Association between gestational age at threatened preterm birth diagnosis and incidence of preterm birth: the Japan Environment and Children's Study

We evaluated the association between gestational age at threatened preterm birth (TPTB) diagnosis and preterm birth (PTB) incidence using a nationwide birth cohort. Data of 94,236 women with singleton deliveries from the Japan Environment and Children's Study (enrolled between 2011 and 2014) were analysed. Participants were divided based on parity and gestational age at TPTB diagnosis (22-24, 25-27, 28-30, 31-33, and 34-36 weeks). Multivariable logistic regression models were used to calculate the odds ratios (ORs) for PTB before 37 and 34 weeks in women from all groups, using participants without TPTB as the reference. The adjusted ORs for PTB before 37 weeks were the highest in the latest gestational age group in nulliparous and multiparous women without previous PTB, while those before 34 weeks were the highest in the earliest and latest gestational age group in multiparous women without previous PTB and in the earliest gestational age group in multiparous women with previous PTB. The association between gestational age at TPTB diagnosis and PTB incidence varies based on maternal parity and PTB before 37 or 34 weeks. Further studies with detailed clinical data and a unified TPTB diagnosis protocol are necessary to clarify this association.

Eight-Year Trends in the Effect of the Great East Japan Earthquake on Obstetrics Outcomes: A Study from the Fukushima Health Management Survey

Information regarding the longitudinal effects of natural/environmental disasters on obstetrics outcomes is limited. This study aimed to analyze the longitudinal changes in obstetrics outcomes over 8 years after the Great East Japan Earthquake and the Fukushima power plant accident. We used data from the first 8 years of the Pregnancy and Birth Survey by the Fukushima prefectural government, launched in 2011. We compared data on obstetrics outcomes by year and divided Fukushima Prefecture into six districts based on administrative districts. Longitudinal changes in the occurrence of preterm birth before 37 gestational weeks, low birth weight, and anomalies in newborns were accessed using the Mantel-Haenszel test for trends in all six districts. Overall, 57,537 participants were included. In 8 years, maternal age, conception rate after sterility treatment, and cesarean section delivery incidence increased. Although significant differences were observed in preterm birth and low birth weight occurrence among districts, there was no significant trend in the occurrence of preterm birth, low birth weight, and anomalies in newborns in all six districts of Fukushima Prefecture. The Great East Japan Earthquake and Fukushima power plant accident were associated with increased cesarean section delivery incidence but had no significant adverse effects on obstetrics outcomes.

Impact of Lifestyle and Psychosocial Factors on the Incidence of Hepatobiliary Enzyme Abnormalities After the Great East Japan Earthquake: Seven-Year Follow-up of the Fukushima Health Management Survey

OBJECTIVE

Residents who lived near the Fukushima Power Plant accident were forced to change their lifestyle after the 2011 accident. This study aimed to elucidate the association of resident lifestyle and psychological factors with onset of hepatobiliary enzyme abnormalities (HEA) after the accident.

METHODS

This longitudinal study included 15705 residents who underwent a comprehensive health check, as well as a mental health and lifestyle survey between June 2011 and March 2012. Follow-up surveys were conducted between June, 2012 and March 2018. Risk factors for new HEA onset were evaluated using the Cox proportional hazards model, moreover, population attributable risks for new HEA onset were calculated.

RESULTS

HEA developed in 29.7% of subjects. In addition to metabolic factors such as overweight, hyperglycemia, and hyperlipidemia; there were differences in alcohol intake, evacuation, unemployment, educational background, and psychological distress between subjects with and without HEA onset. After we adjusted for potential confounding factors, an association of being overweight, hypertension, and dyslipidemia, as well as alcohol consumption, evacuation, and psychological distress with increased risk of HEA onset was realized. Among these identified risk factors, evacuation accounted for the greatest share.

CONCLUSIONS

Metabolic characteristics and disaster-related lifestyle aspects, including mental status, were risk factors for HAE onset after the Fukushima Power Plant accident.

Effects of disaster-related traumatic events on worry about radiation and COVID-19: A decade after the Fukushima nuclear power plant accident

Community residents exposed to nuclear power plant (NPP) accidents have long-term worry about the effects of radiation. After the 2011 Fukushima NPP accident, those who experienced traumatic events during the Great East Japan Earthquake (GEJE) tended to have greater worry about radiation. Along with the prolonged worry about radiation, there may also be cognitive changes caused by the traumatic events. We hypothesized that if there were cognitive changes underlying the prolonged worry about radiation, those who experienced the traumatic events would tend to have greater worry about other issues unrelated to radiation. We examined the effects of the traumatic events during the GEJE on community residents' worry about radiation and COVID-19 a decade after the Fukushima NPP accident. Using the data of a longitudinal questionnaire survey following a random sample of 4900 community residents outside the evacuation zone in Fukushima, this study analyzed 774 responses (15.8%). The traumatic events consisted of (1) injury, (2) injury or death of a family member, and (3) the loss of a house or other property. We developed a mediation model drawing paths from the traumatic events to worry about radiation and COVID-19, including posttraumatic stress symptoms (PTSS) as a mediator, using structural equation modeling. The traumatic events directly affected worry about radiation. Although it did not directly affect worry about COVID-19, it did so indirectly through worry about radiation and PTSS. Traumatic events can increase trauma-related worry independently of PTSS and increase trauma-unrelated worry indirectly through trauma-related worry and PTSS.

Prenatal folic acid supplement/dietary folate and cognitive development in 4-year-old offspring from the Japan Environment and Children's Study

We evaluated the association between maternal prenatal folic acid supplement use/dietary folate intake and cognitive development in 4-year-old offspring (N = 3445) using data from the Japan Environment and Children's Study. Cognitive development was evaluated using the Kyoto Scale of Psychological Development 2001. Multiple regression analysis revealed that offspring of mothers who started using folic acid supplements pre-conception had a significantly higher language-social developmental quotient (DQ) (partial regression coefficient 1.981, 95% confidence interval 0.091 to 3.872) than offspring of mothers who did not use such supplements at any time throughout their pregnancy (non-users). Offspring of mothers who started using folic acid supplements within 12 weeks of gestation had a significantly higher cognitive-adaptive (1.489, 0.312 to 2.667) and language-social (1.873, 0.586 to 3.159) DQ than offspring of non-users. Regarding daily dietary folate intake from preconception to early pregnancy, multiple regression analysis revealed that there was no significant association with any DQ area in the 200 to < 400 µg and the ≥ 400 µg groups compared with the < 200 µg group. Maternal prenatal folic acid supplementation starting within 12 weeks of gestation (but not adequate dietary folate intake from preconception to early pregnancy) is positively associated with cognitive development in 4-year-old offspring.

Association of Maternal Asthma and Total Serum Immunoglobulin E levels with Obstetric Complications: The Japan Environment and Children's Study

OBJECTIVE

To evaluate the association between maternal asthma (MA) and obstetric complications, while considering subdivided total serum immunoglobulin E (IgE) levels.

METHODS

Data of the participants enrolled in the Japan Environment and Children's Study between 2011 and 2014 were analyzed. In total, 77,131 women with singleton live births at and after 22 weeks of gestation were included. MA was defined based on a self-administered questionnaire. Women with MA were stratified based on the quartile of total serum IgE levels during pregnancy as follows: low IgE levels (< 52.40 IU/mL), moderate IgE levels (52.40-331.00 IU/mL), and high IgE levels (> 331.00 IU/mL). The adjusted odds ratios (aORs) for preterm births (PTB), small for gestational age (SGA) infants, gestational diabetes mellitus, and hypertensive disorders of pregnancy (HDP) were calculated using multivariable logistic regression, while considering women without MA as reference and maternal socioeconomic factors as confounders.

RESULTS

The aORs for SGA infants and HDP in women with MA and high total serum IgE levels were 1.26 (95% confidence interval [CI], 1.05-1.50) and 1.33 (95% CI, 1.06-1.66), respectively. The aOR for SGA infants among women with MA and moderate total serum IgE levels was 0.85 (95% CI, 0.73-0.99). The aOR for PTB among women with MA and low total serum IgE levels was 1.26 (95% CI, 1.04-1.52).

CONCLUSIONS FOR PRACTICE

MA with subdivided total serum IgE levels was associated with obstetric complications. Total serum IgE level may be a potential prognostic marker to predict obstetric complications in pregnancies with MA.

Maternal triglyceride levels and neonatal outcomes: The Japan Environment and Children's Study

BACKGROUND

Although maternal triglyceride (TG) is important for fetal growth, there are few large cohort studies investigating the relationships between maternal TG during pregnancy and neonatal outcomes.

OBJECTIVES

The objective of this study was to investigate the associations between maternal TG during the second and third trimesters and neonatal outcomes including preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA) and large for gestational age (LGA).

METHODS

This was a prospective birth cohort study using data of the Japan Environment and Children's Study included data of births from 2011-2014 in Japan including 79,519 pairs. Participants were divided into tertiles according to maternal TG in the second or third trimesters. Multiple logistic regression modeling was used to examine the risks of LBW, SGA, LGA and PTB in association with maternal TG levels in the second or third trimesters RESULTS: In the second trimester, compared with reference TG group (T2), women in higher TG group (T3) and lower TG group (T1) were also at increased risk of LGA (aOR 1.20, 95% CI 1.11-1.29) and SGA (aOR 1.25, 95% CI 1.10-1.41), respectively. In the third trimester, women in T3 and T1 were at increased risk of LGA (aOR 1.27, 95% CI 1.17-1.38) and SGA (aOR 1.17, 95% CI 1.02-1.34), respectively.

CONCLUSION

In this study, higher maternal TG levels in the second or third trimesters were associated with risks of LGA, however, lower maternal TG levels in the second or third trimesters were conversely associated with risks of SGA.

Comparison between external and internal doses to the thyroid after the Fukushima Daiichi Nuclear Power Plant accident

To analyze the association between radiation dose and thyroid cancer after the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, external doses have often been used because of the difficulty to estimate internal thyroid doses individually due to the lack of human data. However, no evaluation has been made as to whether external dose is a good surrogate marker for internal thyroid dose individually. This study aimed at analyzing the relationship between external doses and internal thyroid doses estimated by recently developed methodology. For four municipalities affected by the accident, 200 individuals aged under 20 at the time of the accident per municipality were randomly selected, and their external and internal thyroid doses and their ratios were estimated individually. In a separate analysis, median and arithmetic mean values for external thyroid doses estimated for persons of 16 municipalities that included the above four were compared with those for previously estimated internal thyroid doses. The ratios of the median of internal thyroid dose to that of external thyroid dose in these 16 municipalities ranged from 0.56 to 13.8 for 15-year-old children and 0.91 to 21.1 for 1-year-old children. No consistent relationship between external and internal thyroid doses was found in all 16 municipalities. Thus, thyroid doses from both external and internal exposures should be used to analyze the association between radiation dose and thyroid cancer detection rates for persons who lived in Fukushima Prefecture at the time of the FDNPP accident. (240).

[Relationship between radiation knowledge and radiation effect anxiety on the next generation: An analysis of a questionnaire survey disseminated to residents in Fukushima Prefecture]

Objectives　Since the Fukushima Daiichi Nuclear Power Plant accident caused by the Great East Japan Earthquake, many people in Fukushima Prefecture have been concerned about the effects of radiation on their offspring. Although this fear should be relieved since no epidemiological study has shown evidential cases, situations wherein some people misunderstood the existence of evidence have been independently reported. Therefore, in this study, we examined the relationship between radiation knowledge and anxiety about radiation-based genetic effects using a survey mailed to residents in Fukushima Prefecture.Methods　In August 2016, we attempted to contact 2,000 people aged 20 to 79 years in Fukushima Prefecture through a survey distributed by mail inquiring about residents' health. We received 861 responses. Respondents selected their level of concern about radiation effects on the next generation on a four-point scale and answered five knowledge questions about radiation effects and protection. Responses were "correct," "incorrect," or "not sure." After adjusting according to residential area, family configuration, age, sex, academic background, media used, and trusted information source, we conducted multiple regression analyses to investigate the relationship between the level of concern and answers to the knowledge questions.Results　People who answered the knowledge questions more correctly had lower levels of anxiety. The number of "not sure" responses was unrelated to anxiety level. The results indicated that correct answers to questions related to radiation residuals in the body and genetic effects were negatively associated with anxiety. Incorrect answers to the question about genetic effects and another related to cell repair systems were positively associated with anxiety. Moreover, while a correct answer to another question related to the linear threshold model had a positive association, the association was insignificant. Further, any response related to radiation reference values in foods showed no association.Conclusion　Based on these results, we observed an association between the number of respondents with a correct knowledge of radiation and the degree of anxiety about radiation effects on the next generation. However, this relationship and its strength varied depending on the specific knowledge content. As a limitation of this study, the study could not establish any causality. Further studies, such as prospective interventional studies, should be conducted.

Prevalence trends of metabolic syndrome in residents of postdisaster Fukushima: a longitudinal analysis of Fukushima Health Database 2012-2019

OBJECTIVES

The study aimed to evaluate the long-term metabolic risk profiles of Fukushima residents after the Great East Japan Earthquake of March 2011.

STUDY DESIGN

This was a cross-sectional and a longitudinal design.

METHODS

The Fukushima Health Database (FDB) contains 2,331,319 annual health checkup records of participants aged 40-74 years between 2012 and 2019. We checked the validity of the FDB by comparing the prevalence of metabolic factors with the National Database of Health Insurance Claims and Specific Health Checkups (NDB). We applied a regression analysis to determine the changes and project the trends of metabolic factors over the years.

RESULTS

Compared to the NDB, the prevalence of metabolic factors in Fukushima was higher than the country average from 2013 to 2018, and they showed the same trends as those from the FDB. The prevalence of metabolic syndrome (MetS) increased from 18.9% in 2012 to 21.4% in 2019 (an annual increase of 2.74%) in men and from 6.8 to 7.4% (an annual increase of 1.80%) in women in Fukushima. The standardized prevalence of MetS, being overweight, and diabetes is projected to continue increasing, with disparities among subareas being higher in evacuees than in non-evacuees. An annual decrease of 0.38-1.97% in hypertension was mainly observed in women.

CONCLUSIONS

The prevalence of metabolic risk is higher in Fukushima as compared to the country average. The increasing metabolic risk in subareas, including the evacuation zone, highlights the need to control MetS in Fukushima residents.

Association between Tai Chi Yuttari Exercise and Longevity and Prevention of Long-Term Care Need: Survival Analysis in Kitakata City, Japan

This study examined whether participation in Tai Chi Yuttari exercise is associated with a delay in the death and new certification for long-term care need of older adults. Individuals who participated in Tai Chi Yuttari exercise classes in 2011-2015 (participation group) were compared with individuals from the Basic Resident Register of Kitakata City (non-participation group). Death and new certification for long-term care need were selected to evaluate the effectiveness of participation in Tai Chi Yuttari exercise classes. The periods from the start date of the observation to each person's date of occurrence of events were calculated. The Kaplan-Meier method and log-rank test were used to compare survival curves between the groups. A total of 105 and 202 individuals in the participation and non-participation groups, respectively, were observed. Survival duration (χ2 = 8.782, p = 0.003) and the period before receiving certification for long-term care (χ2 = 5.354, p = 0.021) were longer in the participation group than in the non-participation group. In the stratified analysis by sex, survival duration was longer in the participation group in men only (χ2 = 7.875, p = 0.005). Participation in Tai Chi Yuttari exercise might be effective in delaying death, especially in men, and new certification for long-term care.

Posttraumatic stress response following the loss of significant close others in the Great East Japan Earthquake: Fukushima Health Management Survey

During the Great East Japan Earthquake, many people experienced the loss of family and friends, among other traumatic events. This study sought to clarify the impact of the loss of significant close others on posttraumatic stress symptoms (PTSS), as well as the factors associated with PTSS, among individuals who experienced the loss of significant close others (i.e., bereaved group). Self-administered questionnaires were mailed to men and women (N = 180,604) aged 16 years and older living in municipalities that included evacuated areas surrounding the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Station, which was significantly damaged following an earthquake and tsunami in March 2011, causing subsequent radiation leakage; this mailing yielded a 40.7% response rate, with 57,388 valid responses, in 2012. We used the Posttraumatic Stress Disorder Checklist-Specific (PCL-S) to measure PTSS as the outcome variable. Loss of significant close others in the disaster and respondents' relationship with the deceased constituted the explanatory variables. Basic characteristics and disaster-related factors were the confounding variables. Data were analyzed using chi-square tests and logistic regression analyses. The bereaved group showed more severe PTSS than the nonbereaved group, aOR = 1.58, 95% CI [1.50, 1.67]. The risk of developing PTSS increased if the deceased was a respondent's spouse, aOR = 1.67, 95% CI [1.22, 2.29]; child, 1.51 [1.01, 2.25]; or friend, 1.33 [1.16, 1.53]. Individuals who lose significant close others, including both family and friends, in disasters require close mental health care and, if necessary, should be referred for psychiatric treatment.

Influence of preconception carbohydrate intake on hypertensive disorders of pregnancy: The Japan Environment and Children's Study

AIM

Hypertensive disorders of pregnancy (HDP) are a crucial cause of morbidity and mortality. We aimed to examine whether preconception carbohydrate intake is associated with new-onset HDP and small for gestational age (SGA) births.

METHODS

We identified 93 265 normotensive (primiparous, 37 387; multiparous, 55 878) participants from the Japan Environmental Children's Study database who delivered between 2011 and 2014. After excluding participants with multiple gestations, preconception hypertension, and insufficient data, primiparous and multiparous participants were categorized into five groups according to their preconception carbohydrate-intake quintiles (Q1 and Q5 were the lowest and highest groups, respectively). Multiple logistic regression analysis was performed to identify the effect of preconception carbohydrate intake on early (<34 weeks) and late-onset (≥34 weeks) HDP and the incidence of SGA births.

RESULTS

With the middle carbohydrate intake group (Q3) as a reference, the risk for late-onset HDP among multiparous women was higher in the Q5 group (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.02-1.69). The incidence of SGA births was higher in the Q1 group among both primiparous (aOR 1.16, 95% CI 1.01-1.33) and multiparous women (aOR 1.16, 95% CI 1.02-1.32).

CONCLUSIONS

Excessive carbohydrate intake increases the incidence of HDP in multiparous women, while low-carbohydrate intake increases the incidence of SGA births. New recommendations for preconception carbohydrate intake are required to prevent major HDP-related complications.

Relationship between the Effects of Perceived Damage Caused by Harmful Rumors about Fukushima after the Nuclear Accident and Information Sources and Media

The nuclear accident that accompanied the Great East Japan Earthquake of 11 March, 2011, was also an information disaster. A serious problem that arose after the accident and persisted for a long time was the damage caused by harmful rumors (DCBHR). In 2016, a cross-sectional questionnaire survey on health and information was conducted in Fukushima. The eligible population of this survey was 2000 Fukushima residents, which included those in the evacuated areas. We received 861 responses. Data were analyzed using the responses to the question about perceived DCBHR as the objective variable and the sources of information residents trusted and the media they used as explanatory variables. A multiple logistic regression analysis revealed that those who trusted government ministries and local commercial TV were significantly associated with no effect. In contrast, those who used Internet sites and blogs were significantly associated with a negative effect. This study underlines the pivotal importance of media and information, literacy, and education and discusses how these should be improved to avoid DCBHR in the future. Furthermore, accurate information should be made available to all sections of the population to diminish DCBHR.

Associations of acute medical care with the transfer and acceptance functions of hospitals in a region in Japan with limited medical resources

BACKGROUND

Japan's health care system may be providing inpatient care inefficiently with a low number of physicians per hospital bed and a long average length of stay (LOS). The present study examined associations of acute medical care with hospital-level factors, such as the transfer and acceptance rates, and mediation effect of LOS, using medical service fees per day as an outcome measure for the provision of acute medical care in hospitals in a region with limited medical resources.

METHODS

To analyze the associations of acute medical care with hospital-level factors, this research used multilevel structural equation modeling (SEM) of a dataset that included 225,203 patients admitted to 99 hospitals in Fukushima, Japan. The characteristics of the patients, medical activities, and hospitals, such as the transfer and acceptance rates, were assumed to have both direct and indirect effects through LOS on medical service fees per day.

RESULTS

The final analysis used data from 165,413 patients discharged or transferred from 79 hospitals. After separating patient-level effects using multilevel SEM, the results revealed that, at the hospital level, the transfer rate had a significant and positive association with increased medical service fees per day, both directly (standardized coefficient [SC] = 0.215) and indirectly (SC = 0.057) through shortened LOS. The number of first hospitalized patients per physician had a significant and positive association with increased medical service fees per day only indirectly through shortened LOS (SC = 0.063). The acceptance rate had a significant and negative association with medical service fees per day only indirectly through prolonged LOS (SC = -0.078).

CONCLUSIONS

Hospital-level factors, such as enhanced transfer function, reduced acceptance function, and a large number of patients for treatment of acute episodes per physician, had positive associations with increased medical service fees per day, either directly or indirectly through LOS.

Congenital Anomalies in Infants in Fukushima from 2011 to 2014: The Japan Environment and Children's Study

Introduction

This study aimed to assess congenital anomalies among infants from 2011 to 2014 in Fukushima and compare the assessment with that from other geographical regions in Japan.

Methods

We used the dataset of the Japan Environment and Children's Study (JECS), which is a nationwide prospective birth cohort study. For the JECS, participants were recruited through 15 regional centers (RC), including Fukushima. Pregnant women were recruited between January 2011 and March 2014. The Fukushima RC recruited all municipalities in the Fukushima Prefecture, from where we compared congenital anomalies in infants from the Fukushima RC to those in the infants from 14 other RCs. Crude and multivariate logistic regression analyses were also performed, with the multivariate logistic regression analysis being adjusted for maternal age, maternal body mass index (kg/m²), infertility treatment, multiple pregnancies, maternal smoking, maternal alcohol consumption, pregnancy complications, maternal infection, and infant sex.

Results

In the Fukushima RC, 12,958 infants were analyzed, and 324 infants were diagnosed with major anomalies (2.50%). In the remaining 14 RCs, 88,771 infants were analyzed and 2,671 infants were diagnosed with major anomalies (3.01%). Crude logistic regression analysis demonstrated that the odds ratio for the Fukushima RC was 0.827 (95% confidence interval, 0.736-0.929) using the other 14 RCs as a reference. Multivariate logistic regression analysis also demonstrated that the adjusted odds ratio was 0.852 (95% confidence interval, 0.757-0.958).

Conclusions

Fukushima Prefecture was found not to be an area at high risk for the occurrence of congenital anomalies in infants compared nationwide in Japan from 2011 to 2014.

Longitudinal Trends in Blood Pressure Associated with The Changes in Living Environment Caused by the Great East Japan Earthquake: The Fukushima Health Management Survey

The Great East Japan Earthquake occurred on 11 March 2011, forcing Fukushima Prefecture residents to change their living environment. Such sudden changes possibly have long-term effects on cardiovascular-related diseases. We therefore sought to identify temporal relationships between living environment changes and blood pressure levels over three years following the earthquake. Participants included 14,941 men and 21,533 women aged 16 years or older who answered self-administered questionnaires, including questions on living environment changes at baseline (2012). Blood pressure levels were measured each year from 2012 to 2015. Linear mixed-effects models were used to analyze associations between living environment changes and blood pressure levels. Men with changes in living environment (i.e., those living in shelters or in temporary housing, rental apartments, relatives' houses, or others) showed significantly higher diastolic blood pressure levels than those who lived in their home at baseline (77.3 mmHg vs. 77.8 mmHg; p < 0.001). The time-dependent effect of diastolic blood pressure levels associated with living environment was not statistically significant, indicating a sustained difference in diastolic blood pressure associated with living environment changes at baseline after three years. The effect of living environment changes on diastolic blood pressure increment was also evident in men without antihypertensive medication use during the study period and in men who were current drinkers at baseline. There were no associations between living environment changes and diastolic blood pressure levels among women. Sudden changes in living environment due to the disaster had an impact on the long-term effects of higher diastolic blood pressure among middle-aged men.

Influence of post-disaster evacuation on childhood obesity and liver dysfunction: The Fukushima Health Management Survey

BACKGROUND

After the Great East Japan Earthquake and subsequent Fukushima Daiichi Nuclear Power Plant accident in 2011, the Fukushima Prefectural Government launched a long-term health management survey for the population of Fukushima. Results of the Comprehensive Health Check (CHC) showed that some children aged 6-15 years, who resided in the evacuation area at the time of the disaster, had obesity, hyperlipidemia, liver dysfunction, and/or renal dysfunction from as early as 2011. The aim of the present study was to determine the long-term trend of obesity and hepatic enzyme abnormalities in Fukushima children.

METHODS

We evaluated the changes in body mass index standard deviation score (BMI-SDS), aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase from 2011 to 2018.

RESULTS

Obesity (BMI-SDS ≥ 2) was significantly associated with hepatobiliary enzyme abnormalities. The mean BMI-SDS was significantly higher in 2011 after the disaster, but then soon showed a gradual decrease. The frequency of obesity did not increase significantly after the disaster. There were no significant differences in the prevalence of hepatobiliary enzyme abnormalities in the children aged 6-15 years of either sex from 2011 to 2018.

CONCLUSIONS

In the present study, we found that the increase in the mean BMI-SDS after the disaster was temporary, suggesting that the frequency of obesity and liver dysfunction might not have been significantly influenced by the disaster.

Associations between fetal or infancy pet exposure and food allergies: The Japan Environment and Children's Study

The hygiene hypothesis suggests that pet exposure is effective in preventing allergic disease, and some studies have reported the beneficial effects of dog exposure during fetal development or early infancy on food allergy. However, the effects of exposure to pets other than dogs on the kinds of food allergies remains unaddressed. This study aimed to explore the effect of exposure to various species of pets on the risk of food allergies. We obtained information on pet exposure and food allergy from the Japan Environment and Children's Study, a nationwide, prospective birth cohort study that included 97,413 mothers and their children. We examined the associations between exposure to various species of pets during fetal development or early infancy and the incidence risk of food allergies. We conducted logistic regression analysis for each pet species, causative food, and timing of exposure. Exposure to dogs or cats during fetal development or early infancy was estimated to reduce the incidence risk of food allergies until the age of 3 years. Dog exposure was estimated to reduce the incidence risk of egg, milk, and nut allergies, and cat exposure was estimated to reduce the incidence risk of egg, wheat, and soybean allergies. However, hamster exposure was estimated to increase the incidence risk of nut allergy. In conclusion, the association between pet exposure and food allergies might differ depending on the pet species and causative food. Continued dog and cat exposure from fetal development to infancy was estimated to reduce the incidence risk of food allergies. The findings of this study shall aid in the design of future studies.

Ultrasonography-based reference values for the cross-sectional area of the thyroid gland in children and adolescents: The Fukushima Health Management Survey

We previously described the thyroid volume, which was calculated by measuring the thyroid width, thickness, and longitudinal length using ultrasonography, in children and adolescents. We have proposed a simplified method for quantitatively assessing the thyroid size, to overcome the inaccuracy and challenges in measuring the longitudinal length of the thyroid. Based on measurements of 317,847 (girls: 156,913, boys: 160,934) children and adolescents, we calculated sex-specific means and standard deviations of thyroid width and thickness, and of the cross-sectional area computed by multiplying them, for every age and 0.1 m² of body surface area, after ensuring normal distribution with Box-Cox transformation. Multivariate regression analysis revealed that female sex, age, and body surface area were independently associated with areas of each thyroid lobe. Our novel method may be useful in quantitatively assessing the thyroid size, and appropriately diagnosing pathological conditions, such as hypoplasia, atrophy, and enlargement of the thyroid gland, in children and adolescents.

Blood data trends of children in Fukushima after the Great East Japan Earthquake: Fukushima health management survey

BACKGROUND

After the Great East Japan Earthquake on March 11, 2011 and the subsequent accident at the Tokyo Electric Power Company-operated Daiichi Nuclear Power Plant, the Fukushima Prefecture government initiated the Fukushima Health Management Survey (FHMS) to assess the long-term health effects of the disaster on Fukushima residents. The blood tests of children aged ≤15 years between 2011 and 2012 did not reveal any changes regarding peripheral blood data; however, long-term monitoring is still necessary. Therefore, this study aimed to investigate the long-term health status of children aged ≤15 years who had evacuated the Fukushima Prefecture.

METHODS

From 2011 to 2018, 71,250 evacuees aged 15 years or younger participated in the FMHS and were subjected to blood tests. By analyzing the data of the comprehensive health check survey managed by the FHMS, we examined the changes in hemoglobin (Hb) levels, white blood cell (WBC) counts, including fractions, and platelet (PLT) counts among children from 2011 to 2018.

RESULTS

Minor fluctuations in Hb levels, PLT counts, and WBC counts were observed during the study period, but the central 95% intervals of distribution of the laboratory values were generally within previously reported reference intervals. In particular, there was no increase in the proportions of patients with anemia, polycythemia, or deviating WBC counts.

CONCLUSION

From 2011 to 2018, there was no increase in the percentages of children with anemia, polycythemia, or deviating WBC counts among the Fukushima Prefecture evacuees.

Obesity and glucose metabolism abnormalities by post-disaster evacuation

BACKGROUND

The objectives of this study were to determine the longer-term trends in childhood obesity and glucose metabolism abnormalities among residents of Fukushima Prefecture 5 years after the Great East Japan Earthquake.

METHODS

We evaluated the changes in height, weight, body mass index (BMI), BMI SD score, fasting plasma glucose (FPG) concentration, and hemoglobin A1c (HbA1c) among elementary and junior high school residents who had lived in the evacuation zone between 2011 and 2015.

RESULTS

Of the residents, 11,112 received health checks in 2011, while in 2012, 2013, 2014, and 2015, 5,737, 4522, 4297 and 3405 received health checks, respectively. The mean BMI SD score for all participants in 2011 was 0.149, and this score gradually decreased from 2011 to 2015. FPG levels and HbA1c levels for all participants with a BMI value +2SD or more in 2011 were higher than those in residents with a BMI value of less than +2SD. The frequency of participants with a FPG level of 126 mg/dl or more and the frequency of participants with a HbA1c level of 6.5% or more in 2011 were higher than those in 2012, 2013, and 2015.

CONCLUSIONS

These results suggest that a number of pediatric residents suffered from obesity and glucose metabolism abnormalities. However, the longer-term observations indicated an improvement in obesity and glucose metabolism abnormalities. There was a strong association observed between obesity and glucose metabolism, thus, it is important to continue with health checks for children with obesity and strive to improve their health.

A Six-Year Prospective Study on Problem Drinking among Evacuees of the Great East Japan Earthquake: The Fukushima Health Management Survey

Evacuees of the Great East Japan Earthquake have experienced adverse, long-term physical and psychological effects, including problem drinking. This study examined the risk and recovery factors for problem drinking among evacuees between fiscal years (FY) 2012 and 2017 using data on residents in the evacuation area from the Mental Health and Lifestyle Survey. With the FY 2012 survey as a baseline, a survey comprising 15,976 men and women was conducted in the evacuation area from FY 2013 to FY 2017, examining the risk and protective factors for problem drinking. Particularly, the Cutting down, Annoyed by criticism, Guilty feeling, and Eye-opener (CAGE) questionnaire was used to evaluate problem drinking. Univariate and multivariate Cox proportional hazard models were constructed to identify the risk and recovery factors of problem drinking. The findings indicated that the male gender, insufficient sleep, job change, trauma symptoms, mental illness, family financial issues, and heavy drinking (≥4 drinks per day) were significant risk factors for the incidence of problem drinking among the evacuees. Furthermore, a high blood pressure diagnosis could exacerbate problem drinking among men, while younger age and a diabetes mellitus diagnosis could increase problem drinking among women. Trauma symptoms and heavy drinking inhibited recovery from problem drinking after the disaster. Understanding these factors can shape effective long-term intervention strategies to physically and psychologically support evacuees.