Publications by authors named "Masaharu Tsubokura"

186 Publications

Association of Living in Evacuation Areas With Long-Term Care Need After the Fukushima Accident.

J Am Med Dir Assoc 2021 Jun 16. Epub 2021 Jun 16.

Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan; Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan. Electronic address:

Objectives: A previous report indicated that evacuation owing to the government order after the Fukushima disaster impacted the health status of older people; however, the association between living in evacuation areas and independence in their daily lives was unclear. This study examined the hypothesis that people who were forced to evacuate their homes were more likely to need long-term care (LTC).

Design: Historical cohort study.

Setting And Participants: Older individuals (n = 13,934) in Minamisoma, Fukushima Prefecture, Japan, part of which was designated as an evacuation area.

Methods: Background and certification data from April 2012 to December 2016 were extracted. Logistic regression analysis with sex stratification was performed to examine the association between certification of care levels 1-5 and living in evacuation areas.

Results: In total, 18,178 Minamisoma residents aged ≥65 years who had not received LTC certification as of March 11, 2011, were eligible for follow-up. Of these, 4244 residents without a certificate of residence by June 1, 2016, were excluded. Of 13,934 residents followed up, 1553 (11.1%) were newly certified as care levels 1-5. Certification of care levels 1-5 was associated with living in evacuation areas [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.20-2.18] and living alone at the time of the disaster (OR 2.58, 95% CI 1.92-3.47) in men and living alone at the time of the disaster (OR 1.35, 95% CI 1.15-1.59) in women.

Conclusions And Implications: Living in evacuation areas and living alone were associated with LTC certification. In evacuation areas, individuals with family members were more likely to be certified compared with those in nonevacuation areas. Among residents in evacuation areas, several individuals with family members experiencing family structure changes might need LTC. Preventive measures (including group relocation) may be beneficial for those being evacuated following a disaster.
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http://dx.doi.org/10.1016/j.jamda.2021.05.030DOI Listing
June 2021

Regional Differences in Admission Rates of Emergency Patients Who Visited a Private General Hospital in the Capital City of Cambodia: A Three-Year Observational Study.

Int J Health Policy Manag 2021 May 19. Epub 2021 May 19.

Department of Pediatrics, Sunrise Japan Hospital Phnom Penh, Phnom Penh, Cambodia.

Background: Regional disparity is an imperative component of health disparity. In particular, providing emergency care that is equally available in rural areas is an essential part of reducing the urban-rural disparity. The objective of this study was to examine the worsening admission rate among Cambodian emergency patients in a rural area and determine their background characteristics that cause this decline.

Methods: To investigate the disparity among patients who visited Sunrise Japan Hospital (SJH), a major general private hospital in the capital, patient data from November 2016 to September 2019 were obtained from the electronic reception patient database. The primary outcome was defined as the proportion of admission patients as an indicator of illness severity. The patients' addresses were classified into 4 areas based on distance from the capital.

Results: A total of 6167 patients who visited the emergency department at SJH between January 2017 and September 2019 were included in the analysis. The proportion of patients who needed to be hospitalized or transferred increased with the distance from the capital. The proportion of patients who finished consultation decreased with the distance from the capital (<.01: Chi-square test). The results of the logistic regression analysis showed that the admission rate in rural areas was significantly higher only among males as compared to that of the capital in multivariate analyses adjusted for age, time, and season.

Conclusion: The admission rate of emergency patients who visited a private general hospital in Cambodia's capital city increased with distance from the capital city. To improve regional disparity among emergency patients, further research is necessary to identify the issues among emergency patients, especially those who are vulnerable.
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http://dx.doi.org/10.34172/ijhpm.2021.44DOI Listing
May 2021

Comparative risk assessment of non-communicable diseases by evacuation scenario- a retrospective study in the 7 years following the Fukushima Daiichi nuclear power plant accident.

Glob Health Action 2021 01;14(1):1918886

Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan.

: As a result of the Fukushima Daiichi nuclear power plant accident, many residents evacuated and were exposed to changes in their living environment and socioeconomic status, and to persistent stressors. Past studies have suggested the potential for these circumstances to contribute to long-term changes to population health.: The objective of this study was to gain a better understanding of long-term health effects of evacuation, by evaluating the risk of non-communicable diseases among evacuees from Minamisoma City (one of the closest municipalities to the power plant) until 2017.: The study evaluated data from annual health check-ups for residents aged 40-74 years covered by National Health Insurance (who are largely self-employed) from 2010 to 2017 administered by Minamisoma City. Diabetes, hyperlipidemia, and hypertension were defined from the results of blood sampling. Annual changes in age-adjusted prevalence were estimated by evacuation scenario. We also performed an inverse-probability weighting (IPW) analysis to adjust for baseline covariates in 2010 and estimated the differences in the risk of diabetes, hyperlipidemia, and hypertension by evacuation scenario as of the 2017 health check-up in reference to the no-evacuation group.: A total of 1,837 individuals were considered in this study. Regardless of evacuation scenario, there was statistical evidence suggesting an upward and a downward trend in diabetes and hypertension from 2010 to 2017, respectively, while hyperlipidemia showed no remarkable change. IPW analyses demonstrated that disease risks in 2017 did not differ significantly among people with different evacuation scenarios.: Region-specific factors played an important role in the health effects of the evacuation. Our findings have important implications for the need of an assessment of the health effects of evacuations in more localized manner. Further research in this area will strengthen the communities' preparedness for future disasters that require mass evacuation.
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http://dx.doi.org/10.1080/16549716.2021.1918886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172221PMC
January 2021

Mental distress in a clinical nurse due to a false-positive COVID-19 antibody test result during the COVID-19 epidemic in Japan: A case report.

Clin Case Rep 2021 May 15;9(5):e04122. Epub 2021 May 15.

Department of Radiation Health Management Fukushima Medical University School of Medicine Fukushima City Japan.

This study suggests the importance of instituting accompanying measures to prevent potential negative mental and social impacts on people receiving false-positive results.
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http://dx.doi.org/10.1002/ccr3.4122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123730PMC
May 2021

Successful emergency evacuation from a hospital within a 5-km radius of Fukushima Daiichi Nuclear Power Plant: the importance of cooperation with an external body.

J Radiat Res 2021 May;62(Supplement_1):i122-i128

Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan.

Emergency evacuation during a disaster may have serious health implications in vulnerable populations. After the accident at the Fukushima Daiichi Nuclear Power Plant (FDNPP) in March 2011, the Japanese central government immediately issued an evacuation order for residents living near the plant. There is limited information on the process of evacuation from medical institutions within the evacuation zone and the challenges faced. This study collected and analyzed publicly available resources related to the Futaba Kosei Hospital, located 3.9 km northwest of the FDNPP, and reviewed the hospital's evacuation procedures. On the day of the accident at the FDNPP, 136 patients were admitted in the aforementioned hospital. The hospital's director received information about the situation at the FDNPP from the local disaster task force and requested the immediate evacuation of all patients. Consequently, four patients, including those with an end-stage condition, died during the evacuation. Early intervention by external organizations, such as the Japan Self-Defense Forces, helped the hospital to complete the evacuation without facing major issues. However, despite such an efficient evacuation, the death of four patients suggests that a significant burden is placed on vulnerable people during emergency hospital evacuations. Those with compromised health experience a heavy burden during a nuclear disaster. It is necessary for hospitals located close to a nuclear power plant to develop a more detailed evacuation plan by determining the methods of communication with external organizations that could provide support during evacuation to minimize the burden on vulnerable patients.
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http://dx.doi.org/10.1093/jrr/rraa122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114205PMC
May 2021

Risk trade-off analysis of returning home and radiation exposure after a nuclear disaster using a happy life expectancy indicator.

J Radiat Res 2021 May;62(Supplement_1):i101-i106

Research Center for Community Health, Minamisoma Municipal General Hospital, 2-54-6 Takami, Haramachi, Minamisoma, Fukushima, 975-0033, Japan.

It is crucial to evaluate ethical issues regarding evacuation orders, especially after a nuclear disaster. After the Fukushima accident in 2011, the Japanese government ordered the affected people to evacuate. The evacuation orders have now been lifted in many areas. A risk trade-off analysis between benefits and risk associated with returning home would help in evaluating the justification for the lifting of the evacuation order in the aftermath of a nuclear disaster. Here, we performed a risk trade-off analysis among people returning home after the lifting of an evacuation order between an increase in emotional happiness (positive effect) and loss of life expectancy due to additional radiation exposure (negative effect), using a happy life expectancy (HpLE) indicator. Emotional happiness was estimated using questionnaires distributed among the affected people who lived in municipalities where evacuation orders were lifted. Loss of life expectancy was estimated under a scenario that returnees received 20 mSv in the year of return and subsequent radiation exposure. Increase in emotional happiness due to returning home was ~1-2 orders of magnitude higher among women aged 20, 40 and 65 years than the loss of life expectancy due to additional radiation exposure. This finding has implications for the justification for the lifting of evacuation orders.
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http://dx.doi.org/10.1093/jrr/rraa109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114204PMC
May 2021

Alleviating the consequences of nuclear disasters on views on radiation risks among physicians and patients: Fukushima experience.

J Glob Health 2021 Apr 30;11:03069. Epub 2021 Apr 30.

Department of Radiation Oncology, Fukushima Medical University School of Medicine, Fukushima, Japan.

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http://dx.doi.org/10.7189/jogh.11.03069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053391PMC
April 2021

Response To Commentary By Kageura, et. al.

QJM 2021 Apr 27. Epub 2021 Apr 27.

Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan.

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http://dx.doi.org/10.1093/qjmed/hcab082DOI Listing
April 2021

Overall health information exposure, its barriers and impacts on attitude toward healthcare among cancer patients. The long-term aftermath of the 2011 triple disaster in Fukushima, Japan: A single institution cross-sectional study.

Health Informatics J 2021 Apr-Jun;27(2):1460458221996420

Minamisoma Municipal General Hospital, Japan.

Disasters can hinder access to health information among cancer patients. However, little is known regarding overall health information exposure (HIE), its barriers and its impacts on attitudes toward healthcare among cancer patients in the long-term aftermath of disasters. The aims of this study were threefold: assess the extent of HIE; identify associations between family composition and a non-engagement with HIE; and examine the effects of HIE on attitudes toward healthcare among local cancer patients-5 years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Fukushima, Japan. We conducted self-administered surveys with all cancer and non-cancer surgery department outpatients at Minamisoma Municipal General Hospital (MMGH), Minamisoma City, from October 2016 to January 2017. In total, 404 patients (263 cancer patients and 141 non-cancer patients) voluntarily participated in the study. The results revealed that a regular level of HIE occurred among 90.5% of the cancer patients. In cancer patients, family composition was not significantly associated with HIE, and HIE was not associated with attitude toward healthcare. In conclusion, most cancer patients visiting the MMGH surgical department were regularly engaged in HIE.
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http://dx.doi.org/10.1177/1460458221996420DOI Listing
April 2021

The introduction of telemedicine is required immediately in Cambodia: Barriers and lessons from COVID-19.

J Glob Health 2021 Mar 27;11:03047. Epub 2021 Mar 27.

Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.

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http://dx.doi.org/10.7189/jogh.11.03047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005305PMC
March 2021

COVID-19 risk assessment at the opening ceremony of the Tokyo 2020 Olympic Games.

Microb Risk Anal 2021 Mar 21:100162. Epub 2021 Mar 21.

Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.

The 2020 Olympic/Paralympic Games have been postponed to 2021, due to the COVID-19 pandemic. We developed a model that integrated source-environment-receptor pathways to evaluate how preventive efforts can reduce the infection risk among spectators at the opening ceremony of Tokyo Olympic Games. We simulated viral loads of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emitted from infectors through talking/coughing/sneezing and modeled temporal environmental behaviors, including virus inactivation and transfer. We performed Monte Carlo simulations to estimate the expected number of newly infected individuals with and without preventive measures, yielding the crude probability of a spectator being an infector among the 60,000 people expected to attend the opening ceremony. Two indicators, i.e., the expected number of newly infected individuals and the newly infected individuals per infector entry, were proposed to demonstrate the extent of achievable infection risk reduction levels by implementing possible preventive measures. A no-prevention scenario produced 1.5-1.7 newly infected individuals per infector entry, whereas a combination of cooperative preventive measures by organizers and the spectators achieved a 99% risk reduction, corresponding to 0.009-0.012 newly infected individuals per infector entry. The expected number of newly infected individuals was calculated as 0.005 for the combination of cooperative preventive scenarios with the crude probability of a spectator being an infector of 1 × 10. Based on our estimates, a combination of cooperative preventions between organizers and spectators is required to prevent a viral spread at the Tokyo Olympic/Paralympic Games. Further, under the assumption that society accepts < 10 newly infected persons traced to events held during the entire Olympic/Paralympic Games, we propose a crude probability of infectors of < 5 × 10 as a benchmark for the suppression of the infection. This is the first study to develop a model that can assess the infection risk among spectators due to exposure pathways at a mass gathering event.
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http://dx.doi.org/10.1016/j.mran.2021.100162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981581PMC
March 2021

A call for individualized evacuation strategies for floods: A case report of secondary surgical site infection in a postsurgery breast cancer patient in Fukushima, Japan, following Typhoon Hagibis in 2019.

Clin Case Rep 2021 Mar 15;9(3):1212-1214. Epub 2021 Jan 15.

Department of Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan.

Recognition of Individual and environmental risks is crucial to alleviate damage inflicted by disasters. In particular, an awareness of floods and their health risks in patients' residences is important for patients and their healthcare professionals.
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http://dx.doi.org/10.1002/ccr3.3727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981748PMC
March 2021

Helicobacter pylori Infection Mass Screening for Children and Adolescents: a Systematic Review of Observational Studies.

J Gastrointest Cancer 2021 Jun 24;52(2):489-497. Epub 2021 Mar 24.

Marru-Clinic Yokosuka, Yokosuka, Kanagawa, Japan.

Purpose: Population-based Helicobacter pylori (H. pylori) screening and eradication for adults in areas with a high incidence of gastric cancer have been shown to be effective. The current status of H. pylori screening for young people, however, has not been sufficiently evaluated.

Methods: A systematic review of population-based H. pylori screening of young people was performed using four databases (MEDLINE, EMBASE, the Cochrane Library, and ICHUSHI) and independently evaluated by two investigators. Studies were evaluated with regard to the country, region, screening method, target age, number of screened people, and rate of positive screening.

Results: From 3231 studies, 39 studies were included (14 English original studies published in peer-review journals, 6 Japanese original studies, and 19 conference reports). These studies originated from 10 countries, with the largest number stemming from Japan (29 studies) followed by Germany (2 studies). Screening was performed using the urea breath test, blood antibodies, stool antigens, and urine antibodies. Five countries used the breath test as the first screening method, five used blood samples, two used stool antigens, and only Japan used urinary tests.

Conclusion: Screening for H. pylori in young people was reviewed based on reports from several countries, and findings suggest that local authorities considering screening for H. pylori in young people need to scrutinize the age and potential methods. Further research is required to determine the effectiveness of mid- to long-term H. pylori screening for young people.
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http://dx.doi.org/10.1007/s12029-021-00630-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131279PMC
June 2021

Long-term Care Utilization Discrepancy Among the Elderly in Former Evacuation Areas, Fukushima.

Disaster Med Public Health Prep 2021 Mar 24:1-3. Epub 2021 Mar 24.

Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.

Objective: It is crucial to determine the health status of returnees to former evacuation areas. We aimed to examine the long-term care (LTC) utilization rate among elderly returnees as the indicator of care needs.

Methods: This study used a resident registration database to collect information on LTC utilization rate among elderly returnees to former evacuation areas in Fukushima, Japan, following the 2011 Fukushima Daiichi Nuclear Power Plant accident. LTC utilization rates were descriptively analyzed.

Results: For all age groups, the LTC utilization rates were lower among returnees than evacuees. The LTC utilization rate among returnees in each age group (chi-square test results compared to evacuees) were as follows: 0.78% (P = 0.194) for those aged 65-69, 0.69% (P = 0.003) for those aged 70-74, 3.23% (P = 0.007) for those aged 75-79, 6.79% (P < 0.001) for those aged 80-84, 22.84% (P = 0.011) for those aged 85-89, and 44.09% (P = 0.089) for those aged 90 and over.

Conclusion: Elderly returnees had fewer LTC needs than elderly evacuees. Nevertheless, the proportion of aging people is high in evacuation area, meaning the number of elderly returnees would increase at an enormous rate. Therefore, LTC utilization rate would increase in the future.
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http://dx.doi.org/10.1017/dmp.2020.481DOI Listing
March 2021

Deepening community-aligned science in response to wavering trust in science.

Lancet 2021 Mar;397(10278):969-970

Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.

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http://dx.doi.org/10.1016/S0140-6736(21)00358-5DOI Listing
March 2021

The Nepalese health care system and challenges during COVID-19.

J Glob Health 2021 Feb 11;11:03030. Epub 2021 Feb 11.

Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.

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http://dx.doi.org/10.7189/jogh.11.03030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914404PMC
February 2021

Evacuation of Residents in a Natural Disaster during the COVID-19 Era.

QJM 2021 Feb 27. Epub 2021 Feb 27.

Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan.

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http://dx.doi.org/10.1093/qjmed/hcab044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989190PMC
February 2021

Exacerbation of Subthreshold PTSD Symptoms in a Great East Japan Earthquake Survivor in the Context of the COVID-19 Pandemic.

Case Rep Psychiatry 2021 10;2021:6699775. Epub 2021 Feb 10.

Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan.

Background: In 2011, the people of Fukushima, Japan, experienced the Great East Japan Earthquake (GEJE), a complex disaster of earthquake, tsunami, and nuclear accident. Its residents are experiencing a second global disaster, a COVID-19 pandemic in 2020.

Objective: In this article, we aimed at discussing the effects of subthreshold PTSD in a previous disaster on an exacerbation of PTSD symptoms in another disaster.

Method: We present a case of subthreshold PTSD in the context of a nuclear accident and exacerbation of symptoms due to the COVID-19 pandemic.

Results: Exacerbation of subthreshold PTSD symptoms was likely due to the reemergence of an urgent atmosphere similar to the previously experienced traumatic event.

Conclusions: PTSD may occur not only in those who experience the actual life-threatening like ICU admission but in those who experience the atmospheric change of society. This case demonstrated the characteristics of subthreshold PTSD caused by two disasters that shared a similar sense of insecurity, the scale of impact on the society, invisibility of the threat, restricted movement, and authoritative conflicts. These commonalities led to a recurrence and exacerbation of initial symptoms. This finding should be shared with those involved in the care system for victims' mental health suffering from a large-scale disaster, and we need further research about the issue.
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http://dx.doi.org/10.1155/2021/6699775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889341PMC
February 2021

Once-Weekly Insulin for Type 2 Diabetes without Previous Insulin Treatment.

N Engl J Med 2021 02;384(8):e26

Fukushima Medical University School of Medicine, Fukushima, Japan

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http://dx.doi.org/10.1056/NEJMc2035798DOI Listing
February 2021

The difference between IgM and IgG antibody prevalence in different serological assays for COVID-19; lessons from the examination of healthcare workers.

Int Immunopharmacol 2021 Mar 30;92:107360. Epub 2020 Dec 30.

Department of General Internal Medicine, Hirata Central Hospital, Hirata, Ishikawa district, Fukushima 963-8202, Japan; Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima 960-1295, Japan.

Objectives: The objective of this study was to investigate the differences between the results of two serology assays for detection of COVID-19 among medical staff, who are at higher risks of infection.

Methods: The immunochromatography (ICG) rapid test kit and the chemiluminescence immunoassay (CLIA) quantitative antibody test were performed. The differences in IgM and IgG antibody prevalence in different serological assays were descriptively analyzed.

Results: A total of 637 participants were included in this research. Two staff were IgM positive in the CLIA quantitative antibody test (cutoff value: 10 AU/ml) of 51 staff who were IgM positive in the rapid test kit. Six staff were IgG positive in the CLIA quantitative antibody test of 56 staff who were IgG positive in the rapid test kit. The proportion of antibody positive staff differed greatly between the rapid test kit and the CLIA quantitative antibody test.

Conclusions: There was a vast difference in the proportions of IgG and IgM antibody positive staff in the rapid test kit and the CLIA quantitative antibody test results. The results from the only rapid test kit might have to be interpreted with caution. Further studies to evaluate antibody testing accuracy are required to promote the understanding of each assay's characteristics and determine their purposes in each community.
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http://dx.doi.org/10.1016/j.intimp.2020.107360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836839PMC
March 2021

Current Psychological Distress, Post-traumatic Stress, and Radiation Health Anxiety Remain High for Those Who Have Rebuilt Permanent Homes Following the Fukushima Nuclear Disaster.

Int J Environ Res Public Health 2020 12 19;17(24). Epub 2020 Dec 19.

Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.

The Fukushima Daiichi nuclear disaster in 2011 produced psychological reactions among evacuees. Despite the harsh situation, subsequently, there has been gradual progress in reconstruction, with more than half of the evacuees returning after the evacuation. Our hypothesis is that evacuee mental health will now be better due to new stable living conditions. This study aims to clarify the statuses of psychological distress, post-traumatic stress, and radiation health anxiety among evacuees who have rebuilt permanent homes after evacuation. A cross-sectional questionnaire survey of 1600 residents was conducted in 2020. As primary outcomes, the survey measured psychological distress (Kessler 6), post-traumatic stress (post-traumatic stress four-item checklist), and radiation health anxiety. The data are compared for residents who have rebuilt permanent home and those who did not evacuate. In the co-variant analysis, the statuses of psychological distress ( < 0.001), post-traumatic stress ( < 0.001), and radiation health anxiety ( < 0.001) are found to still be high, with significant differences when compared to those who did not evacuate. These results are still at an equivalent level for the continuing evacuation. Our findings may indicate a necessity for continuing disaster-related mental health activities even though the living conditions have improved.
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http://dx.doi.org/10.3390/ijerph17249532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766246PMC
December 2020

Stay with your community: Bridges between clusters trigger expansion of COVID-19.

PLoS One 2020 3;15(12):e0242766. Epub 2020 Dec 3.

Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan.

In this study, the spread of virus infection was simulated using artificial human networks. Here, real-space urban life was modeled as a modified scale-free network with constraints. To date, the scale-free network has been adopted for modeling online communities in several studies. However, in the present study, it has been modified to represent the social behaviors of people where the generated communities are restricted and reflect spatiotemporal constraints in real life. Furthermore, the networks have been extended by introducing multiple cliques in the initial step of network construction and enabling people to contact hidden (zero-degree) as well as popular (large-degree) people. Consequently, four findings and a policy proposal were obtained. First, "second waves" were observed in some cases of the simulations even without external influence or constraints on people's social contacts or the releasing of the constraints. These waves tend to be lower than the first wave and occur in "fresh" clusters, that is, via the infection of people who are connected in the network but have not been infected previously. This implies that the bridge between infected and fresh clusters may trigger a new spread of the virus. Second, if the network changes its structure on the way of infection spread or after its suppression, a second wave larger than the first can occur. Third, the peak height in the time series of the number of infected cases depends on the difference between the upper bound of the number of people each member actually meets and the number of people they choose to meet during the period of infection spread. This tendency is observed for the two kinds of artificial networks introduced here and implies the impact of bridges between communities on the virus spreading. Fourth, the release of a previously imposed constraint may trigger a second wave higher than the peak of the time series without introducing any constraint so far previously, if the release is introduced at a time close to the peak. Thus, overall, both the government and individuals should be careful in returning to society where people enjoy free inter-community contact.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242766PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714156PMC
December 2020

Health disparity toward noncommunicable diseases among residents in rural Cambodia: a descriptive study.

J Rural Med 2020 Oct 1;15(4):212-216. Epub 2020 Oct 1.

Department of Neurosurgery, Sunrise Japan Hospital Phnom Penh, Cambodia.

Regional disparities in health services is a crucial problem in Cambodia. Particularly, a number of NCD risk factors are more common among the rural poor. Fortunately, 80% of NCDs are preventable and cost-effective interventions exist. Therefore, health care needs assessments regarding NCDs in poor rural areas are vital. The object of this pilot study was to identify health care needs regarding NCDs among residents in poor rural areas in Cambodia. A medical health check-up and questionnaire survey were conducted with 208 rural residents who participated in a free health check-up and doctor consultation in Kaoh Peam Reang. One hundred sixteen (55.8%) females were included in the total sample size of 208 participants; the majority (52.9%) were between 35 and 65 years of age. Twenty-five participants (12%) were current smokers, and 44 (21%) were current alcohol drinkers. Eighty (38.5%) participants had hypertension and 44 participants (21.2%) had a body mass index over 25. Alcohol drinking and smoking habits were more common among men. The five most frequent medical complaints were headache (18.3%), lower back pain (14.4%), foot and hand pain (13.9%), joint pain (10.1%), and difficulty breathing (10.1%). The medical need for doctor consultations regarding chronic disease and chronic pain might be higher in poor rural areas in Cambodia.
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http://dx.doi.org/10.2185/jrm.2020-028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530596PMC
October 2020

PTSD and bipolar II disorder in Fukushima disaster relief workers after the 2011 nuclear accident.

BMJ Case Rep 2020 Sep 17;13(9). Epub 2020 Sep 17.

National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.

The global threat posed by the COVID-19 pandemic has highlighted the need to accurately identify the immediate and long-term postdisaster impacts on disaster-relief workers. We examined the case of a local government employee suffering from post-traumatic stress disorder (PTSD) and bipolar II disorder following the Great East Japan Earthquake. The complex and harsh experience provoked a hypomanic response such as elated feelings with increased energy, decreased need for sleep and an increase in goal-directed activity, which allowed him to continue working, even though he was adversely affected by the disaster. However, 3.5 years later, when he suffered further psychological damage, his PTSD symptoms became evident. In addition to treating mood disorders, trauma-focused psychotherapy was required for his recovery. Thereafter, we considered the characteristics of mental health problems that emerge in disaster-relief workers, a long time after the disaster, and the conditions and treatments necessary for recovery.
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http://dx.doi.org/10.1136/bcr-2020-236725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500185PMC
September 2020

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy.

Sci Rep 2020 09 15;10(1):15096. Epub 2020 Sep 15.

Department of Anesthesiology, Southern Tohoku Research Institute for Neuroscience Southern TOHOKU General Hospital, Koriyama City, Fukushima, 963-8563, Japan.

Proton therapy for paediatric cancer patients is an effective treatment; however, young children have may have difficulties staying still during irradiation. This study investigated the indication of general anaesthesia in paediatric proton therapy. Background information and anaesthesia/treatment protocols were retrospectively extracted from the medical records of cancer patients under 15 years who underwent proton therapy at Southern TOHOKU General Hospital, Fukushima, Japan between April 2016 and December 2018. The anaesthesia and non-anaesthesia groups were compared to evaluate factors determining the need for general anaesthesia. Thirty-two patients who received 285 irradiations were analysed. The median age was 5 years old (range: 1-15), and 13 patients (40.6%) were female. Twelve (37.5%) patients received general anaesthesia. In the general anaesthesia group, airway management using a laryngeal mask was performed in 11 patients (91.6%). Patient age was significantly lower in the general anaesthesia group than in the non-anaesthetised group (p < 0.001). Considering all background factors, only age was strongly associated with anaesthesia in the univariate logistic regression model (odds ratio 0.55 [95% confidence interval 0.35-0.86]; P < 0.01). Thus, age is one of the most important factors determining the need for general anaesthesia during proton therapy in children.
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http://dx.doi.org/10.1038/s41598-020-72223-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493927PMC
September 2020

The risks and characteristics of the delayed bleeding after endoscopic submucosal dissection for early gastric carcinoma in cases with anticoagulants.

Scand J Gastroenterol 2020 Oct 14;55(10):1253-1260. Epub 2020 Sep 14.

Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan.

Background: Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric carcinoma. Vitamin K antagonists and direct oral anticoagulants (DOAC) were reported to increase the risk of delayed bleeding after ESD. However, the evaluation of ESD cases taking anticoagulants is scarce. We analyzed the risk and characteristics of delayed bleeding after gastric ESD in patients on anticoagulants.

Methods: We performed a retrospective observational study at a single center. Consecutive patients who underwent ESD for early gastric carcinoma and took anticoagulants, including warfarin, rivaroxaban, dabigatran, apixaban, and edoxaban, between January 2012 and December 2018, were analyzed. We also calculated delayed bleeding rates for those without anticoagulants.

Results: Of 1855 eligible patients who underwent gastric ESDs, 143 took anticoagulants. Delayed bleeding occurred in 30 (21.0%) cases taking anticoagulants, with 15 (19.5%) cases in the DOAC group [rivaroxaban, seven cases (21.2%); dabigatran, four cases (20.0%); apixaban, four cases (23.5%); and edoxaban, zero cases (0%)] and 15 cases (22.7%) in the warfarin group. Furthermore, 43/344 (12.5%) patients taking antiplatelets and 76/1368 (5.6%) patients without antithrombic drugs experienced delayed bleeding. Multivariable logistic analysis revealed post-heart valve replacement (OR, 6.56; 95% CI, 1.75-24.7;  < .05) as a risk for delayed bleeding in warfarin-taking patients, while no statistically significant factor was found in DOAC-taking patients.

Conclusions: Anticoagulants were associated with a high incidence of severe delayed bleeding. Careful attention should be paid to patients on anticoagulants after gastric ESD, especially those on warfarin after heart valve replacement.
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http://dx.doi.org/10.1080/00365521.2020.1817542DOI Listing
October 2020