Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy.

OBJECTIVE: To study the relationship of post-traumatic stress disorder (PTSD) to severity of the disaster experience. METHOD: A sample of 1785 adult participants of an epidemiological study initiated in the immediate aftermath of the 1988 earthquake in Armenia were interviewed about 2 years following the disaster based on the NIMH DIS-Disaster Supplement. All 154 cases of pure PTSD were compared with 583 controls without symptoms satisfying psychiatric diagnoses of interest. RESULTS: PTSD cases included more persons from areas with the worst destruction. Having the highest level of education compared to lowest (OR 0.6 [95% CI 0.4-0.9]), being accompanied at the moment of the earthquake (OR 0.6 [95% CI 0.4-0.9]) and making new friends after the earthquake (OR 0.6 [95% CI 0.5-0.8]) were protective for PTSD. PTSD risk increased with the total amount of loss to the family (OR for highest level of loss 4.1 [95% CI 2.3-7.5]). CONCLUSION: Based on this large population sample, we believe that early support to survivors with high levels of loss may reduce PTSD following earthquakes.

Long term mortality and morbidity related to degree of damage following the 1998 earthquake in Armenia.

To assess the relation of increased mortality and morbidity to personal loss and damage following the 1988 earthquake in Armenia, the authors conducted a prospective study of mortality and a nested case-control analysis of incident morbidity. Employees of the Armenian Ministry of Health and their immediate families (n = 35,043) who survived the disaster formed the study population. Two sets of interviews with the employees, carried out over a period of 4 years of follow-up, were used as the primary source of data for this study. The highest numbers of deaths from all causes and from heart disease were observed within the first 6 months following the earthquake. The nested case-control analysis of 483 cases of newly reported heart disease and 482 matched non-heart-disease controls revealed that people with increasing levels of loss of material possessions and family members had significant increases in heart disease risk (odds ratios for "loss scores" of 1, 2, and 3 were 1.3, 1.8, and 2.6, respectively). The findings were similar with regard to the relation of damage and loss to newly reported hypertension, diabetes mellitus, and arthritis. The findings of this study support the hypothesis that longer term increased rates of heart disease and chronic disease morbidity following an earthquake are related to the intensity of exposure to disaster-related damage and losses. People sustaining such losses should be closely monitored for increased long term morbidity.

Deaths and injuries due to the earthquake in Armenia: a cohort approach.

BACKGROUND: This is the first population-based study of earthquake injuries and deaths that uses a cohort approach to identify factors of high risk. As part of a special project that collected data about the population in the aftermath of the earthquake that hit Northern Armenia on 7 December 1988, employees of the Ministry of Health working in the earthquake zone on 7 December 1988, and their families, were studied as a cohort to assess the short and long term impact of the disaster. The current analysis assesses short term outcomes of injuries and deaths as a direct result of the earthquake. METHODS: From an unduplicated list of 9017 employees, it was possible to contact and interview 7016 employees or their families over a period extending from April 1990 to December 1992. The current analysis presents the determinants of 831 deaths and 1454 injuries that resulted directly from the earthquake in our study population of 32,743 people (employees and their families). RESULTS: Geographical location, being inside a building during the earthquake, height of the building, and location within the upper floors of the building were risk factors for injury and death in the univariate analyses. However, multivariate analyses, using different models, revealed that being in the Spitak region (odds ratio [OR] = 80.9, 95% confidence interval [CI]: 55.5-118.1) and in the city of Gumri (OR = 30.7, 95% CI: 21.4-44.2) and inside a building at the moment of the earthquake (OR = 10.1, 95% CI: 6.5-15.9) were the strongest predictors for death. Although of smaller magnitude, the same factors had significant OR for injuries. Building height was more important as a factor in predicting death than the location of the individual on various floors of the building except for being on the ground floor of the building which was protective. CONCLUSIONS: Considering that most of the high rise buildings destroyed in this earthquake were built using standard techniques, the most effective preventive effort for this disaster would have been appropriate structural approaches prior to the earthquake.

[Toxoplasmosis in Iran. Results of a seroepidemiological study]. / Toxoplasmose en Iran. Résultats d'une étude séroépidémiologique.

A toxoplasmosis seroepidemiological survey was effected with 13,018 sera collected by stratified cluster random sampling method from 12 provinces in Iran. The samples were studied by indirect immunofluorescent assay (IFA) for the presence of Toxoplasma. In this study, 52.6% of the subjects were male and the remaining 47.4% were female. Anti-Toxoplasma antibody was detected in a total of 51.8% of the samples with no significant difference between male and female affected subjects. The distribution of the infected samples was also investigated in various age groups, the level of infection to Toxoplasma increasing from childhood, culminating to 30 years of age and gradually declining from there after. Between the various age groups, the 10-19 years old demonstrated a 50% increase in relative risk to the infection with high antibody titer. Within the provinces under study, the highest relative frequency of Toxoplasma antibody titer was indicated in Mazandaran province (20.5%), while the lowest frequency was detected in Hormozgan (2.9%). In general, there was a decrease in the number of infected samples from humid areas in north to dry provinces in south of Iran. In the clinical symptoms study, no significant difference between male and female patients was demonstrated. According to the type of clinical manifestation, lymphadenopathy and central nervous system symptoms (encephalitis) were respectively the most and the least frequent manifestations.