An update on the victim assistance continuing to be required for mine survivors, their families, and communities in fragile and conflict-affected states
This report has two main aims: to highlight the need for physical therapist involvement in disaster management and particularly in Emergency Medical Teams (EMTs); and to brief physical therapists who want to work in the field, and national and international agencies who are already working in the field. Following an introduction to the topic of disasters, the paper outlines in separate sections the three phases of disaster management most relevant to physical therapists: preparedness; response; and recovery. Each section includes information on the role of physical therapists and details guidelines and resources to support practice in disaster management. Case studies include: Nepal, 2015 April earthquake; 2011- great East Japan earthquake; integration of rehabilitation professionals into the UK Emergency Medical Team; Nepal, 2011 onwards; Phillipines, typhoon Sendong, 2011; Phillipines, typhoon Haiyan, November 2013; Haiti, 2011- physical therapy in post-earthquake recovery and reconstruction; Pakistan, earthquake Oct 2005; Phillipines, typhoon Bopha 2012-2013.
This advocacy briefing paper shows the challenges to implementing road safety, the benefits of safe roads for communities, the international legal framework that discusses road safety in policy, suggestions for what individual actors can do to increase mobility and vehicle safety, and finally how to measure the progress of road safety programmes
The role of rehabilitation professionals in responding to Sudden Onset Disasters (SODs) is evolving rapidly, and our professions increasingly find themselves at the forefront of emergency response teams. At the same time, there is a movement towards the professionalisation of the humanitarian response sector, in particular Emergency Medical Teams, and a recognition that specialist training is required to prepare professionals for work in an austere humanitarian environment. The intended audience of the manual are physiotherapists and occupational therapists who may deploy to provide rehabilitation in the immediate aftermath of a sudden onset disaster. It was developed to support volunteers on the UK International Emergency Trauma Register (UKIETR), but with the aim of being relevant to all rehabilitation professionals interested in rapid deployment to austere environments. The content is restricted to the context of sudden onset disasters such as an earthquake or tsunami, and has been developed to support work in an austere environment, where the type of equipment and support that is normally available has been disrupted. UKIETR professionals are UK based volunteers who receive specialist training to prepare them for international deployment as part of team in response to emergencies. They may be deployed within a multi-disciplinary foreign medical team in a field hospital scenario, or as part of a more specialist ‘cell’ offering niche medical, surgical or rehabilitation services. The manual is designed to complement the three day core rehabilitation training run by Handicap International which all UKIETR members must attend. It is a clinical manual, and the contents are directly linked to modules taught on the core training course. In addition there are a number of ‘cheat sheets’ and patient education resources at the back of the manual which are designed to be used in the field. Chapters include: rehabilitation and the UKIETR; introduction to rehabilitation following sudden onset disasters; amputee rehabilitation; spinal cord injury; peripheral nerve injury; fractures; burns and soft tissue injury; and acquired brain injury
“The objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad.” The quantitative study shows the methodology used in the collection of data, the findings discovered through evaluation of the data gathered, and interpretation of how to best use those findings to serve specific populations”
PLOS ONE, 10(8)
Background: There seems to be a paucity of research on the initial subjective experiences of family caregivers of survivors of a traumatic brain injury (TBI).
Objective: To explore the challenges that family caregivers face during the initial stages of recovery of a relative who has sustained a TBI.
Methods: Thematic analysis was used to explore the findings from semi-structured interviews that were conducted with 12 female family caregivers of relatives who had sustained a TBI.
Results: Family caregivers recalled their initial experiences of the shock at hearing the news about their relative’s TBI, negative experiences in hospital and frustrating interactions with healthcare professionals as particularly challenging.
Conclusion: The findings of this study emphasise caregivers’ need for support, information and psycho-education, especially from healthcare professionals, from the very beginning stages of recovery from a TBI. Practical and physical needs with regard to admission to and care in the hospital were also highlighted. This research will hopefully contribute to creating awareness amongst healthcare professionals on how they can contribute to improvement of the services provided by the healthcare system based on the experiences of the caregivers who participated in this study.
Introduction: Humanitarian crises continue to pose a significant threat to health; the United Nations estimates that 144 million people are directly affected by conflict or environmental disasters. During most humanitarian crises, surgical and rehabilitative interventions remain a priority.
Objectives: This review assessed the quality of evidence that informs injury and physical rehabilitation interventions in humanitarian crises.
Methods: Peer-reviewed and grey literature sources were assessed in a systematic manner. Selected papers were evaluated using quality criteria based on a modified version of the STROBE protocol.
Results: 46 papers met the inclusion criteria. 63 % of the papers referred to situations of armed conflict, of which the Yugoslav Wars were the most studied crisis context. 59 % of the studies were published since the year 2000. However, only two studies were considered of a high quality.
Conclusions: While there is now a greater emphasis on research in this sector, the volume of evidence remains inadequate given the growing number of humanitarian programmes worldwide. Further research is needed to ensure a greater breadth and depth of understanding of the most appropriate interventions in different settings.
International Journal of Public Health, Vol 60
Details are given of the use of explosive weapons in Syria since 2011 and its effects on the population highlighted. The density of explosive weapons use (2013 - 2015) in Syria is mapped and the numbers of affected population by Syrian governorate are provided. Between December 2012 and March 2015, 77,645 incidents were recorded following conventional weapons and IEDs use in Syria. Explosive weapons represent 83.73% of recorded incidents and the distribution of type of weapons use per rural and urban areas is given. The higher risk of developing permanent impairments by people injured by explosive weapons and the long-term impact of explosive remnants of war on services and infrastructure are highlighted.
A literature review to evaluate quality of life and participation outcomes of individuals with earthquake-related physical injury. A systematic review was performed searching MEDLINE, Embase, PsychINFO, CINAHL and AMED electronic databases from 1966 to January 2014. Studies that measured quality of life or participation outcomes among individuals who acquired a physical disability as a result of an earthquake injury were included, with no limits on research design. The search yielded 961 potentially relevant articles after removal of duplicates. Of these, only 8 articles met the inclusion criteria. Seven papers were reviewed from the following 5 earthquakes: 2001 Gujarat earthquake, India; 2008 Wenchuan earthquake, China (also known as the Sichuan earthquake); 2005 Kashmir earthquake, Pakistan (27); 2009 Padang earthquake, Indonesia; 2010 Port-au-Prince earthquake.
Journal of Rehabilitation Medicine, vol.47, no.5, 2015, 385-393
This Guidance Note provides DFID staff with an overview of how to ensure the needs of older persons and people with disabilities, including people with injuries and chronic diseases, are addressed in humanitarian response
Background: Mortality rates from injuries are higher for people from poorer economic backgrounds than those with higher incomes (according to the World Health Organization [WHO]), and health care professionals and organisations dealing with people with disabilities experience that individuals with spinal cord injury (SCI) in low income countries face serious challenges in their daily lives.
Objectives: The aims of this study were to explore life expectancy (life expectancy is the average remaining years of life of an individual) and the situation of persons living with SCI in low income settings.
Method: Literature studies and qualitative methods were used. Qualitative data was collected through semi-structured interviews with 23 informants from four study sites in Zimbabwe representing persons with SCI, their relatives and rehabilitation professionals.
Results: There are few publications available about life expectancy and the daily life of persons with SCI in low income countries. Those few publications identified and the study findings confirm that individuals with SCI are experiencing a high occurrence of pressure sores and urinary tract infections leading to unnecessary suffering, often causing premature death. Pain and depression are frequently reported and stigma and negative attitudes are experienced in society. Lack of appropriate wheelchairs and services, limited knowledge about SCI amongst health care staff, limited access to health care and rehabilitation services, loss of employment and lack of financial resources worsen the daily challenges.
Conclusion: The study indicates that life expectancy for individuals with SCI in low income settings is shorter than for the average population and also with respect to individuals with SCI in high income countries. Poverty worsened the situation for individuals with SCI, creating barriers that increase the risk of contracting harmful pressure sores and infections leading to premature death. Further explorations on mortality and how individuals with SCI and their families in low income settings are coping in their daily life are required to provide comprehensive evidences.
Purpose: This article explores the reproductive wants and needs of persons with spinal cord injuries (SCI), along with factors that influence these needs and the services available to them.
Method: The study sample comprised persons with SCI from China Rehabilitation Research Centre who matched the research criteria and consented to participate. Data collection took place through questionnaires and in-depth interviews. After the objectives, contents and methods of the survey were explained, 63 respondents answered the questionnaire, and 17 of them (15 men and 2 women) agreed to participate in the in-depth interviews. All the respondents were above 18 years of age, either unmarried or married, and childless.
Results: It was found that 85.7% of the respondents wished to have children. The more severe the SCI, the less was the desire for children. Those with higher levels of education were less inclined to have children. While financial situation had little impact on the wish for children, the impact of traditional concepts was significant. The reproductive experiences of other SCI clients had a significant influence on respondents’ desire to have children. More than 50% of the respondents were ignorant that they could have babies after SCI. 96.8% of them believed that a child played an important role in marital stability. Though 54% of the respondents wished to have their sexual and fertility problems addressed in medical and rehabilitation institutions, 93.7% said they had not received any such professional services during the previous year.
Conclusions: Although most persons with spinal cord injuries are very keen to have children, their wants and needs are not recognised and little attention is paid to specialized service provision to address their needs. This study suggests that steps such as improving awareness, disseminating knowledge and setting up institutions to provide professional services are necessary to address reproductive needs and to protect the reproductive rights of persons with SCI.
This report presents research undertaken to highlight the number and needs of Syrian refugees in Jordan and Lebanon living with impairment, injury and chronic disease – for the purposes of this study these groups are referred to as “people with specific needs”. Throughout the report specific consideration is given to the position of older people with specific needs. Due to access and security constraints it was not possible to collect data in Syria itself, however it is recognised that the needs of refugees identified in the following report will be reflected within Syria, and that in this more extreme humanitarian situation the issues outlined below demand further consideration and response
The aim of this paper is to provide a snapshot of the types of injuries caused by explosive weapons, such as those encountered by Handicap International (HI) while working with Internally Displaced Persons (IDPs) in Syria
This report presents a review of the evidence base of public health interventions in humanitarian crises by assessing the quantity and quality of intervention studies, rather than measuring the actual effectiveness of the intervention itself. It notes an increase in quality and volume of evidence on health interventions in humanitarian crises and recognises that evidence remains too limited, particularly for gender-based violence (GBV) and water, sanitation and hygiene (WASH). This report identifies a number of common needs across all areas, namely more evidence for the effectiveness of systems and delivery, better developed research methods, and more evidence on dispersed, urban and rural populations, on ensuring continuity of care and measuring and addressing health care needs in middle-income settings (particularly NCDs)
Note: Use links on the left hand side of the webpage to access either the full report, the executive summary, or the individual chapters arranged by health topic
Purpose: The study aimed to explore the outcome of current practices in the treatment of persons with traumatic spinal cord injuries (TSCI) in Bangladesh, through the stages of rescue and first contact with physician, transportation to the tertiary hospital and intermediate admission.
Method: This observational study was conducted between June and August 2011, at the Centre for the Rehabilitation of the Paralysed (CRP), in Dhaka, Bangladesh. From the 113 persons with SCI admitted at CRP during this period, 56 persons with TSCI were selected. With the help of a questionnaire, data were collected from these persons or their attendants by trained staff, and also taken from hospital records. Data were processed and analysed by SPSS software version 16.
Results: The male-female ratio among the study participants was 5.25: 1, with a mean age of 33.02 years. 55.3% of them were paraplegic, while 44.7% were tetraplegic. About 70% of the injuries were complete according to ASIA impairment scale (AIS) during admission at CRP.
The most common causes of injury were falls (50%), followed by road traffic accidents (RTA) and carrying loads on the head. 74.8% of the injured persons had been rescued from the accident site by local people but only 16.1% had been transported by ambulance. The spine board had never been used. More than half of the injured received initial treatment only at a sub-district or district hospital where none of the requisite facilities were available.
While being transported from one hospital to the other, 10.7% experienced neurological deterioration of some sort. Significant statistical correlation was found between mode of transfer (P <0.03) and intermediate admission (P<0.001)with neurological deterioration.
Conclusions: There is an urgent need to implement pre-hospital trauma care in Bangladesh. Since resources and places for the rehabilitation of persons with TSCI are scarce, regional and national spinal injury centres should be established without delay.
Limitations: The study focussed only on a small sample of persons with TSCI undergoing treatment at a single centre.
"This report presents information on road safety from 182 countries, accounting for almost 99% of the world’s population. The report indicates that worldwide the total number of road traffic deaths remains unacceptably high at 1.24 million per year. Only 28 countries, covering 7% of the world’s population, have comprehensive road safety laws on five key risk factors: drinking and driving, speeding, and failing to use motorcycle helmets, seat-belts, and child restraints. This report serves as a baseline for the Decade of Action for Road Safety 2011-2020, declared by the UN General Assembly. This is the second in a Global status report series"
"This policy brief focuses on the gender dimension of small ‘p’ priority-setting for land release. Preferences identified through consultation with stakeholders from different gender, age and socio-economic groups should lead to the allocation of resources to, and concentration of activities on, tasks where impact will be the greatest"
GICHD policy brief 5
Purpose: To identify factors influencing the sexual health of women with spinal cord injury (SCI) in Bangladesh.
Methods: This study used both qualitative and quantitative methods. The quantitative part used a case-control design. Cases were women with SCI and controls were age-matched women without SCI. Questionnaires were used to collect data concerning the sexual health status of women. Multivariate logistic regression was done to determine which factors had an independent effect on sexual health. In-depth interviews were held with a sub-group of women from both groups, and interview guides were used. The in-depth interview data was subjected to content analysis.
Results: In total, 92 questionnaires were given out and 30 in-depth interviews were conducted. A relationship was found between physical factors and sexual health, as pain, vaginal dryness and physical discomfort were mentioned more frequently among women with SCI. Environmental and emotional factors such as stigma, satisfaction of the husband and support from the husband and friends had an influence on the sexual health of the women with SCI, as well as the other group of women.
Conclusions: From interviews it became clear that most of the women with SCI were dissatisfied with their sexual health as compared to the women without SCI. However, environmental and emotional factors such as attitudes, support and stigma, rather than physical factors, were the most important influences on sexual health in both groups of women.
Shoulder pain among paraplegic persons has negative effects on their lives. The prevalence of shoulder pain among persons with spinal cord injury (SCI) varies from 30% to 70% in different studies and may be related to repetitive use of the shoulder during self-care and wheelchair-related activities.
Purpose: This study focused on the prevalence of shoulder pain and examined its effects on activities of daily living and social participation, and on functional, work and recreational or athletic activities. It also aimed to detect the degree ofsatisfaction with shoulder functioning in wheelchair users who were paraplegic due to spinal cord injury, in the Gaza strip.
Methods: Cross sectional study design was used to collect data from 80 persons with paraplegia, post rehabilitation, who were still using manual wheelchairs (MWC) for ambulation. After giving informed consent, the selected persons were interviewed directly in their homes, and filled questionnaires which included demographic data, Wheelchair User’s Shoulder Pain Index (WUSPI) and Shoulder Rating Questionnaire (SRQ).
Results: The prevalence rate of shoulder pain among paraplegics who use manual wheelchairs was 62%. Pushing a wheelchair for 10 minutes or more, and propulsion up ramps or inclines outdoors were the most common activities that caused and exacerbated shoulder pain. Sixty four percent from among the study sample mentioned that they had no limitation in shoulder-using ability during daily personal and household activities, while the rest experienced different degrees of limitation. Seventy-four percent reported no limitation during recreational or athletic activities, while the rest (26%) agreed that pain has variably limited their participation in these activities. Fourteen percent from the sample rated the overall degree of satisfaction with their shoulder functioning as fair, and the rest rated their satisfaction from good to excellent.
Conclusion: Shoulder pain, ranging from mild to severe, was highly prevalent among SCI paraplegics who use MWCs during their usual activities, and other activities which involve wheelchair propulsion. About two- thirds of the subjectsreported no limitation in shoulder use during daily personal and household activities and in recreational or athletic activities.
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