Prevalence of non-communicable diseases among healthy male decontamination workers after the Fukushima nuclear disaster in Japan: an observational study

博士（医学）福島県立医科大

Underestimation of COVID-19 cases in Japan: an analysis of RT-PCR testing for COVID-19 among 47 prefectures in Japan

Under the unique Japanese policy to restrict reverse transcriptase-polymerase chain reaction (RT-PCR) testing against severe acute respiratory syndrome coronavirus 2, a nationwide number of its confirmed cases and mortality remains to be low. Yet the information is lacking on geographical differences of these measures and their associated factors. Evaluation of prefecture-based geographical differences and associated predictors for the incidence and number of RT-PCR tests for COVID-19. Cross-sectional study using regression and correlation analysis. We retrieved domestic laboratory-confirmed cases, deaths, and the number of RT-PCR testing for COVID-19 from January 15 to April 6, 2020 in 47 prefectures in Japan, using publicly-available data by the Ministry of Health, Labour and Welfare. We did descriptive analyses of these three measures and identified significant predictors for the incidence and RT-PCR testing through multiple regression analyses and correlates with the number of deaths through correlation analysis. The median prefectural-level incidence and number of RT-PCR testing per 100,000 population were 1.14 and 38.6, respectively. Multiple regression analyses revealed that significant predictors for the incidence were prefectural-level population (p < 0.001) and the number of RT-PCR testing (p = 0.03); and those for RT-PCR testing were the incidence (p = 0.025), available beds (p = 0.045) and cluster infections (p = 0.034). Considering bidirectional association between the incidence and RT-PCR testing, there may have been an underdiagnosed population for the infection. The restraint policy for RT-PCR testing should be revisited to meet the increasing demand under the COVID-19 epidemic.N/

Assessment of drug needs and contributions of pharmacists in the aftermath of the 2011 triple disaster in Fukushima, Japan: A combined analysis

After a major disaster, drug logistics are crucial for maintaining medical care. Although pharmacists play a vital role in healthcare institutions, their role is not well defined, and their recognition from other healthcare professionals is lacking. This was evident at Minamisoma Municipal General Hospital in Fukushima, Japan, which was affected by the Great East Japan earthquake, tsunami, and nuclear power plant accident. The supply of drugs and related information was severely disrupted. In response, two pharmacists were interviewed and the data was analyzed through a thematic approach. Additionally, prescription data collected by pharmacists was analyzed quantitatively. The results from the qualitative survey showed that pharmacists made efforts to supply drugs and collect information, despite facing various psychological challenges, such as confidence, responsibility, anguish, and conflicts. The “leadership” of the hospital's upper managers was instrumental in supporting the pharmacists. The prescription data revealed that drug supply continued for approximately one month without interruption, and the demand for antihypertensive and psychiatric drugs increased. A majority (72.3 %) of the patients (N = 3,518) were 60 years of age or older, which might have contributed to the demand for chronic disease drugs. This study provides an example of the role of pharmacists and drug logistics during major disaster situations, including nuclear accidents

Evaluation of Financial and Non-financial Conflicts of Interest and Quality of Evidence underlying Psoriatic Arthritis Clinical Practice Guidelines-Analysis of Personal Payments from Pharmaceutical Companies and Authors' Self-citation Rate in Japan and the United States

OBJECTIVE: To assess financial conflict of interest (FCOI) and non-financial conflicts of interest (NFCOI) among psoriatic arthritis clinical practice guideline (PsACPG) authors in Japan and US, and to evaluate the quality of evidence and strength of recommendations of PsACPG.METHODS: We performed a retrospective analysis using payment data from major Japanese pharmaceutical companies and the US Open Payments Database from 2016 to 2018. All authors of PsACPG issued by Japanese Dermatological Association (JDAPsACPG) and American College of Rheumatology (ACRPsACPG) were included.RESULTS: Of 23 CPG authors in Japan, 21 (91.3%) received at least one payment, with the combined total of $3,335,413 between 2016 and 2018. Regarding 25 US authors, 21 (84.0$4,081,629 during the same period. The 3-year combined average payment per author was $145,018 (standard division [SD]:$114,302) in Japan and $162,825 (SD:$259,670) in US. 18 (78.3%) JDAPsACPG and 12 (48.0%) ACRPsACPG authors had undisclosed FCOI worth $474,663 and$218,501, respectively. The percentage of citations with at least one CPG author relative to total citations were 3.4% in Japan and 33.6% in US. 71.4% and 88.8% of recommendations for psoriatic arthritis in JDA and ACR were supported by low or very low quality of evidence.CONCLUSION: More rigorous cross-checking of information disclosed by pharmaceutical companies and self-reported by physicians, and more stringent and transparent COI policies are necessary.</p

Mortality risk associated with nuclear disasters depends on the time during and following evacuation of hospitals near nuclear power plants: An observational and qualitative study

This study aimed to examine the factors correlated with emergency evacuations on patients’ prognosis in hospitals severely affected by the Fukushima Daiichi nuclear power plant (FDNPP) accident in March 2011, and to recommend measures mitigating potential health risks among them in future disasters. Seven hospitals within a 20-km radius of the FDNPP were designated as the evacuation zone, of which three hospitals located within a 5-km radius were examined. Information regarding hospital emergency evacuation among the three hospitals from previous literature and official reports were integrated and interview outcomes of staff at each hospital were qualitatively analyzed using thematic analysis. Our thematic analysis identified four themes: insufficient preparedness for disaster, difficulty of patient evacuation, insufficient materials, and insufficient information. Comparison of the three hospitals located within a 5-km radius of the FDNPP revealed that hospitals with several patients or those with a high proportion of bedridden or critically ill patients faced more difficulty in emergency evacuation and experienced higher fatalities. In addition to individual evacuation plans, for future preparedness, external and public organizations should prepare disaster responses such as procedures to integrate information on the status of each medical facility and measures to support them individually

Birth outcomes after the Fukushima Daiichi nuclear power plant disaster:A long-term retrospective study

Changes in population birth outcomes, including increases in low birthweight or preterm births, have been documented after natural and manmade disasters. However, information is limited following the 2011 Fukushima Daiichi Nuclear Power Plant Disaster. In this study, we assessed whether there were long-term changes in birth outcomes post-disaster, compared to pre-disaster data, and whether residential area and food purchasing patterns, as proxy measurements of evacuation and radiation-related anxiety, were associated with post-disaster birth outcomes. Maternal and perinatal data were retrospectively collected for all live singleton births at a public hospital, located 23 km from the power plant, from 2008 to 2015. Proportions of low birthweight (&lt;2500 g at birth) and preterm births (&lt;37 weeks gestation at birth) were compared pre- and post-disaster, and regression models were conducted to assess for associations between these outcomes and evacuation and food avoidance. A total of 1101 live singleton births were included. There were no increased proportions of low birthweight or preterm births in any year after the disaster (merged post-disaster risk ratio of low birthweight birth: 0.98, 95% confidence interval (CI): 0.64–1.51; and preterm birth: 0.68, 95% CI: 0.38–1.21). No significant associations between birth outcomes and residential area or food purchasing patterns were identified, after adjustment for covariates. In conclusion, no changes in birth outcomes were found in this institution-based investigation after the Fukushima disaster. Further research is needed on the pathways that may exacerbate or reduce disaster effects on maternal and perinatal health

Home-visit rehabilitation in a repopulated village after the Fukushima nuclear disaster

Following the evacuation of areas affected by Japan's 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Kawauchi Village was one of the first municipalities repopulated. Although rehabilitation resources were limited, a healthcare facility near the municipality initiated home-visit rehabilitation in 2016. To the best of our knowledge, reports of home-visit rehabilitation in repopulated villages that were evacuated following a nuclear accident are lacking.This article describes a case study of home-visit rehabilitation in Kawauchi Village. The purpose of this study was to explore how users of home-visit rehabilitation services in Kawauchi Village perceive home-visit rehabilitation, and whether it had a positive impact on their daily life. A questionnaire survey was conducted, and their ability to perform activities of daily living was assessed, to understand the living conditions of the visiting-rehabilitation service users.We studied 10 rehabilitation-service users, with a mean age of 86.8 years, who had used the services for an average of 591.4 days. Themes that emerged from the open-ended questionnaire were "established exercise habits and improved physical functions," "the joy of returning to the village," "challenges in the mountainous areas" and "changes in relationships due to the earthquake or evacuation."In conclusion, home-visit rehabilitation was successfully implemented in the repopulated village, and helped maintain the users' physical functions. This may thus be a viable choice for rehabilitation care in repopulated areas after disasters

Association between COVID-19 incidence and postponement or cancellation of elective surgeries in Japan until September 2020: a cross-sectional, web-based survey

Objectives This study aimed to examine whether and how the COVID-19 pandemic has affected the postponement or cancellation of elective surgeries in Japan.Design and setting A cross-sectional, web-based, self-administered survey was conducted nationwide from August 25 to September 30 2020. We used data from the Japan ‘COVID-19 and Society’ Internet Survey collected by a large internet research agency, Rakuten Insight, which had approximately 2.2 million qualified panellists in 2019.Participants From a volunteer sample of 28 000 participants, we extracted data from 3678 participants with planned elective surgeries on any postponement or cancellation of elective surgeries.Outcome measures The main outcome measure was any postponement or cancelltion of elective surgeries. In addition, for all respondents, we extracted data on sociodemographic, health-relatedcharacteristics, psychological characteristics and prefectural-level residential areas. We used weighted logistic regression approaches to fulfil the study objectives, minimising potential bias relating to web-based surveys.Results Of the 3678 participants, 431 (11.72%) reported experiencing postponement or cancellation of their elective surgeries. Notably, the participants living in prefectures where the declaration of the state of emergency was made on 7 April 2020 were significantly more likely to experience postponement or cancellation of elective surgeries than those residing in prefectures with the stateof emergency beginning on 16 April 2020 (174 (26.02%) vs 153 (12.15%)).Conclusions The proportion of patients whose elective surgery had been postponed was limited during Japan’s first wave of the COVID-19 pandemic, although the declaration of a state of emergency increased the likelihood of postponement. It is imperative to increase awareness of the secondary health effects related to policy intervention in pandemics and other health crises and to use appropriate countermeasures such as standard infectious control measures and triage of surgical patients