Managing Type 2 Diabetes Mellitus through Periodical Hospital Visits in the Aftermath of the Great East Japan Earthquake Disaster: A Retrospective Case Series

<div><p>Aims</p><p>To assess the impact of the Great East Japan Earthquake Disaster on daily diabetes practice and to determine the feasibility of controlling type 2 diabetes mellitus in an outpatient department.</p><p>Methods</p><p>We retrospectively reviewed the data on disaster-affected patients with type 2 diabetes who periodically attended outpatient department of Soma Central Hospital. There were 767 patients with type 2 diabetes mellitus in total. The primary outcome measure was the change in HbA1c.</p><p>Results</p><p>HbA1c levels of 58 patients with periodical hospital visits did not deteriorate after the disasters. Moreover, there observed no significant difference in the mean of HbA1c levels among all age and sex throughout the year. While several changes in diabetes medication usage occurred, DPP4-inhibitor was the only oral diabetic agent that increased in frequency (+60%).</p><p>Conclusions</p><p>Patients with type 2 diabetes who were managed with periodical hospital visits did not show significant deterioration in HbA1c levels.</p></div

Number of patient using diabetes treatment drugs, lipid-lowering drugs and antihypertensive drugs pre-disaster and post-disaster and percentage changes.

<p>ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CCB, calcium channel blocker; DPP-4, dipeptidyl peptidase-4</p><p>Number of patient using diabetes treatment drugs, lipid-lowering drugs and antihypertensive drugs pre-disaster and post-disaster and percentage changes.</p

Parameters (glycemic control, lipid test) of PV (+), PV (-), and all the rest of diabetes patients other than PV (+) at SCH.

<p>Data are presented as the mean (SD).</p><p>*: p<0.05.</p><p>BG, blood glucose concentration; cLDL-C, calculated low-density lipoprotein cholesterol; F, female; HbA1c, glycosylated haemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; M, male; NGSP, National Glycohemoglobin Standardization Program; TC, total cholesterol; TG, triglycerides</p><p>Parameters (glycemic control, lipid test) of PV (+), PV (-), and all the rest of diabetes patients other than PV (+) at SCH.</p

Map of north coastal area of Fukushima prefecture with level of soil contamination in April 2011.

<p>Patients’ locations, except for three patients from Miyagi, SCH and Fukushima Daiichi nuclear power plant are plotted on the map of Fukushima. Soma is a city located in the coastal area of Fukushima Prefecture affected by the Great East Japan Earthquake, tsunami, and the Fukushima Nuclear Disaster. Soma has a population of 36,000, of which about 26.9% are aged ≥65 years. The tsunami was recorded to have exceeded 9 m and spread 4 km inland into the city. Moreover, Soma is located about 40 km north of the Fukushima Daiichi nuclear power plant. The mountainous region of the city was contaminated with radiation due to the Fukushima Nuclear power plant incident. Four-hundred sixty-two people were killed, and more than 2,000 people were evacuated to temporary housing due to the series of disasters. Copyright © 2015 Esri, HERE, DeLorme, USGS, Intermap, iPC, NRCAN, Esri Japan, METI, Esri China (Hong Kong), Esri (Thailand), MapmyIndia, TomTom, © OpenStreetMap contributors, and the GIS User Community. All rights reserved.</p

Changes in HbA1c levels from the pre- to post-disaster period.

<p>Patients were categorized by age: (A) all patients, (B) ≥65-years, and (C) <65 years.</p

Parameters (BMI, glycemic control, lipid tests and blood pressure) of all study subjects pre-disaster and post-disaster.

<p>Data are presented as the mean (SD).</p><p>BG, blood glucose concentration; BMI, body mass index; cLDL-C, calculated low-density lipoprotein cholesterol; DBP, diastolic blood pressure; E, no. of patients whose house destroyed by the earthquake; F, female; HbA1c, glycosylated haemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; M, male; N, evacuation area due to the Fukushima Nuclear Disaster; NGSP, National Glycohemoglobin Standardization Program; SBP, systolic blood pressure; T, the area hit by the Tsunami; TC, total cholesterol; TG, triglycerides</p><p>Parameters (BMI, glycemic control, lipid tests and blood pressure) of all study subjects pre-disaster and post-disaster.</p

Hospital Staff Shortage after the 2011 Triple Disaster in Fukushima, Japan-An Earthquake, Tsunamis, and Nuclear Power Plant Accident: A Case of the Soso District

<div><p>Introduction</p><p>In 2011, Fukushima was struck by a triple disaster: an earthquake, tsunamis, and a nuclear accident. In the aftermath, there was much fear among hospital staff members about radiation exposure and many staff members failed to report to work.</p><p>Objectives</p><p>One objective is to measure this shortage in hospital staff and another is to compare the difference in recovery by hospital types and by categories of hospital staff.</p><p>Design</p><p>The monthly records of the number of staff members from May 2011 to September 2012 were extracted anonymously from the records of 7 local hospitals in the Soso district in Fukushima. Change in the number of staff was analyzed.</p><p>Results</p><p>Staff shortages at hospitals reached a maximum within one month after the disaster (47% reported to work). The shortage of clerks was the most severe (38% reported to work), followed by nurses (48% reported to work). The shortages remained even 18 months after the disaster.</p><p>Conclusion</p><p>After a disaster in which the damage to hospital functions surpasses the structural damage, massive support of human resources in the acute phase and a smaller volume of support in the mid-term phase appear to be required, particularly for non-medical staff.</p></div

Characteristics of and number of staff members at Soso district hospitals (Source from Soso Public Health Institute).

<p>Characteristics of and number of staff members at Soso district hospitals (Source from Soso Public Health Institute).</p

The % change in the number of hospital staff members at each hospital within 18 months after the triple disaster.

<p>The % change in the number of hospital staff members at each hospital within 18 months after the triple disaster.</p

The % change in the estimated workload of staff members.

<p>The numbers of outpatients (A) and inpatients (B) were divided by the number of staff members.</p