Demographic Change of the Kawauchi Special Nursing Home Occupants in a Former Evacuation Area After the Nuclear Power Plant Accident: A Retrospective Observational Study.

OBJECTIVE: This retrospective observational study aimed to look into the social demographic change of the occupants of a long-term care (LTC) facility that was constructed in 2015 as a restoration support after the Fukushima Daiichi nuclear power plant accident. METHODS: The social demographic information during 2015-2021 of occupants in the Kawauchi Special Nursing Home was analyzed. RESULTS: A total of 172 participants were included in the analysis. The number (proportion) of evacuees was 37 (69.8%) in 2015, then gradually decreased to 7 (31.8%) in 2018, yet increased to 21 (58.3%) in 2019. There were 121 occupants (70.4%) who were from Kawauchi Village and other municipalities of the former evacuation area. CONCLUSION: The Kawauchi Special Nursing Home initially received people who hoped to return to the former evacuation zone; however, its role changed to receive people who became in need of LTC after returning to Kawauchi Village. The construction of LTC facilities in the former evacuation area may help enhance the local LTC service where returnees are rapidly aging.

Long-term care issues in a municipality affected by the great East Japan earthquake: A case of Katsurao Village, Fukushima prefecture.

Information regarding the proposed measures addressing long-term care problems during disasters at a municipal level is scarce. Thus, this study reviewed the long-term care insurance measures taken in the Katsurao Village after the Fukushima nuclear accident and summarized the measures that municipalities can take against such issues in the future.

Promoting independent living and preventing lonely death in an older adult: Soma Idobata-Nagaya after the 2011 Fukushima disaster.

Contrary to the assumption that older adults are only cared for by their families in rural Japan, this case illustrates that community formation can effectively provide older adult care after an emergency as well. We look at the life of a woman who lived in a housing facility for older adults, Idobata-Nagaya in Soma, Japan, exploring how social housing-which addresses the needs of older adults regarding community, familiarity and socialising-can provide a viable, effective and comfortable environment for older adults to live. In the case of Idobata-Nagaya, not only could older adults take care of one another but they could also share experiences of the Fukushima disaster with each other. This is a qualitative case study which provides a stable foundation for policymakers, healthcare workers and government officials to better understand the effectiveness of housing projects for communities and older adults in Japan and globally.

Older adult living independently in a public rowhouse project after the 2011 Fukushima earthquake: A case report.

We study an older Japanese woman who lived independently with minimal nursing or informal support from others in the rowhouse after the 2011 Fukushima disaster. This case report supports the effectiveness of Idobata nagaya as a measure of the municipality and offers an evidence-based approach to reconstruction after a disaster. Considering the global population aging and isolation trends, the lesson from this case may apply to other settings beyond disasters.

Characteristics of Flood Fatalities in Japan's Typhoon Hagibis in 2019: Secondary Analysis of Public Data and Media Reports.

OBJECTIVE: Typhoon Hagibis struck Japan on October 12, 2019. This study documents and characterizes deaths caused by Hagibis and helps identify strategies to reduce mortality in future disasters. METHODS: Japanese residents, who were killed by Typhoon Hagibis, as reported by Japan's Fire and Disaster Management Agency, were considered for the study. Details were collected from mainstream Japanese media, and flooding data from hazard maps published by local municipalities. RESULTS: Out of the 99 total fatalities, 65 (73.0%) were aged 65 years or above. Among those who drowned indoors (20), 18 (90.0%) lived in high-risk areas of flooding, and their bodies were found on the first floor of their residences. A total of 10 (55.6%) out of the 18 fatalities lived in homes with 2 or more floors, indicating that they could have moved upstairs to avoid the floodwater. However, 6 (33.3%) could not do so due to existing health issues. CONCLUSIONS: Relatively elderly people, particularly those in areas at high risk of flooding, were most affected. Seeking higher ground is a standard safety measure in times of flooding, but this may not be possible for everyone depending on their health status, structure of their residence, and the depth of floodwaters.

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

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.

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

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.

The Increase in Frequency of Protective Behavior against Pesticide Poisoning in Narail, Bangladesh through Use of an Easy Paper Checklist; an Interventional Study.

Protecting the health of farmworkers is a crucial issue. Previous studies report that safety training and educational interventions might increase farmworkers' protective behaviors. The present study aimed to investigate the effectiveness of distributing a checklist as an interventional measure for pesticide protection in rural Asia, where pesticide poisoning is a major problem. This study was a community-based interventional study, using the distribution of a checklist with pesticide protective habits in Narail district, Bangladesh, with a total of 100 eligible males. Two questionnaire surveys were conducted before distributing the checklist and 25 days after. Change between the baseline and follow-up surveys was measured by frequency scores of protective behavior. The average pesticide-protective behavioral score increased from 4.58 in the baseline survey to 8.11 in the follow-up. Additionally, the checklist was more effective in the group with higher education, the younger group, and the group with lower pesticide-protective behavioral scores in the baseline survey. The paper checklist on protective behaviors against pesticide poisoning was effective because of the increase in the frequency of such positive behavior among farmworkers. Thus, intervention measures should be implemented to increase the knowledge and awareness regarding pesticide protection habits to protect the health of farmworkers.

Evaluation of the emergency medical system in an area following lifting of the mandatory evacuation order after the Fukushima Daiichi Nuclear Power Plant accident: A retrospective cross-sectional observational study.

ABSTRACT: Following the lifting of the evacuation order due to the Fukushima Daiichi Nuclear Power Plant accident, the medical demand and emergency medical system (EMS) in the area where the evacuation orders were lifted have not been well-investigated. This study aimed to evaluate the emergency transportation in such areas and compare the differences with areas that had minimal impact.Using the local EMS transport records, the characteristics of patients who were transferred by an EMS vehicle in Minamisoma City were collected between July 12, 2016 and July 31, 2018, and were compared between former evacuation zones and outside the evacuation zones in the city.The number of emergency transports in the study period in Minamisoma City were 325 cases in the area where the evacuation orders were lifted and 4307 cases in the other areas. The total EMS time was significantly longer in the area where the evacuation order was lifted (48 ±â€Š16 minutes) than in the other areas (40 ±â€Š15 minutes) (P < .001). In the analysis of each component of EMS times, the transport time, which is the time from departure from the patient's location to arrival at a hospital, was significantly longer in the former evacuation zone than in the other areas (16 ±â€Š9 vs 9 ±â€Š9 minutes, P < .001), suggesting that transport time contributed to the longer EMS response times.In areas where the evacuation orders were lifted, the EMS transport time was significantly longer than that in the area outside the former evacuation zone; correspondingly, the total EMS time significantly increased in the former evacuation zone. A plausible reason for this may be the closure of local medical facilities following the evacuation order after the nuclear accident.

Concealment of trauma and occupational accidents among Fukushima nuclear disaster decontamination workers: A case report.

OBJECTIVES: Limited information exists concerning occupational risks in decontamination work after the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Workers involved tend to be migrant workers, face various health risks, and are usually from a low socioeconomic background and generally have difficulty in finding employment. We report a specific case to illustrate the way these workers tend to get injured during working hours and draw attention to the problems arising. CASE PRESENTATION: A 59-year-old Japanese male decontamination worker was referred to our emergency department after a fall while he was working in an Exclusion Zone surrounding the FDNPP. He was blind in his right eye. He was diagnosed with traumatic multiple rib fractures and a tube thoracostomy was performed. He was discharged from hospital after 7 days. Payment has been changed from "occupational accident," which is required to be reported to the Local Labor Standards Office, to "general medical treatment" which is no obligation. CONCLUSION: Trauma or physical injury of any kind is an occupational hazard for workers, especially those operating in the chaotic and unpredictable environments following any disasters. Companies employing such workers and owners of any facilities or locations in which they may be working are responsible for the safety of their workers. They should provide appropriate training and should comply with all prevailing Employment Laws and follow mandatory safety regulations. If companies and authorities are in breach of any laws, ignore their responsibilities, or jeopardize the health of their workers, they should be held accountable.

Breast Cancer Provider Interval Length in Fukushima, Japan, After the 2011 Triple Disaster: A Long-Term Retrospective Study.

BACKGROUND: Minimizing the interval from symptom onset to treatment commencement is essential for a favorable outcome among breast cancer (BC) patients. This study examined whether provider interval (time elapsed from first consultation to treatment initiation) lengthened among BC patients after Japan's 2011 earthquake, tsunami, and nuclear disaster in Fukushima. Factors associated with the length of postdisaster interval and whether the interval was associated with BC stage were also investigated. PATIENTS AND METHODS: So-so District (study site) was an area damaged by the 2011 disasters. Data of all BC patients who made their first medical consultation and received initial treatment at the core medical institutions in the area 5 years before or after the disaster were extracted from patient medical records. We used several regression approaches to fulfill our study objectives. RESULTS: We included 263 (140 predisaster and 123 postdisaster) patients. After adjustment for covariates, the interval did not significantly change after the disaster compared to before the disaster. Those with 4 or 5 cohabiting family members experienced a shorter interval after the disaster than those with 0 or 1 cohabiting family members (relative length, 0.47; 95% confidence interval, 0.28-0.78). Those with an interval of > 60 days had lower odds of stage III or IV cancer after the disaster than those with an interval of < 30 days (odds ratio, 0.09; 95% confidence interval, 0.01-0.84). CONCLUSION: Overall, provider interval did not lengthen after the disaster. However, those with fewer cohabiting family members might have experienced a longer total interval. Cancer stage may not necessarily reflect the influence of interval on patient outcome.

High internal radiation exposure associated with low socio-economic status six years after the Fukushima nuclear disaster: A case report.

RATIONALE: Managing the health of vulnerable groups is an important component of health care. Given the long-term burden of radiation-release incidents among those exposed, managing the health of vulnerable groups following a nuclear disaster is very important. However, there is limited information available concerning the long-term management of the health effects of radiation exposure in vulnerable groups following nuclear disasters. After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Minamisoma City launched internal radiation exposure monitoring program for local residents, using whole body counter (WBC) units. In 2017, a man of low socio-economic status (SES), was found to have the highest level of internal contamination detected in a person living in the Soma District in recent years. This report describes the case so that the lessons learned can be applied in future nuclear disaster settings. PATIENT CONCERNS: A 77-year-old Japanese man, who had been homeless for 2 months and had been staying in the exclusion zone of Minamisoma City, was brought to our hospital. He had become homeless because a lack of communication between social support services had led to his eviction from leased housing after free housing support for evacuees was terminated. DIAGNOSES: He was admitted with a diagnosis of dehydration and malnutrition. A WBC unit was used to assess his body burden of radioactive cesium. This revealed levels of Cs-134 and Cs-137 of 538 Bq/body and 4,993 Bq/body, respectively. INTERVENTION: He received intravenous fluid therapy and health monitoring. The paperwork required for him to receive public income support was processed during hospitalization. OUTCOME: He was discharged to public housing after 9 days, and municipal workers started visiting him regularly after his discharge. LESSONS: A high level of internal radiation contamination may occur after a nuclear disaster. This may be associated with a decline in social support, poverty, and social isolation, and may have more impact on people in poor health than on the general population. It would be useful to strengthen linkages between local government and welfare service providers to increase social support for vulnerable groups requiring health care, not only following disasters, but also under normal circumstances.

Mass evacuation and increases in long-term care benefits: Lessons from the Fukushima nuclear disaster.

BACKGROUND: Though mass evacuation may increase the need for long-term care (LTC) services, how the need for LTC services increases and how the public LTC system affects it is not well understood. We evaluated changes in public LTC benefits for the people living in the mandatory evacuation areas established after the 2011 Fukushima nuclear disaster and examined the roles of the universal LTC insurance system in Japan. METHODS: In order to evaluate the effect of the mandatory evacuation on LTC benefits, we examined the trends of LTC benefits in the Fukushima evacuation group and the nationwide non-evacuation group. We first decomposed per-elderly-individual benefits at the municipality level into the LTC certification rate and per-certified-individual benefits, and then implemented difference-in-differences analysis using these variables as outcomes. RESULTS: Per-elderly-individual benefits significantly increased from 2012 onward in the evacuation group, and this was explained by an increase in the certification rate rather than in per-certified-individual benefits. Increases in per-elderly-individual benefits and the certification rate in the post-disaster period were observed in all but the highest care level, and the corresponding outcomes for the highest care level decreased immediately after the disaster. We also found that the increase in the certification rate had been mostly realized by an increase in the number of certified individuals. CONCLUSIONS: The increase in LTC benefits can be associated with the impact of the increase in the number of people newly certified to receive LTC benefits after the mandatory evacuation. In order to cope with the increase in utilization of long-term care and associated costs after disasters in aging societies, both formal long-term care services and social support for informal care for evacuees should be considered important.

Premature death associated with long-term evacuation among a vulnerable population after the Fukushima nuclear disaster: A case report.

RATIONALE: The health vulnerability of certain populations such as children, the elderly and individuals with illnesses or physical disability can become significant in disasters. After the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, significant health impacts on vulnerable populations were observed during early or mid-term phase of the disaster, presumably associated with the evacuation. However, there is limited information available on the health impacts owing to long-term evacuation after disaster among them. PATIENT CONCERNS: A 56-year-old physically challenged male with arteriovenous malformation on his right lower limb, diagnosed when he was 2 years' old, lived near the FDNPP. He and his family were forced to evacuate immediately after the accident. DIAGNOSIS: Three months after evacuation following the FDNPP accident, he developed a refractory foot ulcer associated with atrial fibrillation and congestive cardiac failure because of deterioration of arteriovenous malformation, presumably led by repeated evacuations. INTERVENTION: Although anticoagulation therapy and diuretic therapy improved his cardiac failure in the initial admission, he decided to only be treated with supportive care after revelation that his arteriovenous malformation was no longer eligible for aggressive intervention. OUTCOME: Three years after the long-term evacuation in temporary houses, the patient died of bleeding and infection of the ulcer. LESSONS: This case suggests that long-term evacuation for individuals with physical disability may lead to significant health impacts, and even premature death, through the deterioration of daily life activities due to physical and psychological burdens. This case presents a need for further research on ways that disasters impact the health of individuals with physical disabilities, and greater disaster preparation for the needs of populations with physical disabilities.

Premature Death of a Schizophrenic Patient due to Evacuation after a Nuclear Disaster in Fukushima.

Although psychiatric patients are likely to be adversely impacted by disasters, information regarding the processes involved in adverse impacts is limited. In March 2011, Japan experienced an earthquake, tsunami, and the Fukushima Daiichi Nuclear Power Plant accident. In its aftermath, Takano Hospital, 22 km south of the power plant, underwent forced patient evacuation. A 54-year-old Japanese male with schizophrenia, who had been hospitalized in the psychiatric ward for over 20 years, was transferred and experienced a series of hospital relocations. Although his physical status was intact when he left Takano Hospital, his condition gradually worsened, presumably due to incomplete exchange of patient information between institutions and changes in the treatment environment. Having developed ileus a few days prior, he was bedridden when he returned to Takano Hospital in May 2011. Over the course of treatment, he developed aspiration pneumonia and died in August 2011. A review of medical records revealed that all his purgative medicines had been stopped after his evacuation, possibly contributing to the development of ileus. This case highlights the necessity of establishing systems enabling patient information sharing between institutions in disaster settings and the importance of recognizing that long-term evacuation may have fatal impacts for psychiatric patients.

Change of access to emergency care in a repopulated village after the 2011 Fukushima nuclear disaster: a retrospective observational study.

OBJECTIVES: Sustaining emergency care access is of great concern. The aim of this study is to evaluate access to emergency care in a repopulated village following the 2011 Fukushima disaster. DESIGN: This research was a retrospective observational study. The primary outcome measure was total emergency medical services (EMS) time. A Bayesian time series analysis was performed to consider local time series trend and seasonality. SETTING: The residents in Kawauchi Village, Fukushima, Japan were forced to evacuate after the 2011 Fukushima disaster. As the radiation dose was an acceptable level, the residents began the process of repopulation in April 2012. PARTICIPANTS: This study included patients transported by EMS from January 2009 to October 2015. Patients transported during the evacuation period (from March 2011 to March 2012) were excluded. RESULTS: A total of 781 patients were transferred by EMS (281 patients before the disaster, 416 after repopulation and 84 during the evacuation period). A Bayesian time series analysis revealed an increase in total EMS time, from the first request call to arrival at a hospital of 21.85 min (95% credible interval 14.2-29.0, Bayesian one-sided tail-area probability p=0.001). After the disaster, 42.3% of patients were transported to a partner hospital. CONCLUSIONS: Total EMS time increased after repopulation of the area affected because of a massive number of hospital closures. Proactive partnerships would be a possible countermeasure in the affected areas after a major disaster.