Impact of type of reconstructed residence on social participation and mental health of population displaced by disasters.

After disasters, people are often forced to reconstruct or move to new residences. This study aimed to reveal the association between the types of reconstructed residences and psychosocial or psychiatric conditions among the population. A total of 1071 adult residents in a coastal town, whose houses were destroyed by the tsunami caused by the Great East Japan Earthquake, enrolled in the study five years after the disaster. The type of reconstructed post-disaster residences (reconstructed on the same site/disaster-recovery public condominium/mass-translocation to higher ground/privately moving to remote areas) and the current psychosocial indicators were investigated. The results revealed that individuals living in public condominiums showed significantly worse scores on the Lubben Social Network Scale-6 (p < 0.0001) and the Center for Epidemiologic Studies Depression Scale (p < 0.0001), and slightly worse scores on the Kessler Psychological Distress Scale (p = 0.035) and the Impact of Event Scale-Revised (p = 0.028). Lower psychosocial indicator scores in the public condominium group were more remarkable in younger adults aged < 65 years. Insomnia evaluated using the Athens Insomnia Scale was not different among the four residential types. In summary, residents moving into disaster-recovery public condominiums are likely to have less social interaction, be more depressed, and may need additional interventions.

Causal Inference in Studying the Long-Term Health Effects of Disasters: Challenges and Potential Solutions.

Two frequently encountered but underrecognized challenges for causal inference in studying the long-term health effects of disasters among survivors include 1) time-varying effects of disasters on a time-to-event outcome and 2) selection bias due to selective attrition. In this paper, we review approaches for overcoming these challenges and demonstrate application of the approaches to a real-world longitudinal data set of older adults who were directly affected by the 2011 Great East Japan Earthquake and Tsunami (n = 4,857). To illustrate the problem of time-varying effects of disasters, we examined the association between degree of damage due to the tsunami and all-cause mortality. We compared results from Cox regression analysis assuming proportional hazards with those derived using adjusted parametric survival curves allowing for time-varying hazard ratios. To illustrate the problem of selection bias, we examined the association between proximity to the coast (a proxy for housing damage from the tsunami) and depressive symptoms. We corrected for selection bias due to attrition in the 2 postdisaster follow-up surveys (conducted in 2013 and 2016) using multivariable adjustment, inverse probability of censoring weighting, and survivor average causal effect estimation. Our results demonstrate that analytical approaches which ignore time-varying effects on mortality and selection bias due to selective attrition may underestimate the long-term health effects of disasters.

Large-scale experiment to assess the collision impact force from a tsunami wave on a drifting castaway.

Although most fatalities in tsunami-related disasters are conjectured to be a result of drowning, injury risk owing to collision with other floating debris or fixed buildings has not been studied sufficiently. In this study, the impact force corresponding to the collision of a concrete block and drifting test body in a tsunami wave was experimentally investigated, and the injury risk was evaluated in terms of different biomechanical indexes; specifically, maximum acceleration, head injury criterion, and impact force. The injury risk indicated by the considered indexes was reasonably low. It was noted that if a healthy adult collided with a concrete wall under a velocity of 2.5 m s-1 and wave height of 0.59 m, the adult would likely not be critically injured. However, a similar collision impact poses considerable risk to infants and children, as well as the more sensitive regions of the adult body. Moreover, in the case of large tsunamis, such as that in the 2011 Great East Japan Earthquake, a drifting person may be at considerable risk for injuries. The collision impact occurring on the tip of a surge flow is notably significantly larger than that on a bore flow. This is because a surge flow, which arrives at the concrete block earlier than a bore flow, forms a certain water layer along the concrete wall and that layer acts as a cushion for any body drifting on the bore flow, indicating the importance of such a buffering effect. These findings can provide practical guidance regarding the formulation of effective tsunami-protection measures.

Evacuees and Migrants Exhibit Different Migration Systems After the Great East Japan Earthquake and Tsunami.

Research on the destinations of environmentally induced migrants has found simultaneous migration to both nearby and long-distance destinations, most likely caused by the comingling of evacuee and permanent migrant data. Using a unique data set of separate evacuee and migration destinations, we compare and contrast the pre-, peri-, and post-disaster migration systems of permanent migrants and temporary evacuees of the Great East Japan Earthquake and Tsunami. We construct and compare prefecture-to-prefecture migration matrices for Japanese prefectures to investigate the similarity of migration systems. We find evidence supporting the presence of two separate migration systems-one for evacuees, who seem to emphasize short distance migration, and one for more permanent migrants, who emphasize migration to destinations with preexisting ties. Additionally, our results show that permanent migration in the peri- and post-periods is largely identical to the preexisting migration system. Our results demonstrate stability in migration systems concerning migration after a major environmental event.

Survival-oriented personality factors are associated with various types of social support in an emergency disaster situation.

Mutual help is common in human society, particularly during a disaster. The psychological processes underlying such social support are of interest in social and evolutionary psychology, as well as in the promotion of community resilience. However, research in terms of personality factors or support types is sporadic and has yet to address actual emergency situations. In this study, we analyzed survey data from survivors of the 2011 Tohoku earthquake and tsunami. The data included five types of social support occurring during the evacuation from a potential tsunami area: providing and receiving actual help and oral encouragement, as well as perceived support. The personality factor items included the Big Five dimensions and eight "power to live" factors, which were identified as advantageous for survival during this disaster. While none of the Big Five dimensions were associated with social support, six of the power to live factors were. Altruism, problem solving, etiquette, and self-transcendence contributed to the provision of actual help. Leadership and active well-being contributed to oral encouragement with the latter contributing also to perceived support. The findings were largely consistent with the literature in a non-emergency context. The relevance of the majority of these pro-survival personality factors to social support appeared to support the view that the propensity to cooperate in service of human survival in a disaster situation is primarily a social, rather than an individual, phenomenon, and encourages research on the mechanisms underlying how personality factors provide a benefit to both the individual and their community.

Did kindergarteners who experienced the Great East Japan earthquake as infants develop traumatic symptoms? Series of questionnaire-based cross-sectional surveys: A concise and informative title: traumatic symptoms of kindergarteners who experienced disasters as infants.

BACKGROUND: The Great East Japan Earthquake (GEJE) and tsunami of March 11, 2011 left behind many survivors, including children. This study aimed to assess changes in traumatic symptoms with time among kindergarteners who experienced GEJE as infants and to discuss the relationship between these symptoms and the disaster experience. METHODS: The 15-item Post-Traumatic Stress Symptoms for Children (PTSSC-15) questionnaire were distributed to the parents of kindergarteners (children aged 4-5 years) at 8, 20, 30, and 42 months after GEJE. Questionnaires regarding environmental damage conditions affecting the children were distributed to teachers 8 months after the tsunami. RESULTS: The number of kindergarteners was 262, 255, 236, and 202 at 8, 20, 30, and 42 months after the disaster. The PTSSC-15 total score was not different between kindergartners with and without environmental damage conditions. After 8 and 20 months, the PTSSC-15 total score of children who usually ate breakfast was significantly higher than that of children who did not. Moreover, after 30 and 42 months, the PTSSC-15 total score of kindergarteners who usually ate breakfast was not significantly higher than that of kindergarteners who did not. CONCLUSIONS: The traumatic symptoms of kindergarteners were not related to disaster experiences.

Effect of seawalls on tsunami evacuation departure in the 2011 Great East Japan Earthquake.

OBJECTIVE: To quantitatively evaluate the effect of seawalls on tsunami evacuation departure. METHODS: A mixed-effect Cox proportional-hazards regression model was applied to evacuation behavioural data obtained from a probability survey of survivors of the 2011 Great East Japan Earthquake and Tsunami in Iwate and Miyagi prefectures. FINDINGS: Presence of a seawall higher than the forecast tsunami height at any given time reduces the likelihood of prompt evacuation by 30%. Findings suggest the existence of a false sense of security among residents deriving from the presence of seawalls. CONCLUSION: Prompt evacuation is a key factor affecting survival. The effect of seawalls on evacuation decisions is an important policy consideration. More work is needed in disaster preparedness education and in the way tsunami warnings are given, taking into consideration the risk of forecast error. Priority should be given to promoting prompt evacuation and educating residents as to the uncertainty of tsunami forecasting, to ensure that residents do not ignore evacuation warnings due to false impressions of the safety provided by seawalls.

Differences in infant and child mortality before and after the Great East Japan Earthquake and Tsunami: a large population-based ecological study.

OBJECTIVES: To examine associations between access to medical care, geological data, and infant and child mortality in the area of North-Eastern Japan that was impacted by the Great East Japan Earthquake and Tsunami (GEJET) in 2011. DESIGN: A population-based ecological study using publicly available data. SETTING: Twenty secondary medical areas (SMAs) in the disaster-affected zones in the north-eastern prefectures of Japan (Iwate, Fukushima and Miyagi). PARTICIPANTS: Children younger than 10 years who died in the 20 SMAs between 2008 and 2014 (n=1 748). Primary and secondary outcome measures: Multiple regression analysis for infant and child mortality rate. The mean values were applied for infant and child mortality rates and other factors before GEJET (2008-2010) and after GEJET (2012-2014). RESULTS: Between 2008 and 2014, the most common cause of death among children younger than 10 years was accidents. The mortality rate per 100 000 persons was 39.1±41.2 before 2011, 226.7±43.4 in 2011 and 31.4±39.1 after 2011. Regression analysis revealed that the mortality rate was positively associated with low age in each period, while the coastal zone was negatively associated with fewer disaster base hospitals in 2011. By contrast, the number of obstetrics and gynaecology centres (ß=-189.9, p=0.02) and public health nurses (ß=-1.7, p=0.01) was negatively associated with mortality rate per person in 2011. CONCLUSIONS: In 2011, the mortality rate among children younger than 10 years was 6.4 times higher than that before and after 2011. Residence in a coastal zone was significantly associated with higher child mortality rates.

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.

Potential tsunami risk assessment to the city of Alexandria, Egypt.

Tsunami extreme events present a highly significant hazard and considerable risk to the coastal communities. The continued occurrence of tsunami incidents, together with population growth, increases the risk in coastal communities. Two known catastrophic historic tsunamis in Alexandria occurred in the years 365 and 1303 AD, with reported wave heights of 1 m and 2.9 m, respectively. Approximately 5000 people lost their lives and 50,000 homes were destroyed in the city after the earthquake in 365. The 1303 tsunami destroyed the great lighthouse of Alexandria, one of the seven wonders of the ancient world. In order to avoid such events in the future, a detailed knowledge about the tsunami phenomenon and its potential risk is needed. In this paper, the vulnerability and risk to the city of Alexandria will be examined by remote sensing and GIS techniques considering three scenarios. Methodology used depends on building a comprehensive GIS in addition to recent satellite images. After digitizing raster data, it was then stored into a vector format. A digital parcel map was created; attributes (like distance to shore line, elevation, land use/cover, and population) for each polygon were added. Using the Shuttle Radar Topography Mission images, a digital elevation model was created, to test all the tsunami scenarios (based on 5 m, 9 m, and 20 m wave's height). Finally, vulnerability analysis including physical as well as social and economic constraints was executed for the determination of the vulnerability level of elements. Results indicated that Alexandria city is highly vulnerable to tsunami hazard. Very high risk covers the biggest portion of the area in Alexandria (49.16% and 58.71%), followed by high risk (30% and 28.41%), medium risk (13.61% and 7.76%), and low and very low risk (20.82% and 12.88%).

Effectiveness of cognitive-behavioural therapy for post-disaster distress in post-traumatic stress symptoms after Chilean earthquake and tsunami / Eficacia de la terapia cognitivo-conductual para el estrés posdesastre en síntomas de estrés postraumático tras un terremoto y tsunami en Chile

Objective: This is the first time that the effectiveness of cognitive-behavioural therapy for post-disaster stress (CBT-PD) in symptoms of posttraumatic stress disorder (PTSD) has been tested outside the United States of America. Design: Quasi-experiment with three groups. In the quasi-control group, complete CBT-PD was applied even though its members did not have PTSD; in quasi-experimental conditions, participants received complete treatment because they had this diagnosis; and in the third group, participants with PTSD received an abbreviated treatment (double sessions) due to organisational requirements. Location: Primary health care workers in Constitución (Chile), city exposed to earthquake and tsunami; public department workers in Talca (city exposed only to earthquake) and teachers from a school (Constitución). Participants: A total of 13 of the 91 people diagnosed with PTSD participated. In addition, 16 people without diagnosis voluntarily participated. The treatment was completed by 29 participants. There were no dropouts. Only 1 of the 9 participants in the quasi-experimental group did not respond to treatment. Interventions: CBT-PD is a group therapy (10-12 sessions) that includes psychoeducation, breathing retraining, behavioural activation and cognitive restructuring. CBT-PD (complete and abbreviated) was applied between September and December 2010. Measurements: Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E) was used to measure PTSD symptoms before and after treatment. Results: The group that received the complete treatment and was diagnosed with PTSD showed a significant decrease in the total symptoms to below dangerous levels (IGAAB: 31.556; p<0.01; 95%CI: 0.21-2.01]; η2=0.709). Discussion: The effectiveness and benefits of incorporating CBT-PD in the health network after events like disasters were discussed

Objetivo: Evaluar la eficacia de la terapia cognitivo-conductual para el estrés posdesastre (TCC-PD) en síntomas de estrés postraumático (TEPT) por primera vez fuera de los Estados Unidos. Diseño: Cuasiexperimental con tres grupos. Al grupo de cuasicontrol se le aplicó la TCC-PD completa pese a que sus miembros no tenían diagnóstico de TEPT; el grupo cuasiexperimental recibió el tratamiento completo porque sus miembros tenían ese diagnóstico. En el tercer grupo, las personas con TEPT recibieron un tratamiento abreviado (sesiones dobles) por exigencias organizativas. Emplazamiento: Trabajadores de atención primaria de salud de Constitución (Chile), ciudad expuesta al terremoto y tsunami; trabajadores de un servicio público de Talca (ciudad expuesta solo al terremoto) y profesores de escuela (Constitución). Participantes: Participaron 13 de las 91 personas diagnosticadas de TEPT; además, 16 personas sin diagnóstico participaron voluntariamente. Finalizaron el tratamiento 29 personas. No se produjeron abandonos. Solo uno de los nueve participantes del grupo cuasiexperimental no respondió al tratamiento. Intervenciones: La TCC-PD es una terapia grupal (10-12 sesiones) que incluye psicoeducación, reentrenamiento respiratorio, activación conductual y reestructuración cognitiva. Se aplicó TCC-PD (completa y abreviada) entre septiembre y diciembre de 2010. Mediciones principales: Para medir síntomas de TEPT se utilizó la Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E), antes y después del tratamiento. Resultados: Solo el grupo que recibió el tratamiento completo y fue diagnosticado de TEPT disminuyó significativamente sus síntomas por debajo de los niveles peligrosos (IGAAB: 31,556; p<0,01; IC95%: 0,21-2,01]; η2=0,709). Conclusiones: Se comprueban la efectividad y los beneficios de incorporar la TCC-PD en la red de salud después de desastres

Have the tsunami and nuclear accident following the Great East Japan Earthquake affected the local distribution of hospital physicians?

OBJECTIVE: The Great East Japan Earthquake occurred on 11 March 2011 near the northeast coast of the main island, 'Honshu', of Japan. It wreaked enormous damage in two main ways: a giant tsunami and an accident at the Fukushima Daiichi Nuclear Power Plant (FDNPP). This disaster may have affected the distribution of physicians in the region. Here, we evaluate the effect of the disaster on the distribution of hospital physicians in the three most severely affected prefectures (Iwate, Miyagi, and Fukushima). METHODS: We obtained individual information about physicians from the Physician Census in 2010 (pre-disaster) and 2012 (post-disaster). We examined geographical distributions of physicians in two ways: (1) municipality-based analysis for demographic evaluation; and (2) hospital-based analysis for geographic evaluation. In each analysis, we calculated the rate of change in physician distributions between pre- and post-disaster years at various distances from the tsunami-affected coast, and from the restricted area due to the FDNPP accident. RESULTS: The change in all, hospital, and clinic physicians were 0.2%, 0.7%, and -0.7%, respectively. In the municipality-based analysis, after taking account of the decreased population, physician numbers only decreased within the restricted area. In the hospital-based analysis, hospital physician numbers did not decrease at any distance from the tsunami-affected coast. In contrast, there was a 3.3% and 2.3% decrease in hospital physicians 0-25 km and 25-50 km from the restricted area surrounding the FDNPP, respectively. Additionally, decreases were larger and increases were smaller in areas close to the FDNPP than in areas further away. CONCLUSIONS: Our results suggest that the tsunami did not affect the distribution of physicians in the affected regions. However, the FDNPP accident changed physician distribution in areas close to the power plant.

Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems.

BACKGROUND: On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear-reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this 'triple disaster' on the health of local populations and the health system was substantial. In this study we examine population-level health indicator changes that accompanied the disaster, and discuss options for re-designing Fukushima's health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks. METHODS: We used country-level (Japan-average) or prefecture-level data (2005-2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005-2010) and after (2011-2014) the 'disaster'. We made time-trend line plots to describe changes over time in age-adjusted cause-specific mortality rates in each prefecture. FINDINGS: All three prefectures, and in particular Fukushima, had lower socio-economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher-level industry than the Japan average. All three prefectures were 'medically underserved', with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age-adjusted all-cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all-cause mortality (Miyagi and Fukushima) were also observed post-disaster. The cause-specific mortality rate from cancer followed similar trends in all three prefectures to those in Japan as a whole. Although we found a sharp rise in ambulance calls in Iwate and Miyagi, we did not see such a rise in Fukushima: a finding which may indicate limited responsiveness to acute demand because of pre-existing restricted capacity in emergency ambulance services. CONCLUSIONS: We analyze changes in indicators of health and health systems infrastructure in Fukushima before and five years following the disaster, and explored health systems' strengths and vulnerabilities. Spikes in mortality rates for selected non-infectious conditions common among older individuals were observed compared to the national trends. The results suggest that poorer reserves in the health care delivery system in Fukushima limited its capacity to effectively meet sudden unexpected increases in demand generated by the disaster.

Assessing the Mental Health Impact of the 2011 Great Japan Earthquake, Tsunami, and Radiation Disaster on Elementary and Middle School Children in the Fukushima Prefecture of Japan.

BACKGROUND: On March 11, 2011, a magnitude 9.0 earthquake occurred off of Japan's Pacific coast, which was followed by huge tsunamis that destroyed many coastal cities in the area. Due to the earthquake and subsequent tsunami, malfunctions occurred at the Fukushima Daiichi (Fukushima I) nuclear power plant, resulting in the release of radioactive material in the region. While recent studies have investigated the effects of these events on the mental health of adults in the region, no studies have yet been performed investigating similar effects among children. METHODS AND FINDINGS: This study aims to fill that gap by: 1) assessing the mental health of elementary and middle school children living within the Fukushima prefecture of Japan, and 2) identifying risk and protective factors that are associated with the children's mental health scores. These factors were quantified using an original demographics survey, the Strengths and Difficulties Questionnaire (SDQ), and the Impact of Event Scale-Revised (IES-R), the latter two of which have been previously validated in a Japanese setting. The surveys were distributed to approximately 3,650 elementary and middle school students during the months of February and March, 2012. The data suggests that those children who had been relocated to the city of Koriyama had significantly higher SDQ scores than those children who were native to Koriyama (p < .05) as well as a control group that lived outside of the Fukushima prefecture (p < .01). Using a multivariate regression, we also found that younger age and parental trauma were significantly correlated with higher SDQ scores (p < .001), while gender, displacement from one's home, and exposure to violence were not. CONCLUSIONS: These results suggest that, among children affected by natural disasters, younger children and those with parents suffering from trauma-related distress are particularly vulnerable to the onset of pediatric mental disturbances.

Social Factors Associated With Psychological Distress and Health Problems Among Elderly Members of a Disaster-Affected Population: Subgroup Analysis of a 1-Year Post-disaster Survey in Ishinomaki Area, Japan.

OBJECTIVE: We aimed to investigate the influence of social factors, especially social support, on psychological distress and the prevalence of health problems (HPs) among victims living in their homes 14 to 21 months after the Great East Japan Earthquake and tsunami. METHODS: A subgroup analysis was performed for elderly participants of a cross-sectional household survey in Ishinomaki area, Japan. The prevalence of psychological HPs was assessed by using a psychological distress questionnaire (K6) and by recording the number of subjective HPs. Perceived social support was assessed in 3 dimensions: informational, emotional, and instrumental support. Univariate and multivariate logistic regression models were used to examine the association between social factors and psychological health. RESULTS: An elderly subgroup with 879 participants was used for analyses. Psychological distress (K6 score≥9) was observed in 6.8% of the participants aged 65 to 74 years and in 8.0% of those aged ≥75 years. Receiving a long-term care service was associated with having HPs, and discontinuation of attendance at a hospital as an outpatient was associated with psychological distress. Receiving emotional support was associated with lower psychological distress and not having HPs. CONCLUSIONS: Emotional support was found to be an important factor for promoting health among elderly disaster victims. (Disaster Med Public Health Preparedness. 2017;11:64-71).

Sex differentials in the risk factors of post traumatic stress disorder among tsunami survivors in Tamil Nadu, India.

This study assessed if pre disaster, with-in disaster and post disaster factors predicted Post Traumatic Stress Disorder (PTSD) differently, among men and women survivors of the 2004 Southeast Asian tsunami in Kanyakumari district, Tamil Nadu, India. PTSD was identified using a validated tool, Impact of Events Scale-Revised (IES-R) among the participants in a cross-sectional community based survey (n=485). Case control analysis of 299 subjects was done to determine the predictors of PTSD. The odds of having PTSD were 6.35 times higher in women than men. Higher odds for PTSD was seen among women who were married, aged over 40, belonged to low socioeconomic status and resided in heavily damaged areas. Protective odds for PTSD was found among women who had received more than three times of counseling services whereas men were not at risk if they were free from fear of recurrence of tsunami, when adjusted for other variables. Women were vulnerable to PTSD because of their socially constructed roles. It is important to consider gender based vulnerabilities while designing interventions to combat mental health problems among disaster affected communities.

Hospital Staff Shortage after the 2011 Triple Disaster in Fukushima, Japan-An Earthquake, Tsunamis, and Nuclear Power Plant Accident: A Case of the Soso District.

INTRODUCTION: In 2011, Fukushima was struck by a triple disaster: an earthquake, tsunamis, and a nuclear accident. In the aftermath, there was much fear among hospital staff members about radiation exposure and many staff members failed to report to work. OBJECTIVES: One objective is to measure this shortage in hospital staff and another is to compare the difference in recovery by hospital types and by categories of hospital staff. DESIGN: The monthly records of the number of staff members from May 2011 to September 2012 were extracted anonymously from the records of 7 local hospitals in the Soso district in Fukushima. Change in the number of staff was analyzed. RESULTS: Staff shortages at hospitals reached a maximum within one month after the disaster (47% reported to work). The shortage of clerks was the most severe (38% reported to work), followed by nurses (48% reported to work). The shortages remained even 18 months after the disaster. CONCLUSION: After a disaster in which the damage to hospital functions surpasses the structural damage, massive support of human resources in the acute phase and a smaller volume of support in the mid-term phase appear to be required, particularly for non-medical staff.

Defining, Describing, and Categorizing Public Health Infrastructure Priorities for Tropical Cyclone, Flood, Storm, Tornado, and Tsunami-Related Disasters.

OBJECTIVES: The study aim was to undertake a qualitative research literature review to analyze available databases to define, describe, and categorize public health infrastructure (PHI) priorities for tropical cyclone, flood, storm, tornado, and tsunami-related disasters. METHODS: Five electronic publication databases were searched to define, describe, or categorize PHI and discuss tropical cyclone, flood, storm, tornado, and tsunami-related disasters and their impact on PHI. The data were analyzed through aggregation of individual articles to create an overall data description. The data were grouped into PHI themes, which were then prioritized on the basis of degree of interdependency. RESULTS: Sixty-seven relevant articles were identified. PHI was categorized into 13 themes with a total of 158 descriptors. The highest priority PHI identified was workforce. This was followed by water, sanitation, equipment, communication, physical structure, power, governance, prevention, supplies, service, transport, and surveillance. CONCLUSIONS: This review identified workforce as the most important of the 13 thematic areas related to PHI and disasters. If its functionality fails, workforce has the greatest impact on the performance of health services. If addressed post-disaster, the remaining forms of PHI will then be progressively addressed. These findings are a step toward providing an evidence base to inform PHI priorities in the disaster setting. (Disaster Med Public Health Preparedness. 2016;10:598-610).

Can Community Social Cohesion Prevent Posttraumatic Stress Disorder in the Aftermath of a Disaster? A Natural Experiment From the 2011 Tohoku Earthquake and Tsunami.

In the aftermath of a disaster, the risk of posttraumatic stress disorder (PTSD) is high. We sought to examine whether the predisaster level of community social cohesion was associated with a lower risk of PTSD after the earthquake and tsunami in Tohoku, Japan, on March 11, 2011. The baseline for our natural experiment was established in a survey of older community-dwelling adults who lived 80 kilometers west of the epicenter 7 months before the earthquake and tsunami. A follow-up survey was conducted approximately 2.5 years after the disaster. We used a spatial Durbin model to examine the association of community-level social cohesion with the individual risk of PTSD. Among our analytic sample (n = 3,567), 11.4% of respondents reported severe PTSD symptoms. In the spatial Durbin model, individual- and community-level social cohesion before the disaster were significantly associated with lower risks of PTSD symptoms (odds ratio = 0.87, 95% confidence interval: 0.77, 0.98 and odds ratio = 0.75, 95% confidence interval: 0.63, 0.90, respectively), even after adjustment for depression symptoms at baseline and experiences during the disaster (including loss of loved ones, housing damage, and interruption of access to health care). Community-level social cohesion strengthens the resilience of community residents in the aftermath of a disaster.