Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires.

BACKGROUND: The first cases of the COVID-19 pandemic in Australia were recorded in January 2020, which was during the 'Black Summer' bushfires of 2019-20 and prior to additional disasters in some regions. Few studies have considered the compound impact of disasters and the pandemic. AIMS: To improve understanding of the impact on mental health and well-being of the pandemic in disaster-affected communities. METHOD: We conducted semi-structured interviews (n = 18) with community members and online focus groups (n = 31) with help providers from three regions of rural Australia affected by bushfires and the pandemic. RESULTS: Six themes were produced: (a) 'Pulling together, pulling apart', describing experiences after bushfires and prior to impacts of the pandemic; (b) 'Disruption of the 'normal response', encompassing changes to post-disaster recovery processes attributed to the pandemic; (c) 'Escalating tensions and division in the community', describing impacts on relationships; (d) 'Everywhere you turn you get a slap in the face', acknowledging impacts of bureaucratic 'red tape'; (e) 'There are layers of trauma', highlighting intersecting traumas and pre-existing vulnerabilities; and (f) 'Where does the help come from when we can't do it?', encompassing difficulties accessing services and impacts on the helping workforce. CONCLUSIONS: This study furthers our understanding of compound disasters and situates pandemic impacts in relation to processes of adjustment and recovery from bushfires. It highlights the need for long-term approaches to resilience and recovery, investment in social infrastructure, multi-component approaches to workforce issues, and strategies to increase mental health support and pathways across services.

Addressing moral injury in the military.

Moral injury is a relatively new, but increasingly studied, construct in the field of mental health, particularly in relation to current and ex-serving military personnel. Moral injury refers to the enduring psychosocial, spiritual or ethical harms that can result from exposure to high-stakes events that strongly clash with one's moral beliefs. There is a pressing need for further research to advance understanding of the nature of moral injury; its relationship to mental disorders such as posttraumatic stress disorder and depression; triggering events and underpinning mechanisms; and prevalence, prevention and treatment. In the meantime, military leaders have an immediate need for guidance on how moral injury should be addressed and, where possible, prevented. Such guidance should be theoretically sound, evidence-informed and ethically responsible. Further, the implementation of any practice change based on the guidance should contribute to the advancement of science through robust evaluation. This paper draws together current research on moral injury, best-practice approaches in the adjacent field of psychological resilience, and principles of effective implementation and evaluation. This research is combined with the military and veteran mental health expertise of the authors to provide guidance on the design, implementation and evaluation of moral injury interventions in the military. The paper discusses relevant training in military ethical practice, as well as the key roles leaders have in creating cohesive teams and having frank discussions about the moral and ethical challenges that military personnel face.

Prevalence and implications of gambling problems among firefighters.

Firefighting is a high-risk occupation that accounts for vulnerability to a range of mental health problems and addictive behaviours. However, no research has addressed whether this vulnerability extends to gambling problems, and the aim of this study was thus to provide new data on frequency and implications of such problems in this occupational context. The sample consisted of n = 566 career and retained firefighters who participated in a cross-sectional survey of an Australian metropolitan fire service. The Problem Gambling Severity Index (PGSI) was used to operationalise both clinically significant levels of problem gambling (PGSI ≥ 5), and 'at-risk' gambling (PGSI 1-4); alongside measures of major depression (PHQ-9), anxiety (GAD-7), Posttraumatic Stress Disorder (PCL-5) and alcohol problems (AUDIT), as well as other addictive behaviours, wellbeing and psychosocial issues. Results indicated 12.3% of firefighters that reported any gambling problems across a continuum of severity (PGSI ≥ 1), including 2.3% that were problems gamblers, and 10.0% reporting at-risk gambling. The weighted prevalence of problem gambling was comparable to other significant mental health conditions including depression and PTSD, while the rate of any gambling problems was high relative to other addictive behaviours. Gambling problems were associated with poor mental health and wellbeing, but not psychosocial indicators (e.g., financial difficulties). The findings suggest that gambling problems across a spectrum of severity may be significant yet hidden issues among emergency service workers, and thus require increased recognition and responses at the organisational level.

Hepatitis B among homeless and other impoverished US military veterans in residential care in Los Angeles.

Findings are presented for a cross-sectional study of serological markers of hepatitis B virus (HBV) infection in an underserved population-impoverished veterans of the US armed forces in a Veterans Administration (VA) residential program in the US. We examine the demographic, background, and risk factors associated with HBV infection in this high-risk population. This paper presents a secondary analysis of cross-sectional survey and clinical data for 370 male veterans who were residents of a domiciliary care program for homeless veterans in Los Angeles, using chi(2), Fisher's Exact, and logistic regression analysis. About one-third (30.8%) of the sample tested positive for current or past HBV infection (ie, seropositive for either the HBV core antibody or surface antigen). After multivariate analysis, rates of HBV were significantly higher among veterans who were older, non-white, or who had a history of regular heroin use (a proxy measure for injection drug use), drug overdose, or drug detoxification treatment. The rate of current or past HBV infection among veterans in this sample (30.8%) was high compared to an estimated 5% to 8% of the general US population. Also, 3% of the sample were currently infected with HBV. Strategies for intervention include broader screening, immunization, and treatment interventions with this high-risk group.

Homeless veterans' utilization of medical, psychiatric, and substance abuse services.

This study focuses on the association between homeless veterans' prior utilization of medical, psychiatric, and substance abuse services and biopsychosocial characteristics reported at admission into a domiciliary care program. Given the large number of veterans in the US homeless population and their health care needs, understanding factors associated with health service use among homeless veterans is significant. Research participants were 429 homeless male veterans who had been admitted to the Domiciliary Care for Homeless Veterans Program site at the West Los Angeles Veterans Affairs Medical Center between February 1988 and July 1992 for treatment of medical, psychiatric, or substance disorders. Results of logistic regression analyses indicated that self-reported need (chronic medical problems, serious psychiatric symptoms, combat stress, alcohol use) and evaluated need for care (evidence of liver dysfunction) were important to veterans' use of health services in the 6 months before program admission. Predisposing social structure factors (education, residential stability, and usual sleeping place) were also significant predictors of service utilization. Overall, need factors were more strongly related to service use. Supplementary logistic regression analyses indicated that comorbidity of need factors deserves attention in understanding homeless veterans' use of services. In conclusion, it is important to attend to predisposing social structure factors as potential barriers to care for homeless veterans.

Application of the Folin-Ciocalteau reagent to the determination of salbutamol in pharmaceutical preparations.

A method for the determination of salbutamol in both tablets and syrups is described. It utilizes the reduction of the Folin-Ciocalteau reagent by the phenolic group, monitoring the absorbance of the resulting complex at 760 nm. Results obtained are linear over the range 0-6 mug ml(-1) salbutamol. Coloring material was removed by anionexchange chromatography prior to analysis and there was no interference from sucrose, neutral flavorings or the common preservative sodium benzoate. This method appears suitable as a general assay for salbutamol.

Predictors of homeless veterans' irregular discharge status from a domiciliary care program.

This study addresses the relationship of homeless veterans' discharge status from a domiciliary care program to biopsychosocial characteristics presented at admission into the program. Hypotheses were that younger age, less education, and substance abuse or psychiatric disorder would predict an irregular discharge. Research participants were 367 homeless male veterans who had been admitted to a domiciliary care program at the West Los Angeles Veterans Affairs Medical Center for treatment of medical, psychiatric, or substance disorders. Status of veterans' program discharge (regular or irregular) served as the outcome measure. Logistic regression analysis revealed that irregular discharge from the program was more likely among veterans who were black, who had poor employment histories, or who had problems with alcohol. Results are discussed in light of the need to maintain homeless veterans in treatment programs so that they can achieve maximum benefit from available programs.

Indicators of chronic homelessness among veterans.

OBJECTIVE: This study sought to develop a set of indicators of chronic homelessness as a basis for better understanding and treatment of the homeless veteran population. METHODS: Chi square analysis and the t test or Mann-Whitney U test were used to compare characteristics of veterans who reported long-term homelessness (more than 12 months total since age 18) with those of veterans who reported short-term homelessness (12 months or less). Subjects were 343 homeless male veterans receiving treatment for physical, mental, or substance abuse disorders at the West Los Angeles site of the Domiciliary Care for Homeless Veterans Program. Variables included history of homelessness, employment history, physical and mental health, substance abuse history, social and financial support, criminal history, age, ethnic group, education, military service, and program discharge status. RESULTS: Veterans experiencing long-term homelessness were more likely to be white, to have had a longer period of recent homelessness and a greater number of homeless episodes, to have a poor employment history, to have symptoms of mental and substance abuse disorders, and to have weaker social support. CONCLUSIONS: Results show that variables besides duration of lifetime homelessness are important indicators of chronic homelessness.

Doppler evaluation of bioprosthetic and mechanical aortic valves: data from four models in 107 stable, ambulatory patients.

To test the applicability of Doppler ultrasound in the evaluation of prosthetic valve function, 107 patients with normal ejection fractions in whom Starr-Edwards, Björk-Shiley, Carpentier-Edwards, and Hancock models had been implanted in the aortic position were examined. Maximal transvalvular velocity was recorded by non-imaging continuous wave Doppler ultrasound. Means of maximal velocities by model and size ranged from less than 2 to 4 m/sec. The Starr-Edwards valve showed the highest velocities, the Björk-Shiley the lowest, and the bioprosthetic models showed velocities in between. A significant inverse relation between velocity and size, and standard deviations averaging +/- 14% enabled the technique to measure differences between sizes of the same model. Aortic regurgitation was detected in 24% of the patients. This study, conducted in well and stable patients, established values for maximal velocity across normally functioning aortic mechanical and tissue prostheses of different models and sizes. The intersubject variability was relatively small which, together with a previously shown minimal intrasubject variability, was testimony to a methodology that should prove useful in longitudinal postoperative evaluations.

Echocardiographic observations of calcium in operatively excised stenotic aortic valves.

Qualitative and quantitative 2-dimensional (2-D) echocardiographic methods were developed to define the anatomic and physiologic significance of valvular calcium in aortic stenosis (AS). Qualitative methods assigned etiologic diagnoses by matching patterns of calcium with anatomic criteria. Quantitative techniques measured echodensities from superimposed short-axis views of calcium. Fifty-five pathologic specimens procured from surgery were photographed and radiographed. Etiologic diagnoses were assigned from gross examination and radiodensities were planimetered. Echocardiographic and anatomic diagnoses were compared. Sensitivities for diagnosing the most common etiologies, congenitally bicuspid and degenerative, were 58% and 100% and specificities were 100% and 76%. Calcium tended to be heaviest in congenitally diseased valves and lightest in those with degenerative disease (p less than 0.2) and showed propensity for the right cusp in all etiologies except for those with degenerative disease. Correlation of echodensities to radiodensities was 0.82. The relation of calcific echodensities to orifice area was curvilinear; beyond a level of calcium, further deposits did not reduce the orifice more. A systematic echocardiographic examination of calcium in stenotic aortic valves can give a correct etiologic diagnosis in most patients and identify the severely narrowed orifice.

Pathway of Phloem unloading of sucrose in corn roots.

The pathway of phloem unloading and the metabolism of translocated sucrose were determined in corn (Zea mays) seedling roots. Several lines of evidence show that exogenous sucrose, unlike translocated sucrose, is hydrolyzed in the apoplast prior to uptake into the root cortical cells. These include (a) presence of cell wall invertase activity which represents 20% of the total tissue activity; (b) similarity in uptake and metabolism of [(14)C]sucrose and [(14)C]hexoses; and (c) randomization of (14)C within the hexose moieties of intracellular sucrose following accumulation of [(14)C] (fructosyl)sucrose. Conversely, translocated sucrose does not undergo apoplastic hydrolysis during unloading. Asymmetrically labeled sucrose ([(14)C](fructose)sucrose), translocated from the germinating kernels to the root, remained intact indicating a symplastic pathway for unloading. In addition, isolated root protoplasts and vacuoles were used to demonstrate that soluble invertase activity (V(max) = 29 micromoles per milligram protein per hour, K(m) = 4 millimolar) was located mainly in the vacuole, suggesting that translocated sucrose entered via the symplasm and was hydrolyzed at the vacuole prior to metabolism.