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Nonaka S, Odaka M, Takada A, Senoo Y, Sawano T, Ozaki A, Murakami M, Yoshida M, Uchi Y, Onoda K, Oikawa T, Tsubokura M. Primary care clinic visits in formerly evacuated areas due to radiation disaster following the Great East Japan Earthquake: A retrospective descriptive study. Medicine (Baltimore) 2024; 103:e37942. [PMID: 38701284 PMCID: PMC11062722 DOI: 10.1097/md.0000000000037942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Radiation disasters pose distinctive medical challenges, requiring diverse care approaches. Beyond radiation exposure assessment, addressing health impacts due to lifestyle changes, especially among vulnerable populations, is vital. Evacuation orders issued in radiation-affected areas introduce unique healthcare dynamics, with their duration significantly influencing the recovery process. Understanding evolving patient demographics and medical needs after lifting evacuation orders is crucial for post-disaster care planning. Minamisoma Municipal Odaka Hospital, located 13 to 20 km from Fukushima Daiichi Nuclear power plant in a post-evacuation zone, was greatly affected by the Great East Japan Earthquake and subsequent radiation disaster. Data were retrospectively collected from patient records, including age, gender, visit date, diagnoses, and addresses. Patient records from April 2014 to March 2020 were analyzed, comparing data before and after the July 2016 evacuation order lift. Data was categorized into pre and post-evacuation order lifting periods, using International Classification of Diseases, Tenth Edition codes, to identify the top diseases. Statistical analyses, including χ-square tests, assessed changes in disease distributions. Population data for Odaka Ward and Minamisoma City fluctuated after lifting evacuation orders. As of March 11, 2011, Odaka Ward had 12,842 residents (27.8% aged 65+ years), dropping to 8406 registered residents and 2732 actual residents by April 30, 2018 (49.7%). Minamisoma City also saw declines, with registered residents decreasing from 71,561 (25.9%) to 61,049 (34.1%). The study analyzed 11,100 patients, mostly older patients (75.1%), between 2014 and 2020. Post-lifting, monthly patient numbers surged from an average of 55.2 to 213.5, with female patients increasing from 33.8% to 51.7%. Disease patterns shifted, with musculoskeletal cases declining from 23.8% to 13.0%, psychiatric disorders increasing from 9.3% to 15.4%, and trauma-related cases decreasing from 14.3% to 3.9%. Hypertension (57.1%) and dyslipidemia (29.2%) prevailed post-lifting. Urgent cases decreased from 1.3% to 0.1%. This study emphasizes the importance of primary care in post-evacuation zones, addressing diverse medical needs, including trauma, noncommunicable diseases, and psychiatric disorders. Changing patient demographics require adaptable healthcare strategies and resource allocation to meet growing demands. Establishing a comprehensive health maintenance system tailored to these areas' unique challenges is crucial for future disaster recovery efforts.
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Affiliation(s)
- Saori Nonaka
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
- Department of General Medicine, Taito Hospital, Japan Association for Development of Community Medicine, Tokyo, Japan
| | - Masaaki Odaka
- Clinic Director, Odaka Clinic Affiliated with Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Akemi Takada
- Department of Nursing, Odaka Clinic Affiliated with Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Yuki Senoo
- Department of Internal Medicine, Higashi-Totsuka Memorial Hospital, Kanagawa, Japan
| | - Toyoaki Sawano
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Akihiko Ozaki
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, Fukushima, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Osaka, Japan (current address)
| | - Makoto Yoshida
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuna Uchi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Katsuko Onoda
- Department of Nursing, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Tomoyoshi Oikawa
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
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Tsuboi M, Sawano T, Ozaki A, Nonaka S, Kohayakawa Y, Kondo H, Tsubokura M. Comparison of mortality patterns after the Fukushima Daiichi Nuclear Power Plant radiation disaster and during the COVID-19 pandemic. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:031502. [PMID: 35764063 DOI: 10.1088/1361-6498/ac7c9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
The initial health impact caused by radiation disasters can be broadly classified into direct and indirect effects. Though no direct health hazards caused by radiation, such as acute radiation injury, were observed following the Fukushima Daiichi nuclear power plant accident, indirect deaths have been reported, including those caused by initial emergency evacuation and relocation, medical disruption, and psychological and social health effects. However, these indirect health effects have not been prioritised for addressal. We evaluated the radiation disaster experience with that of the coronavirus disease (COVID-19) pandemic that emerged while facing the challenges from the radiation disaster. Most of the health effects of COVID-19 are directly associated with infection, but indirect health effects of various scales and entities have been reported. The two disasters have similarities in terms of the strain on community healthcare and the large number of deaths. Adapting the measures implemented in the acute to subacute phases of the COVID-19 disaster to radiation disasters may help improve management following future radiation disasters. Based on the experience and findings during the COVID-19 pandemic, the pattern of deaths in radiation disasters can be divided into five major groups: direct deaths, and four indirect patterns of deaths due to a deteriorating supply-demand balance (a hospital-level problem), collapse of the healthcare system (a community-level problem), death due to neglect alongside underlying disease, and diseases other than direct invasion. From the similarities between the two disasters, three main issues should be prioritised as initial emergency evacuation measures in a radiation disaster: emergency exposure medicine, the establishment of a medical system, and protection of death with dignity. The validity of these priority issues needs to be verified in future research.
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Affiliation(s)
- Motohiro Tsuboi
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan
- Department of International Cooperation for Disaster Medicine, International Research Institute of Disaster Science (IRIDeS), Tohoku University, Miyagi, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Japan
- Department of Radiation Health Management, Fukushima Medical University, Fukushima City, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Japan
- Department of Ggastrointestinal Tract Surgery, Fkushima Medical University School of Medicine, Fukushima City, Japan
| | - Saori Nonaka
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
| | | | - Hisayoshi Kondo
- DMAT Secretariat, National Hospital Organization Headquarters, Tokyo, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University, Fukushima City, Japan
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3
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Fukunaga H, Asano T. A brief overview of the registration system of radiation exposure doses for decontamination workers and their occupational health management. J Occup Health 2022; 64:e12357. [PMID: 36377572 PMCID: PMC9453322 DOI: 10.1002/1348-9585.12357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/11/2022] Open
Abstract
Following the Fukushima nuclear accident in March 2011, decontamination and related works have been carried out over a wide area, mainly in Fukushima Prefecture. In November 2013, the Radiation Dose Registration and Management System for Decontamination Workers was established to manage the occupational exposure doses of workers engaged in such work. The Radiation Effects Association mainly operates the registration system. This paper summarizes existing reports on this system and occupational health issues among decontamination workers. We collected previous reports and related regulatory laws on occupational health management for decontamination workers working in Fukushima Prefecture, summarized the outline of the radiation dose registration and management system for these decontamination workers, and discussed future issues related to their health management. Approximately 100 000 decontamination workers were registered in the system as of 2020, but none showed radiation doses that exceeded the dose limit. To our knowledge, there have been no reports of decontamination workers presenting physical symptoms suspected to be related to radiation exposure. On the other hand, heatstroke countermeasures and anxiety about radiation exposure have been reported as possible issues in the occupational health management of decontamination workers. Although decontamination workers are unlikely to experience biological effects from radiation exposure, epidemiological studies are needed to examine this evidence. Further analysis is also needed on non-radiation effects, which pose occupational health concerns for decontamination workers. The registration system would allow for tracking decontamination workers, providing data for analyzing radiological and non-radiological effects.
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Affiliation(s)
- Hisanori Fukunaga
- Faculty of Health SciencesHokkaido UniversitySapporoJapan
- Center for Environmental and Health SciencesHokkaido UniversitySapporoJapan
| | - Tomohiro Asano
- Radiation Dose Registration CenterRadiation Effects AssociationTokyoJapan
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Sawano T, Murakami M, Ozaki A, Nishikawa Y, Fukuda A, Oikawa T, Tsubokura M. Prevalence of non-communicable diseases among healthy male decontamination workers after the Fukushima nuclear disaster in Japan: an observational study. Sci Rep 2021; 11:21980. [PMID: 34753966 PMCID: PMC8578545 DOI: 10.1038/s41598-021-01244-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
The health status of healthy decontamination workers employed after the Fukushima nuclear disaster remains unclear. This study aimed to evaluate the prevalence of non-communicable diseases among such workers. In this observational study, questionnaires on lifestyle and social factors were administered as part of a health promotion program for decontamination workers in 2016 in Minamisoma City, Fukushima. The questionnaires and health check-up results were compared with those of the 2016 National Health and Nutrition Examination Survey (NHANES) in Japan. Overall, 123 male decontamination workers were enrolled; 93 (75.6%) were drinkers, and 84 (68.3%) were current smokers. The age-adjusted prevalence (95% confidence interval) of hypertension, dyslipidemia, diabetes mellitus, and obesity were 27.2% (20.1–34.4%), 30.4% (22.6–38.2%), 11.3% (5.5–17.1%), and 49.0% (39.0–58.9%), respectively. The age-adjusted prevalence in the NHANES were 32.8% (31.1–34.5%), 16.1% (14.5–17.6%), 7.0% (6.2–7.7%), and 31.2% (29.9–32.5%), respectively. The prevalence of obesity, dyslipidemia, binge drinking, and smoking were higher in healthy male decontamination workers than in the general population. Decontamination workers in disaster-struck areas may have higher risks of developing non-communicable diseases, possibly due to their original health status. Continuous monitoring of their health status and proper interventions are warranted.
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Affiliation(s)
- Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan. .,Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan. .,Research Center for Community Health, Minamisoma Municipal General Hospital, 54-6 Takamicho 2 chome, Haramachi, Minamisoma, Fukushima, Japan.
| | - Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan.,Center for Infectious Disease Education and Research, Osaka University, Suita, Osaka, Japan
| | - Akihiko Ozaki
- Research Center for Community Health, Minamisoma Municipal General Hospital, 54-6 Takamicho 2 chome, Haramachi, Minamisoma, Fukushima, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Yoshitaka Nishikawa
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - Aoi Fukuda
- Department of Surgery, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Tomoyoshi Oikawa
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan.,Research Center for Community Health, Minamisoma Municipal General Hospital, 54-6 Takamicho 2 chome, Haramachi, Minamisoma, Fukushima, Japan
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Papatheodorou S, Gold DR, Blomberg AJ, Hacker M, Wylie BJ, Requia WJ, Oken E, Fleisch AF, Schwartz JD, Koutrakis P. Ambient particle radioactivity and gestational diabetes: A cohort study of more than 1 million pregnant women in Massachusetts, USA. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 733:139340. [PMID: 32464573 PMCID: PMC7472683 DOI: 10.1016/j.scitotenv.2020.139340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Exposure to ionizing radiation increases the risk of chronic metabolic disorders such as insulin resistance and type 2 diabetes. Internal ionizing radiation from inhaled radioactive aerosol may contribute to the associations between fine particulate matter (PM2.5) and gestational diabetes mellitus (GDM). METHODS We used the Massachusetts Registry of Vital Records to study 1,061,937 pregnant women from 2001 to 2015 with a singleton pregnancy without pre-existing diabetes. Gross β activity measured by seven monitors of the U.S. Environmental Protection Agency's RadNet monitoring network was utilized to represent ambient particle radioactivity (PR). We obtained GDM status from birth certificates and used logistic regression analyses adjusted for socio-demographics, maternal comorbidities, PM2.5, temperature and relative humidity. We also examined effect modification by smoking habits. RESULTS Ambient particle radioactivity exposure during first and second trimester of pregnancy was associated with higher odds of GDM (OR: 1.18 (95% CI 1.10 to 1.22). Controlling for PM2.5 did not substantially change the effects of PR on GDM. In women that reported being former or current smokers, the association between PR and GDM was null. In the full cohort, the overall effect of PM2.5 on GDM without adjusting for PR was not significant. CONCLUSION This is the first population-based study to examine the association between particle radioactivity and gestational diabetes mellitus - one of the most common pregnancy-related diseases with lifelong effects for the mother and the fetus. This finding has important public health policy implications because it enhances our understanding about the toxicity of PR, a modifiable risk factor, which to date, has been considered only as an indoor and occupational air quality risk.
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Affiliation(s)
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115, USA
| | - Annelise J Blomberg
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michele Hacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Weeberb J Requia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Abby F Fleisch
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
| | - Joel D Schwartz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sawano T, Tanaka H, Watanabe D, Ozaki A, Tsukada M, Nishikawa Y, Saito H, Shimada Y, Morita T, Ohira H, Tsubokura M. Concealment of trauma and occupational accidents among Fukushima nuclear disaster decontamination workers: A case report. J Occup Health 2020; 62:e12123. [PMID: 32515901 PMCID: PMC7199476 DOI: 10.1002/1348-9585.12123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Limited information exists concerning occupational risks in decontamination work after the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Workers involved tend to be migrant workers, face various health risks, and are usually from a low socioeconomic background and generally have difficulty in finding employment. We report a specific case to illustrate the way these workers tend to get injured during working hours and draw attention to the problems arising. CASE PRESENTATION A 59-year-old Japanese male decontamination worker was referred to our emergency department after a fall while he was working in an Exclusion Zone surrounding the FDNPP. He was blind in his right eye. He was diagnosed with traumatic multiple rib fractures and a tube thoracostomy was performed. He was discharged from hospital after 7 days. Payment has been changed from "occupational accident," which is required to be reported to the Local Labor Standards Office, to "general medical treatment" which is no obligation. CONCLUSION Trauma or physical injury of any kind is an occupational hazard for workers, especially those operating in the chaotic and unpredictable environments following any disasters. Companies employing such workers and owners of any facilities or locations in which they may be working are responsible for the safety of their workers. They should provide appropriate training and should comply with all prevailing Employment Laws and follow mandatory safety regulations. If companies and authorities are in breach of any laws, ignore their responsibilities, or jeopardize the health of their workers, they should be held accountable.
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Affiliation(s)
- Toyoaki Sawano
- Department of SurgeryMinamisoma Municipal General HospitalFukushimaJapan
- Department of Public HealthFukushima Medical University School of MedicineFukushimaJapan
- Department of SurgerySendai City Medical CenterMiyagiJapan
| | - Hayato Tanaka
- Department of SurgeryMinamisoma Municipal General HospitalFukushimaJapan
| | - Daiki Watanabe
- Department of SurgeryMinamisoma Municipal General HospitalFukushimaJapan
| | - Akihiko Ozaki
- Department of Breast SurgeryJyoban Hospital of Tokiwa FoundationFukushimaJapan
- Research Center for Community HealthMinamisoma Municipal General HospitalFukushimaJapan
| | - Manabu Tsukada
- Department of SurgeryMinamisoma Municipal General HospitalFukushimaJapan
| | - Yoshitaka Nishikawa
- Department of Internal MedicineSoma Central HospitalFukushimaJapan
- Department of Health InformaticsSchool of Public HealthKyoto UniversityKyotoJapan
| | - Hiroaki Saito
- Department of GastroenterologySendai Kousei HospitalMiyagiJapan
| | - Yuki Shimada
- Department of NeurosurgeryMinamisoma Municipal General HospitalFukushimaJapan
| | - Tomohiro Morita
- Department of Internal MedicineSoma Central HospitalFukushimaJapan
| | - Hiromichi Ohira
- Department of SurgeryMinamisoma Municipal General HospitalFukushimaJapan
| | - Masaharu Tsubokura
- Department of Public HealthFukushima Medical University School of MedicineFukushimaJapan
- Research Center for Community HealthMinamisoma Municipal General HospitalFukushimaJapan
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Endo S, Kakamu T, Masuishi Y, Hidaka T, Fukushima T. Metabolic syndrome and central obesity in domestic migrant radiation decontamination workers. ENVIRONMENTAL AND OCCUPATIONAL HEALTH PRACTICE 2020. [DOI: 10.1539/eohp.2020-0009-br] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
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Sawano T, Kambe T, Seno Y, Konoe R, Nishikawa Y, Ozaki A, Shimada Y, Morita T, Saito H, Tsubokura M. High internal radiation exposure associated with low socio-economic status six years after the Fukushima nuclear disaster: A case report. Medicine (Baltimore) 2019; 98:e17989. [PMID: 31764810 PMCID: PMC6882598 DOI: 10.1097/md.0000000000017989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Managing the health of vulnerable groups is an important component of health care. Given the long-term burden of radiation-release incidents among those exposed, managing the health of vulnerable groups following a nuclear disaster is very important. However, there is limited information available concerning the long-term management of the health effects of radiation exposure in vulnerable groups following nuclear disasters. After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Minamisoma City launched internal radiation exposure monitoring program for local residents, using whole body counter (WBC) units. In 2017, a man of low socio-economic status (SES), was found to have the highest level of internal contamination detected in a person living in the Soma District in recent years. This report describes the case so that the lessons learned can be applied in future nuclear disaster settings. PATIENT CONCERNS A 77-year-old Japanese man, who had been homeless for 2 months and had been staying in the exclusion zone of Minamisoma City, was brought to our hospital. He had become homeless because a lack of communication between social support services had led to his eviction from leased housing after free housing support for evacuees was terminated. DIAGNOSES He was admitted with a diagnosis of dehydration and malnutrition. A WBC unit was used to assess his body burden of radioactive cesium. This revealed levels of Cs-134 and Cs-137 of 538 Bq/body and 4,993 Bq/body, respectively. INTERVENTION He received intravenous fluid therapy and health monitoring. The paperwork required for him to receive public income support was processed during hospitalization. OUTCOME He was discharged to public housing after 9 days, and municipal workers started visiting him regularly after his discharge. LESSONS A high level of internal radiation contamination may occur after a nuclear disaster. This may be associated with a decline in social support, poverty, and social isolation, and may have more impact on people in poor health than on the general population. It would be useful to strengthen linkages between local government and welfare service providers to increase social support for vulnerable groups requiring health care, not only following disasters, but also under normal circumstances.
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Affiliation(s)
- Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital
- Department of Public Health, Fukushima Medical University School of Medicine
| | - Toshiyuki Kambe
- Department of Pulmonary Medicine, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Yuki Seno
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Ran Konoe
- Department of Surgery, Minamisoma Municipal General Hospital
| | - Yoshitaka Nishikawa
- Department of Internal Medicine, Soma Central Hospital, Fukushima
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto
| | - Akihiko Ozaki
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima
| | - Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Fukushima
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Masaharu Tsubokura
- Department of Public Health, Fukushima Medical University School of Medicine
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma
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Sawano T, Nishikawa Y, Ozaki A, Leppold C, Takiguchi M, Saito H, Shimada Y, Morita T, Tsukada M, Ohira H, Tsubokura M. Premature death associated with long-term evacuation among a vulnerable population after the Fukushima nuclear disaster: A case report. Medicine (Baltimore) 2019; 98:e16162. [PMID: 31277119 PMCID: PMC6635282 DOI: 10.1097/md.0000000000016162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The health vulnerability of certain populations such as children, the elderly and individuals with illnesses or physical disability can become significant in disasters. After the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, significant health impacts on vulnerable populations were observed during early or mid-term phase of the disaster, presumably associated with the evacuation. However, there is limited information available on the health impacts owing to long-term evacuation after disaster among them. PATIENT CONCERNS A 56-year-old physically challenged male with arteriovenous malformation on his right lower limb, diagnosed when he was 2 years' old, lived near the FDNPP. He and his family were forced to evacuate immediately after the accident. DIAGNOSIS Three months after evacuation following the FDNPP accident, he developed a refractory foot ulcer associated with atrial fibrillation and congestive cardiac failure because of deterioration of arteriovenous malformation, presumably led by repeated evacuations. INTERVENTION Although anticoagulation therapy and diuretic therapy improved his cardiac failure in the initial admission, he decided to only be treated with supportive care after revelation that his arteriovenous malformation was no longer eligible for aggressive intervention. OUTCOME Three years after the long-term evacuation in temporary houses, the patient died of bleeding and infection of the ulcer. LESSONS This case suggests that long-term evacuation for individuals with physical disability may lead to significant health impacts, and even premature death, through the deterioration of daily life activities due to physical and psychological burdens. This case presents a need for further research on ways that disasters impact the health of individuals with physical disabilities, and greater disaster preparation for the needs of populations with physical disabilities.
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Affiliation(s)
- Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital
- Department of Public Health, Fukushima Medical University School of Medicine
| | - Yoshitaka Nishikawa
- Department of Internal Medicine, Soma Central Hospital, Fukushima
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Claire Leppold
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Mai Takiguchi
- Department of Cardiology, Sukagawa Hospital, Fukushima
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Fukushima
| | - Manabu Tsukada
- Department of Surgery, Minamisoma Municipal General Hospital
| | - Hiromichi Ohira
- Department of Surgery, Minamisoma Municipal General Hospital
| | - Masaharu Tsubokura
- Department of Public Health, Fukushima Medical University School of Medicine
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
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10
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Sawano T, Tsubokura M, Ozaki A, Leppold C, Kato S, Kambe T. Legionnaires' disease as an occupational risk related to decontamination work after the Fukushima nuclear disaster: A case report. J Occup Health 2017; 60:271-274. [PMID: 29311436 PMCID: PMC5985351 DOI: 10.1539/joh.17-0041-cs] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: Legionnaires' disease (LD), which is atypical pneumonia with a broad variety of clinical symptoms, can lead to death despite its low incidence. There are multiple risk factors for LD, yet little information is available concerning what kind of environmental factors are linked to higher risk of LD development. We have experienced a fatal case of LD, which occurred in a decontamination worker after the Fukushima nuclear disaster. Case: A 53-year-old Japanese male visited our hospital with symptoms of fever, vomiting, diarrhea, and altered mental status, but not with respiratory manifestations. He was engaged in decontamination work, which generally includes operations such as the removal of topsoil in mountainous areas and cleaning roads and roofs of residential buildings with high-pressure water. He was required to wear specific equipment to prevent radiation exposure, and lived in a workers' dormitory or shared house, thereby sharing spaces with other workers. Normal antibiotic therapy did not improve his symptoms following his diagnosis with pneumonia. A urinary antigen detection test was then conducted, leading to a diagnosis of LD. Despite the change of antibiotic to levofloxacin, multiple organ failure led to his death. Conclusion: Decontamination workers may be at a high risk for developing LD and living and working conditions among them are possible contributors.
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Affiliation(s)
- Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital
| | - Masaharu Tsubokura
- Department of Radiation Protection, Minamisoma Municipal General Hospital
| | - Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital
| | - Claire Leppold
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh
| | - Shigeaki Kato
- Research Institute of Innovative Medicine, Jyoban Hospital
| | - Toshiyuki Kambe
- Department of Pulmonary Medicine, Minamisoma Municipal General Hospital
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Endo S, Kakamu T, Sato S, Hidaka T, Kumagai T, Nakano S, Koyama K, Fukushima T. Preventive measures and lifestyle habits against exertional heat illness in radiation decontamination workers. J Occup Health 2017; 59:428-432. [PMID: 28794393 PMCID: PMC5635151 DOI: 10.1539/joh.17-0051-oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives: The aim of this study was to reveal the current state of preventive measures and lifestyle habits against heat illness in radiation decontamination workers and to examine whether young radiation decontamination workers take less preventive measures and have worse lifestyle habits than the elder workers. Methods: This was a cross-sectional study. Self-administered questionnaires were sent to 1,505 radiation decontamination workers in Fukushima, Japan. Five hundred fifty-eight men who replied and answered all questions were included in the statistical analysis. The questionnaire included age, duration of decontamination work, previous occupation, lifestyle habit, and preventive measures for heat illness. We classified age of the respondents into five groups: <30, 30-39, 40-49, 50-59, and ≥60 years and defined the workers under 30 years of age as young workers. Logistic regression analysis was used to reveal the factors associated with each lifestyle habit and preventive measures. Results: In comparison with young workers, 50-59-year-old workers were significantly associated with refraining from drinking alcohol. Workers 40 years of age or older were significantly associated with cooling their bodies with refrigerant. Furthermore, 30-39-year-old workers and 40-49-year-old workers were significantly associated with adequate consumption of water compared to young workers. Conclusion: The results of our study suggests that young decontamination workers are more likely to have worse lifestyle habits and take insufficient preventive measures for heat illness. This may be the cause of higher incidence of heat illness among young workers.
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Affiliation(s)
- Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | - Sei Sato
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | - Tomohiro Kumagai
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
| | | | | | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine
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