Depression can be considered to be a common psychological response to adversity or loss from which an individual may recover quickly based on a natural resilience mechanism. In major depressive disorder, however, we see that biopsychosocial factors exist that can prevent this natural resilience mechanism from taking effect.

To investigate neurotransmitter pathways linked with antidepressant response, genetic epidemiological studies and a literature assessment of biopsychosocial factors were conducted.

Newly admitted patients with a depressive episode according to the criteria of ICD-10 (F32 or F33) who had not been on antidepressant medication for at least 6 months were recruited. More than half the patients have never been treated with antidepressant medication during their entire life. The patients’ depression was of at least moderate severity as measured by the Hamilton’s Depression Rating Scale (HAMD-17).

To determine the effect of adrenergic pathway genes to antidepressant response, the outcome was measured by the difference in HAMD-17 score between entry and two weeks of treatment after two and four weeks of treatment and entry and four weeks of treatment. Multiple linear regression was conducted to identify the independent factor associated with ΔHAMD-17 between the three time periods, including age, sex, depression diagnosis, type of antidepressant taken and selected SNPs.

Literature assesement utilised a snowball technique, building on prior literature reviews conducted. The selection of included literature was determined by the authors.

The Tomosk cohort was mainly women, with less than 20% of patient being male. The cohort was dynamic thus the number of participants involved in each investigation varied. Most patients took SSRIs, specifically sertraline, paroxetine, escitalopram, fluoxetine and fluvoxamine. Comparing the medication taken, ΔHAMD-17 was significantly more improved in participants taking tricyclic antidepressants at 0 - 2 weeks and 0 - 4 weeks.

From our literature assesment, we determined that targeted therapy can undermine the influence of biopsychosocial factors and allow natural resilience to bring depression to an end. Many mental activities is not exclusively individual, but depends on the sociocultural context as people are part of a community.

Depressive disorders can be understood as a rather habitual dysregulation of human behavior which, unlike normal behavior, is not limited by natural resilience in time and severity. Our investigations looked at polymorphisms impacting serotonergic, dopaminergic and adrenergic neurotransmissions and enzymes.

While some associations were found, it did not match our literature findings. For future investigation, epidemiological and pathogenetic biological psychiatric research should be aimed at identifying biopsychosocial factors that frustrate the natural recovery process.

None Declared

Behaviors to avoid infection are key to minimizing casualties of the COVID-19 pandemic. Even so, infection-avoidance behavior may also cause distant health impacts like immobility and obesity. This research aims at identifying behavioral patterns associated with SARS-CoV-2 infection, exercise habits, and being overweight in the Japanese population.

Nationwide online questionnaires were conducted five times from October 2020 to October 2021. Individuals who answered with consistency to have been diagnosed with SARS-CoV-2 at a medical facility were categorized into a SARS-CoV-2 group. The difference in lifestyle is compared using multiple regression and inverse probability weighing. In addition, the change in exercise habits, body mass index (BMI), and status of overweight (BMI>25kg/m2) were compared between the first questionnaire and the later ones. Risk factors of losing exercise habits or developing overweight were analyzed using multiple regression.

Diagnosis of SARS-CoV-2 was negatively correlated with crowd avoidance, mask wearing, hand washing behavior. On the contrary, the diagnosis was positively correlated with some behaviors that appear as preventive actions against the infection, such as changing clothes frequently, sanitizing belongings, and remote working. Regarding exercise habit and overweight, people with high income and elderly females showed higher risk of decreased exercise days. The proportion of overweight was increased from 22.2% to 26.6% in males and from 9.3% to 10.8% in females. Middle-aged males, elderly females, males who experienced SARS-CoV-2 infection were at higher risks of developing overweight.

It is important to conduct an evidence-based intervention on people’s behaviors and to avoid excessive intervention that is less effective so that people can minimize indirect harm such as exhaustion, economic loss, and other chronic health impacts. Our findings suggest that high-risk groups of COVID-19 infection and immobility and/or overweight are quite different. Further research may enable us to establish more effective interventions for each group.

Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists.

The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes.

A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme.

All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending.

All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists.

Local health facilities play a critical role in mitigating the deterioration of health after catastrophic disasters. However, limited information is available on clinic damage. Therefore, the National Institute of Public Health conducted surveillance on clinic damage after the 2011 Great East Japan Earthquake (GEJE) to identify risk factors.

A cross-sectional study using a paper-based questionnaire was conducted that targeted 728 clinics located in coastal areas in the 3 prefectures most affected by the GEJE.

The risk of building damage was inversely correlated with distance from the coast, whereas the risk of ceasing operations was significantly correlated with building damage and some specialties of clinics, namely, internal medicine and pediatrics.

In mountainous countries like Japan, clinics often need to be built in coastal areas, where the majority of residents live. This surveillance revealed that clinics built in readily accessible locations and that provide care with high needs are more likely to get damaged by tsunamis. As clinics are often the frontline health facilities in disaster settings, local disaster plans need to include plans to reinforce disaster preparedness among clinics. For effective planning and resource allocation, nationwide hazard vulnerability analysis using a global standard will be helpful. (Disaster Med Public Health Preparedness. 2018; 12: 291–295)

Although much attention is now being paid to the health risks associated with nuclear disasters, reliable information is lacking. We retrospectively evaluated the health effects of living in highly contaminated radioactive areas in Japan.

The health evaluation was conducted in Tamano district, Fukushima prefecture, in 2011 and 2012. The surface deposition density of cesium in Tamano was 600 to 1000 kBq/m2 shortly after the Fukushima nuclear accident. Clinical parameters included body mass index, blood pressure, and laboratory examinations for blood cell counts, glucose levels, and lipid profiles. A screening program for internal and external exposure was also implemented.

One hundred fifty-five residents participated in the health evaluation. Significant decreases in average body mass index and blood pressure were observed from 2011 to 2012. Annual internal exposure levels did not exceeded 1 mSv in any participants. The levels of external exposure ranged from 1.3 to 4.3 mSv/y measured in the first test period but decreased to 0.8 to 3.6 mSv/y in the second test period.

These findings suggest that inhabiting nuclear contaminated areas is not always associated with short-term health deterioration and that radiation exposure can be controlled within safety limitations. (Disaster Med Public Health Preparedness. 2016;10:34–37)

Hospital preparedness against disasters is key to achieving disaster mitigation for health. To gain a holistic view of hospitals in Japan, one of the most disaster-prone countries, a nationwide surveillance of hospital preparedness was conducted.

A cross-sectional, paper-based interview was conducted that targeted all of the 8701 registered hospitals in Japan. Preparedness was assessed with regard to local hazards, compliance to building code, and preparation of resources such as electricity, water, communication tools, and transportation tools.

Answers were obtained from 6122 hospitals (response rate: 70.3%), among which 20.5% were public (national or city-run) hospitals and others were private. Eight percent were the hospitals assigned as disaster-base hospitals and the others were non-disaster-base hospitals. Overall compliance to building code, power generators, water tanks, emergency communication tools, and helicopter platforms was 90%, 84%, 95%, 43%, and 22%, respectively.

Major vulnerabilities in logistics in mega-cities and stockpiles required for chronic care emerged from the results of this nationwide surveillance of hospitals in Japan. To conduct further intensive surveillance to meet community health needs, appropriate sampling methods should be established on the basis of this preliminary study. Holistic vulnerability analysis of community hospitals will lead to more robust disaster mitigation at the local level. (Disaster Med Public Health Preparedness. 2015;9:614–618)

When disasters that affect a wide area occur, external medical relief teams play a critical role in the affected areas by helping to alleviate the burden caused by surging numbers of individuals requiring health care. Despite this, no system has been established for managing deployed medical relief teams during the subacute phase following a disaster.

After the Great East Japan Earthquake and tsunami, the Ishinomaki Medical Zone was the most severely-affected area. Approximately 6,000 people died or were missing, and the immediate evacuation of approximately 120,000 people to roughly 320 shelters was required. As many as 59 medical teams came to participate in relief activities. Daily coordination of activities and deployment locations became a significant burden to headquarters. The Area-based/Line-linking Support System (Area-Line System) was thus devised to resolve these issues for medical relief and coordinating activities.

A retrospective analysis was performed to examine the effectiveness of the medical relief provided to evacuees using the Area-Line System with regards to the activities of the medical relief teams and the coordinating headquarters. The following were compared before and after establishment of the Area-Line System: (1) time required at the coordinating headquarters to collect and tabulate medical records from shelters visited; (2) time required at headquarters to determine deployment locations and activities of all medical relief teams; and (3) inter-area variation in number of patients per team.

The time required to collect and tabulate medical records was reduced from approximately 300 to 70 minutes/day. The number of teams at headquarters required to sort through data was reduced from 60 to 14. The time required to determine deployment locations and activities of the medical relief teams was reduced from approximately 150 hours/month to approximately 40 hours/month. Immediately prior to establishment of the Area-Line System, the variation of the number of patients per team was highest. Variation among regions did not increase after establishment of the system.

This descriptive analysis indicated that implementation of the Area-Line System, a systematic approach for long-term disaster medical relief across a wide area, can increase the efficiency of relief provision to disaster-stricken areas.

YamanouchiS , IshiiT , MorinoK , FurukawaH , HozawaA , OchiS , KushimotoS . Streamlining of Medical Relief to Areas Affected by the Great East Japan Earthquake with the “Area-based/Line-linking Support System”Prehosp Disaster Med. 2014;29(6):1-9.

In catastrophic events, a key to reducing health risks is to maintain functioning of local health facilities. However, little research has been conducted on what types and levels of care are the most likely to be affected by catastrophic events.

The Great East Japan Earthquake Disaster (GEJED) was one of a few “megadisasters” that have occurred in an industrialized society. This research aimed to develop an analytical framework for the holistic understanding of hospital damage due to the disaster.

Hospital damage data in Miyagi Prefecture at the time of the GEJED were collected retrospectively. Due to the low response rate of questionnaire-based surveillance (7.7%), publications of the national and local governments, medical associations, other nonprofit organizations, and home web pages of hospitals were used, as well as literature and news sources. The data included information on building damage, electricity and water supply, and functional status after the earthquake. Geographical data for hospitals, coastline, local boundaries, and the inundated areas, as well as population size and seismic intensity were collected from public databases. Logistic regression was conducted to identify the risk factors for hospitals ceasing inpatient and outpatient services. The impact was displayed on maps to show the geographical distribution of damage.

Data for 143 out of 147 hospitals in Miyagi Prefecture (97%) were obtained. Building damage was significantly associated with closure of both inpatient and outpatient wards. Hospitals offering tertiary care were more resistant to damage than those offering primary care, while those with a higher proportion of psychiatric care beds were more likely to cease functioning, even after controlling for hospital size, seismic intensity, and distance from the coastline.

Implementation of building regulations is vital for all health care facilities, irrespective of function. Additionally, securing electricity and water supplies is vital for hospitals at risk for similar events in the future. Improved data sharing on hospital viability in a future event is essential for disaster preparedness.

OchiS , NakagawaA , LewisJ , HodgsonS , MurrayV . The Great East Japan Earthquake Disaster: Distribution of Hospital Damage in Miyagi Prefecture. Prehosp Disaster Med. 2014;29(3):1-8.