Cognition and Implementation of Disaster Preparedness among Japanese Dialysis Facilities

Management of pediatric dialysis and kidney transplant patients after natural or man-made disasters

Pediatric patients on kidney replacement therapy (KRT) are among the most vulnerable during large-scale disasters, either natural or man-made. Hemodialysis (HD) treatments may be impossible because of structural damage and/or shortage of medical supplies, clean water, electricity, and healthcare professionals. Lack of peritoneal dialysis (PD) solutions and increased risk of infectious/non-infectious complications may make PD therapy challenging. Non-availability of immunosuppressants and increased risk of infections may result in graft loss and deaths of kidney transplant recipients. Measures to mitigate these risks must be considered before, during, and after the disaster including training of staff and patients/caregivers to cope with medical and logistic problems. Soon after a disaster, if the possibility of performing HD or PD is uncertain, patients should be directed to other centers, or the duration and/or number of HD sessions or the PD prescription adapted. In kidney transplant recipients, switching among immunosuppressants should be considered in case of non-availability of the medications. Post-disaster interventions target treating neglected physical and mental problems and also improving social challenges. All problems experienced by pediatric KRT patients living in the affected area are applicable to displaced patients who may also face extra risks during their travel and also at their destination. The need for additional local, national, and international help and support of non-governmental organizations must be anticipated and sought in a timely manner.

Factors related to preparedness for emergency hemodialysis in the event of a natural disaster

This study aimed to explore patients' preparedness for emergency hemodialysis in the event of a natural disaster and to determine the factors affecting such preparedness.A cross-sectional study was conducted in undergoing hemodialysis at dialysis facilities in Sapporo, Hokkaido. The participants were a cohort of 256 outpatients aged 20 years or older, 186 (72.7%) were male, and the average age was 61.9 ± 10.9 years. The participants were divided into those who had prepared for emergency dialysis treatment and those who had not. Cross tabulations were performed on the 2 groups using the following participant attributes: preparedness for dialysis during a disaster, knowledge of how to protect themselves during a disaster, and intention to dialyze and evacuate during a disaster, followed by binomial logistic regression analysis.Of the 256 study patients, 184 (71.9%) were not prepared for dialysis treatment. In logistic regression models, patients who were not prepared for dialysis treatment were found to have higher odds of being employed (odds ratio (OR): 2.469; 95% confidence interval (CI): 1.205-5.058), not being aware of disaster information acquisition methods in the event of a disaster (OR: 4.580, 95%; CI: 2.048-10.241), did not receive explanations on proper disaster response from dialysis facility staff (OR: 2.557, 95%; CI: 1.319-4.954), and believing that their family away from home would not be concerned about them (OR: 2.021; 95% CI: 1.062-3.847).Disaster preparedness in patients undergoing dialysis remain inadequate. Dialysis facilities need to strengthen their explanations of disaster response, particularly with regard to working, middle-aged people.

Depression, Insomnia, and Probable Post-Traumatic Stress Disorder among Survivors of the 2016 Kumamoto Earthquake and Related Factors during the Recovery Period Amidst the COVID-19 Pandemic

The aftereffects of the severe 2016 Kumamoto earthquake were complicated by the COVID-19 pandemic. This study aimed to identify mental health problems and related factors among survivors five years after the earthquake and clarify its long-term effects. A cross-sectional survey was conducted in 2020 among 19,212 survivors affected by the earthquake who moved from temporary to permanent housing. We analysed 8966 respondents (5135 women, 3831 men; mean age 62.25 ± 17.29 years). Logistic regression analysis was conducted to examine associations between mental health problems and socioeconomic factors. Prevalence rates of psychological distress, insomnia, and probable post-traumatic stress disorder were 11.9%, 35.2%, and 4.1%, respectively. Female gender (OR = 1.33, 95% CI = 1.13–1.57; OR = 1.21, 95% CI = 1.08–1.34; OR = 1.81, 95% CI = 1.41–2.32), public housing (OR = 2.14, 95% CI = 1.63–2.83; OR = 1.54, 95% CI = 1.26–1.88; OR = 2.41, 95% CI = 1.62–3.58), loneliness (OR = 9.08, 95% CI = 7.71–10.70; OR = 5.55, 95% CI = 4.90–6.30; OR = 3.52, 95% CI = 2.77–4.49), COVID-19-induced activity reduction (OR = 1.41, 95% CI = 1.19–1.66; OR = 1.86, 95% CI = 1.68–2.07; OR = 1.80, 95% CI = 1.40–2.31), and COVID-19-induced income reduction (OR = 1.33, 95% CI = 1.12–1.57; OR = 1.43, 95% CI = 1.28–1.59; OR = 1.92, 95% CI = 1.51–2.43) were significantly associated with mental health problems. These results suggest that gender, current housing, loneliness, and COVID-19 affected the survivors’ mental health during recovery.