The prevalence of psychological distress during pregnancy in Miyagi Prefecture for 3 years after the Great Eas t Japan Earthquake

BACKGROUND@#To examine changes in psychological distress prevalence among pregnant women in Miyagi Prefecture, which was directly affected by the Great East Japan Earthquake and tsunami, and compare it with the other, less damaged areas of Japan.@*METHODS@#This study was conducted in conjunction with the Japan Environment and Children`s Study. We examined 76,152 pregnant women including 8270 in Miyagi Regional Center and 67,882 in 13 other regional centers from the all-birth fixed data of the Japan Environment and Children's Study. We then compared the prevalence and risk of distress in women in Miyagi Regional Center and women in the 13 regional centers for 3 years after the disaster.@*RESULTS@#Women in the Miyagi Regional Center suffered more psychological distress than those in the 13 regional centers: OR 1.38 (95% CI, 1.03-1.87) to 1.92 (95% CI, 1.42-2.60). Additionally, women in the inland area had a consistently higher prevalence of psychological distress compared to those from the 13 regional centers: OR 1.67 (95% CI, 1.18-2.38) to 2.19 (95% CI, 1.60-2.99).@*CONCLUSIONS@#The lack of pre-disaster data in the Japan Environment and Children's Study made it impossible to compare the incidence of psychological distress before and after the March 2011 Great East Japan Earthquake. However, 3 years after the Great East Japan Earthquake, the prevalence of pregnant women with psychological distress did not improve in Miyagi Regional Center. Further, the prevalence of mental illness in inland areas was consistently higher than that in the 13 regional centers after the disaster.

Changes in smoking behavior among victims after the great East Japan earthquake and tsunami

BACKGROUND@#In areas affected by the tsunami of the great East Japan Earthquake, smoking behavior may have deteriorated due to high stress and drastic changes in living environment. Surveys were conducted to reveal changes in smoking behaviors among victims.@*METHODS@#A population-based random-sample home-visit interview survey of victims in Iwate and Miyagi Prefectures affected by the tsunami disaster was conducted in 2012 (n = 1978), while a population-based nationwide survey was conducted in 2013 (n = 1082). A panel survey in 2014 was conducted with respondents of the 2012 survey (n = 930). Multiple logistic regression analysis was performed to reveal factors related to smoking status after the disaster.@*RESULTS@#There was high smoking prevalence of both sexes in the tsunami disaster area (current smoking rate in coastal area, 50.0% for male, 21.4% for female; inland area, 34.7% for male, 7.6% for female). Low prevalence of male quitters was observed (quitter rate in coastal area, 20.8% for male, 8.0% for female; inland area, 23.4% for male, 5.5% for female). The prevalence of nicotine-dependent people assessed by FTND (Fagerström Test for Nicotine Dependence) in the coastal area was also higher than in the inland area or other areas of Japan. Smoking behavior among victims worsened after the disaster and did not improve 3 years from the disaster. Post-disaster factors related to smoking were living in coastal area, complete destruction of house, and living in temporary housing.@*CONCLUSIONS@#Smoking prevalence and the level of nicotine dependence of tsunami victims were still high even 3 years after the disaster. It is important to emphasize measures for smoking control in the disaster areas for an extended time period.

Fukushima: lecciones japonesas para la Salud Pública colombiana. Reporte de caso / Fukushima: japanese lessons to colombian Public Health

Resumen Introducción: Durante el 21o. Congreso Mundial de Epidemiología, organizado por la Asociación Internacional de Epidemiología (IEA) en Saitama-Japón en agosto de 2017, se aceptó invitación de los organizadores para visitar la Planta Nuclear # 1 de Fukushima. Objetivo: Explorar la situación operacional y de salud pública en el área de la prefectura de Fukushima y su planta nuclear #1, sitio afectado por el terremoto y tsunami de 2011. Métodos: Salida de inspección de campo (Inspection Tour) y encuentro con representantes de TEPCO (Tokyo Energy Power Company) en área de control; explicación didáctica de antecedentes y situación actual zonal, e instrucciones (briefing) para acceso. Visita con explicación de zonas de atención de salud y trabajos realizados. Recorrido en autobús especialmente adaptado al perímetro de cada reactor, portando dosímetro individual. Reunión final para resolución de dudas e inquietudes y lecciones del caso. Resultados: Visita y reuniones ejecutadas; exposición personal = 0,01 mSv/h. Radiación por zonas de reactor: central=230 mSv/h; paredes=40 mSv/h; planta=0,26 mSv/h, periferia=0,26 mSv/h. Zona de exclusión=20 km. Políticas de salubridad basadas en limpieza y remoción de fuentes de contaminación; aislamiento de aguas y bombeo de fuentes subterráneas; prevención y contención de escapes. Conclusión: La prevención lo es todo en asuntos industriales, sean nucleares o no; la colaboración interpersonal e interagencias es esencial en el manejo a muy largo plazo de desastres similares; debe evitarse incorporar técnicas o tecnologías industriales desconocidas o foráneas sin antes valorar su costo, alcance y posibles riesgos de salud individual, pública o medio-ambiental.

Abstract Introduction. During the 21st. International Epidemiology Association (IEA) World Congress of Epidemiology at Saitama (Japan), celebrated in August 2017, an invitation from its organizers to visit Fukushima Nuclear Plant # 1 was accepted. Objective: To explore operational and public health situation at the area of the Fukushima Prefecture and its nuclear plant #1, place affected by the 2011 earthquake and tsunami. Methods. Inspection tour and appointment with representatives of TEPCO (Tokyo Energy Power Company) at the control area; explanation on background and actual situation, and briefing before access. Guided visit to areas dedicated to healthcare and workers' attention, and work done. Tour by specially adapted autobus to the perimeter of each reactor, using individual dosimeter. Final meeting to solve questions and lessons of this case. Results. Visit and meetings were executed; individual exposure = 0,01 mSv. Radioactivity by reactor zones: central (inside) =230 mSv/h; walls =40 mSv/h; plant =0,26 mSv/h, perimeter =0,26 mSv/h. Exclusion zone =20 km. Public Health policies in place based upon cleansing and removal of sources of contamination; water isolation and subterranean sources pumping; prevention and containment of leaks. Conclusion. About industrial issues, prevention is everything, whether they be nuclear or not; interpersonal / interagencies' cooperation is paramount when dealing with similar disasters at a very long term; unknown or poorly understood industrial techniques or technologies should be avoided before a proper evaluation of their risk/benefit balance, scope and possible health risks to subjects, communities or environment.

Factors associated with social support in child-rearing among mothers in post-disaster communities

BACKGROUND@#Natural disasters have long-term negative impacts on the health and socioenvironmental conditions of a population, affecting the physical environment as well as the relationships within the community, including social networks. Mothers in post-disaster communities may have difficulty receiving social support not only from family members and relatives but also from members of their community, such as people in their neighborhoods. This study focused on mothers with infants and preschool-aged children in post-disaster communities. The associations of social support with sociodemographic characteristics and socioenvironmental conditions related to child-rearing among mothers in post-disaster communities were assessed.@*METHODS@#An anonymous self-administered questionnaire survey was conducted in October 2015 in 988 households in areas affected by the Great East Japan Earthquake and Tsunami. The data collected on sociodemographic and socioenvironmental characteristics included the presence of pre-disaster acquaintances in the neighborhood and social support for child-rearing. The associations of sociodemographic and socioenvironmental characteristics with social support were examined.@*RESULTS@#We analyzed 215 completed questionnaires from mothers living in different houses from those they lived in before the disaster to reflect continuous relationships with people from the pre-disaster communities. Social support was significantly associated with infant sex, extended family, support obtained from relatives not living together, pre-disaster acquaintances, use of child support resources, and no perceived difficulties in child-rearing. In addition, the presence of pre-disaster acquaintances was associated with categories of mental/physical place of comfort and child-rearing support, with adjusted odds ratios of 1.88 (95% CI 1.03-3.44) and 2.84 (95% CI 1.46-5.52) compared with mothers who did not have any pre-disaster acquaintances.@*CONCLUSIONS@#Factors associated with the obtainment of social support in child-rearing among mothers in post-disaster communities were attributed not only to mothers themselves and family members but also to socioenvironmental factors such as the presence of pre-disaster acquaintances. The presence of pre-disaster acquaintances promoted rich social support in child-rearing in post-disaster communities. When reconstructing a community following changes in residence location after a disaster, the pre-disaster relationships among the community dwellers should be considered from the viewpoint of child-rearing support.

Ultrasound cardiography examinations detect victims' long-term realized and potential consequences after major disasters: a case-control study

BACKGROUND@#An increase in cardiovascular diseases has been reported following major disasters. Previous work has shown that ultrasonographic findings from ultrasound cardiography examination (UCG) increased until the 44th month after the tsunami caused by the Great East Japan Earthquake. The present study conducted UCG among victims in the tsunami disaster area and investigated the frequency of disaster-related cardiovascular diseases and changes over time until the 55th month after the disaster.@*METHODS@#The subjects were residents of temporary housing complexes and neighboring housing in Watari-gun, Miyagi Prefecture, Japan. There were 207 subjects in the 18th month, 125 in the 30th month, 121 in the 44th month, and 106 in the 55th month after the disaster. Data were collected through UCG and self-report questionnaire.@*RESULTS@#Significant changes were observed among subjects with clinical findings from the UCG, which increased over the study period-from 42.0 to 60.8, 72.7, and 73.6% beginning in the 18th month after the disaster (p < 0.0001).@*CONCLUSIONS@#It is possible that the UCG can become a useful examination to visualize the potential impact of a major disaster on the cardiac function of victims. Victims with clinical findings continued increasing not only during the acute phase after a disaster but also in the long term. We therefore need to keep this in mind, and note that it is important to establish a support system to control cardiovascular diseases from the early stage of disaster.@*TRIAL REGISTRATION@#UMIN; ID000029802. R000034050 . 2 November 2017.

Factores socio-demográficos, crecimiento y sintomatología postraumática en sobrevivientes del terremoto de Chile del 2010 / Socio-demographic factors, posttraumatic growth and symptoms in survivors of Chile earthquake 2010

El propósito de este estudio es evaluar la relación entre factores socio-demográficos y del evento con la sintomatología postraumática (SPT) y el crecimiento postraumático (CPT) en personas que perdieron su hogar en el terremoto de Chile del 27 de febrero de 2010. Con este fin, se seleccionaron 351 personas adultas, entre 18 y 84 años, de las cuales 63,2% eran mujeres. Se aplicó el Inventario de Crecimiento Postraumático y la Escala de Impacto de Evento Revisada, además de un cuestionario socio-demográfico. Se evidencia en el estudio la relación significativa con la SPT o el CPT de elementos tales como sexo, edad, ingresos económicos, cambio de comuna tras el sismo y la razón de la pérdida de la vivienda Se presentan los resultados y argumenta su alcance para la promoción y prevención de salud en sobrevivientes de desastres naturales.

The purpose of this study is to evaluate the relationship that socio-demographic and event factors share with post-traumatic symptomatology (PTSD) and posttraumatic growth (PTG) in people who lost their home in the earthquake that hit Chile on february 27th, 2010. To this end, 351 adults from 18 to 84 years old were selected, of whom 63.2% were women. For this study, the Posttraumatic Growth Inventory (PTGI) and the revised Impact of Event Scale (IES) were applied, in addition to a socio-demographic questionnaire. This study shows that elements such as gender, age, economic income, change of location after the earthquake, and the reason behind the loss of housing bear a significant relation with PTSD or PTG. Results are presented, and their consequences for health promotion and prevention in survivors of natural disasters are discussed. Keywords: posttraumatic

Psychosocial Interventions for Children and Adolescents after a Disaster: A Systematic Literature Review (1991–2015)

OBJECTIVES: The aim of this systematic literature review is to analyze the psychosocial interventions for children and adolescents after disasters. METHODS: We conducted a review of the extant research literature from 1991 to 2015 via a comprehensive search of the MEDLINE, EMBASE, Cochrane CENTRAL, PubMed and PsyclNFO databases. The keywords employed in this research included: ‘child’, ‘adolescent’, ‘youth’, ‘disaster’, ‘posttraumatic’, ‘psychosocial’, ‘therapy’ and ‘intervention’. The researchers followed the PRISMA guidelines. A total of 850 articles were screened for their eligibility and fifty-nine were found to meet the study criteria. The final data analysis was performed based on the disaster type, study design, type of intervention, sample size, age, school grade, number of sessions, setting of intervention delivery, providers, approach and parent involvement. RESULTS: Countries worldwide have experienced various kinds of disasters, including earthquakes, hurricanes, vessel accidents, tornados, tsunamis, volcanic eruptions, war, fire, terrorism, and traffic accidents. The types of psychosocial intervention that were conducted after these disasters included: psychological first aid, psychological debriefing, psychoeducation, trauma focused cognitive behavior therapy, eye movement desensitization reprocessing, prolonged exposure therapy, group play therapy and arts therapy, project interventions, school-based interventions and web-based interventions. CONCLUSION: The findings of the systematic literature review suggest that an appropriate psychosocial intervention could be utilized as evidence-based mental health treatment for children and adolescents after disasters.

Review of Disaster Mental Health System in Japan / 신경정신의학

Mental health is one of the most important issues for disaster survivors, and many studies have reported higher rates of mental health problems after disasters. Because Japan has experienced frequent earthquakes, tsunami, typhoons, and volcanoes, mental health problems have been a matter of great concern after disasters in Japan. To serve the psychiatric services after the Hanshin-Awaji (Kobe) earthquake, 'Hyogo institute for traumatic stress' was established. And when the disaster caused by the great east Japan earthquake and tsunami occurred, 'National information center of disaster mental health' and 'Disaster psychiatric assistance team' had the important role of reducing mental health problems.

How Digital Technology Will Contribute to Future Innovations in Healthcare / 임상당뇨병

Digital technology is dramatically transforming today's healthcare. Over the past decade, exponential advances in digital technology, especially in smart phones, have radically changed many aspects of everyday life. Medicine will be the next aspect. Maturation of innovative digital technologies such as next generation sequencing, internet of things, cloud computing and artificial intelligence has generated a perfect storm to revolutionize the status quo in medicine. In the near future, clinical practice will be much different than it is today. It is important to pay attention to the changes and be prepared for the inevitable tsunami of transformation. In this paper I will discuss how digital technology has been changing healthcare.

Respuesta de los centros de atención primaria en salud mental después del terremoto y tsunami del 2010 en la Región del Maule / Response of primary care teams to manage mental health problems after the 2010 earthquake

Background: Thirty to 50% of people exposed to a natural disaster suffer psychological problems in the ensuing months. Aim: To characterize the activities in mental health developed by Primary Health Care centers after the earthquake that affected Chile on february 27th, 2010. Material and Methods: A cross-sectional study analyzing 16 urban centers of Maule Region, was carried out. A questionnaire was developed to know the preparatory and supportive activities directed to the community and the training and self-care activities directed to Health Care personnel that were made during the 12 months following the catastrophe. In addition, a questionnaire evaluating structural aspects was designed. Results: Only 1/3 of the centers made some preparatory activity and none of them made a diagnosis of population vulnerability. The average of protective Mental Health interventions coverage reached 35% of the population estimated to be most affected. The activities lasted 31 to 62% of the optimal duration standards set by experts (according to the type of action). Important differences between centers in economic and geographical accessibility, construction and professional resources were found. Conclusions: This study shows the difficulties faced by urban centers of Maule Region to deal with mental health problems caused by the earthquake, which were attributable to the absence of local planning and drills, and to the lack of intra and inter sectorial coordination.

Propiedades psicométricas de la escala de síntomas de TEPT para niños (CPSS) en población chilena afectada por el terremoto y tsunami del 27-F de 2010 / Psychometric properties of the children's posttraumatic symptoms scale in the earthquake and tsunamis chileans' victims

Existen pocos instrumentos para la evaluación de sintomatología postraumática en niños/as y adolescentes en Latinoamérica. El presente estudio analiza las propiedades psicométricas de la child PTSD Symptom Scale CPSS (Foa, Johnson, Feeny y Treadwell, 2001), en niños y niñas víctimas de un desastre natural. Se realizan los análisis psicométricos habituales, incluyendo un análisis factorial exploratorio y uno confirmatorio. Se analiza la convergencia de la escala CPSS con el diagnóstico de TEPT a través de la entrevista estructurada DISC-IV Una estructura de tres factores de primer orden fue la que mostró mejor ajuste en el análisis confirmatorio. La escala mostró alta consistencia interna. Un puntaje de 24 o más puntos permite obtener una sensibilidad de 82 por ciento y especificidad de 88 por ciento respecto del diagnóstico de TEPT con el DISC-IV Estas positivas cualidades psicométricas indican la utilidad de la escala para ser usada en chile con niños/ as y adolescentes expuestos a desastres naturales.

There are not many instruments about evaluation of post Traumatic symptomatology in Latin-American children and adolescents. The current study analyzes the psychometric properties of the child PTSD Symptom Scale CPSS (Foa, Johnson, Feeny y Treadwell, 2001), among young victims of a natural disaster. Regular psychometric analyses were carried out, including an exploratory and confirmatory factor analysis of the instrument. The structured interview DISC-IV was used as a criterion test. An structure of three first order factors showed the best fit. The scale presented high internal consistency. A score of 24 or more points allowed a sensitivity of 82 percent and a specificity of 88 percent according to DISC-IV. These positive psychometric qualities indicate the utility of this scale to be used in chilean children and adolescents.

Estrés postraumático en población infantojuvenil post 27F / Post-traumatic stress disorder in young population after the natural disaster on February 27, 2010

Introduction: the post-traumatic stress disorder (PTSD) is one of the most frequent consequences of exposure to natural disasters, disabling both children and adults. Objectives: to describe prevalence of probable PTSD in children who experienced the disaster that occurred in southern Chile in february 2010. Methodology: the sample consisted of 1,300 participants aged 9-16 from the Bío Bío region. The study took place six months after the event occurred. The Child PTSD Symptom Scale (CPSS) and a questionnaire to assess socio-demographic aspects and potential PTSD predictors were used. Results: The overall rate of probable PTSD was 30.4 percent in the young population of females and 15.0 percent in males. The most strongly linked factors to the presence of PTSD were deteriorating family relationships after the event and intense fear and life threatening experiences during the event. Conclusions: results show the need for implementing preventive programs on young population affected by disasters that also include the response of the families involved.

Introducción: el trastorno de estrés postraumático (TEPT) es una de las consecuencias de la exposición a desastres naturales más frecuente y discapacitante tanto en niños y niñas como en adultos. Objetivos: se describe la prevalencia de probable TEPT en niños, niñas y adolescentes que vivieron el desastre natural de febrero de 2010 en el sur de Chile. Metodología: se estudió una muestra de 1.300 participantes de 9 a 16 años de la región del Bío Bío. La aplicación se realizó a seis meses de ocurrido el evento. Se empleó la Escala Infantil de Síntomas de Trastorno de Estrés Postraumático CPSS y un cuestionario de aspectos sociodemográficos y de potenciales factores predictores de estrés postraumático. Resultados: la tasa total probable de TEPT fue de 30,4 por ciento en la población infantojuvenil de sexo femenino y de 15,0 por ciento en la de sexo masculino. Los factores que aparecieron más fuertemente vinculados a la presencia de TEPT fueron el empeoramiento de las relaciones familiares posterior al evento y la experiencia de miedo intenso y de riesgo vital durante el evento. Conclusiones: los resultados indican la importancia de implementar programas preventivos en población infantojuvenil afectada por desastres que consideren también la respuesta de las familias.

Intervención de salud mental en niños expuestos a desastre natural / Mental health intervention in children exposed to natural disasters

Introduction: this study is part of the mental health intervention, conducted by a child psychiatry team for children exposed to the february 2010 earthquake/tsunami in a community of the VII Region that was strongly affected by the natural disaster. Objective: to describe the intervention and evaluate the effectiveness of the strategies implemented for both children and teachers. Methodology: interventions are described and classified in three categories. (1) Case report and child care consulting, referred by their teacher. (2) Psychoeducational workshops for teachers of the intervened school. (3) Self-Care day aimed at professionals of the same school. The evaluation is done through an anonymous survey designed to measure the effectiveness of the intervention. Results: 33 children were evaluated and treated, the most common diagnoses were adaptive disorders (8/33) and ADHD (11/33), and only 3 patients met the criteria for post-traumatic stress disorder (PTSD). Intervention implementation included psychoeducation for parents (100 percent), coordination with schools and local health network (100 percent), counseling (70 percent) and drug prescription (45 percent). Only 45 percent of the cases evaluated had symptoms triggered or exacerbated by the earthquake/tsunami. Regarding teacher evaluation (N: 11), 100 percent described the intervention as "very good". 90 percent considered it appropriate to the needs at the moment and as a contribution to their educational work. Conclusions: after events of this nature, many interventions take place to support the affected population. It is important to have more scientific information about the effectiveness of such interventions to prevent the development of post-traumatic psychopathology.

Introducción: este trabajo forma parte de la intervención de salud mental, realizada por un equipo de psiquiatría infantil para niños expuestos al terremoto/maremoto de febrero de 2010, en una comunidad de la VII Región fuertemente afectada por el desastre natural. Objetivos: describir la intervención realizada y evaluar la efectividad de las estrategias implementadas tanto a niños como a profesores. Metodología: se describe las intervenciones realizadas, clasificadas en 3 categorías: 1) Consultoria de casos clínicos y atención de niños derivados por sus profesores. 2) Talleres psicoeducativos a profesores de la escuela intervenida. 3) Jornada de autocuidado, dirigida a los profesionales de la misma escuela. La evaluación se realiza a través de encuesta anónima a los profesores diseñada para cuantificar la efectividad de la intervención. Resultados: se evaluaron y trataron 33 niños, los diagnósticos más frecuentes fueron Trastornos adaptativos (8/33) y Déficit atencional (11/33); sólo 3 casos cumplían criterios de Trastorno por Estrés Postraumático(TEPT). Las intervenciones utilizadas incluyeron psicoeducación a padres (100 por ciento), coordinación con colegios y red de salud municipal (100 por ciento), apoyo psicológico (70 por ciento) y farmacológico (45 por ciento). Sólo en el 45 por ciento de los casos evaluados la sintomatología se había desencadenado o agravado con el terremoto/maremoto. En relación a la evaluación de profesores (n: 11), 100 por ciento consideró la intervención como "muy buena". Un 90 por ciento la consideró adecuada a las necesidades y constituyó un aporte a su quehacer educativo. Conclusiones: tras eventos como éste, se realizan variadas intervenciones de apoyo a la población afectada. Es importante contar con mayor información científica acerca de la efectividad de dichas intervenciones para prevenir el desarrollo de psicopatología postraumática.

Red semántica de terremoto y maremoto en personas expuestas directa y vicariamente / Rede semântica de terremoto e tsunami em pessoas expostas diretamente e vicariamente / Semantic networks of earthquake and tsunami in people exposed directly and vicariously

Se busca identificar el significado de los conceptos 'terremoto' y 'maremoto' en dos grupos diferentemente expuestos al evento acaecido en Chile el 27/02/2010, en una muestra no probabilística intencional, compuesta por 240 personas provenientes de las ciudades de Constitución (n=104) - expuestas directamente al terremoto y maremoto -, y de Punta Arenas (n=136) expuestas vicariamente. Mediante redes semánticas naturales (R.S.) construidas ad-hoc, fue observado que terremoto y tsunami tienen significados semejantes, relacionados al miedo, muerte, destrucción, desesperación, desastre, pérdida, angustia, tristeza, pena, dolor y pánico. Adicionalmente, aquellos que vivieron directamente el fenómeno utilizan más definidoras de tipo emocional al definir terremoto que aquellos que fueron expuestos a él de modo vicario.

Procurou-se identificar o significado dos conceitos 'terremoto' e 'tsunami' em dois grupos diferentemente expostos ao evento acontecido no Chile em 27/02/2010, em uma amostra não-probabilística intencional, composta por 240 pessoas provenientes das cidades de Constitución (n=104), expostas diretamente ao terremoto e ao maremoto, e de Punta Arenas (n=136), expostas vicariamente. Pelas redes semânticas naturais (R.S.) construídas ad hoc, foi observado que terremoto e tsunami têm significados semelhantes, relacionadas a medo, morte, destruição, desespero, desastre, perda, angústia, tristeza, pena, dor e pânico. Além disso, aqueles que experimentaram diretamente o fenômeno tendem a usar mais palavras de cunho emocional para definir terremoto, do que aqueles que foram expostos a ele vicariamen.

The purpose of this research was to describe the meaning of "earthquake" and "tsunami" in two groups with different exposures to the Chilean natural disaster on February 27th, 2010. A non-probabilistic sample of two-hundred-forty subjects from Constitución (n=104) and Punta Arenas (n=136) was selected. The first group was directly exposed to the earthquake and tsunami and the second group was indirectly exposed. Natural semantic network analysis (SNA) evidenced that both groups have the same semantic representation of earthquake and tsunami, using emotional words such as fear, death, destruction, despair, disaster, loss, anxiety, sadness, pain and panic. Additionally, those who directly experienced the phenomenon use more emotional words to define earthquake than those exposed to it vicariously.

Marco geológico y tectónico de la Isla del Coco y la región marítima circunvecina, Costa Rica / Geological and geotectonic framework of Isla del Coco and the marine zone off the central Pacific coast of Costa Rica

The Isla del Coco (also known as Cocos Island), in the Eastern Pacific Ocean, has a rough topography, an area of 24km², and is the only sub-aerial topographic height of the summit of a volcano located in the margin of the Cordillera Volcánica del Coco (also known as Cocos Ridge). The Cocos Ridge is a well defined linear bathymetric height, issued from the active volcanism of the Galápagos hotspot during the last 15 million years (Ma); it is the largest geographic feature of Costa Rica, as a volcanic range of 780km long in its territorial seawaters. Isla del Coco is part of a submarine shield volcano of complex evolution, which erupted several times above sea level during the Lower Pleistocene (2.2-1.5Ma). The island and other seamounts are the result from a mantle thermal anomaly that erupted through volcano-tectonic fissures in the oceanic crust. The rocks consist mainly of alkali basaltic lava flows (aa, pahoehoe, blocky lavas) and dikes, minor trachyte lava flows, volcanic domes and dikes, with subordinate pyroclastic and epivolcanic rocks. Colluvial, soils and local littoral deposits such as sand and gravel beaches are also present. The island has a juvenile erosive stadium, but their submarine erosive arcs and platforms (90-110m and 183m depth) are probably the result of the erosion occurred during last two glacial maxima, besides slow subsidence events of the island due the thermal cooling of the volcanic shield and its oceanic crust. The most important current external geodynamic hazards are landslides, tsunamis and rare seismic events, Mw ≤ 5.8 in a 300km radio associated to N-S right lateral strike slip faults. However, the limited seismic data available, and geomorphological alignments, indicates that there is some seismic activity related to local faults oriented N-S, ENE and in a lesser extend NW trend. Seismicity and rainfall have triggered landslides; liquefaction is restricted to Chatham and Wafer bays’ beaches. Moderate historical and prehistorical tsunamis were related to regional seismic events. The relative young age of Isla del Coco makes it an interesting place to study the evolution and migration of species, and their genetic features. More detailed studies related to tephrostratigraphy, neotectonics, marine geomorphology, evolution of seamounts, lava flow morphology, and submarine hydrothermal activity, are still necessary to understand the expression of internal geodynamic processes in this region.

La Isla del Coco es la única isla oceánica y el único afloramiento subaéreo de la Cordillera Volcánica del Coco, el rasgo geográfico y geológico más extenso en aguas territoriales costarricenses. Desde el punto de vista geológico, está conformada por rocas volcánicas, predominantemente coladas de lavas basálticas y traquíticas en menor cantidad, con rocas piroclásticas y epiclásticas subordinadas. Posee suelos, coluvios y depósitos de playas (arenas y cantos) superficiales; su topografía es muy variable pero predomina el relieve quebrado y rugoso. La Isla del Coco es la parte emergida de un volcán submarino de evolución compleja, desarrollado a partir y durante el Pleistoceno Inferior (entre 2.2 y 1.5 millones de años, Ma), producto de una anomalía térmica en el manto a través de varias fisuras, que originaron varios alineamientos de volcanes submarinos. La Isla del Coco se encuentra en un estadio de erosión activo, y sus arcos y plataformas sumergidas (90-110m y 183m) son probablemente el producto de una erosión subaérea durante las dos últimas máximas glaciaciones, combinados quizás con la subsidencia debida al enfriamiento del escudo volcánico y de la corteza oceánica. Al ser la isla geológicamente joven, posee importantes implicaciones para la comprensión de la evolución y el endemismo de su biodiversidad. Las amenazas en la geodinámica principales identificadas son los deslizamientos, los tsunamis y, en menor grado, la sismicidad, poco frecuente y con magnitudes moderadas (≤ 5.8 Mw hasta la fecha) dentro de un radio de alrededor de 300km, predominantemente asociada con fallas dextrales de rumbo N-S. Los pocos datos obtenidos hasta el momento indican que hay un cierto grado de actividad sísmica en los alrededores de la Isla del Coco, relacionados con las fallas locales. Algunos pequeños tsunamis históricos y prehistóricos han afectado a la Isla del Coco y los sismos así como la precipitación pluvial elevada han generado deslizamientos. La licuefacción está restringida a las dos playas arenosas (bahías Chatham y Wafer).

Efecto de las estrategias de afrontamiento al estrés en los síntomas de estrés post-traumático en sobrevivientes de un terremoto. Hacia un modelo explicativo del estrés post-traumático / The effects of stress coping strategies in post-traumatic stress symptoms among earthquake survivors: an explanatory model of post-traumatic stress

Se determinó el efecto de las estrategias de afrontamiento (WOC) en los síntomas de estrés post-traumático (PTSD) ante un evento estresante común para 304 personas (Chile, terremoto 27 de febrero de 2010), mediante la aplicación del ways of coping questionnaire y de la davidson scale of trauma. Los resultados muestran 4 modelos de regresión lineal múltiple significativos que explican el total y los 3 tipos de síntomas del PTSD a partir de las WOC evitación y resolución de problemas. Sin embargo, un primer modelo integrado mediante ecuaciones estructurales no obtuvo buenos índices de ajuste. Se concluye con un modelo integrado alternativo que presenta muy buenos índices de ajuste. Finalmente se entregan explicaciones basadas en neuroimágenes y covert conditioning, además de reflexiones sobre prevención y prevalencia del PTSD.

The effect of the ways of coping (WOC) in post-traumatic stress disorder (PTSD) symptoms in a stressing event common to a sample of 304 people (Chile, earthquake february, 27 2010) was determined through the application of the ways of coping questionnaire and the davidson scale of trauma. The results show 4 significant regression multiple linear models explaining the total and the 3 types of PTSD symptoms through WOC such as avoidance and problem solution. However, a first integrated model through structural equations did not attain good fit indexes. The study has been concluded with an alternative integrated model presenting very good adjustment indexes (CMIN/DF=.058, RMSEA=.000, NFI=.999, CFI=.999 and PNFI=.100). Finally, explanations based on neuroimages and covert conditioning are provided along with reflections on the prevention and prevalence of the PTSD.

Características epidemiológicas de los fallecidos durante el terremoto y maremoto de Chile 2010 / Epidemiological profile of deaths after the 2010 earthquake in Chile

Background: On February 27, 2010 a powerful earthquake followed by a tsunami stroke Chile. The study of mortality during this emergency can provide important public health information. Aim: To describe the main characteristics of people who died during the earthquake and the following three months. Material and Methods: Cross sectional analysis of death records databases obtained from Department of Health Statistics and Information of the Ministry of Health and the Coroner office. Results: Until May 25,2010, 505 corpses were completely identified. Seventy two of these corresponded to people aged 80 years or more. The higher age adjusted death rates per 100,000 inhabitants were observed among subjects aged more than 80 years and those aged 70 to 79 years (22.6 and 7.7 respectively). The higher rates of deaths were observed in regions where the earthquake had a higher intensity and coastal regions affected by the tsunami. The causes of death were trauma in 75% of cases and drowning in 25%. There was no association between the Mercalli scale of earthquake intensity and rates of death. Among deceased subjects, there was a concentration of unemployed, under educated and low socioeconomic status subjects. Conclusions: After the earthquake, the higher rates of deaths occurred among older people and in the region of the epicenter of the earthquake. Most deaths were due to trauma.

Crisis management of Tohoku; Japan earthquake and tsunami, 11 March 2011

The huge earthquake in 11 March 2012 which followed by a destructive tsunami in Japan was largest recorded earthquake in the history. Japan is pioneer in disaster management, especially earthquakes. How this developed country faced this disaster, which had significant worldwide effects? The humanitarian behavior of the Japanese people amazingly wondered the word's media, meanwhile the management of government and authorities showed some deficiencies. The impact of the disaster is followed up after the event and the different impacts are tried to be analyzed in different sectors. The situation one year after Japan 2011 earthquake and Tsunami is overviewed. The reason of Japanese plans failure was the scale of tsunami, having higher waves than what was assumed, especially in the design of the Nuclear Power Plant. Japanese authorities considered economic benefits more than safety and moral factors exacerbate the situation. Major lessons to be learnt are 1] the effectiveness of disaster management should be restudied in all hazardous countries; 2] the importance of the high-Tech early-warning systems in reducing risk; 3] Reconsidering of extreme values expected/possible hazard and risk levels is necessary; 4] Morality and might be taken as an important factor in disaster management; 5] Sustainable development should be taken as the basis for reconstruction after disaster

Terremoto 2010: Impacto en la incidencia de lesiones subepicárdicas. experiencia en telemedicina / Impact of the 2010 earthquake and tsunami in Chile: a telemdicine evaluation of suepicardial lesions

Background: The association of stress and acute coronary events has been extensively explored. An increased output of catecholamines leading to high blood pressure and alteration of hemostasis may be responsible for this effect. A severe earthquake and tsunami is a major stress. Methods and Results. 280,592 electrocardiograms (ECG) obtained via a telemedicine system in the years 2009 and 2010 were analyzed. The frequency of subepicardial lesions recorded during the weekend in which the earthquake took place (27/2/2010 - 28/2/2010) was compared to that observed in all other weekends throughout the period. 7 subjects had a blood pressure Holter monitoring on that weekend. A subepicardial lesion was diagnosed in 0.64% of ECGs recorded throughout the period, increasing significantly in the earthquake's weekend (p<0.05). The age distribution of subepicardial lesions was similar in all weekends. However, the higher proportion of males with sub epicardial lesions throughout the study period changed to a higher proportion of females in the earthquake's weekend. Significant increases in blood pressure and heart rate were observed in coincidence with the earthquake in patients undergoing blood pressure monitoring. Conclusion: a statistically significant increase in subepicardial lesions demonstrated by telemedicine ECG recordings was associated to the stressful situation of the 2010 earthquake in Chile.

La asociación de estrés y eventos coronarios agudos ha sido extensamente estudiada. En relación a un evento estresante existiría un aumento en la liberación de ca-tecolaminas que incide en un incremento en la presión arterial y alteraciones de hemostasia, como sería el caso de un terremoto. En el presente trabajo se describe la relación contemporánea observada entre el terremoto del 27 de febrero del 2010 y el diagnóstico de lesión subepicárdica, en electrocardiogramas recibidos en ITMS, Telemedicina de Chile. Se analizaron 280.592 electrocardiogramas (ECGs) provenientes de todo el territorio nacional, que corresponden a un periodo de 12 meses de los años 2009 y 2010. Se realizó una comparación estadística entre el porcentaje de lesiones subepicárdicas registradas en el fin de semana del terremoto (27/02/2010 y 28/02/2010) versus los fines de semana de los meses estudiados. Se obtuvieron los datos correspondientes a siete pacientes que se encontraban con monitoreo ambulatorio de presión arterial (MAPA) el día 27/02. El diagnóstico de lesión subepicárdica se hizo en 1.795 trazados, correspondientes a un 0.64% del total de ECGs recibidos. Hubo un aumento estadísticamente significativo de las lesiones subepicárdicas (p<0,05) en el fin de semana del terremoto, la distribución por edad se mantuvo similar al resto de los períodos analizados. Sin embargo se invirtió la distribución por género durante dicho fin de semana siendo mayor en mujeres que en hombres, como es en el resto de los períodos analizados. En los registros MAPA se documentó un aumento de la presión arterial y frecuencia cardíaca en relación al evento estresante. Se confirmó entonces un aumento estadísticamente significativo del diagnóstico electrocardiográfico de lesiones subepicárdicas en relación al estrés producido por el terremoto del 27 de febrero de 2010.