Thoughts, perceptions and concerns of coastal residents regarding the discharge of tritium-containing treated water from the Fukushima Daiichi Nuclear Power Plant into the Pacific Ocean.

BACKGROUND: As a part of the decontamination process after the Fukushima Daiichi Nuclear Power Plant accident of 2011, 1.32 million tonnes of tritium-containing water will be discharged from the power plant into the Pacific Ocean. Although radiobiological impacts of the treated water discharge on the public and the environment were reported to be minimal, Tomioka and Okuma locals expressed unease regarding the long-term recovery of their towns, which are economically dependent on the agricultural, fishery, and tourism sectors. This study presents thoughts, perceptions and concerns of Tomioka and Okuma locals regarding the discharge of FDNPP-treated water containing tritium into the Pacific Ocean to facilitate a more inclusive decision-making process that respects local stakeholder interests. METHODS: Conducted from November to December 2022, surveys were mailed to current residents and evacuees aged 20 years or older registered with the town councils. RESULTS: Out of 1268 included responses, 71.5% were from those > 65 years. 65.6% were unemployed, 76.2% routinely visited hospitals, and 85.5% did not live with children. 61% did not want to return to Okuma/Tomioka. Anxiety about radiation-related health effects (38.7%), consuming food produced in Okuma/Tomioka (48.0%) and genetic effects (45.3%) were low. >50% reported poor physical and mental health. 40% were acceptive, 31.4% were unsure, and 29.7% objected to the discharge plans. Multinomial regression analysis revealed that, compared to acceptive responders, those who objected were more likely to be female, unemployed, and have anxiety about radiation-related genetic effects and poor mental health. Unsure responders were similarly more likely to be female, anxious about radiation-related genetic effects and have poor mental health. CONCLUSION: The poor mental health of the locals, connected to high levels of risk perception and anxiety about the loss of economic opportunities related to the discharge plans, must be addressed. The 30-year discharge process could handicap local industries and hamper post-disaster socioeconomic recovery due to the circulation of false rumours among consumers. These results highlight the need to actively involve residents in the towns' recovery process to address local concerns. The focus should be on the judicious combination of transparent science with the human aspect of recovery and narratives highlighting dialogues between local stakeholders and experts to enable the locals and the general public to make informed decisions about their protection and future.

[Delayed diagnosis of hydroa vacciniforme-like lymphoproliferative disorder in a patient with skin rashes].

Chronic active Epstein-Barr virus (CAEBV) infection is characterized by persistent EBV infection and can lead to fatal conditions such as hemophagocytic syndrome and malignant lymphoma through the clonal expansion of EBV-infected T or natural killer (NK) cells. Hydroa vacciniforme lymphoproliferative disorder (HV) and hypersensitivity to mosquito bites (HMB) have been identified as skin diseases in EBV-associated T- or NK-cell lymphoproliferative diseases. We present the case of a 33-year-old man. The patient had frequent episodes of a facial rash for three years before he visited our hospital, he visited several dermatologists but did not receive a diagnosis of HV. He was referred to the hematology department of our hospital for assessment of atypical lymphocytes in peripheral blood. Based on routine blood and bone marrow test we were unable to diagnose HV. However, when the patient's liver function deteriorated six months later, we considered the possibility of HV after reevaluating the skin rash. After performing EBV-related tests, we were able to definitively diagnose CAEBV with HV. It is crucial to be able to connect clinical observations to EBV-related tests when diagnosing CAEBV. Hematologists must be knowledgeable of the EBV-associated skin conditions of HV and HMB.

Risk perception regarding implementation of iodine thyroid blocking during a nuclear disaster of mothers living near a nuclear power station in Japan.

Pre-emptive evacuation orders following the accident at the Fukushima Daiichi Nuclear Power Station (FDNPS) in March 2011 and subsequent regulatory limits regarding contaminated food, milk, and water minimized the external and internal radiation exposure doses of nearby residents. However, with regard to implementation of iodine thyroid blocking (ITB), residents were confused because no information on the matter was released by the central and/or local governments. Based on lessons learned from the FDNPS accident, many countries have revised their guidelines regarding ITB during nuclear disasters. To adequately revise such guidelines and ensure effective ITB implementation during a nuclear disaster, however, residents' perceptions of ITB must be clarified. In this study, the perception of risks associated with ITB was investigated in mothers residing near the Sendai Nuclear Power Plant (SNPP) in Kagoshima Prefecture, Japan. Of the 520 mothers surveyed, 467 (89.8%) expressed anxiety regarding the administration of potassium iodine (KI) to their children. Logistic regression analysis revealed that the mothers' anxiety regarding the administration of KI to their children was positively correlated with their wish to consult an expert about KI and their hesitation to let their children eat foods produced in Fukushima, and negatively correlated with having confidence about administering KI to their children. Careful communication of potential risks to mothers residing near nuclear power plants is thus critical for implementing effective ITB in children.

Awareness of the implementation of stable iodine prophylaxis by parental guardians living in the urgent protective action planning zone of an operating nuclear power plant in Japan.

PURPOSE: The aim of this study was to clarify the characteristics and awareness of the need for protection against ionizing radiation, such as sheltering, evacuation, and implementing stable iodine prophylaxis, of guardians parenting young children living in an urgent protective action planning zone (UPZ) of an operating nuclear power plant in Japan. METHODS: Self-administered questionnaires were distributed to approximately 3000 guardians through 26 kindergartens located within a UPZ. Responses were obtained from 1172 who lived in the UPZ and were included in the analysis. RESULTS: Of the 1172 guardians, 460 (39.2%) responded that sheltering is not useful to reduce the dose of radiation exposure. On the other hand, 395 (33.7%) guardians responded that implementing stable iodine (SI) prophylaxis could prevent exposure from all radionuclides, and 876 (74.7%) responded that pregnant women should also implement SI prophylaxis in a nuclear emergency. Furthermore, 83.0% (973) responded that they wanted to receive pre-distribution of stable iodine (PDSI) for their children. On the other hand, 38.9% (456) of guardians had not known about SI before the study, and 71.8% (841) of guardians felt anxious about implementing SI prophylaxis for their children. CONCLUSION: Most guardians had expectations regarding SI and received PDSI, but they felt anxious about implementing SI prophylaxis for their children. It is essential that guardians living in the UPZ of restarted nuclear power plants be educated, and that risk communication about protection against ionizing radiation, including the side effects of implementing SI prophylaxis and radiation health effects, be conducted.

Negative Aspects of Self-Imposed Evacuation among Mothers of Small Children Following Japan's Fukushima Daiichi Nuclear Power Station Accident.

This study clarified the negative aspects of the self-imposed evacuation of mothers of small children seeking to avoid radiation exposure from the Fukushima Daiichi Nuclear Power Station accident on 11 March 2011. We conducted semi-structured interviews with 27 mothers, employing open-ended inquiries based on an interview guide. Our analysis of their responses using the Ka-Wakita-Jiro (KJ) method categorized the results into eight distinct groups comprising 142 labels. These categories included continued anxiety about the health effects of radiation, differences in risk perception, changes in spousal relationships, the inability to make friends and find support, living as a single parent, financial concerns, the unfamiliar feel of the area to which they evacuated, and uncertainty about the future. Despite their hardships, the mothers continued their self-imposed evacuation to avoid radioactivity. Our findings underscore that their anxieties about radiation exposure persisted even after self-imposed evacuation, leading to deteriorated relationships with key individuals who would have been involved in raising their children. These results offer valuable insights into the challenges experienced by the indirect victims of the nuclear accident, such as the mothers of small children.

Risk perception in long-term evacuees of Futaba town, Fukushima: a cross-sectional study reveals greater concerns outside the prefecture, 12 years after the accident.

For over 12 years since the 2011 East Japan Earthquake, the decontamination of radioactive materials is still incomplete. Although evacuation orders had been lifted in ~15% of Futaba town, the site of the Fukushima Daiichi Nuclear Power Plant, by August 2022, anxiety regarding the effects of nuclear radiation persists among evacuees, and their intention to return (ITR) remains low. As of August 2023, only 90 residents lived there. As the only town with government functions relocated outside Fukushima Prefecture, Futaba has more residents who evacuated outside the prefecture. Although numerous factors affect risk perception and ITR to the place of previous residence, the impact of evacuation destination on risk perception remains unknown. Therefore, this study aimed to evaluate the impact of evacuation destination on radiation risk perception. In 2022, a survey was conducted on 404 evacuees aged >18 years. The responses were compared between groups outside and inside Fukushima using the chi-square test and multivariate logistic regression analysis. Significant relationships were found between the evacuation destination and risk perception of genetic effects in the next generation (odds ratio [OR] = 1.92, 95% confidence interval [CI]: 1.15-3.20) and of the health effects of radiation (OR = 1.76, 95% CI: 1.10-2.84), which were both higher in those who had evacuated outside Fukushima. These findings stress the importance of evacuation destination choice and information access for evacuees' risk perception. Enhanced education and support efforts are necessary to help evacuees not only in Fukushima but also throughout Japan.

Tyrosine Kinase Inhibitor-induced Cerebrovascular Occlusion Presenting with Moyamoya Disease-like Stenosis of the Circle of Willis.

Vascular occlusive events are notable adverse effects of tyrosine kinase inhibitors (TKIs), which are promising treatments for chronic myeloid leukemia (CML). We herein report the case of a patient with CML who developed cerebrovascular occlusion of the circle of Willis during TKI treatment. Our patient did not meet the diagnostic criteria for moyamoya disease due to the insignificant development of moyamoya vessels. The lack of moyamoya vessel development may be explained by the suppression of tyrosine kinases that are responsible for angiogenesis. Cerebrovascular occlusion of the circle of Willis, without significant development of moyamoya vessels, may be an important phenotype of TKI-associated vasculopathy.

Comparison of quality of life between elderly and non-elderly adult residents in Okuma town, Japan, in a post-disaster setting.

With the growing elderly population who are susceptible to poor health, improvement of their quality of life is essential. In the post-disaster setting of the 2011 Fukushima Dai-ichi nuclear power plant (FDNPP) accident, affected municipalities such as Okuma town commenced their recovery processes and lifted evacuation orders in 2019. This study examines the differences in self-reported mental and physical health status, social functioning, risk perception, and intention to return between elderly (age ≥65 years) and non-elderly (age 20-64 years) residents. Questionnaires were distributed to current residents and evacuees of Okuma. Results revealed that the elderly had a 1.4 times higher odds ratio (95%CI 1.0-1.8, p = 0.034) for having anxiety regarding radiation-related health effects on future generations and a 1.3 times higher odds ratio (95%CI 1.1-1.5, p = 0.001) for wanting to know about the release of FDNPP-treated water into the environment than the younger group. Elderly residents also demonstrated a 2.2 times higher odds ratio for reporting poor physical health than younger residents. Clearing misconceptions and disseminating coherent information will reduce risk perception among this group. Further in-depth research regarding the disposal of FDNPP-treated water and its perceived risks is required. Health promotion through the encouragement of social participation, improvement of surroundings to facilitate healthy behaviors, and enhanced access to health services will improve the quality of life of elderly Okuma residents.

Changes in the Intention to Return and the Related Risk Perception Among Residents and Evacuees of Tomioka Town 11 Years After the Fukushima Nuclear Accident.

OBJECTIVE: This study examined temporal trends in risk perception and intention to return to Tomioka among residents and evacuees with the aim of aiding community recovery. METHODS: Responses to questionnaires distributed in 2017 and 2021 were compared regarding demographic information, intention to return to Tomioka, desire to consult radiation experts, and risk perception such as anxiety about food consumption, drinking tap water, self-health, and genetic effects. Questionnaires were distributed to all persons registered with the Tomioka town council, both current residents and evacuees. RESULTS: In 2021, the proportion of responders who had already returned/ wanted to return and those who did not want to return increased by 3.2% and 6.8% respectively, and the proportion unsure about returning decreased by 10.1%. Anxiety for self-health decreased by 15.4%, for genetic effects decreased by 24.4%, for food consumption decreased by 30.9%, and the latter 2 remained significant factors among responders unsure of returning and among those who did not want to return in 2021. CONCLUSIONS: Risk perception for food and genetic effects was significantly associated with uncertainty about returning or not returning. There is a need for continual monitoring of risk perception trends and implementation of targeted risk communication strategies.

Frequency of visits to Tomioka town and related factors among evacuees more than a decade after the Fukushima Daiichi Nuclear Power Plant accident.

This study aimed to clarify the frequency of visits (FOV) to Tomioka town, Japan, and related factors among evacuees more than a decade after the Fukushima Daiichi Nuclear Power Plant accident. A questionnaire survey was conducted on residents (age ≥ 18 years) who had residence cards in August 2021. Of the 2260 respondents, the FOV to Tomioka was as follows: 926 (41.0%) more than twice a year (Group 1 [G1]), 841 (37.2%) once a year (G2) and 493 (21.8%) no visits (G3). About 70% of the respondents who had decided not to return to Tomioka visited once a year or more. No significant differences in the FOV or radiation risk perception were found between groups. Multinomial logistic regression analysis using G3 as a reference revealed independent associations between living inside Fukushima in G1 (odds ratio [OR] = 5.4, 95% confidence interval [CI]: 4.1-7.3; P < 0.01) and G2 (OR = 2.3, 95% CI: 1.8-3.0, P < 0.01), undecided about returning in G1 (OR = 2.5, 95% CI: 1.9-3.3, P < 0.01), females in G1 (OR = 2.0, 95% CI: 1.6-2.6, P < 0.01) and motivation to learn more about tritiated water in G2 (OR = 1.8, 95% CI: 1.3-2.4, P < 0.01). Overall, 80% of the residents had visited Tomioka within a decade after the accident. These findings suggest the need to continue the effective dissemination of information about the effects of a nuclear accident and the subsequent decommissioning process to evacuees after evacuation orders have been lifted.

Temporal variation in environmental radioactivity and radiation exposure doses in the restricted areas around the Fukushima Daiichi Nuclear Power Plant.

Temporal variation and fluctuation in environmental contamination in Futaba town and Okuma town, the location of the Fukushima Daiichi Nuclear Power Plant (FDNPP), were evaluated based on a car-borne survey conducted from October 2021 to November 2022. Although the environmental radioactivity in the interim storage facility area (ISF) was higher than that in open areas (i.e., the evacuation order lifted areas in Futaba town and the Specific Reconstruction and Regeneration Base area [SRRB] in Okuma town), only minor temporal changes were seen in the ambient dose and detection rate of radiocesium (the proportion of radiocesium detected points per all measuring points) in those areas, respectively. These findings suggest that the observed variations may result from physical decay and environmental remediation. Resuspension caused by human activities and weather could also affect the detection rate of radiocesium. The annual external effective doses in Futaba town and Okuma town were estimated to be at a limited level (< 1 mSv/year). Nevertheless, to help ensure the safety and future prosperity of residents and communities in the affected areas around the FDNPP, long-term follow-up monitoring of temporal exposure dose levels during the recovery and reconstruction phases is extremely important.

Assessment of Radiation Risk Perception and Interest in Tritiated Water among Returnees to and Evacuees from Tomioka Town within 20 km of the Fukushima Daiichi Nuclear Power Plant.

In this study, we aimed to investigate radiation risk perception, mental health, and interest in tritiated water among evacuees from and returnees to Tomioka town, Japan, as well as to evaluate the intention to return (ITR) among evacuees living inside and outside Fukushima Prefecture. Of the 1728 respondents, 318 (18.4%) and 1203 (69.6%) participants reported living outside and inside Fukushima Prefecture, and 207 (12.0%) reported living in Tomioka. The ITR was not significantly different between those who lived inside and outside the prefecture among the evacuees. Similarly, there were no significant differences in radiation risk perception, mental health, and interest in tritiated water. However, the evacuees were independently associated with a motivation to learn about tritiated water (OR = 1.242, 95%Cl: 1.041-1.438, p = 0.016), reluctance to consume food from Tomioka (OR = 1.635, 95%Cl: 1.372-1.948, p < 0.001), and concern that adverse health effects would occur because of the Fukushima Daiichi Nuclear Power Plant accident (OR = 1.279, 95%Cl: 1.055-1.550, p = 0.012) compared to returnees, according to logistic regression analysis. Interestingly, the returnees were found to have better mental health but lower life satisfaction than the evacuees. These findings suggest the importance of ongoing risk communication about radiation exposure and tritiated water among residents regardless of their place of residency.

IgE Plasma Cell Leukemia Harboring t(11;14) and 1q Amplification.

IgE plasma cell neoplasm is the rarest subtype of plasma cell neoplasms and is known for its poor prognosis and high incidence of t(11;14). However, t(11;14) has been classified as a standard-risk rather than high-risk cytogenetic abnormality in multiple myeloma. We have been unable to explain the discrepancy that the hallmark of IgE plasma cell neoplasm with a poor prognosis is a standard-risk cytogenetic abnormality. Here, we report a case of IgE primary plasma cell leukemia with extramedullary lesions of the liver, stomach, and lymph nodes. Plasma cell infiltration was pathologically confirmed in each organ. Cytogenetic analysis of plasma cells revealed t(11;14) and amplification of 1q21. Chemotherapy, with immunomodulatory imide drugs, proteasome inhibitors, and CD38 antibodies, was unsuccessful. In IgE plasma cell neoplasm, coexistence of other cytogenetic abnormalities with t(11;14) may be important. Investigating the presence of cytogenetic abnormalities coexisting with t(11;14) is not only useful for evaluating prognosis but also important for understanding the pathogenesis of the disease. Recently, venetoclax, an oral BCL2 inhibitor, has demonstrated promising efficacy in plasma cell neoplasm patients harboring t(11;14). Development of an effective venetoclax-based regimen for treating aggressive IgE plasma cell neoplasm with t(11;14) is expected.

Multilineage Lymphoblastic Lymphoma as an Initial Presentation of Mixed Phenotype Acute Leukemia.

Mixed phenotype acute leukemia (MPAL) is characterized by leukemic blasts that express markers of multiple lineages. Compared with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), MPAL is considered to have a poor treatment outcome. We report a case of MPAL T/myeloid not otherwise specified that was initially presented as multilineage lymphoblastic lymphoma and subsequently developed into leukemic MPAL. An acute lymphoblastic leukemia-based treatment regimen was ineffective, but azacitidine and venetoclax therapy resulted in hematological complete remission. Our case suggests that multilineage lymphoblastic lymphoma should be considered to be the same disease as MPAL, albeit with different clinical presentations. Optimal treatment for MPAL has not been established yet, but azacitidine and venetoclax therapy may be a potential approach.

LIFE SATISFACTION AND FACTORS AFFECTING SATISFACTION IN KAWAUCHI VILLAGE RESIDENTS AT 10 Y AFTER THE FUKUSHIMA DAIICHI NUCLEAR POWER PLANT ACCIDENT.

We assessed the life satisfaction and related factors, including the mental health state, of residents of Kawauchi village, Fukushima Prefecture. Among the 374 residents who responded, 237 (63.4%) were satisfied with their current life. Of all respondents, 275 (73.5%) had a sense of belonging to the Kawauchi village community and 158 (42.2%) thought that Kawauchi had recovered after the Fukushima Daiichi Nuclear Power Station (FDNPS) accident. Regression analysis revealed that post-traumatic stress disorder checklist-Specific score, sense of belonging to the Kawauchi village community, opinion that Kawauchi village had recovered, timing of return to Kawauchi <2 y and concern about consumption of mushrooms and wild plants from Kawauchi were independently associated with life satisfaction. Although 10 y have passed since the FDNPS accident, it is necessary to continue with risk communication, particularly for new residents of Kawauchi.

Assessment of localized and resuspended 137 Cs due to decontamination and demolition in the difficult-to-return zone of Tomioka town, Fukushima Prefecture.

As the next step that occurred more than one decade after the accident at the Fukushima Dai-ichi Nuclear Power Station (FDNPS), decontamination and demolition have been carried out in the Specified Reconstruction and Revitalization Base (SRRB) of the difficult-to-return zone around the FDNPS. However, the risk of internal exposure among workers due to airborne dust inhalation after building demolition operations has not been sufficiently evaluated. To evaluate the working environment and internal exposure risk due to inhalation in the SRRB of Tomioka town, Fukushima Prefecture, the cesium-137 (137 Cs) radioactivity levels in the airborne dust at building demolition sites were analyzed using gamma spectrometry. The 137 Cs radioactivity levels and resuspension factors of the airborne dust at the subject building sites in the difficult-to-return zone remained at high levels compared with those of the control, which was located in the evacuation order-lifted area in Tomioka town. However, the 137 Cs radioactivity levels did not increase significantly, despite demolition operations that used heavy machinery. In this case, no substantial increases in accident-derived 137 Cs levels due to decontamination and demolition in the SRRB of Tomioka town, Fukushima Prefecture, were observed in the airborne dust samples, which suggests that the 137 Cs radioactivity in the airborne dust is primarily associated with particles that are resuspended by localized winds accompanied by the transfer of construction vehicles as opposed to the decontamination and demolition operations. However, the internal exposure doses due to aspirating airborne dust containing 137 Cs were extremely low compared with the estimated annual effective doses of decontamination workers or the limits recommended by the Japanese government. Additionally, countermeasures such as wearing protective masks could help reduce the on-site inhalation of soil-derived radionuclides. Integr Environ Assess Manag 2022;18:1555-1563. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Evaluation of Residents' Timing of Return to or New Settlement in Kawauchi Village, at 10 Years after the Fukushima Daiichi Nuclear Power Plant Accident.

Kawauchi village in Fukushima prefecture was affected by the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, and residents had to evacuate from their hometown in 2011. This study clarified the timing and related factors with regard to residents returning to or newly settling in Kawauchi. A survey was conducted using a questionnaire, from February to March 2021, with assistance from the Kawauchi village office and post office. Of the 374 residents, 170 (45.5%) had returned to or newly settled in Kawauchi within the past 2 years (group 1), 84 (22.5%) in the past 2-5 years (group 2), and 99 (26.5%) after more than 5 years (group 3) following the evacuation order. An additional 21 residents (5.5%) who had lived in Kawauchi at the time of the FDNPP had not yet returned (group 4). Compared with the other groups, residents in group 1 were more satisfied with their current lives and were coping better with stress. Even though they had experienced a serious nuclear disaster, residents of Kawauchi village who returned to their hometown in the early phase had a high sense of satisfaction with their current life one decade after the FDNPP accident.

Occupational Difficulties of Disaster-Affected Local Government Employees in the Long-Term Recovery Phase after the Fukushima Nuclear Accident: A Cross-Sectional Study Using Modeling Analysis.

Local government officials play a central role in post-disaster community reconstruction. However, few studies have reported on the actual difficulties during a complex disaster involving a nuclear accident. A self-rated questionnaire survey was administered to a total of 583 public employees in four municipalities around the Fukushima Daiichi Nuclear Power Station. The relationship between universal occupational factors and radiation disaster-specific factors on job satisfaction and intention to leave the job due to radiation anxiety was evaluated using structural equation modeling. The results showed that interpersonal problems (ß = -0.246) and service years (ß = -0.127) were related to job satisfaction, whereas radiation-specific factors were not related to job satisfaction, and only to the intention to leave work due to radiation anxiety. A sense of coherence was associated with job satisfaction (ß = 0.373) and intention to leave work due to radiation anxiety (ß = -0.182), and it served as a moderator of the universal occupational factors and the radiation disaster-specific factors. Therefore, it is suggested that outcomes could be improved through increased stress coping capacity by providing support for relationships and radiation risk communication to public employees during the disaster recovery period.

Intention to Return and Perception of the Health Risk Due to Radiation Exposure Among Residents in Tomioka Town, Fukushima Prefecture, Stratified by Gender and Generation.

OBJECTIVE: The aim of this study was to clarify residents' intentions to return (ITR) to Tomioka town, Fukushima Prefecture; and their risk perception of the health effects of radiation exposure as stratified by gender and generation. METHODS: Of almost 8000 residents who were 20 years of age or older and who had lived, prior to the accident, in the zones of Tomioka town where residents were permitted to return, 1860 were included in the analysis. For the analysis, the residents were divided into 4 groups which were stratified by gender and age: older males (over 50 years), young males (20-49 years), older females (over 50 years), and young females (20-49 years). RESULTS: ITR was found to be significantly lower in young males, young females, and older females than in older males. Conversely, young and older females had significantly higher levels of anxiety about drinking tap water and consuming food collected in Tomioka town. Young and older females also had greater concerns about adverse health effects on themselves and their offspring due to living in Tomioka town. CONCLUSION: Our results showed that special attention should be paid to younger residents, particularly to young females, with regard to recovery from a nuclear disaster.