A survey and cause analysis of community resilience in a Chinese city from the perspective of nursing.

BACKGROUND: Community resilience, which fully reflects the ability of communities to resist, absorb, recover or adapt to disasters, has attracted international attention. Nurses are an important force in disaster prevention, relief and postdisaster reconstruction. This study aims to test the current level of community resilience in Dujiangyan city, which was seriously damaged by the Wenchuan earthquake, and analyze the causes. METHODS: Community data from 952 residents, 574 families, 5 health care institutions and 12 communities in Dujiangyan city were collected by using stratified, cluster, map and systematic sampling methods. A new community resilience evaluation system from the perspective of nursing was used to test individual, family, health care and environmental resilience. RESULTS: In Dujiangyan city, average scores were obtained for community resilience (3.93 ± 0.12), individual resilience (4.07 ± 0.64), family resilience (4.07 ± 0.6), health care resilience (3.84 ± 0.33) and community environment resilience (3.69 ± 0.46). CONCLUSIONS: The urban communities in Dujiangyan city had acceptable resilience, with good family and individual resilience and medium health care and community environment resilience, but environmental resilience had the lowest score. Because conditions and resilience levels varied among the communities, targeted measures should be taken to improve resilience based on population characteristics, management, professional organizations, hardware and software facilities.

Post-traumatic stress symptoms of children and adolescents exposed to the 2008 Wenchuan Earthquake: A longitudinal study of 5-HTTLPR genotype main effects and gene-environment interactions.

Experiencing disasters causes severe mental disorders, among which post-traumatic stress disorder (PTSD) is the most common. We conducted a longitudinal study to examine the effect of 5-hydroxyl tryptamine transporter gene-linked polymorphic region (5-HTTLPR) genotype on child and adolescent PTSD symptom course after the 2008 Wenchuan Earthquake. We genotyped 963 participants who personally experienced the earthquake. PTSD symptoms were measured by University of California, Los Angeles PTSD reaction index at 2.5, 3.5, 4.5 and 5.5 years after the earthquake, respectively. Latent growth model was utilised to examine the main effect and gene-environment interaction effect of 5-HTTLPR on PTSD's symptom course. 5-HTTLPR genotype predicted initial PTSD symptom severity (ß = 0.108, p = .019) and rates of symptom recovery (ß = -0.120, p = .031) between 2.5 and 5.5 years. Compared with L' allele carriers, those with S'S' genotype showed higher initial symptom severity but also faster recovery rate. 5-HTTLPR genotype only predicted symptom severity at 2.5 years after the earthquake, after controlling for sex, age, ethnicity and trauma severity (ß = 0.108, p = .019). This is the first evidence of the effect of 5-HTTLPR genotype on child and adolescent PTSD symptoms longitudinally, offering a novel perspective on the effect of 5-HTTLPR on PTSD symptom development following trauma exposure.

Health education program improves QOL in students with irritable bowel syndrome after the Wenchuan earthquake: a five-year multi-center study.

BACKGROUND: Stress is a common contributing factor for irritable bowel syndrome (IBS). This study was to evaluate the efficacy of the centralized health education program in improving the quality of life (QOL) of middle school students with IBS who experienced the Wenchuan earthquake on May 12, 2008. METHODS: A multi-center, randomized and open evaluation study design was adopted. A total of 584 students who met the Rome III criteria for IBS in four middle schools were identified. Of these students, 29 were excluded for various reasons, and the remaining 555 students were randomly assigned to either the health education group (n = 277) or the control group (n = 278, received no health education). De-identified data were collected via the IBS quality of life (IBS-QOL) questionnaire and abdominal pain was assessed during the 5-year follow-up survey. RESULTS: The IBS-QOL mean total score was comparable at baseline between no-education group and education group no matter in quake-unaffected areas or quake-affected areas (52.27 vs 51.43, t = 1.15, P > 0.05; 51.02 vs 50.64, t = 1.98, P > 0.05). During the 5-year study period, 84 students opted out during follow-up. After 5 years, a significant difference of the IBS-QOL mean total score was observed between the no-education group and education group in quake-unaffected areas (80.53 vs 93.67, t = - 55.45, P < 0.01), which was also observed in quake-affected areas (64.23 vs 93.80, t = - 188.10, P < 0.01). In addition, there was a reciprocal action between factor 1(health education or not) and factor 2(affected by the earthquake or not) regarding IBS-QOL for dysphoria(Q1), interference with activity(Q2), food avoidance(Q5) and relationships(Q8)(P < 0.001) at year 1, 3 and 5. In all students, abdominal pain scores gradually reduced from baseline in each subgroup over 5 years (P < 0.001).The improvement was greater in the education group than in the control group no matter in quake-unaffected area and in quake-affected areas(P < 0.001). There was a reciprocal action between factor 1(health education or not) and factor 2(duration of follow-up) regarding the mean abdominal pain symptom score irrespective of quake-unaffected or quake-affected areas (P = 0.029 and P < 0.001). CONCLUSION: The health education program improved quality of life and abdominal pain in middle school IBS students in Wenchuan quake-affected areas.

Rural Households' Livelihood Capital, Risk Perception, and Willingness to Purchase Earthquake Disaster Insurance: Evidence from Southwestern China.

Earthquake disaster insurance can effectively reduce the impact of earthquake disasters on rural households. Exploring rural households’ willingness to purchase earthquake disaster insurance in earthquake disaster areas provides an understanding of the motivations underlying the implementation of an insurance policy. However, few studies have examined the perspectives of rural households, in order to explore the correlations between the rural households’ livelihood capital, their disaster risk perception, and their willingness to purchase earthquake disaster insurance. A cross-sectional survey data including 241 rural households from the most severe disaster counties (cities) during the 5 • 12 Wenchuan earthquake was examined with regard to rural households’ livelihood and disaster risk perception, and ordinal logistic regression models were constructed to explore rural households’ willingness to purchase earthquake disaster insurance, as well as the driving mechanism behind this willingness. The results showed that 34.44% of rural households were very willing to purchase earthquake disaster insurance, and 7.05% of rural households were very reluctant to purchase earthquake insurance. Rural households’ livelihood capital and risk perceptions were the most important factors affecting their willingness to purchase earthquake disaster insurance. Rural households with higher scores on natural capital, physical capital, possibility, and worry were more likely to purchase earthquake disaster insurance. Specifically, keeping all other variables constant, every one unit increase in nature capital and physical capital corresponded to an increase in the odds of willingness to purchase earthquake disaster insurance by a factor of 0.14 and 0.06, respectively; every one unit increase in possibility and worry corresponded to an increase in the odds of willingness to purchase earthquake disaster insurance by a factor of 0.03 and 0.04, respectively. This study contributes to the current literature by increasing the understanding of the relationships between Chinese rural households’ livelihood capital and risk perceptions, and their willingness to purchase earthquake disaster insurance.

Effects of Xuebijing Injection for Patients With Sepsis-induced Acute Kidney Injury After Wenchuan Earthquake.

Context • Earthquakes are devastating disasters that have claimed countless lives in the past, partially owing to the danger of direct and indirect injuries to vital organs. In the deadly earthquake that occurred in Sichuan Province of China on May 12, 2008, some victims suffered from severe damage to multiple organs and tissue and developed sepsis, a systematic inflammatory reaction resulting from infection and trauma. Xuebijing injection (CCXG) could beneficial for improvement of clinical symptoms in those patients, but no research has yet examined its potential. Objective • The study intended to investigate whether a combination of conventional treatment and CCXG was superior to conventional treatment alone, or the control group (CG), in the treatment of clinical symptoms in patients with sepsis-induced acute kidney injury (AKI). Design • The study retrospectively analyzed the medical records of individuals who were injured in an earthquake that occurred in the Sichuan Province of China on May 12, 2008, and who developed AKI. Setting • The study took place in the hospital associated with Chengdu University of Traditional Chinese Medicine (Chengdu, Sichuan, China). Participants • Participants were 55 injured individuals who were treated at the hospital. The CG included 27 patients and the CCXG group included 28 patients. Intervention • Both the intervention group (CCXG group) and the CG received the conventional treatment. The CCXG group was also given intravenous drips containing 100 mL of CCXG. The CG was given 100 mL of a 10% normal saline injection in addition to conventional treatment. Both received the treatments within 30 to 40 min, 3 ×/d. Outcome Measures • Blood urea nitrogen (BUN), creatine phosphate kinase (CPK), serum creatinine (Cr), interleukin 1 (IL-1), and interleukin 6 (IL-6) were measured before treatment and on days 5, 7, and 10 after treatment. Results • The levels of CPK, BUN, Cr, and IL-6 for both groups were significantly lower than at baseline on day 5, 7, and 10 after treatment (P < .05). The levels of the CCXG group were significantly lower than those of the CG group on days 5, 7, and 10 (P < .05). Conclusions • As a supplement, CCXG is an effective method of improving the clinical symptoms of sepsis-induced AKI.

Long-Term Effects of Acute Stress on the Prefrontal-Limbic System in the Healthy Adult.

Most people are exposed to at least one traumatic event during the course of their lives, but large numbers of people do not develop posttraumatic stress disorders. Although previous studies have shown that repeated and chronic stress change the brain's structure and function, few studies have focused on the long-term effects of acute stressful exposure in a nonclinical sample, especially the morphology and functional connectivity changes in brain regions implicated in emotional reactivity and emotion regulation. Forty-one months after the 5/12 Wenchuan earthquake, we investigated the effects of trauma exposure on the structure and functional connectivity of the brains of trauma-exposed healthy individuals compared with healthy controls matched for age, sex, and education. We then used machine-learning algorithms with the brain structural features to distinguish between the two groups at an individual level. In the trauma-exposed healthy individuals, our results showed greater gray matter density in prefrontal-limbic brain systems, including the dorsal anterior cingulate cortex, medial prefrontal cortex, amygdala and hippocampus, than in the controls. Further analysis showed stronger amygdala-hippocampus functional connectivity in the trauma-exposed healthy compared to the controls. Our findings revealed that survival of traumatic experiences, without developing PTSD, was associated with greater gray matter density in the prefrontal-limbic systems related to emotional regulation.

Effect of Home-Based Complementary Food Fortification on Prevalence of Anemia Among Infants and Young Children Aged 6 to 23 Months in Poor Rural Regions of China.

Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of complementary food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China.

Assessing the underlying dimensionality of DSM-5 PTSD symptoms in Chinese adolescents surviving the 2008 Wenchuan earthquake.

By analyzing data yielded from a sample of Chinese adolescents surviving a high-intensity earthquake, this study investigated the underlying dimensionality of DSM-5 PTSD symptoms. The sample included 743 traumatized middle school students (396 females and 332 males) aged 11-17 years (mean=13.6, SD=1.0). Results of confirmatory factor analysis showed that an intercorrelated seven-factor model comprised of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal factors provided a significant better representation of DSM-5 PTSD symptoms than other alternative models. Further analyses indicated that external measures of major depression disorder and panic disorder symptoms displayed unique associations with four PTSD factors. The findings provide further support for the newly proposed seven-factor model of DSM-5 PTSD symptoms, add to very limited empirical knowledge on the latent structure of DSM-5 PTSD symptoms among adolescents, and carry implications for further refinement of the current classifications of PTSD symptoms and further clinical practice and research on posttraumatic stress symptomatology.

[Spatial variability of surface soil nutrients in the landslide area of Beichuan County, South- west China, after 5 · 12 Wenchuan Earthquake].

Based on grid sampling and laboratory analysis, spatial variability of surface soil nutrients was analyzed with GS⁺ and other statistics methods on the landslide area of Fenghuang Mountain, Leigu Town, Beichuan County. The results showed that except for high variability of available phosphorus, other soil nutrients exhibited moderate variability. The ratios of nugget to sill of the soil available phosphorus and soil organic carbon were 27.9% and 28.8%, respectively, showing moderate spatial correlation, while the ratios of nugget to sill of the total nitrogen (20.0%), total phosphorus (24.3%), total potassium (11.1%), available nitrogen (11.2%), and available potassium (22.7%) suggested strong spatial correlation. The total phosphorus had the maximum range (1232.7 m), followed by available nitrogen (541.27 m), total nitrogen (468.35 m), total potassium (136.0 m), available potassium (128.7 m), available phosphorus (116.6 m), and soil organic carbon (93.5 m). Soil nutrients had no significant variation with the increase of altitude, but gradually increased from the landslide area, the transition area, to the little-impacted area. The total and available phosphorus contents of the landslide area decreased by 10.3% and 79.7% compared to that of the little-impacted area, respectively. The soil nutrient contents in the transition area accounted for 31.1%-87.2% of that of the little-impacted area, with the nant reason for the spatial variability of surface soil nutrients.

The relationship between posttraumatic stress symptoms and suicide ideation among child survivors following the Wenchuan earthquake.

The association between posttraumatic stress disorder (PTSD) symptoms and suicide ideation was examined in a sample of 2,298 child survivors of the Wenchuan earthquake. Results indicated that intrusion, avoidance, hyperarousal symptom clusters, and PTSD total score were significantly associated with suicide ideation. Except for intrusion, other measures of PTSD remained as statistically significant correlates of suicide ideation even after controlling for age, gender, direct exposure, indirect exposure, and depression. Furthermore, results showed that PTSD symptoms had an indirect influence on suicide ideation that was mediated by depression. The findings suggest that avoidance and hyperarousal symptom clusters of PTSD may be two important indicators of suicide ideation among child survivors of the Wenchuan earthquake. Implications of the results for intervention and prevention of suicide behavior are discussed.

Effectiveness of a large-scale health and nutritional education program on anemia in children younger than 5 years in Shifang, a heavily damaged area of Wenchuan earthquake.

This study aimed to explore an ideal way to prevent anemia among children younger than 5 years after disasters especially when health care facilities are not enough. A preliminary survey was carried out involving 13 065 children younger than 5 years. Pretested questionnaires were used for data collection and hemoglobin levels were measured. After 12-month intervention, the impact survey involving 2769 children was conducted. Results showed that there were some improvements both in feeding knowledge and practice related to anemia. The total prevalence of anemia decreased from 14.3% to 7.8% (P < .001), and the severity of anemia also declined. The hemoglobin concentration increased significantly from 118.8 ± 10.5 to 122.0 ± 9.9 g/L (P < .001). Thus, health and nutritional education could be an ideal way to combat anemia after disasters especially in less developed areas with multiparty cooperation. The methods and experiences of this study may be well worth learning and implementing.

[Preliminary analysis of serum enzymes indicators in childhood amputees due to earthquake resulting trauma].

OBJECTIVE: To retrospectively analyze the serum enzymes in childhood amputees as a result of earthquake, and to discuss their clinical significance. METHODS: From 150 children amputees who were victims of Sichuan Wenchuan earthquake in 2008 and Sichuan Lushan earthquake in 2013, 45 cases with complete records of serum enzymes examinations were reviewed retrospectively. They were divided into three groups: amputation group (n=6), fasciotomy decompression group (n=5), general trauma without injury to extremity group (n=34). Serum enzyme examination data were compared for statistical analysis to find the difference among groups. Ten children who were not victims of earthquake were selected from department of orthopaedics to serve as controls, and 20 adult amputees as a result of earthquake served as another control group. RESULTS: There were significant differences in injury severity scale (ISS) and the contents of all serum enzymes, including aspartate transaminase (AST), alanine aminotransferase (ALT), creatine kinase (CK), lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH), between the amputation group and other patients (FISS=15.474, P<0.001; FAST=10.770, P<0.001; FALT=12.799, P<0.001; FCK=12.848, P<0.001; FLDH=13.126, P<0.001; FHBDH=13.186, P<0.001), and the difference in amputation group was even more significant. AST, LDH, HBDH in childhood amputees group were significantly higher than those in adult amputation group. The contents of ALT and CK were slightly increased. Serum enzyme contents were found to be significantly helpful for prediction of disease condition and prognosis. It was also found that CK was extremely helpful in assessing the degree of illness in patients with severe trauma, especially in patients complicated by severe soft tissue injury. In all the groups, of patients, it was found that CK rose from (129±62) U/L in non-earthquake induced trauma group to (44 208±39,788) U/L in earthquake amputation group, and it was thus increased more than 300 times. Its highest value even reached 117,513 U/L, which was more than 840 times of the normal. If a timely amputation or muscle compartment decompression was performed, CK might decline rapidly down to the normal value. CONCLUSIONS: The comprehensive and continuous assessment of serum enzymes is mandatory during the treatment of children with acute trauma. It is of important clinical significance to correctly judge the condition and to determine optional treatment measures.

Classification tree analysis of the factors influencing injury-related disability caused by the Wenchuan earthquake.

OBJECTIVE: To identify the factors that influenced the risk of injury-related disability caused by the Wenchuan earthquake. METHODS: A chi-squared automatic interaction detection (CHAID) classification tree analysis was used to retrospectively analyse clinical data from patients who underwent surgical treatment for earthquake-related injuries in the first 5 days after the earthquake. The CHAID classification tree explored the relationships between the development of disability and potential influencing factors including sex, age, time interval between injury and treatment, wound type, preoperative and postoperative haemoglobin levels, and operation time. RESULTS: A total of 334 patients underwent surgery; of these, 113 (33.8%) were discharged with varying degrees of permanent disability. The CHAID classification tree showed that children (≤ 17 years old), a long time interval between injury and treatment, an open wound and a low preoperative haemoglobin level were significant risk factors for disability. CONCLUSION: The results of this study can help to stratify patients according to their medical needs and to help allocate the available resources efficiently to ensure the best outcomes for injured patients during future earthquakes.

Psychosomatic conditions of the children and adolescents exposed to 5.12 Wenchuan earthquake.

BACKGROUND: A devastating earthquake registering 8.0 on the Richter Scale struck Wenchuan County in Northwest Sichuan Province in China on May 12, 2008, claiming over 69,200 lives, seriously wounding more than 374,600 people, and rendering more than 18,400 people missing. The epicenter was close to Yingxiu Township in Wenchuan County. PURPOSE: This study aimed to investigate the psychosomatic conditions of the children and adolescents exposed to the devastating earthquake and explore the risk factors for psychosomatic symptoms. METHOD: A total of 1,828 participants aged 6 to 16 years, of whom 842 from the affected area and 986 from non-affected area, were administered a Psychosomatic Conditions Scale. RESULTS: Each factor score, total somatic score, total psychological score, and total psychosomatic score of the experimental group were significantly higher than those of the control group (P < 0.001). Positive correlation was found between the psychological state and somatic symptoms in the experimental group(r = 0.157 ~ 0.489, P < 0.01). Respiratory system, cardiovascular system, nervous system, digestive system, urogenital system, emotion, behavior, and language, combined as a panel, were significantly differentiated between the two groups, accounting for 73.4% of the total difference. In the experimental group, the factor scores of anxiety, behavior, total psychological score, and total psychosomatic score of the girls were obviously higher than those of the boys (P < 0.01 ~ 0.05); most somatic factors and psychological factors, total somatic score, total psychological score, and total psychosomatic score of the elder adolescents were significantly higher than those of the younger children (P < 0.01 ~ 0.05). CONCLUSION: The children and adolescents exposed to 5.12 earthquake greatly suffered from terrible psychosomatic conditions, among whom the elder girls had more severe symptoms, particularly in terms of anxiety and behavior.

Organization and implementation of mass medical rescue after an earthquake.

On May 12, 2008, an 8.0-magnitude earthquake occurred in Wenchuan, Sichuan Province. In this disaster, 69,000 people were killed, 18,000 people were reported missing, and 37,000 people were injured, including more than 10,000 who were seriously injured. Trauma was the most commonly observed type of injury, with fractures accounting for 74% of all injury cases. On April 14, 2010, a 7.1-magnitude earthquake occurred in Yushu of Qinghai Province. In this disaster, 2,698 people were killed, 270 people were reported missing, and 11,000 people were injured, including more than 3,100 who were seriously injured. Fracture injury accounted for 58.4% of all injury cases. After each earthquake, the Chinese Army Medical Services responded promptly, according to the previously established guidelines, and sent out elite forces to the disaster areas, with the objectives of organizing, coordinating and participating in an efficient and evidence-based medical rescue effort. After the Wenchuan earthquake, 397 mobile medical service teams including 7,061 health workers were sent to the disaster areas. A total of 69,000 casualties were treated, and 22,000 surgeries were performed. After the Yushu earthquake, 25 mobile medical service teams involving 2,025 health workers were sent. They performed 1,635 surgeries and created an astounding outcome of "zero deaths" in the aftermath of the earthquake during their treatment of casualties in a high-altitude region. Within a week after each earthquake, the military teams rescued approximately 60% of the total number of rescued casualties and evacuated approximately 80% of the total number of evacuated sick or wounded victims, playing a critical role and making invaluable contributions to earthquake relief. The experience and lessons learned from the rescue efforts of the Chinese military after the two earthquakes have highlighted several key aspects in emergency medical rescue: (1) medical rescue theories must be updated; (2) military-civilian cooperation must be stressed; (3) professional rescue forces must be strengthened; (4) supporting facilities must be improved; and (5) international exchanges and cooperation must be deepened.

[Comparative analysis of the clinical characteristics of orthopedic inpatients in Lushan and Wenchuan earthquakes].

OBJECTIVE: To systematically analyze and compare the clinical characteristics of orthopedic inpatients in Lushan and Wenchuan earthquake, so as to provide useful references for future earthquakes injury rescue. METHODS: Based on the orthopedic inpatients in Lushan and Wenchuan earthquakes, the data of the age, gender, injury causes, body injured parts and speed of transport were classified and compared. RESULTS: The duration of patients admitted to hospital lasted long and the peak appeared late in Wenchuan earthquake, which is totally opposed to Lushan earthquake. There was no significant difference in the patient's age and gender between the two earthquakes. However, the occurrence rate of crush syndrome, amputation, gas gangrene, vascular injury and multiple organ dysfunction syndrome (MODS) in Wenchuan earthquake was much higher than that in Lushan earthquake. Blunt traumas or crush-related injuries (79.6%) are the major injury cause in Wenchuan earthquake, however, high falling injuries and falls (56.8%) are much higher than blunt trauma or crush-related injuries (39.2%) in Lushan earthquake. The incidence rate of foot fractures, spine fractures and multiple fractures in Lushan earthquake was higher than that in Wenchuan earthquake, but that of open fractures and lower limb fractures was lower than that in Wenchuan earthquake. CONCLUSION: The rapid rescue scene is the cornerstone of successful treatment, early rescue and transport obviously reduce the incidence of the wound infection, crush syndrome, MODS and amputation. Popularization of correct knowledge of emergency shelters will help to reduce the damage caused by blindly jumping or escaping while earthquake happens.

Incidence of Japanese encephalitis, visceral leishmaniasis and malaria before and after the Wenchuan earthquake, in China.

The objective of this study was to investigate the incidence of insect-borne diseases from 2005 to 2011, before and after the 2008 Wenchuan earthquake in Longnan City, Gansu Province, China. The data include Japanese encephalitis, Kala-azar and malaria cases from 2005 to 2011 that occurred in Longnan City. We calculated the incidence rates and analyzed the epidemiological characteristics of the diseases before and after the Wenchuan earthquake. During 2005-2011, 212 Japanese encephalitis cases were reported in Longnan City, and the average incidence was 1.11/100,000. Compared with any year from 2005 to 2010 the incidence of Japanese encephalitis in Longnan City in 2011 was not significantly different (P≥0.05). From 2005 to 2011, there were 719 Kala-azar cases in Longnan City, the annual incidence was 3.77/100,000, and the incidence in males was higher than females (P<0.001). Compared with 2011, there was no significant difference in incidence of Kala-azar in 2009 or 2010 (P≥0.05). There were seven total cases of malaria from 2005 to 2011, and the annual incidence was 0.07/100,000. Wudu District and Wen County were the main endemic areas of insect-borne diseases in Longnan City. The results showed that Japanese encephalitis and Kala-azar were common insect-borne infectious diseases in Longnan City, and that the incidence of insect-borne disease did not increase after the Wenchuan earthquake. It is possible that vector control measures implemented after the earthquake prevented an increase in such diseases.

[Clinical characteristics of pediatric victims in the Lushan and Wenchuan earthquakes and experience of medical rescue].

OBJECTIVE: To get a more comprehensive understanding of the clinical characteristics of pediatric victims in earthquake and to summarize the experience of medical rescue. METHODS: The clinical information was collected from the pediatric victims who were admitted to West China Hospital, Sichuan University following the Lushan earthquake in 2013 and Wenchuan earthquake in 2008. The clinical data were compared between the pediatric victims in the two earthquakes. RESULTS: Thirty-four children under 14 years of age, who were injured in the Lushan earthquake, were admitted to the West China Hospital before April 30, 2013. Compared with the data in the Wenchuan earthquake, the mean age of the pediatric victims in the Lushan earthquake was significantly lower (P<0.01), and the mean time from earthquake to hospitalization was significantly shorter (P<0.01). In the Lushan earthquake, 67.6% of the injured children had variable limb fractures; traumatic brain injury was found in 29.4% of hospitalized children, versus 9.5% in the Wenchuan earthquake (P<0.05). Among the 34 children, no amputation and death occurred, and all the 13 severe cases started to recover. CONCLUSIONS: There were higher proportions of severely injured children and children with traumatic brain injury in the Lushan earthquake than in the Wenchuan earthquake. But these cases recovered well, which was possibly due to timely on-site rescue and transfer and multi-sector, multi-institution, and multidisciplinary cooperation.

Hospital stay as a proxy indicator for severe injury in earthquakes: a retrospective analysis.

INTRODUCTION: Earthquakes are the most violent type of natural disasters and injuries are the dominant medical problem in the early phases after earthquakes. However, likely because of poor data availability, high-quality research on injuries after earthquakes is lacking. Length of hospital stay (LOS) has been validated as a proxy indicator for injury severity in high-income settings and could potentially be used in retrospective research of injuries after earthquakes. In this study, we assessed LOS as an adequate proxy indicator for severe injury in trauma survivors of an earthquake. METHODS: A retrospective analysis was conducted using a database of 1,878 injured patients from the 2008 Wenchuan earthquake. Our primary outcome was severe injury, defined as a composite measure of serious injury or resource use. Secondary outcomes were serious injury and resource use, analysed separately. Non-parametric receiver operating characteristics (ROC) and area under the curve (AUC) analysis was used to test the discriminatory accuracy of LOS when used to identify severe injury. An 0.7

Infectious complications in patients with crush syndrome following the Wenchuan earthquake.

OBJECTIVE: To analyze the results of clinical and bacteriological examinations in patients with crush syndrome who suffered infectious complications after an earthquake in Sichuan, China. METHODS: A total of 313 bacteriological samples among 147 patients with crush syndrome were collected. Infectious complications, results of microbiological examinations, potential risk factors of infection and mortality were analyzed statistically. RESULTS: In the obtained database, 112 out of the 147 (75.7%) patients had infectious complications, in which, wound infection, pulmonary infection, and sepsis were most common. The time under the rubble and the time from injury to treatment were related to the occurrence of wound infection (P equal to 0.013, odds ratio 2.25; P equal to 0.017, odds ratio 2.31). Sepsis and wound infection were more common in patients who underwent fasciotomy or amputation than in those who did not (P equal to 0.001). CONCLUSION: Quick rescue and injury treatment can decrease the infection risk in crush syndrome patients. It is better to obtain microorganic proofs before applying antibiotics, and bacteriological and drug sensitivity data should be taken into account, especially considering that most of these infections are hospital-acquired and drug resistance. Emphasizing the accuracy and efficiency of wound management in emergency situations, cautiously assessing the indications for fasciotomy to avoid open wounds from unnecessary osteofascial compartment decompression incisions may decrease the incidence of infection and ameliorate the prognosis.