Search

Aim: This study categorized quality-of-life trajectories among disaster victims in South Korea and identified the characteristics and predictors of each trajectory., Background: Disaster victims experience tremendous physical and mental distress, which has a long-term impact on their quality of life., Methods: We conducted a cross-sectional study using data obtained from the fourth Long-term Survey on the Change of Life of Disaster Victims conducted from 2017 to 2019. The study included 257 participants who experienced a typhoon, earthquake, or fire and completed the three-year follow-up. Latent transition analysis was used to identify the potential class of quality-of-life trajectories among disaster victims. Independent t tests, χ 2 tests, and logistic regression were used to identify the predictors of quality-of-life trajectories., Results: Two latent quality-of-life classes were identified: persistent low-level and persistent high-level. Factors associated with the persistent high-level trajectory included higher education level, no injury/disease from the disaster, better subjective health status, higher social support, and lower social maladjustment., Discussion: Quality of life early after a disaster is maintained throughout subsequent years; early and active support following disasters is essential to promote its rapid improvement., Conclusion: Targeted educational programs in disaster-prone areas are recommended to bolster resilience among individuals with lower education. Moreover, governmental and institutional efforts are needed to support victims who lack resources for disaster recovery., Implications for Nursing and Health Policy: There is a need to establish community-based social support systems and enhance nurses' disaster response capabilities to support vulnerable groups, with such interventions tailored to reflect disaster-affected victims' unique characteristics and needs, along with ongoing research and evaluation for continuous improvements to nursing practice and disaster response., (© 2024 The Author(s). International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

The 2023 Turkey earthquake, one of the most devastating natural disasters in recent history, highlighted the need to understand factors driving public support. This study aimed to explore the determinants of donation and volunteer intentions for earthquake victims by integrating Protection Motivation Theory and the Extended Theory of Planned Behavior. Using a convenience sampling approach, an online questionnaire with 76 items was distributed to 509 voluntary respondents. Partial least squares structural equation modeling (PLS-SEM) revealed that past earthquake experience significantly enhanced understanding of the 2023 Turkey earthquake, which subsequently increased perceived vulnerability and severity. These perceptions influenced perceived behavioral control, which strongly predicted intentions to donate and volunteer. The media played a critical role in shaping attitudes, while religious influence and financial capacity impacted subjective norms, both of which further contributed to these intentions. Notably, people demonstrated a stronger inclination to donate than to engage in volunteer activities. As one of the first studies focusing on the 2023 Turkey earthquake, this research provides crucial insights into the factors motivating public engagement during natural disasters. The proposed framework offers valuable guidance for enhancing donation and volunteer participation in future disaster relief efforts, ultimately fostering more effective public support., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Posttraumatic stress disorder (PTSD) symptoms after natural disaster can have a detrimental effect on marital relationships, which may be through parenting-related factor., Aims: The study aimed to examine the mechanism underlying the long-term effects of PTSD symptoms on marital satisfaction via coparenting, and its differences between men and women following the Super Typhoon Lekima., Methods: Participants were 465 married victims with children. They reported their PTSD, coparenting, and marital satisfaction at three and fifteen months after the tropical cyclone., Results: The results showed that for women, only higher negative cognitive and emotional alterations (NCEA) symptoms were associated with lower marital satisfaction through conflict coparenting. For men, higher intrusion, NCEA, and hyperarousal symptoms were associated with marital satisfaction through different coparenting. To be specific, for men, higher intrusion symptoms were associated with lower marital satisfaction via less reprimand coparenting; higher NCEA symptoms were associated with lower marital satisfaction via less integrity coparenting, and associated with higher marital satisfaction via less conflict coparenting; higher hyperarousal symptoms were associated with lower marital satisfaction via more conflict coparenting., Conclusions: These findings suggested that the long-term effect of PTSD symptoms on marital satisfaction via coparenting mainly showed for men.

This study examined the usefulness of drama and music therapies as communication strategies for reducing symptoms of post-traumatic stress disorder (PTSD) and generalised anxiety disorder (GAD) among school children (aged 10-16) who were victims of the 2022 floods in Nigeria. The researchers randomly assigned the children to control (n = 122) drama therapy (n = 120) and music therapy (n = 120) groups. The result of the study revealed that after the intervention, school children in the drama and music therapies (unlike those in the control group) reported a significant reduction in their PTSD and GAD symptoms; the reduction achieved statistical significance (p = 0.001, η p 2  = 0.48). Further results revealed a significant interactive effect of gender (p = 0.001) with boys reporting a significant reduction more than girls. The results showed that drama therapy contributed more to reducing PTSD symptoms, while music therapy contributed more to reducing GAD symptoms. The difference did not achieve statistical significance (p = 0.23). The researchers conclude that both drama and music therapies were associated with reduced symptoms, indicating the interventions may be beneficial therapies., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: An earthquake has significant effects on health and livelihood of people. It is important to identify health needs and challenges of earthquake victims and use them to prepare for other possible earthquakes. Therefore, the purpose of this study is to explain the challenges and health needs of earthquake victims in Iran., Methods: This was a qualitative study with 25 participation who were affected by the earthquake in Khoy City, and were selected using purposive sampling by snowball method technique in 2023. The study data was collected through open and semi-structured interviews. To analyze the data, the conventional content analysis with an inductive approach was used., Results: The results show two main categories. The main categories "Management as a missing link in unexpected events" includes 9 subcategories: "The challenge of access to emergency resources and health facilities", "Feeling of abandonment in medical personnel", "Weakness in the structural safety and infrastructure of the health system", "Logistical challenges", "Risk management training", "Crisis response management challenges", "Weakness in the intelligent relief system", "Management of secondary incidents", and "Need to provide medical services and disease prevention". Also, the main categories "Emotional actions of people in crisis" consist of 5 subcategories: "Overexcitement", "Psychological vulnerability of children", "Physical complaints caused by stress", "Confusion caused by the lack of reliable information sources" and "Negative effects of living together with several families"., Conclusion: To help deal with threats and other challenges in the earthquake crisis, countries should try to improve their capacity to manage natural disasters., (© 2024. The Author(s).)

Introduction: Ambiguous loss refers to the lack of clear information about the fate of a missing person or object., Aim: This study aims to examine in-depth the experiences of earthquake victims regarding the methods of coping with the uncertain losses they experienced after the Kahramanmaraş-based earthquake disaster on February 6, 2023., Methods: In this qualitative study conducted using phenomenological research design, the snowball sampling method, one of the purposive sampling methods, was used. Face-to-face, in-depth interviews of approximately 30 to 40 minutes were conducted with 20 earthquake victims reached by this method. Colaizzi's phenomenological analysis method was used to analyze the data obtained. Data were collected by COREQ criteria., Results: According to the results of the analysis, three main categories ( inner journey and emotional transformation, bridges of solidarity built on destruction , and change and growth in life perspectives ) and nine themes ( whispers coming from under the rubble, the reaction of facing ambiguity, mental labyrinths in the search for meaning, hearts united amid destruction, the search for meaning in ambiguity and ways out of spiritual wreckage, growth among the rubble , and the value of transience and new horizons rising from the ruins ) emerged., Discussion: The research reveals that the coping methods adopted by earthquake victims in the face of personal and objective ambiguous losses range from spirituality to social support mechanisms., Implications for Practice: In line with the results obtained from the findings, it is suggested that the coping strategies of earthquake victims should be strengthened, and new methods should be developed.

Background: The physical, psychological, and social effects of the earthquake affect a person's functionality directly. It challenges individuals because it is often traumatizing, intense fear is experienced, and it is unpredictable, uncontrollable, and destructive. Nurses are one of the professional groups that have important duties in social disasters, and they are constantly exposed to the details of the traumatic situation, sometimes physically and sometimes by listening. To understand the severity of the trauma caused by this exposure, it is important to understand the emotions and thoughts that nurses feel while caring for earthquake victims., Aims: This study was planned to reveal the perceptions of nurses, who were themselves earthquake victims, regarding caring for earthquake victims through metaphors., Methods: This study was conducted as a phenomenological study with a qualitative research approach, in a province affected by the earthquake, with 85 surgical clinic nurses who were also earthquake victims and cared for earthquake victims., Results: The metaphors produced were examined together with their reasons and grouped under 3 categories (positive, negative, both positive and negative)., Conclusions: As a result, when the metaphors used by earthquake victims are evaluated, the effects of nurses being earthquake victims themselves can be seen in the metaphors. It is revealed through metaphors that nurses' earthquake-related traumas are triggered while caring for earthquake victims., Competing Interests: Declaration of competing interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Pain is widely studied and is considered a major clinical, social, and economic problem worldwide, although it remains poorly understood. For disaster victims, the complex picture, biologically, psychologically, and socially, only makes the situation even more complicated. This narrative review aims to describe specific aspects of pain and pain management in disaster victims. We reviewed relevant literature, both on pain management and selected specific data related to conflict victims. We discuss the complexity of the picture, its different aspects, and mechanisms. We discuss the limitations of current approaches and propose a simple strategy, including mitigation plans, all illustrated by a case study based on a personal experience in the Gaza Strip in 2022. The vulnerability factors are well known, as well as the tangle of intense acute pain and the persistence of pain in the subacute and chronic phase. However, the management of acute pain is, in a disaster context, more constrained than chosen. Empirical evidence suggests a focus on modifiable risk factors as well as the evaluation of strategies guiding future management. This management may depend on obstacles and barriers, linked to the context of the disaster, the availability of medicines, techniques, skills as well as linguistic and cultural barriers. Our proposal includes systematic assessment and, in a later phase, tailored and personalized treatment. In the chronic phase of rehabilitation and follow-ups, the essential place for management of psychological and social aspects become predominant. In disaster areas, including during and after conflict, the management, and recommendations for the management of acute and chronic pain are complex, distinct but interdependent. Acute pain must be systematically assessed and treated while personalized care pathways are desirable at a later stage. Psychological and social considerations are essential. Data collection should be systematically considered.

This study examined co-occurring patterns of mental health among disaster victims using latent profile analysis and assessed the difference between sociodemographic factors and protective factors that affect group classification. The data of 2300 disaster victims from 2019 (4th wave) NDMI (National Disaster Management Research Institute) for Long-term Survey on the Change of Life of Disaster Victims were analyzed. The latent profile analysis revealed that three profiles; High comorbid symptom (HCS) (6.2%), Medium comorbid symptom (MCS) (22.6%), and Low symptom (LS) (71.2%). The factors that explain the difference in this divided profile group were the type of disaster, hurt, income, age, elapsed years, resilience, and community resilience in the multinomial logistic regression. When individual resilience and community resilience are high, more effective in making people belong to the low comorbid symptom group. Therefore, there is a need for a strategy that promotes synergy between the two relationships while maintaining a dual focus point of view that fosters resilience at the individual and community level together.

This study aimed to classify patterns of trauma exposure among disaster victims using latent class analysis (LCA) and to examine group differences in post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms over three years. Data were obtained from a 3-year panel survey of Korean disaster victims (male = 461, female = 513) who responded to four types of trauma experiences: threatened death, injury or disease, witnessing injury or death, and loss of family or relatives in 2017. The LCA yielded three classes: the low-threat (66.1%), life-threat (29.4%), and multi-threat (4.5%) groups. One-way analysis of variance showed that the multi-threat group had the highest levels of PTSD, depressive, and anxiety symptoms in 2017, 2018, and 2019. Post-traumatic stress disorder symptoms significantly decreased between 2017 and 2018 in the life-threat and multi-threat groups. However, there were no differences between 2018 and 2019 in any groups. These results highlight the importance of early intervention during the proximal period after trauma, particularly in individuals exposed to multiple types of traumatic experiences., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose Disaster victim identification (DVI) service requires knowledge, confidence, and an attitude (KCA) of readiness. The purpose of this study was to assess allied dental students' perceived KCA regarding DVI skills and topics. Methods A convenience sample of senior dental hygiene students (n=27) and senior dental assistant students (n=14) were recruited by email then presented mismatched simulated antemortem (AM) and postmortem (PM) bitewing radiographs and asked to indicate correct matches. Collectively, participants made 205 radiographic matches and indicated 205 degrees of certainty binarily as "positive" or "possible" (one per match). Participants also completed a researcher designed pretest/posttest electronic survey with seven 3-point Likert-scale items with answer options of "slightly", "moderately", or "extremely" regarding self-perceived knowledge. Statistical analyses were conducted with R software using an α=0.05 significance level. Results A total of n=41 students participated, yielding a response rate of 85.4%. A one-sided linear trend test revealed statistically significant increases of perceived confidence in knowledge from pretest to posttest regarding forensic odontologists' role in DVI ( p <0.0001), DVI applications for mass fatality incidents (MFI) ( p <0.0001), role of dental radiology in DVI ( p <0.0001), and dental morphology applications for DVI ( p <0.0001). Participants indicated moderate or extreme confidence in personal clinical skillsets to assist forensic odontologists with DVI. A one-sided Fisher's exact test revealed a statistically significant ( p <0.05) positive association between expressed degree of certainty (confidence) and correct radiographic matches. A one-sided linear trend test revealed statistically significant ( p <0.0001) improvements in attitude regarding participants' perceived importance for their respective professions to volunteer in DVI. Conclusion Participants of this study reported significant improvements of self-perceived KCA regarding DVI skills and topics. These characteristics may encourage allied dental professionals to pursue further DVI educational opportunities and future service when support is needed for MFI., (Copyright © 2024 The American Dental Hygienists’ Association.)

There have been a large number of masscasualty incidents in recent years, including climate change-related disasters, mass shootings, terrorist attacks, transportation accidents and a global pandemic. Communities, families and friends have suffered grief and loss, while nations continue to bear the scars of trauma. Disasters caused by acts with criminality, although necessarily managed by the police for the investigative aspect, must be planned for, and responded to with victim-centred practices by the police, local government and other relevant community stakeholders for the duration of the response and recovery. Inconsistency and confusion over terminology and language in emergency management can lead to a lack of understanding about which stakeholders or agencies should be engaged in, and responsible for different aspects of the planning, preparedness, mitigation and response to a community disaster - regardless of what type of disaster it is, and irrespective of the disaster being caused by a person or persons with ill-intent. This paper discusses how a wholeof- community and victim-centred approach to criminal act disaster response should be applied to support those persons most adversely affected by the incident. It also promotes the application of victim-centred practices to ensure that the needs of victims are regarded ethically, and with compassion following any disaster caused by an act of criminality. The term 'mass victimisation incident' will be introduced and applied through a case study.

Objective: In January 2022, Fiji was hit by multiple natural disasters, including a cyclone causing flooding, an underwater volcanic eruption, and a tsunami. This study aimed to investigate perceived needs among the disaster-affected people in Fiji and to evaluate the feasibility of the Humanitarian Emergency Settings Perceived Needs Scale (HESPER Web) during the early stage after multiple natural disasters., Methods: A cross-sectional study using a self-selected, non-representative study sample was conducted. The HESPER Web was used to collect data., Results: In all, 242 people participated. The number of perceived serious needs ranged between 2 and 14 (out of a possible 26), with a mean of 6 (SD = 3). The top 3 most reported needs were access to toilets (60%), care for people in the community who are on their own (55%), and distress (51%). Volunteers reported fewer needs than the general public., Conclusions: The top 3 needs reported were related to water and sanitation and psychosocial needs. Such needs should not be underestimated in the emergency phase after natural disasters and may require more attention from responding actors. The HESPER Web was considered a usable tool for needs assessment in a sudden onset disaster.

The objective of the current study was to complete a systematic review of the relationship between prenatal maternal stress due to potentially traumatic events (PTEs) and child temperament. Eligible studies through June 2020 were identified utilizing a search strategy in PubMed and PsycInfo. Included studies examined associations between prenatal maternal stress due to PTE and child temperament. Two independent coders extracted study characteristics and three coders assessed study quality. Of the 1969 identified studies, 20 met full inclusion criteria. Studies were classified on two dimensions: (1) disaster-related stress and (2) intimate partner violence during pregnancy. For disaster-related prenatal maternal stress, 75% (nine out of 12) of published reports found associations with increased child negative affectivity, 50% (five out of 10) also noted associations with lower effortful control/regulation, and 38% (three out of eight) found associations with lower positive affectivity. When considering prenatal intimate partner violence stress, 80% (four out of five) of published reports found associations with higher child negative affectivity, 67% (four out of six) found associations with lower effortful control/regulation, and 33% (one out of three) found associations with lower positive affectivity. Prenatal maternal stress due to PTEs may impact the offspring's temperament, especially negative affectivity. Mitigating the effects of maternal stress in pregnancy is needed in order to prevent adverse outcomes on the infant's socioemotional development., (© 2021 Wiley Periodicals LLC.)

Background: The Skills for Life Adjustment and Resilience (SOLAR) programme is a brief, scalable, psychosocial skill-building programme designed to reduce distress and adjustment difficulties following disaster., Objectives: We tested the feasibility, acceptability, efficacy and safety of a culturally adapted version of SOLAR in two remote, cyclone-affected communities in the Pacific Island nation of Tuvalu., Method: This pilot adopted a quasi-experimental, control design involving 99 participants. SOLAR was administered to the treatment group ( n = 49) by local, non-specialist facilitators (i.e. 'Coaches') in a massed, group format across 5 consecutive days. The control group ( n = 50) had access to Usual Care (UC). We compared group differences (post-intervention vs. post-control) with psychological distress being the primary outcome. We also examined whether changes were maintained at 6-month follow-up., Results: Large, statistically significant group differences in psychological distress were observed after controlling for baseline scores in favour of the SOLAR group. Mean group outcomes were consistently lower at 6-month follow-up than at baseline. SOLAR was found to be acceptable and safe, and programme feedback from participants and Coaches was overwhelmingly positive., Conclusions: Findings contribute to emerging evidence that SOLAR is a flexible, culturally adaptable and scalable intervention that can support individual recovery and adjustment in the aftermath of disaster. RCTs to strengthen evidence of SOLAR's efficacy are warranted., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objectives　To obtain suggestions for improving disaster-prevention literacy, this study elucidated the daily information-gathering behavior of residents living in areas affected by two Japanese natural disasters (the Great East Japan Earthquake of 2011 and the Kanto-Tohoku Heavy Rainfall Disaster in September 2015) and examined factors affecting life backgrounds and disaster experiences.Methods　In June 2017, we administered a cross-sectional survey using a self-administered questionnaire to 1,065 households in areas affected by the Great East Japan Earthquake and the Kanto-Tohoku Heavy Rainfall. One person in each household responded to the questionnaire. Of 362 respondents (response rate 34.0%), 336 with definite attributes were analyzed. After ascertaining their daily information-gathering behavior, we applied binary logistic regression analysis, incorporating-as dependent variables-three variables previously used in times of disaster.Results　Of the respondents, 179 were men (53.3%); the average age (standard deviation) was 65.5 (10.6) years. Information-gathering modes used by more than half the subjects were "television," "newspaper," "conversation/word of mouth," "radio," and "community magazine" in descending order of use.　Examination of the factors of the three variables revealed the following. (1) Four variables were significantly and positively correlated with "conversation/word of mouth": "woman" (1.82 odds ratio [OR]; 1.05-3.15 95% confidence interval [CI]); "I have" a co-resident family member (OR, 2.46; 95% CI, 1.06-5.72); "I can expect" mutual aid from community residents (OR, 2.31; 95% CI, 1.27-4.21); and "I feel more" fear of typhoons and heavy rains now than before (OR, 1.82; 95% CI, 1.04-3.18). (2) "Radio" has two variables with significant and positive correlations: "I have" a co-resident family member (OR, 3.22; 95% CI, 1.35-7.67) and "I was affected" by the Great East Japan Earthquake and the Kanto-Tohoku Heavy Rainfall Disaster (OR, 1.73; 95% CI, 1.01.2.97). (3) Two variables are significantly correlated with "Internet service": "Age" has a negative correlation (OR, 0.91; 95% CI, 0.88-0.94); "I can expect" mutual aid from community residents has a positive correlation (OR, 2.66; 95% CI, 1.19-5.93).Conclusion　Damage and fear instilled by natural disasters influence subsequent information-gathering behavior. Disaster prevention literacy in ordinary times can be improved because of the correlation between awareness of mutual aid in local communities and information-gathering behavior.

Objectives: Environmental hazards are part of the Earth's natural cycle and are ongoing within human history. When vulnerable situations meet environmental hazards, disasters occur where human and natural costs could be enormous. This study aimed to explore the experiences of the victims of coastal erosion during the monsoon season., Methods: Seven victims of catastrophic coastal erosion in the Kollam District of Kerala, India, were interviewed from December 2013 to February 2014. The study followed Edmond Husserl's descriptive phenomenological method., Result: These interviews constituted the primary data source. Three main themes with eleven subthemes emerged from these data. The main themes were impact, consequences and recovery. The subthemes were living in constant fear, escaping from the catastrophe; cataclysmic sea waves and their tumultuous behaviour, instant damage and destruction, the epoch of losses; agony and suffering; homelessness-helplessness-sleeplessness mixed with fear; government aid only in dreams; haunting memories; never-ending daily needs; first home and native land; and the desire to go back to the site of the disaster., Conclusion: From the derived themes, a phenomenon associated with coastal erosion evolved. The phenomenon is termed "Catastrophic coastal erosion: A cycle of impact, consequences, and recovery.", Competing Interests: CONFLICT OF INTEREST Authors declared no conflict of interest., (© Copyright 2021, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objective: If the narrative of "coronavirus" has an underlying theme, it may perhaps for some be one of survival, whilst for others, the theme might be suffering. The recurring motif of survival has continued throughout history, yet for the first time the sum of all fears has amounted to a run on the bare essentials. This paper seeks to offer an alternative formulation of "panic buying," with references to literature, philosophy, and contemporary neurobiology., Conclusion: The bare essentials disappeared perhaps as part of some self-fulfilling prophecy: the supermarkets became bare because others inadvertently lead us to believe they would become bare. The contagion model of emotional propagation provides a psychological model of how "panic buying" by an individual might lead to the replication of panic in an observer. The Polyvagal Theory further informs us of how the threat posed by the pandemic primes our limbic system to perceive danger, and explains how witnessing others engaging in fight-flight responses might evoke a fearful affect in an observer. In the end, it is perhaps through Nietzsche's study of classical tragedy that we may find some meaning to the pandemic, allowing our collective lived experience to serve as a template for growth.

Displacement from one's home after a natural disaster results not only in physical separation from significant others but also in profound disruptions of psychological and social resources such as community support and sense of belonging. Frequent displacement can exacerbate health and mental health problems brought by the disaster, especially among lower-income families in resource-scarce regions., Objective: The present study examined the association among frequency of displacement after the disaster, health status, and psychological adjustments among survivors four years after the 2013 Super Typhoon Haiyan in the Philippines., Method: The study surveyed 345 typhoon survivors using randomized cluster samples in 13 towns in Eastern Philippines and assessed their physical and mental health status., Result: Path analysis revealed that, after controlling for age, gender, and traumatic exposure severity, frequency of displacement was a significant predictor for subjective health ratings and stress but not for posttraumatic stress symptoms, depression, and anxiety., Conclusion: These findings underscore the detrimental impact of long-term displacement on health outcomes following a disaster, especially in countries where public health resources are largely unavailable. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

This article looks at chronic crisis on an empirical example of radiation embodiment by survivors of a nuclear disaster. Developing further the work of Henrik Vigh, this article argues that chronic crisis is conflictual in nature, where some individuals fully embrace it, while others reject it. A total of 16 in-depth interviews were conducted with survivors of the Chernobyl nuclear disaster from Belarus who were below 18 years in 1986 and born in or after 1986. It is shown that survivors do not consider themselves affected, when they argue against social stigma imposed by others and when development discourse in relation to post-communist health care is used as a background against which nuclear victimhood can be argued. It is also demonstrated that survivors do consider themselves affected, when they embrace disaster temporality and victimhood and argue against narrow scientific definitions of victimhood which downplay a variety of health conditions attributed to the disaster. This article concludes that chronic crisis may not always be transformative, but reproduce the existing inequalities. It contributes to the anthropology of disaster and the anthropology of suffering by bringing together scholarship in feminist theory of disability and critical perspectives on development.

Background: Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. Therefore, the present study aimed to investigate the experiences of rural women with damages resulting from an earthquake in Iran., Methods: In this research, a qualitative approach, as well as the conventional content analysis was employed. The study population consisted of rural women residing in the earthquake-stricken areas of Sarpol-e Zahab and Salas-e Babajani counties in Kermanshah Province, Iran. Semi-structured interviews were used for data collection. Moreover, sampling was purposeful, theoretical saturation was achieved by conducting 22 interviews, and the data analysis process was performed according to the steps proposed by Graneheim and Lundman. For the strength and transferability of the research, Lincoln and Guba's Evaluative Criteria were used., Results: There were seven categories regarding the experiences of rural women after the earthquakes including neglecting the health needs; tension in the family and marital relations; gender inequality in the provision of assistance; feeling insecure; ignoring the ruling culture of the region; concealing needs for fear of stigmatization, and incoherent mourning as well as two categories regarding their reactions to and interaction with the earthquake consequences including positive and negative interactions., Conclusions: Paying more attention to the needs of rural women, taking the culture governing the village into account at the time of service delivery, and helping them with positive adaptations are some indispensable measures that should be taken.

Background: Social support plays an important role in adolescents' mental health and well-being, and even more so for disaster survivors. To measure the level of social support, one needs an appropriate tool to produce valid and reliable results; therefore, we aimed to measure the invariance across gender groups, and analyze the construct validity and reliability of the Indonesian version of the Multidimensional Scale of Perceived Social Support (MSPSS), a social support measurement tool which was theoretically constructed and has been well validated in many countries with various cultures and backgrounds., Methods: A school-based assessment was conducted in junior and senior high schools in a post-disaster setting in Yogyakarta Province, Indonesia. We analyzed 299 adolescent survivors of a volcanic eruption, aged 12~18 years who completed a 12-item Indonesian version of the MSPSS., Results: The factorial validity confirmed the three-factor structure of the scale (Family, Friends, and Significant Others) which met all of the criteria of parameter indices and provided evidence of high internal consistency reliability. The three-level measurement of invariance, which consisted of configural, metric, and scalar invariance, also performed very well across gender groups with our data and corresponded to the recommended parameters. Our composite reliability values were all fine (>0.7) and indicated that the items in the same construct were strongly correlated and reliable., Conclusions: The Indonesian version of the MSPSS was shown to be a valid, reliable, theoretically constructed, and applicable instrument for adolescent disaster survivors., Competing Interests: The authors have declared that no competing interests exist.

Background: We aimed to perform a cluster analysis on sleep quality and insomnia severity in addition to predicting the clusters based on personality traits, experiential avoidance, stress, anxiety, depression, and dysfunctional beliefs and attitudes about sleep., Study Design: A cross-sectional study., Methods: This study was conducted on earthquake victim in Kermanshah (western Iran) in 2017. Data collection began 15 d after the earthquake and lasted for 2 weeks. First, 1002 copies of the questionnaire were distributed and, finally, analyses were performed for 778 individuals. Data analysis was conducted using cluster analysis., Results: Based on sleep quality and insomnia severity, four clusters were formed, and a correlation existed between some personality traits, psychological distress, experiential avoidance, and dysfunctional beliefs and attitudes about sleep with unhealthy clusters (P<0.05). The summary of the model showed the sufficient fit of the model (P<0.0005) and that it could predict 22.8%-42.4% of the variance of unhealthy clusters., Conclusion: Dysfunctional beliefs and attitudes about sleep, experiential avoidance, stress, anxiety, depression, and personality traits could contribute to sleep problems and reduce sleep quality in earthquake victims.

Objective: The current study compares the measures of sleep quality and intensity of insomnia based on the clustering analysis of variables including dysfunctional beliefs and attitudes about sleep, experiential avoidance, personality traits of neuroticism, and complications with emotion regulation among the individuals struck by an earthquake in Kermanshah Province., Methods: This study is a cross-sectional study that was carried out among earthquake victims of Kermanshah Province (western Iran) in 2017. Data were gathered starting 10 days after the earthquake and lasted for 2 weeks; of 1,200 standard questionnaires distributed, 1,001 responses were received, and the analysis was performed using 999 participants. The data analysis was carried out using a cluster analysis (K-mean method)., Results: Two clusters were identified, and there is a significant difference between these two clusters in regard to all of the variables. The cluster with higher mean values for the selected variables shows a higher intensity of insomnia and a lower sleep quality., Conclusions: Considering the current results, it can be concluded that variables of dysfunctional attitudes and beliefs about sleep, experiential avoidance, the personality traits of neuroticism, and complications with emotion regulation are able to identify the clusters where there is a significant difference in regard to sleep quality and the intensity of insomnia. (Disaster Med Public Health Preparedness. 2019;13:745-752).

Electromagnetic radiation influences in many ways humans and animals, while earthquakes are known to be related with electromagnetic phenomena. We recently showed that large earthquakes reduced admissions of psychiatric patients, whereas small earthquakes were associated with increased number of admissions. Our aim was to examine the effect of seismic-related electromagnetic activity on two chronic and severe psychiatric disorders varying in terms of etiology and treatment, i.e. bipolar disorder and schizophrenia. Retrospective data concerning monthly admission rates of patients diagnosed with schizophrenia or bipolar disorder in the Psychiatric Unit of the University Hospital of Heraklion, Crete, Greece between 2008 and 2010 were analyzed in relation to the number of earthquakes with small (≥2) or larger magnitude in the Crete region in Greece. Results showed a marked reduction of acute admissions during a storm of large earthquakes, which was greater in patients with bipolar disorder (91.2%) than schizophrenia patients (52.4%). In addition there was a significant increase of admissions during a period of frequent small earthquakes, primarily among patients with bipolar disorder. The results suggest that electrostatic fields that accompany large earthquakes may have a protective effect on psychiatric disorders, particularly on bipolar disorder. These findings are consistent with the ameliorating effect of electromagnetic fields used in Electroconvulsive therapy (ECT) and Transcranial Magnetic Stimulation (TMS) in patients with bipolar disorder. Future studies focusing on the underlying mechanisms may lead to more specific treatments of psychiatric disorders.

This paper reviews the role of news with respect to the mental health of a population exposed to a disaster. It is based on the five essential elements of psychosocial care presented by Stevan E. Hobfoll et al. (2007) that can be introduced after a potentially traumatic event: promoting a sense of safety, calming, self and collective efficacy, connectedness, and hope. This study developed a method to relate these elements to television coverage and applied it to the stories (n=1,169) aired by the main networks in Chile in the 72 hours after an 8.8 magnitude earthquake struck on 27 February 2010. Of the five elements, promoting a sense of safety occurred most often (82.72 per cent), whereas the others were barely present (less than 10 per cent). The study argues that these elements can increase the possibility of framing the news, given that the audience watching can also be affected by a disaster., (© 2019 The Author(s). Disasters © Overseas Development Institute, 2019.)

This study investigates the attitudes and behavioural intentions of community crisis response and tourism community participation in tourist destinations after the occurrence of a disaster. Further, we built a conceptual model of perceived community participation benefit, community attachment, community resilience, and crisis response and community participation intention and measured it using 556 samples surveyed after the Wenchuan earthquake, China. The results indicated that benefit perception, community attachment, and community resilience have a positive effect on crisis response and community participation. The study further reveals that the local tourism community gradually transforms the negative aspects of terrible disasters into development opportunities. Our case study particularly focuses on the initiative shown by and positive participation of the tourist community in the aforementioned transformation. The study proposes the Attachment, Benefit, and Capability framework of tourist community participation based on the crisis response perspective and expands the boundaries of tourist community participation research. The study has theoretical and practical significance, puts forward relevant countermeasures, and has significant implications.

Natural disasters impact people of every age in the communities where they occur, with older adults being a vulnerable subset of the population. Most disaster shelter volunteer nurses are experienced in addressing common health needs of older adult clients such as diabetes, hypertension, and pulmonary disease. These nurses also have the requisite training to respond to more acute medical events, including the symptoms of a heart attack or stroke. They provide care and comfort to those suffering from the distress, anxiety, and fear caused by disasters. However, they may be less adept at triaging and caring for older adults with mental health conditions such as delirium, depression, or dementia. The trauma associated with a disaster and relocation will challenge cognitive abilities in those with dementia, may exacerbate existing depression, or lead to the onset of delirium, which is a medical emergency. Older adults experiencing these conditions are at risk for harm and deterioration with serious short and long-term consequences. Since disaster shelter volunteer health care staff may not be well-versed in distinguishing between dementia, depression, or delirium, behavior observation, and safety considerations are critical determinants of whether it is possible to support the older adult in the shelter environment or it is necessary to transition to a higher level of care., (© 2018 Wiley Periodicals, Inc.)

Although working with trauma survivors can be a source of both deleterious and positive transformations in mental health professionals, little is known about the experience of clinicians in shared traumatic contexts, particularly in the Global South, where most humanitarian crises occur. In collective disasters or armed conflicts, the personal and professional experiences of mental health staff inform each other, situating the clinical space at the intersection between singular and collective spheres. Drawing on an intersubjective and socioecological perspective, this qualitative study explored the ways in which working in a shared traumatic context affected mental health and psychosocial staff in postearthquake Haiti. We interviewed 22 local mental health workers in the capital, Port-au-Prince, 2.5 years after the 2010 disaster. We coded and thematically analyzed interviews using an iterative process, based on grounded theory principles. Thematic analysis uncovered four dynamic poles in clinicians' narratives: balancing duty and desire to help, experiencing fragility and strength, negotiating separation and connection, and sharing hurt and hope. Our findings suggest clinicians considered their work mainly as a source of strength in the face of adversity, whereas experiences of trauma and growth transmissions were mutual and intimately intertwined. We discuss the complexities of clinical work in shared traumatic settings as well as the dynamic interplay between professionals' experiences of suffering and growth. We conclude with recommendations on ways to involve local mental health clinicians in postdisaster contexts while addressing the special needs that they may have to process their own trauma., (© 2019 International Society for Traumatic Stress Studies.)

This study aimed to determine the population-based typologies of posttraumatic stress disorder (PTSD) symptomatology, the longitudinal patterns of transitions across these typologies, and the predictive effects of distress and fear disorder symptoms on these transitions in a frequently referred but scantly studied population of traumatized youth. A sample of 1,278 Chinese adolescents (54.0% girls) with a mean age of 13.4 years (SD = 0.8, range = 12-16) completed 2-wave surveys 2.5 and 3.5 years after a major disaster. Psychopathological symptoms were assessed with the UCLA PTSD Reaction Index for DSM-IV, the Depression Self-Rating Scale for Children, and the Screen for Child Anxiety Related Emotional Disorders. Latent class analyses identified 4 classes characterized by high, reexperiencing/hypervigilance, dysphoria, and low symptoms, respectively at each time point. Latent transition analyses revealed relatively high levels of temporal stability within low symptom and dysphoria classes but relatively high probabilities of migration from re-experiencing/hypervigilance and high symptom classes into lower symptom classes. Multinomial logistic regression analyses found that some of the between-class movements during the year were predicted by baseline distress or fear disorders. This study provides an initial depiction of both quantitative and qualitative changes in youth's long-term PTSD symptom patterns over time and gives a further elucidation of other forms of posttrauma psychopathology's impacts on PTSD course. These findings carry implications for ongoing evaluation and adjustable intervention individually tailored to youth's PTSD manifestations and comorbidities in the long-term disaster aftermath.

Background: Many people who experience a disaster will do so as part of an occupational group, either by chance or due to the nature of their role., Sources of Data: This review is based on literature published in scientific journals., Areas of Agreement: There are many social and occupational factors, which affect post-disaster mental health. In particular, effective social support-both during and post-disaster-appears to enhance psychological resilience., Areas of Controversy: There is conflicting evidence regarding the best way to support trauma-exposed employees. Many organisations carry out post-incident debriefing despite evidence that this is unhelpful., Growing Points: Employees who are well supported tend to have better psychological outcomes and as a result may be more likely to perform well at work., Areas Timely for Developing Research: The development and evaluation of workplace interventions designed to help managers facilitate psychological resilience in their workforce is a priority. Successful interventions could substantially increase resilience and reduce the risk of long-term mental health problems in trauma-exposed employees., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Orexigenic hormones are a group of hormones that can up-regulate appetite. Current studies have shown that orexigenic hormones also play important roles in stress responses and may be implicated in regulation of fear memory. However, these conclusions lack evidence from human studies. In this study, we examined associations between orexigenic hormone genes and fear-related mental disorders by investigating main, G × E, and G × G effects of ghrelin and orexin gene single nucleotide polymorphisms (SNPs) on human posttraumatic stress disorder (PTSD) symptoms in 1134 Chinese earthquake survivors. SNPs Leu72Met of the GHRL gene (rs696217), Ile408Val of the HCRTR1 gene (rs2271933) and Val308Ile of the HCRTR2 gene (rs2653349) were genotyped. None of the SNPs showed significant main or G × E effects. However, a significant interaction effect between GHRL rs696217 and HCRTR1 rs2271933 was found to predict the PTSD Checklist (PCL-5) total score (P =  0.007). Further analysis revealed different interaction patterns in males and females. For females, the rs2271933 G allele was associated with an increased PCL-5 total score (B = 2.59, P =  0.024) when the rs696217 genotype TT/TG was present. For males, the rs696217 T allele is associated with an increased PCL-5 total score (B = 3.62, P =  0.040) when the rs2271933 genotype GG/GA was present. These current findings expand our knowledge of physiological function of the orexigenic hormone system, and suggest its involvement in development of fear-related mental disorders such as PTSD., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

To substantiate psychological symptoms following humidifier disinfectant (HD) disasters, counseling records of 26 victims and 92 family members of victims (45 were bereaved) were analyzed retrospectively. Among the victims, 34.6% had Clinical Global Impression-Severity scores of over 4, which meant they were moderately ill. While anxiety/fear and depression with respiratory symptoms were frequently observed in victims and family members, chronic psychological distress such as alcohol/smoking abuse and insomnia was relatively high in bereaved family members. In conclusion, it is important to provide mental health support for victims and their families, focusing on the characteristic symptoms of each group as well as monetary compensation., Competing Interests: Disclosure: The authors have no potential conflicts of interest to disclose.

Background: In April 2014, a ferry carrying 476 passengers sunk on the coast of Korea, resulting in 304 deaths. Of these, 250 were local high school students, and the disaster significantly affected their community. This study aimed to examine the prevalence of depressive symptoms and anxiety among Ansan city residents to understand their recovery process after the accident., Methods: Two cross-sectional surveys (survey 1, after 4-6 months and survey 2, after 16-18 months of disaster) were used to compare prevalence among residents of Ansan city and adjacent cities. Symptoms were determined by the Center for Epidemiologic Studies-Depression Scale and the Generalized Anxiety Disorder 7-item Scale., Results: A total of 1,773 and 1,748 participants were included in Survey 1 and Survey 2, respectively. Survey 1 showed a significantly higher prevalence of depressive symptoms (19.0%; 95% confidence interval [CI], 16.9-21.1) and anxiety (6.1%; 95% CI, 5.0-7.5) among Ansan city, compared to participants from adjacent cities (depressive symptoms: 14.3%; 95% CI, 12.7-16.1; anxiety: 3.6%; 95% CI, 2.9-4.5). Survey 2 showed a decreased prevalence of depression (15.8%; 95% CI, 14.0-17.9) and anxiety (5.0%; 95% CI, 4.0-6.4) among Ansan city residents. Depressive symptoms and anxiety adjusted odds ratio in survey 2 compared with survey 1 were 0.74 (95% CI 0.62-0.89) and 0.81 (0.60-1.08) among Ansan city, respectively., Limitations: Cross-sectional study design and lack of pre-disaster baseline data for comparison are limitations of this study., Conclusions: Psychological distress occurred at a population level, not only among survivors and their families, but also among Ansan city residents indirectly impacted by the traumatic event. Although populations indirectly affected by a disaster show a natural recovery process, timely population-based interventions may be helpful., (Copyright © 2018 Elsevier B.V. All rights reserved.)

In 1953, the South-Western parts of The Netherlands (particularly the province of Zeeland) were flooded. At the time, posttraumatic stress disorder (PTSD) did not yet exist as a formal diagnosis. Research following more recent natural disasters has identified risk factors for the development of PTSD. These risk factors are applied as guidance for research into the circumstances around the 1953 floods. Risk factors such as lower socioeconomic status, pre-existence of psychiatric symptoms and limited support from the government were certainly present. Furthermore, some affected people were evacuated for an extended period of time, thereby abruptly extracting them from their established social networks. During oral history initiatives, many participants report reliving the experience and having nightmares. It is probable that a number of people affected by the 1953 floods developed symptoms of an illness that nowadays would have been diagnosed as PTSD.

Background: Post-traumatic stress disorder (PTSD) is associated to recurrent, obsessive recollection of severe traumatic events. This condition is still not completely understood. Elective treatment of PTSD is psychotherapy. Standardized supplements, used for improving chronic fatigue syndrome (i.e. Robuvit®, Horphag Research Ltd) can also be used to control some of the symptoms associated to PTSD, as well as to control the associated increased oxidative stress, present in many of these patients. The aim of this open registry was to evaluate the effects of supplementary Robuvit® 300 mg/day, added to standard management (SM), in subjects with PTSD over a period of 4 weeks, both on the psychological and the inflammatory level., Methods: Otherwise healthy individuals with a diagnosis of PTSD were included in this registry. A clear main traumatic event occurred with different modalities in all subjects during or just after major earthquakes in Central Italy. SM included exposure therapy and psychotherapy. Supportive psychotherapy was used in all affected subjects. Subjects autonomously decided which group to enter (either SM or SM + Robuvit®), without any pre-defined group allocation or randomization. No placebo was used., Results: The two groups were comparable: 18 subjects (11 females; age range 25-49) were included in the SM group, and 16 subjects (8 females; age range 26-52) using SM in combination with Robuvit® supplementation. BMI of all subjects was below 25 kg/m2. After 4 weeks, the percentages of subjects with recurrent memories and dreams, transient walking-dissociative states and reactive flashbacks/hallucinations, alarm reactions and intense emotional distress, emotional numbness, social disinterest and detachment were significantly lower in the subjects treated with Robuvit® (P<0.05%). Sleeping problems, irritability, and fatigue were also significantly reduced with supplementation., Conclusions: The results of our preliminary, pilot registry show that symptoms of PTSD as well as the high oxidative stress-related to the condition can be controlled and improved using Robuvit® as a supplementary management. The improvement with Robuvit® is faster and larger than that seen with standard management only. Supplementation is safe and well tolerated and may represent an important option in PTSD treatment.

Place attachment is the social, emotional, and functional bond people experience with a specific geographic area. The formation of this bond is based on several different characteristics of the place, such as property values, local relationships, and employment opportunities as well as the internal attributes of a person, such as age, gender, and income. While gaining an understanding of place attachment through these characteristics and attributes is indispensable to our understanding of disaster recovery, few studies have explored this relationship using qualitative methods. Here, the authors address two main questions: how does place attachment vary among different groups of individuals, and what factors contribute to place attachment in a disaster context? This study included a survey of 772 citizens of Moore, Oklahoma, who lived in the path of the May 20, 2013, tornado and decided to rebuild in situ after disaster. The authors explored place attachment using open-response questions probing residents' perceptions of their place of living. The authors found 18 common codes within their descriptions, in which community (social network), infrastructure, and commercial were the three most commonly cited parameters. Also, comparisons of participants' groups such as age and income showed that distinguishable parameters have formed post-disaster place attachment within different groups of participants.

This study describes the existence of the long-lasting disillusionment phase for the victims after the accident at the Fukushima Daiichi Nuclear Power Plant following the Great East Japan Earthquake in March 2011. Through analyzing the mental situation of the victims, the situations were categorized into 2 groups for forced evacuees: "in the disillusionment phase" and "in the reconstruction phase," Other 2 groups are for host Iwaki residents: "with negative feelings against evacuees" and "leading their life constructively." The negative feeling enhances the vicious psychological cycle for the evacuees in the long-lasting disillusionment phase and repeating emotion of survivor's guilt in the reconstruction phase. We propose that people who were getting back to a normal life while leading their life constructively should raise their voices in favor of living together with evacuees., (© 2018 Wiley Periodicals, Inc.)

Six years after the March 2011 Triple Disaster, over 35,000 Japanese individuals remain in temporary housing. Evacuated residents, many of who are elderly, face mental health challenges. This study evaluates the well being of individuals living in temporary housing within Fukushima. Reactions to relocation were explored using Photovoice, a community-based participatory research method, in which a set of research questions are examined qualitatively through photographs and interviews. Seven participants (average age = 69.7) were provided cameras to answer a set of self-generated questions, a process that was repeated three times. An initial analysis found resilience among participants, which was explored using a theoretical framework of resiliency. Residents discussed how relocation has disrupted their lives and coping strategies they employ to ameliorate stressors. They were often optimistic and future-oriented, stating that they wanted to "live strong" after the disaster. These resilient mindsets were personified in action: all engaged in hobbies, critical for their emotional well being. Participants also emphasized the importance of community and familial support. The evidence of resilience in participants is encouraging, suggesting that these vulnerable elderly internally displaced residents are recovering from the disruption of relocation. These themes should be explored in larger temporary housing communities. Considering the number of relocated individuals today, understanding how to foster resilience could be used to inform the development of future temporary housing shelters.

Objective: Policy-makers and practitioners have a need to assess community resilience in disasters. Prior efforts conflated resilience with community functioning, combined resistance and recovery (the components of resilience), and relied on a static model for what is inherently a dynamic process. We sought to develop linked conceptual and computational models of community functioning and resilience after a disaster., Methods: We developed a system dynamics computational model that predicts community functioning after a disaster. The computational model outputted the time course of community functioning before, during, and after a disaster, which was used to calculate resistance, recovery, and resilience for all US counties., Results: The conceptual model explicitly separated resilience from community functioning and identified all key components for each, which were translated into a system dynamics computational model with connections and feedbacks. The components were represented by publicly available measures at the county level. Baseline community functioning, resistance, recovery, and resilience evidenced a range of values and geographic clustering, consistent with hypotheses based on the disaster literature., Conclusions: The work is transparent, motivates ongoing refinements, and identifies areas for improved measurements. After validation, such a model can be used to identify effective investments to enhance community resilience. (Disaster Med Public Health Preparedness. 2018;12:127-137).

A number of recent incidents in the United States resulted in a large number of citizens reporting to the Emergency Room seeking reassurance that they were okay. These citizens are being referred to in the medical community as the "Worried Well." We conducted a review of a transportation incident involving a chemical release and fire, which resulted in over 100 people reporting to the local emergency room for evaluation. Few, if any of the patients seen in the hospital had a potential exposure to the chemical or combustion byproducts. It is probable that stress hormones released by the sympathetic nervous system caused the symptoms experienced by the majority of the patients. This review suggest the need for better coordination between incident command and the hospital, including more timely situation reports including parameters such as the wind direction and potential downwind pollutant levels, to assist the physicians and nurses more appropriately manage these "Worried Well."

Background: The psychological impact of disasters has been well-documented; less attention has been paid to factors affecting the wellbeing of those exposed to disasters as occupational groups., Aims: To conduct a systematic literature review identifying social and occupational factors affecting the wellbeing of disaster-exposed employees; to use these factors to identify recommendations for potential interventions., Method: Four electronic literature databases were searched; reference lists of relevant papers were hand-searched., Results: A total of 18 005 papers were found, 571 full texts were read and 36 included in the review. The psychological impact of disasters on employees was associated with pre-disaster factors (experience/training; income; life events/health; job satisfaction), peri-disaster factors (exposure; peri-traumatic experiences; perceptions of safety; injury), social factors (organisational support; social support generally) and post-disaster factors (impact on life)., Conclusions: It is important to build a resilient workforce outside of a crisis. Pre-disaster training in recognising signs of distress, understanding vulnerability factors such as those described above, which may put certain employees at greater risk of distress and how to support colleagues may be useful. Further research into the effectiveness of post-disaster interventions is needed.

Objective: Prenatal hurricane exposure may be an increasingly important contributor to poor reproductive health outcomes. In the current literature, mixed associations have been suggested between hurricane exposure and reproductive health outcomes. This may be due, in part, to residual confounding. We assessed the association between hurricane exposure and reproductive health outcomes by using a difference-in-difference analysis technique to control for confounding in a cohort of Florida pregnancies., Methods: We implemented a difference-in-difference analysis to evaluate hurricane weather and reproductive health outcomes including low birth weight, fetal death, and birth rate. The study population for analysis included all Florida pregnancies conceived before or during the 2003 and 2004 hurricane season. Reproductive health data were extracted from vital statistics records from the Florida Department of Health. In 2004, 4 hurricanes (Charley, Frances, Ivan, and Jeanne) made landfall in rapid succession; whereas in 2003, no hurricanes made landfall in Florida., Results: Overall models using the difference-in-difference analysis showed no association between exposure to hurricane weather and reproductive health., Conclusions: The inconsistency of the literature on hurricane exposure and reproductive health may be in part due to biases inherent in pre-post or regression-based county-level comparisons. We found no associations between hurricane exposure and reproductive health. (Disaster Med Public Health Preparedness. 2017;11:407-411).

Background and Objectives: Women in Sri Lanka have been uniquely exposed to a complex and protracted set of stressors stemming from a civil war conflict spanning over 25 years and the tsunami which struck Southeast Asia in 2004. This study investigates coping strategies and their association with trauma-related symptoms of tsunami-exposed mothers in Sri Lanka at two time points., Design: Data for this study come from surveys administered in two waves of data collection to investigate both mothers' and adolescent children's post-tsunami mental health in early 2005, three months after the tsunami struck, and again in 2008, three years later., Methods: Latent-variable structural equation modeling was used to test the study hypotheses among 160 tsunami-affected mothers in the Polhena village, Matara district, Sri Lanka., Results: Among the various coping strategies examined, the use of cultural rituals as well as inner psychological strength was associated with lower levels of posttraumatic stress symptoms. In contrast, passive religious beliefs were associated with greater posttraumatic stress levels., Conclusions: The results of this study reveal the differential associations of various coping strategies including rituals used by mothers exposed to the tsunami in Sri Lanka and their posttraumatic stress symptom levels.

Background: In November 2013, the Haiyan typhoon hit parts of the Philippines. The typhoon caused severe damage to the medical facilities and many injuries and deaths. Health professionals have a crucial role in the immediate disaster response system, but knowledge of their experiences of working during and in the immediate aftermath of a natural disaster is limited. Aim The aim of this study was to explore health professionals' experiences of working during and in the immediate aftermath of a natural disaster., Method: Eight health professionals were interviewed five months after the disaster. The interviews were analyzed using phenomenological hermeneutic methods., Results: The main theme, being professional and survivor, described both positive and negative emotions and experiences from being both a helper, as part of the responding organization, and a victim, as part of the surviving but severely affected community. Sub-themes described feelings of strength and confidence, feelings of adjustment and acceptance, feelings of satisfaction, feelings of powerless and fear, feelings of guilt and shame, and feelings of loneliness., Conclusion: Being a health professional during a natural disaster was a multi-faceted, powerful, and ambiguous experience of being part of the response system at the same time as being a survivor of the disaster. Personal values and altruistic motives as well as social aspects and stress-coping strategies to reach a balance between acceptance and control were important elements of the experience. Based on these findings, implications for disaster training and response strategies are suggested. Hugelius K , Adolfsson A , Örtenwall P , Gifford M . Being both helpers and victims: health professionals' experiences of working during a natural disaster. Prehosp Disaster Med. 2017;32(2):117-123.

Objectives: To examine whether disaster-related variables, in addition to known work-related risk factors, influence burnout and its subscales (exhaustion, cynicism, and lack of professional efficacy) among public servants who experienced a major disaster., Methods: Cross-sectional studies were conducted among public servants of Miyagi prefecture at 2 and 16 months after the Great East Japan Earthquake (n=3,533, response rate 66.8%); burnout was assessed at 16 months using the Japanese version of the Maslach Burnout Inventory-General Survey. We examined the relationships between burnout and its subscales with disaster-related variables at 2 months after the disaster, while controlling for age, gender, and work-related variables at 16 months after the disaster., Results: After controlling for age, gender, and work-related variables, a significant risk factor of burnout was having severe house damage. For the each subscale of burnout, living someplace other than their own house increased the risk of both exhaustion and cynicism, while handling residents' complaints did so only for exhaustion. Notably, workers from health and welfare departments showed an increased risk of burnout, exhaustion, and cynicism, but not lack of professional efficacy., Conclusions: The findings suggest that special attention is needed for workers with severe house damage to prevent burnout, as well as those who lived someplace other than their own house to prevent exhaustion and cynicism after a major disaster. Interventions directed at workers of the health and welfare department should focus more on limiting exhaustion and cynicism, rather than promoting professional efficacy.

Background: Research in emergencies is needed to understand the prevalence of mental health and psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and psychosocial support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies., Discussion: Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.