International Medical Crisis Response Alliance

Supported by grants from the Japanese Medical Society of America and the Give 2 Asia Foundation ,

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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.
Jennifer Newman, Ph.D	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. 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。
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.
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.
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.
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.
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.
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
Craig Katz, MD	Psychiatric Disaster Response: Staging and PTSD The psychotherapeutic response to the aftermath of a life-threatening disaster must be taken within a defined timeframe. 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。
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。
Jun Shigemura, MD	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. 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。
Ema Saito, MD	Japanese Version - 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... 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...

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.
Tomo Tarui, MD	Japanese Version - 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... 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...
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.
Hiroshi Kato, MD	Disaster Relief During the Great Hanshin Earthquake in Kobe (Japanese) 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...
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...
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.
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。
Shinich 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.
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.
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.
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 (Japanese) 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.
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.
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.
Akira Nishisaki, MD	Managing Shock in Children During Disaster Relief (Japanese) Managing Shock in Children During Disaster Relief (English) 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.
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.
Nahoko Harada, MSN, RN	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...
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.
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.
Akira Ohtsuru, MD	IMCRA Colloquium 2 - Fukushima Daiichi Nuclear Disaster and Radiation Health Risk Management The purposes of the survey are; firstly to monitor residents’ long-term health and to promote their future well-being, and secondly to confirm whether this long-term low-dose radiation exposure will have any effect on their health.
Drs. Homma, Hedberg, Niwa, Suzuki and Makishima	IMCRA Colloquium 3 - Faculty Question and Answer Session - Part 2 Short description.
Drs. Homma, Hedberg, Suzuki, Niwa, and Makishima	IMCRA Colloquium 3 - Faculty Question and Answer Session - Part 1 Drs. Homma, Hedberg, Suzuki, Niwa, and Makishima discuss key aspects of their presentations with each other and with the audience at large. Part 1
Mitsuru Suzuki, MD, PhD	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.
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 dnager 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.
Dr. Robert Yanagisawa - Mt. Sinai School of Medicine	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.
Dr. F. Owen Hoffman - SENES, Oak Ridge	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.
Dr. Makoto Akashi - National Institute of Radiological Sciences - Chiba Japan	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. Because many key area infrastructural elements were disrupted, even simple countermeasures for decontamination such as removing clothes and wiping the skin with wet towels were not performed. This absence of local contingency plans is unacceptable. Since the general public does not have sufficient knowledge about radiation and its effects, they were not adequately protected from exposure, did not understand what information was right or wrong and become confused, a situation leading to environmental, psychological, and economic problems.
Dr. Yoshitomo Takahashi - Dept Disaster Psychiatry - Tsukuba University	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 disorders such as PTSD was fortunately much smaller than we had initially assumed due to the appreciation received from the earthquake and tsunami victims.
Thomas G. Hedberg, MSci PhD	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.
Toshiharu Makishima, MD	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.
Kazuma Yonekura, RN	IMCRA Colloquium 3 - Nagomi: Care Center for the Heart of Soma 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.
Hiroaki Homma MD	IMCRA Colloquium 3 - The Mental Health of Children Affected by Historical Disaster 1.5 Years Later 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.
Thomas G. Hedberg, MSci PhD	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.
Nahoko Harada, MSN, RN, PhD	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.

Major Depressive Disorder in Primary Care: Implementing Evidence-Based Care Pathways

Medium: Online publication,

Major depressive disorder (MDD) is a leading cause of disability and premature mortality, but it remains underdiagnosed and undertreated. Effective screening, early diagnosis, and appropriate treatment can greatly mitigate the harmful and debilitating effects of this chronic psychiatric disorder. However, evidence suggests that management of depression is challenging for primary care providers (PCPs). First, PCPs must recognize and treat a wide range of manifestations in diverse populations. Second, it may be difficult to communicate the diagnosis of MDD to patients in a manner that promotes acceptance. Finally, selecting appropriate treatment from various psychosocial and pharmacologic options can be a formidable task. To ensure that an individualized patient-centered treatment plan is formulated, PCPs should remain knowledgeable about the clinical profiles of available agents. Importantly, they must implement treatment and monitoring strategies to achieve remission and full functional recovery in patients. This activity presents a comprehensive overview of best practices in screening, diagnosis, and treatment of MDD.

International Medical Crisis Response Alliance

Supported by grants from the Japanese Medical Society of America and the Give 2 Asia Foundation ,