The 2024 Noto Peninsula Earthquake and the Strategy of Medical Assistance from the Tohoku University Hospital.

A moment magnitude (Mw) 7.5 earthquake (the Global IDentifire (GLIDE) number: # Q-2024-000001-JPN) struck the Noto Peninsula of Ishikawa Prefecture on 1 January 2024 at 16:10 (Japan Standard Time). The reversed fault, 150 km in length and subducting beneath the peninsula, resulted in maximum seismic intensity 7 shaking, triggered the tsunami, destroyed over 43 thousand buildings, and disrupted roads and lifelines. The disaster claimed 236 deaths, including 15 indirect disaster deaths as of Jan. 28, 2024. There were Disaster Base Hospitals (DBHs) in the region, which survived structurally but suffered from impaired functions and the surge of medical needs of affected people. The disaster medical system of Japan immediately responded and coordinated the hundreds of emergency medical teams (EMTs), i.e., the Japan Disaster Medical Assistance Team (DMAT), from all over the country. Tohoku University Hospital, which had the experience of the 2011 Great East Japan Earthquake (GEJE), joined the coordinated response, dispatching a chain of DMATs, which helped the medical and public health coordination in Wajima City. The medical and public health needs included injuries, non-communicable diseases, infectious diseases, mental health issues, and maternal and child health issues, which were similar in the affected communities in GEJE. Although the actual damage far exceeded expectations, the structural retrofitting and business continuity plans of DBHs and the coordinated response of the national disaster medical system enhanced the effectiveness of medical and public health response.

Improving child nutrition in disasters by developing a modeled disaster preparedness nutrition education curriculum.

In contemporary global society, largely because of climate change and other natural and human-induced hazards, disasters are an almost daily occurrence. The nutritional impact of disasters on children results in long-term physical and mental health problems. As children are one of the most vulnerable demographic groups, they must be empowered with disaster preparedness nutrition knowledge, and the skills and motivation to survive, prevent/reduce malnutrition, and maintain good health during disasters. A disaster preparedness nutrition education program (DPNEP) was developed in this study to improve children's nutrition in daily life and during disasters through student-centered education. A consultative approach was used to synthesize the knowledge of a diverse group of four experts in disaster medicine and management, public health, education, and food and nutrition sciences to reach a consensus through discussion. A model DPNEP was developed by targeting grade 4 and 5 students and using interactive teaching methods. This can lead to the implementation of continuous nutrition education to empower children to make healthy food choices in daily life and reduce the risk of disaster-nutrition-related morbidity and mortality. Furthermore, once children acquire the necessary information, they are likely to share this knowledge with their families and communities, thereby enhancing society's resilience.

Universal health coverage mitigated COVID-19 health-related consequences in Asia Oceania.

The COVID-19 pandemic has been a continual challenge since 2020, and it continues to impact people and industries as a disaster caused by a biological hazard. This study examined universal health coverage (UHC) scores in relation to the performance in combating COVID-19 in the Southeast Asian region (SEAR) and the Western Pacific region (WPR), along with the State Party Self-Assessment Annual Reporting (SPAR) index under the international health regulations (IHC). The numbers of infections and deaths per million population from December 2019 to June 2022 were used as primary outcomes to measure countries' performance. Countries with UHC scores of 63 or higher had a significantly lower number of infected patients and deaths. In addition, several inter-capacity correlations within the SPAR capacities, including with C8 (the National Health Emergency Framework), as well as a very strong correlation to C4 (Food Safety), C5 (Laboratory), and C7 (Human Resources). Furthermore, C9 (Health Service Provisions) has a very strong correlation to C1 (Legislation and Financing), C2 (International Health Regulation Coordination and a National IHR Focal Point function), and C4 (Food Safety), suggesting that the capability to manage an emerging infectious disease form blocks of capacities. In conclusion, UHC clearly mitigated the health-related consequences of COVID-19 in South-East Asia Region (SEAR) and Western Pacific Region (WPR). Investigating the correlation between the SPAR capacities and UHC is a promising approach for future research, including the importance of the provision of health services, points of entry, and, most importantly, risk communications as critical factors for managing pandemic. This study constitutes a good opportunity to apply the SPAR index to define which capacities correlate with the outcome of the pandemic in terms of infections and deaths.

Evacuation at Home Delayed the First Medical Intervention in Minamisanriku Town after the 2011 Great East Japan Earthquake.

INTRODUCTION: In Japan, evacuation at home is expected to increase in the future as a post-disaster evacuation type due to the pandemic, aging, and diverse disabilities of the population. However, more disaster-related indirect deaths occurred in homes than in evacuation centers after the 2011 Great East Japan Earthquake (GEJE). The health risks faced by evacuees at home have not been adequately discussed. STUDY OBJECTIVE: This study aimed to clarify the gap in disaster health management for evacuees at home compared to the evacuees at the evacuation centers in Minamisanriku Town, which lost all health care facilities after the 2011 GEJE. METHODS: This was a retrospective cross-sectional and quasi-experimental study based on the anonymized disaster medical records (DMRs) of patients from March 11 through April 10, 2011, that compared the evacuation-at-home and evacuation-center groups focusing on the day of the first medical intervention after the onset. Multivariable Cox regression analysis and propensity score (PS)-matching analysis were performed to identify the risk factors and causal relationship between the evacuation type and the delay of medical intervention. RESULTS: Of the 2,838 eligible patients, 460 and 2,378 were in the evacuation-at-home and evacuation-center groups, respectively. In the month after the onset, the evacuation-at-home group had significantly lower rates of respiratory and mental health diseases than the evacuation-center group. However, the mean time to the first medical intervention was significantly delayed in the evacuation-at-home group (19.3 [SD = 6.1] days) compared to that in the evacuation-center group (14.1 [SD = 6.3] days); P <.001). In the multivariable Cox regression analysis, the hazard ratio (HR) of delayed medical intervention for evacuation-at-home was 2.31 with a 95% confident interval of 2.07-2.59. The PS-matching analysis of the adjusted 459 patients in each group confirmed that evacuation at home was significantly associated with delays in the first medical intervention (P <.001). CONCLUSION: This study suggested, for the first time, the causal relationship between evacuation at home and delay in the first medical intervention by PS-matching analysis. Although evacuation at home had several advantages in reducing the frequencies of some diseases, the delay in medical intervention could exacerbate the symptoms and be a cause of indirect death. As more evacuees are likely to remain in their homes in the future, this study recommends earlier surveillance and health care provision to the home evacuees.

Real-Time Prediction of Medical Demand and Mental Health Status in Ukraine under Russian Invasion Using Tweet Analysis.

Russia's invasion of Ukraine (February 24, 2022) has begun and there are concerns about the impact on health care supply and mental health. This study analyzed tweets in the Ukrainian language to capture the medical needs and mental health conditions in wartime Ukraine by focusing on ostensibly relevant words. The number of tweets containing the keywords and their overall proportion was compared before and after the Russian invasion of Ukraine. The survey period was divided into four phases-the pre-2022 Russian invasion, acute phase (4 weeks), subacute phase (12 weeks), and the chronic phase (8 weeks) up to August 10, 2022. The analysis targeted tweets sent in Ukrainian. The tweets were screened using a set of six classes with 75 key groups and 303 Ukrainian (204 original Japanese) keywords. Overall, 98,526,440 tweets were analyzed, with a pre-invasion and post-onset average of 1,096,976 and 3,328,243 tweets/week (a 3.0-fold increase), respectively. Of these, 3,197,443 tweets contained the keywords, with a pre-invasion and invasion average of 26,241 and 114,640 tweets/week (a 4.4-fold increase), respectively. The post-onset phase witnessed a considerable increase in all classes-medical services, treatment, medical resources, medical situations, and special situations-but not in the symptom class. Keywords related to psychological distress and anxiety immediately increased during the acute phase; those related to depression and post-traumatic stress reactions continued increasing as the invasion persisted, which may have reflected the mental state of those impacted. Analyzing tweets is useful for predicting people's real-time physical and mental health needs during wartime.

Health Emergency and Disaster Risk Management Workforce Development Strategies: Delphi Consensus Study.

INTRODUCTION: Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM). STUDY OBJECTIVE: The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC). METHODS: A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking. RESULTS: In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were "Human Resources" (n = 15), "Planning and Coordination" (n = 7), and "Community Capacities for Health EDRM" (n = 6) in the LMIC group. "Policies, Strategies, and Legislation" (n = 7) and "Human Resources" (n = 7) were the components with the most recommendations for the HIC group. CONCLUSION: The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.

Health System Disruption at the Primary Health Center Level Affected by Earthquake, Tsunami, and Liquefaction in 3 Districts of Central Sulawesi, Indonesia.

OBJECTIVES: An earthquake followed by tsunami and liquefaction on September 28, 2018, in Central Sulawesi caused health system disruptions. This study aimed to know health system disruption at the primary health center (PHC) level due to the disaster in 3 districts (Palu, Sigi, Donggala) of Central Sulawesi. METHODS: This was a qualitative study conducted in March 2019 involving 36 PHCs. Data were collected through interview of PHC officers using a structured questionnaire. Variables included disruption of management, budget, human resources, drug supply, Early Warning Alert and Response System (EWARS) of epidemic prone disease (EPD), human resource migration, health facility damage, and health facility access. Descriptive analysis was conducted to define disruption for a 1-y projection. RESULTS: Health system disruptions in Palu affected management, budget, human resources, EWARS, health facility damage, and health access; occurred within 1-2 mo; and were projected to become better after 6 mo. Problems in Sigi were management, human resources, drug supply, EPD, and EWARS for 1 mo after disaster and were projected to be better after 2 mo. The problems in Donggala were health services access, management, human resources for 1 mo after the disaster and were projected to be normal after 2 mo. CONCLUSIONS: Health system disruptions occurred in Central Sulawesi Province at the PHC level within 1-2 mo and were projected to become better after 3 mo in most PHCs.

Child Nutrition in Disaster: A Scoping Review.

Disaster endangers the nutritional health of children with resulting effects on their mental, physical, and social well-being. Adequate infant and young child feeding (IYCF) in disaster prevents malnutrition and save lives. Although much progress has been made in nutritional support in disaster, malnutrition among children is still evident. This scoping review study was conducted to identify gaps in child nutrition in disaster. Published articles (1946-2020) in PubMed were sought primarily and were assessed with some additional relevant articles. Overall, 103 articles were included in the scope of this review. Increased morbidity and mortality from malnutrition (macro- and micro-nutrient deficiencies), communicable diseases and mental health issues are nutritional effects of disaster. Pre-disaster malnutrition, food insecurity, living environments in shelters, poor breast-feeding practices, sociocultural factors, and organizational and administrative challenges strongly affect child nutrition in disaster. The efforts and collaboration of relief agencies resulted in the development of standardized guidelines and codes represented as the Sphere Project and Operational Guideline for IYCF in Emergency. This study recommends a well-coordinated and explicit approach that includes preparedness, advocacy, development/updating of policies, and education of children, family and relief aid workers on nutrition. Periodic nutritional assessment of children and nutritional support in disaster by designated IYCF authority are necessary. Education and participation of the general population are also important. Future assessments must examine food allergies in children and nutrition effects on child mental health in disaster.

Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations.

The Sendai Framework for Disaster Risk Reduction 2015-2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster risk management across prevention, preparedness, readiness, response, and recovery to improve the resilience and health security of communities, countries, and health systems. Evidence-based Health EDRM workforce development is vital. However, there are still significant gaps in the evidence identifying common competencies for training and education programmes, and the clarification of strategies for workforce retention, motivation, deployment, and coordination. Initiated in June 2020, this project includes literature reviews, case studies, and an expert consensus (modified Delphi) study. Literature reviews in English, Japanese, and Chinese aim to identify research gaps and explore core competencies for Health EDRM workforce training. Thirteen Health EDRM related case studies from six WHO regions will illustrate best practices (and pitfalls) and inform the consensus study. Consensus will be sought from global experts in emergency and disaster medicine, nursing, public health and related disciplines. Recommendations for developing effective health workforce strategies for low- and middle-income countries and high-income countries will then be disseminated.

Expected Scopes of Health Emergency and Disaster Risk Management (Health EDRM): Report on the Expert Workshop at the Annual Conference for the Japanese Association for Disaster Medicine 2020.

The World Health Organization (WHO) and its partners established the WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Network (HEALTH EDRM RN) in 2016 to respond to the increasing burden of recent health emergencies and disasters. The mission of the HEALTH EDRM RN, whose secretariat is located at the WHO Kobe Centre (WKC), is to promote global research collaboration and strengthen research activities to inform policies and programs by generating new evidence to manage health risks associated with all types of emergencies and disasters. With the strong support and involvement of all WHO regional offices, the HEALTH EDRM RN now works with more than 200 global experts and partners to pursue its mission. The first Core Group Meetings of the HEALTH EDRM RN were held on 17-18 October 2019, and concluded with the HEALTH EDRM RN-activity priorities to (1) promote operational research to better meet the needs of emergency- and disaster-exposed individuals and communities and efforts to translate science to policies and programs and (2) strengthen the research capacity of the Health EDRM community. In collaboration with the Japanese Association for Disaster Medicine, the WKC held a workshop on 21 February 2020, in which 20 Japanese experts from different research fields participated to further discuss these two points. This paper summarizes the discussion at the workshop.

Progress of Disaster Medicine during Ten Years after the 2011 Great East Japan Earthquake.

The 2011 Great East Japan Earthquake (GEJE) has renewed the paradigm of disaster medicine. The Tohoku Journal of Experimental Medicine (TJEM) widened its scope to include the disaster science from the health perspectives. TJEM has been accumulating 76 articles related with "disaster" or "pandemic" out of which 69 were published after 2011. Tohoku University established the International Research Institute of Disaster Science (IRIDeS) that took initiative to impact the Sendai Framework for Disaster Risk Reduction 2015-2030 (Sendai Framework) to include health aspect. Sendai Framework provided the platform for collaboration of different sectors, including the terminology that defines the concept of disaster, risk, hazard & exposure, vulnerability and coping capacity. Disaster medicine covers the diverse causes and damages of disasters by various hazards in this globalized and rapidly changing world. TJEM articles range the physical and mental health damage after the GEJE and other disasters with approved ethical consideration of investigations from the view point of affected area, mechanisms of hazard to affect human health including the radiation, virus or hazardous materials, proposal of refinement of health system to cope with disasters such as mental health support, risk communication, disaster medical coordination and hospital business continuity plan and future perspectives with reconstruction including Tohoku Medical Megabank Project. TJEM scope on disaster medicine had been widened during the 10 years after GEJE and IRIDeS can be the bridging hub not only between the health sector and other sectors, but also between disaster medicine and other medical disciplines.

Study Profile of the Tohoku Medical Megabank Community-Based Cohort Study.

BACKGROUND: We established a community-based cohort study to assess the long-term impact of the Great East Japan Earthquake on disaster victims and gene-environment interactions on the incidence of major diseases, such as cancer and cardiovascular diseases. METHODS: We asked participants to join our cohort in the health check-up settings and assessment center based settings. Inclusion criteria were aged 20 years or over and living in Miyagi or Iwate Prefecture. We obtained information on lifestyle, effect of disaster, blood, and urine information (Type 1 survey), and some detailed measurements (Type 2 survey), such as carotid echography and calcaneal ultrasound bone mineral density. All participants agreed to measure genome information and to distribute their information widely. RESULTS: As a result, 87,865 gave their informed consent to join our study. Participation rate at health check-up site was about 70%. The participants in the Type 1 survey were more likely to have psychological distress than those in the Type 2 survey, and women were more likely to have psychological distress than men. Additionally, coastal residents were more likely to have higher degrees of psychological distress than inland residents, regardless of sex. CONCLUSION: This cohort comprised a large sample size and it contains information on the natural disaster, genome information, and metabolome information. This cohort also had several detailed measurements. Using this cohort enabled us to clarify the long-term effect of the disaster and also to establish personalized prevention based on genome, metabolome, and other omics information.

Sleep Disturbance of Evacuees in Minamisanriku Town after Great East Japan Earthquake: Risk Factors and Treatment.

In 2011, Minamisanriku Town lost all of its medical facilities during the Great East Japan Earthquake. Using 10,459 anonymized disaster medical records of affected people in Minamisanriku Town, we assessed the prevalence and risk factors of sleep disturbance, which is known to exacerbate non-communicable diseases (NCDs) and anxiety disorder. Because sleep disturbance is a part of mental health issues, we divided the patients into two groups: patients (n = 492) with mental health issues other than sleep disturbance and the remaining (n = 9,967) with other comorbidities. Out of 492 patients with mental health issues, 295 patients (60.0%, 114 male, 158 female and 23 unknown) had sleep disturbance who might have required specific treatments. Out of the remaining 9,967 patients, 1,203 patients (12.1%, 361 male and 769 female and 73 unknown) had sleep disturbance. Univariate and multivariate analyses of the 9,967 patients revealed that the odds ratio (OR) of sleep disturbance was higher for female (OR 1.95), elderly persons over 60 (OR 16.15) and residing in evacuation centers (OR 1.36). Patients with two or more NCD had higher risk (OR 1.42). Importantly, sleep disturbance affects younger patients without NCD residing in evacuation center. Emergency medical teams most frequently prescribed benzodiazepines both for sleep induction and anxiolysis. In addition to high risk groups (female, older, with other mental health issues, residing in evacuation center), it is important to survey sleep disturbance in younger and healthier populations especially in evacuation centers and to provide psychosocial and medical support for them.

Plasma Osteopontin Levels is Associated with Biochemical Markers of Kidney Injury in Patients with Leptospirosis.

: Leptospirosis becomes severe, with a fatality rate of >10%, and manifests as severe lung injury accompanied by acute kidney injury. Using urine and blood samples of 112 patients with leptospirosis, osteopontin (OPN), galectin-9 (Gal-9) and other kidney-related biomarkers were measured to understand the pathological and diagnostic roles of OPN and Gal-9 in leptospirosis. Plasma levels of full-length (FL)-OPN (pFL-OPN) (p < 0.0001), pFL-Gal-9(p < 0.0001) and thrombin-cleaved OPN (p < 0.01) were significantly higher in patients with leptospirosis than in healthy controls (n = 30), as were levels of several indicators of renal toxicity: serum cystatin C (p < 0.0001), urine N-acetyl-ß-glucosaminidase (NAG)/creatinine (p < 0.05), and urine clusterin/creatinine (p < 0.05). pFL-Gal-9 levels were negatively correlated with pFL-OPN levels (r = -0.24, p < 0.05). pFL-OPN levels were positively correlated with serum cystatin C (r = 0.41, p < 0.0001), urine NAG/creatinine (r = 0.35, p < 0.001), urine clusterin/creatinine (r = 0.33, p < 0.01), and urine cystatin C/creatinine (r = 0.33, p < 0.05) levels. In a group of patients with abnormally high creatinine levels, significantly higher levels of serum cystatin C (p < 0.0001) and pFL-OPN (p < 0.001) were observed. Our results demonstrate that pFL-OPN reflect kidney injury among patients with leptospirosis.

Scoping Review of Hospital Business Continuity Plans to Validate the Improvement after the 2011 Great East Japan Earthquake and Tsunami.

During a disaster, all hospitals are expected to function as "social critical institutions" that protect the lives and health of people. In recent disasters, numerous hospitals were damaged, and this hampered the recovery of the affected communities. Had these hospitals business continuity plans (BCPs) to recover quickly after the disaster, most of the damage could have been avoided. This study conducted a scoping review of the historical trend and regional differences in hospital BCPs to validate the improvement of the BCP concept based on our own experience at Tohoku University Hospital, which was affected by the 2011 Great East Japan Earthquake and Tsunami (GEJET). We searched PubMed by using keywords related to BCP and adapted 97 articles for our analysis. The number of articles on hospital BCPs has increased in the 2000s, especially after Hurricane Katrina in 2005. While there are regional specificity of hazards, there were many common topics and visions for BCP implementation, education, and drills. From our 2011 GEJET experience, we found that BCPs assuming region-specific disasters are applicable in various types of disasters. Thus, we suggest the following integral and universal components for hospital BCPs: (1) alternative methods and resources, (2) priority of operation, and (3) resource management. Even if the type and extent of disasters vary, the development of BCPs and business continuity management strategies that utilize the abovementioned integral components can help a hospital survive disasters in the future.

Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: A nationwide, cancer registry-based study from the Japan Pancreas Society.

BACKGROUND: The importance of peritoneal washing cytology status both as a sign of irresectability and as a prognostic factor for pancreatic ductal adenocarcinoma remains controversial. The purpose of this nationwide, cancer registry-based study was to clarify the clinical implications of operative resection in patients who had positive cytology status. METHODS: Clinical data from 1,970 patients who underwent tumor resection were collected from the Pancreatic Cancer Registry in Japan. Clinicopathologic factors and overall survival curves were analyzed, and multivariate Cox proportional hazard models were evaluated. RESULTS: Among the 1,970 patients analyzed, positive cytology status was found in 106 patients and negative cytology status was found in 1,864 patients. The positive cytology status group had a greater frequency of pancreatic body and tail cancer and greater preoperative serum carbohydrate antigen 19-9 levels than the negative cytology status group (P < .001 each). The ratio of peritoneal recurrence tended to be greater in the positive cytology status group (14% vs 43%; P < .001). Overall median survival times were less in the positive cytology status group (17.5 months vs 29.4 months; P < .001). The 5-year survival rates were 13.7% and 31.1% in the positive cytology status and negative cytology status groups, respectively. Multivariate analysis of positive cytology status patients revealed that adjuvant chemotherapy was an independent prognostic factor. CONCLUSION: Positive cytology status was an adverse prognostic factor in patients who underwent resection for pancreatic ductal adenocarcinoma but did not preclude attempted curative resection. Curative resection followed by adjuvant chemotherapy may contribute to long-term prognosis in patients with positive cytology status.

Medical Needs in Minamisanriku Town after the Great East Japan Earthquake.

The medical records of service in disaster provided at a place other than a medical facility are defined as disaster medical records (DMRs). In this epidemiological study, to clarify medical need characteristics and trends after disaster, we analyzed the all anonymized DMRs of Minamisanriku Town that lost medical facilities in 2011 Great East Japan Earthquake and its consequent tsunami. After screening of duplicated or irrelevant documents, there were 10,464 DMRs with 18,532 diagnoses from March 11 through May 13. From 34 diagnostic groups according to International Classification of Diseases (ICD)-10, we integrated diagnostic groups into five modules that might require treatment concepts of different types: non-communicable disease (NCD), infectious disease, mental health issue, trauma, and maternal and child health (MCH). Age and sex distributions of the patients were similar to those of population before the disaster. The largest diagnostic module was NCD (68%), followed by infectious disease (21%), mental health issues (6%), trauma (4%), and MCH (0.2%). The age-specific rate of NCD exhibited a similar or suppressed level from that of nationwide survey, with higher rate of pollinosis among young population. Infectious disease increased in most age groups but there was no apparent outbreak because of early interventions. Sleep deprivation was twice as frequent in middle-aged women, compared with men. Trauma and MCH were less frequent, but each exhibited a unique time trend. Trauma onset was continuously recorded, while MCH visits were concentrated on a specific day. The medical need after disaster dynamically changes, and appropriate anticipatory countermeasures are necessary.