Claire Leppold

Individual external doses below the lowest reference level of 1 mSv per year five years after the 2011 Fukushima nuclear accident among all children in Soma City, Fukushima: A retrospective observational study

After the 2011 Fukushima Daiichi nuclear power plant accident, little information has been available on individual doses from external exposure among residents living in radioactively contaminated areas near the nuclear plant; in the present study we evaluated yearly changes in the doses from external exposure after the accident and the effects of decontamination on external exposure. This study considered all children less than 16 years of age in Soma City, Fukushima who participated in annual voluntary external exposure screening programs during the five years after the accident (n = 5,363). In total, 14,405 screening results were collected. The median participant age was eight years. The geometric mean levels of annual additional doses from external exposure attributable to the Fukushima accident, decreased each year: 0.60 mSv (range: not detectable (ND)–4.29 mSv), 0.37 mSv (range: ND–3.61 mSv), 0.22 mSv (range: ND–1.44 mSv), 0.20 mSv (range: ND–1.87 mSv), and 0.17 mSv (range: ND–0.85 mSv) in 2011, 2012, 2013, 2014, and 2015, respectively. The proportion of residents with annual additional doses from external exposure of more than 1 mSv dropped from 15.6% in 2011 to zero in 2015. Doses from external exposure decreased more rapidly than those estimated from only physical decay, even in areas without decontamination (which were halved in 395 days from November 15, 2011), presumably due to the weathering effects. While the ratios of geometric mean doses immediately after decontamination to before were slightly lower than those during the same time in areas without decontamination, annual additional doses reduced by decontamination were small (0.04–0.24 mSv in the year of immediately after decontamination was completed). The results of this study showed that the levels of external exposure among Soma residents less than 16 years of age decreased during the five years after the Fukushima Daiichi nuclear power plant accident. Decontamination had only limited and temporal effects on reducing individual external doses.

Social isolation and cancer management after the 2011 triple disaster in Fukushima, Japan: A case report of breast cancer with patient and provider delay

AbstractBreast cancer patients may present with patient delay or experience provider delay—2 factors which can lead to a late-stage diagnosis and poor prognosis. Mass disasters drastically change social structures, and have the potential to contribute to these delays. However, there is little information available on patient and provider delay related to cancer after disasters. In March 2011, an earthquake, followed by a tsunami and nuclear accident struck Fukushima, Japan. In July 2014, a 59 year-old Japanese widow, living alone, presented to our hospital with a lump and pain in her right breast, which had originally appeared in April 2011 and continuously deteriorated for 3 years and 3 months. She was diagnosed with stage IIIB right breast cancer. Detailed history revealed that she was exposed to social isolation in the aftermath of the disasters due to evacuation of her friends and daughter. Although she regularly saw her general practitioner, she did not disclose her breast symptoms for 1 year and 5 months, at which time she was falsely diagnosed with intercostal neuralgia. She did not seek further medical attention for the breast symptoms for another 1 year and 10 months, despite multiple clinic visits for unrelated reasons. The present disasters, particularly the nuclear disaster, seem to have led to the social isolation of local residents, reducing their opportunities to discuss health concerns with others and seek subsequent medical attention.This case highlights that social isolation may contribute to patient and provider delay in breast cancer patients, as accentuated in this disaster setting.

Abandoned areas in post-disaster Fukushima, Japan

On 11 March, 2011, Northeast Japan experienced an earthquake, followed by a tsunami and the Fukushima Daiichi Nuclear Power Plant accident, referred to as Japans triple disaster.1 Most local residents within the 20 km radius of the power plant have …

The increase in long-term care public expenditure following the 2011 Fukushima nuclear disaster

The increasing proportions of older people in populations are a reflection of global trends of increased longevity and decreased fertility rates. In the multifaceted consequences of this population change, the burden of increasing public expenditure on long-term care (LTC) may be one of the biggest problems for developed countries.1 Public expenditure on LTC is calculated by multiplying the number of adults aged 65 years and older by the average amount of public expenditure per individual in this age group. While it is estimated that the number of older adults will continue to increase in many countries, the corresponding increases in public expenditure per …

Estimated association between dwelling soil contamination and internal radiation contamination levels after the 2011 Fukushima Daiichi nuclear accident in Japan

Objectives Measurement of soil contamination levels has been considered a feasible method for dose estimation of internal radiation exposure following the Chernobyl disaster by means of aggregate transfer factors; however, it is still unclear whether the estimation of internal contamination based on soil contamination levels is universally valid or incident specific. Methods To address this issue, we evaluated relationships between in vivo and soil cesium-137 (Cs-137) contamination using data on internal contamination levels among Minamisoma (10–40 km north from the Fukushima Daiichi nuclear power plant), Fukushima residents 2–3 years following the disaster, and constructed three models for statistical analysis based on continuous and categorical (equal intervals and quantiles) soil contamination levels. Results A total of 7987 people with a mean age of 55.4 years underwent screening of in vivo Cs-137 whole-body counting. A statistically significant association was noted between internal and continuous Cs-137 soil contamination levels (model 1, p value <0.001), although the association was slight (relative risk (RR): 1.03 per 10 kBq/m2 increase in soil contamination). Analysis of categorical soil contamination levels showed statistical (but not clinical) significance only in relatively higher soil contamination levels (model 2: Cs-137 levels above 100 kBq/m2 compared to those <25 kBq/m2, RR=1.75, p value <0.01; model 3: levels above 63 kBq/m2 compared to those <11 kBq/m2, RR=1.45, p value <0.05). Conclusions Low levels of internal and soil contamination were not associated, and only loose/small associations were observed in areas with slightly higher levels of soil contamination in Fukushima, representing a clear difference from the strong associations found in post-disaster Chernobyl. These results indicate that soil contamination levels generally do not contribute to the internal contamination of residents in Fukushima; thus, individual measurements are essential for the precise evaluation of chronic internal radiation contamination.

Death of the sole doctor at Takano Hospital 6 years after the Fukushima nuclear crisis—who is responsible for health care delivery in the Fukushima disaster zone?

Death of the sole doctor at Takano Hospital 6 years after the Fukushima nuclear crisis—who is responsible for health care delivery in the Fukushima disaster zone? A. Ozaki, Y. Shimada, K. Yamamoto, A. Hori, T. Sawano, T. Morita, C. Leppold, T. Tanimoto and M. Tsubokura From the Department of Surgery, Department of Neurosurgery, Department of Obstetrics and Gynecology, Minamisoma Municipal General Hospital, Fukushima 975-0033, Hori Mental Clinic, Fukushima 979-2335, Department of Internal Medicine, Soma Central Hospital, Fukushima 976-0016, Japan, Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK and Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation, Fukushima 972-8322, Japan

Klebsiella Pneumoniae sepsis deteriorated by uncontrolled underlying disease in a decontamination worker in Fukushima, Japan

Patients with underlying conditions are at a higher risk of developing sepsis, a systematic response to infection, which has a high mortality rate. After the March 2011 Fukushima Daiichi nuclear power plant accident, there has been an influx of migrant decontamination workers; however, little is known about their health status.

Defining and Acting on Global Health: The Case of Japan and the Refugee Crisis

What counts as global health? There has been limited discourse to date on the ways in which country-level contexts may shape positioning in global health agendas. By reviewing Japans response to the refugee crisis, we demonstrate a clash between rhetoric and action on global responsibility, and suggest that cultural and historical factors may be related to the ways of perceiving and acting upon global health.

Sociodemographic patterning of long-term diabetes mellitus control following Japan's 3.11 triple disaster: a retrospective cohort study

Objective To assess the sociodemographic patterning of changes in glycaemic control of patients with diabetes affected by the 2011 triple disaster in Japan (earthquake, tsunami and nuclear accident). Methods A retrospective cohort study was undertaken with 404 patients with diabetes at a public hospital in Minamisoma City, Fukushima Prefecture. Glycated haemoglobin (HbA1c) levels were measured in 2010, 2011 and 2012 to capture changes in glycaemic control postdisaster. Age, sex, urban/rural residency, evacuation status and medication use were also assessed. Results There was an overall deterioration in glycaemic control after the disaster, with the mean HbA1c rising from 6.77% in 2010 to 6.90% in 2012 (National Glycohemoglobin Standardization Program, NGSP). Rural residency was associated with a lower likelihood of deteriorating control (OR 0.34, 95% CI 0.13 to 0.84), compared with urban residency. Older age (OR 0.95, 95% CI 0.91 to 0.98) was also slightly protective against increased HbA1c. Evacuation and sex were not significant predictors. Conclusions Patients with diabetes who were affected by Japans triple disaster experienced a deterioration in their glycaemic control following the disasters. The extent of this deterioration was mediated by sociodemographic factors, with rural residence and older age protective against the effects of the disaster on glycaemic control. These results may be indicative of underlying social determinants of health in rural Japan.

Excess mortality due to indirect health effects of the 2011 triple disaster in Fukushima, Japan: a retrospective observational study

Background Evidence on the indirect health impacts of disasters is limited. We assessed the excess mortality risk associated with the indirect health impacts of the 2011 triple disaster (earthquake, tsunami and nuclear disaster) in Fukushima, Japan. Methods The mortality rates in Soma and Minamisoma cities in Fukushima from 2006 to 2015 were calculated using vital statistics and resident registrations. We investigated the excess mortality risk, defined as the increased mortality risk between postdisaster and predisaster after excluding direct deaths attributed to the physical force of the disaster. Multivariate Poisson regression models were used to estimate the relative risk (RR) of mortality after adjusting for city, age and year. Results There were 6163 and 6125 predisaster and postdisaster deaths, respectively. The postdisaster mortality risk was significantly higher in the first month following the disaster (March 2011) than in the same month during the predisaster period (March 2006–2010). RRs among men and women were 2.64 (95% CI 2.16 to 3.24) and 2.46 (95% CI 1.99 to 3.03), respectively, demonstrating excess mortality risk due to the indirect health effects of the disaster. Age-specific subgroup analyses revealed a significantly higher mortality risk in women aged ≥85 years in the third month of the disaster compared with predisaster baseline, with an RR (95% CI) of 1.73 (1.23 to 2.44). Conclusions Indirect health impacts are most severe in the first month of the disaster. Early public health support, especially for the elderly, can be an important factor for reducing the indirect health effects of a disaster.