Diagnostic accuracy of Japanese posttraumatic stress measures after a complex disaster: The Fukushima Health Management Survey

BACKGROUND

The Posttraumatic Stress Disorder (PTSD) Checklist (PCL) has been widely used among traumatized populations to screen people with PTSD; however, the Japanese version of the PCL has yet to be validated. We examined the diagnostic accuracy of the Japanese version PCL-Specific (PCL-S) and the abbreviated versions of the PCL-S among the evacuees of the Fukushima Daiichi Nuclear Power Plant accident.

METHODS

Fifty-one participants were recruited from an evacuee and clinical sample. The PCL-S, Impact of Event Scale-Revised (IES-R), and World Health Organization Composite International Diagnostic Interview were administered. Screening properties of the PCL-S, IES-R, and abbreviated PCL-S against PTSD diagnosis, including sensitivity, specificity, and diagnostic efficiency, were calculated. Receiver operating characteristic curves were drawn, and optimal cutoff points were examined.

RESULTS

The sensitivity, specificity, and diagnostic efficiency of the PCL-S were 66.7%, 84.9%, and 79.2%, respectively (at 52, the area under the curve was 0.83). The cutoff point method for the PCL-S performed better than did the symptom cluster method. The screening properties of the abbreviated versions were comparable with those of the full version.

CONCLUSIONS

The Japanese version of the PCL-S showed moderate diagnostic accuracy and improved performance over the IES-R for PTSD diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. The Japanese version of the PCL-S was a reliable and valid measure, and its diagnostic accuracy was reasonable for both full and abbreviated versions.

Radioactive impacts on nekton species in the Northwest Pacific and humans more than one year after the Fukushima nuclear accident

This study investigated the radioactive impacts on 10 nekton species in the Northwest Pacific more than one year after the Fukushima Nuclear Accident (FNA) from the two perspectives of contamination and harm. Squids were especially used for the spatial and temporal comparisons to demonstrate the impacts from the FNA. The radiation doses to nekton species and humans were assessed to link this radioactivity contamination to possible harm. The total dose rates to nektons were lower than the ERICA ecosystem screening benchmark of 10μGy/h. Further dose-contribution analysis showed that the internal doses from the naturally occurring nuclide ²¹⁰Po were the main dose contributor. The dose rates from ¹³⁴Cs, ¹³⁷Cs, ⁹⁰Sr and ^110mAg were approximately three or four orders of magnitude lower than those from naturally occurring radionuclides. The ²¹⁰Po-derived dose was also the main contributor of the total human dose from immersion in the seawater and the ingestion of nekton species. The human doses from anthropogenic radionuclides were ~ 100 to ~ 10,000 times lower than the doses from naturally occurring radionuclides. A morbidity assessment was performed based on the Linear No Threshold assumptions of exposure and showed 7 additional cancer cases per 100,000,000 similarly exposed people. Taken together, there is no need for concern regarding the radioactive harm in the open ocean area of the Northwest Pacific.

Impacts of the 2011 Fukushima nuclear accident on emergency medical service times in Soma District, Japan: a retrospective observational study

OBJECTIVE

To assess the influence of the 3.11 triple disaster (earthquake, tsunami and nuclear accident) on the emergency medical service (EMS) system in Fukushima.

METHODS

Total EMS time (from EMS call to arrival at a hospital) was assessed in the EMS system of Soma district, located 10-40 km north of the nuclear plant, from 11 March to 31 December 2011. We defined the affected period as when total EMS time was significantly extended after the disasters compared with the historical control data from 1 January 2009 to 10 March 2011. To identify risk factors associated with the extension of total EMS time after the disasters, we investigated trends in 3 time segments of total EMS time; response time, defined as time from an EMS call to arrival at the location, on-scene time, defined as time from arrival at the location to departure, and transport time, defined as time from departure from the location to arrival at a hospital.

RESULTS

For the affected period from week 0 to week 11, the median total EMS time was 36 (IQR 27-52) minutes, while that in the predisaster control period was 31 (IQR 24-40) min. The percentage of transports exceeding 60 min in total EMS time increased from 8.2% (584/7087) in the control period to 22.2% (151/679) in the affected period. Among the 3 time segments, there was the most change in transport time (standardised mean difference: 0.41 vs 0.13-0.17).

CONCLUSIONS

EMS transport was significantly delayed for ∼3 months, from week 1 to 11 after the 3.11 triple disaster. This delay may be attributed to malfunctioning emergency hospitals after the triple disaster.

Impact of the Fukushima Dai-ichi Nuclear Power Plant Accident on dolphin fishes in the Northwest Pacific

More than 9 years since the Fukushima Dai-ichi Nuclear Power Plant Accident (FDNPPA), the impact of FDNPPA on marine biota is being revealed. In this work, the evolution of FDNPPA derived ¹³⁴Cs, ¹³⁷Cs and ^110mAg in dolphin fishes (Coryphaena hippurus) in the Northwest Pacific from Dec. 2011 to Sept. 2018 were studied. Bioconcentration factors (BCF) of radiocesium (29-69 with the average of 48) in dolphin fishes were calculated. The background level of ¹³⁷Cs in dolphin fishes (<0.14 Bq/kg_{fresh weight}) before FDNPPA was estimated. The radioactive levels of these three radionuclides in dolphin fishes decreased with time. Among them, ¹³⁴Cs and ^110mAg decreased at the half-lives of 158 days and 54 days at the population level, respectively. After May 2014, ¹³⁴Cs and ^110mAg cannot be detected and the activity of ¹³⁷Cs returned to the background level before FDNPPA. Radiation dose assessment demonstrated that it was far from causing radiation harm to dolphin fishes in the open ocean of Northwest Pacific and humans who ingested them.

How to Deal With the Risk of Evacuation of Psychiatric Hospital in Nuclear Disaster: A Case Study

OBJECTIVE

People with psychiatric disorders are one of the most vulnerable populations in disasters, and the 2011 Great East Japan Earthquake reported higher post-evacuation mortality rates among psychiatric inpatients. A psychiatric hospital evacuated after the nuclear accident was surveyed to gain valuable insights for future disaster preparedness.

METHODS

The authors interviewed two Odaka Akasaka Hospital (a private psychiatric hospital) staff responsible for evacuation due to the nuclear accident.

RESULTS

At the time of the earthquake, 104 patients had been admitted to the hospital. They were instructed to evacuate on the grounds that they existed within a 20 km radius of Fukushima Daiichi Nuclear Power Station. Although the evacuation process was extraordinarily demanding, the staff acted professionally, and no patient experienced a significant deterioration in health during the evacuation.

CONCLUSION

It was reasonable to follow the evacuation order because of the difficulty of obtaining accurate information about radiation exposure and staff availability in high-risk situations. The staff's knowledgeable and attentive care of the patients was one of the factors that enabled them to successfully carry out this severe evacuation. However, this may be related to the high mortality rate after the evacuation of patients who were separated from such caregivers.

Establishing historical 90Sr activity in seawater of the China seas from 1963 to 2018

Historical ⁹⁰Sr activity in seawater was established in the China seas from 1963 to 2018. Based on the exponential decrease in ⁹⁰Sr activity in seawater, the effective half-life (EHL) of ⁹⁰Sr was quantified to be 11.5 ± 1.6 a, 16.5 ± 2.4 a, 27.2 ± 6.2 a, and 26.7 ± 4.3 a in the Bohai Sea, Yellow Sea, East China Sea, and South China Sea, respectively. We found contrasting patterns in the EHL of ⁹⁰Sr and ¹³⁷Cs in the marginal seas and open oceans that were closely related to the subtly different pathways of ⁹⁰Sr and ¹³⁷Cs in marine environment. Additionally, we demonstrated that Fukushima-derived ⁹⁰Sr (<0.01 Bq/m³) would be difficult to identify in the China seas. Our study not only provided the key parameter of the EHL in marine models for predicting the ⁹⁰Sr activity in the China seas in the post-Fukushima era but also enhanced our understanding of ⁹⁰Sr behavior and its fate in marine environments.

The mental health status of children who have been evacuated or migrated from rural areas in Fukushima prefecture after the Fukushima daiichi nuclear power station accident:results from the Fukushima health management survey

INTRODUCTION

We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children's experience of the nuclear disaster.

METHODS

We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS);FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the "Strengths and Difficulties Questionnaire (SDQ)" scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster - "nuclear disaster (+)" and "nuclear disaster (-)" - were also compared.

RESULTS

Our effective response was 93 (59.6%);the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between "elementary school" and "junior high school" or "nuclear disaster" (+) and (-). There was no significant difference between these items.

CONCLUSIONS

We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster.

Radiation Emergency Medical Preparedness in Japan: A Survey of Nuclear Emergency Core Hospitals

OBJECTIVE

Based on experiences following the Great East Japan Earthquake and nuclear power plant accident in 2011, Nuclear Emergency Core Hospitals (NECHs) were designated as centers for radiation disaster management in Japan. This study aimed to investigate their current status and identify areas for improvement.

METHODS

This cross-sectional study was conducted in October 2018. Demographic data were collected by a questionnaire with free text responses about attitudes toward NECHs. Considerations regarding risk communications during a radiation disaster were analyzed using qualitative text mining analysis.

RESULTS

A total of 36 hospitals participated in this study. Only 31% of NECHs anticipated a radiation disaster. The importance of business continuity plans and risk communications was shown. Text analysis identified 7 important categories for health care workers during a radiation disaster, including media response, communications to hospital staff, risk communications, radiation effects on children, planning for a radiation disaster in the region, rumors, and the role in the region.

CONCLUSION

The radiation disaster medical system and NECHs in Japan were surveyed. The importance of risk communications, planning for a radiation disaster in each region, and the role in the region are identified as issues that need to be addressed.