Short and long term determinants of incident multimorbidity in a cohort of 1988 earthquake survivors in Armenia

BACKGROUND: Multimorbidity, presence of two or more health conditions, is a widespread phenomenon affecting populations’ health all over the world. It becomes a serious public health concern due to its negative consequences on quality of life, mortality, and cost of healthcare services utilization. Studies exploring determinants of multimorbidity are limited, particularly those looking at vulnerable populations prospectively over time. This study aimed at identifying short and long term socioeconomic, psychosocial, and health behavioral determinants of incident multimorbidity among a cohort of the 1988 Armenian earthquake survivors. METHODS: The study included a representative subsample of 725 from a larger initial cohort of the earthquake survivors. Data on this subsample were collected via four phases of this cohort study during the period 1990–2012. The final logistic regression analysis eliminated all those cases with baseline multimorbidity to investigate short and long term determinants of incident multimorbidity; this subsample included 600 participants. RESULTS: More than 75% of the studied sample had multimorbidity. Perceived low affordability of healthcare services, poor living standards during the post-earthquake decade, and lower education were independent predictors of incident multimorbidity developed during the period 1990–2012. Stressful life events and poor social support were among psychosocial determinants of incident multimorbidity. Participants’ baseline BMI reported in 1990 was independently associated with incident multimorbidity. CONCLUSIONS: Most of the identified determinants of incident multimorbidity in our study population were markers of social inequities, indicating that inequities pose a serious threat to both individual and public health-related outcomes. Strategies targeting to decrease such inequities along with promotion of healthy lifestyle and strengthening of social networks may considerably reduce multimorbidity among population groups with similar socioeconomic and cultural profiles

Perceptions from epidemiologic research in an endemic war

Several endemic wars have developed since the second world war. In these wars, like endemic diseases, war becomes an accepted and expected activity incorporated into the lives of a large proportion of the population. This paper illustrates some of the special problems of epidemiologic research in an endemic war based on a number of studies conducted in Lebanon over the past decade. The special problems faced by epidemiologists in an endemic war include; a situation of dynamic change where long term planning is next to impossible, the military sensitivities involved in data collection, and the compromises one has to make with scientific rigor. The paper concludes with a perspective for action by health professionals in wartime. It recommends preventive action in wartime in addition to relief and an involvement in the search for alternative approaches to conflict resolution.war epidemiology conflict resolution public health

Prospective study of predictors of poor self-rated health in a 23-year cohort of earthquake survivors in Armenia

Long-term prospective studies exploring general health outcomes among disaster survivors are rare. Self-rated health (SRH) – a proven correlate of morbidity and mortality prognosis – was used to investigate predictors of perceived health status among a 23-year cohort of survivors of 1988 Spitak earthquake in Armenia. A geographically-stratified subsample of 725 adults from a larger initial cohort was followed during the period of 1990–2012. A logistic regression model identified predictors of SRH. Adjusted relative risks for the long-term predictors of SRH were calculated. The rate of poor SRH among the survivors was 18.8%, fair 56.5%, and good/excellent 24.7%. In the fitted model, long-term risk factors of poor SRH included baseline body mass index, baseline multi-morbidity, number of experienced stressful life events, and perceived poor living standards during the post-earthquake decade, while participation in sports in the early 1990s was a protective factor. Short-term protective factors included socio-economic status score, social support, employment and dignity, while current household size was a risk factor for poor SRH. No association was found between earthquake exposure severity and SRH after 23 years. However, the identified predictors included a number of modifiable lifestyle, material and psychological factors. Thus, interventions targeting these factors could have a long-lasting impact on disaster victims’ health status

Influence of wartime stress and psychosocial factors in Lebanon on analgesic requirements for postoperative pain

Requirements of analgesics following appendectomy was used as a model to assess the impact of the civil war situation in Lebanon on patient reaction to pain. The records of 246 patients who had undergone appendectomy for acute appendicitis under general anesthesia with no complications or concurrent diagnoses were reviewed. Sixty seven of these patients were operated in the prewar years, 67 during the war and 112 in the postwar period. The total dose of analgesics in pethidine equivalents and the number of injections were calculated for each patient. In addition, socioeconomic, demographic and clinical data were collected on all these patients. Patients, operated during and after the war required significantly less postoperative analgesics compared to prewar patients. Following stepwise multiple regression analyses, it was shown that males, ward patients and residents of Beirut required significantly lower amounts of postoperative analgesics compared to females, private patients and those living outside Beirut. The major difference between the requirements of prewar patients and war time and postwar patients may be explained on the basis of a combination of patient and system related factors. System related factors may include a change in attitude and assessment of patient pain by nurses in war time that has continued after the war. Patient related factors may be secondary to changes in the perception of pain due to the stressful war situation.