Developing a broad perspective of future work and career in medical students through field trips to a disaster area: a qualitative study.

OBJECTIVE: Field trips to disaster-affected areas (FTDAs) without a specific purpose, such as medical cooperation, are widely used in medical education. However, what medical students gain from FTDAs remains unclear. The present study aimed to clarify what medical students gain from FTDAs. Five medical students who had visited the Fukushima nuclear power plant in Japan participated in a semi-structured group interview to ask what they gained from such a visit. The narratives were analysed using open coding. RESULTS: The following four themes emerged: "Spirit of scientific inquiry", "Foundation for lifelong education and personal growth", "Broadened understanding of the medical profession", and "Importance of practicing medicine in the community setting". The ambiguity of medical students' specific roles in the field trip compared to the fieldwork may have encouraged them to make sense of the experience from their perspective. As a result, students may have gained a broader perspective of their future work and career through the FTDA. If medical educators can gain consensus from the residents of a disaster site, different disaster-affected areas can be potential sites for medical education using FTDAs.

Attempted Suicide Is Independently Associated with Increased In-Hospital Mortality and Hospital Length of Stay among Injured Patients at Community Tertiary Hospital in Japan: A Retrospective Study with Propensity Score Matching Analysis.

Suicide is an increasingly important public healthcare concern worldwide. Studies examining the effect of attempted suicide on clinical outcomes among patients with trauma are scarce. We conducted a retrospective cohort study at a community emergency department in Japan. We included all severely injured patients with an Injury Severity Score > 15 from January 2002 to December 2021. The primary outcome measure was in-hospital mortality. The other outcome of interest was hospital length of stay. One-to-one propensity score matching was performed to compare these outcomes between suicide attempt and no suicide attempt groups. Of the 2714 eligible patients, 183 (6.7%) had trauma caused by a suicide attempt. In the propensity score-matched analysis with 139 pairs, the suicide attempt group showed a significant increase in-hospital mortality (20.9% vs. 37.4%; odds ratio 2.27; 95% confidence intervals 1.33-3.87) compared with the no suicide attempt group. Among survivors, the median hospital length of stay was significantly longer in the suicide attempt group than that in the no suicide attempt group (9 days vs. 12 days, p = 0.0076). Because of the unfavorable consequences and potential need for additional healthcare, increased attention should be paid to patients with trauma caused by a suicide attempt.

Post-Disaster Community Transition of Psychiatric Inpatients: Lessons from the Fukushima Nuclear Accident.

This study sought to explore factors related to community transition after the mandatory evacuation of psychiatric inpatients to other hospitals owing to the Fukushima Daiichi Nuclear Power Plant accident. A retrospective cohort design was adopted and 391 psychiatric patients were examined. Univariate and multivariate analyses were conducted to confirm the association between the achievement or non-achievement of discharge to community living and their backgrounds (age, gender, evacuation destination, psychiatric diagnoses, and physical complications). Multivariate analysis indicated that patients with psychiatric diagnoses of schizophrenia, schizotypal, and delusional disorders (International Statistical Classification of Diseases and Related Health Problems 10th revision, F20-29), and those with physical diagnoses of the circulatory (I00-95) and digestive (K00-93) systems showed a significant association with the non-attainment of community transition. From these results, we hypothesized that difficulties in the management of medication during and immediately after the extremely chaotic settings of evacuation could have negative effects on the community transitions. Furthermore, another possible concern was that individuals' persistent psychotic status before the accident had been carried over to the destination hospitals. Therefore, pre-disaster daily cooperation across hospitals and challenges for vulnerable psychiatric patients' future community lives are also essential.

Association between home meal preparers and salt intake in haemodialysis patients: a cross-sectional study.

OBJECTIVES: This study aimed to examine the association between home meal preparer and salt intake among haemodialysis patients, including daily dietary status. We hypothesised that salt intake is higher among individuals who rely on meal preparation from others than those who prepare meals by themselves. DESIGN: Cross-sectional study. SETTING: Two medical facilities in Fukushima Prefecture, Japan. PARTICIPANTS: 237 haemodialysis outpatients who visited one of the medical facilities between February 2020 and August 2021 and were diagnosed with anuria, defined as urination of <100 mL/day, were the potential participants of the present study. Finally, 181 participants (131 male and 50 female) were included in the analysis. OUTCOME MEASURE: Salt intake amount was calculated from the results of predialysis and postdialysis blood draws, using Watson's formula based on predialysis weight, predialysis serum sodium level, postdialysis weight and serum sodium level at the end of dialysis. RESULTS: Salt intake was significantly higher in participants who relied on meal preparation from others ('relying on others') than those who prepared meals by themselves ('self-prepared') (B=1.359; 95% CI: 0.495 to 2.222). No statistical difference was found between individuals who ate out or ate takeout ('outsourcing') and those who prepared their own meals ('self-prepared'). These results were robust after adjustment for confounding factors. CONCLUSIONS: The present study revealed an association between self-preparation of meals at home and reduced salt intake among dialysis patients. Our findings suggest that whoever is the home meal preparer is possibly a social determinant of salt intake. To improve the prognosis of haemodialysis patients, actively reaching out to the family and assessing their social environment, such as identifying the home meal preparer and, if the patient relies on others for meal preparation, conducting nutritional/dietary guidance for that person, are effective in enhancing salt reduction.

Inappropriate timing of salt intake increases the risk of heat-related illness: An observational study.

The importance of salt intake in preventing heat-related illness (HRI) is well established, however, the specific method of ingestion has not been sufficiently studied. This study, therefore, aimed to investigate the optimal timing of salt intake to prevent HRI during hot outdoor work. We recruited 28 healthy male firefighters working at a fire department in Japan. They were provided a questionnaire to complete before and after receiving training in the summer season. We assessed their salt intake as before, during, and after training or none. In addition, they completed a brief self-administered diet history questionnaire to evaluate their daily salt and alcohol intake. HRI was determined through subjective and objective symptoms listed in the questionnaire, and environmental data were obtained from a national database. Subsequently, factors related to HRI were determined using a logistic regression model. The mean age of the participants was 31.0 ± 7.7 years. The study was performed within 250 working days, and we detected 28 HRI symptoms (11.2%). The median alcohol intake was 25.6 g/day when calculated according to the actual work system. Logistic mixed effect model analysis revealed that salt intake before training (OR: 5.893, 95% CI: 1.407-24.675), and salt intake before and during training (OR: 22.889, 95% CI: 4.276-122.516) were positively associated with HRI symptoms. The results indicate that inappropriate timing of salt intake increases the risks of HRI. Thus, a timely intake of salt in adequate amounts may be important in preventing these risks.

Associations of endurance, muscle strength, and balanced exercise with subjective sleep quality in sedentary workers: A cross-sectional study.

BACKGROUND: The optimal exercise combination for improving sleep quality among sedentary workers is unclear. OBJECTIVE: To reveal what combination of exercises contributes to good sleep quality. METHODS: In this cross-sectional study, we enrolled 5,201 sedentary workers who underwent health examinations in 2019. Data on sleep quality, basic attributes, energy expenditure, and lifestyle aspects such as exercise and physical activity, supper time close to bedtime, and alcohol intake were obtained. The subjects reported their exercise habits by selecting up to three forms of exercise from a list of 182 options, which were classified into three types: endurance (e.g., jogging), muscle strength (e.g., bench pressing), and balanced types which combined both endurance and muscle strength characteristics. (e.g., walking). These forms were then categorized into eight combination patterns: endurance only; muscle strength only; balanced only; endurance and muscle strength; endurance and balanced; muscle strength and balanced; all types; and absence of any exercise habits. Binary logistic regression analysis was used to examine the associations between the exercise combination patterns and sleep quality. RESULTS: Good sleep quality was significantly associated with "endurance" (OR = 1.419; 95% CI 1.110-1.814), "balanced only" (OR = 1.474; 95% CI 1.248-1.741), and "endurance and balance" (OR = 1.782; 95% CI 1.085-2.926) exercise patterns. No significant associations were found between the combinations that included muscle strength exercises and sleep quality. CONCLUSION: The endurance or balanced-type exercises, or a combination of both, may help to improve the sleep quality of sedentary workers as part of occupational health management.

The Relationship Between Conventionally Obtained Serum-Based Liver Function Indices and Intravoxel Incoherent Motion Diffusion-Weighted Imaging and Magnetic Resonance Elastography in Patients With Hepatocellular Carcinoma.

OBJECTIVES: To investigate the relationship between conventionally obtained serum-based biochemical indices and intravoxel incoherent motion imaging (IVIM) parameters compared with magnetic resonance elastography (MRE). METHODS: Patients with hepatocellular carcinoma who underwent ≥2 liver magnetic resonance imaging (MRI) scan, including IVIM and MRE, between 2017 and 2020 and biochemical testing within 1 week before or after MRI were included in this study. Biochemical tests were performed to determine the albumin-bilirubin (ALBI) score and modified ALBI (mALBI) grade, aspartate aminotransferase to platelet ratio index (APRI), and fibrosis-4 index (FIB-4). The diffusion coefficient (D), pseudo-diffusion coefficient (D*), fractional volume occupied by flowing spins (f), and apparent diffusion coefficient were calculated for IVIM. The correlations between (1) the imaging parameters and biochemical indices and (2) the changes in mALBI grades and imaging parameters were evaluated. RESULTS: This study included 98 scans of 40 patients (31 men; mean age, 67.7 years). The correlation analysis between the biochemical and IVIM parameters showed that ALBI score and D* had the best correlation (r = -0.3731, P < 0.001), and the correlation was higher than that with MRE (r = 0.3289, P < 0.001). However, among FIB-4, APRI, and MRI parameters, MRE outperformed IVIM parameters (MRE and FIB-4, r = 0.3775, P < 0.001; MRE and APRI, r = 0.4687, P < 0.001). There were significant differences in the changes in MRE among the 3 groups (improved, deteriorated, and unchanged mALBI groups) in the analysis of covariance (P = 0.0434). There were no significant changes in IVIM. CONCLUSIONS: Intravoxel incoherent motion imaging has the potential to develop into a more readily obtainable method of liver function assessment.

Prediction of Anemia From Cerebral Venous Sinus Attenuation on Deep-Learning Reconstructed Brain Computed Tomography Images.

OBJECTIVE: The aim of the study is to evaluate whether the prediction of anemia is possible using quantitative analyses of unenhanced cranial computed tomography (CT) with deep learning reconstruction (DLR) compared with conventional methods. METHODS: This cross-sectional retrospective study included 116 participants (76 males; mean age, 66.7) who had hemoglobin (Hb) levels obtained within 24 hours of unenhanced cranial CT, which included 2 reconstruction methods: DLR and hybrid iterative reconstruction. Regions of interest were the confluence of sinuses (CoS) and the right and left transverse sinuses. In addition, edge rise distance of cerebrospinal fluid and venous was measured. RESULTS: Spearman rank correlation coefficient demonstrated a positive association between Hb levels and sinus attenuation values. Among these, the CoS in DLR had the best correlation ( r = 0.703, P < 0.001). For the prediction of anemia (Hb < 11 g/dL), the area under the curve of CoS in DLR (area under the curve = 0.874; 95% confidence interval, 0.798-0.949; P < 0.001) was the highest; however, there were no significant differences among reconstruction method and sinus. The attenuation values of DLR were significantly higher than those of hybrid iterative reconstruction ( P < 0.001, paired t test), and the differences between the 2 methods were 4.1 (standard deviation [SD], 1.6) for CoS, 5.2 (SD, 2.2) for right transverse sinuses, and 5.8 (SD, 2.4) for left transverse sinuses. The signal-to-noise ratio ( P < 0.001, paired t test) and edge rise distance ( P < 0.001, Wilcoxon signed rank test) of DLR was significantly higher. CONCLUSIONS: Higher CT attenuation values should be considered for predicting anemia based on brain DLR images.

Lumbar intradural space reduction during the Valsalva maneuver observed using cine MRI and MR myelography: a single-case experimental study.

BACKGROUND: Previous studies have shown that the Valsalva maneuver (VM) causes spinal canal object movements. We hypothesized that this occurs because of cerebrospinal fluid (CSF) flow generated from intradural space reduction. Previous studies using myelograms reported lumbar CSF space changes during inspiration. However, no similar studies have been conducted using modern MRI. Therefore, this study analyzed intradural space reduction during the VM using cine magnetic resonance imaging (MRI). METHODS: The participant was a 39-year-old, healthy, male volunteer. Cine MRI involved fast imaging employing steady-state acquisition cine sequence during three resting and VM sets for 60 s each. The axial plane was at the intervertebral disc and vertebral body levels between Th12 and S1 during cine MRI. This examination was performed on 3 separate days; hence, data from nine resting and VM sets were available. Additionally, two-dimensional myelography was performed during rest and the VM. RESULTS: Intradural space reduction was observed during the VM using cine MRI and myelography. The intradural space cross-sectional area during the VM (mean: 129.3 mm2; standard deviation [SD]: 27.4 mm2) was significantly lower than that during the resting period (mean: 169.8; SD: 24.8; Wilcoxon signed-rank test, P < 0.001). The reduction rate of the vertebral body level (mean: 26.7%; SD: 9.4%) was larger than that of the disc level (mean: 21.4%; SD: 9.5%; Wilcoxon rank sum test, P = 0.0014). Furthermore, the reduction was mainly observed on the ventral and bilateral intervertebral foramina sides at the vertebral body and intervertebral disc levels, respectively. CONCLUSION: The intradural space was reduced during the VM, possibly because of venous dilatation. This phenomenon may be associated with CSF flow, intradural object movement, and nerve compression, potentially leading to back pain.

Perceived Future Outcomes of Unsuccessful Treatment and Their Association with Treatment Persistence Among Type-2 Diabetes Patients: A Cross-Sectional Content Analysis.

INTRODUCTION: Despite the known strong association between patients' knowledge of outcomes of type 2 diabetes mellitus (T2DM) and treatment persistence, this knowledge in this patient population requires further clarification. The aim of our study was to reveal the perception of unsuccessful treatment outcomes among patients with T2DM and its association with treatment persistence by analysing answers to open-ended questions. METHODS: In this cross-sectional study, 106 patients with T2DM who lived in Fukushima Prefecture, Japan, had a medical record in the Fukushima National Health Insurance Organisation database and had no cognitive problems were enrolled by purposive sampling. Treatment status was defined as "non-persistent" when a participant's treatment medical record was absent for a continuous period of ≥ 6 months; otherwise, it was referred to as "persistent". We asked about the possible future problems of untreated T2DM, inductively classified the open answers into 15 codes and then statistically examined the association between these codes and treatment persistence using logistic regression analysis adjusted for age and sex. RESULTS: Persistent treatment was prevalent among participants who mentioned the code "treatment", which encompasses the terms that indicated invasiveness, such as dialysis, insulin injection, and shots (odds ratio 4.339; 95% confidence interval 1.104-17.055). CONCLUSION: Persistent treatment was prevalent among patients with T2DM who mentioned the code "treatment", suggesting that these patients may anticipate a threat due to the invasiveness of diabetes and thus participate in persistent treatment to avoid this threat. Healthcare professionals should provide appropriate information and supportive conditions to achieve both a reduced feeling of threat and persistent treatment engagement.

Prediction of the prognosis of somatoform disorders using the Minnesota Multiphasic Personality Inventory.

BACKGROUND: Somatoform disorders are frequently resistant to treatment. This study aimed to determine the utility of the Minnesota Multifaceted Personality Inventory (MMPI) in predicting the prognosis of somatoform disorders. METHODS: Overall, 125 patients diagnosed with somatoform disorders between January 1, 2013 and December 31, 2017 in the psychiatric department of Fukushima Medical University Hospital were included. Patients with positive outcomes were identified based on a subjective estimation regarding (1) pain and (2) social functions, including activities of daily living. They were divided into the improved group (IG) and the non-improved group (NIG). Each factor was then descriptively compared between the two groups, and the sensitivity and specificity were determined. RESULTS: The NIG had significantly higher scores but only on the Hy scale. Thus, the optimal Hy scale cutoff score was calculated. The cutoff point was 73.5, with a sensitivity of 55.7% and a specificity of 71.7%. CONCLUSION: An MMPI Hy scale score higher than a cutoff value of 73.5 predicts a poor response to conventional supportive psychotherapy or drug therapy in patients with somatoform disorders. This cutoff point may be used as an important index for selecting treatment for somatoform disorders.

Relationship between lumbar spinal stenosis and cauda equina movement during the Valsalva maneuver.

OBJECTIVE: To confirm the relationship between lumbar spinal stenosis (LSS) and cauda equina movement during the Valsalva maneuver. MATERIALS AND METHODS: Two radiologists at our institution independently evaluated cauda equina movement on pelvic cine MRI, which was performed for urethrorrhea after prostatectomy or pelvic prolapse in 105 patients (99 males; mean age: 69.0 [range: 50-78] years), who also underwent abdominopelvic CT within 2 years before or after the MRI. The qualitative assessment of the cine MRI involved subjective determination of the cauda equina movement type (non-movement, flutter, and inchworm-manner). The severity of LSS on abdominopelvic CT was quantified using our LSS scoring system and performed between L1/2 and L5/S1. We calculated the average LSS scores of two analysts and extracted the worst scores among all levels. RESULTS: Cauda equina movement was observed in 15 patients (14%), inchworm-manner in 10 patients, and flutter in five patients. Participants with cauda equina movement demonstrated significantly higher LSS scores than those without movement (P < 0.001, Wilcoxon's rank-sum test). A significant difference was observed in the worst LSS scores between participants without movement and those with inchworm-manner movement (P < 0.001, Bonferroni's corrected). There were no significant differences between participants without movement and those with flutter movement (P = 0.3156) and between participants with flutter movement and those with inchworm-manner movement (P = 0.4843). CONCLUSION: Cauda equina movement in cine MRI during the Valsalva maneuver is occasionally observed in patients with severe LSS, and may be associated with pathogenesis of redundant nerve roots.

Post-evacuation return of psychiatric hospital inpatients evacuated to hospitals outside the Fukushima prefecture after the nuclear accident: A Retrospective Cohort Study.

BACKGROUND: Post-evacuation return after mandatory hospital evacuation due to complicated disasters is often overlooked and not well-discussed. AIMS: In this study, we explored the factors which are related to the ease or difficulty of the post-evacuation return to Fukushima prefecture of psychiatric inpatients who had been evacuated to hospitals outside the prefecture because of the Great East Japan Earthquake (GEJE) and subsequent Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. METHOD: This retrospective cohort study included evacuated psychiatric hospital inpatients who were registered in the Matching Project for Community Transition (MPCT) and had been traced until July 31, 2019. A total of 531 patients were included for the analyses. Univariable and multivariable analysis were conducted to detect the patients' traits including their psychiatric/physical backgrounds which were associated with their outcome - the time from GEJE to the date of return to Fukushima. RESULTS: Over half of the patients returned to Fukushima. In the multivariable analysis, the patients' gender (male), age (older), and psychiatric diagnoses of schizophrenia, schizotypal and delusional disorders (ICD-10, F20-29) showed lower hazard ratio (HR) and statistically significant association with the difficulties of post-evacuation return. Meanwhile, disorders of psychological development (F80-89), diseases of the nervous (G00-99, except G40-41) and genitourinary (N00-99) systems showed higher HR and statistically significant association with the ease of return. CONCLUSIONS: The specific characteristics of the psychiatric inpatients including their psychiatric and physical status are associated with their post-evacuation return to their hometown. These results indicated that the evacuated hospitals' practitioners and staffs from the MPCT understood the necessity of the earlier return of inpatients to their hometown. Moreover, clinicians should pay more attention to some symptoms unique to psychiatric patients which contributed to their difficulties in returning safely or expressing their hope to return.

Reliability and validity of the Japanese version of the weight bias internalization scale.

OBJECTIVE: The weight bias internalization scale (WBIS) is widely used in several languages. However, there is no Japanese version of the WBIS. The purpose of this study is to develop a Japanese version of the WBIS and to verify its reliability and validity. We translated the original version of the WBIS and had approval from the scale developer. Adults who perceived themselves to be obese completed online baseline survey (N = 285) and two-week follow-up survey (N = 100). We used the Japanese WBIS and scales for obesity-related quality of life, self-esteem, self-efficacy, and depression. We calculated Cronbach's alpha and intra-class correlation coefficient (ICC) to assess reliability of the WBIS and conducted confirmatory factor analysis (CFA) and correlation analysis to assess its validity. RESULTS: Cronbach's alpha was 0.91 at baseline and 0.92 at follow-up, and the ICC was 0.87. CFA showed that a one-factor model demonstrated an acceptable fit (χ2 (44) = 158.6, CFI = 0.93, RMSEA = 0.096, SRMR = 0.051), similar to the original version. As we had hypothesized, overall, the Japanese version of the WBIS was significantly correlated with obesity-related quality of life, self-esteem, self-efficacy, and depression. These results confirmed its adequate reliability and validity.

Concerns related to returning home to a "difficult-to-return zone" after a long-term evacuation due to Fukushima Nuclear Power Plant Accident: A qualitative study.

This study aimed to identify concerns related to returning to the Nagadoro district of Iitate Village, Fukushima Prefecture, Japan, in 2023 among its residents as it is designated as a difficult-to-return zone after the Fukushima Daiichi nuclear power plant accident. The following four concerns were extracted from the interviews and qualitative analysis: "Difficulties in restarting/continuing farming," which represent the difficulties in making a living from agriculture due to the absence of family members and neighbors, and the insufficient radiation decontamination; "Discriminatory treatment of products and residents from villagers," which suggests the presence of discriminations that residents of Nagadoro district are eccentrics and its agricultural products should not be treated together with those of other districts in the Village due to the recognition that the district is severely polluted by radiation; "Shift of the responsibility of returning home from the country to residents by scapegoating," which is characterized by the shift of responsibility from the government to the residents, including harsh social criticism of the residents of Nagadoro district for not returning even though the evacuation order has been lifted, when it should have been the government's responsibility to recover the district to a habitable state; "Loss of options for continued evacuation," which is the loss or weakening of the position of residents of the Nagadoro district who continue to evacuate, and of administrative compensation, resulting from the legal change that they are no longer "evacuees" after the evacuation order is lifted. The findings of this study will provide a foundation for the support of residents of the Nagadoro district after lifting the evacuation order scheduled for the spring of 2023. The findings may be transferable to the residents of other difficult-to-return zones expected to be lifted after the Nagadoro district and to also a radiation disaster-affected place in the future.

Current situation survey for establishing personally acceptable radiation dose limits for nuclear disaster responders.

When responding to disasters, emergency preparedness is essential to ensure that disaster activities are performed smoothly, safely and efficiently. Investigations on the Fukushima accident revealed that lack of preparedness, poor communication and unsuitable emergency measures contributed to an inadequate emergency response to the nuclear disaster. In this study, we conducted a questionnaire survey on the establishment of a personal radiation exposure dose among Disaster Medical Assistance Team (DMAT) members in Japan who might be involved in the initial response to a nuclear disaster. Establishing personal exposure doses for personnel can encourage emergency preparedness and inform decisions on appropriate role assignments during nuclear response activities. Valid responses were obtained from 178 participants, and the response distribution was as follows: 'Already have own acceptable dose standard,' 16 (9%); 'Follow own institution's standard (and know its value),' 30 (17%); 'Follow own institution's standard (but do not know its value),' 59 (33%); 'Haven't decided,' 63 (35%) and 'Don't understand question meaning,' 10 (6%). We also assessed intention to engage in nuclear disaster activities among respondents via engagement intent scores (EIS) and found that participants who had established personal exposure standards had significantly higher EIS scores than those who had not decided or who did not understand the question. Thus, educating potential nuclear disaster responders on personal exposure doses may contribute to a higher intention to engage in emergency responses and improve preparedness and response efficiency.

The Systematic Workplace-Improvement Needs Generation (SWING): Verifying a Worker-Centred Tool for Identifying Necessary Workplace Improvements in a Nursing Home in Japan.

This study developed and tested a new measurement instrument, the Systematic Workplace-Improvement Needs Generation (SWING), to identify workplace-improvement needs. The participants were 53 workers in a Japanese nursing home for the elderly. The respondents used the SWING questionnaire to self-generate five 'cues' they considered important to improve the workplace. The workers determined each cue's sufficiency level and weight balance (importance), and then we summarised the 265 cues into 21 categories for workplace improvements. The respondents identified the following items as the most important and the least sufficiently provided areas for workplace improvement: 'interaction with customers', 'physical and psychological harassment', 'rewarding and challenging work', and 'sharing goals and objectives'. Although the workplace-improvement recommendations differed greatly from person to person, SWING prioritised the items by weight (importance) and sufficiency (current status), allowing organisations to address the needed improvements systematically. The SWING tool effectively elicited and prioritised respondents' recommendations for improving the workplace. Because its items are self-generated by the respondents, SWING can be used for any occupation or workplace. Visualisation with bubble plots to clarify the improvement needs is incorporated into SWING.

Visualizing the decline of public interest in the Great East Japan Earthquake and Fukushima Daiichi nuclear power plant accident by analyzing letters to the editor in Japanese newspapers.

This study aimed to delineate the decline in public interest toward the March 2011 Great East Japan Earthquake (GEJE) and the Fukushima Daiichi nuclear power plant (FNPP) accident in Japan over a ten-year period. In this longitudinal descriptive study, we searched for publications within a ten-year period in Letters to the Editor that mentioned the GEJE, the FNPP accident, or the January 1995 Great Hanshin-Awaji Earthquake (GHAE) that occurred in Japan, using the official databases of the three largest Japanese newspapers. The GEJE- and GHAE-related publications (4,809 and 2,092, respectively) are depicted as scatter plots. The results show a gradual decrease in the publications mentioning GEJE or GHAE. The impact of GEJE and FNPP on Japanese society was enormous, but the public interest waned over time. Communication strategies that maintain a high public interest in previous disasters may be necessary.