Risk communication regarding radiation exposure by experts using two concepts of regulatory science and ALARA.

In the Tohoku region of Japan, risk communication programs on radiation exposure are of great importance, especially with respect to reducing the stress and anxiety among those affected by radiation exposure. Although the concepts of 'as low as reasonably achievable' (ALARA) and regulatory sciences (RS) were very important for the smooth operation of risk communication among a wide range of stakeholders, our previous research showed that only 23.5% and 16.5% of medical doctors in Japan had an accurate awareness of them, respectively. To make risk communication more effective, this study examined the levels of awareness of the concepts of ALARA and RS among academic experts in Japan and compared their level of awareness of technical terms regarding radiation to that of the expected level for a layperson. This study also showed that, even among faculty working at graduate schools in Japan, only 29.8% and 39.4% had an accurate knowledge of ALARA and RS. To improve the knowledge of laypeople and experts on these concepts, they should be added to the primary education curriculum. This study demonstrated that among experts in many academic fields, a significant range of estimates existed of lay knowledge of technical terms regarding radiation. The highest scores were assigned by faculty in the field of humanities. Thus, before conducting risk communications, experts from all fields should identify the expected level of awareness among laypeople on the topic. In addition, risk communications regarding radiation should be conducted by academic experts and healthcare professionals together with facilitators or lecturers.

Association Between Lifestyle Habits and the Prevalence of Abdominal Obesity After the Great East Japan Earthquake: The Fukushima Health Management Survey.

BACKGROUND: The proportion of overweight individuals living in the evacuation zone of Fukushima increased after the Great East Japan Earthquake. However, the change in the prevalence of abdominal obesity has not been reported. Lifestyle habits and changes in these habits after the disaster might have affected the onset of abdominal obesity; however, the association between the two is unclear. METHODS: This study evaluated 19,673 Japanese participants of the Fukushima Health Management Survey. We used data from general health check-ups conducted in 13 municipalities between 2008 and 2010. Follow-up examinations were performed from June 2011 to March 2013. Changes in the proportion of individuals with abdominal obesity before and after the disaster were compared. Then, lifestyle habits affecting these changes were assessed. RESULTS: We found that 34.2% and 36.6% of participants (P < 0.001), both evacuees (37.0% and 42.1% [P < 0.001]) and non-evacuees (32.8% and 34.0% [P < 0.001]), had abdominal obesity before and after the disaster, respectively. Abdominal obesity was positively associated with smoking cessation, snacking after dinner, and non-breakfast skipping after the disaster and alcohol drinking before and after the disaster (all P < 0.05). Smoking cessation was positively associated with abdominal obesity in both evacuees and non-evacuees and in both men and women (all P < 0.01). CONCLUSION: The prevalence of abdominal obesity increased among residents in the area affected by nuclear disaster. It might be associated with not only lifestyle habits before the disaster but also changes in these habits after the disaster, especially smoking cessation.

Relationship Between Risk of Hyper-Low-density Lipoprotein Cholesterolemia and Evacuation After the Great East Japan Earthquake.

BACKGROUND: The Great East Japan Earthquake and the Fukushima Daiichi nuclear disaster forced the evacuation of residents and led to many changes in lifestyle for the evacuees. The Comprehensive Health Check was implemented to support the prevention of lifestyle-related disease and we analyzed the effect of prolonged evacuation (average of 3.0 years) on the new onset of hyper-LDL cholesterolemia. METHODS: The study participants were Japanese adults living near the Fukushima Daiichi nuclear power plant in Fukushima Prefecture. Annual health checkups focusing on metabolic syndromes were conducted for persons ≥40 years by the Specific Health Checkup. Based on data from annual checkups from 2011 or 2012, we followed 18,670 participants without hyper-LDL cholesterolemia who underwent at least one other annual checkup during 2013-2015. RESULTS: We found that the new onset of hyper-LDL cholesterolemia was 31% higher in evacuees than in non-evacuees. Evacuees had a significantly higher prevalence of obesity, hypertension, and diabetes, and higher frequency of weight change. Furthermore, logistic regression model analysis showed that the evacuation was significantly associated with the new onset of hyper-LDL cholesterolemia after adjusting age, gender, body mass index, smoking habit, alcohol consumption, diabetes, weight change, sleep deprivation, and exercise. CONCLUSION: The findings of the present study suggest that prolonged evacuation after a disaster is a risk factor for the new onset of hyper-LDL cholesterolemia, and lead to an increase in cardiovascular disease. It is therefore important to follow-up evacuees and recommend lifestyle changes where necessary.

Disaster response among hospital nurses dispatched to evacuation centers after the Great East Japan Earthquake: a thematic analysis.

BACKGROUND: Disaster relief operations involve a variety of components of healthcare efforts. The post-disaster recovery is a key component of hospital preparedness. This study aimed to investigate the role of hospital nurses in the disaster area and their challenges during the relief efforts after the Great East Japan Earthquake in 2011. METHODS: Semi-structured interviews were conducted with ten nurses who worked in a general public hospital before the Great East Japan Earthquake and were dispatched to the evacuation centers after the disaster. A qualitative approach with the thematic analysis method was employed. Three research queries (RQs) were prepared before the interview. RESULTS: The study participants played administrative roles as city employees in addition to performing nursing services as healthcare providers in evacuation centers. The first RQ on their challenges in evacuation centers gave us four themes: criticism by the evacuees, conflicts between multiple roles, difficulties in performing the first experience, and anxiety in working. The second RQ asking about motivation to accomplish disaster relief efforts raised three themes of carrying out the nursing role, acceptance by evacuees, and strengths of human connections. Two themes of awareness of disaster medicine and professional growth were raised from the third RQ of gains from the experiences in the evacuation centers. CONCLUSIONS: The hospital nurses in the disaster area performed multiple roles in the relief efforts in the evacuation centers, which developed a psychological burden on them. A sense of competence supported the motivation to accomplish the disaster relief activities and professional growth as a specialist in disaster medicine. A study limitation is missing hospital nurses who resigned during the relief efforts. Further study is warranted to refine the disaster preparedness of hospital operations.

Sleep disturbance is associated with neck pain: a 3-year longitudinal study after the Great East Japan Earthquake.

BACKGROUND: Neck pain is a common health problem in the general population as well as in people after natural disasters. Sleep disturbances are gaining attention as risk factors for musculoskeletal pain; however, the association between sleep disturbance and neck pain has not been clarified. The present study aimed to clarify the association between sleep disturbance and neck pain, especially focusing on the effect of the duration of sleep disturbance, after the Great East Japan Earthquake. METHODS: This study used 3-year longitudinal data obtained from individuals (n = 2,059) living in disaster-affected areas after the Great East Japan Earthquake. Sleep disturbance and neck pain were investigated at 4, 5, 6, and 7 years after the disaster. Multivariate logistic regression analyses were used for the assessment. RESULTS: Sleep disturbance was significantly associated with neck pain, and the association was stronger as the duration of sleep disturbance increased (adjusted odds ratios [95% confidence intervals]: 1.84 [1.23-2.75] for " < 1 year"; 2.41 [1.53-3.81] for " ≥ 1 year and < 2 years"; 2.80 [2.09-3.76] for " ≥ 2 years"). Furthermore, preceding sleep disturbance was significantly associated with the onset of neck pain, and the association was stronger as the duration of sleep disturbance increased (adjusted odds ratios [95% confidence intervals]: 1.86 [1.08-3.20] for " < 1 year"; 2.39 [1.22-4.70] for " ≥ 1 year and < 2 years"; 3.00 [1.94-4.65] for " ≥ 2 years"). CONCLUSIONS: Sleep disturbance is associated with neck pain, and long-lasting sleep disturbance strengthens the association. Clinicians should consider this association to effectively treat patients with neck pain, especially those affected by natural disasters.

Lifestyle factors associated with prevalent and exacerbated musculoskeletal pain after the Great East Japan Earthquake: a cross-sectional study from the Fukushima Health Management Survey.

BACKGROUND: While the prevalence of post-disaster musculoskeletal pain has been documented, its associated disaster-related factors have not been investigated. This study was to investigate the association of lifestyle factors associated with musculoskeletal pain after the Great East Japan Earthquake. METHODS: We conducted a cross-sectional study of 34,919 participants, aged 40-89 years, without any major disabilities at about 1 year after the disaster. The participants were asked about their musculoskeletal pain (low back and limb pain) and lifestyle factors: use of evacuation shelters or temporary housing at any point of time, job loss after the disaster, decreased income after the disaster, current smoking status, current drinking status, lack of sleep, regular exercise, and participation in recreational or community activities. Furthermore, psychological factors, such as traumatic reactions, psychological distress, and uncomfortable symptoms, affecting musculoskeletal pain were assessed. We used multinomial logistic regression analysis to calculate odds ratios of each lifestyle factor for prevalent and prevalent plus exacerbated musculoskeletal pain. RESULTS: Musculoskeletal pain prevalence was 32.8%: 27.6% for prevalent and 5.2% for prevalent plus exacerbated musculoskeletal pain. Multivariable adjusted odds ratios and 95% confidence intervals of lifestyle factors associated with prevalent and prevalent plus exacerbated musculoskeletal pain were as follows: shelter use (prevalent: 1.02, 0.96-1.08; exacerbated: 1.44, 1.29-1.60), job loss (prevalent: 1.03, 0.96-1.10; exacerbated: 1.30, 1.16-1.47), decreased income (prevalent: 1.13, 1.05-1.21; exacerbated: 1.29, 1.14-1.45), current heavy drinking (prevalent: 1.33, 1.21-1.47; exacerbated: 1.38, 1.14-1.68), insomnia (prevalent: 1.22, 1.15-1.29; exacerbated: 1.50, 1.36-1.65), exercising almost daily (prevalent: 0.83, 0.77-0.91; exacerbated: 0.80, 0.68-0.95), and participating in community activities often (prevalent: 0.83, 0.75-0.92; exacerbated: 0.76, 0.61-0.95). CONCLUSIONS: Prevalent and exacerbated musculoskeletal pain were inversely associated with exercising almost daily and participating in recreational or community activities sometimes or often, and positively associated with decreased income, current heavy drinking, and insomnia. Besides, the use of evacuation shelters or temporary housing/job loss was positively associated only with exacerbated musculoskeletal pain. These results suggest that post-disaster lifestyle factors are potentially associated with musculoskeletal pain. To achieve better post-disaster pain management, further studies are needed to confirm the consistency of these results in other disasters and to highlight the underlying causative mechanisms.

Night-Time Urinary Frequency Is Increased after the Great East Japan Earthquake along with Seasonal Variation: A Five-Year Longitudinal Study in Kesennuma City.

Disasters influence various health conditions; however, little has been reported about urinary symptoms. The objective of this study is to evaluate whether night-time urinary frequency was influenced by the Great East Japan Earthquake (GEJE) in March 2011. We also evaluated seasonal variation of night-time frequency, which may affect the primary objective. A retrospective chart review was conducted on 300 evaluable patients who resided in the impacted area: 263 men with benign prostatic hyperplasia and/or overactive bladder and 37 women with overactive bladder. Data concerning night-time frequency were collected repeatedly every three months from March 2009 until March 2014, then compared yearly and seasonally among same patients. In addition, night-time frequency was analyzed for potential relations to sex, age, comorbidities, and whether residences had been destroyed. There was a significant increase of night-time frequency during 2011-2013 when compared yearly with 2009 and 2010. In seasonal comparisons of the entire period, night-time frequency was greater during autumn and winter compared with summer. In quarterly comparisons, a sudden increase was not observed after the GEJE, but night-time frequency was increased significantly in spring, summer and autumn in 2011 when compared with the corresponding seasons in 2010. While hypertension was related to exacerbation of night-time frequency during winter, we did not find any factors associated with increase after the disaster out of sex, age, comorbidities or residential situations. In conclusion, night-time urinary frequency is increased shortly after the GEJE and remains elevated for the following three years along with seasonal variation.

[Trajectory of evacuees' health condition after the Great East Japan Earthquake: Health survey of residents in prefabricated temporary housing and private rented housing in the Miyagi prefecture].

Objectives The Great East Japan Earthquake occurred in March 2011. As of November 2018, 1100 survivors of its still lived in the Miyagi prefecture's temporary housing. Previous studies revealed that the residential relocation to temporary housing from their own houses due to damages caused by the earthquake exacerbated the evacuees' health. However, there is a lack of long-term observation of the trajectory of their health conditions in temporary housing. To the best of our knowledge, there is no study involving residents in public disaster housing. The aim of the present study was to reveal the trajectory of health conditions of residents of temporary and public disaster housing.Method This repeated cross-sectional study included residents aged 20 years and older, residing in private rented housing, prefabricated temporary housing, and public disaster housing. The survey period lasted for six years (2011 to 2017). We used self-rated health as the dependent variable, the year of the survey and type of house as independent variables, and sex and age as covariates. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated using multivariate logistic regression analysis.Results In total, 179,255 participants were included in this study. The average age was the highest among the residents of public disaster housing: 63.0 years in 2017. The number of residents who reported poor self-rated health declined yearly of private rented housing, but not of prefabricated temporary housing. The highest number of residents reporting poor self-rated health was from public disaster housing, compared to other temporary housing. Multivariate analysis showed that self-rated health improved in recent years (P for trend <0.001). Compared to the residents of private rented housing, those from public disaster housing reported poorer health conditions (aOR, 1.20 ; 95% CI, 1.15-1.27), although no significant difference was observed among the residents of prefabricated housing.Conclusion Health conditions of residents of temporary housing and public disaster housing tended to improve on a yearly basis. Residents of public disaster housing reported poor health. Therefore, monitoring and adequate intervention should be offered.

Does the Type of Temporary Housing Make a Difference in Social Participation and Health for Evacuees of the Great East Japan Earthquake and Tsunami? A Cross-Sectional Study.

BACKGROUND: Although the majority of survivors of the huge Great East Japan Earthquake and Tsunami evacuated to two types of temporary housings, prefabricated housing and rented housing, health effects of these different environments were unclear. We examined whether prevalent social participation in prefabricated housing brought larger health benefits than in rented housing using the largest health survey data of the disaster survivors. METHODS: This cross-sectional study used a 2012 survey by the Miyagi Prefectural Government, in which almost all of evacuees were targeted (response rate: 61.6%). Self-rated health (SRH) and psychological distress measured via K6 score were the dependent variables, and social participation was the independent variable. Odds ratios of the social participation on health variables were estimated using logistic regression models. To assess the contribution of social participation, the population attributable fraction (PAF) was estimated. RESULTS: The participants lived in prefabricated and rented housing numbered 19,726 and 28,270, respectively. Participants in prefabricated housing had poorer SRH and K6 than those in rented housing. The proportions of participants engaging in social participation of prefabricated and rented housing were 38.2% and 15.4%, respectively. The absence of social participation was significantly associated with poor SRH and K6 among participants in both housing types. The PAFs of social participation with good SRH were 39.5% in prefabricated housing and 14.4% in rented housing. For K6, the PAFs were 47.1% and 19.5% in prefabricated and rented housing, respectively. CONCLUSION: Compared to the residents in rented housing, residents in prefabricated housing had more frequent opportunities for social participation, which was associated with larger health benefits.

Design of the health examination survey on early childhood physical growth in the Great East Japan Earthquake affected areas.

BACKGROUND: To investigate the impact of the Great East Japan Earthquake on preschool children's physical growth in the disaster-affected areas, the three medical universities in Iwate, Miyagi, and Fukushima Prefectures conducted a health examination survey on early childhood physical growth. METHODS: The survey was conducted over a 3-year period to acquire data on children who were born in different years. Our targets were as follows: 1) children who were born between March 1, 2007 and August 31, 2007 and experienced the disaster at 43-48 months of age, 2) children who were born between March 1, 2009 and August 31, 2009 and experienced the disaster at 19-24 months of age, and 3) children who were born between June 1, 2010 and April 30, 2011 and were under 10 months of age or not born yet when the disaster occurred. We collected their health examination data from local governments in Iwate, Miyagi, and Fukushima Prefectures. We also collected data from Aomori, Akita, and Yamagata Prefectures to use as a control group. The survey items included birth information, anthropometric measurements, and methods of nutrition during infancy. RESULTS: Eighty municipalities from Iwate, Miyagi, and Fukushima Prefectures and 21 from the control prefectures participated in the survey. As a result, we established three retrospective cohorts consisting of 13,886, 15,474, and 32,202 preschool children. CONCLUSIONS: The large datasets acquired for the present survey will provide valuable epidemiological evidence that should shed light on preschool children's physical growth in relation to the disaster.

Effect of evacuation on liver function after the Fukushima Daiichi Nuclear Power Plant accident: The Fukushima Health Management Survey.

BACKGROUND: The Great East Japan Earthquake and subsequent Fukushima Daiichi Nuclear Power Plant accident caused residents to switch from their normal lives to lives focused on evacuation. We evaluated liver function before and after this disaster to elucidate the effects of evacuation on liver function. METHODS: This study was a longitudinal survey of 26,006 Japanese men and women living near the Fukushima Daiichi Nuclear Power Plant. This study was undertaken using data from annual health checkups conducted for persons aged 40-90 years between 2008 and 2010. Follow-up examinations were conducted from June 2011 to the end of March 2013, with a mean follow up of 1.6 years. Changes in liver function before and after the disaster were compared among evacuees and non-evacuees. We also assessed groups according to alcohol drinking status. RESULTS: The prevalence of liver dysfunction significantly increased in all participants from 16.4% before to 19.2% after the disaster. The incidence of liver dysfunction was significantly higher in evacuees than in non-evacuees. Multivariate logistic regression analysis showed that evacuation was significantly associated with liver dysfunction among residents. CONCLUSIONS: This is the first study to show that evacuation due to the Fukushima Daiichi nuclear power plant disaster was associated with an increase in liver dysfunction.

School-Based Interventions Aimed at the Prevention and Treatment of Adolescents Affected by the 2011 Great East Japan Earthquake: A Three-Year Longitudinal Study.

How natural disasters affect the psychological state of adolescents has not been well studied. Thus, we examined the effect of a natural disaster on high-school-aged youth and considered the most effective forms of support following such a disaster. We examined students from two high schools that were near the epicenter of the 9.0-magnitude Great East Japan Earthquake, which struck the Tohoku coastal area on March 11, 2011, causing severe damage to the region. The questionnaires measuring depression, anxiety, and post-traumatic stress reaction (PTSR) was administered to the students 3 times between July 2012 and August 2014; students who scored above the cut-off values of these measures were considered high-risk students. School teachers, nurses, and counselors provided a school-based intervention for all high-risk students identified in the survey. Data were analyzed using the Kruskal-Wallis H-test. Survey data revealed that 860 of the 1,432 (55.9%) high school students were at high risk of psychological trauma in 2012. This rate did not change substantially in the following 2 years, reaching 1,059 of 1,488 (69.1%) in 2013, and 949 of 1,430 (62.7%) in 2014. Depression and PTSR scores were significantly lower after the intervention (for 2nd and 3rd grade students in 2013 and 2014) compared to before (for the initial 2012 survey). However, there were no significant differences between the 1st grade students for all three years. Thus, school-based interventions involving psychological testing and interviews might reduce the rates of depression and PTSR in high school students.

A survey conducted immediately after the 2011 Great East Japan Earthquake: evaluation of infectious risks associated with sanitary conditions in evacuation centers.

In cooperation with the Miyagi prefectural government, we conducted a survey of the management of sanitation at evacuation centers and the health of the evacuees by visiting 324 evacuation centers at two weeks after the 2011 Great East Japan Earthquake. The facilities often used as evacuation centers were community centers (36%), schools (32.7%) and Nursing homes (10.2%). It was more difficult to maintain a distance of at least 1 m between evacuees at the evacuation centers with a larger number of residents. At evacuation centers where the water supply was not restored, hygienic handling of food and the hand hygiene of the cooks were less than adequate. Among evacuation centers with ≤50 evacuees, there was a significant difference in the prevalence rate of digestive symptoms between the centers with and without persons in charge of health matters (0.3% vs. 2.1%, respectively, p < 0.001). The following three factors had an important influence on the level of sanitation at evacuation centers and the health of evacuees: 1) the size of the evacuation center, 2) the status of the water supply, and 3) the allocation of persons in charge of health matters. Given that adjusting the number of evacuees to fit the size of the evacuation center and prompt restoration of the water supply are difficult to achieve immediately after an earthquake, promptly placing persons in charge of health matters at evacuation centers is a practicable and effective measure, and allocation of at least one such person per 50 evacuees is desirable.

How differently we should prepare for the next disaster?

Following the Great East Japan earthquake (the Big Quake) that hit the northeastern parts of Japan on March 11, 2011, aid was dispatched from multiple levels of organizations including the Japanese Nurses Association (JNA). Evidence indicates that the JNA did not play an effective role in the aid efforts, since the professional organization had pulled out and stopped sending nursing personnel from the end of April 2011. In view of the way that things were handled in terms of aid efforts immediately, a year, or two years after the Big Quake occurred, the authors of this paper have identified issues related to nurse's role at the time of the disaster. By looking back at what happened, we have gained insights into how to prepare for future disasters.

An experimental verification of fungal overgrowth in temporary houses at the site of the Great East Japan Earthquake.

Fungal contamination in the indoor air of prefabricated temporary houses at the site of the Great East Japan Earthquake revealed extremely high levels compared to those found in conventional residences. We experimentally investigated fungal growth levels on different interior materials to support fungal overgrowth in prefabricated temporary houses. Three species each of allergenic fungi and invasive fungi observed in temporary housing were selected for inoculation tests with various interior materials. The experiments with fungal inoculation were conducted in conformance with standards for industrial products described in the Japanese" JIS Z 2911:2018 Methods of test for fungus resistance" with small modifications. After incubation, visual and stereomicroscopic assessments were performed to determine fungal growth levels. The viability of the fungi varied according to the interior material type. Our findings demonstrate the importance of antifungal measures in indoor environments and the need for additional research on the growth levels of fungal species on various interior materials.

Marine debris induced by the Great East Japan Earthquake and Tsunami: A multi-sensor remote sensing assessment.

Using satellite remote sensing, we show the distribution, dominant type, and amounts of marine debris off the northeast coast of Japan after the Great East Japan Earthquake on 11 March 2011 and subsequent tsunami. Extensive marine debris was found on March 12, with the maximal amount found on March 13. The debris was found to be mainly wood (possibly lumber wood), with an estimated 1.5 million metric tons in an elongated water area of 6800 km2 (18 km E-W and 380 km N-S) near parallel to the coast between 36.75°N and 40.25°N. The amount decreased rapidly with time, with scattered debris patches captured in high-resolution satellite images up to April 6. These results provide new insights on the initial distribution of the Japanese Tsunami Marine Debris, which may be used to help find bottom deposition of debris and help refine numerical models to predict the debris trajectory and fate. SYNOPSIS: Marine debris induced by the 2011 Great East Japan Earthquake and Tsunami is found to be mainly composed of wood and possibly lumber wood from constructions, with maximum amount on 13 March 2011 distributed within a narrow band of ∼18 km near parallel to the northeast coast of Japan between 36.75°N and 40.25°N.

Indoor air quality, air exchange rates, and radioactivity in new built temporary houses following the Great East Japan Earthquake in Minamisoma, Fukushima.

This study measured air exchange rates, indoor concentrations of aldehydes and volatile organic compounds (VOCs), and radioactivity levels at 19 temporary houses in different temporary housing estate constructed in Minamisoma City following the Great East Japan Earthquake. The 19 surveyed houses represented all of the companies assigned to construct temporary houses in that Minamisoma City. Data were collected shortly after construction and before occupation, from August 2011 to January 2012. Mean air exchange rates in the temporary houses were 0.28/h, with no variation according to housing types and construction date. Mean indoor concentrations of formaldehyde, acetaldehyde, toluene, ethylbenzene, m/p-xylene, o-xylene, styrene, p-dichlorobenzene, tetradecane, and total VOCs (TVOCs) were 29.2, 72.7, 14.6, 6.35, 3.05, 1.81, 7.29, 14.3, 8.32, and 901 µg/m(3), respectively. The levels of acetaldehyde and TVOCs exceeded the indoor guideline (48 µg/m(3)) and interim target (400 µg/m(3)) in more than half of the 31 rooms tested. In addition to guideline chemicals, terpenes (α-pinene and d-limonene) and acetic esters (butyl acetate and ethyl acetate) were often detected in these houses. The indoor radiation levels measured by a Geiger-Müller tube (Mean: 0.22 µSv/h) were lower than those recorded outdoors (Mean: 0.42 µSv/h), although the shielding effect of the houses was less than for other types of buildings.

The Impact of the COVID-19 Pandemic on Suicide Rate Trends in the Tsunami-Disaster-Affected Area Following the Great East Japan Earthquake.

Background: People who experienced the Great East Japan Earthquake (GEJE) were expected to have additional levels of psychological burden resulting from the stressful conditions imposed during the coronavirus disease 2019 (COVID-19) pandemic; consequently, suicide rates may increase. Aim: We aimed to carry out continuous monitoring of suicide rates in the affected area following the GEJE under COVID-19 pandemic conditions. Method: This descriptive study monitored the suicide rates of the coastal area of Miyagi Prefecture, where disaster-related mental health activities have been continuing following severe damage caused by the tsunami disaster. An exponential smoothing time-series analysis that converted suicide rates into a smooth trend was conducted. Results: Although the suicide rate in the affected area was higher than the national average in February 2020, it showed a declining trend during the COVID-19 pandemic, while showing an increase trend in the national and non-affected areas. Limitations: Uncertainty about the direct reasons for suicide and the short time-scale observation are the limitations of this study. Conclusion: Although the national suicide rate increased, this was not the case for the affected area. Our findings may provide important lessons for suicide prevention during the COVID-19 pandemic, which needs careful regional monitoring of the state of suicide and of high-risk approaches such as disaster-related mental health activities.

Longitudinal Trends in Blood Pressure Associated with The Changes in Living Environment Caused by the Great East Japan Earthquake: The Fukushima Health Management Survey.

The Great East Japan Earthquake occurred on 11 March 2011, forcing Fukushima Prefecture residents to change their living environment. Such sudden changes possibly have long-term effects on cardiovascular-related diseases. We therefore sought to identify temporal relationships between living environment changes and blood pressure levels over three years following the earthquake. Participants included 14,941 men and 21,533 women aged 16 years or older who answered self-administered questionnaires, including questions on living environment changes at baseline (2012). Blood pressure levels were measured each year from 2012 to 2015. Linear mixed-effects models were used to analyze associations between living environment changes and blood pressure levels. Men with changes in living environment (i.e., those living in shelters or in temporary housing, rental apartments, relatives' houses, or others) showed significantly higher diastolic blood pressure levels than those who lived in their home at baseline (77.3 mmHg vs. 77.8 mmHg; p < 0.001). The time-dependent effect of diastolic blood pressure levels associated with living environment was not statistically significant, indicating a sustained difference in diastolic blood pressure associated with living environment changes at baseline after three years. The effect of living environment changes on diastolic blood pressure increment was also evident in men without antihypertensive medication use during the study period and in men who were current drinkers at baseline. There were no associations between living environment changes and diastolic blood pressure levels among women. Sudden changes in living environment due to the disaster had an impact on the long-term effects of higher diastolic blood pressure among middle-aged men.

A Comparison of Mental Health among Earthquake, Tsunami, and Nuclear Power Plant Accident Survivors in the Long Term after the Great East Japan Earthquake.

Even now, ten years after the Great East Japan Earthquake (GEJE), thousands of residents of Fukushima Prefecture are still living as evacuees. To understand the mental health states and needs for psychological care of the survivors, we conducted a questionnaire survey of survivors who were evacuated from Fukushima to Ibaraki due to the nuclear power plant accident and of the residents of two areas in Ibaraki where damage was particularly severe due to the tsunami or liquefaction. Our results show that stress related to participants' hometowns and to the disaster was a risk factor for depression and post-traumatic stress among the survivors in the medium to long term in all regions examined. Other risk factors for post-traumatic stress differed by region. This study shows that in a complex disaster such as the GEJE, where damage is widespread, the causes of damage and the experiences of disaster survivors differ greatly from region to region and that risk factors for depression and post-traumatic stress among disaster survivors over the medium to long term may also differ. To provide appropriate care to disaster survivors, it is necessary to determine what is causing the risk of depression and post-traumatic stress at any given time and in specific regions.