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)