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英文摘要
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Updated
Aug 16, 2002
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Psychological
Reactions to Terrorist Attacks: Findings From the National Study
of Americans' Reactions to September 11
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Schlenger, William E. PhD; Caddell,
Juesta M. PhD; Ebert, Lori PhD; Jordan, B. Kathleen PhD; Rourke,
Kathryn M. MPE; Wilson, David MS; Thalji, Lisa MA; Dennis, J. Michael
PhD; Fairbank, John A. PhD; Kulka, Richard A. PhD
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Context:
The
terrorist attacks of September 11, 2001, represent an unprecedented
exposure to trauma in the United States.
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| Objectives: To assess psychological
symptom levels in the United States following the events of September
11 and to examine the association between postattack symptoms and
a variety of indices of exposure to the events. |
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| Design: Web-based epidemiological
survey of a nationally representative cross-sectional sample using
the Posttraumatic Stress Disorder (PTSD) Checklist and the Brief Symptom
Inventory, administered 1 to 2 months following the attacks. |
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| Setting and Participants:
Sample of 2273 adults, including oversamples of the New York,
NY, and Washington, DC, metropolitan areas. |
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| Main Outcome Measures:
Self-reports of the symptoms of PTSD and of clinically significant
nonspecific psychological distress; adult reports of symptoms of distress
among children living in their households. |
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Results: The prevalence of probable
PTSD was significantly higher in the New York City metropolitan area
(11.2%) than in Washington, DC (2.7%), other major metropolitan areas
(3.6%), and the rest of the country (4.0%). A broader measure of clinically
significant psychological distress suggests that overall distress
levels across the country, however, were within expected ranges for
a general community sample. In multivariate models, sex, age, direct
exposure to the attacks, and the amount of time spent viewing TV coverage
of the attacks on September 11 and the few days afterward were associated
with PTSD symptom levels; sex, the number of hours of television coverage
viewed, and an index of the content of that coverage were associated
with the broader distress measure. More than 60% of adults in New
York City households with children reported that 1 or more children
were upset by the attacks.
Conclusions: One to 2 months following the events of September 11,
probable PTSD was associated with direct exposure to the terrorist
attacks among adults, and the prevalence in the New York City metropolitan
area was substantially higher than elsewhere in the country. However,
overall distress levels in the country were within normal ranges.
Further research should document the course of symptoms and recovery
among adults following exposure to the events of September 11 and
further specify the types and severity of distress in children. (JAMA
2002;288:581-588)
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Measuring
Trauma and Health Status in Refugees: A Critical Review
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| Hollifield, Michael MD; Warner, Teddy
D. PhD; Lian, Nityamo DOM, (NM); Krakow, Barry MD; Jenkins, Janis
H. PhD; Kesler, James MD; Stevenson, Jayne MD; Westermeyer, Joseph
MD, PhD |
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| Context: Refugees experience
multiple traumatic events and have significant associated health problems,
but data about refugee trauma and health status are often conflicting
and difficult to interpret. |
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| Objectives: To assess
the characteristics of the literature on refugee trauma and health,
to identify and evaluate instruments used to measure refugee trauma
and health status, and to recommend improvements. |
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| Data Sources: MEDLINE,
PsychInfo, Health and Psycho Social Instruments, CINAHL, and Cochrane
Systematic Reviews (searched through OVID from the inception of each
database to October 2001), and the New Mexico Refugee Project database. |
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| Study Selection: Key
terms and combination operators were applied to identify English-language
publications evaluating measurement of refugee trauma and/or health
status. |
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| Data Extraction: Information
extracted for each article included author; year of publication; primary
focus; type (empirical, review, or descriptive); and type/name and
properties of instrument(s) included. Articles were excluded from
further analyses if they were review or descriptive, were not primarily
about refugee health status or trauma, or were only about infectious
diseases. Instruments were then evaluated according to 5 criteria
(purpose, construct definition, design, developmental process, reliability
and validity) as described in the published literature. |
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| Data Synthesis: Of
394 publications identified, 183 were included for further analyses
of their characteristics; 91 (49.7%) included quantitative data but
did not evaluate measurement properties of instruments used in refugee
research, 78 (42.6%) reported on statistical relationships between
measures (presuming validity), and 14 (7.7%) were only about statistical
properties of instruments. In these 183 publications, 125 different
instruments were used; of these, 12 were developed in refugee research.
None of these instruments fully met all 5 evaluation criteria, 3 met
4 criteria, and 5 met only 1 of the criteria. Another 8 standard instruments
were designed and developed in nonrefugee populations but adapted
for use in refugee research; of these, 2 met all 5 criteria and 6
met 4 criteria. |
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| Conclusions: The majority
of articles about refugee trauma or health are either descriptive
or include quantitative data from instruments that have limited or
untested validity and reliability in refugees. Primary limitations
to accurate measurement in refugee research are the lack of theoretical
bases to instruments and inattention to using and reporting sound
measurement principles. (JAMA 2002;288:611-615) |
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The Model State
Emergency Health Powers Act: Planning for and Response to Bioterrorism
and Naturally Occurring Infectious Diseases
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| Gostin, Lawrence O. JD; Sapsin, Jason
W. JD; Teret, Stephen P. JD, MPH; Burris, Scott JD; Mair, Julie Samia
JD, MPH; Hodge, James G. Jr JD, LLM; Vernick, Jon S. JD, MPH |
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| The Center for Law and the Public's Health
at Georgetown and Johns Hopkins Universities drafted the Model State
Emergency Health Powers Act (MSEHPA or Model Act) at the request of
the Centers for Disease Control and Prevention. The Model Act provides
state actors with the powers they need to detect and contain bioterrorism
or a naturally occurring disease outbreak. Legislative bills based
on the MSEHPA have been introduced in 34 states. Problems of obsolescence,
inconsistency, and inadequacy may render current state laws ineffective
or even counterproductive. State laws often date back to the early
20th century and have been built up in layers over the years. They
frequently predate the vast changes in the public health sciences
and constitutional law. |
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The Model Act is structured to reflect
5 basic public health functions to be facilitated by law: (1) preparedness,
comprehensive planning for a public health emergency; (2) surveillance,
measures to detect and track public health emergencies; (3) management
of property, ensuring adequate availability of vaccines, pharmaceuticals,
and hospitals, as well as providing power to abate hazards to the
public's health; (4) protection of persons, powers to compel vaccination,
testing, treatment, isolation, and quarantine when clearly necessary;
and (5) communication, providing clear and authoritative information
to the public. The Model Act also contains a modernized, extensive
set of principles and requirements to safeguard personal rights. Law
can be a tool to improve public health preparedness. A constitutional
democracy must balance the common good with respect for personal dignity,
toleration of groups, and adherence to principles of justice. (JAMA
2002;288: 622-628) |
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