Long-term Recovery Process Research Articles

Disaster case management and individuals with disabilities.

To examine the case management and disaster recovery needs of individuals with disabilities following Hurricane Katrina. The case managers and supervisors in this study provided case management to individuals with disabilities as part of the largest coordinated disaster case management program in U.S. history, the Katrina Aid Today consortium. This study provides an account of the disaster case management needs of individuals with disabilities as well as a picture of their long-term recovery process two years following the disaster. Forty-two case managers and 12 case management supervisors from this program provided services to a collective caseload of 2,047 individuals with disabilities and their families. Interviews and telephone surveys were conducted with these participants 20-24 months after the disaster. The qualitative data were analyzed using grounded theory methodology, and descriptive statistics summarize the demographic data. Findings suggest that the disaster recovery process is typically more complex and lengthy for individuals with disabilities and requires negotiation of a service system sometimes unprepared for disability-related needs. Barriers to disaster recovery for individuals with disabilities included a lack of accessible housing, transportation, and disaster services. Supports to disaster recovery included the individual effort and advocacy of a case manager, connecting with needed resources, collaboration with other agencies, and client motivation and persistence. Results suggest that disaster recovery is facilitated by case managers with disability expertise, including knowledge about the needs of individuals with disabilities and about disability-related services.

Using Building Permits to Monitor Disaster Recovery: A Spatio-Temporal Case Study of Coastal Mississippi Following Hurricane Katrina

The pace of disaster recovery varies considerably from one place to another. Even when places suffer impacts from the same event, recovery studies often lack the spatial and temporal resolution to fully understand such local variability in the recovery process and patterns. This paper discusses the novel use of building permits and a spatial scan statistic to identify the spatial and temporal dimensions of recovery in coastal Mississippi following Hurricane Katrina. Our work identifies significant space-time clusters of recovery activity and indicates that the amount of damage experienced and the amount of pre-event housing strongly influence the timing and location of building permit clusters. This analytical method and the use of publicly available data are valuable for a better understanding of long-term recovery processes.

Services for eating disorders: how comprehensive is comprehensive?

The theme of my commentary will be “how comprehensive is comprehensive?”. I will add a number of points that are not mentioned by K. Halmi that I think are important to developing a comprehensive service, and highlight a number of areas that are mentioned. These include: a) the emergence of new concepts in the nomenclature of eating disorders; b) the need to separate children and younger adolescents from adults and older adolescents in treatment facilities; c) the role of prior trauma and its link to psychiatric comorbidity; d) the importance of the Maudsley family based treatment approach for the treatment of children and adolescents, and e) the role of complementary treatments. Approximately one-half of patients treated in eating disorder clinics do not meet full criteria for either anorexia nervosa, bulimia nervosa or binge eating disorder, and are best diagnosed with eating disorder not otherwise specified according to DSM-IV. There has been some work aimed at more specifically delineating this large subgroup. One myth that exists is that patients with eating disorder not otherwise specified are less severely ill than patients with full syndromes, but this is not necessarily true. Consider someone who vomits several times a day but does not binge eat, in contrast to someone who binges and purges twice a week. The term “purging disorder” has been coined to describe such individuals who purge but don’t binge, and they have been found to be just as impaired and to have similar medical morbidity, psychiatric comorbidity and course of illness as patients with bulimia nervosa 1,2. Brewerton et al reported that the lifetime prevalence of any purging to lose weight was 12.6% in a large representative sample of women in the United States 3. This group had significantly higher lifetime histories of major depression, substance abuse, post-traumatic stress disorder (PTSD) and victimization experiences, as well as higher body mass index and number of comorbid psychiatric disorders. One of the issues that Halmi does not address is how to manage the treatment of eating disorder patients of different ages. Most experts in the field recommend age-appropriate services and consider it optimal to separate children and younger adolescents from adults and older adolescents during treatment in inpatient, residential, partial hospital and day treatment facilities 4. It is important to protect children and adolescents from being exposed to older patients, who may inadvertently “teach” children new maladaptive behaviors, and who often have very serious “adult” issues to process, such as working through traumatic life experiences. It is now well established that eating disorder patients with bulimic symptomatology have significantly higher rates of criminal victimization experiences and resulting PTSD or partial PTSD, which in turn mediates higher rates of comorbidity 5-7. Such patients can be quite challenging and are overrepresented in inpatient settings. This necessitates that comprehensive eating disorder services are well prepared to assess and treat severely traumatized individuals and all trauma-related disorders 5. Halmi notes that “the most robust evidence-based trials for anorexia nervosa are those of family therapy with adolescents”, and this very important finding deserves further elaboration. The first major study that reported the efficacy of family therapy for anorexia nervosa indicated its usefulness in weight recovered patients upon discharge from the Maudsley hospital 8. After one year of treatment, family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun prior to age 19 years. In addition, a more provisional finding was the greater value of individual supportive therapy in older, more chronic patients. These results were confirmed at 5-year follow-up 9. Since then other studies have successfully applied the Maudsley model of family based treatment in underweight children and adolescents with anorexia nervosa 10. Some comprehensive programs have incorporated specific complementary and spiritually oriented treatments into their armamentarium, such as massage therapy, yoga, meditation and 12-step groups. In one study of patients with anorexia nervosa, massage therapy significantly reduced measures of body dissatisfaction as well as plasma cortisol levels 11. In bulimia nervosa, those who received massage reported less depression and anxiety and had significantly improved scores on several subscales of the Eating Disorders Inventory 12. Other complementary treatments, such as yoga, can be an effective method for increasing self-awareness, personal reflection and body satisfaction, as well as reducing anxiety 13,14. Principles of mindfulness meditation are an integral part of dialectical behavior therapy, an empirically validated treatment for bulimia nervosa, binge eating disorder and borderline personality disorder 15-17. Some models have incorporated 12-step programs, such as Overeaters Anonymous, which has been shown to be helpful in eating disorder patients 18. Mounting evidence suggests that spirituality is an important but underestimated factor in the long-term process of full recovery from an eating disorder 19-23, and comprehensive treatment programs would do well to honor these findings.

Long-term Recovery from Recent Disasters in Japan and the United States

Long-term Recovery from Recent Disasters in Japan and the United States

Prolonged Microgliosis in the Rhesus Monkey Central Nervous System after Traumatic Brain Injury

Impaired fine motor functions after traumatic brain injury (TBI) in humans and non-human primates often continue to improve months after injury. To initiate a series of studies in the primate model designed to investigate possible involvement of microglia/macrophage in the long-term recovery processes, changes in these cells were studied in the rhesus monkey central nervous system at 1, 6, and 12 months after a combined unilateral lesion of the arm area of the primary motor cortex and arm area of the lateral premotor cortex. Immunohistological studies showed profound CD68 immunoreactivity in the lesion area and the contralateral lateral corticospinal tract in the spinal cord at all time points, demonstrating that microglia/macrophage remain reactive at the sites of injury and axonal degeneration/survival for at least 12 months. We also observed marked increases in brain-derived neurotrophic factor (BDNF) and its receptor subtypes, TrkB[gp145] and TrkB[TK-], around the cortical lesion site after 6-month survival. Similar increases were also observed in the spinal cord, although it was less apparent for TrkB[gp145]. Double-labeling revealed that a subpopulation of CD68-immunoreacitve microglia/macrophage co-expressed BDNF in the cortex and spinal cord, and also TrkB[gp145] or TrkB[TK-] in the spinal cord. In contrast, cytokine expression of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and interleukin-6 (IL-6) at these time intervals was less prominent, suggesting that immediate inflammatory responses had subsided. These results demonstrate that microglia/macrophage undergo prolonged activation after TBI in the non-human primate brain and express BDNF and its receptors, suggesting their tropic/trophic roles in the long-term recovery processes.

Predicting Long-Term Stable Recovery from Heroin Addiction

Heroin addiction is increasingly being recognized as a chronic relapsing condition, but relatively little is known about long-term recovery processes among addicts who attain and maintain long periods of abstinence. This study is to identify predictors of long-term stable recovery from heroin addiction based on 242 heroin addicts that have been followed for more than 30 years. Results showed that recovery and non-recovery groups did not differ in deviant behaviors and family/school problems in their earlier lives. Both groups tried formal treatment and self-directed recovery (“self-treatment”), often many times. While the non-recovered addicts were significantly more likely to use substances in coping with stressful conditions, to have spouses who also abused drugs, and to lack non-drug-using social support, stable recovery ten years later was predicted only by ethnicity, self-efficacy, and psychological distress. These findings suggest that in addition to early intervention to curtail heroin addiction, increasing self-efficacy and addressing psychological problems are likely to enhance the odds of maintaining long-term stable recovery.

Long-term recovery process in a case of severe motor aphasia

重度運動性失語症を呈した若年発症例に言語訓練を実施し，発症から 11 年 10 ヵ月の経過を追跡することができた。発症 41 日目からの訓練内容および経過を示し，標準失語症検査 （以下 SLTA） 成績によって言語機能成績の推移を評価した。その結果，発症 5 年を過ぎた時点でも訓練効果が認められることがわかった。また，SLTA 成績の経過から，回復は長期にわたることと言語機能により回復の推移と時期が異なることが示された。そのことから，失語症の訓練効果は発症後短期間にのみ見られるものではなく，失語症に対する長期的なアプローチが重要であることが示唆された。

Reorganization of sleep patterns in severe OSAS under prolonged CPAP treatment

Objective To evaluate the immediate and long-term recovery processes of sleep and daytime vigilance in patients with sleep apnea syndrome (OSAS) after continuous CPAP treatment. Methods Five consecutive polysomnographic (PSG) studies were carried out on 10 male patients with severe OSAS. The first recording (baseline) was accomplished without ventilatory support (N0). The other 4 recordings were carried out during the CPAP titration night (N1), during the second night of treatment (N2), during the third night of treatment (N3), and after 30 days of regular CPAP use (N30). Ten age-balanced healthy male subjects were selected from the Parma Sleep Center database as controls. Respiratory variables, conventional PSG variables, arousals, CAP (cyclic alternating pattern) variables, and daytime function (including MSLT) were quantified. ANOVA followed by post-hoc tests explored the differences between controls and OSAS patients in the different recording conditions (N0, N1, N2, N3, N30). The PSG measures that showed significant ANOVA values were correlated with the MSLT scores. Results Values of control subjects were recovered by REM sleep, REM latency, subtypes A3 and arousal index during N1, by CAP rate and total arousals during N2, by deep sleep (stages 3+4) during N3, by light sleep (stages 1+2) during N30. The only measures which remained below control values even after 1 month of sustained treatment were the amount of CAP cycles and A1 subtypes. MSLT scores correlated significantly with CAP rate, deep sleep and arousals. Conclusions The changes induced by CPAP treatment do not restore immediately a normal sleep structure, which is re-established with different time scales Significance The modifications of sleep patterns and the different adjustments of phase A subtypes allow us to monitor the reorganization of sleep in OSAS patients treated with CPAP and the hierarchy of the mechanisms involved in sleep regulation.

長期間の重症心身障害状態から著しい回復を示した脳損傷児の回復経過に関する事例研究

長期間の重症心身障害状態から著しい回復を示した脳損傷児の回復経過に関する事例研究

Long-term remyelination after optic neuritis

Thirty-one patients were followed-up, at 3-month intervals for the first year and at 6-month intervals for the second year, after an episode of optic neuritis. The object was to confirm previous evidence for a progressive shortening of visual evoked potential (VEP) latencies and to determine whether this is associated with any change in the clinical ocular examination, visual fields or contrast sensitivity. VEP latencies were found to decrease significantly during both the first and (less strikingly) the second year, the most marked changes occurring between 3 and 6 months. Contrast sensitivity improved during the first 9 months, but subsequently tended (non-significantly) to deteriorate. A similarly transient improvement in central visual field sensitivity was seen in a subgroup of patients with clinically overt multiple sclerosis. In the data from the acutely unaffected fellow eyes, no significant changes in VEP parameters or functional indices were observed. The findings extend those of a previous study which showed significant shortening of VEP latencies between 6 months and 3 years without significant functional improvement. Over this period, a significant prolongation of VEP latencies occurred in the asymptomatic fellow eye, accompanied by contrast sensitivity deterioration. Taken in conjunction, the two studies suggest that recovery processes involving remyelination or, possibly, ion channel reorganization proceed for at least 2 years. The concurrent effects of insidious demyelination and/or axonal degeneration (also occurring in the fellow optic nerve) are initially masked by the recovery process, but gradually become more evident. The functional benefits of the long-term recovery process are relatively minor and are usually reversed within a few years. Nevertheless, it is suggested that long-term remyelination may perform an important role in protecting demyelinated axons from degeneration. Understanding the factors which promote long-term remyelination may have significant implications for therapy in multiple sclerosis.

地震災害を考える 予測と対策 地震災害からの復興過程とその対策計画

In the process of long-term recovery following a devastating earthquake disaster, the basic principle would be to create a better society by considering the damage caused by the earthquake as “creative destruction”. On the other hand, the basic principle for the recovery processes from a flood disaster is restoring the damaged area to its condition before the disaster. It was pointed out that the 1995 Hanshin-Awaji (Kobe) earthquake disaster was the first disaster that let the Japanese people recognize this difference between recovery from earthquake disasters and from flooding disasters. The long-term recovery processes started with a trial-and-error basis with an enormous amount of service volumes. This paper, reviews the planning mechanism of local restoration plans, and the basic structure of physical, restoration economic revitalization, and social reconstruction. After evaluating the progress of restoration in the impacted area for the first five years, remaining issues were analyzed.

Reconstruction of a long-term recovery process from pasture to forest

We used space-for-time substitution to obtain a directed successional sequence for subalpine meadow vegetation in the Swiss National Park. Since human impacts (e.g., domestic animal grazing) ceased in 1914, the successional processes documented are assumed to be autogenic in nature. The data consist of 59 permanent plots spanning almost 90 years, and include many spatial replications. An initial inspection of the individual time series revealed the existence of a variety of response patterns, which are described in the literature as representing different successional types. However, a closer inspection suggested that many of these series can be superimposed, as they are part of a much longer deterministic series. Linking the individual time series proved to be challenging. A heuristic approach produced results that differed depending on initial starting conditions. We therefore derived a deterministic algorithm to produce a unique solution. The resulting sequence largely confirmed the heuristic interpret...

Lessons from 10 Years of Post-Exxon Valdez Monitoring on Intertidal Shorelines

ABSTRACT Intertidal shorelines impacted by the Exxon Valdez oil spill have been monitored by the National Oceanic and Atmospheric Administration (NOAA) since late 1989. Originally intended to document oil fate and impacts of hot-water high-pressure washing, the program evolved into a comprehensive examination of long-term recovery processes in these environments. Annual field sampling and laboratory and statistical analyses are combined to document trends in biology, chemistry, and geomorphology of 26 sites in Prince William Sound. Recovery processes in shoreline ecosystems occur over different time frames, depending on the particular measure and scale used. Using a geomorphological measure, most boulder/cobble sites where berm relocation was carried out to remove subsurface oil took 1–2 years to return to pre-treatment configurations. Mean levels of polyaromatic hydrocarbons in mussels from oiled sites remained elevated for approximately 3–4 years after the spill. Abundance trends for most epibiota species at mid intertidal zones from oiled sites were parallel to those from unoiled sites after 1–2 years. Longer lasting impacts were found for infaunal species at low elevations, perhaps related to changes in grain size composition at washed sites. Some impacts from oiling remained at sensitive sites through at least 1997, including subsurface oiling, species abundance differences, and patchy areas of sediment and bivalve contamination from polyaromatic hydrocarbons.

Systemic and metabolic responses in Daphnia magna to anoxia

The anoxic tolerance of the water flea Daphnia magna proved to be well-developed. During the first 1 or 2 h of anoxia, perfusion rate was not essentially impeded: admittedly, there was a 30–40% reduction of the amplitude of heart contractions, but the heart beat at a rate either similar to normoxia (150 min −1 at T=15°C) or markedly higher (in more than half of the experiments). During that period, energy was provided by a high rate of anaerobic metabolism: l-lactate partly accumulated in the animals (0.36 μmol lactate g −1 FW min −1), partly it was excreted into the medium (0.08 μmol lactate g −1 FW min −1). The anaerobiosis was accompanied by a decrease of intracellular as well as extracellular pH (metabolic acidosis). A metabolic depression, starting after about 1 or 2 h of anoxia, helped to prolong survival time during long-term anoxia (up to 24 h): in many experiments, heart and perfusion rate sharply declined to a much lower level (well below the normoxic rate), which was maintained during the next hours of anoxia. The accumulation of lactate stopped, while lactate excretion into the medium continued at an unchanged rate. If the anoxic period exceeded 20 min, long-term recovery processes, lasting up to 4 h, were found during normoxia: the heart rate increased and reached a maximum frequently after 40–50 min of recovery. There was also a restoration of pre-anoxic intra- and extracellular pH values. Additional experiments on the effects of altered ambient P CO 2 /pH on heart rate and blood pH revealed pH to be a possible control factor of heart rate.

Neurophysiological markers of relapse, remission and long-term recovery processes

Neurophysiological markers of relapse, remission and long-term recovery processes

Can we achieve accountability for long-term outcomes?

Objective: To explore options for the development of a set of indicators to assess the long-term outcomes achieved by all people with a given disabling condition in a given population. Data Sources: The review draws on empirical studies of predictive indicators, theoretical literature on long-term recovery processes, and literature from administrative science on the use of indicators in accountability systems. Study Selection: Studies were selected that explicitly sought to relate short-term and long-term outcomes or that explored the mediating factors in the relationship between impairment, disability, and handicap. Data Extraction: The focus of the review is on (1) empirical evidence of the relationship between short- and long-term outcomes, particularly in causal claims, and (2) theoretical analyses of the factors that mediate this relationship. Data Synthesis: Evidence is presented that certain outcome states can be considered thresholds that make the outcome usable and, hence, sustainable or that create the opportunity for further improvement. Such thresholds could meet the construct validity criteria necessary for measures that are to be used as indicators in an accountability system. The interaction between psychological and physical factors in setting thresholds means that both objective and subjective indicators are required in an indicator system. Conclusions: It may well be possible to develop a parsimonious set of population-based outcome indicators for people with disabilities. The key safeguards required are construct validity and the involvement of people with disabilities in both the development and use of the indicators.

The extent, time course, and fraction size dependence of mouse spinal cord recovery from radiation injury

Purpose : This experiment was designed to assess: (a) the influence of fraction size and time interval between fractions on the tolerance of the spinal cord to high cumulative doses of radiation; and (b) the influence of the long-term recovery process on the tolerance of the spinal cord to reirradiation. Methods and Materials : The T10-L2 level of the spinal cord of C3Hf mice was irradiated using a conventionally fractionated regimen of 2.0 Gy once daily, a prolonged fractionated regimen of 1.2 Gy once daily, a hyperfractionated regimen of 1.2 Gy twice daily, or a single dose of 12 Gy followed 0–190 days later by a second dose of 5–20 Gy. Mice in the multifractionated regimen groups were given a single 15 Gy top-up dose 24 h after reaching a cumulative fractionated dose of 24–70 Gy. Hind limb strength was measured weekly for 2 years after the completion of irradiation. Results : Paralysis occurred in a bimodal time distribution, with peaks at 5–10 months and 15–23 months after the completion of irradiation. The cumulative radiation dose was directly associated with the incidence of paralysis in each radiation schedule ( p < 0.0001) and inversely associated with the time to onset of paralysis in the 1.2 Gy b.i.d. ( p = 0.0001) and 2.0 Gy q.d. schedules ( p = 0.03). The median latency of paralysis in each group was inversely associated with the incidence of paralysis in that group ( p < 0.001). Decreasing the fraction size from 2.0 to 1.2 Gy once daily markedly increased the radiation tolerance of the spinal cord ( p < 0.0001), consistent with a very small alpha-beta value of −0.30 Gy (∼ 95% confidence interval −0.72, +0.18) in the linear-quadratic model. Decreasing the time interval from 24 h to alternating 8 and 16 h periods produced an offsetting diminuation in cord tolerance ( p < 0.0001). The 1.2 Gy once daily schedule resulted in ED 20 and ED 50 values that were approximately double those of the 2.0 Gy once daily and the 1.2 Gy twice daily schedules and a relative risk of paralysis from a given dose that was 0.03 times the risk associated with the other two regimens ( p < 0.0001). There was no significant difference between the 2.0 Gy once daily and the 1.2 Gy twice daily dose-paralysis curves ( p = 0.86). The residual from a single 12 Gy radiation dose was 17% after 190 days, leaving the retreatment ED 50 only 10% below the ED 50 of previously unirradiated spinal cord. The relative risk of paralysis after 12 Gy plus a second radiation dose decreased from 1.00 with no time interval between doses to 0.51–0.73 with a 0.25, 1 or 3 day interval, 0.32 with a 7 day interval, 0.11 with a 30 day interval, and 0.06 with a 190 day interval. Conclusion : The increased radiation tolerance of the murine spinal cord produced by decreasing the fraction size from 2.0 to 1.2 Gy was offset by the diminished tolerance produced by decreasing the time interval between fractions from 24 to 8–16 h, resulting in no significant difference in the dose-paralysis curves of conventional and hyper-fractionated radiation schedules. The rodent spinal cord eliminates the majority of the occult radiation injury produced by a radiation dose equal to half the ED5o during the months following irradiation. This permits retreatment of previously irradiated spinal cord to high doses without the induction of myelopathy.

The response of semi-arid vegetation assemblages following the abandonment of mining towns in south-western Montana

Abandoned mining towns provide an excellent opportunity to examine long-term vegetation recovery processes. Analysis of data collected in five ghost towns in semi-arid south-western Montana indicated considerable differences remain after 45–77 years of recovery. Two measures of vegetation recovery, introduced grass cover and species richness, differed markedly between undisturbed sites and disturbed sites at four of the towns. Disturbances favoured the invasion of introduced grasses and greater species diversity. At the fifth town, the driest location, the presence of a native sod grass, Bouteloua gracilis , which can withstand severe disturbances, apparently inhibited the establishment of non-native species, thereby hastening the recovery process.

The Local Recovery Process after a Major Natural Disaster

An organizing framework of the long-term recovery process was developed, after studying first hand how 14 U.S. communities recovered from a major disaster. The framework depicts the dynamic processes that contribute to an efficient local recovery, including the three key elements identified and the inter-relationships among them. The three key elements are personal leadership, ability to act, and knowledge of what to do. Although only one of the disaster events investigated during the four-year study period was a major damaging earthquake, the framework developed appears to be useful for understanding the aftermath of many types of natural disasters. Information about an effective recovery process should be factored into earthquake hazard mitigation and preparedness efforts because sooner or later, whether we are ready or not, we will be recovering from a major earthquake.

Symptomatology in alcoholics at various stages of abstinence.

Evaluation of 312 abstinent alcoholics (163 men and 149 women) with the Symptom Check-List 90 revealed high levels of symptomatology for subjects in the early months of abstinence. Symptomatology decreased progressively with prolonged abstinence, approximating normal levels for subjects abstinent 10 years or more. The levels were similar for men and women. At all stages, for both men and women, symptomatology was highest on the depression, interpersonal sensitivity, and obsessive-compulsive symptom dimensions, with guilt a particularly persistent symptom. It is suggested that the findings depict a long-term process of recovery from active alcoholism and are consistent with the concept of a protracted withdrawal syndrome, an intermediate (partially reversible) brain syndrome, and general psychosocial dysfunction and demoralization consequent to active alcoholism.