Symposium on disaster-related deaths after the Fukushima Daiichi Nuclear Power Plant accident.

Disaster deaths can be classified into direct and indirect deaths. Direct deaths are those caused by the direct physical effects of disasters, such as earthquakes, tsunamis, and radiation exposure. Indirect deaths are those caused by secondary health effects such as emergency evacuation, relocation, evacuation environment, disruption of health care delivery services, and psychosocial effects. In addition, in Japan, the term disaster-related deaths refers to indirect deaths in accordance with the disaster condolence payments system, which provides relief for bereaved families. On 11 March 2011, the Great East Japan Earthquake exposed several issues related to disaster-related deaths in Japan. Therefore, on 1 February 2022, a symposium on disaster-related deaths hosted by this study was held on the website. The symposium discussed the issues and challenges associated with disaster-related deaths for future disaster preparedness. The authors introduced the concept of 'shaking' at the symposium by defining 'shaking' as 'the repeated changes in the social and living environment that worsen health conditions, regardless of the disaster'. It was also pointed out that vulnerable populations are more likely to experience more pronounced health effects. This generalised concept of 'shaking' associated with disaster-related deaths suggests that it is important to anticipate disasters before they occur to take specific preventive measures, targeted at vulnerable populations. This study found that disaster-related deaths in Japan create several problems in terms of future radiation disaster preparedness and medical countermeasures. In the future, there will be a need to examine the relevance of the issues of disaster-related deaths identified as a result of this symposium for future radiation disaster preparedness.

[Report from Minamisoma City: diversity and complexity of psychological distress in local residents after a nuclear power plant accident].

Natural disasters can severely impact local communities. When a disaster is limited in type or scope, the loss and distress felt by individual residents can be sympathetically visualized and shared, and this can help bring the community together. In 2011, however, Japan experienced the Great East Japan Earthquake and accompanying tsunami, and the scale of this disaster was compounded by the Fukushima nuclear power plant accident. As a result of this complex disaster, residents experienced very different problems, particularly in Fukushima Prefecture. In this paper, we describe the situation in Minamisoma City, which is located to the north of the Fukushima Daiichi nuclear power plant. After the accident, the city was divided into three zones. The southern part of the city, which is within 20 km of the plant, was designated as a restricted area; the middle section, located between 20 and 30 km of the plant, was initially designated as an evacuation readiness area; and the northern part of the city received no evacuation-related designation. In April 2012, ordinary residents were finally allowed to visit the restricted area, but utilities and municipal services in the area had not yet been restored, and residents were still prohibited from staying overnight even in August 2013. The overall situation was further complicated by the existence of conflicting opinions regarding exposure to low dose ionizing radiation and compensation for subsequent distress. Things became so complex that residents of the same city sometimes struggled to imagine their neighbors' feelings and state of mind. After the disaster, aging of the city accelerated dramatically. The proportion of elders (those aged 65 or older) in the population stood at 25.9% in March 2011, but this had increased to 32.9% by March 2013. Elders tend to have strong emotional ties to their hometowns, while younger generations are more likely to move away and start over. As some young people have left the area or stopped working, the city is suffering from a lack of workers. A number of residents are in a state of being overworked. While children and mothers face more difficulties after the disaster, they are less able to find support in the city. As of the end of March 2013, 406 deaths in Minamisoma were officially attributed to disaster-related distress. The psychological burdens placed on residents of this city are too heavy to be ignored. Robust efforts and interventions are urgently needed in order to improve mental hygiene in the area.

Categorization of disaster-related deaths in Minamisoma city after the Fukushima nuclear disaster using clustering analysis.

The medical situation during disasters often differs from that at usual times. Disasters can lead to significant mortality that can be difficult to monitor. The types of disaster-related deaths are largely unknown. In this study, we conducted a survey to categorize the disaster-related deaths caused by a radiation disaster. A total of 520 people living in Minamisoma City, Fukushima Prefecture, at the time of the Fukushima Daiichi Nuclear Power Plant accident, who were certified to have died due to disaster-related causes were surveyed. We divided the participants into those who were at home at the time of the earthquake and those who were in hospitals or facilities when the disaster struck and conducted a hierarchical cluster analysis of the two groups. Disaster-related deaths could be divided into seven groups for those who were at home at the time of the disaster and five groups for those who were in hospitals or facilities at the time of the disaster. Each group showed different characteristics, such as "the group with disabilities," "the group receiving care," and "the group with depression," and it became evident that not only uniform post-disaster support, but support tailored to the characteristics of each group is necessary.

How to Deal With the Risk of Evacuation of Psychiatric Hospital in Nuclear Disaster: A Case Study.

OBJECTIVE: People with psychiatric disorders are one of the most vulnerable populations in disasters, and the 2011 Great East Japan Earthquake reported higher post-evacuation mortality rates among psychiatric inpatients. A psychiatric hospital evacuated after the nuclear accident was surveyed to gain valuable insights for future disaster preparedness. METHODS: The authors interviewed two Odaka Akasaka Hospital (a private psychiatric hospital) staff responsible for evacuation due to the nuclear accident. RESULTS: At the time of the earthquake, 104 patients had been admitted to the hospital. They were instructed to evacuate on the grounds that they existed within a 20 km radius of Fukushima Daiichi Nuclear Power Station. Although the evacuation process was extraordinarily demanding, the staff acted professionally, and no patient experienced a significant deterioration in health during the evacuation. CONCLUSION: It was reasonable to follow the evacuation order because of the difficulty of obtaining accurate information about radiation exposure and staff availability in high-risk situations. The staff's knowledgeable and attentive care of the patients was one of the factors that enabled them to successfully carry out this severe evacuation. However, this may be related to the high mortality rate after the evacuation of patients who were separated from such caregivers.

Importance of continuing health care before emergency hospital evacuation: a fatal case of a hospitalized patient in a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant: a case report.

BACKGROUND: After a disaster, it is essential to maintain the health care supply levels to minimize the health impact on vulnerable populations. During the 2011 Fukushima Daiichi Nuclear Power Plant accident, hospitals within a 20 km radius were forced to make an immediate evacuation, causing a wide range of short- and long-term health problems. However, there is limited information on how the disaster disrupted the continuity of health care for hospitalized patients in the acute phase of the disaster. CASE PRESENTATION: An 86-year-old Japanese man who needed central venous nutrition, oxygen administration, care to prevent pressure ulcers, skin and suctioning care of the trachea, and full assistance in the basic activities of daily living had been admitted to a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant and experienced Fukushima Daiichi Nuclear Power Plant accident. After the accident, the hospital faced a manpower shortage associated with hospital evacuation, environmental changes caused by infrastructure and medical supply disruptions, and the difficulty of evacuating seriously ill patients. As a result, antibiotics and suction care for aspiration pneumonia could not be appropriately provided to the patient due to lack of caregivers and infrastructure shortages. The patient died before his evacuation was initiated, in the process of hospital evacuation. CONCLUSIONS: This case illustrates that decline in health care supply levels to hospitalized patients before evacuation during the acute phase of a radiation-released disaster may lead to patient fatalities. It is important to maintain the health care supply level even in such situations as the radiation-released disaster; otherwise, patients may experience negative health effects.

Eleven-Year Trend of Drug and Chemical Substance Overdose at a Local Emergency Hospital in Japan.

PURPOSE: The purpose of this study was to investigate long-term trends of overdose in the emergency department of a regional core hospital in Sendai, Miyagi Prefecture, Japan, and to identify patient characteristics as well as drugs and chemicals associated with overdose. METHODS: Patients who visited the emergency department from January 1, 2010, to December 31, 2020, and were diagnosed with a drug or chemical overdose were included in the study. We conducted a descriptive analysis based on the data collected. RESULTS: In total, 577 patients (mean 38.4 years old, female 75.0%) were considered, and 16.8% had a history of repeated overdose. The number of patients during the study period showed a downward trend, with slight increases in 2012 and 2020. In addition, the top four drugs suspected of causing overdose were over the counter (OTC) antipyretic analgesics and cold medicines (N=97), followed by flunitrazepam (N=80), etizolam (N=72), and brotizolam (N=70). CONCLUSION: There was a decreasing trend in overdose, and OTC medicines, sedatives, and anxiolytics were the primary medications causing overdose. OTC antipyretic analgesics and cold medicines were the most common suspected overdose drugs, with an increasing trend in the later years.

Emergency Hospital Evacuation From a Hospital Within 5 km Radius of Fukushima Daiichi Nuclear Power Plant: A Retrospective Analysis of Disaster Preparedness for Hospitalized Patients.

Emergency evacuation during disasters may have significant health impacts on vulnerable populations. The Japanese Government issued evacuation orders for surrounding residents of the Fukushima Daiichi nuclear power plant (FDNPP) immediately after the March 11, 2011, nuclear accident. Little is known of difficulties associated with the disaster-specific evacuation from health care facilities located in this area. Among the 338 patients hospitalized at Futaba Hospital, located 4.6 km west of FDNPP, at the time of the accident, 39 patients (11.5%), predominantly critically ill patients who were bedridden or disabled, died before the evacuation was completed. The shortage of hospital staff and disruption of infrastructure resulted in a lack of adequate care provision, such as infusion therapy or sputum suctioning, leading to premature death of some hospitalized patients during the emergency hospital evacuation. As hospital evacuation is sometimes unavoidable during disasters, potential health impacts of hospital evacuation should be recognized and reflected in disaster preparedness plans.

Why only me? A case report of a breast cancer patient with unresolved trauma from a past disaster experience developing a mental disorder.

Little is known about how the psychological stress of having experienced a natural disaster affects cancer patients. We experienced a patient who was treated with breast cancer after having been stricken by a typhoon, which resulted in significant psychological damage. Treatment strategies should incorporate patients' mental health appropriately after disasters.

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

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.

Trends in Suicide Mortality in 10 Years around the Great East Japan Earthquake: Analysis of Evacuation and Non-Evacuation Areas in Fukushima Prefecture.

This study analyzed the suicide mortality rate in 12 municipalities in Fukushima Prefecture designated as evacuation areas following the 2011 nuclear disaster. Changes in suicide rates were examined using an exponential smoothing time series model. In the evacuation areas, the suicide rate of men increased immediately after the disaster and then decreased from 47.8 to 23.1 per 100,000 during about 1½ years after the disaster. However, with the lifting of the evacuation order, it again exceeded that of non-evacuation areas and continued to do so for the next 3 years. On the other hand, the suicide rate in women in the evacuation areas increased later than that in men. These results indicate the need for continuous support following the lifting of the evacuation order. In addition, it is necessary to enhance social networks, which continue to confer protection, because of the isolation of the elderly as highlighted in our previous study.

Development of Behavior Abnormalities in a Patient Prevented From Returning Home After Evacuation Following the Fukushima Nuclear Disaster: Case Report.

After Japan's major nuclear accident in 2011, approximately 150,000 Fukushima residents were ordered to evacuate. Beginning in 2015, the evacuation orders have been systematically lifted. However, the health impacts of allowing residents to return to homes in areas previously uninhabitable due to nuclear radiation remain poorly understood.Declaring radiation levels to be safe does not necessarily eliminate the concerns of residents about the effects of radiation exposure. Rebuilding medical, welfare, and commercial infrastructure and services takes time. Nontangible community elements, such as mutually dependent social networks, also require time to be re-established. Nevertheless, the Japanese government prioritizes policies that encourage evacuees to return home as soon as it is safe to do so.Post-disaster evacuation situations and subsequent return home pose substantial-and as yet relatively unknown-mental and physical health threats for those affected, especially those in vulnerable groups, such as the sick, the elderly, and children.Here we report a case of an elderly female evacuee with dementia, who was prevented from returning home after her hometown evacuation order was lifted, began exhibiting marked behavioral abnormalities. Loss of emotional ties that were created while she was housed in temporary accommodation appeared to be a critical contributing factor.

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.

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.

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

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.

Factors Affecting the Help-Seeking Behaviours of Patients with Schizophrenia in Rural Cambodia.

In low- and middle-income countries in Asia, the use of supernatural, religious, and magical approaches to mental illness is widespread. We aimed to document the help-seeking behaviours and barriers to effective mental healthcare in the case of a psychiatric patient in rural Cambodia. The present case report describes the pathway that a patient with schizophrenia utilised to receive effective treatment in a rural area. First, the patient was taken by his parents to a pagoda. Subsequently, they took him to the home of a Kru Khmer (a Cambodian traditional healer). Nevertheless, his condition did not improve, and after seeing this, a neighbour suggested to his mother that they visit the provincial hospital. The patient received a diagnosis after an assessment by the hospital psychiatrist. Following several months of treatment with medication, the patient no longer exhibited paranoid behaviour. In this case, the patient's and his family's beliefs are strongly related to help-seeking behaviour toward medical care among psychiatric patients. To promote timely visits to the hospital, it is crucial to clarify and understand the type of beliefs held by psychiatric patients and their families. Besides, an educational approach to the beliefs is essential for shortening the duration of untreated illness.

Cognitive-behavioral family therapy as psychoeducation for adolescents with high-functioning autism spectrum disorders: Aware and Care for my Autistic Traits (ACAT) program study protocol for a pragmatic multisite randomized controlled trial.

BACKGROUND: One aim of an autism spectrum disorder (ASD) diagnosis is to obtain special support for the disorder, though this does not guarantee practical support. We developed a psychoeducational program using cognitive-behavioral therapy (CBT) and Aware and Care for my Autistic Traits (ACAT) for Japanese adolescents with high-functioning ASD and their parents. METHODS: This multisite study is a randomized controlled trial. In total, 24 participants will be assigned to the ACAT group and 24 to the treatment-as-usual (TAU) group. The ACAT group will receive a weekly 100-min session for 6 weeks, regular medical care, and one follow-up session. In this ongoing clinical trial, we will compare the scores of the measures recorded in the pre- and post-intervention stages between the ACAT and TAU groups. A total of 41 patients out of a target of 48 have participated in the trial to date. The primary outcome measure is the Autism Knowledge Questionnaire. Secondary outcome measures include Barriers to Access to Care Evaluation 3rd Edition, the Strengths and Difficulties Questionnaire, the Vineland Adaptive Behavior Scales second edition, the Parenting Resilience Elements Questionnaire, the General Health Questionnaire 12, and the Depression Self-Rating Scale for Children assessments, as well as an electroencephalographic recording. DISCUSSION: It is expected that participants in the ACAT group will significantly increase their self-understanding and awareness of ASD symptoms compared to those in the TAU group. Additionally, the ACAT group is expected to exhibit improved social adaptation and mental health if children and parents are able to better understand the ASD characteristics through sessions. This intervention will contribute to the establishment of an effective evidence-based treatment strategy for adolescents with ASD. TRIAL REGISTRATION: UMIN Register 000029851 . Registered on January 06, 2018.

Efficacy of prolonged exposure therapy for a patient with late-onset PTSD affected by evacuation due to the Fukushima nuclear power plant accident.

Trauma-focused cognitive-behavioural therapy (TF-CBT), such as prolonged exposure therapy, is a first-line treatment for post-traumatic stress disorder (PTSD). However, adapting TF-CBT as an intervention in situations with limited resources, such as in disaster settings, is problematic. This case report concerns a Japanese man in his 30s who was diagnosed with late-onset PTSD 5 years after the 2011 Great East Japan Earthquake. The onset and progression of his symptoms were heavily affected by changes in his life after evacuation due to the postearthquake nuclear power plant accident. We were able to successfully implement structured CBT and help the patient better cope with his symptoms in a disaster-stricken location. CBT for PTSD includes exposure to traumatic memories, which may lead to worsening of PTSD symptoms, but we were able to administer the therapy successfully with clinical support through the use of modern information and communication technology.

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.

Enhancement of PTSD treatment through social support in Idobata-Nagaya community housing after Fukushima's triple disaster.

Cognitive-behavioural therapy is a first-line treatment for post-traumatic stress disorder (PTSD), but it is difficult to implement in disaster settings. We report the case of an 80-year-old Japanese woman, who was diagnosed with PTSD after the 2011 triple disaster (earthquake, tsunami and nuclear plant accident) in Fukushima. Her recovery was greatly enhanced by the social support she received while living in Idobata-Nagaya community housing, established by Soma city in Fukushima, where residents could naturally discuss their traumatic experiences. Habituation to traumatic memories and processing of cognitive aspects of the psychological trauma, which are therapeutic mechanisms of trauma-focused psychotherapies, spontaneously occurred in this setting. The details of this case support the effectiveness of Idobata Nagaya as a provider of psychological first aid, an evidence-informed approach to assist children, adolescents, adults and families in the aftermath of a disaster.