Two-Year-Span Breast Cancer Screening Uptake in Japan after the COVID-19 Pandemic and Its Association with the COVID-19 Vaccination.

There is limited information on whether the COVID-19 pandemic was associated with decreased breast cancer screening uptake and if COVID-19 vaccination was associated with an increase in screening uptake. Our study explored the uptake of breast cancer screening in Japan after the COVID-19 pandemic and assessed its association with the COVID-19 vaccination. We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), a web-based prospective cohort survey, and we included 6110 women without cancer history who were aged 40 to 74 years that participated in the 2012 and 2022 surveys. We examined the regular breast cancer screening uptake before and after the pandemic and employed a multivariable Poisson regression model to seek any association between COVID-19 vaccination and screening uptake. Of 6110, 38.2% regularly participated in screening before the pandemic and 46.9% did so after the pandemic. Individuals unvaccinated due to health reasons (incidence rate ratio (IRR) = 0.47, 95% CI: 0.29-0.77, p = 0.003) and for other reasons (IRR = 0.73, 95% CI: 0.62-0.86, p < 0.001) were less likely to undergo screening compared to fully vaccinated individuals. There was no long-term decrease in breast cancer screening uptake after the pandemic in Japan. Vaccination was linked to increased uptake, but there was no dose relationship.

Primary care clinic visits in formerly evacuated areas due to radiation disaster following the Great East Japan Earthquake: A retrospective descriptive study.

Radiation disasters pose distinctive medical challenges, requiring diverse care approaches. Beyond radiation exposure assessment, addressing health impacts due to lifestyle changes, especially among vulnerable populations, is vital. Evacuation orders issued in radiation-affected areas introduce unique healthcare dynamics, with their duration significantly influencing the recovery process. Understanding evolving patient demographics and medical needs after lifting evacuation orders is crucial for post-disaster care planning. Minamisoma Municipal Odaka Hospital, located 13 to 20 km from Fukushima Daiichi Nuclear power plant in a post-evacuation zone, was greatly affected by the Great East Japan Earthquake and subsequent radiation disaster. Data were retrospectively collected from patient records, including age, gender, visit date, diagnoses, and addresses. Patient records from April 2014 to March 2020 were analyzed, comparing data before and after the July 2016 evacuation order lift. Data was categorized into pre and post-evacuation order lifting periods, using International Classification of Diseases, Tenth Edition codes, to identify the top diseases. Statistical analyses, including χ-square tests, assessed changes in disease distributions. Population data for Odaka Ward and Minamisoma City fluctuated after lifting evacuation orders. As of March 11, 2011, Odaka Ward had 12,842 residents (27.8% aged 65+ years), dropping to 8406 registered residents and 2732 actual residents by April 30, 2018 (49.7%). Minamisoma City also saw declines, with registered residents decreasing from 71,561 (25.9%) to 61,049 (34.1%). The study analyzed 11,100 patients, mostly older patients (75.1%), between 2014 and 2020. Post-lifting, monthly patient numbers surged from an average of 55.2 to 213.5, with female patients increasing from 33.8% to 51.7%. Disease patterns shifted, with musculoskeletal cases declining from 23.8% to 13.0%, psychiatric disorders increasing from 9.3% to 15.4%, and trauma-related cases decreasing from 14.3% to 3.9%. Hypertension (57.1%) and dyslipidemia (29.2%) prevailed post-lifting. Urgent cases decreased from 1.3% to 0.1%. This study emphasizes the importance of primary care in post-evacuation zones, addressing diverse medical needs, including trauma, noncommunicable diseases, and psychiatric disorders. Changing patient demographics require adaptable healthcare strategies and resource allocation to meet growing demands. Establishing a comprehensive health maintenance system tailored to these areas' unique challenges is crucial for future disaster recovery efforts.

Trust in governments, public health institutions, and other information sources as determinants of COVID-19 vaccine uptake behavior in Japan.

OBJECTIVES: Trust in governments and public institutions as a determinant of public health outcomes has gained increased attention since the COVID-19 pandemic. Provided historically low confidence in vaccines in Japan, investigating the role of trust in information sources and actual COVID-19 vaccination uptake behavior will be invaluable for future vaccine promotion policymaking. Therefore, the objective of this study was to elucidate the determinants of COVID-19 vaccination uptake and evaluate the relationship between trust in different information sources and COVID-19 vaccination behavior in Japan. METHODS: For this study, we leveraged a longitudinal series of web-based surveys of 19,174 individuals in Japan conducted between 2021 and 2022 which asked questions regarding a wide range of sociodemographic and psychographic characteristics related to the COVID-19 pandemic. Determinant analysis for vaccination (at least one dose of a COVID-19 vaccine) was conducted via multiple logistic regression, and odds ratios (OR) with 95% confidence intervals (CI) were estimated. RESULTS: After adjustment for sociodemographic determinants of vaccine uptake, aggregate trust in the systems and institutions of vaccine approval (OR: 1.42, 95% CI: 1.30-1.56), and trust in information about the COVID-19 pandemic coming from government sources (OR: 1.27, 95% CI: 1.12-1.44) were found to be consistently powerful predictors of COVID-19 vaccination. Trust in media sources including traditional media (OR: 1.21, 95% CI: 1.07-1.36), and the internet (OR: 0.77, 95% CI: 0.66-0.89) had significant and opposing effects. CONCLUSIONS: Our findings support the broader hypothesis that trust in governments and public health institutions remains a powerful determinant for COVID-19 vaccine uptake in Japan. We also found that vaccination decision-making is a multifactorial process that includes the synthesis of trust in public institutions and media, and its interaction with psychosocial determinants such as prosociality and health literacy. We hope to apply this study's findings towards future vaccine programs for contagious diseases.

Comparing the risks of environmental carcinogenic chemicals in Japan using the loss of happy life expectancy indicator.

In this study, we aimed to use the loss of happy life expectancy (LHpLE), an indicator that enables risk assessment considering wellbeing, to compare the risks of environmental carcinogenic chemicals in Japan. First, we surveyed Japanese people to determine their emotional happiness by age and sex and evaluated whether cancer incidence reduced emotional happiness. Questionnaires were administered to a general population panel and a panel of patients with cancer in 2022, recruiting a predetermined number of responses of 5000 and 850, respectively. Second, using the survey data, LHpLE was calculated for radon, arsenic, and fine particulate matter (aerodynamic diameter <2.5 µm; PM2.5) and compared to psychological distress, considering increased mortality and decreased emotional happiness due to these risks. We discovered no significant decrease in emotional happiness due to cancer incidence and no significant associations between emotional happiness and cancer type, history, or stage. LHpLE was calculated to be 6.4 × 10-3 years for radon, 2.6 × 10-3 years for arsenic, 1.1 × 10-2 years (2012 exposure) and 8.6 × 10-4 years (2020 exposure) for PM2.5, and 9.7 × 10-1 years for psychological distress. The fraction of losses caused by these carcinogenic chemicals to HpLE exceeded 10-5, suggesting that risk reduction for these chemicals is important in environmental policies. The LHpLE indicator allows for comparing different types of risks, such as environmental chemicals and psychological distress. This is the first study to compare chemical risks using the LHpLE indicator.

Public Attitudes toward the Final Disposal of Radioactively Contaminated Soil Resulting from the Fukushima Daiichi Nuclear Power Station Accident.

Radioactively contaminated soil from the Fukushima Daiichi nuclear power station accident in 2011 is required by law to be finally disposed of outside Fukushima Prefecture by 2045. To gain public acceptance of this policy, it is essential to promote understanding and nationwide discussion. We conducted a web-based survey of 2000 people in Japan to examine public attitudes toward final disposal of the contaminated soil outside Fukushima Prefecture. Results show that policy approval was negatively correlated with perceived risk of a final disposal site, sense of inequity associated with building a final disposal site near residential areas, and values that are absolutely non-negotiable or protected from trade-offs with other values (protected values). Policy approval was positively correlated with high levels of interest in the Fukushima accident and subjective knowledge of decontamination and the policy. Respondents' comments and opinions about the policy indicated that respondents who approved of the policy accepted burden sharing, while those who disapproved were unconvinced by the rationale behind disposal outside Fukushima Prefecture and were dissatisfied by the lack of information disclosure and transparency. While the government's efforts to disseminate information about the current status and future of Fukushima have been effective to a certain extent, they are insufficient to achieve widespread public understanding of the policy. Our results indicate that attention needs to be paid to procedural fairness and explanations of risks.

Exploratory study to characterise the individual types of health literacy and beliefs and their associations with infection prevention behaviours amid the COVID-19 pandemic in Japan: a longitudinal study.

Background: During a global infectious disease pandemic such as the coronavirus disease 2019 (COVID-19), individuals' infection prevention/risk-taking behaviours are likely to differ depending on their health literacy and beliefs regarding the disease. To effectively promote infection prevention behaviours, it is necessary to enable information dissemination and risk communication that consider individuals' health literacy and beliefs. In this study, we exploratorily characterised segments based on individual health literacy and beliefs regarding COVID-19 among the Japanese during the early stage of the COVID-19 pandemic, and investigated whether infection prevention/risk-taking behaviours and fear of COVID-19 differed among these segments. Methods: In this study, we conducted two web-based longitudinal surveys in Japan (PHASE 1, 1-30 November 2020, 6,000 participants; PHASE 2, 1-31 December 2020, 3,800 participants). We characterised segments of the target population using cluster analysis on health literacy and beliefs regarding COVID-19 obtained in PHASE 1. We further investigated the associations between the clusters and infection prevention/risk-taking behaviours and fear of COVID-19, obtained from PHASE 2. Results: Five clusters were identified: 'Calm/hoax denial', 'Hoax affinity/threat denial', 'Minority/indifference', 'Over vigilance', and 'Optimism'. There were significant differences in infection prevention/risk-taking behaviours and fear of COVID-19 among the five clusters. The belief in susceptibility to infection, rather than affinity for hoaxes and conspiracy theories, was coherently associated with infection prevention/risk-taking behaviours and fear of infection across clusters. This study provides foundational knowledge for creating segment-specific public messages and developing interactive risk communication to encourage infection prevention behaviours.

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.

Japanese physicians' perceptions of conflicts of interest with pharmaceutical companies: Estimating two different questioning approaches.

Despite being one of the world's largest pharmaceutical markets, interactions between Japanese physicians and pharmaceutical companies often remain opaque. Importantly, potential conflicts of interest associated with these interactions can compromise patient care and increase costs. We conducted an online survey of Japanese physicians to elucidate perspectives on pharmaceutical company promotional activities and how these influence physician prescribing patterns. Anticipating that physicians might downplay their reliance on, or the value of, pharmaceutical company-provided information, the survey incorporated a direct questioning method and an unmatched count technique (UCT) to identify hidden perceptions on factors likely to influence prescribing. Overall, 1080 eligible physicians participated. Of these, 105 (9.7%) self-identified as hospital directors or managers. Surprisingly, nearly twice as many participants responding to direct questioning (18.9%) versus those responding to the UCT (10.1%) asserted that information provided by pharmaceutical companies was important when prescribing medicine. Hospital directors or managers (adjusted odds ratio [adjOR] 2.56, 95% confidence interval [95% CI]: 1.00-6.54, reference = physician without title) and frequent interactions with pharmaceutical sales representatives (adjOR 5.96, 95% CI: 1.88-18.9, reference = rare interaction) significantly valued the information from sales representatives and sponsored lectures when considering prescribing decisions. Additionally, 77.1% of respondents believed that sales representatives provide fair, neutral, or relatively honest and unbiased information about their products. Few Japanese physicians acknowledged the influence of industry-provided information on prescribing patterns. Our study uniquely applies two distinct question formats, providing a novel approach to understanding the depth of physician-industry relationships and the effectiveness of various survey methodologies.

Maximum proportion of masks worn: Collaborative efforts in Japanese professional football.

Mass gathering events in Japan have gradually mitigated their novel coronavirus disease (COVID-19) control regulations, along with a minimum infection risk. The Japan Professional Football League (J.League) conducted pilot surveys on holding events with chant cheers. In this commentary, we introduce the collaborative efforts based on scientific knowledge among experts, J.League, and their fans. We performed risk assessment in advance, by updating a previously developed model. We further observed the average proportion of masks worn, chant cheering time of participants, and CO2 levels in the stand. The number of new COVID-19 cases in an event with 5,000 chant cheering participants and 35,000 non-chant cheering participants was estimated to be 1.02 times of an event, with 40,000 non-chant cheering participants. The average proportion of masks worn during the game was 98.9 %, for chant cheer participants. The chant cheering participants spent 50.0-51.1 % of their time chant cheering. Monitored average CO2 levels were ≤ 540 ppm, suggesting high ventilation rates in the stand. The high proportion of masks worn represents the willingness of norm-conscious fans to cooperate in regular recovery of the sport. This has proved to be one of the successful models for future mass gathering events.

COVID-19 infection risk assessment and management at the Tokyo 2020 Olympic and Paralympic Games: A scoping review.

The Tokyo 2020 Olympic and Paralympic Games was one of the largest international mass-gathering events held after the beginning of coronavirus disease 2019 (COVID-19) pandemic. In this scoping review, we extracted papers discussing COVID-19 risk assessment or management at the Tokyo 2020 Games to determine the nature of studies that were conducted. Among the 75 papers obtained from two search engines (PubMed and ScienceDirect) and four papers collected from hand-searches, 30 papers were extracted. Only eight papers performed both COVID-19 prior risk assessment and quantitative evaluation of effectiveness measures, highlighting the importance of rapid, solution-focused risk assessment. Furthermore, this review revealed that the findings regarding the spread of COVID-19 infection to citizens in the host country were inconsistent depending on the assessment methods and that assessments of the spread of infection outside the host country were lacking.

Differences in and associations between belief in just deserts and human rights restrictions over a 3-year period in five countries during the COVID-19 pandemic.

Discrimination, which arose during the coronavirus disease 2019 outbreak, is a global public health issue. This study aimed to provide fundamental knowledge in proposing control measures to mitigate discrimination. We focused on two psychological variables: belief in just deserts (BJD, i.e., the belief that the infected individual deserves to be infected), a psychological factor that potentially promotes discrimination and prejudice, and human rights restrictions (HRR; i.e., the degree of individuals' agreement with government restrictions on citizens' behavior during emergencies). Differences in these items, as well as their annual trends from 2020 to 2022, were examined in Japan, the United States (US), the United Kingdom (UK), Italy, and China. In addition, the associations between BJD and HRR by country and year and the direction of the associations between them in Japan and Italy were analyzed. Online surveys were conducted annually, with 392-518 participants per country and year. The BJD was higher in Japan and lower in the UK. BJD increased significantly from 2020 to 2021 in all countries, except in China. Meanwhile, HRR was higher in China and lower in Japan. The HRR decreased from 2020 to 2021 in Japan and decreased from 2020 to 2022 in the US, the UK, and Italy. There were significant positive associations between BJD and HRR in Japan and Italy. Cross-lagged panel models revealed positive bidirectional associations between BJD and HRR in Japan and Italy, respectively, indicating that the HRR declined among those with weak BJD and that the BJD increased among those with high HRR. In Japan and Italy, the dissemination of public messages targeting those with a high HRR in the early stages of an infectious disease outbreak could potentially mitigate the adverse impact of the BJD, eventually reducing discrimination, especially when the infection is not attributed to the fault of the infected individuals.

Factors influencing acceptability of final disposal of incinerated ash and decontaminated soil from TEPCO's Fukushima Daiichi nuclear power plant accident.

TEPCO's Fukushima Daiichi nuclear power plant accident prompted extensive decontamination work. The decontaminated soil and incinerated ash generated by the process are scheduled for final disposal by March 2045 outside Fukushima Prefecture. The final disposal is unprecedented worldwide. Clarifying their acceptability will contribute to the final disposal of decontaminated soil and incinerated ash, as well as add knowledge about the perceived risk of low-concentration radioactive waste. A questionnaire survey was conducted to assess the psychological factors influencing final disposal acceptability. The results of the structural equation modeling demonstrated stable results, with risk perception decreasing acceptability, social benefits increasing acceptability, and personal benefits having limited impact. The initiative for the final disposal of decontaminated soil and incinerated ash can facilitate the reconstruction of Fukushima Prefecture after the disaster. Trust and intergenerational expectations are critical factors influencing the acceptability of this disposal. The responses were classified based on the relevance of moral norms using cluster analysis and moral foundations. The influence of each element on acceptability varied depending on the cluster. Trust was identified as the most influential factor in acceptability, regardless of the level of importance placed on moral norms.

Scientific consensus views are useful, but dangerous, without a code of ethics.

Using the Fukushima accident experience, this letter discusses recent efforts on measuring scientific consensus views-that is, quantifying the agreement among scientists. In the field of radiological protection, the efforts to measure scientific consensus views deserve attention, because hoaxes have been spreading even after the Fukushima nuclear accident. We discussed two points. First, the visualization of the diversity of scientific opinions shatters the diversity illusion caused by the mass media's irresponsible dissemination of pro and con arguments. Second, the use of scientific consensus views without an ethical code is dangerous. Measuring scientific consensus views should be accompanied with the development of ethical guidelines on using it.

Quantifying the effect of isolation and negative certification on COVID-19 transmission.

Isolation of close contact people and negative test certification are used to manage the spread of new coronavirus infections worldwide. These effectively prevent the spread of infection in advance, but they can lead to a decline in socio-economic activity. Thus, the present study quantified the extent to which isolation and negative test certification respectively reduce the risk of infection. To this end, a discrete-time SEIR model was used as the infectious disease model, and equations for calculating the conditional probability of non-infection status given negative test results on two different days were derived. Then the respective non-infection probabilities with two negative PCR test results, and with one negative PCR test result and one antigen test result, were quantified. By substituting initial parameters of the SEIR model into these probabilities, the present study revealed the following: (1) isolating close contact individuals can reduce by [Formula: see text] the risk of infection during the first 5 days, but five more days are needed to reduce the risk [Formula: see text] more, and seven more days to reduce the risk [Formula: see text] more; and (2) if an individual with a negative PCR test result has a negative antigen test result the next day, then his or her infection probability is between 0.6 and [Formula: see text]. Our results show that 5-day isolation has a proportionally greater effect on risk reduction, compared to longer isolation; and thus, if an isolation period of longer than 5 days is contemplated, both the risk reduction and the negative effects from such increased isolation should be considered. Regarding negative test certification, our results provide those in managerial positions, who must decide whether to accept the risk and hold mass-gathering events, with quantitative information that may be useful in their decision-making.

Long-term uptake rate of a breast cancer screening program in Fukushima, Japan, following the 2011 Triple Disaster: a retrospective observational study.

Little is known about how crises might affect the long-term uptake of breast cancer screening programs. This study aimed to clarify the long-term trend of breast cancer screening program uptake in Minamisoma City following the 2011 Triple Disaster in Fukushima, Japan (earthquake, tsunami, and nuclear disaster), and to evaluate the factors associated with this uptake. This study retrospectively analyzed data from the Basic Resident Registry and Breast Cancer Screening Program in Minamisoma City following the Triple Disaster. We calculated the annual breast cancer screening uptake rate for women aged 40-74 years who were of an even-numbered age at the end of each fiscal year and the incidence of at least one instance of uptake of the breast cancer screening initiative during the biennial intervals. We further performed cross-sectional and longitudinal regression analyses for the biannual screening uptake and investigated its associated factors. Breast cancer screening participation rates were 19.8% and 18.2% in 2009 and 2010, respectively. They decreased to 4.2% in 2011, and gradually increased thereafter, reaching the pre-disaster level of 20.0% in 2016. Similar but longer decrease of the uptake was observed in the biannual screening uptake rate. No pre-disaster screening uptake between 2009 and 2010, those living alone, or those who were evacuated, were factors that were found to be associated with non-uptake of the breast cancer screening program following the 2011 disaster. This study showed a long-term decline in breast cancer screening uptake in the area affected by the Triple Disaster, which was the most severe among those under evacuation, those who were isolated, and those without previous uptake. The insights emerging from this study could be used to increase awareness of this issue and establish potential countermeasures.

Wastewater-based prediction of COVID-19 cases using a highly sensitive SARS-CoV-2 RNA detection method combined with mathematical modeling.

Wastewater-based epidemiology (WBE) has the potential to predict COVID-19 cases; however, reliable methods for tracking SARS-CoV-2 RNA concentrations (CRNA) in wastewater are lacking. In the present study, we developed a highly sensitive method (EPISENS-M) employing adsorption-extraction, followed by one-step RT-Preamp and qPCR. The EPISENS-M allowed SARS-CoV-2 RNA detection from wastewater at 50 % detection rate when newly reported COVID-19 cases exceed 0.69/100,000 inhabitants in a sewer catchment. Using the EPISENS-M, a longitudinal WBE study was conducted between 28 May 2020 and 16 June 2022 in Sapporo City, Japan, revealing a strong correlation (Pearson's r = 0.94) between CRNA and the newly COVID-19 cases reported by intensive clinical surveillance. Based on this dataset, a mathematical model was developed based on viral shedding dynamics to estimate the newly reported cases using CRNA data and recent clinical data prior to sampling day. This developed model succeeded in predicting the cumulative number of newly reported cases after 5 days of sampling day within a factor of √2 and 2 with a precision of 36 % (16/44) and 64 % (28/44), respectively. By applying this model framework, another estimation mode was developed without the recent clinical data, which successfully predicted the number of COVID-19 cases for the succeeding 5 days within a factor of √2 and 2 with a precision of 39 % (17/44) and 66 % (29/44), respectively. These results demonstrated that the EPISENS-M method combined with the mathematical model can be a powerful tool for predicting COVID-19 cases, especially in the absence of intensive clinical surveillance.