professionals need to devote careful attention to psychiatric and cognitive status when treating survivors of EI.

Alteration in functional brain systems after electrical injury.

Neuropsychological studies in electrical injury patients have reported deficits in attention, learning, and working memory, but the neural substrates of these deficits remain poorly characterized. In this study we sought to examine whether electrical injury subjects demonstrate abnormal patterns of brain activation during working memory and procedural learning tasks. Fourteen electrical injury subjects and fifteen demographically matched healthy control subjects performed a spatial working memory paradigm and a procedural learning paradigm during functional MRI studies. For the spatial working memory task, electrical injury patients exhibited significantly greater activation in the middle frontal gyrus and motor and posterior cingulate cortices. Increased activation in EI subjects also was observed on a visually-guided saccade task in several sensorimotor regions, including the frontal and parietal eye fields and striatum. On the procedural learning task, electrical injury patients exhibited significantly less activation in the middle frontal gyrus, anterior cingulate cortex, and frontal eye fields than controls. This is the first study to document task-dependent, system-level cortical and subcortical dysfunction in individuals who had experienced an electrical shock trauma.

Lightning Strike and Electric Shock Survivors, International.

Prior to1989 no known support group existed for victims of lightning or electrical shock injury and their families. A lightning strike survivor of twenty years, Steve Marshburn, recognized the need both from his personal experience and after meeting two other survivors. With his wife and psychologist, he formed Lightning Strike and Electric Shock Survivors International. The organization has grown nearly one hundredfold from the thirteen who attended the first annual meeting. The support group serves people from around the world, has produced a number of publications, participated in research about these injuries and has become active in prevention activities. This paper will describe some of the factors that have led to such success for the organization.

Chemical peritonitis from champagne.

Abdominal pain is a frequent presentation to the Emergency Department and it is often difficult to find a clear diagnosis. This is a unique case of a woman with worsening abdominal pain over 2 days with no clear etiology despite extensive, repeat evaluations with eventual spontaneous resolution. The diagnosis of chemical peritonitis was established when the patient revealed an extremely rare mechanism of injury the night before presentation that has never been described previously. Access to the abdominal cavity through the uterus has been documented by retrograde flow during menses, and through vigorous insufflation during oral sex leading to pneumoperitoneum. Passage of an exogenous fluid through the same mechanism mimicking an acute abdomen has never been documented. This entity presents another possible explanation for the frequently encountered abdominal pain that after thorough work-up does not have a definitive diagnosis.

Electron paramagnetic resonance spectroscopic evidence of increased free radical generation and selective damage to skeletal muscle following lightning injury.

The present case study examined changes in peripheral markers of free radical metabolism and skeletal/myocardial muscle damage 30 h after a mountaineer had survived a lightning storm, having experienced contact with what was considered to be "upward leaders" at 4200 m. Sea-level control data were available between 3 and 8 weeks prior to the altitude sojourn for comparative purposes. Follow-up measurements were obtained for the same individual 3 weeks following the incident after simulated exposure to the combined stresses of inspiratory hypoxia and physical exercise. Venous blood was assayed for molecular markers of skeletal [myoglobin and total creatine phosphokinase (CPK)] and myocardial [cardiac troponin I (cTnI)] muscle damage. Ex-vivo spin trapping with alpha-phenyl-tert-butylnitrone (PBN) combined with electron paramagnetic resonance (EPR) spectroscopy was incorporated for the direct detection of free radicals. The relative increases [post-exposure/preexposure x 100 (%)] in the concentration of the PBN adduct, myoglobin, and CPK in the "lightning blood" were markedly greater than those observed following the simulation study (PBN: 276 vs. 129%; CPK: 1130 vs. 182%; myoglobin: 205 vs. 115%). In contrast, no changes were observed for cTnI. A marked decrease in the PBN adduct, myoglobin, and CPK was observed within 2 h of completing the simulation study, following oral administration of water and lipid-soluble antioxidant vitamins in normoxia. These findings are the first to document lightning-induced free radical generation and selective damage to skeletal muscle in a high altitude mountaineer. Furthermore, free radicals may contribute to the pathogenesis of lightning injury, and dietary supplementation with antioxidant vitamins may prove of some benefit against associated tissue damage.

Lightning safety guidelines.

On average, lightning causes more casualties annually in the United States than any other storm-related phenomenon except floods. Although 90% of those injured survive, they may have permanent sequelae and disability. Many of these people incur injuries or are killed by lightning because of misinformation and inappropriate behavior during thunderstorms. A few simple precautions can reduce lightning injury risk. To standardize recommended actions during thunderstorms, the Lightning Safety Group (LSG), composed of lightning experts from many lightning-related backgrounds, met at the American Meteorological Society meeting Phoenix, AZ, in January 1998 to collectively address personal lightning safety. This paper is a summary of the recommendations developed by the LSG.

A large group of children struck by lightning.

We report on the largest case to date of children with significant injuries from a single lightning strike. A retrospective analysis was done of the camping scene and injuries to 28 people (26 preadolescent girls and 2 adult supervisors) and 7 dogs from a documented lightning strike. Of the 35 victims sleeping in the tent, 4 girls and 4 dogs were fatally injured. The 2 adults were unharmed, but 23 of the children suffered injuries including burns (23), cataracts (8), macular holes (4), tympanic membrane rupture (2), and skull fracture (2). Many of these injuries occurred more frequently than would be expected from prior large reviews and reports.

A fifth mechanism of lightning injury.

The four classic electrical mechanisms of lightning injury cannot account for all injuries. A fifth mechanism, injury by a weak upward streamer that does not become part of a completed lightning channel, has long been postulated in the engineering literature by lightning researchers. This paper reports a case of death where injury from a weak upward streamer is strongly suspected following forensic investigation. Neither high voltage nor any of the previously accepted mechanisms of lightning injury can explain this incident.