Factors related to the fatigue of relief workers in areas affected by the Great East Japan Earthquake : survey results 2.5 years after the disaster

Background: After the Great East Japan Earthquake (March 11, 2011), the fatigue of relief workers became a major problem in affected areas. In the present study, we conducted a questionnaire survey 2.5 years post-disaster identifying factors related to the fatigue of relief workers. Methods: This survey was cross-sectional and participants (N = 119) were relief workers living in affected areas. We used a self-administered questionnaire which included participants’ current problems, sources of strong feeling of loss, psychological distress and compassion fatigue. Based on answers (Yes/No) to the fatigue item, we created 2 groups; a Fatigue-group and a Non-fatigue group. We employed bivariate analysis on items with significant differences between the two groups and entered them into a multivariable logistic regression model. Results: Fifty-seven (48%) reported that they were “very tired” and were assigned to the Fatigue group. The total score of the 6-item Kessler Psychological Distress Scale (K6) and each subscale score (burnout, secondary trauma, and compassion satisfaction) of the Professional Quality of Life measure (Pro-QOL) in the Fatigue group were significantly higher than those in the Non-fatigue group. There were significant differences between the two groups for 11 items relating to current problems and sources of strong feelings of loss, and the following items were extracted as factors related to the fatigue of relief workers: loss of trust in others (adjusted OR, 10.03: 95%CI, 2.30–43.79), no confidence to continue work (adjusted OR, 6.27: 95%CI, 1.72–22.83), loss of important person(s) (adjusted OR, 5.58: 95%CI, 2.05–15.19), and sleep disturbance (adjusted OR, 5.14: 95%CI, 1.93–13.67). Conclusion: Many relief workers who reported fatigue had experienced various losses and current problems. Adequate consideration and care systems for local relief workers with fatigue should be given for a long-period after a disaster and it is important for the workers themselves to continue accepting support from others and maintaining self-care habits

An Epstein-Barr Virus-Associated Leukemic Lymphoma in a Patient Treated with Rabbit Antithymocyte Globulin and Cyclosporine for Hepatitis-Associated Aplastic Anemia

Lymphoproliferative disorders (LPDs) are generally caused by uncontrolled B-cell proliferation induced by the Epstein-Barr virus (EBV) in the setting of impaired EBV-specific T-cell immunity, particularly when there is pharmacological immunosuppression including antithymocyte globulin. We herein present an unusual case of EBV associated with LPD (EBV-LPD) in which LPD occurred 3 weeks after the use of rabbit antithymocyte globulin administered for severe hepatitis-associated aplastic anemia; the patient died of fulminant leukemic lymphoma 5 days after the onset. We also review the pertinent literature on EBV-LPD after immunosuppressive therapy and document the efficacy of EBV viral load monitoring and the need for preemptive therapy. Copyright © 2011 S. Karger AG, Basel

Community Trial on Heat Related-Illness Prevention Behaviors and Knowledge for the Elderly

This study aims to explore whether broadcasting heat health warnings (HHWs), to every household and whether the additional home delivery of bottled water labeled with messages will be effective in improving the behaviors and knowledge of elderly people to prevent heat-related illness. A community trial on heat-related-illness-prevention behaviors and knowledge for people aged between 65 and 84 years was conducted in Nagasaki, Japan. Five hundred eight subjects were selected randomly from three groups: heat health warning (HHW), HHW and water delivery (HHW+W), and control groups. Baseline and follow-up questionnaires were conducted in June and September 2012, respectively. Of the 1524 selected subjects, the 1072 that completed both questionnaires were analyzed. The HHW+W group showed improvements in nighttime AC use (p = 0.047), water intake (p = 0.003), cooling body (p = 0.002) and reduced activities in heat (p = 0.047) compared with the control, while the HHW group improved hat or parasol use (p = 0.008). An additional effect of household water delivery was observed in water intake (p = 0.067) and cooling body (p = 0.095) behaviors. HHW and household bottled water delivery improved heat-related-illness-prevention behaviors. The results indicate that home water delivery in addition to a HHW may be needed to raise awareness of the elderly

Comprehensive Prospective Analysis of the Factors Contributing to Aspiration Pneumonia Following Endoscopic Submucosal Dissection in Patients with Early Gastric Neoplasms

Endoscopic submucosal dissection (ESD) has become the first-line treatment for early gastric neoplasms; however, a subset of patients treated by this method develop aspiration pneumonia. We conducted a comprehensive prospective analysis of the factors contributing to post-ESD aspiration pneumonia in early gastric neoplasms in this study, with special focus on whether pre-treatment oral care can prevent aspiration pneumonia. Sixty-one patients who underwent ESD for gastric neoplasms were randomly assigned to the oral care or control groups. ESD was performed under deep sedation. Of 60 patients whose data were available for analysis, 5 (8.3%) experienced pneumonia confirmed either by chest radiography or computed tomography. Although no difference in the rate of pneumonia was found between the control and oral care groups, the post-oral care bacteria count was significantly higher in the saliva of patients who developed pneumonia compared to those without pneumonia. In addition, the presence of vascular brain diseases and the dose of meperidine were also significantly associated with the occurrence of pneumonia. These results suggest that the number of oral bacteria as well as pre-existing vascular brain diseases and high-dose narcotics can affect the incidence of post-ESD pneumonia