Seiji Yasumura

Study Protocol for the Fukushima Health Management Survey

Background The accidents that occurred at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on 11 March 2011 have resulted in long-term, ongoing anxiety among the residents of Fukushima, Japan. Soon after the disaster, Fukushima Prefecture launched the Fukushima Health Management Survey to investigate long-term low-dose radiation exposure caused by the accident. Fukushima Medical University took the lead in planning and implementing this survey. The primary purposes of this survey are to monitor the long-term health of residents, promote their future well-being, and confirm whether long-term low-dose radiation exposure has health effects. This report describes the rationale and implementation of the Fukushima Health Management Survey. Methods This cohort study enrolled all people living in Fukushima Prefecture after the earthquake and comprises a basic survey and 4 detailed surveys. The basic survey is to estimate levels of external radiation exposure among all 2.05 million residents. It should be noted that internal radiation levels were estimated by Fukushima Prefecture using whole-body counters. The detailed surveys comprise a thyroid ultrasound examination for all Fukushima children aged 18 years or younger, a comprehensive health check for all residents from the evacuation zones, an assessment of mental health and lifestyles of all residents from the evacuation zones, and recording of all pregnancies and births among all women in the prefecture who were pregnant on 11 March. All data have been entered into a database and will be used to support the residents and analyze the health effects of radiation. Conclusions The low response rate (<30%) to the basic survey complicates the estimation of health effects. There have been no cases of malignancy to date among 38 114 children who received thyroid ultrasound examinations. The importance of mental health care was revealed by the mental health and lifestyle survey and the pregnancy and birth survey. This long-term large-scale epidemiologic study is expected to provide valuable data in the investigation of the health effects of low-dose radiation and disaster-related stress.

Neonatal hyperbilirubinemia and a common mutation of the bilirubin uridine diphosphate-glucuronosyltransferase gene in Japanese

AbstractNeonatal hyperbilirubinemia, which is prevalent among Asian peoples, has been considered as a physiological phenomenon, and its metabolic basis has not been clearly explained. Gilbert syndrome is a common inherited disease of unconjugated hyperbilirubinemia due to decreased bilirubin uridine diphosphate-glucuronosyltransferase (B-UGT), and its role in neonatal jaundice has recently been considered. We have previously reported that the Gly71Arg mutation of the B-UGT gene associated with Gilbert syndrome is prevalent in Japanese, Korean, and Chinese populations and was more frequently detected in neonates with severe hyperbilirubinemia than in control subjects. We have studied 159 Japanese full-term neonates, evaluating the relationship between the B-UGT genotype and the severity of jaundice, as assessed with a transcutaneous bilirubinometer. The gene frequency of the Gly71Arg mutation in these neonates was 0.19, and neonates carrying the Gly71Arg mutation had significantly increased bilirubin levels on days 2–4, manifested in a gene dose-dependent manner. The frequency of the Gly71Arg mutation was 0.47 in the neonates who required phototherapy (i.e., those with more severe hyperbilirubinemia), significantly higher than 0.16 in the neonates who did not require the therapy. The gene frequency of the TA repeat promoter polymorphism, the (TA)7 mutation, was 0.07, and neonates carrying this mutation did not have an increase in bilirubin. These results suggested that the Gly71Arg mutation contributes to the high incidence of neonatal hyperbilirubinemia in Japanese.

Factors associated with unintended pregnancy in Yamagata, Japan

Data on unintended pregnancy are scarce in Japan. The purpose of this study is to examine the association of sociodemographic, reproductive, and other health behavioral factors with unintended pregnancy. A survey was conducted from May through November 1999 in Yamagata, Japan. We distributed anonymous self-administered questionnaires to cervical and breast cancer screening participants aged 35-49 years. There were 564 eligible women, and the number of respondents was 421 (74.6%). The proportion of women who had experienced unintended pregnancy was 46.2%, and 40.1% of them had repeated experiences. Among 312 pre-menopausal married women who did not want to become pregnant, 15.4% were not using any contraception. Factors that were significantly associated with the experience of unintended pregnancy were age of husband being 4 or more years older [Odds ratio (OR) = 1.83], and age at initiation of sexual intercourse (OR = 1.86) and marriage during teens (OR = 11.14). Analysis of 1255 pregnancies that the subjects had experienced showed that 51.2% and 25.9% of mistimed and unwanted pregnancies occurred as a result of no contraceptive use, and 39.5% and 71.1% of these ended in abortions. The number of past unintended pregnancies was significantly (p < 0.001) correlated with the number of pregnancies (r(s) = 0.49), live births 0.20) and abortions (r(s) = 0.63). This is the first epidemiological study in Japan to examine factors associated with unintended pregnancy, and also contraceptive use and pregnancy outcome for each of the unintended pregnancy women had experienced. Unintended pregnancy is not a rare event among our target population, and many unintended pregnancies leading to abortion could be prevented by effective contraceptive use. Results suggest that Yamagatas family planning strategies need to target both the younger and older generations, and address the role of men. A womans pregnancy history reflecting her past experience of unintended pregnancy could be used as an indicator for recognizing the womans need for appropriate contraceptive counseling for the prevention of repeated unintended pregnancies.

Psychological distress and the perception of radiation risks: the Fukushima health management survey.

Abstract Objective To assess relationships between the perception of radiation risks and psychological distress among evacuees from the Fukushima nuclear power plant disaster. Methods We analysed cross-sectional data from a survey of evacuees conducted in 2012. Psychological distress was classified as present or absent based on the K6 scale. Respondents recorded their views about the health risks of exposure to ionizing radiation, including immediate, delayed and genetic (inherited) health effects, on a four-point Likert scale. We examined associations between psychological distress and risk perception in logistic regression models. Age, gender, educational attainment, history of mental illness and the consequences of the disaster for employment and living conditions were potential confounders. Findings Out of the 180 604 people who received the questionnaire, we included 59 807 responses in our sample. There were 8717 respondents reporting psychological distress. Respondents who believed that radiation exposure was very likely to cause health effects were significantly more likely to be psychologically distressed than other respondents: odds ratio (OR) 1.64 (99.9% confidence interval, CI: 1.42–1.89) for immediate effects; OR: 1.48 (99.9% CI: 1.32–1.67) for delayed effects and OR: 2.17 (99.9% CI: 1.94–2.42) for genetic (inherited) effects. Similar results were obtained after controlling for individual characteristics and disaster-related stressors. Conclusion Among evacuees of the Fukushima nuclear disaster, concern about radiation risks was associated with psychological distress.

How often and how far do frail elderly people need to go outdoors to maintain functional capacity

The purpose of this study was to investigate the relationship between the frequency of going outdoors into the life-space and functional impairment in community-living frail elderly people. Participants were 1872 community-dwelling elderly people (65-100 years). The participants were asked activities of daily living (ADL) status and how far they traveled and how often they traveled to that area in the 4 weeks before the assessment. We selected two demographic variables, five physiological variables, 11 primary diseases or geriatric syndromes, and four psychosocial variables as possible confounding factors of ADL limitations and correlates of going outdoors. After adjusting for the confounders, multiple logistic regression showed that limitations in basic ADL and instrumental ADL were most strongly associated with going outside the home less than once a week and with going into the neighborhood less than once a week, respectively. Low self-efficacy for going outdoors related most strongly to restrictions in these outdoor activities. These results suggest that going outdoors into the neighborhood at least once a week is beneficial for maintaining physical function in frail elderly people.

Predictors of all-cause mortality between ages 70 and 80: the Koganei study.

The present paper explores predictors of all-cause mortality based on a longitudinal multidisciplinary study of 422 community residents (197 men, 225 women) aged 69-71 years at baseline examination. The 422 subjects were followed up for 10 years (1976-1986), during which time 102 (59 men, 43 women) died. The Cox proportional hazards model was used to examine the effects of baseline variables on a time-dependent 10-year mortality. Body mass showed a U-shaped relationship to mortality in both sexes. Ex-drinking, current-smoking, history of stroke, history of diabetes mellitus, low ADL and ST and/or T changes in ECG had significant and direct effects on mortality in both sexes or either sex. Whereas, level of education, current-drinking, grip strength, visual retention, and serum albumin revealed significantly inverse relationships to mortality.

The Fukushima Health Management Survey: estimation of external doses to residents in Fukushima Prefecture

The Fukushima Health Management Survey (including the Basic Survey for external dose estimation and four detailed surveys) was launched after the Fukushima Dai-ichi Nuclear Power Plant accident. The Basic Survey consists of a questionnaire that asks Fukushima Prefecture residents about their behavior in the first four months after the accident; and responses to the questionnaire have been returned from many residents. The individual external doses are estimated by using digitized behavior data and a computer program that included daily gamma ray dose rate maps drawn after the accident. The individual external doses of 421,394 residents for the first four months (excluding radiation workers) had a distribution as follows: 62.0%, <1 mSv; 94.0%, <2 mSv; 99.4%, <3 mSv. The arithmetic mean and maximum for the individual external doses were 0.8 and 25 mSv, respectively. While most dose estimation studies were based on typical scenarios of evacuation and time spent inside/outside, the Basic Survey estimated doses considering individually different personal behaviors. Thus, doses for some individuals who did not follow typical scenarios could be revealed. Even considering such extreme cases, the estimated external doses were generally low and no discernible increased incidence of radiation-related health effects is expected.

Association of health behavior and social role with total mortality among Japanese elders in Okinawa, Japan

Background and aims: Longitudinal studies on the relationship of life-style factors and social networking with mortality have been only slightly conducted in a comprehensive manner among the Japanese elderly. This study aims at examining associations of health behavior and social role with total mortality among Japanese elders in Okinawa. Methods: All residents aged 65 years or older were recruited in 1987 from the village of Ohgimi, and 724 subjects were followed for 12 years. A comprehensive health assessment questionnaire was used, and the resulting data were analyzed by the Cox proportional hazards model. Results: The number of deaths during the study period was 139 (55.4%) for men and 166 (35.1%) for women. The standardized mortality rates of malignancy, cerebrovascular disease, heart disease and pneumonia were higher for men. In the final model of multivariate analysis for women, less than 6 hours of sleep [Hazard ratio (HR)= 2.62] and lower social role (HR=1.88) significantly increased the risk of mortality. As for men, neither health behavioral items nor social role showed a significant association with mortality. Conclusions: Our study results suggest that having sufficient hours of sleep and enhancing social role could greatly help elderly women in Okinawa to maintain good health. Moreover, our study provides direction for future research to explore the difference in adequate health promotion measures between women and men.

Circumstances of injurious falls leading to medical care among elderly people living in a rural community

The objective of the present study is to describe the circumstances of injurious falls leading to medical care among the elderly living in a rural community, which have never been reported comprehensively. From 1992 to 1993, an interview survey on falls was carried out every 3 months. Of the 1349 subjects aged 65 or more of Nakazato village in Japan, 1317 persons responded to the survey by a door-by-door interview. Two-hundred-and-fifty-six elderly people experienced a fall at least once during the 1-year period. One-hundred-and-twenty-four falls were recorded by 94 men and 215 falls were experienced by 162 women. In men, 16 (31.31/1000 person-year) injurious falls leading to medical care were documented. In women, 58 (75.74/1000 person-year) falls were found to be injurious. The difference in the rate of injurious falls between the sexes was statistically significant (P < 0.01). In each sex, there was no increased rate of injurious falls with advancing age. Most of the injurious falls occurred in the daytime. As for the location of injurious falls, outdoor falls were more frequent than indoor falls in the case of men. Half of the injurious falls in women occurred indoors. Extrinsic factors largely contributed to the occurrence of injurious falls compared with intrinsic ones. Women tended to be injured in the buttocks and hip in a greater proportion than men. This study reveals the circumstances of injurious falls leading to medical care and provides useful information on preventing injurious falls among the elderly living in the community.

Excess mortality among relocated institutionalized elderly after the Fukushima nuclear disaster

Immediately after the accident at the Fukushima Daiichi nuclear power plant following the Great East Japan Earthquake on 11 March 2011, the Japanese Government ordered all residents within 20 km of the plant to evacuate. Among the evacuees were 1770 institutionalized elderly at 34 community facilities in the evacuation zone, including: specialist nursing homes; general nursing homes; geriatric health service facilities; and group homes. The Government arranged transportation, and transfers started on 12 March, moving the elderly to hospitals, municipal gymnasiums and public schools. They could not take any personal belongings (even clothes and blankets) because of limited space, and many were transferred several times to different locations over a few months. Some institutions in other prefectures rejected evacuees from the radiation zone due to fears that they could transmit radiation to others. Evacuees were required to present certificates of being ‘radiation free’ to the shelters, and if not presented, they were refused entrance. Previous studies outside Japan have reported that the relocation of elderly inpatients increases their mortality risk by two to four times. This is the first report of data on excess mortality among relocated institutionalized elderly after the nuclear disaster in Fukushima prefecture.