Sustained Psychiatric and Psychosocial Care - Japan and USA
Understanding Post-Traumatic Stress Disorder (PTSD) in the Wake of the Tohoku Disaster
Hitoshi Tanabe, MD

東日本大震災後における心的外傷後ストレス障害(PTSD)について

2011年3月11日の東北の地震と津波の生存者にとって、メンタル・ヘルスは重要な医療問題です。生存者が立ち向かう問題の中でも、災害を常に思い出して不安を感じるため、睡眠不足は特に深刻になっています。また、大切な人たちを亡くした中で生き延びた罪悪感は長期的不安や自殺に寄与します。そのような患者の治療は長期間行われるべきで、数回のセッションでは不十分でしょう

Understanding Post-Traumatic Stress Disorder (PTSD) in the Wake of the Tohoku Disaster

Mental health is a prominent medical concern among survivors of the Tohoku earthquake and tsunami of 11 March 2011. Among the issues confronting survivors, sleep has become seriously compromised due to anxiety over a continual reliving of the disaster. Also, guilt over survival amidst the loss of loved ones contributes to long-term anxiety and suicidality. Treatment of such patients should be ongoing; a few sessions of counseling will probably be inadequate.

Family and Child Intervention: Families Impacted by Trauma and Tragedy
Jennifer Newman, Ph.D

家族と子供のための介入:トラウマや悲劇に影響を受けた家族

トラウマや災害を経験した子供は、心的外傷後ストレス障害(PTSD)、睡眠障害、うつ病、分離不安、怒りのコントロール障害などの反応を起こしやすいです。 子供は避難所や仮設住宅に住む間には、災害当時よりも大きなストレスを経験します。治療は子供の年齢(つまり乳児、幼児、学童期、思春期)に合わすべきです。

Family and Child Intervention: Families Impacted by Trauma and Tragedy

Children who have experienced trauma and disaster are prey to adverse reactions which can include PTSD, sleep problems, depression, separation anxiety and difficulties with anger and mood control. Children lodged in evacuation centers and temporary housing will experience stressors in excess of those encountered during the disaster itself. Therapy is best matched to age group and should be stratified by infants/toddlers, preschoolers, school age children and adolescents.

Issues Impacting Pediatric Mental Health in the Wake of the Tohoku Earthquake/Tsunami
Takako Ohkawa, RN, PhD

東日本大震災後における小児の精神状態に影響を与える問題

私たち精神科医、看護師や他の医療従事者からなるチームは、地震と津波の直後から、家族が避難所と仮設住宅を行き来させられているという重要な問題を特定 しました。小児心理はひどく影響を受けたようで、こういう家族ではあらゆる理由による小児科医への訪問が増えています。これは、身体的な病のほかに、子供 たちの間で精神的な問題も重要だということを示唆しています。

Issues Impacting Pediatric Mental Health in the Wake of the Tohoku Earthquake/Tsunami

Our team of psychiatrists, nurses, and other medical staff have identified issues of significant concern where families have been shuttled between established evacuation centers and temporary housing since shortly after the earthquake and tsunami. Pediatric mental health appears to be heavily impacted and visits to pediatricians for multiple causes has escalated significantly in this group, suggesting that apart from actual somatic illness, psychiatric problems may be profound in many of these children.

東日本大震災後における小児心理学
Masako Mori, PhD

東日本大震災後における小児心理学

子供の身体的・精神的傷害に対する心理的反応は年齢によって著しく異なり、以下のように年齢別で説明します:(乳児期(0-2歳)、幼児期(3-6歳)、学童期(7-11歳、 思春期 12-18歳。 子供に現れる症状には、気分的、認知的、および身体的症状があります

Pediatric Psychology in the Aftermath of a Major Disaster

A child’s psychological response to physical and mental trauma changes very markedly with age but is best sorted into the following groups: infants, 0 to 2 years of age, young children, 3 to 6 years of age, school age children, 7 to 11 years of age and adolescents, 12 to 18 years of age. The symptoms manifested by these children will span the affective, cognitive and physical domains.

現場での被災者のための効果的なこころのケアの実現と維持
Takahito Takahashi, MD

現場での被災者のための効果的なこころのケアの実現と維持

災害後、臨床医は生存者のメンタル・ヘルスに従事すると同時に、急性な生理的ニーズも満たさなければなりません。患者はしばしばあからさまな精神的助けを 受け入れようとしないため、この移行は穏やかに徐々に起こるべきです。地域に戻って崩壊した生活を築き直そうとしている患者にとっては特に、メンタル・ヘ ルスは臨床医がしばらくの間対応しなければならない重要な問題で

Maintaining Effective Psychiatric Field Service for Survivor Patient Populations

After a disaster, clinicians may find themselves attending to survivor’s mental health at the same time as attending to their acute physiological needs. The transition should be gentle and incremental since patients will often not accept overt psychiatric help. Nevertheless, mental health will remain a significant concern that clinicians will have to continue dealing with for some time; particularly with patients who have returned to their communities and are attempting to reconstruct shattered lives.

医療施設の被害による東日本大震災の医学的および精神療法的対応への影響
Shinichi Niwa, MD

医療施設の被害による東日本大震災の医学的および精神療法的対応への影響

2011年3月11日に地震、津波、複数の原発事故の3重災害が発生しました。災害の影響は、現在に至ってもまだ続いており、病院への交通の困難さ、必要な薬の不足、精神病院や薬局の被害、原発から20-30キロの範囲にある医療施設の閉鎖など、様々な領域に及んでいます

Consequences of Infrastructural Damage on Medical and Psychotherapeutic Responses to the Tohoku Earthquake and Tsunami

The event of 11 March 2011 initiated a simultaneous triple disaster of an earthquake, a tsunami and multiple nuclear power plant accidents. The ongoing impact of such a conjunction includes restricted access to patients, patients without access to needed medications, loss of psychiatric hospitals and pharmacies plus loss of medical facilities within a 20-30 kilometer radius of the nuclear accident site.

I国際医療危機対応アライアンス:東日本大震災対応における進展と課題
Thomas Hedberg, MSci, PhD

I国際医療危機対応アライアンス:東日本大震災対応における進展と課題

当アライアンスは、自然災害または人災に直面した医師や医療従事者のために重要な医学教育資源を提供する目的で設立されました。 PSYCHClinician.comおよびPrimaryCAREClinician.comのホームページは、様々なマルチメディア技術を生かし、医 学教育および資料交換のためのフォーラムを提供いたします。また、このホームページを通し、医学的・精神的緊急事態の根拠に基づいた対応方法に関する情報 提供が可能になります。様々な緊急時対応施設、医科大学および教育病院の協力のおかげで、専門家による小セミナー、診断手段や評価方法がホームページでア クセスできます。最終的に、アライアンスはSMS技術や紙の参考資料も提供する予定です。災害から数ヶ月後、こうした資料は多くの医療従事者に必要とされ ています。

International Medical Crisis Response Alliance: Progress and Challenges in Responding to the Tohoku Earthquake and Tsunami

The Alliance was developed to provide physicians and allied healthcare workers confronting natural or manmade disasters with instant access to critical medical education resources. Using a range of multimedia technologies, two primary websites, PsychClinician.com and PrimaryCareClinican.com provide a forum for medical education, resource sharing, and evidence-based best practice in the management of medical and psychiatric emergencies. In collaboration with a number of emergency response entities, medical schools and teaching hospitals, the system permits access to video mini-seminars and diagnostic/assessment tools provided by experts. Ultimately, SMS technology and printed reference documents will also available through the Alliance. Months after the disaster, the need for such resources remains strong.

東日本大震災の被災者のための支援プログラムの調整
Toshiharu Makishima, MD

東日本大震災の被災者のための支援プログラムの調整

赤十字の支援団体による医療援助は、主に災害復興の急性期に行われます。被災者が仮説住宅に移動された後といった最も重要な復興期間には、救急精神医療が すでに中止になってしまったことがあります。地域組織と協力し、精神・社会的な復興サポートを提供することは、生存者のストレス対処を支える「精神の心肺 蘇生法」に必要とされる要素です

Coordination of Support Programs for Victims of the Great East Japan Earthquake

Medical relief by Red Cross teams most frequently targets the acute phase of disaster recovery. However, the critically-important reconstruction period, after victims are moved to interim housing, is coincidentally when emergency mental health relief may be discontinued. Reconstruction mental/social support, in collaboration with community organizations is essential to the “psychiatric CPR” which helps survivors cope with stress

Psychiatric Disaster Response: Staging and PTSD
Craig Katz, MD

災害時の精神的対応:対応の段階と心的外傷後ストレス障害(PTSD)

致命的な災害後における精神療法的対応は限られた期間に行わければなりません。

Psychiatric Disaster Response: Staging and PTSD

The psychotherapeutic response to the aftermath of a life-threatening disaster must be taken within a defined timeframe.

Sensitivity to Disaster-Related Trauma
Jun Shigemura, MD

災害関連心的外傷に対する感受性

2011年3月11日の東北大災害は地震、津波、原発事故の三重災害でした。今回のような大災害が起こった場合、比較的影響を受けていない地域住民や医療従事者には、心理的後遺症を体験している生存者や救援活動者にどのように対応すれば良いか分からないことが多いです。

Sensitivity to Disaster-Related Trauma

The disaster of 3-11-11 simultaneously encompassed an earthquake, a tsunami and an explosion-related radiation release making this triple disaster one of the most severe ever facing an advanced nation. In a catastrophe like this medical professionals, and relief workers do not always know the best way to respond to survivors experiencing psychological sequelae – especially those in relatively undisturbed areas.
Psychological Impact of Disaster Worker Interactions with Dead Bodies
Jun Shigemura, MD

遺体と関わる仕事による災害救援活動者への心理的影響

災害救援活動者における遺体と関わる際の心理的反応は重要な話題ですが、これまであまり注目されていません。遺体と関わる仕事は救援活動者における長期に渡る根深い神経症の原因となる場合が多くあると考えられています。

Psychological Impact of Disaster Worker Interactions with Dead Bodies

The psychological responses of disaster workers to interactions with dead bodies is a particularly important topic which has received too little attention to date. This interaction has proven to be the sources of many long lasting and deep-seated neuroses which affect disaster workers for years.

Japanese Version - Long-Term Psychological Effects of Disaster in Children and Adolescents
Ema Saito, MD

Long-Term Psychological Effects of Disaster in Children and Adolescents

Long-Term Psychological Effects of Disaster in Children and Adolescents

Emotional wounds and scars remain long after a disaster is over. Less well known is that recovery itself can cause new wounds and scars. Relocation, occupational/academic change, isolation, separation and financial struggles can have profound psychological effects. Depression, particularly in adolescents and children shows fewer clear-cut signs as in adults and should not be confused with the normal changes associated with adolescence.

Psychiatric Remediation Care in Disasters: The Impact of Traditional Art and Performance
Tomoko Wakabayashi, M.A.

Psychiatric Remediation Care in Disasters: The Impact of Traditional Art and Performance

In the wake of disasters of large magnitude, survivors are frequently disoriented and lose touch with what had been familiar and comforting about everyday life. Psychiatric and psychosocial counseling fills only part of this need. Kigyo...

 

Sustained - Primary Care - Japan and USA
Cardiovascular Health Concerns in Post-Disaster Settings
Shunichi Homma, MD

Cardiovascular Health Concerns in Post-Disaster Settings

Among the more prevalent cardiovascular concerns following a disaster, particularly in areas with a large number of elderly, are hypertension, stroke, coronary artery disease, stress, and increased levels of physical activity which may exacerbate atherosclerotic illness. Interruption of chronically-used medications like ACE-inhibitors, anti-coagulants and diuretics should be avoided at all costs. Because of myriad lifestyle changes, including changes in diet, all cardiovascular patients need close monitoring.

Cardiovascular Health Concerns in Post-Disaster Settings – For Patients

In the aftermath of a major disaster, you may find yourself living in a very different way from what you have been used to. Among other concerns, such lifestyle changes can have a significant impact on your heart medications, which ones you take, and how you take them. Here, Dr. Homma discusses particular issues you will want to pay attention to keep yourself in the best health possible.

Japanese Version - Radiation Exposure and Risks in Prenatal and Early Natal Life
Tomo Tarui, MD

Radiation Exposure and Risks in Prenatal and Early Natal Life

Radiation Exposure and Risks in Prenatal and Early Natal Life

Although guidelines for the exposure of pregnant women to external radiation sources have been established, not a great deal is presently known about how fetal neural development is affected by internal radioisotope exposure. Given that early development involves highly active neural proliferation from a small number of progenitor cells, factors such as genetic mutations, toxic chemicals, infections and radioactivity can have a significant effect - and damage to reproductive cells can transmit malformations to subsequent generations. Careful monitoring of at risk populations is essential.

いわきヘルスセンターにて医学的および精神的支援の調整
Tomio Kato, MD

いわきヘルスセンターにて医学的および精神的支援の調整

国立精神神経病センターはいわきヘルスセンターにて災害後支援に関する医学的や精神的問題に取り組んでいます。最大の懸念は、短期的な医療支援チームが被災地を離れた後、地域の医療関係者が人数不足や不十分な災害医療トレーニングで困る可能性です。

Coordinating Medical and Psychiatric Efforts in the Iwaki Health Center

The National Psychiatric Institute’s work at the Iwaki Health Center has encompassed discussions of medical and psychiatric issues associated with post-disaster outreach. A chief concern arising from these discussions is that after our departure, the planned revision to local healthcare providers may expose insufficient training for too few professionals.

Radiation Issues: One Year and Beyond
David Brenner, PhD

Radiation Issues: One Year and Beyond

More than one year after the Fukushima disaster, new biological and environmental impacts are being discovered and disclosed internationally. In Fukushima, projections call for 900 cancer deaths among a population of a million, approximately a 0.1% probability. Although the individual risk is small, any increased risk of cancer remains a serious public health concern. When accompanied by a lack of clarity and hard facts, a secondary public health issue, radiation anxiety, assumes enhanced importance.

地震と津波:生存者の記憶
Nao Hashimoto

地震と津波:生存者の記憶

橋本さんは2011年3月11日の福島県海岸で起こった地震と津波の生存者です。ここでは、橋本さんは今回のような災害に逢った方々へ、喪失感への対処法を提案します。また、ご自分やご家族の経験、特にわずかの間に下した決断による重大な結果について語ります。

The Earthquake and Tsunami: Recollections of a Survivor

Mrs. Hashimoto survived the earthquake and tsunami which struck the coastal areas of Fukushima prefecture around Iwaki on 11 March 2011. Here, she makes some suggestions to help other survivors learn how to deal with loss, and relates some of her personal experiences and those of her family, focusing on how decisions made in a few moments could have profound consequences.

Hedberg (Reportage)
Thomas Hedberg, MSci, PhD

Victim Shelter near Iwaki

This facility in a converted school gymnasium housed some 60 families, mostly within cardboard dividers which made do for what were once homes. These people illustrate that overwhelming calamity need not lead to chaos and despair.

通常のインフラが崩れた被災地における感染症
Kentaro Iwata, MD

通常のインフラが崩れた被災地における感染症

災害後には、感染病は急速に大きな問題になりえます。特に小児と高齢者には、呼吸器疾患は深刻な問題です。下痢も頻繁に現れ、被災された環境で傷んだ食品や汚染された水を摂取した後に発症します。破傷風は最大の問題といえるかもしれません。

Infectious Disease in Areas Where Normal Infrastructure Has Been Disrupted

Infectious disease can rapidly become a serious concern in the aftermath of a disaster. Respiratory problems are a major concern, especially among children and the elderly. Diarrhea is also common and follows ingestion of spoiled food and contaminated water in disrupted environments. Tetanus is perhaps the biggest challenge

Cardiac Health Care in Disaster Settings
Shinichi Iwata, MD

Cardiac Health Care in Disaster Settings

抗凝血剤、ACE阻害薬、利尿剤、抗血小板薬、降圧剤などの投薬計画が途絶えた場合に特に懸案されるのは、病気のリバウンドです。例えば、ベータ遮断薬使用のギャップは高血圧の悪化につながります。患者は、生活の他の部分が崩壊しても、薬を定期的に摂ることを推奨されるべきです。全ての循環器患者には緊密なモニタリングが必要です。薬が入手できない場合、壊滅的な病状を防ぐには、単なるアスピリンでも有効かもしれません。

A particular concern when medication regimens, e.g. anticoagulants, ACE-inhibitors, diuretics antiplatelet agents, and anti-hypertensives, are disrupted is rebound illness. For example, gaps in the use of beta-blockers can lead to increased hypertension. Patients should be encouraged to take their medications on a regular schedule regardless of the disruption of other aspects of their lives. All cardiovascular patients need close monitoring - and when medications are not available, simple aspirin may be of use in preventing the development of catastrophic conditions.

放射性同位体に被ばくした患者の治療と放射線のある地域の住民へのアプローチ
Jacob Kamen, MS, PhD

放射性同位体に被ばくした患者の治療と放射線のある地域の住民へのアプローチ

原 発事故後の放射性物質の広がりは医療上の重要な問題ではありますが、放射性同位体の内服と体外からの被ばくでは危険性が違います。X−線やガンマ線のよ うな電離放射線はよく知られていますが、粒子放射についてはあまり知られていなく、恐怖や不安を生み出します。最終的に、被ばくの危険性は組織の時間毎の 放射量に関係しています。毎時4ミリレムの体外からの被ばくは胸部レントゲン一枚に匹敵しますが、毎分同じ放射線量の体内の脾臓への被ばくは違う効果をも たらします。

Treatment of Patients Exposed To Radioisotopes and Approaches to Those Still Living in Radioactively-Contaminated Environments

While the spread of radioactive materials in the wake of a nuclear accident is a serious medical concern, the risks must be assessed in reference to the physical realities of radioisotope ingestion vs. external exposure. Although ionizing radiation types like X and gamma rays are well known, particle emissions are less understood and inspire fear and grave concern. Ultimately, the danger associated with exposure is a function of the irradiation of a given tissue over time. While external exposure of 4 millirem per hour equals 1 chest x-ray, the same dose internally to the spleen per minute will have different consequences.

Acute and Long-Term Medical Response to the 911 Disaster in New York City and the Role of Occupational Medicine in Similar Catastrophic Situations
Phillip Landrigan, MD, MSci

Acute and Long-Term Medical Response to the 911 Disaster in New York City and the Role of Occupational Medicine in Similar Catastrophic Situations

Given the exposure of first responders in any disaster to dust, smoke, toxins, airborne pollutants and disrupted environments, the disciplines of occupational medicine become particularly important. Surprisingly, one of the most important initial steps is to inform first responders that a team has been assembled to care for their medical needs secondary to their disaster work.

Lead and Other Toxic Agents Impacting Neural Development in Children

Frequently, pediatric public health concerns require an aggressive investigative approach. In several cases of environmental contamination with molecular lead and other neurotoxins years of pursuit and research were required to achieve major advances in public health and child protection.

現場での被災者のための効果的なこころのケアの実現と維持
Toku Takahashi MD, PhD

現場での被災者のための効果的なこころのケアの実現と維持

Report from the Front: What Medical Volunteers are Encountering in the Devastated Areas of Tohoku

After a disaster, clinicians may find themselves attending to survivor’s mental health at the same time as attending to their acute physiological needs. The transition should be gentle and incremental since patients will often not accept overt psychiatric help. Nevertheless, mental health will remain a significant concern that clinicians will have to continue dealing with for some time; particularly with patients who have returned to their communities and are attempting to reconstruct shattered lives.

Falls and Physical Stress: Effects of Long-Term Living in Evacuation Settings
David Thomas, MD

Falls and Physical Stress: Effects of Long-Term Living in Evacuation Settings

The risk of falls and associated injuries pose serious problems for elderly patients, especially when displaced elderly are living in disrupted environments in the aftermath of a large-scale disaster. Non-syncopal falls are common in such settings and, in addition to possible physical injury, often leave the patient fearful of further ambulation. Falls tend be associated with either predisposing factors or situational factors.

放射線への不安と甲状腺がんの現実
Robert Yanagisawa, MD

放射線への不安と甲状腺がんの現実

2011年3月11日の津波により起こった福島の原発事故の健康への最も重要な影響は、被ばくに対する恐怖と、放射線の未知なる効果によるストレスです。放射線の甲状腺への効果についての情報を与えることで、この恐怖を和らげることができます。

Radiation Fears and the Reality of Thyroid Cancers

The most significant impact on general health from the nuclear power plant accident in Fukushima following the tsunami of 11 March 2011 may be fear of radiation exposure and the stress of not knowing its effect. By providing more information about the effect of radiation on the thyroid, this fear can be appropriately reduced.

Managing Shock in Children During Disaster Relief (Japanese)
Akira Nishisaki, MD

Managing Shock in Children During Disaster Relief

Managing Shock in Children During Disaster Relief

Many healthcare workers who are not pediatricians are faced with caring for children in emergencies and one of the most serious situations they may face in this context is shock. Immediately upon recognition, a child in shock should be.

Field Dentistry in Disrupted Environments
Richard Epstein, D.D.S.

Field Dentistry in Disrupted Environments

Dental care in remote or disrupted environments is often neglected or considered a secondary priority. A number of secondary medical issues may thus arise which are both preventable and more difficult to treat.

 

IMCRA Colloquia 1-4 - Japan and USA
Niwa Introduction (FUKU 1)
Shinichi Niwa, MD

Introduction to IMCRA Colloquium 1

Dr. Shinichi Niwa introduces the faculty and explains the purpose of the colloquium, organized to coordinate local and international relief efforts. Fukushima Medical University faculty have been intensively involved in psychosocial relief programs locally and elsewhere in Tohoku. This includes children's programs, relief for displaced parents, visits to temporary housing, and one-on-one counseling

 IMCRA Colloquium 1 - International Medical Crisis Response Alliance: Medical Information and Educational Resources To Healthcare Workers And Victims Of Natural And Manmade Disasters Worldwide
Thomas G. Hedberg, MSci, PhD

IMCRA Colloquium 1 - International Medical Crisis Response Alliance: Medical Information and Educational Resources To Healthcare Workers And Victims Of Natural And Manmade Disasters Worldwide

One of the clearest needs in the aftermath of a major disaster is for relief personnel to operate as effectively as possible. IMCRA provides simple and rapid access to expert faculty skilled in the key medical needs of affected populations....
IMCRA Colloquium 1 - Experience of the Great Northeastern Earthquake and Accidents at the Fukushima Daiichi Nuclear Power Plant (Japanese)
Hirooki Yabe, M.D. Ph.D.

IMCRA Colloquium 1 - Experience of the Great Northeastern Earthquake and Accidents at the Fukushima Daiichi Nuclear Power Plant

IMCRA Colloquium 1 - Experience of the Great Northeastern Earthquake and Accidents at the Fukushima Daiichi Nuclear Power Plant

The current state of mental healthcare in coastal Fukushima remains fragile. However initiatives like the Kokoro-no-Care program have done much to alleviate some of the issues faced by both patients and their families. Recent establishment of a mental healthcare clinics in outlying regions have helped local populations which otherwise would have limited access to these resources.

IMCRA Colloquium 1 - Disaster Relief During the Great Hanshin Earthquake in Kobe (Japanese)
Hiroshi Kato, M.D.

IMCRA Colloquium 1 - Disaster Relief During the Great Hanshin Earthquake in Kobe

The Great Hanshin-Awaji (Kobe) earthquake, which struck Japan on January 17, 1995, caused 5,488 deaths and tens of thousands of other casualties. The medical issues faced immediately after the quake were challenging, as were the changing health...

 IMCRA Colloquium 1 - Support Program for Sichuan (Japanese)
Dr. Eizaburo Tanaka, MD, MPH

IMCRA Colloquium 1 - Support Program for Sichuan

The Great Sichuan Earthquake, measured at 8.0 Richter, occurred at 14:28:01 CST on Monday, May 12, 2008 in Sichuan province China, killing an estimated 68,000 people. This report details some of the relief efforts - with a concentration on traumatic stress and its sequelae.

IMCRA Colloquium 1 - Coordination of International Support Efforts with a Future Vision in Post-Disaster Settings
Shunichi Homma, MD

IMCRA Colloquium 1 - Coordination of International Support Efforts with a Future Vision in Post-Disaster Settings

Coordination of international response to disasters of the magnitude that effected Tohoku during the Great East Japan Earthquake is essential. In the present crisis numerous NGO and other agencies, including JMSA, AmeriCares, the Japan Society of New York, IMCRA, JAMSNET, Mt. Sinai College of Medicine and Columbia University, have cooperated to maximize effectiveness and reach. With good coordination efforts are not dupliciated and greatest efficiency is attained in getting the correct services to the people who need the m most.

Katz  (FUKU1)
Craig Katz, MD

災害時の精神的対応:対応の段階と心的外傷後ストレス障害(PTSD)

致命的な災害後における精神療法的対応は限られた期間に行わければなりません。

Psychiatric Care in Disasters: The American Experience with Disasters and Mental Health

Disaster psychiatry has existed for many decades and may be best examined from the broad perspective of epidemiology and appropriate intervention. Key to understanding the psychiatric impact of disaster is establishing an understanding of the spectrum of victims, as well as the degree to which they include special populations. Interventional efforts should attempt to strengthen resistance factors that may be protective. Systems issues that may pose a challenge to establishing an effective and sustainable psychiatric response are covered in detail.

IMCRA Colloquium 2 - Beyond Dose Assessment: Using Risk with Full Disclosure in Public and Scientific Communications
Dr. F. Owen Hoffman - SENES, Oak Ridge

IMCRA Colloquium 2 - Beyond Dose Assessment: Using Risk with Full Disclosure in Public and Scientific Communications

線量評価を越えて―線量評価の向こうに公的・科学的報道での完全開示に伴うリスク

IMCRA Colloquium 2 - Beyond Dose Assessment: Using Risk with Full Disclosure in Public and Scientific Communications

When dose is the endpoint of a radiation exposure assessment, opportunities to communicate the significance of exposures are limited to comparisons with dose criteria in regulations, doses due to natural background or medical x rays, and doses above which a statistically significant increase of disease has been observed in epidemiologic studies. Communication of risk with uncertainty is essential for reaching informed consent, whether communicating to a larger community debating the tradeoffs of risks and benefits of possible radiation exposure, or communicating at the level of a physician and patient.

IMCRA Colloquium 2 - Cellular Low-Dose Radiation Damage
Dr. Makoto Akashi - National Institute of Radiological Sciences - Chiba Japan

IMCRA Colloquium 2 - Cellular Low-Dose Radiation Damage

リヒター・スケールで9.0を計測する地震が、2011年3月11日14:46に日本本州の東北沿岸を襲い、巨大な津波を引き起こした。地震後、数えきれないほどの持続的な余震が続いた。地震と余震により、15,867名が死亡し、2,906名が行方不明となった(2012年7月18日現在)。

IMCRA Colloquium 2 - Cellular Low-Dose Radiation Damage

An earthquake struck the northeast coast of Japan at 14:46 on March 11, 2011, and in consequence major nuclides were released including I-131, Cs-134 and Cs-137. Infrastructural elements such as the monitoring system for radiation, the telecommunications system, and community lifelines for water supply and electricity were also affected so that even simple countermeasures for decontamination such as removing clothes and wiping the skin with wet towels was not performed. Hospitals designated as radiation emergency hospitals lost function because of the damage to their facilities. We have already learned from past accidents that misunderstandings and wrong knowledge cause excess anxiety. Since the general public did not have sufficient knowledge about radiation and its effects, they did not understand which information is right or wrong and became confused. Radiation accidents can cause medical, environmental, psychological, and economic problems. We learned again that basic knowledge on radiation and its effects is extremely important for public people and health care providers.

IMCRA Colloquium 2 - Mental Health for Rescue Personnel in the Tohoku - Pacific Ocean Earthquake
Dr. Yoshitomo Takahashi - Dept Disaster Psychiatry - Tsukuba University

IMCRA Colloquium 2 - Mental Health for Rescue Personnel in the Tohoku - Pacific Ocean Earthquake

2011年3月11日に発生した東北地方太平洋沖地震は、約20,000人の犠牲者と行方不明者を出した。この地震は日本の歴史上最悪の天災であったため、レスキュー隊員の総人数は最大規模であった。我々は、陸上自衛隊の救助隊員のメンタルヘルスの維持に関するプランの作成に努めた。隊員の活動がさまざまな精神障害の引き金となった可能性があったことから、レスキュー隊員の事前教育と、活動後の隊員の追跡調査を計画した。しかしながら、この隊員たちにおける心的外傷後ストレス症候群のような精神障害の発生率は、幸いにもこちらが当初想定した率よりも大幅に低かった。彼らは地震や津波の犠牲者から感謝の気持ちを受けて自分たちの活動の意義を認識できたため、この点において戦場で心的外傷を受ける場合と異なっている。

IMCRA Colloquium 2 - Mental Health for Rescue Personnel in the Tohoku - Pacific Ocean Earthquake

The Tohoku-Pacific Ocean Earthquake, the worst natural disaster in the history of Japan, yielded the largest total number of rescue personnel. Mental health for the Ground Self-Defense Forces became a necessary concern. However, the incidence of PTSD was fortunately much smaller than we had initially assumed possibly due to the appreciation received from the earthquake and tsunami victims.

IMCRA Colloquium 2 - The Years Afterward: Conflicting Messages and Changing Definitions
Thomas G. Hedberg, MSci, PhD, International Medical Crisis Response Alliance

数年後に:矛盾するメッセージと変化する定義

大勢の人々に健康不安を与える福島第一原発事故や他の放射能災害から学ぶべき教訓のひとつに素早い協力しあった対応があげられるし、遅れや過小評価があってはならない。対応マニュアルは災害の後ではなく前に新しくしておくことが重要である。避難させられている人々は安全が確保されればいつでも戻ることができる。他方、避難対象ではない人々見過ごされたりゆっくりとしか認識されない危険にさらされている可能性がある。

IMCRA Colloquium 2 - The Years Afterward: Conflicting Messages and Changing Definitions

Among the many lessons learned from Fukushima-Daiichi and other radiation disasters is that rapid and coordinated response to the health threats facing large populations in the wake of a nuclear accident is essential and should be neither delayed nor underestimated. Response should be planned in advance and implemented rapidly. In addition to protecting populations from initial radiation exposure, public health efforts need to focus on avoiding secondary exposure to sites of radioisotope deposition.

IMCRA Colloquium 2 - A case report on reproductive concerns and psychological well-being in an adult female in Fukushima.
Nahoko Harada, MSN, RN

福島在住の20代女性に対する心理社会的支援

本報告では、福島在住の女性における放射線被ばくの影響への懸念、およびそれに関連する心理的ストレスとその対処法について報告する。相談者とは、地方行政主催の健康診断に併設された「よろず相談」にて相談を受けた。Bronfenbrennerのエコロジカルモデルを用い、相談者との会話を通して、相談者のストレス反応とコーピングスタイルに影響を及ぼす因子をアセスメントした。

IMCRA Colloquium 2 - A case report on reproductive concerns and psychological well-being in an adult female in Fukushima

Utilizing the Bronfenbrenner Biotechnological Model, factors influencing stress reactions and coping strategies were assessed and possible solutions found for health concerns related to radiation exposure following the Great East Japan Earthquake and Tsunami. In this case history the client presented a psychological burden from this socio-historical event. However; she also demonstrated resiliency in coping strategies.

IMCRA Colloquium 2 - Fukushima Daiichi Nuclear Disaster and Radiation Health Risk Management
Akira Ohtsuru, MD

IMCRA Colloquium 2 - Fukushima Daiichi Nuclear Disaster and Radiation Health Risk Management

2011年3月11日の福島第一原子力発電所(原発)事故は、マグニチュード9の大地震と最高45メートルの津波の発生後に生じ、大気中に放射性核種を大量に放出する結果となった。主に2011年3月15日の南東の風を受けた雨と雪が、人工放射性核種の多くの沈着物を広域にわたって、特に福島第一原発から北西の方向にもたらした。したがって、寒空の中を200,000人以上の住民が避難ルートに沿って緊急避難所へと長距離移動した。さまざまな農産物や海産物が放射性物質で汚染されたため、生産物によっては、その濃度が暫定的規定値を上回った。このことは、当初から福島に住む人々の通常の安全なライフスタイルを一変させ、これまで予測もできなかった恐怖と、低線量放射線への不安と、将来の生活に対する厳しい事実が伴った。

IMCRA Colloquium 2 - Fukushima Daiichi Nuclear Disaster and Radiation Health Risk Management

The Fukushima Daiichi nuclear power plant (NPP) accident on March 11th, 2011 resulted in a massive deposition of artificial radionuclides over a large area, especially northwest and then due to rain and snow with southeasterly wind on March 15th, 2011. The Fukushima Prefectural office and Fukushima Medical University took the lead in planning and implementing of the “Fukushima Health Management Survey” in response to a long-term low-dose radiation exposure caused by the accident.

IMCRA Colloquium 2 - Psychological Support after Major Disasters: The Kobe and Tohoku Experience
Hiroshi Kato, M.D.

Psychological Support after Major Disasters: The Kobe and Tohoku Experience

Psychological Support after Major Disasters: The Kobe and Tohoku Experience

The psychological sequelae of disaster begins with shock and fear, and leads, through the evolution of grief and guilt, to secondary outcomes such as PTSD, depression, addiction, and various psychosomatic disorders. Recovery is a process of adjustment - and a major contributor to delayed or misrouted recovery is Complicated Grief.

IMCRA Colloquium 2 - Radiation Fears and the Reality of Thyroid Cancers
Dr. Robert Yanagisawa - Mt. Sinai School of Medicine

放射線恐怖と甲状腺癌の実際

福島県の原子力発電所事故が健康状態に与える最大の影響は、放射線被曝の恐怖とその影響が不明なことによるストレスと言える。この恐怖は、甲状腺への放射線の影響に関する詳細な情報を提供することで、適度に抑えられる

IMCRA Colloquium 2 - Radiation Fears and the Reality of Thyroid Cancers

The most significant impact on general health from the nuclear power plant accident in Fukushima following the tsunami of 11 March 2011 may be fear of radiation exposure and the stress of not knowing its effect. By providing more information about the effect of radiation on the thyroid, this fear can be appropriately reduced.

IMCRA Colloquium 2 - Mental Health Support for the Workers of Fukushima Daiichi and Daini Nuclear Plants
Jun Shigemura, MD

福島第一および第二原発の労働者のためのメンタルヘルス支援

福島第一・第二原子力発電所で原発事故の復旧作業にあたる職員の殆どは、浜通りに生活圏を持つ被災者である。発電所爆発、被曝への恐怖など、想像を絶する惨状の経験に加えて、家や財産を失い、自宅避難を余儀なくされ、身内や友人を失っている。心に傷を負い、不眠不休で人々のために奮闘したにもかかわらず、電力会社に対する社会的風当たりは日増しに高まるばかりで、アパート入居拒否、家族へのいじめや暴言など、職員の基本的尊厳を傷つける差別行為が横行している。

IMCRA Colloquium 2 - Mental Health Support for the Workers of Fukushima Daiichi and Daini Nuclear Plants

Most of the Fukushima Daichi and Daini nuclear plant workers are local residents who went through unimaginable workplace experiences, such as plant explosions and irradiation fear. In the midst of this, the behavior of many was heroic. Nonetheless, public criticism continues and workers suffer from discrimination and harassment, including refusal of apartment rental contracts, bullying of children, and the experience of slurs.

IMCRA Colloquium 2 - Panelist Discussion
Akashi, Shigemura, Yanagisawa, Niwa, Yabe, Harada

IMCRA Colloquium 2 - Panelist Discussion

Drs. Akashi, Shigemura and Harada discuss key aspects of their presentations with the audience at large. Drs. Niwa and Yabe are moderators.

IMCRA Colloquium 2 - Panelist Discussion

Drs. Akashi, Shigemura and Harada discuss key aspects of their presentations with the audience at large. Drs. Niwa and Yabe are moderators.

IMCRA Colloquium 2 - Radiation Biology Poster Session
Multiple Authors

IMCRA Colloquium 2 - Radiation Biology Poster Session

This is a short video overview of the Poster Session held in conjunction with Day 1 of the First International Symposium on Post-Disaster Radiation Psychology and Physiology. These posters are available for download.

IMCRA Colloquium 2 - Radiation Biology Poster Session

This is a short video overview of the Poster Session held in conjunction with Day 1 of the First International Symposium on Post-Disaster Radiation Psychology and Physiology. These posters are available for download.

 IMCRA Colloquium 3 - Overview, Introduction and Welcome
Toshiharu Makishima, MD

IMCRA Colloquium 3 - Overview, Introduction and Welcome

The people of Miyagi prefecture have not always been at the forefront of relief efforts after 311. Fukushima has had the added danger of a serious radiation leak, and Iwate is closer to some of the major population areas. In this first collaborative effort, the Japanese Red Cross has joined forces with the International Medical Crisis Response alliance to address some of the outstanding issues facing Miyagi in the wake of 311. Our particular focus will be ongoing impact on children and the elderly.

IMCRA Colloquium 3 - Overview, Introduction and Welcome

The people of Miyagi prefecture have not always been at the forefront of relief efforts after 311. Fukushima has had the added danger of a serious radiation leak, and Iwate is closer to some of the major population areas. In this first collaborative effort, the Japanese Red Cross has joined forces with the International Medical Crisis Response alliance to address some of the outstanding issues facing Miyagi in the wake of 311. Our particular focus will be ongoing impact on children and the elderly.

IMCRA Colloquium 3 - Japan Red Cross Society: Psychosocial Support Programs
Toshiharu Makishima, MD

東日本大震災における日本赤十字社の真理社会的支援

東日本大震災は日本の観測史上初めてM9を記録し、超巨大地震と呼ばれている。地震の直接的な作用だけでなく、それによって引きおこされた津波や、原子力発電所の放射能汚染事故という多重災害であったことが被害を深刻で多彩なものにした

IMCRA Colloquium 3 - Japan Red Cross Society: Psychosocial Support Programs

The great East Japan earthquake and tsunami was the worst in Japan's recorded history. The necessity of establishing proper care for its victims is extremely high and the treatments required exceptionally diverse and complex. The Japan Red Cross Society has responded with specially trained nurses, a mental health care group, and psycho-social support for individuals as well as communities.

IMCRA Colloquium 3 - Nagomi: Care Center for the Heart of Soma
Hiroaki Homma MD

歴史的災害 1.5 年後を受けた子供たちの精神的健康

この度の東日本大震災では宮城県の死者と行方不明者の総数は被災地全体の6割に及んだ。子どもたちも甚大な被害に見舞われ、宮城県の子どもの被害の実態 は、生命を奪われた子どもは501名、孤児となった子どもは132名(石巻市49名、名取市21名、気仙沼市17名、女川町10名、南三陸町10名)、遺 児となった子どもの数は877名であった

IMCRA Colloquium 3 - Nagomi: Care Center for the Heart of Soma

The total number of missing and dead in Miyagi Prefecture after the east Japan earthquake is devastating; over 500 children were killed and nearly 900 lost parents and family. The Miyagi Prefecture Comprehensive Children's Center launched a psychological response team focused on the care of children immediately after the disaster which included child psychiatrists, nurses, clinical psychologists and school teachers. Their task remains difficult and cannot be deferred because many children will not express mental pain or problems the way an adult would and inadequately addressed psychological problems only grow worse over time, impacting all family members.

 IMCRA Colloquium 3 - Family-Centered Remedies for Displacement and Loss in Miyagi
Nahoko Harada, MSN, RN, PhD

変位と宮城県での損失のための救済の家族を中心としました。

この度の東日本大震災では宮城県の死者と行方不明者の総数は被災地全体の6割に及んだ。子どもたちも甚大な被害に見舞われ、宮城県の子どもの被害の実態 は、生命を奪われた子どもは501名、孤児となった子どもは132名(石巻市49名、名取市21名、気仙沼市17名、女川町10名、南三陸町10名)、遺 児となった子どもの数は877名であった.

IMCRA Colloquium 3 - Family-Centered Remedies for Displacement and Loss in Miyagi

Cannus Tohoku, a disaster aid agency led by nurses, sent over 11,000 professional and non-professional volunteers to Ishinomaki, Minami-Sanriku, and Oshika Peninsula right after the disaster onset. Cannus was established as a nationwide volunteer visiting care nursing agency in 1997 and expanded its activities significantly following the Great East Japan Earthquake Disaster.

 IMCRA Colloquium 3 - Isolation of the Elderly in Miyagi Prefecture
Thomas G. Hedberg, MSci PhD

宮城県における高齢者の分離

この度の東日本大震災では宮城県の死者と行方不明者の総数は被災地全体の6割に及んだ。子どもたちも甚大な被害に見舞われ、宮城県の子どもの被害の実態 は、生命を奪われた子どもは501名、孤児となった子どもは132名(石巻市49名、名取市21名、気仙沼市17名、女川町10名、南三陸町10名)、遺 児となった子どもの数は877名であった

IMCRA Colloquium 3 - Isolation of the Elderly in Miyagi Prefecture

In Tohoku, persons over 60 constituted the greatest number of causalities attributable to the 3-11-11 event. The elderly face isolation in temporary housing, the loss of social associations and the loss of routines, leading to depression, a wide range of physical illnesses, hikikomori and kodokushi. New awareness of the need for intervention in these cases has led to innovations in reconstructed living spaces and outreach techniques including cultural therapy and internet-based correspondence with family, friends and medical professionals.

IMCRA Colloquium 3 - PTSD and Long-Term Psychological Trauma in Miyagi Adolescents
Ema Saito MD

心的外傷後ストレスと宮城県青年の長期的な心理的な外傷

感情的な傷や傷跡、災害が終わった後長く残る。あまり知られて回復自体が新しい傷と傷を引き起こす可能性が。移転、職業/学術変更、分離、分離および金融闘争方法弾力性のある個人に関係なく深遠な心理的な効果を持つことができます

IMCRA Colloquium 3 - PTSD and Long-Term Psychological Trauma in Miyagi Adolescents

Emotional wounds and scars remain long after a disaster is over. Less well known is that recovery itself can cause new wounds and scars. Relocation, occupational/academic change, isolation, separation and financial struggles can have profound psychological effects no matter how resilient the individual.

IMCRA Colloquium 3 - Long-term View: Rehabilitation and Reconstruction of the Tohoku region - Support Activities for the Aging
Mitsuru Suzuki, MD, PhD

東北地方の震災復興と再生に関する長期展望

東日本大震災の被害は地震、津波、放射能と複合的であり、これらの被災内容には地域差がある。震災から1年半が 経過し、上記地域差に加えて行政庁舎の損害度や首都圏からのアクセスのしやすさによる復興格差が目立ち始めている。復興のための医療支援には災害弱者であ る障害者、高齢者、小児、外国人の多寡や被災前からの地域医療サービスの充足度などによる配慮が必要であるが、東北沿岸の医療過疎地における復興は物療や 人材派遣などの面で遅れが見られている。

IMCRA Colloquium 3 - Long-term View: Rehabilitation and Reconstruction of the Tohoku region - Support Activities for the Aging

Nearly two years have passed since 3-11-11 yet significant gaps remain in progress toward recovery. These include reconstruction, ease of access from metropolitan areas and continuing psychosocial issues facing children, the elderly and the infirm, especially in under-populated areas along the northeast coast. Long term community health support projects need to comprehensively address concerns over rising rates on long-term care, and relocation and adjustment stresses faced by elderly people living in temporary housing.

IMCRA Colloquium 3 - The Mental Health of Children Affected by Historical Disaster 1.5 Years Later
Kazuma Yonekura, RN

福島県相双地区のこころのケアの取り組みと課題

東 日本大震災の後、福島県相双地区では平成23年3月29日から、相馬市を拠点に福島県立医科大学と福島県で福島こころのケアチームが活動を開始されまし た。その後、米国日本人医師(JMSA)や邦人医療支援ネットワーク(JAMSNET)はじめとした諸団体の支援を受けNPO法人が設立され、平成24年 1月9日、当センターへ引き継がれております。特にこの地区では、福島第一原子力発電所事故の影響よって住民が避難し、地域コミュニティーが破壊されまし た。将来、労働人口が減少し高齢化が促進され少ないマンパワーで高齢者を支援していかなければならないと予想されます。相馬広域こころケアセンターなごみ では、活動の一環として被災者の認知症を予防するための訪問活動や認知症の疑われる高齢者への早期介入を行っております。今回は、相双地区の現状やこのよ うな当センターの取り組みを紹介いたします。

IMCRA Colloquium 3 - The Mental Health of Children Affected by Historical Disaster 1.5 Years Later

The Fukushima bi-district mental health care center in Soma has had an especial focus on area residents who have fled the Fukushima Daiichi nuclear power station in the district where local communities were destroyed. We also provide early intervention to elderly suspected of dementia, including visit services for elderly at risk for psychosocial disorders as a consequence of disaster.

IMCRA Colloquium 3 - Faculty Question and Answer Session
Drs. Homma, Hedberg, Suzuki, Niwa, and Makishima

教員の質問と回答セッション

医師本間、Hedberg、鈴木、丹羽、槇島で大規模な視聴者と彼らのプレゼンテーションの重要な側面について説明します。

IMCRA Colloquium 3 - Faculty Question and Answer Session

Drs. Homma, Hedberg, Suzuki, Niwa, and Makishima discuss key aspects of their presentations with the audience at large.

IMCRA Colloquium 4 - The Mobile Medical Caregiver Experience After the March 11th Earthquake and Tsunami
Dr. Jun Shigemura

IMCRA Colloquium 4 - The Mobile Medical Caregiver Experience After the March 11th Earthquake and Tsunami

Many local medical professionals in Tohoku have been continuously serving populations hit hard by the earthquake, tsunami and radiation leak disaster of 3/11/11 for three years now. While continually facing issues like emotional stress, overwork and burnout, these professionals have also built up a tremendous wealth of knowledge and experience of exceptional value to disaster workers worldwide. In an upcoming colloquium/workshop, Dr. Shigemura and IMCRA will identify professionals who seek an outlet for sharing their knowledge and experiences.

 

Addressing Global PTSD
Genetics of PTSD - Part 1
Mark Miller, Ph.D.

Genetics of PTSD - Part 1

This module and those that follow were recorded at the Second Annual BUMC/VA Joining Forces TBI/PTSD Conference on Monday December 11th 2013 at the Boston University School of Medicine.  IMCRA will continue working with BUMC/VA in future to disseminate critically important clinical findings.  Here, Dr. Miller presents new research detailing genetic risk variants contributing to a patient's predisposition to PTSD and associated disorders.

Genetics of PTSD - Part 2

Continuation of Part 1

From the Battlefront to the Homefront:  Experiences of a Military Psychiatrist
John Bradly MD

From the Battlefront to the Homefront: Experiences of a Military Psychiatrist Part 1.

The management of Post-Traumatic Stress Disorder (PTSD) in soldiers returning home after deployment begins most effectively on the battlefield itself. Dr. Bradly has extensive experience in state-of-the-art integrative inpatient and outpatient management strategies. Here he reviews the practical realities of essential clinical interventions within the theatre of operations most responsible for inducing the distinctive psychopathology of PTSD in soldiers.

From the Battlefront to the Homefront: Experiences of a Military Psychiatrist Part 2

Continuation of Part 1

Advances in the Assessment and Management of Traumatic Brain Injury
Douglas Katz, MD

Advances in the Assessment and Management of Traumatic Brain Injury - Part 1

Soldiers with Traumatic Brain Injury (TBI) experience a wide variety of physical, cognitive and emotional changes including problems with attention, memory, and executive function. Emotional changes include depression, anxiety, impulsivity, and emotional outbursts; symptoms that can overlap with PTSD. There is a strong clinical need to identify the neuroanatomical source of TBI in each case. This is often the most effective route to designing mechanisms enabling the patient to communicate effectively, a first and critical step in the recovery process.

Advances in the Assessment and Management of Traumatic Brain Injury - Part 2

Continuation of Part 1 - Case Histories

 

Sustained Emergency Care - China
Triage Procedures After a Disaster
Dr. Joseph Chang

Triage Procedures After a Disaster

The aim of triage is to do the greatest good for the greatest number of badly injured patients in difficult circumstances and with limited resources. First steps include: a) Assure the well-being of first responders, b) Determine if the region is safe for medical intervention, c) Assign treatment priorities by establishing categories, d) Maintain established categories by checking patients at multiple time points.

.

灾难发生后的会审程序

分流的目的是要为最多的严重受伤的病人,在困难的情况下,有限的资源做最大的好处。第一步骤包括:) 保证福祉的第一反应,b) 确定是否该区域是安全的医疗干预,通过建立类别,c) 分配待遇优先 d) 维持建立类别通过检查病人在多个时间点。

Breast Cancer – Recognition and Detection – A Clinician’s Guide
Guangzuo State Hospital

Breast Cancer – Recognition and Detection – A Clinician’s Guide

Breast cancer is an insidious disorder than can go unrecognized in its earliest stages when treatment can be most successful.   This module reviews the digital breast exam technique and shows examples of normal, abnormal non-cancerous conditions, pre-cancerous conditions and breast cancer of various stages.

"

乳腺癌 — 识别和检测 — 临床医师指南

乳腺癌是一种危险的疾病,往往得不到承认,当它仍可能治愈。

这段视频讨论如何识别乳腺癌和如何进行完整的数字考试。您还将看到正常乳腺、 非癌症异常乳腺癌和癌前期乳房的例子和乳腺癌的不同阶段。

The Epidemic of Diabetes in China
Liu Liping, MD

The Epidemic of Diabetes in China

China now has 92 million diabetes patients, the most in the world, as well as 140,000,000 pre-diabetic patients - for a total of nearly 230 million. In China, diabetes is a direct cause of the sharp rise in stroke and heart disease as well as markedly increased health care costs. Recent demographic studies have shown that the number of Chinese diabetics is substantially more than had been suspected in the recent past. Our most important concern now should be to change our habits, as well as raise awareness through basic public health education.

糖尿病在中国的流行

中国现在有9200万糖尿病患者,是世界上最多的,还有1.4亿糖尿病前期患者 - 共计近2.3亿人。在中国,糖尿病是中风和心脏疾病急剧增高以及医疗费用显著增加的直接原因。最近的人口研究显示,中国糖尿病患者的数量实际上大大超过了此前的猜想。目前,我们最重要的关注点应该是改变我们的生活习惯,以及通过基本的公共卫生教育提高认识。

Childhood Obesity in the US and Internationally
Ilisa Spitzer Nussbaum, RDN, CD-N

Childhood Obesity in the US and Internationally

Figures for Beijing published in state media show that 25.6 per cent of 12-year-old children are obese. There is even a problem among the under fives, 17 per cent of whom are obese and therefore five times as likely to be overweight in later childhood.

 

Sustained Emergency Care - Phillipines
Basic Intake and Diagnostic Procedures
Dr. Rod Saclolo

Basic Intake and Diagnostic Proceedures

The first approach in a catastrophic situation begins with a head-to-toe assessment and a check of vital signs. With the elderly, first make certain there are no chronic medical problems like high blood pressure, diabetes, asthma and heart disease. Make certain there is an adequate supply of clean water and uncontaminated food. Finally, instill in the survivors the importance of maintaining their health despite the disaster.

"

Basic na Paggamit at Diagnostic Pamamaraan

Ang unang diskarte sa isang sakuna sitwasyon ay nagsisimula sa isang pagtatasa head-to-daliri ng paa at ng isang tseke ng mga mahahalagang mga palatandaan. Sa mga matatanda, gumawa ng ilang mga walang mga talamak na medikal na problema tulad ng mataas na presyon ng dugo, diyabetis, hika at sakit sa puso muna. Gawing tiyak na mayroong isang sapat na supply ng malinis na tubig at uncontaminated pagkain. Sa wakas, makintal sa nakaligtas ang kahalagahan ng pagpapanatili ng kanilang kalusugan sa kabila ng kalamidad.

 

Sustained Emergency Care - Vietnam
Yếu tố góp phần để chăm sóc chu sinh nghèo ở Việt Nam (Factors Contributing to Poor Perinatal Care in Vietnam)
Huong Giang Bac, M.D.

Yếu tố góp phần để chăm sóc chu sinh nghèo ở Việt Nam (Factors Contributing to Poor Perinatal Care in Vietnam)

Như với nhiều nước đang phát triển, có là một tỷ lệ cao của suboptimal chăm sóc chu sinh tại miền Bắc Việt Nam. Trẻ em từ xa của tỉnh là thường xuyên thiếu cân và có một tỷ lệ cao của bệnh nhiễm trùng đường hô hấp và rối loạn tiêu hóa, bao gồm tiêu chảy. Mặc dù hầu hết các bà mẹ báo cáo cho con bú, nhiều người cảm thấy nó là tốt hơn để sử dụng công thức cho trẻ sơ sinh.

As with many developing countries, there is a high incidence of suboptimal perinatal care in Northern Vietnam. Children from outlying provinces are frequently underweight and have a high incidence of respiratory infections and gastrointestinal disorders including diarrhea. Although most mothers report breastfeeding, many feel it is better to use infant formulas.

 

Sustained Emergency Care - Indonesia
Ectopic Pregnancy in Indonesia
Valeria Syulfani, MD

Indonesia Kehamilan Ektopik (Ectopic Pregnancy in Indonesia)

Konsekuensi dari kehamilan ektopik tidak diobati dapat parah dan berkisar dari tuba pecah dan pendarahan rasa sakit, hemoperitoneum, gejala-gejala saraf, infeksi dan kematian. Kehamilan ektopik adalah penyebab utama kematian di seluruh dunia, terutama selama trimester pertama kehamilan. Beberapa perawatan dan intervensi yang tersedia di Indonesia dan tempat lain harus dipertimbangkan oleh dokter setelah diagnosis.

The consequences of an untreated ectopic pregnancy can be severe and range from fallopian rupture and hemorrhaging to intense pain, hemoperitoneum, neurological symptoms, infection and death. Ectopic pregnancy is a leading cause of death from pregnancy worldwide, especially during the first trimester. Several treatments and interventions available in Indonesia and elsewhere should be considered by the clinician after diagnosis.

 

Sustained Emergency Care - Korea
Coping with the Sewol Disaster
Benedict Sungho Kim, PhD

Coping with the Sewol Disaster - Part 1

세월호와 같은 재난을 받았을 때 전문가들을 찾아서 도움을 받아야합니다. 자신을 표현하는 거이 익숙치 않은 한국인들은 개인의 감정에 낯설면서 집단 정서에는 익숙합니다. 개인이 약할 수로 집단을 통해서 자신을 표현하지만 개인이 강해지면 집단은 더 건강해집니다.

Coping with the Sewol Disaster - Part 2

세월호와 같은 재난을 받았을 때 전문가들을 찾아서 도움을 받아야합니다. 자신을 표현하는 거이 익숙치 않은 한국인들은 개인의 감정에 낯설면서 집단 정서에는 익숙합니다. 개인이 약할 수로 집단을 통해서 자신을 표현하지만 개인이 강해지면 집단은 더 건강해집니다

Coping with the Sewol Disaster - English

When dealing with the aftermath of a disaster like the Sewol sinking, it is not shameful for Koreans to seek professional help. Koreans are normally not trained to express their feelings. Instead they are usually more comfortable expressing feelings through group interactions. Unfortunately however, individuality is lost in the midst of group traumas and when the group disperses, the individual is left alone. Koreans need to learn to be connected to their true feelings.

Insights from Korea on a National Disaster - Part 1
Benedict Kim and Simon Shin

Insights from Korea on a National Disaster - Part 1

세월호와 같은 큰 재난이 일어 날때면 살아남은 사람들이나, 유가족이나, 국민 대부분이 급성 스트레스 장애 (Acute Stress Disorders, ASD)를 앓게됩니다. ASD는 사건 발생 이 삼일 후 부터 약 한 달 사이에 겪에되는 심리적인 고통을 말합니다. ASD가 진행된 이후에 사건의 경중에 따라서 PTSD (Posttraumatic Stress Disorders) 트라우마 후기 스트레스 장애를 겪게 됩니다. 이때는 과도한 자기 비난이나 빠를 해결 보다는 서로를 이해해 주면서 고통스러운 과정을 통과하도록 전문가나 가족이나 이웃들의 이해와 도움이 필요합니다.

Insights from Korea on a National Disaster - Part 2

세 월호와 같은 큰 재난이 일어 날때면 살아남은 사람들이나, 유가족이나, 국민 대부분이 급성 스트레스 장애 (Acute Stress Disorders, ASD)를 앓게됩니다. ASD는 사건 발생 이 삼일 후 부터 약 한 달 사이에 겪에되는 심리적인 고통을 말합니다. ASD가 진행된 이후에 사건의 경중에 따라서 PTSD (Posttraumatic Stress Disorders) 트라우마 후기 스트레스 장애를 겪게 됩니다. 이때는 과도한 자기 비난이나 빠를 해결 보다는 서로를 이해해 주면서 고통스러운 과정을 통과하도록 전문가나 가족이나 이웃들의 이해와 도움이 필요합니다.