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      Interruption of Medication among Outpatients with Chronic Conditions after a Flood

      , ,
      Prehospital and Disaster Medicine
      Cambridge University Press (CUP)

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          Abstract

          Introduction:

          The disruption of routine treatment, including the interruption of medication, exacerbates chronic conditions during disasters. However, the health consequences of the interruption of medication have not been fully examined. On 22 July 2006, a flash flood affected more than 3,000 households in five cities and four towns in the northern part of Kagoshima Prefecture in southwest Japan. The aims of this study are to describe the prevalence of the interruption of medication among the outpatients in the flood-affected area and to determine the risk and preventive factors for the interruption of medication.

          Methods:

          This was a cross-sectional study using a self-administered questionnaire. The study subjects were the outpatients who visited nine of 15 medical facilities in the flood-affected area from 23 January and 31 January 2007. Of 810 valid respondents, 309 who received medication treatment before the event were eligible for the study. Information on socio-demographic factors, chronic health conditions, preparedness-related factors before the event and damage-related factors were collected. Overall and evacuation status-specific prevalence of interruption of medication were presented. For those evacuated, the associations between interruption of medication and relevant patient characteristics, as well as deterioration of health status after the event, were examined.

          Results:

          The prevalence of interruption of medication was 9% in total, but it increased up to 23% among the evacuated subjects. Interruption of medication was more likely among those aged ≥75 years (odds ratio [OR] = 3.6; 95% confidence interval [CI] = 1.0−12.6) and those receiving long-term care services (OR = 4.6; 95% CI = 1.1−19.1), while it was less likely among those with hypertension (OR = 0.2; 95% CI = 0.1−0.8) and those prepared to go out with medication (OR = 0.2; 95% CI = 0.03−0.8). Those who experienced interruption of medication were more likely to have deteriorated health status one month after the event (OR = 4.5; 95% CI = 1.2−17.6).

          Conclusions:

          Interruption of medication occurred more commonly among the evacuated subjects. Among the evacuated, the elderly and those receiving longterm care services were at high risk for interruption of medication, while the preparedness behavior of “preparing to go out with medication” had preventive effect. Special attention must be paid to the high-risk subgroups, and some preventive behaviors should be recommended.

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          Most cited references10

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          Experiences of hurricane Katrina evacuees in Houston shelters: implications for future planning.

          To shed light on how the public health community can promote the recovery of Hurricane Katrina victims and protect people in future disasters, we examined the experiences of evacuees housed in Houston area shelters 2 weeks after the hurricane. A survey was conducted September 10 through 12, 2005, with 680 randomly selected respondents who were evacuated to Houston from the Gulf Coast as a result of Hurricane Katrina. Interviews were conducted in Red Cross shelters in the greater Houston area. Many evacuees suffered physical and emotional stress during the storm and its aftermath, including going without adequate food and water. In comparison with New Orleans and Louisiana residents overall, disproportionate numbers of this group were African American, had low incomes, and had no health insurance coverage. Many had chronic health conditions and relied heavily on the New Orleans public hospital system, which was destroyed in the storm. Our results highlight the need for better plans for emergency communication and evacuation of low-income and disabled citizens in future disasters and shed light on choices facing policymakers in planning for the long-term health care needs of vulnerable populations.
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            Earthquake-induced potentiation of acute risk factors in hypertensive elderly patients: possible triggering of cardiovascular events after a major earthquake.

            We sought to investigate the potentiation of acute risk factors after the Hanshin-Awaji earthquake (7.2 on the Richter scale). The frequency of cardiovascular events increases just after a major earthquake, but the causative factors have not been fully investigated. We studied the changes in cardiovascular risk factors in 42 elderly outpatients with well-controlled hypertension living near the epicenter (Awaji-Hokudan districts) 7 to 14 days after the earthquake when the major felt-aftershocks persisted. They all experienced the highest stress grading of 6 (catastrophic stress) according to the DSM-III-R. To study the hemostatic profile and endothelial cell state, we measured the blood pressure (BP), hematocrit and lipid profiles as well as fibrinogen, a marker of fibrin turnover (D-dimer), fibrinolytic factors (plasmin-alpha2-plasmin inhibitor complex [PIC], tissue-type plasminogen activator [t-PA] antigen and t-PA inhibitor [PAI] activity) and an endothelial cell-derived marker (von Willebrand factor [vWF]). Systolic and diastolic blood pressures and other variables increased after the earthquake. Before and after the earthquake, the median (25th to 75th percentiles) systolic BP was 152 (range 142 to 164) and 170 mm Hg (range 161 to 178), respectively (p < 0.0001), and the diastolic BP was 83 (range 79 to 88) and 91 mm Hg (range 84 to 96), respectively (p < 0.0001). Of blood viscosity determinants, hematocrit was 38.1% (range 40.7% to 35.9%) and 39.7% (range 42.9% to 38.3%), respectively (p < 0.001), and fibrinogen 316 (range 272 to 360) and 335 mg/dl (range 307 to 391), respectively (p < 0.05). Von Willebrand factor was 128% (range 74% to 148%) and 148% (range 100% to 178%), respectively (p < 0.01); D-dimer was 410 (range 285 to 633) and 560 ng/ml (range 391 to 888), respectively (p < 0.0001); and PIC was 0.74 (range 0.58 to 0.91) and 0.75 microg/ml (range 0.58 to 1.1), respectively (p < 0.05). In contrast, lipid profiles did not change after the quake. When the patients were classified into the high stress and moderate stress groups according to the degrees of damage to their house and injury to family members, the levels of fibrinogen, vWF, PIC and t-PA antigen were increased only in the former group, whereas BP, hematocrit and D-dimer levels were increased in both groups. These abnormalities of acute risk factors, except for vWF, were transient and decreased to prequake levels by 4 to 6 months after the quake. Earthquake-induced stress seems to induce transient increases in BP, blood viscosity determinants and fibrin turnover and to prolong endothelial cell stimulation. The potentiation of these acute risk factors might contribute to the occurrence of cardiovascular events just after a major earthquake in elderly subjects with hypertension.
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              Effect of the Kobe earthquake on stress and glycemic control in patients with diabetes mellitus.

              To examine the effects of the Kobe, Japan, earthquake, a life-threatening event, on stress and glycemic control in diabetic patients. Hemoglobin A1c levels before and after the earthquake were evaluated in diabetic patients in Kobe (N = 157; magnitude, 7.2) and in Osaka, Japan, as a control (N = 277; magnitude, 4.2), where little damage to houses and traffic facilities occurred. Glycosylated hemoglobin levels were also compared with those of 2 years before and 1 year after the earthquake. The General Health Questionnaire (GHQ) and a self-administered questionnaire regarding damage to houses and relatives killed or injured were used to assess psychological and mental stresses on earthquake survivors. Glycemic control was aggravated in diabetic patients after the earthquake in Kobe but not in Osaka. THe GHQ scores were significantly higher in the patients in Kobe than those in Osaka. Increased hemoglobin A1c concentrations and high scores on the GHQ were especially evident in diabetic patients with severe damage to houses and/or with relatives killed or injured. These results suggest an association between chronic, life-threatening stress and the worsening of metabolic control in patients with diabetes mellitus.
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                Author and article information

                Journal
                applab
                Prehospital and Disaster Medicine
                Prehosp. Disaster med.
                Cambridge University Press (CUP)
                1049-023X
                1945-1938
                February 2010
                June 28 2012
                February 2010
                : 25
                : 01
                : 42-50
                Article
                10.1017/S1049023X00007652
                0c5532ee-ceda-4854-a30c-5890f47276c3
                © 2010
                History

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