Toyoaki Sawano

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 …

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.

The importance of family caregiving to achieving palliative care at home: a case report of end-of-life breast cancer in an area struck by the 2011 Fukushima nuclear crisis

Rationale: The primary setting of palliative care has shifted from inpatient care to patients’ residences. Family caregiving is essential for patients with life-limiting illnesses to receive palliative care at home, however little information is available regarding potential interventions to achieve palliative homecare for those without sufficient support from family members in various settings, including disasters. Patient concerns: In March 2011, Fukushima, Japan experienced an earthquake, tsunami and nuclear disaster. In August 2015, a 59-year-old Japanese female presented to our hospital, located 23 km north of Fukushima Daiichi Nuclear Power Plant, with a right breast ulcer. Diagnoses: The patient was diagnosed with stage IV breast cancer. Interventions: The patients general condition gradually worsened despite a one-year course of chemotherapy, and she became bedridden after a fall in October 2016. Although the patient wished to receive palliative homecare, this appeared challenging to achieve because she resided alone in a temporary housing shelter. Although she originally lived with her family in Odaka District, Fukushima, she relocated outside of the city following evacuation orders after the disaster. The evacuation orders for Odaka District were still in effect when she returned to the city alone in 2014. We contacted her sister who moved apart from her during the evacuation, and explained the necessity of family caregiving to enable her palliative homecare. Outcomes: The sister decided to move back to their original residence in Odaka District and live with the patient again. The patient successfully spent her end-of-life period and died at home. Lessons: Health care providers and community health workers may need to take a pro-active approach to communicating with family members to draw informal support to enable patients’ end-of-life management according to their values and preferences. This is a lesson which may be applicable to broader healthcare settings beyond cancer, or disaster contexts, considering that population ageing and social isolation may continue to advance worldwide.

Social isolation and cancer management – advanced rectal cancer with patient delay following the 2011 triple disaster in Fukushima, Japan: a case report

BackgroundLittle is known about the effects of social isolation in the elderly on their process of gaining health information and seeking health care.Case presentationIn March 2011, Fukushima, Japan experienced an earthquake, tsunami, and nuclear disaster, also known as Japan’s triple disaster. In June 2016, an 80-year-old Japanese man, who lived alone after divorce at the age of 42, presented to our hospital with bloody stools and dizziness. Although his bloody stools initially occurred in May 2015, a year earlier, he did not pursue the possibility of malignancy. He was diagnosed as having stage IIIA rectal cancer. Detailed history taking revealed that he experienced social isolation after the disaster, due to the evacuation of his friends, losing his regular opportunities for socialization. He additionally reported that the current diagnosis of rectal cancer made him feel he had lost his health in addition to his social relationships. Although radical surgery was attempted, it failed to resect the lesion completely, and thereafter his disease gradually progressed. As support from family or friends was not available, he was not able to receive palliative radiation therapy or home-based care in his end-of-life period. He died at a long-term care facility in February 2017.ConclusionsThis case suggests that intense social isolation after the Fukushima disaster was a likely contributor to the patient delay, poor treatment course, and poor outcome of an elderly patient with rectal cancer. Direct communication with family and friends may play an indispensable role in increasing health awareness and promoting health-seeking behaviors, and in the midst of social isolation, elderly patients with cancer may lose these opportunities and experience increased risk of patient delay. Although health care providers may be able to alleviate isolation-induced delay by promoting cancer knowledge and awareness widely among local residents, policy-led interventions at the community level may be essential to reducing social isolation and its health consequences.

Birth Outcomes after the Fukushima Daiichi Nuclear Power Plant Disaster: A Long-Term Retrospective Study

Changes in population birth outcomes, including increases in low birthweight or preterm births, have been documented after natural and manmade disasters. However, information is limited following the 2011 Fukushima Daiichi Nuclear Power Plant Disaster. In this study, we assessed whether there were long-term changes in birth outcomes post-disaster, compared to pre-disaster data, and whether residential area and food purchasing patterns, as proxy measurements of evacuation and radiation-related anxiety, were associated with post-disaster birth outcomes. Maternal and perinatal data were retrospectively collected for all live singleton births at a public hospital, located 23 km from the power plant, from 2008 to 2015. Proportions of low birthweight (<2500 g at birth) and preterm births (<37 weeks gestation at birth) were compared pre- and post-disaster, and regression models were conducted to assess for associations between these outcomes and evacuation and food avoidance. A total of 1101 live singleton births were included. There were no increased proportions of low birthweight or preterm births in any year after the disaster (merged post-disaster risk ratio of low birthweight birth: 0.98, 95% confidence interval (CI): 0.64–1.51; and preterm birth: 0.68, 95% CI: 0.38–1.21). No significant associations between birth outcomes and residential area or food purchasing patterns were identified, after adjustment for covariates. In conclusion, no changes in birth outcomes were found in this institution-based investigation after the Fukushima disaster. Further research is needed on the pathways that may exacerbate or reduce disaster effects on maternal and perinatal health.

Asymptomatic hepatic portal venous gas with gastric emphysema as a chronic complication of gastrostomy tube placement: a case report

BackgroundPercutaneous endoscopic gastrostomy feeding is widely used as a route for enteral feeding for patients with impaired swallowing ability, particularly in older patients. Hepatic portal venous gas is a condition that may arise from several causes. Hepatic portal venous gas that develops after an endoscopic procedure is generally reported to be nonfatal, yet there is little information available concerning the characteristics of hepatic portal venous gas as a chronic complication of percutaneous endoscopic gastrostomy feeding.Case presentationWe experienced a case of hepatic portal venous gas that happened to be detected in an 81-year-old Japanese man with long-term percutaneous endoscopic gastrostomy use who was admitted to our hospital with aspiration pneumonia. While aspiration pneumonia was treated with antibiotics and suspension of tube feedings, he recovered from hepatic portal venous gas without any treatment.ConclusionsThe presence of a percutaneous endoscopic gastrostomy tube may have induced hepatic portal venous gas through a mechanism in which vomiting led to increased abdominal pressure and eventually gastric emphysema. This case suggests that hepatic portal venous gas without any signs of bowel ischemia or emphysematous gastritis can resolve without treatment, which is a finding that could be helpful for clinicians who deal with those supported by percutaneous endoscopic gastrostomy feeding.

Non-communicable diseases in decontamination workers in areas affected by the Fukushima nuclear disaster: a retrospective observational study

Objectives To assess the prevalence of non-communicable diseases (NCDs), and whether NCDs were treated or not, among hospitalised decontamination workers who moved to radio-contaminated areas after Japans 2011 Fukushima Daiichi Nuclear Power Plant disaster. Methods We retrospectively extracted records of decontamination workers admitted to Minamisoma Municipal General Hospital between 1 June 2012 and 31 August 2015, from hospital records. We investigated the incidence of underlying NCDs such as hypertension, dyslipidaemia and diabetes among the decontamination workers, and their treatment status, in addition to the reasons for their hospital admission. Results A total of 113 decontamination workers were admitted to the hospital (112 male patients, median age of 54 years (age range: 18–69 years)). In terms of the demographics of underlying NCDs in this population, 57 of 72 hypertensive patients (79.2%), 37 of 45 dyslipidaemic patients (82.2%) and 18 of 27 hyperglycaemic patients (66.7%) had not been treated for their NCDs before admission to the hospital. Conclusions A high burden of underlying NCDs was found in hospitalised decontamination workers in Fukushima. Managing underlying diseases such as hypertension, hyperlipidaemia and diabetes mellitus is essential among this population.

Long-term vulnerability of access to hemodialysis facilities in repopulated areas after the Fukushima Nuclear Disaster: a case report

Abstract In 2011, an earthquake and tsunami struck Japan, and these were followed by the Fukushima Daiichi nuclear power plant accident. The long-term impact on hemodialysis care access in rural areas after the disaster is unknown. Here we report on a 66-year-old male hemodialysis patient who was forced to evacuate and relocate multiple times to receive hemodialysis after the accident. While he returned to his hometown in 2012, all the available hemodialysis facilities had been placed in different districts. Therefore, the patient needed to cross a mountain to visit the hemodialysis facility. On a snowy day, the patient was unable to reach hemodialysis care in a timely manner. With community cooperation, a public ambulance successfully transferred the patient via a detour, taking 4 h to reach the hemodialysis facility. This case demonstrates that access to hemodialysis care in rural areas remains vulnerable even in the long term after a nuclear disaster.

The Fukushima Daiichi Nuclear Power Plant accident and school bullying of affected children and adolescents: the need for continuous radiation education

Abstract The health threats of radiation-release incidents are diverse and long term. In addition to direct radiation effects, it is imperative to manage the indirect effects of radiation such as stigma, prejudice and broader mental health impacts. Six years after the Fukushima Daiichi Nuclear Power Plant accident of March 2011, bullying caused by stigma and prejudice toward evacuees, including children, has become a social problem in Japan. This phenomenon may be associated with the fact that knowledge about radiation has still not reached the general public, and to a potential lack of motivation among Japanese citizens to learn about radiation and bullying. Continuous and sustained education regarding radiation is warranted in order to enhance the general knowledge level about the effects of radiation in Japan after the Fukushima Daiichi Nuclear Power Plant accident, and this education will become an important reference for education after future nuclear disasters.