Change of access to emergency care in a repopulated village after the 2011 Fukushima nuclear disaster: a retrospective observational study

Outpatient rehabilitation for an older couple in a repopulated village 10 years after the Fukushima nuclear disaster:An embedded case study

BackgroundLittle information is available on the role of community-based rehabilitation after a nuclear disaster. Here, we report the case of an older couple living in an area repopulated after the Fukushima nuclear disaster of 2011 who received outpatient rehabilitation.Case presentationAn 84-year-old woman underwent total hip arthroplasty (THA) after she fell and sustained a trochanteric fracture while caring for her husband with Alzheimer's disease. The 85-year-old husband experienced worsening behavioral and psychological symptoms of dementia (BPSD) following his wife's hospitalization. The couple received rehabilitation at an outpatient facility in a nearby village using a shuttle service. The woman's postoperative anxiety was relieved and her physical function improved. Moreover, the husband's BPSD symptoms decreased.ConclusionA wife and husband showed improvement in physical function after THA and alleviation of BPSD, respectively, following rehabilitation. In post-disaster, resource-scarce areas, older adults may benefit from utilizing the outpatient rehabilitation services available in the surrounding area.

Impact of lifting the mandatory evacuation order after the Fukushima Daiichi Nuclear Power Plant accident on the emergency medical system: a retrospective observational study at Minamisoma City with machine learning analysis

OBJECTIVES

This study aimed to identify factors that delayed emergency medical services (EMS) in evacuation order zones after the 2011 Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident and to investigate how the lifting of the evacuation affected these factors over time.

DESIGN

This research was a retrospective observational study. The primary outcome measure was onsite EMS time. A gradient boosting model and a decision tree were used to find the boundary values for factors that reduce EMS.

SETTING

The target area was Minamisoma City, Fukushima, Japan that was partly designated as an evacuation order zone after the 2011 Fukushima disaster, which was lifted due to decreased radiation.

PARTICIPANTS

This study included patients transferred by EMS from 1 January 2013 through 31 October 2018. Patients who were not transported and those transported for community events, interhospital patient transfer and natural disasters were excluded.

OUTCOME MEASURES

This study evaluated the total EMS time using on-site time which is the time from arrival at the scene to departure to the destination, and other independent factors.

RESULTS

The total number of transports was 12 043. The decision tree revealed that the major factors that prolonged onsite time were time of day and latitude, except for differences by year. While latitude was a major factor in extending on-site time until 2016, the effect of latitude decreased and that of time of day became more significant since 2017. The boundary was located at N37.695° latitude.

CONCLUSIONS

The onsite time delay in EMS in evacuation order zones is largely due to regional factors from north to south and the time of day. However, the north-south regional factor decreased with the lifting of evacuation orders.

Home-visit rehabilitation in a repopulated village after the Fukushima nuclear disaster

Following the evacuation of areas affected by Japan's 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Kawauchi Village was one of the first municipalities repopulated. Although rehabilitation resources were limited, a healthcare facility near the municipality initiated home-visit rehabilitation in 2016. To the best of our knowledge, reports of home-visit rehabilitation in repopulated villages that were evacuated following a nuclear accident are lacking.This article describes a case study of home-visit rehabilitation in Kawauchi Village. The purpose of this study was to explore how users of home-visit rehabilitation services in Kawauchi Village perceive home-visit rehabilitation, and whether it had a positive impact on their daily life. A questionnaire survey was conducted, and their ability to perform activities of daily living was assessed, to understand the living conditions of the visiting-rehabilitation service users.We studied 10 rehabilitation-service users, with a mean age of 86.8 years, who had used the services for an average of 591.4 days. Themes that emerged from the open-ended questionnaire were "established exercise habits and improved physical functions," "the joy of returning to the village," "challenges in the mountainous areas" and "changes in relationships due to the earthquake or evacuation."In conclusion, home-visit rehabilitation was successfully implemented in the repopulated village, and helped maintain the users' physical functions. This may thus be a viable choice for rehabilitation care in repopulated areas after disasters.

Evaluation of the emergency medical system in an area following lifting of the mandatory evacuation order after the Fukushima Daiichi Nuclear Power Plant accident: A retrospective cross-sectional observational study

Following the lifting of the evacuation order due to the Fukushima Daiichi Nuclear Power Plant accident, the medical demand and emergency medical system (EMS) in the area where the evacuation orders were lifted have not been well-investigated. This study aimed to evaluate the emergency transportation in such areas and compare the differences with areas that had minimal impact.Using the local EMS transport records, the characteristics of patients who were transferred by an EMS vehicle in Minamisoma City were collected between July 12, 2016 and July 31, 2018, and were compared between former evacuation zones and outside the evacuation zones in the city.The number of emergency transports in the study period in Minamisoma City were 325 cases in the area where the evacuation orders were lifted and 4307 cases in the other areas. The total EMS time was significantly longer in the area where the evacuation order was lifted (48 ± 16 minutes) than in the other areas (40 ± 15 minutes) (P < .001). In the analysis of each component of EMS times, the transport time, which is the time from departure from the patient's location to arrival at a hospital, was significantly longer in the former evacuation zone than in the other areas (16 ± 9 vs 9 ± 9 minutes, P < .001), suggesting that transport time contributed to the longer EMS response times.In areas where the evacuation orders were lifted, the EMS transport time was significantly longer than that in the area outside the former evacuation zone; correspondingly, the total EMS time significantly increased in the former evacuation zone. A plausible reason for this may be the closure of local medical facilities following the evacuation order after the nuclear accident.

Seroprevalence of SARS-CoV-2 antibodies among hospital staff in rural Central Fukushima, Japan: A historical cohort study

Performing a cohort-based SARS-CoV-2 antibody assay is crucial for understanding infection status and future decision-making. The objective of this study was to examine consecutive antibody seroprevalence changes among hospital staff, a high-risk population. A two-time survey was performed in May and October 2020 for 545 hospital staff to investigate the changes in the results of the rapid kit test and chemiluminescence immunoassay (CLIA). The seroprevalence of each assay was summarized at both the survey periods. The proportion of seropositive individuals in the CLIA for each survey period and the number of confirmed COVID-19 cases in Central Fukushima were then compared. We chose 515 participants for the analysis. The proportion of IgM seroprevalence in CLIA increased from 0.19% in May to 0.39% in October, and IgG seroprevalence decreased from 0.97% in May to 0.39% in October. The proportion of IgM seroprevalence in the rapid kit test decreased from 7.96% in May to 3.50% in October, and IgG seroprevalence decreased from 7.77% in May to 2.14% in October.

The IgG and IgM antibody seroprevalence among hospital staff in rural Central Fukushima decreased; the seroprevalence among hospital staff was consistent with the number of confirmed COVID-19 cases in the Central Fukushima area. Although it is difficult to interpret the results of the antibody assay in a population with a low prior probability, constant follow-up surveys of antibody titers among hospital staff had several merits in obtaining a set of criteria regarding the accuracy of measures against COVID-19 and estimating the COVID-19 infection status among hospital staff.

Spatial accessibility to emergency care in Sichuan province in China

Timely access to emergency care can substantially improve overall population's health outcomes. However, currently existed evidence focusing on access to emergency care in China remains insufficient. A better understanding of emergency care from the perspective of spatial accessibility is therefore essential to assist in future healthcare planning. This study provided a brief introduction to the emergency medical service system of China, and assessed the spatial accessibility of emergency care as well as its associated social-economic characteristics based on Sichuan province. Based on populational and hospital administrative data in 2018, we employed the nearest-neighbor method to measure the spatial accessibility while identifying its associated social-economic factors via conventional Ordinary Least Square (OLS) model. The shortest travel time analysis reported a relatively high level of overall spatial accessibility to emergency care in Sichuan. However, substantial geographical disparity in accessibility could nevertheless be observed throughout the province, with the eastern area presenting much higher accessibility than the western area. Regression results suggested that county-level discrepancies in accessibility could be significantly attributed to the variance in local economic development, urbanization level and administrative area. These findings indicated that long-term efforts need to be made by central government on optimizing the allocation of healthcare resources, as well as on fortifying financial support and providing preferential policies for economically disadvantaged regions.