No significant association between stable iodine intake and thyroid dysfunction in children after the Fukushima Nuclear Disaster: an observational study.

PURPOSE: Stable iodine prophylaxis helps prevent childhood thyroid cancer in nuclear emergencies; however, there is limited information on its effect on thyroid function. This study aimed to examine thyroid function and autoimmunity among children and adolescents that took stable iodine after the Fukushima Nuclear Disaster. METHODS: For this observational study, data were obtained from children and adolescents that underwent thyroid cancer screening at Hirata Central Hospital from April 2012 to March 2018. Participant characteristics, including possible hypothyroidism and hyperthyroidism, were compared between the prophylaxis and no-prophylaxis groups. Multivariable logistic regression models were used to assess for possible hypothyroidism, autoantibodies positive, and hyperthyroidism. RESULTS: A total of 1,225 participants with stable iodine prophylaxis and 3,946 without prophylaxis were enrolled. Of those participants, blood samples were available for 144 and 1,201 participants in the prophylaxis and no-prophylaxis groups, respectively. There were 17 (11.8%) and 146 cases (12.2%) of possible hypothyroidism or autoantibodies positive cases in the prophylaxis and no-prophylaxis groups, respectively, and there were no cases and 3 cases (0.2%) of possible hyperthyroidism in those two groups, respectively. Multivariable analysis for possible hypothyroidism revealed no association between stable iodine intake and possible hypothyroidism or autoantibodies positive [odds ratio 0.716 (95% confidence interval 0.399-1.284)] (p = 0.262). We did not perform multivariable analysis for hyperthyroidism due to the limited number of cases. CONCLUSION: Significant adverse effects of stable iodine intake on thyroid function were not observed among children and adolescents 7 years after the Fukushima Nuclear Disaster.

Displaced Intra-Articular Calcaneal Fractures: Evaluation of Clinical and Radiological Outcome Following Open Reduction and Internal Fixation with Locking Branched Calcaneal Plate.

Background An introduction of the World Health Organization Surgical Safety Checklist (WHO SSC) is essential to promote surgical safety. Objective To obtain country-specific information regarding the checklist in a leading medical institution in Nepal. Method The present research was a cross-sectional study with a survey conducted among healthcare professionals working in the operation theatre at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal. A questionnaire was distributed to 150 healthcare professionals working in the operating theatre. Responses to the questionnaire were analysed descriptively and regression analyses used to identify factors associated with awareness of the checklist. Result In total, 127 healthcare professionals participated in the study, of whom 118 (92.9%) had been aware of the WHO SSC. A substantial proportion of participants (108, 91.5%) were not satisfied with the prevailing practice whereby the checklist was not routinely used during surgery. Lack of appropriate training was the most prevalent barrier to the checklist use (72, 67.9%), followed by unwillingness of staff to use the checklist (54, 50.9%), and lack of experience (42, 39.7%). The mean score on the survey was 6.0 out of 10. Regarding the results of the regression model on survey scores, surgeons had higher scores compared to nurses (unadjusted coefficient 0.80, 95% CI 0.20-1.40). Conclusion Most of the healthcare professionals were aware of the WHO SSC, however multiple barriers to the checklist use were identified. It is important to establish an effective use of WHO SSC in the operation theatre.

New physician specialty training system impact on distribution of trainees in Japan.

OBJECTIVES: The problem of uneven distribution of medical services and inequitable distribution of physicians is drawing much attention worldwide. Revealing how changes in the specialty training system in Japan have affected the distribution of doctors could help us understand this problem. In 2018, a new and standardized specialty training system was implemented by the Japanese Medical Specialty Board, which is recognized by the Ministry of Health, Labor and Welfare. The purpose of this study was to investigate how this new system has affected the geographical distribution of doctors commencing specialty training (trainees) and choice of specialty in Japan. STUDY DESIGN: Retrospective observational study. METHODS: The change in the number of trainees between the control period (2012-2014) and 2018 was investigated, taking into account the prefecture and specialty selected. Population, the proportion of residents aged 65 years or older (aging rate), and the total number of overall doctors in each prefecture were considered as the background characteristics of each prefecture. We created a Lorenz curve and calculated the Gini coefficient for the distribution of trainees. RESULTS: In 2018, the number of trainees per 100,000 population increased to 6.6 nationwide compared with 5.5 during the control period. The number of trainees per 100,000 population in 2018 increased in prefectures with a large population of ≧ 2,000,000, a low aging rate (<27%), and a high doctor density (≧ 250 doctors per 100,000 population). The Gini coefficient showed an increase to 0.226 in 2018 compared with only 0.160 during the control period. CONCLUSIONS: After the implementation of the new training system, there was an increase in the number of doctors enrolling in specialty programs, and the specialties other than internal medicine and surgery have attracted more trainees. Inequality in the distribution of doctors between urban and rural prefectures worsened. This indicates the need to explore new ways of balancing distribution while maintaining optimal opportunities for specialist training.

Trend in unequal geographical distribution of doctors by age and sex in Japan from 2004 to 2014.

OBJECTIVES: In Japan, the proportion of female doctors and elderly doctors is increasing as in other countries. We investigated the relationship between doctors' demographic changes and their geographical distribution. STUDY DESIGN: A national database study. METHODS: We assessed trends in unequal geographical distribution of the number of doctors by sex and age from 2004 to 2014 in Japan. RESULTS: The Gini coefficient values for the number of female doctors (0.18) were larger than those for male doctors across all generations (0.13-0.14). The Gini coefficient values for the number of elderly doctors aged 60 years and older (male: 0.12, female: 0.18-0.23) were larger than those for majority age groups aged 40-59 years (male: 0.10, female: 0.16-0.17). CONCLUSION: The persisting geographical maldistribution of doctors may be associated with demographic changes, such as increase in the number of female doctors.

Exposure and current health issues in Minamisoma.

Various reports have shown that internal and external exposure levels of local residents after the accident at Fukushima Daiichi nuclear power plant were very low. However, there are serious postdisaster health effects in the form of increased prevalence of diabetes and other chronic conditions. Stress, changes in the social environment and in living arrangements, and disruption in healthcare support provided by a network of people have resulted in increasing the cost of care and changing patients' behaviour, such as delay in visiting a hospital. In addition to radiation protection, it is necessary, when looking after the health of Fukushima residents, to focus on human networking, social infrastructure, and protection of culture and history that are intangible, and not to overlook their roles in health.

Isolation and partial characterization of adenylate cyclase-enriched membranes from human platelets.

Isolation of adenylate cyclase-enriched membranes from human platelets was attempted using glycerol lysis technique followed by ultracentrifugation on discontinuous sucrose gradients composed of 24, 30, 34, 37, and 41% (w/w). Adenylate cyclase activity was enriched 4-fold in sample/24% sucrose interface, 7-fold in 24%/30% sucrose interface, and 4-fold in 30%/34% sucrose interface fractions with the recovery of 15-20% of the total activity. The enrichment and subcellular distribution of adenylate cyclase resembled in general those of phosphodiesterase and acid phosphatase with slight differences in each other. Protein profiles from SDS-polyacrylamide gel electrophoresis showed that the heavy chain of myosin (Mr = 200,000) was enriched in sample/24% sucrose interface and lower molecular weight proteins in 34%/37% sucrose interface and pellet. The interface fractions between 24 and 34% sucrose were, therefore, collected as adenylate cyclase-enriched membranes. Adenylate cyclase associated with the membranes displayed high specific activity (0.1 and 1-2 nmol/min/mg protein in the absence and presence of stimulants, respectively), and possessed sensitivities to prostaglandins (E1, I2, and D2) as well as cholera toxin. Activation of adenylate cyclase by these compounds required added GTP, indicating that the contamination of the membrane preparations with GTP-like substance (s) was minimal, if at all present.

Isolation and use of eight phages for typing Yersinia enterocolitica O3.

Subdivision of 137 isolates of Yersinia enterocolitica O3 into eight phagovars has been achieved. Some geographical differences were found in the sources of these phagovars and also of two biovars.

Lack of correlation between haemagglutination and adherence to epithelial cells in Yersinia pseudotuberculosis.

Yersinia pseudotuberculosis was examined for its haemagglutinating activity and adherence to cultured epithelial cells (HEp-2) in relation to possession of a virulence (VW) plasmid and to growth conditions. VW-lacking (VW-) bacteria were isolated from ten VW+ strains of each serovar which, after they were grown on CFA plates at 37 degrees C, agglutinated the erythrocytes from five different species. In contrast to the bacteria possessing the plasmid (VW+) half of the VW- bacteria, grown on CFA plates at 37 degrees C, did not agglutinate any of the erythrocytes used and the other half agglutinated only human erythrocytes. Furthermore, when grown on CFA plates at 25 degrees C, neither VW+ nor VW- bacteria showed a haemagglutinating activity. When the bacteria were grown in CFA broth, only two strains grown at 25 degrees C did not agglutinate any of the erythrocytes tested. The VW+ and VW- bacteria of the remaining strains, grown either at 25 degrees C or 37 degrees C, showed relatively high haemagglutinating activity. Adherence to HEp-2 cells did not correlate with haemagglutinating activity in Y. pseudotuberculosis; the VW+ bacteria grown at 37 degrees C adhered to HEp-2 cells more efficiently than either the VW- derivatives or the VW+ bacteria grown at 25 degrees C, regardless of the growth medium. These results indicate that some of the haemagglutinins detected on Y. pseudotuberculosis are not involved in the adherence to HEp-2 cells.

Intracerebral pathogenicity for chickens of avian influenza viruses isolated from free-living waterfowl in Japan.

The pathogenicity for chickens of 91 strains of avian influenza A virus isolated from such free-living waterfowl as whistling swan, pintail, tufted duck, mallard and black-tailed gull in Japan was tested. The majority of the virus strains infected and were pathogenic for the chickens. The virulence of these viruses seemed not to be as high as that of fowl plague virus. There were no significant differences in the intracerebral index score among the viruses belonging to the same subtype, irrespective of year of isolation or host.

Suppression of heat-stable enterotoxin production by Yersinia spp. in milk.

One of 16 raw milk isolates of Yersinia enterocolitica and Y. intermedia produced heat-stable enterotoxin (ST) in milk at 25 degrees C but not at 4 degrees C after 21 days of incubation. A catabolite repression of ST synthesis by the lactose-fermenting strain of Y. enterocolitica was observed when 4.6% lactose was added to trypticase soy broth. However, the lactose-fermenting strain was killed by acid produced by lactose fermentation in milk and did not produce ST in milk with the pH adjusted to neutrality. This study suggested that lactose and fat in milk are not the fundamental inhibitors of ST synthesis by Y. enterocolitica and that repression of ST synthesis may be related to other components.

Comparison of two strains of avian infectious bronchitis virus for their interferon induction, viral growth and development of virus-neutralizing antibody in experimentally-infected chickens.

Two field strains of avian infectious bronchitis virus were tested in specific pathogen-free chickens for interferon induction, growth and stimulation of virus-neutralizing antibody. Both strains induced interferon in lungs and trachea and neither strain induced it in kidneys. Strain Kagoshima-34, isolated from the kidneys of a chicken that had died of nephrosis/nephritis, induced interferon earlier than Strain Tottori-2, which was isolated from the trachea of a chicken with respiratory disease. Virus growth was generally more prolonged with Kagoshima-34, especially in the kidneys, but Tottori-2 persisted longer in the lungs.

Significance of milk as a possible source of infection for human yersiniosis. I. Incidence of Yersinia organisms in raw milk in Shimane Prefecture, Japan.

Twelve strains of Yersinia enterocolitica and 4 strains of a Y. enterocolitica-like organism (Y. intermedia) were isolated from 374 pooled raw milk samples. Growth occurred in a cold enrichment system using phosphate buffer solution (7 strains), peptone solution (5 strains) and yeast extract-casein-cystine broth (5 strains). Serovar 13,7 was most frequently isolated (8 strains) followed by serovars 5,27 (2 strains), 6,31, 7,8, 14 and 22 (each one strain). Two strains were untypable, serologically. Seasonal variation was of little consequence, but the regional incidence was an important feature of the bacteriological findings. Autoagglutination tests gave negative results with all isolates. Although so-called "clinical strains" were not identified, the relationship of the strains of Yersinia to milk-borne infections in humans cannot be excluded.

Ecological studies of Yersinia enterocolitica. III. Cross-protection against fecal excretion between Y. enterocolitica serovars 3 and 5.27 in pigs.

Yersinia enterocolitica biovar 4 serovar 3 and biovar 2 serovar 5.27 failed to establish in the intestines of pigs when challenged with the homologous or heterologous strains. After inoculation, the serum O-agglutinin titers were 1/10 or less and were not boosted by challenge with either serovar. Y. enterocolitica were not recovered in any specimens at the time of slaughter.