Solutions to physician undersupply in rural areas: from the experience of rural Fukushima.

Key words: Fukushima nuclear accident, health care facilities, health education, Japan, manpower and services.

Trends in the geographic distribution of nursing staff before and after the Great East Japan Earthquake: a longitudinal study.

BACKGROUND: Medical care systems in Iwate, Miyagi and Fukushima prefectures were greatly damaged by the Great East Japan Earthquake (GEJE), which struck on 11 March 2011. The shortage of nurses in this area was concerning; however, temporal trends have not been investigated. This study aimed to investigate the trends in the geographic distribution of total nursing staff per population in the secondary medical areas (SMAs) of these prefectures before and after the GEJE. We also aimed to qualify the above trends. METHODS: We conducted a longitudinal study at four time points (July 2007, 2010, 2011 and 2013) over 6 years using reports of basic hospitalization charges from all hospitals within Iwate, Miyagi and Fukushima prefectures that experienced severe damage from the GEJE. We calculated the number of total nursing staff per population in the SMAs and compiled descriptive statistics. Changes from 2010 to 2013 were qualified and mapped. RESULTS: In coastal SMAs, the ratios of total nursing staff per population decreased immediately after the GEJE. In most SMAs in 2013, the ratios increased and exceeded the pre-GEJE level. However, the changes in total nursing staff per population from 2010 to 2013 were negative in Ryouban (-4.0%), Ishinomaki-Tome-Kesennuma (-1.9%), Sousou (-47.7%) and Iwaki (-1.9%). In Sousou, which is closest to the Fukushima Daiichi Nuclear Power Plant, the changes in total nursing staff per population qualified by job role were -33.7% for nurses, -57.7% for associate nurses and -63.2% for nursing aides. CONCLUSIONS: Our study indicated that the temporal trends in the number of total nursing staff per population due to the GEJE differed between the physically damaged areas and those affected by radiation. We also found the difference in the trend by qualifications: the reduction in total nursing staff per population was larger in Sousou, the area most affected by radiation, than in any other SMAs. Moreover, the number of nursing aides was most affected among the three types of staff. To promote the post-GEJE reconstruction of medical care systems, it might be necessary to develop policies to secure both nurses and nursing aides after nuclear disasters.

Medical relief for the 2011 Japan earthquake: a nursing account.

In 2011 the east coast of Japan experienced a massive earthquake which triggered a devastating tsunami destroying many towns and killing over 15 000 people. The work presented in this paper is a personal account that outlines the relief efforts of the Humanitarian Medical Assistance team and describes the efforts to provide medical assistance to evacuees. The towns most affected had a large proportion of older people who were more likely to have chronic conditions and required medication to sustain their health. Since personal property was destroyed in the tsunami many older people were left without medication and also did not remember which type of medication they were taking. Some evacuees had brought a list of their medication with them, this assisted relief teams in obtaining the required medication for these people. The more successful evacuation centers had small numbers of evacuees who were given tasks to administer the center that kept them occupied and active.

Psychologic distress and QOL in medical staff after a disaster: A longitudinal 4-year study.

Aiming to improve post-disaster care of medical staff, we conducted an early and ongoing assessment of post-disaster psychologic distress and quality of life (QOL) in one center of a disaster-response hospital. Twelve days after the Great East Japan Earthquake, as the Fukushima Daiichi Nuclear Power Plant crisis was unfolding, we began a survey to examine the physical and mental state of medical staff to assess their motivation toward work. Surveys were administered in March 2011 (Survey 1), March 2012 (Survey 2), March 2013 (Survey 3), March 2014 (Survey 4), and March 2015 (Survey 5). Participants completed the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), EuroQol (EQ-5D), and MOS Short-Form 36-item Health Survey (SF-36). Although BDI scores significantly improved over time following Survey 1, participants in their 30s had significantly higher Survey 2 scores than those in their 40s/50s, and significantly higher Survey 3 scores than those in their 20s. STAI scores significantly improved over time following Survey 1. However, participants in their 30s had significantly higher Survey 3 scores than those in their 20s. EQ-5D scores did not significantly vary among survey time points or age groups. SF-36 physical functioning, role physical, social functioning, role emotional, and mental health subscale scores significantly improved over time. In conclusion, post-disaster longitudinal changes, including recovery period, differed among age groups. Thus, age should be taken into account in longitudinal evaluations of psychologic distress and QOL in medical staff after a disaster and, as more recent events suggest, during a pandemic.

A Comparison of the Contents of Disaster Nursing Practices and Perceived Difficulties among Nurses Working at Welfare Evacuation Shelters during Natural Disasters and Multiple Disasters: A Qualitative Study.

In this study, we compared the disaster relief practices of nurses who worked in welfare shelters in Iwate and Miyagi Prefectures, areas in which only natural disasters occurred, and nurses who worked in Fukushima Prefecture, an area in which both nuclear and natural disasters occurred during the Great East Japan Earthquake in 2011, in order to identify commonalities and differences between them. We conducted semi-structured interviews with two nurses from each prefecture. The results revealed that "nursing practice with minimal available materials and personnel" and "nursing practice based on knowledge and experience as a nurse" were common themes in the content of nursing practices, whereas "securing human resources during disasters and considering ideal welfare evacuation centers" and "recording the difficulties in dealing with nuclear disasters" were uncommon themes. The findings confirmed that even in Fukushima Prefecture, in which the nuclear disaster occurred, participants did not talk about their concerns regarding radiation exposure while working at welfare evacuation shelters where people with special requirements were evacuated, and that they were expected to respond in the same way as they would in natural disasters. However, participants reported several difficulties relating to nuclear disasters that should be considered in future disaster support.

Characteristics of Physician Outflow from Disaster Areas following the Great East Japan Earthquake.

OBJECTIVE: The shortage of physicians after a major disaster is a crucial issue. We aimed to evaluate the characteristics of physicians who left affected areas following the accident at Fukushima Daiichi Nuclear Power Plant caused by the Great East Japan Earthquake on March 11, 2011. METHODS: Using data from a physician census conducted in 2010 (pre-disaster) and 2012 (post-disaster), we evaluated changes in the number of physicians in affected areas. We then calculated the odds ratios and 95% confidence intervals using a logistic regression model to evaluate the association between physician characteristics and outflow. We also conducted stratified analyses based on physician characteristics. RESULTS: The number of physicians decreased in Fukushima Prefecture (-5.3%) and increased in Miyagi Prefecture (2.8%). The decrease in Fukushima and increase in Miyagi were evident even after taking the prefecture's population change into account (change in physician to population ratios: -1.9% and 3.2%, respectively). Compared with physicians who lived in areas >100 km from the nuclear power plant, physicians living 20-50 km and 50-100 km were, respectively, 3.9 times (95% confidence interval, 2.6-5.7) and 2.6 times (95% confidence interval, 1.7-3.8) more likely to migrate to distant areas. In the stratified analysis, younger physicians and those earlier in their careers had higher odds ratios for outflow than other physicians (P for interaction = 0.02 and <0.01, respectively). CONCLUSIONS: The risk of outflow was greater among younger and early-career physicians in areas around the power plant. Political support may be necessary to recruit and retain such physicians, who will be responsible for future community health in the disaster area.

Trends of Training Courses Conducted in the Human Resources Development Center of the National Institute for Quantum and Radiological Science and Technology After the Fukushima Dai-Ichi Nuclear Power Plant Accident.

Environmental contamination with radioactive materials caused by the Fukushima Dai-ichi Nuclear Power Plant (NPP) accident in 2011 raised a serious health concern among residents in Japan, and the demand for radiation experts who can handle the radiation-associated problems has increased. The Human Resources Development Center (HRDC) of the National Institute of for Quantum and Radiological Science and Technology in Japan has offered a variety of training programs covering a wide range of technologies associated with radiation since 1959. In this study, the time-course change in the number and age of the applicants for training programs regularly scheduled at HRDC were analyzed to characterize the demand after the NPP accident. The results suggested that the demand for the training of industrial radiation experts elevated sharply after the NPP accident followed by a prompt decrease, and that young people were likely stimulated to learn the basics of radiation. The demand for the training of medical radiation experts was kept high regardless of the NPP accident. The demand for the training of radiation emergency experts fluctuated apparently with three components: a terminating demand after the criticality accident that occurred in 1999, an urgent demand for handling of the NPP accident, and a sustained demand from local governments that undertook reinforcement of their nuclear disaster prevention program. The demand for the training of school students appeared to be increasing after the NPP accident. It could be foreseen that the demand for training programs targeting young people and medical radiation experts would be elevated in future.