A systematic review of rapid needs assessments and their usefulness for disaster decision making:Methods, strengths and weaknesses and value for disaster relief policy

Disaster and humanitarian aid authorities are expected to ensure a timely responsive to the needs of populations affected by disaster. However, they typically have to operate under challenging conditions, hindered by lack of time, capacity and other practical complications. Aim of this systematic review is to provide a comprehensive overview of the methods, strengths and weaknesses and implementation factors of rapid needs assessments (RNAs) in a disaster context. A structured search was applied in PubMed, Web of Science and PsycINFO. A total of 45 assessments were included and categorized in different need categories. Most RNAs focused on health care and basic assistance needs and were mostly carried out in the first days to week post-impact using single measurements, based on questionnaires in (mostly limited) samples of affected populations or occasionally based on registries. Few examples were found that used existing data sources. The review suggests that it is certainly possible to collect information on needs on behalf of disaster decision-making. However, its practical implementation depends on two conditions: the level of preparedness (e.g. availability of standardized pre-developed methods to register the affected for follow-up, standardized measurement instruments and strategies to utilize existing data sources) on the one hand, the nature and dynamic circumstances of the incident on the other. Disaster response authorities are encouraged to give priority to strengthening the first beforehand, while anticipating on the latter, preferably as part of an all hazards approach, with the intention to repeat RNAs beyond the first part of the disaster timeline

Решение задач многокритериальной оптимизации с использованием генетических алгоритмов

В данной работе представлены существующие подходы и методы применения генетических алгоритмов для решения задач многокритериальной оптимизации. Предложены математическая модель и алгоритмы решения многокритериальной задачи выбора стратегии развития производственной системы. Представлены также результаты применения для решения этой задачи метода присваивания рангов Голдберга и гибридного генетического алгоритма.Представлені існуючи підходи і методи застосування генетичних алгоритмів для рішення залач багатокритеріальної оптимізації. Запропоновано математичну модель і алгоритми розв’язку багатокритеріальної задачі вибору стратегії розвитку виробничої системи. Навелено результати застосування для розв’язку цієї задачі методу надання рангів Голдберга і гібридного генетичного алгоритму.This paper describes the existing approaches and methods of application of genetic algorithms for multiobjective optimization. The mathematical model and algorithms for solving multiobjective optimization problems in management have been proposed. Experimental results of application of the hybrid genetic algorithms for solving combinatorial optimization problems have been presented

Longitudinal health effects of disasters.

Background: We carry out prospective, longitudinal studies on the possible health effects of two disasters in the Netherlands: the explosion of fireworks depot in a residential area (Enschede) and a fire in discotheque in Volendam. Learning from the chaotic aftermath previous disasters, the Dutch government attempts to prevent longterm public health damage by means of a pro-active public health response; monitoring of the health problems is one of the options. Aim: We aim at answering the following questions: a) What are the (public) health consequences of disasters for the survivors and for the community? b) Which lessons were learned about implementing studies after disasters? Methods: In nschede all problems presented to general practitioners (GPs), company doctors and mental health professionals are monitored using the electronical medical/client records. In Volendam, this monitoring includes GPs and pharmacists. Since the registrations were already operational one year before the disaster, baseline information is available on survivors and controls. In Enschede we analyse some 9,000 afflicted persons one year preand 3 1/2 years post-disaster. In Volendam, (some 1,000 afflicted, among who 200 seriously injured youngsters) one year pre- and three years post-disaster. Results: Most prevalent health problems belong to the groups psychosocial problems and ‘medically unexplained physical symptoms’ (MUPS). In addition, symptoms of the locomotive and the gastro-intestinal systems are often presented. Three years post-disaster GP utilization is still increased, while the number of survivors suffering from Post Traumatic Stress Disorder decreased. Conclusions: In the presentation, we present the health problems found in the two studies, focusing on MUPS (some 25% of all problems). We describe the possible public health consequences of disasters in today’s culture (of threats and fear). Finally, we learned some lessons on implementing our studies. We had a lot of trouble with the registration of victims and survivors (in epidemiological jargon: the denominator)

Health problems among children and adolescents before and after a disaster.

Aim: In May 2000, a firework factory exploded in a residential area in the Netherlands, resulting in 22 deaths, 947 wounded people and about 1.500 people who lost their homes. Following the explosion, a large-scale monitoring study was implemented to examine disasterrelated health consequences for the residents of the neighbourhood. In this presentation the longitudinal course of the health problems of children and adolescents involved in the disaster are discussed. Methods: Data are collected in general practices through a standardised reporting procedure, in which the general practitioners (GPs) register each contact with their patients in a computerised format. The monitoring provides information about the number of medical consultations and the type of health problems patients present to their GPs. In addition, information is available on demographic characteristics, and on the degree of exposure to the explosion. Health problems are registered by the GPs according to the International Classification of Primary Care (ICPC). Both pre-disaster data and data of a control group are available. Results: Youngsters between 1-20 years of age were examined. Data were available for 1.681 victims (53% male; mean age = 11.0, SD=6.0) and 2.675 controls (50.4% male; mean age = 10.6, SD=5.8). Prior to the disaster 10.4% of the victims presented psychological problems to their GP, compared to 8.1% in the control group. The first year post-disaster still 8.1% of the control group reported psychological problems, while in the victim group the number of youths with psychological problems increased to 26.8%. Results for other types of health problems, for different age groups and risk factors for post-disaster psychological problems will be examined as well. Conclusions: Youngsters exposed to this disaster showed long-term increases in morbidity, especially in psychological problems. Health care providers should be alert for such problems even among very young children. Extreme weather events in Europe and Public Health responses: an overview of contributions to an European conference to this topic and recommendations from the WHO and European experts

Prevalence of symptoms in a case-control study before and after a disaster.

Background: Individuals exposed to trauma report poorer health status and more physical symptoms than do similar non-exposed individuals while it is generally assumed that posttraumatic psychological symptoms precede physical symptoms. Aim: This study’s objective is to explore the prevalence of health symptoms after a man made disaster: the explosion of a firework depot in a residential area in Enschede, the Netherlands. Ten percent of the victims had to be relocated because their houses were destroyed. Methods: Design: Pre-disaster baseline symptoms compared with post-disaster symptoms by monitoring in general practice using medical records of 9392 victims and 7392 controls. Outcome measures: Psychological symptoms and medically unexplained physical symptoms (MUPS) were registered using the International Classification of Primary Care (ICPC). Prevalence rates in four weeks periods were calculated as the number of individuals presenting symptoms divided by the numbers at risk, taking into account the amount of person-time during which events were counted as well as the time elapsed before health symptoms were presented. Results: Prevalence rates for pre-disaster psychological symptoms were 26 per 1000 per 4 weeks for both victims and controls. Immediately after the disaster the prevalence rate increased to 181 for victims and than gradually decreased to 41 in de last 4 weeks of the study-period. Relocated victims showed much higher prevalence rates for psychological symptoms than non-relocated victims. Prevalence rates for MUPS were 77 per 1000 per 4 weeks for victims and 67 for controls. Immediately after the disaster the prevalence rate increased to 84 for victims but rapidly fell back to the pre-disaster rate. However, relocated victims showed slowly increasing post-disaster rates for MUPS. Post-disaster psychological symptoms preceded MUPS in 50% of the victims presenting both symptoms, compared to 32% in the period before the explosion (p< .001). Conclusions: Immediately after the disaster a lot of psychological problems and physical symptoms were presented to general practitioners but even two and a half years later an excess of psychological symptoms wasobserved. Furthermore, individuals presenting psychological symptoms had an increased risk for developing medically unexplained physical symptoms

Health problems in children and adolescents before and after a man-made disaster.

OBJECTIVE:: The aims of this study were to examine health problems of children (4-12 years old at the time of the disaster) and adolescents (13-18 years old at the time of the disaster) before and after exposure to a fireworks disaster in the Netherlands (May 2000), to compare these health problems with a control group, and to identify risk factors for postdisaster psychological problems. METHOD:: Because the electronic medical records of family practitioners were used, longitudinal monitoring of health problems from 1 year predisaster until 2 years postdisaster for both victims (N = 1,628) and controls (N = 2,856) was possible. Health problems were classified according to the International Classification of Primary Care. RESULTS:: Postdisaster increases were significantly larger in victims than in controls for psychological problems, musculoskeletal problems, stress reactions, and symptoms of the extremities. Children 4-12 years old presented larger increases in sleep problems compared with controls, whereas children 13-18 years old showed larger increases in anxiety problems than their controls. Significant predictors for postdisaster psychological problems included being relocated, presenting predisaster psychological problems, and a low to medium socioeconomic status. CONCLUSIONS:: Children and adolescents exposed to a disaster are at risk of long-lasting increases in both psychological and physical health problems. Postdisaster interventions should focus on those who were relocated and presented predisaster psychological problems. (aut.ref.

Quality indicators to self-assess the level of disaster preparedness.

Introduction: It impossible to predict when or where a disaster will happen next, or what its cause will be. This presentation describes an instrument that was developed to allow hospitals to self-assess their level of disaster preparedness and to prioritize areas for improvement for future disaster response. Methods: An instrument of quality indicators of preparedness was developed from a telephone survey (n = 134) and seven focus group discussions with experts in emergency and disaster management.The resulted initial long list of quality indicators of preparedness was then consolidated and organized by consulting experts and representatives of umbrella organizations. The resulting indicators comprised two of the three quality dimensions as defined by Donabedian: 1. Structure—Human and material resources, procedures; and 2. Process—Education, training, practice, and cooperation within the hospital and with other disciplines. The quality indicators were evaluated as to their content validity, and usefulness in a 19-hospital pilot study conducted in the fall of 2006 in the Netherlands. Results: The pilot test resulted in further improvements of the instrument. Most of the participants acknowledged the usefulness of the instrument for self-assessment of their current level of disaster preparedness. It also was determined to be useful for prioritizing areas for improvement. Respondents supported repeated use of the instrument to assess any progress in preparedness levels. Conclusions: The current instrument consists mainly of generic quality indicators of preparedness. The instrument could be extended and modified to assess specific indicators disaster preparedness. (aut. ref.

Medically unexplained symptoms and psychological problems before and after disasters.

Background: Medically unexplained symptoms (MUS) may be a major public health problem, especially after disasters. What is the course of MUS in the aftermath of a disaster? Is there a difference between self-reported symptoms and those presented to the general practitioner (GP)? Is there an association between MUS and psychological problems? Methods: Data was collected in the context of two Dutch disasters, the Bijlmermeer plane crash (1992) and the Enschede fireworks disaster (2000). Research after the Bijlmermeer disaster was carried out retrospectively, based on self-report to a call center and compared to GP records. Research after the Enschede disaster was also based on self-report (questionnaires) and GP records. In the Enschede study pre-disaster GP data was available. Results: Almost all symptoms presented after the plane crash were unexplained. One out of eight symptoms was already known to the GP before the disaster and 16% of symptoms were presented 5–6 years post-disaster, during a media hype. According to the GPs, only 6% of the symptoms were directly related to the disaster. Self-reported symptoms after the fireworks disaster were likely to remain unexplained (57–91%) and only a minority was presented to the GP, although persistent symptoms were more often presented. The number of symptoms presented to the GP had increased in the first two years post-disaster. A high level of post-disaster MUS was associated with a high number of pre-disaster MUS (OR 5.5), with pre-disaster GP contacts (1.8) and with concurrent psychological problems (3.9). Until four years post-disaster the correlations between MUS and psychological problems were statistically significant among survivors. Conclusions: The risk of increased and persistent numbers of MUS is higher after a tumultuous aftermath of a disaster (Bijlmermeer, media hype). In survivors, MUS and psychological problems were significantly correlated for many years.(aut. ref.

Chronic diseases of victims and controls before and after disaster.

Background: The aim is to quantify chronic diseases and to assess possible risk factors for developing chronic diseases during the 4 years following the explosion of a firework depot at Enschede, The Netherlands, on 13 May 2000. The immediate impact of the explosion was a completely destroyed neighbourhood with a death toll of 22 and 1000 persons injured. Methods: A longitudinal monitoring in (89% of all) victims (n = 9329) and controls (n = 7392) of continuous predisaster baseline morbidity for 16 months and post-disaster data for 4 years using the electronic medical records of general practitioners. Symptoms and diagnoses were recorded using the International Classification of Primary Care. Prevalence rates for chronic diseases were compared between victim and control groups, pre and post-disaster. Risk factors for developing chronic diseases were examined using hierarchical linear models. Results: In the first 2 years post-disaster, the prevalence of chronic diseases showed a stronger rise in victims compared with controls. Four years post-disaster, the prevalence of chronic diseases was 12% higher in victims. The higher prevalence was due to a higher prevalence of chronic psychiatric, digestive, cardiovascular, and musculoskeletal problems. No differences in cancer rates were observed. Inevitable relocation post-disaster was the strongest predictor of chronic diseases in disaster victims. Increasing age, female gender, and a lower socio-economic status were strong predictors of more chronic diseases in victims and controls, although female gender was a stronger predictor in victims. Conclusions: Four years post-disaster, a higher prevalence in chronic psychiatric, digestive, cardiovascular, and musculoskeletal problems was observed in victims compared with controls. (aut.ref.

Prospective cohort study into post-disaster benzodiazepine use demonstrated only short-term increase.

OBJECTIVES: Benzodiazepines are typically prescribed for anxiety and insomnia, two complaints often reported after disasters. Benzodiazepines can cause mental or physical dependence, especially when taken for a long time. This study aims at evaluating benzodiazepine use in a disaster-stricken community with the help of computer-based records. STUDY DESIGN AND SETTING: This prospective cohort study covers a period of 4 years. For every patient, predisaster baseline data are available. Multilevel regression is applied to study differences in benzodiazepine use in 496 patients whose children were involved in the Volendam café fire on January 1, 2001 compared with 1,709 community controls, and 4,530 patients from an unaffected cohort. RESULTS: In community controls and patients from the unaffected cohort, benzodiazepine use remained stable in the course of the years. In the first year postfire, parents of disaster victims were 1.58 times more likely to use benzodiazepines than community controls (95% confidence interval 1.13-2.23). With regard to long-term use, differences between community controls and parents were statistically nonsignificant. CONCLUSIONS: In the studied community, benzodiazepines were predominantly prescribed as a short-term intervention. Clinical guidelines that advocate a conservative prescription policy were well adhered to. (aut. ref.