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Ratter-Rieck JM, Roden M, Herder C. Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders. Diabetologia 2023; 66:1003-1015. [PMID: 36964771 PMCID: PMC10039694 DOI: 10.1007/s00125-023-05901-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 03/26/2023]
Abstract
Climate change will be a major challenge for the world's health systems in the coming decades. Elevated temperatures and increasing frequencies of heat waves, wildfires, heavy precipitation and other weather extremes can affect health in many ways, especially if chronic diseases are already present. Impaired responses to heat stress, including compromised vasodilation and sweating, diabetes-related comorbidities, insulin resistance and chronic low-grade inflammation make people with diabetes particularly vulnerable to environmental risk factors, such as extreme weather events and air pollution. Additionally, multiple pathogens show an increased rate of transmission under conditions of climate change and people with diabetes have an altered immune system, which increases the risk for a worse course of infectious diseases. In this review, we summarise recent studies on the impact of climate-change-associated risk for people with diabetes and discuss which individuals may be specifically prone to these risk conditions due to their clinical features. Knowledge of such high-risk groups will help to develop and implement tailored prevention and management strategies to mitigate the detrimental effect of climate change on the health of people with diabetes.
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Affiliation(s)
- Jacqueline M Ratter-Rieck
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Hirai H, Okazaki K, Ohira T, Maeda M, Sakai A, Nakano H, Hayashi F, Nagao M, Harigane M, Takahashi A, Ohira H, Kazama JJ, Hosoya M, Yabe H, Suzuki Y, Yasumura S, Ohto H, Kamiya K, Shimabukuro M. Suboptimal diabetic control and psychological burden after the triple disaster in Japan: the Fukushima Health Management Survey. BMJ Open Diabetes Res Care 2021; 9:9/1/e002007. [PMID: 34497045 PMCID: PMC8438729 DOI: 10.1136/bmjdrc-2020-002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/17/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION A triple disaster struck eastern Japan in March 2011. We investigated the psychological distress and post-traumatic stress disorder (PTSD) symptoms caused by the disaster in people without or with diabetes mellitus. RESEARCH DESIGN AND METHODS This cross-sectional analysis examined the 16 097 evacuees (1820 (11.3%) with and 14 277 (88.7%) without diabetes mellitus) included in the Fukushima Health Management Survey. Non-specific mental health distress was assessed using the Kessler-6 Scale, and traumatic symptoms were evaluated using the PTSD Checklist. Logistic regression analyses were used to estimate the OR and 95% CI associated with symptoms, adjusted for diabetes-related and disaster-related factors. RESULTS In the age-adjusted and sex-adjusted logistic models, suboptimal diabetic control (hemoglobin A1c (HbA1c) ≥7%) was associated with both psychological distress and possible PTSD. In the same models, current smoking, evacuation, and sleep dissatisfaction were associated with psychological distress and possible PTSD. In the multivariate-adjusted logistic models, HbA1c ≥7% was associated with psychological distress, independent of job change, evacuation, or sleep dissatisfaction. CONCLUSION After the triple disaster, non-specific mental health distress was associated with suboptimal diabetic control. Thus, patients with diabetes, especially those with suboptimal diabetic control, may be vulnerable to postdisaster psychological burden.
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Affiliation(s)
- Hiroyuki Hirai
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Japan
| | - Kanako Okazaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masaharu Maeda
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hironori Nakano
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Fumikazu Hayashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masanori Nagao
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mayumi Harigane
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromasa Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junichiro James Kazama
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirooki Yabe
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuriko Suzuki
- Department of Adult Mental Health, National Center of Neurology and Psychiatry National Institute of Mental Health, Kodaira, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima, Japan
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Medical Problems and Concerns with Temporary Evacuation Shelters after Great Earthquake Disasters in Japan: A Systematic Review. Disaster Med Public Health Prep 2021; 16:1645-1652. [PMID: 34103106 DOI: 10.1017/dmp.2021.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Japan has repeatedly suffered from natural disasters. A number of temporary evacuation shelters have been opened for the benefit of evacuees. Although the operation of such evacuation shelters has improved after the Great Hanshin-Awaji Earthquake (1995), a number of operational difficulties were encountered during the Great East Japan Earthquake in 2011 and the Kumamoto Earthquake in 2016. A systematic literature review was conducted to identify the medical concerns encountered in temporary evacuation shelters by focusing on unsanitary environment, food and nutrition, and shortage of medication. Actual sanitary conditions have been found to be below the standards stipulated by the Japanese government as per international guidelines. Food aid in evacuation shelters was neither nutritionally balanced, nor was the distribution to different shelters balanced. Furthermore, evacuees with chronic diseases feared that there may be a shortage of medication. Crowding in evacuation shelters increased the risk of outbreaks of infectious diseases (e.g., tuberculosis). Malnutrition and shortage of medication exacerbated the risk of deterioration of chronic diseases (e.g., diabetes mellitus, hypertension) among evacuees. Therefore, it is recommended that healthcare professionals should be promptly deployed to evacuation shelters, to promote sanitary control and education, as well as address limited space availability, and food and medication shortage.
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Imai J. Regulation of Adaptive Cell Proliferation by Vagal Nerve Signals for Maintenance of Whole-Body Homeostasis: Potential Therapeutic Target for Insulin-Deficient Diabetes. TOHOKU J EXP MED 2021; 254:245-252. [PMID: 34373421 DOI: 10.1620/tjem.254.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In insulin-resistant states such as obesity, pancreatic β-cells proliferate to prevent blood glucose elevations. Failure of this β-cells proliferative response leads to the development of diabetes. On the other hand, when organs are damaged, cells proliferate to repair the organs. Therefore, these proliferations are compensatory mechanisms aimed at maintaining whole-body homeostasis. We previously discovered vagal signal-mediated systems regulating adaptive proliferation of β-cells and hepatocytes. Neuron-mediated liver-β-cell inter-organ crosstalk is involved in promotion of β-cell proliferation during obesity, and in this system, vagal signals directly stimulate β-cell proliferation. Meanwhile, in the liver, the multi-step mechanisms whereby vagal nerve signals activate hepatic resident macrophages are involved in hepatocyte proliferation after severe injury. Diabetes mellitus develops on the pathological basis of insufficient insulin action. Insulin action insufficiency is attributable to insulin resistance, i.e., the failure of insulin to exert sufficient effects, and/or to impairment of insulin secretion. Impairment of insulin secretion is attributable not only to the β-cell dysfunction but also to functional β-cell mass reduction. In this regard, there are already therapeutic options to increase insulin secretion from residual β-cells, such as sulfonyl urea and incretin-related drugs. In contrast, there are as yet no applicable therapeutic strategies to increase functional β-cell mass in vivo. Therefore, we have conducted the basic investigations to tackle this issue based on the discovery of neuron-mediated liver-β-cell inter-organ crosstalk. This review introduces vagal signal-mediated regulatory systems of adaptive cell proliferation in vivo and efforts to develop cell-increasing therapies based on vagal nerve-mediated cell proliferation.
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Affiliation(s)
- Junta Imai
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine
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Kondo T, Miyakawa N, Motoshima H, Hanatani S, Ishii N, Igata M, Yoshinaga K, Kukidome D, Senokuchi T, Kawashima J, Furukawa N, Matsumura T, Araki E. Impacts of the 2016 Kumamoto Earthquake on glycemic control in patients with diabetes. J Diabetes Investig 2019; 10:521-530. [PMID: 29978571 PMCID: PMC6400205 DOI: 10.1111/jdi.12891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/19/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION On April 14 and 16 2016, the Kumamoto area was severely damaged by several massive magnitude 7 class earthquakes. MATERIALS AND METHODS To examine the effects of these earthquakes on glycemic control and stress factors, glycated hemoglobin, glycated albumin, other biochemical parameters, a self-administered lifestyle-associated questionnaire and disaster-associated stress scores were analyzed. A total of 557 patients with diabetes were enrolled, and data were collected at 13 months before to 13 months after the earthquakes. RESULTS In patients with type 1 diabetes and specific types of diabetes due to other causes, glycemic control was not altered during the observational period. This glycemic stability in type 1 diabetes might result from self-management of insulin doses. In patients with type 2 diabetes, glycated hemoglobin decreased by 0.11% (from 7.33 to 7.22%) at 1-2 months after the earthquakes, and increased thereafter. The reduction of glycated hemoglobin after 1-2 months in type 2 diabetes was associated with 'early restoration of lifelines' and 'sufficient sleep.' The glycemic deterioration at a later stage was related to 'shortage of antidiabetic agents,' 'insufficient amount of food,' 'largely destroyed houses' and 'changes in working environments.' Disaster-associated stress levels were positively correlated with 'age,' 'delayed restoration of lifelines,' 'self-management of antidiabetic agents' and 'increased amount of physical activity/exercise,' and negatively associated with 'early restoration of lifelines' and 'sufficient sleep.' CONCLUSIONS Glycemic control, associated factors and stress levels are altered in chronological order. Post-disaster diabetic medical care must consider these corresponding points in accordance with the time-period.
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Affiliation(s)
- Tatsuya Kondo
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Nobukazu Miyakawa
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Hiroyuki Motoshima
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Satoko Hanatani
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Norio Ishii
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Motoyuki Igata
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Kayo Yoshinaga
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Daisuke Kukidome
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Takafumi Senokuchi
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Junji Kawashima
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Noboru Furukawa
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Takeshi Matsumura
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Eiichi Araki
- Department of Metabolic MedicineFaculty of Life SciencesKumamoto UniversityKumamotoJapan
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Harville EW, Shankar A, Zilversmit L, Buekens P. Self-Reported Oil Spill Exposure and Pregnancy Complications: The GROWH Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070692. [PMID: 28654004 PMCID: PMC5551130 DOI: 10.3390/ijerph14070692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 06/15/2017] [Accepted: 06/22/2017] [Indexed: 12/30/2022]
Abstract
Adverse infant outcomes often rise in the aftermath of disaster, but few studies have assessed the effects of disaster on maternal health. 1091 southern Louisiana women were interviewed about their pregnancy history, including pregnancy complications. Associations between oil spill exposures and gestational diabetes, hypertensive disorders, and nausea/vomiting were assessed for all reported pregnancies. 631 women had a pregnancy both before and after the oil spill. Generalized estimating equations (logistic regression) with adjustment for confounders were used. To assess possible unmeasured confounding, instead of considering oil spill exposure as a time-varying exposure, women were defined as oil spill-exposed or not. If oil spill-exposed women were equally prone to complications in pregnancies that occurred prior to the oil spill as after it, it was considered that any associations were likely due to selection or reporting issues. Women who reported oil spill exposure, particularly loss of use of the coast, were more likely to report gestational diabetes; however, the level of association was similar for pregnancies before and after the spill (p for interaction >0.10 and odds ratios (ORs) for pregnancies prior to the spill > than those after the spill). No associations were found between oil spill exposure and hypertensive disorders. This analysis does not suggest an increased risk of pregnancy complications associated with exposure to the oil spill; however, future studies should assess exposure and outcomes prospectively and clinically instead of relying on self-report.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal St. Ste. 2000 #8318, New Orleans, LA 70112-2715, USA.
| | - Arti Shankar
- Department of Global Biostatistics and Data Science, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112-2715, USA.
| | - Leah Zilversmit
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal St. Ste. 2000 #8318, New Orleans, LA 70112-2715, USA.
| | - Pierre Buekens
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal St. Ste. 2000 #8318, New Orleans, LA 70112-2715, USA.
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Tsuboya T, Inoue M, Satoh M, Asayama K. Perspectives acquired through long-term epidemiological studies on the Great East Japan Earthquake. Environ Health Prev Med 2017; 22:3. [PMID: 29165127 PMCID: PMC5661910 DOI: 10.1186/s12199-017-0615-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 03/04/2017] [Indexed: 11/25/2022] Open
Abstract
The Great East Japan Earthquake (GEJE) and subsequent tsunamis that occurred in 2011 caused extensive and severe structural damage and interrupted numerous research activities; however, the majority of such activities have been revived, and further public health researches and activities have started to follow the population affected by the disaster. In this mini-review, we overview our recent activities regarding epidemiologic studies in Miyagi Prefecture, the region most affected by the GEJE. Through our study processes, we were able to identify the particular characteristics of vulnerable populations, and provide ideas that may help save lives and reduce the amount of damage caused by a future disaster. Long-term follow-up and care of survivors is essential in affected areas, and health professionals should pay particular attention to various diseases, e.g., cardiovascular complications and mental disorders. Furthermore, building up resilience and social relationships in the community is beneficial to survivors. Ongoing cohort studies conducted before disasters can help minimize biases regarding the survivors’ pre-disaster information, and emerging cohort studies after disasters can find potential helpful novel indices. To identify characteristics of vulnerable populations, save lives, and reduce the amount of damage caused by a future disaster, constant research that is consistently improved by new data needs to be performed.
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Affiliation(s)
- Toru Tsuboya
- Liaison Center for Innovative Dentistry / Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-cho, Aoba-ku, Sendai, 980-0872, Japan
| | - Mariko Inoue
- Graduate School of Public Health, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aobaku, Sendai, 981-8558, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan. .,Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575, Japan.
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Ebner DK, Ohsawa M, Igari K, Harada KH, Koizumi A. Lifestyle-related diseases following the evacuation after the Fukushima Daiichi nuclear power plant accident: a retrospective study of Kawauchi Village with long-term follow-up. BMJ Open 2016; 6:e011641. [PMID: 27401362 PMCID: PMC4947762 DOI: 10.1136/bmjopen-2016-011641] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Kawauchi Village lies 20 km west of the Fukushima Daiichi nuclear power plant. On 16 March 2011, evacuation was ordered due to the threat of radiological exposure, and was lifted in April 2012. In this study, we aimed to evaluate the predisaster and postdisaster health status of the Kawauchi Villagers, measured by routine yearly physical examinations. METHODS We analysed the annual health examination data of residents of Kawauchi Village from 2008 to 2013, as available from the Japanese National Health Insurance system. Data from 2011 were not available due to the disaster. Since the health data included the same participants repeatedly from year to year, the sample was non-independent and generalised estimated equation modelling was used. A predisaster time period (2008-2010) was categorised for comparison with postdisaster 2012 and 2013. The outcome examined was the prevalence of metabolic disease, and was adjusted for confounding factors. RESULTS Data for 20.6%-25.9% of the total residents were available in this period. In 2013, the prevalence of metabolic syndrome (from 17.0% to 25.2%, p<0.001), diabetes (from 11.3% to 17.0%, p<0.001), dyslipidaemia (from 43.2% to 56.7%, p<0.0001), hyperuricaemia (from 5.2% to 8.4%, p=0.006) and chronic kidney disease (from 16.1% to 26.7%, p<0.001) was found to be elevated significantly compared to predisaster years, while that of obesity or hypertension did not change. CONCLUSIONS The present follow-up study for Kawauchi Village revealed an increase in lifestyle-related disease following the March 2011 disaster and subsequent evacuation, and this trend still continues 2 years later.
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Affiliation(s)
- Daniel K Ebner
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Brown University Alpert Medical School, Providence, Rhode Island, USA
| | - Megumi Ohsawa
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keiko Igari
- Yufune Health Care Center, Kawauchi Village Office, Fukushima, Japan
| | - Kouji H Harada
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Koizumi
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Lee DC, Gupta VK, Carr BG, Malik S, Ferguson B, Wall SP, Smith SW, Goldfrank LR. Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy. BMJ Open Diabetes Res Care 2016; 4:e000248. [PMID: 27547418 PMCID: PMC4964212 DOI: 10.1136/bmjdrc-2016-000248] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/13/2016] [Accepted: 07/01/2016] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012. RESULTS In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. CONCLUSIONS We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Vibha K Gupta
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Brendan G Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Health & Human Services, Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness & Response, Washington, DC, USA
| | - Sidrah Malik
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Brandy Ferguson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Lewis R Goldfrank
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
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Tanaka M, Imai J, Satoh M, Hashimoto T, Izumi T, Sawada S, Uno K, Hasegawa Y, Kaneko K, Yamada T, Ishigaki Y, Imai Y, Katagiri H. Impacts of the Great East Japan Earthquake on diabetic patients. J Diabetes Investig 2015; 6:577-86. [PMID: 26417417 PMCID: PMC4578499 DOI: 10.1111/jdi.12336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/12/2015] [Accepted: 01/29/2015] [Indexed: 12/24/2022] Open
Abstract
AIMS/INTRODUCTION We investigated impacts of the Great East Japan Earthquake on diabetic patients and characterized those with disaster-susceptible diabetes. MATERIALS AND METHODS We enrolled 497 diabetic patients who had been followed at hospitals in devastated areas. We collected metabolic parameters prospectively, 1 and 3 months after the earthquake, and retrospectively for pre-earthquake time-points. Questionnaire surveys were carried out regarding earthquake-related damage and post-earthquake lifestyle alterations. Available data were analyzed to examine associations with post-earthquake glycosylated hemoglobin alterations. RESULTS The mean glycosylated hemoglobin level of the participants was not elevated at 1 month, and was significantly decreased at 3 months as compared with the pre-earthquake glycosylated hemoglobin. There were no significant differences in earthquake-related damage or lifestyle alterations between the improved and worsened glycemic control groups according to the data obtained from the questionnaire survey. As reported, fasting serum C-peptide levels were significantly lower in the worsened glycemic control group (P < 0.05). Notably, plasma noradrenaline levels were significantly higher in the worsened glycemic control group (P < 0.05). Furthermore, at 1 month after the earthquake, the plasma noradrenaline level was significantly higher in the low C-peptide group (fasting serum C-peptide <1.0 ng/mL) than in the high C-peptide group (fasting serum C-peptide ≥1.0 ng/mL), but this difference had disappeared by 3 months after the earthquake. These findings show that post-earthquake plasma noradrenaline levels were temporarily increased in the low C-peptide group. CONCLUSIONS Sympathetic nerve activation might be elicited more easily in subjects with lower endogenous insulin secretory capacity, and could be involved in the mechanism underlying post-earthquake worsening of glycemic control.
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Affiliation(s)
- Mamiko Tanaka
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Junta Imai
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Michihiro Satoh
- Department of Pharmacy, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Takanao Hashimoto
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Medicine and Pharmaceutical Sciences Sendai, Miyagi, Japan
| | - Tomohito Izumi
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Shojiro Sawada
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Kenji Uno
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Yutaka Hasegawa
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Keizo Kaneko
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Tetsuya Yamada
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
| | - Yasushi Ishigaki
- Department of Diabetes and Metabolism, Iwate Medical University Hospital Morioka, Iwate, Japan
| | - Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Medicine and Pharmaceutical Sciences Sendai, Miyagi, Japan
| | - Hideki Katagiri
- Department of Diabetes and Metabolism, Tohoku University Hospital Sendai, Miyagi, Japan
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