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Aim After the Great East Japan Earthquake, over 160,000 residents in Fukushima Prefecture were forced to evacuate the area around the Fukushima Daiichi power plant following nuclear accident there. Health problems in these evacuees have since become a major issue. We have examined the association between evacuation and incidence of hyperuricemia among residents in Fukushima. Methods We conducted a cohort study of residents aged 40–90 years without hyperuricemia at the time of the Fukushima disaster. Among 8173 residents who met the inclusion criteria before the disaster, 4789 residents (men: 1971, women: 2818; follow-up duration: 1.38 years; and follow-up rate: 58.6%) remained available for follow-up examinations at the end of March 2013. The main endpoint was incidence of hyperuricemia, defined by the Japanese committee guidelines, using local health data from before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of hyperuricemia, adjusting for potential confounders, age, gender, waist circumference, physical activity, and alcohol consumption. Results Incidence of hyperuricemia was higher in evacuees (men 10.1%; women 1.1%) than in non-evacuees (men 7.4%, women 1.0%). Evacuees had higher body mass index, waist circumference, triglycerides, LDL-cholesterol, fasting plasma glucose, HbA1c, and lower HDL-cholesterol after the disaster than non-evacuees. We found that evacuation was associated with incidence of hyperuricemia (adjusted odds ratio: 1.38; 95% confidence interval: 1.03–1.86). Conclusion This is the first study to demonstrate an association between evacuation after a disaster and increased incidence of hyperuricemia.

Background After the Fukushima Daiichi Nuclear Power Plant accident, a preliminary ultrasound-based screening for thyroid cancer was conducted to establish a baseline for subsequent evaluations. In this survey, we assessed the relationship between the proportion of non-examinees and characteristics of the target populations. Methods After summarizing a regional difference of non-examinees among the population of 359,200 (primary evaluation) and 2,246 (confirmatory testing) individuals who were living in Fukushima Prefecture on March 11, 2011, we estimated odds ratios (ORs) for each characteristic, including age, sex, area of residence, and moving after the accident, based on the proportion of non-examinees for the primary examination and the confirmatory testing, using a multivariate logistic regression model. Results The dataset included 64,117 non-examinees (primary evaluation) and 194 (confirmatory testing). The logistic regression result indicated that girls were not likely to be non-examinees compared to boys, with adjusted OR of 0.80 (95% confidence interval [CI], 0.78-0.81) for the primary evaluation. Odds were lowest for children 6-10 years old (OR 0.26; 95% CI, 0.25-0.27), and higher for those 11-15 years old (OR 1.28; 95% CI, 1.25-1.32) and over 16 years old (OR 5.30; 95% CI, 5.16-5.43) when compared to children 0-5 years old. Individuals residing in the western part of the prefecture showed higher ORs. There was a higher proportion of non-examinees among those who moved after the accident compared to those who did not in the primary evaluation (OR 1.72; 95% CI, 1.64-1.79). Conclusions In addition to demographic characteristics, a change of residence could be a potential factor that influenced the proportion of non-examinees. Our results will help proper interpretation of reports and prospective management of the survey.

Individual external doses for the first 4 months after the Fukushima accident have been estimated by the ‘Basic Survey’ of the Fukushima Health Management Survey. On the other hand, the UNSCEAR 2013 report presented the first-year effective dose due to external radiation for each municipality in nonevacuated areas of Fukushima Prefecture. In this study, the doses estimated by the Basic Survey were averaged for each of three age groups (infants, 0–5 y; children, 6–15 y; and adults, >16 y), in accordance with the categories adopted by the UNSCEAR report. The average dose ratios (infants/adults and children/adults) obtained from the Basic Survey were 1.08 and 1.06 for nonevacuated areas, respectively. These were smaller than the estimation by the UNSCEAR report (1.7 and 1.4, respectively). Three factors (body size factor, location factor and occupancy factor) were discussed and the location and occupancy factors were likely to be reasons for the difference.

Aim The Fukushima Daiichi Nuclear Power Plant accident dramatically changed the lifestyle of residents who lived near the plant. We evaluated the association of metabolic syndrome (MetS) with specific lifestyle- and disaster-related factors in residents following the accident. Methods This cross-sectional study included 20,920 residents who underwent both the Comprehensive Health Check and the Mental Health and Lifestyle Survey from June 2011 to March 2012. Associations between MetS and lifestyle- and disaster-related factors, including psychological distress (post-traumatic stress disorder [PTSD]), were estimated using logistic regression analysis, adjusted for demographic and lifestyle factors, in 2019. Results MetS was present in 30.4% of men and 11.5% of women. There were significant differences in smoking, drinking status, and PTSD prevalence between subjects with and without MetS. Multivariable logistic regression analysis showed that age, quitting smoking, and low physical activity were significantly associated with MetS. Moreover, PTSD and light to moderate drinking were also significantly associated with MetS in women. Conclusions Lifestyle- and disaster-related factors, including PTSD, were associated with MetS among subjects who lived near the Fukushima Daiichi Nuclear Power Plant accident.

Background Overdiagnosis of thyroid cancer has become a major global medical issue. Ultrasound-based thyroid cancer screening has promoted overdiagnosis, and recently international recommendations indicate that such screening should not be conducted, even after a nuclear accident. The Fukushima thyroid cancer screening program was initiated in 2011 as a health policy after the nuclear accident, although the risk for radiation-induced thyroid cancer was unlikely given the low radiation levels. However, the thyroid cancer screening program has continued at 2-year intervals with a relatively high participation rate and is now in its fifth round. Therefore, it is crucial to clarify whether those targeted for screening understand the disadvantages of screening and identify factors that influenced their decision to participate. Methods We conducted an anonymous mail-based questionnaire that included young people from Fukushima (subjects) and a neighboring prefecture that was not targeted for screening (non-subjects). We asked them about the significance of the thyroid cancer screening in Fukushima, the reasons for taking or not taking a screening, their perception of the harms of screening, and their opinions on thyroid examination at school. Then we compared the results of the questionnaire between subjects and non-subjects and examinees (who accepted screening) and non-examinees (who declined screening). Results Only 16.5% of respondents were aware of the harms associated with thyroid cancer screening, with most perceiving that the benefits outweighed the harms. Comparison of subjects’ and non-subjects’ responses showed there were no significant differences between subjects and non-subjects. In addition, among subjects, there were no differences of responses between examinees and non-examinees. The most common reason for participation in screening was that the screening was conducted in schools and perceived as obligatory. Conclusions These results highlighted a serious ethical issue in that school-based screening leads to making young people think that it is mandatory screening in an opt-out and default setting manner, with a lack of knowledge about the disadvantages of screening. Based on the autonomy of the subjects and the ethical principle of the post-disaster, surveys after a nuclear disaster should be conducted in an opt-in style without an opt-out style such as school-based screening.

Various studies have investigated radiation risk perceptions after the accident at the Fukushima Daiichi Nuclear Power Station. However, student surveys are limited. This study aimed to investigate the perception of radiation risk among students aged 18–20 years who were in the 5th and 6th grades of elementary school at the time of the accident. We surveyed students in the Fukushima Prefecture and outside the prefecture. Out of all the data, 59% of the respondents were living in the Fukushima Prefecture at the time of the accident and 41% outside the prefecture. Trajectory analysis showed that changes in anxiety levels over time since 2011 could be divided into five classes: (a) the anxiety was the highest, and this tendency persisted. (b) High at the beginning, but decreased more quickly than class 1. (c) High at the beginning, but it diminished quickly. (d) Not high, but did not diminish easily in later years. (e) Low from the beginning, and persisted. Multinomial logistic analysis showed that among students living outside the prefecture at the time of the accident, a significantly higher proportion was in groups 4 and 5 than in group 2. A significant proportion of boys were present in groups 3, 4 and 5. A significant proportion of students whose current educational institutions were inside the prefecture were present in group 3. The level of anxiety was associated with the academic course, but not with subjective knowledge of radiation. In contrast, in the qualitative analysis of the free text, 31% considered ‘knowledge about radiation’ as the reason for the reduction in anxiety level. At the time of the investigation, most young people were not anxious about radiation. However, approximately 20% still had strong anxiety. We established that continuous risk communication is necessary. Furthermore, that stabilization and support related to life in general is important.

Lipodystrophy is a common complication in human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) or antiretroviral therapy (ART). Previous studies demonstrated that endoplasmic reticulum (ER) stress-mediated unfolded protein response (UPR) is involved in lipodystrophy; however, the detailed mechanism has not been fully described in human adipogenic cell lineage. We utilized adipose tissue-derived stem cells (ADSCs) obtained from human subcutaneous adipose tissue, and atazanavir (ATV), a protease inhibitor (PI), was administered to ADSCs and ADSCs undergoing adipogenic conversion. Marked repression of adipogenic differentiation was observed when ATV was administered during 10 days of ADSC culture in adipogenic differentiation medium. Although ATV had no effect on ADSCs, it significantly induced apoptosis in differentiating adipocytes. ATV treatment also caused the punctate appearance of CCAAT-enhancer-binding (C/EBP) protein homologous protein (CHOP), and altered expression of CHOP and GRP78/Bip, which are the representation of ER stress, only in differentiating adipocytes. Administration of UPR inhibitors restored adipogenic differentiation, indicating that ER stress-mediated UPR was induced in differentiating adipocytes in the presence of ATV. We also observed autophagy, which was potentiated in differentiating adipocytes by ATV treatment. Thus, adipogenic cell atrophy leads to ATV-induced lipodystrophy, which is mediated by ER stress-mediated UPR and accelerated autophagy, both of which would cause adipogenic apoptosis. As our study demonstrated for the first time that ADSCs are unsusceptible to ATV and its deleterious effects are limited to the differentiating adipocytes, responsible target(s) for ATV-induced lipodystrophy may be protease(s) processing adipogenesis-specific protein(s)., International Journal of Molecular Sciences, 22(4), art.no.2114; 2021

BackgroundThe Great East Japan Earthquake and the Fukushima Daiichi nuclear disaster forced the evacuation of residents and led to many changes in lifestyle for the evacuees. The Comprehensive Health Check was implemented to support the prevention of lifestyle-related disease and we analyzed the effect of prolonged evacuation (average of 3.0 years) on the new onset of hyper-LDL cholesterolemia.MethodsThe study participants were Japanese adults living near the Fukushima Daiichi nuclear power plant in Fukushima Prefecture. Annual health checkups focusing on metabolic syndromes were conducted for persons ≥ 40 years by the Specific Health Checkup. Based on data from annual checkups from 2011 or 2012, we followed 18,670 non-hyper-LDL cholesterolemia who underwent at least one other annual checkup during 2013-2015.ResultsWe found that the new onset of hyper-LDL cholesterolemia was significantly by 31% higher in evacuees than in non-evacuees. Evacuees had a significantly higher prevalence of obesity, hypertension, and diabetes, and higher frequency of weight change. Furthermore, logistic regression model analysis showed that the evacuation was significantly associated with the new onset of hyper-LDL cholesterolemia after adjusting age, gender, body mass index (BMI), smoking habit, alcohol consumption, diabetes, weight change, sleep deprivation, and exercise.ConclusionsThe findings of the present study suggest that prolonged evacuation after a disaster is a risk factor for the new onset of hyper-LDL cholesterolemia, and lead to an increase in cardiovascular disease. It is therefore important to follow-up evacuees and recommend lifestyle changes where necessary.

The complex disaster of the Great East Japan Earthquake and the Fukushima nuclear accident caused concern about their various health impacts. Many types of intervention are desired as a countermeasure, depending on the phase of the disaster cycle. The importance of developing and applying codes of conduct has recently been emphasized for post-disaster investigations. Thyroid examination as a type of cancer screening survey was launched from October 2011 after the Fukushima nuclear accident as part of the Fukushima Health Management Survey. In this article, we reviewed the results of three rounds of thyroid examination from 2011 to 2018, and summarized the points to consider in the health survey conducted after the Fukushima nuclear accident. Large-scale mass screening by ultrasound thyroid examination resulted in many cancer diagnoses, >200 cases from a large reservoir of thyroid cancer that goes mainly unnoticed without screening. To prevent the harms of such over-diagnosis, we should be aware of the disadvantage of mass-screening based on the expected natural history of thyroid cancer. A change in strategy from mass-screening to individual monitoring is urgently needed according to international recommendations that are opposed to thyroid ultrasound cancer screening even after a nuclear disaster. To guarantee autonomy and informed choice on post-disaster disease monitoring for residents in a disaster-zone, it is important to set protocol participation and on a voluntary code of conduct basis.

IMPORTANCE: Ultrasonographic (US) screening for thyroid cancer was performed in the Fukushima Health Management Survey after the 2011 Fukushima Daiichi nuclear power station accident. Clinical characteristics of thyroid cancers screened by US among children and young adults during the first 5 years after the accident were analyzed. OBJECTIVES: To evaluate the number of detected thyroid cancers by age group within 5 years of the Fukushima Daiichi nuclear power station accident and to compare the basic clinical characteristics and demographic patterns in first- and second-round examinations. DESIGN, SETTING, AND PARTICIPANTS: In this observational study, 324 301 individuals 18 years or younger at the time of accident were included. Patients received a cytologic diagnosis of malignant or suspected malignant thyroid cancer during the first (fiscal years 2011-2013) or second round (fiscal years 2014-2015) of screening. Number of detected cases of cancer was evaluated, correcting for the number of examinees by age group at the time of the accident and for the incidence of detected cancers according to age group at the time of the screening (age groups were divided into 3-year intervals). Results were compared using the age-specific incidence of unscreened cancers from a national cancer registry. MAIN OUTCOMES AND MEASURES: Clinical baseline characteristics of the patients and the age-specific number and incidence of thyroid cancers detected during the second round. RESULTS: Among 299 905 individuals screened in the first round (50.5% male; mean [SD] age at screening, 14.9 [2.6] years), malignant or suspected thyroid cancer was diagnosed in 116. Among 271 083 individuals screened in the second round (50.4% male; age at screening, 12.6 [3.2] years), malignant or suspected thyroid cancer was diagnosed in 71. The most common pathologic diagnosis in surgical cases was papillary thyroid cancer (149 of 152 [98.0%]). The distribution pattern by age group at the time of the accident, where the number of detected thyroid cancer cases was corrected by the number of examinees, increased with older age in both screening rounds. This demographic pattern was similar between the first and second examinations. The distribution pattern of the incidence rate by age group at the time of screening in the second round also increased with older age. The incidence rate detected by screening was 29 cases per 100 000 person-years for those aged 15 to 17 years, 48 cases per 100 000 person-years for those aged 18 to 20 years, and 64 cases per 100 000 person-years for those aged 21 to 22 years. CONCLUSIONS AND RELEVANCE: Large-scale mass US screening of young people resulted in the diagnosis of a number of thyroid cancers, with no major changes in overall characteristics within 5 years of the 2011 Fukushima nuclear power station accident. These results suggest that US screening can identify many detectable cancers from a large pool of nonclinical and subclinical thyroid cancers among individuals of a relatively young age, in an age-dependent manner.

Supplemental Digital Content is available in the text, We have been examining the Comprehensive Health Check of the Fukushima Health Management Survey of residents of 13 municipalities who were forced by the government to evacuate due to the 2011 Great East Japan Earthquake (GEJE). Our findings showed that evacuation is a risk factor for polycythemia and suggested that experiencing an unprecedented disaster and exposure to chronic stress due to evacuation might be a cause of polycythemia. We analyzed the relationship between the prevalence of polycythemia and the following factors observed in the Mental Health and Lifestyle Survey in an observational study with a cross-sectional design: traumatic symptoms, depression status, socioeconomic factors such as residential environment, and working situation after the GEJE. Target population of the survey included men and women who were at least 15 years of age and who lived in the evacuation zones specified by the government. Participants analyzed consisted of 29,474 persons (12,379 men and 16,888 women) who had participated in both the 2011 Comprehensive Health Check and Mental Health and Lifestyle Survey from June 2011 through March 2012. The prevalence of polycythemia was not associated with mental states associated with traumatic symptoms (Post-Traumatic Stress Disorder Checklist Scale ≥ 44) and depression status (Kessler 6-item Scale ≥ 13). Furthermore, multivariate analysis showed that there was a tendency for males to develop polycythemia, with characteristics such as being aged 65 years and older, highly educated, obese (body mass index ≥ 25), hypertensive, diabetic, having liver dysfunction, and a smoker being significantly related to the prevalence of polycythemia. Our findings conclusively demonstrated that polycythemia was not significantly related to psychological factors, but was significantly related to the onset of lifestyle-related disease after the GEJE.

Following the Fukushima Daiichi Nuclear Power Plant accident, a survey for estimating individual external doses for the first 4 months after the accident was started, and it remains ongoing. Since the authors’ previous paper, 44 605 new dose estimates have been made. The new dose estimates increase the number of dose estimates to 465 999 and are reported in this note. Since the previous paper, most of the recently collected responses have been gotten through public relations activities to encourage responses across the prefecture. Thus, recent respondents might be biased (‘selection bias’). Also, the dose estimates were based on self-administered responses about personal behaviour, which relied on memories of residents. In this respect, incorrect behaviour records possibly resulted as memories have faded over time (‘recall bias’). However, the effects of these biases on dose distribution on a whole-prefecture basis seemed to be small.

Work-related mental health impairment is recognized as a real problem in the context of helping responders, including health professionals, due to adverse health outcomes after a severe disaster. The Great East-Japan Earthquake, which occurred on 11 March 2011, was an unprecedented complex disaster that caused a nuclear accident at the Fukushima Daiichi Nuclear Power Plant (NPP). In addition to disaster stress and daily work, medical and health-care professionals, particularly nurses, provided counseling services to residents concerned about radiation health risks or mental health issues. This review focuses on the psychological aspects of the complex nuclear disaster, which was a combined artificial nuclear accident and natural disaster, and we investigated the psychological effects on hospital nurses associated with their experiences during the disaster. We looked at several investigations into the mental health of nurses after a nuclear disaster and in other situations. It was shown that mental health of nurses is impacted, not only after nuclear disasters but also in other circumstances. Furthermore, we noted the effects of extended periods of a heavy workload and daily life. Regarding anxiety about radiation exposure, nurses who had more knowledge of radiation tended to have better mental health, suggesting that education about the health risks of radiation exposure is important for health-care professionals. In summary, it is essential that nurses are provided with education about radiation exposure and its associated health risks, and also that there is a comprehensive approach to mental health care for nurses during the chronic phase of a disaster.

The use of computed tomography (CT) has increased dramatically over the past several decades and has resulted in a concurrent increase in medical exposure to ionizing radiation. Several recent studies have examined the link between medical radiation and the risk of cancer, especially in children. The cancer risk associated medical exposure has not been definitively confirmed. However, we have to reduce unwarranted medical radiation exposure in pediatric patients. Justification and optimization are of great importance in order to minimize these risks, and the standardization of CT usage is essential. However, in Japan no clinical guidelines for the use of CT have been commonly agreed upon, especially in children. Furthermore, the CT-associated radiation exposure in Japan varies widely among the different facilities. Further studies based on a nationwide survey in Japan will be required in order to establish simple and useful clinical guidelines., Journal of Radiation Research, 59(suppl 2), pp.ii130-ii136; 2018

Context Childhood thyroid cancer is of great concern after the Fukushima nuclear power plant accident. Baseline analytical data on thyroid ultrasound examination (TUE) in children are important for future studies. Objective We analyzed the age and sex distribution of findings from the TUEs of children and adolescents in the Fukushima Health Management Survey (FHMS). Design, setting, and participants From October 2011 through March 2014, 294,905 participants aged 18 years or younger at the time of the earthquake voluntarily had TUEs in the first round of the FHMS. A secondary confirmatory examination was performed in 2032 subjects. Age- and sex-dependent prevalence and size of thyroid cysts, nodules, and cancers were analyzed. Main outcome measures Age, sex, and size distribution of findings were analyzed. Results Thyroid cysts, nodules, and cytologically suspected cancers were detected in 68,009, 1415, and 38 male subjects and in 73,014, 2455, and 74 female subjects, respectively. There was an age-dependent increase in the detection rate of thyroid nodules and cancer, but that of cysts reached a peak at 11 to 12 years. Sex affected the prevalence of thyroid nodules and cancers after the onset of puberty, but only a small difference was exhibited in that of cysts. Conclusions The thyroid cancer detection rate in Fukushima was clarified, and the proportion of individuals with thyroid nodules and cysts varied substantially by age. The results of this study will contribute to future epidemiological research on nodular thyroid diseases in children and adolescents.

Although the incidence of hepatobiliary enzyme abnormality increased immediately after the Great East Japan Earthquake and subsequent Fukushima Daiichi Nuclear Power Plant accident, longer-term trends remain unclear. The aims of this study were to determine longer-term trends in hepatobiliary enzyme abnormality and to elucidate lifestyle factors associated with such changes among residents of a nuclear-disaster-affected area. This longitudinal survey enrolled 20,395 adults living in the vicinity of Fukushima Daiichi Nuclear Power Plant. Data were obtained from the records of annual health checkups of adults aged ≥40 years between 2011 and 2012. Follow-up examinations were conducted from June 2013 to March 2014. Associations were assessed between changes in hepatobiliary enzyme abnormality immediately and 3–4 years after the disaster and lifestyle factors. The overall prevalence of hepatobiliary enzyme abnormality significantly decreased over the study period, from 29.9% to 27.1%. Multivariate logistic regression analysis revealed significant associations between improved hepatobiliary enzyme abnormality and improvements in daily physical activity and frequency of breakfast consumption. The results suggest that improvements in daily physical activity and frequency of breakfast consumption significantly reduced the incidence of hepatobiliary enzyme abnormality 3–4 years after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident.

The mental health of hospital nurses is a key health issue in public health promotion during the recovery phase following the Fukushima disaster. In this study, conducted 4 years after the disaster, we analyzed the overall mental health, knowledge, risk perception of radiation, and work and daily life burdens of nurses working at medical institutions in the Fukushima Prefecture (collection rate = 89.6%; response number = 730). Overall mental health status was estimated using the 12-item version of the General Health Questionnaire, and 333 respondents (45.6%) scored above the 12-item General Health Questionnaire threshold point (≥4), indicating probable emotional distress compared with the general population under normal circumstances. Multivariate logistic analysis suggested that the ability to cope with daily life and work-related stressors were more important than risk perception and acquisition of knowledge regarding radiation and its control methods for supporting the mental health of nurses following the Fukushima disaster.

The Fukushima nuclear power plant accident caused widespread radiation contamination. Mothers of young children were at risk of negative emotional and mental health consequences. Using data from 2 independent prefecture-wide surveys of pregnant women, we examined the associations of disaster-related stressors with both maternal self-confidence and depressive symptoms. Two postal surveys were conducted targeting women who registered their pregnancies in Fukushima Prefecture (n = 6686 in 2012 and n = 6423 in 2013). The proportions of mothers with lower self-confidence in child rearing and with depressive symptoms were 53% and 25% in 2012 and 55% and 24% in 2013, respectively. After adjusting for maternal and infant characteristics, evacuation and concern about radiation were significantly associated with depressive symptoms but not lower maternal confidence, although these 2 outcomes were significantly associated. Mothers in Fukushima showed resilience in parenting, whereas their experiences and concerns in the aftermath of nuclear disaster were associated with depressive symptoms.

Background About 146,000 people were forced into long-term evacuation due to the nuclear power plant accident caused by the Great East Japan Earthquake in 2011. Disaster is known to induce hypertension in survivors for a certain period, but it is unclear whether prolonged disaster stress influences chronic kidney disease (CKD). We conducted an observational cohort study to elucidate the effects of evacuation stress on CKD incidence. Methods Participants were individuals living in communities near the Fukushima nuclear power plant, aged 40–74 years without CKD as of their 2011 general health checkup (non-evacuees: n = 9780, evacuees: n = 4712). We followed new-onset CKD [estimated glomerular filtration rate (eGFR)

A thyroid ultrasound examination program has been conducted in the aftermath of the Fukushima Daiichi Nuclear Power Plant accident to address concerns about the increased risk of thyroid cancer similar to those experienced by local residents after the 1986 Chernobyl accident. This is the second-largest thyroid cancer screening in younger age ever, following only that conducted after Chernobyl. As the natural history of thyroid cancer in younger populations is not well characterized, large-scale screening using thyroid ultrasound could result in overdiagnosis, even with careful planning, as has been experienced in South Korea. Awareness regarding the thyroid gland is generally low among residents, who tend to directly associate examination results with radiation exposure and are likely to develop newfound anxiety and feelings of self-condemnation and guilt. We reviewed the dilemma surrounding cancer screening and particularly underscored the need to address psychosocial issues associated with possible overdiagnosis. We modified our approach to address individual and social anxiety induced by results of screening conducted after the Fukushima accident. These findings and our experiences regarding the psychosocial issues related to thyroid examination should assist residents in their lifelong decision making and help them prepare for future disasters.

Since radiation accidents, particularly nuclear disasters, are rarer than other types of disasters, a comprehensive radiation disaster medical curriculum for them is currently unavailable. The Fukushima compound disaster has urged the establishment of a new medical curriculum in preparation for any future complex disaster. The medical education will aim to aid decision making on various health risks for workers, vulnerable people, and residents addressing each phase in the disaster. Herein, we introduce 3 novel educational programs that have been initiated to provide students, professionals, and leaders with the knowledge of and skills to elude the social consequences of complex nuclear disasters. The first program concentrates on radiation disaster medicine for medical students at the Fukushima Medical University, together with a science, technology, and society module comprising various topics, such as public risk communication, psychosocial consequences of radiation anxiety, and decision making for radiation disaster. The second program is a Phoenix Leader PhD degree at the Hiroshima University, which aims to develop future leaders who can address the associated scientific, environmental, and social issues. The third program is a Joint Graduate School of Master’s degree in the Division of Disaster and Radiation Medical Sciences at the Nagasaki University and Fukushima Medical University.

Computed tomography (CT) is an essential tool in modern medicine and is frequently used to diagnose a wide range of conditions, particularly in industrial countries, such as Japan and Germany. However, markedly higher doses of ionizing radiation are delivered during CT imaging than during conventional X-ray examinations. To assess pediatric CT practice patterns, data from three university hospital databases (two in Japan and one in Germany) were analyzed. Anonymized data for patients aged 0 to 14 years who had undergone CT examinations between 2008 and 2010 were extracted. To assess CT practice, an interdisciplinary classification scheme for CT indications, which incorporated the most common examination types and radiosensitive tissues, was developed. The frequency of CT examinations was determined according to sex, age at examination, and indications. A total of 5182 CT examinations were performed in 2955 children. Overall, the frequency of CT examinations at the Japanese university hospitals did not differ significantly from that at the German hospital. However, differences were detected in the age distribution of the patients who underwent CT examinations (the proportion of patients ?5 years of age was significantly higher in Japan than in Germany) and in the indications for CT. Substantial practice differences regarding the use of CT in pediatric health care were detected between the three hospitals. The results of this study point towards a need for approaches such as clinical guidelines to reduce unwarranted medical radiation exposures, particularly abdominal and head CT, in the Japanese health system., Journal of Radiation Research, 58(1), pp.135-141; 2017

Aim After the Great East Japan Earthquake, over 160,000 residents near the Fukushima Daiichi Nuclear Power Plant were forced to evacuate due to a nuclear accident. Health problems in these evacuees have since become major issues. We examined the association between evacuation and incidence of metabolic syndrome (METS) among residents in Fukushima. Methods We conducted a cohort study among residents aged 40-74 years without METS at the time of the disaster in Fukushima. Among 20,269 residents who met the inclusion criteria before the disaster, 8,547 residents (3,697 men and 4,850 women; follow-up proportion: 42.2%) remained available for follow-up examinations after the disaster by the end of March 2013. The main outcome was incidence of METS, defined by guidelines from the Japanese committee, using data from the Comprehensive Health Check before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of METS, adjusting for potential confounders, age, gender, waist circumference, exercise habit, and alcohol consumption. Results Incidence of METS was higher in evacuees (men 19.2%, women 6.6%) than in non-evacuees (men 11.0%, women 4.6%). Evacuees had higher body mass index, waist circumference, triglycerides, and fasting plasma glucose after the disaster than non-evacuees. We found a significant association between evacuation and incidence of METS (adjusted odds ratio 1.72, 95% confidence interval; 1.46-2.02). Conclusion This is the first study to demonstrate that evacuation after a disaster is associated with increased incidence of METS.

To the Editor:In 2011, the Great East Japan Earthquake and subsequent tsunami hit the Fukushima Daiichi Nuclear Power Plant, causing it to release radioactive elements. Six months later, Fukushima Prefecture started thyroid gland examinations to determine the effects of radiation on incidence of thy

The Great East Japan Earthquake of March 11, 2011, caused the Fukushima Daiichi Nuclear Power Station accident, which is regarded as a level 7, major accident, on the International Nuclear and Radiological Event Scale. There was a great concern among the general public in Japan about the various health impacts of this compound nuclear disaster, including rapid changes in the overall lifestyle and dispersion of radioactive material [1]. In particular, radiation-induced thyroid cancers are one of the greatest concerns among local residents after the disaster. To address the health risks, it is necessary to communicate health-related information and establish a system to support residents through health surveillance [2, 3] (see Chap. 12). Although the radiation exposure level in Fukushima has been reported to be much lower than that in Chernobyl [4], conducting surveys is required for both scientific and social demand [5]. Thyroid ultrasound examinations have been conducted as part of the Fukushima Health Management Survey (FHMS) commissioned by Fukushima Prefecture [6, 7]. Along with the advances of ultrasonic imaging diagnostic technology, overdiagnosis has become a global issue in recent decades [8, 9]. Therefore, careful attention must be paid when interpreting screening results [10, 11].

The Great East Japan Earthquake of 11 March 2011, caused the Fukushima Daiichi Nuclear Power Plant Accident, which resulted in the release of a large amount of radioactive materials into the environment, and there is a serious concern about the radiation effects on the health of residents living in the affected areas. The evaluation of exposure dose is fundamental for the estimation of health effects, and whenever possible, the exposure dose should be evaluated by actual measurements as opposed to estimations. Here, the outline of the exposure doses of residents estimated from surveys or obtained by measurements is described. Fukushima Health Management Survey reported the results for 460 408 residents during the first 4 months after the accident; 66.3% received doses

The actual implementation of the epidemiological study on human health risk from low dose and low-dose rate radiation exposure and the comprehensive long-term radiation health effects survey are important especially after radiological and nuclear accidents because of public fear and concern about the long-term health effects of low-dose radiation exposure have increased considerably. Since the Great East Japan earthquake and the Fukushima Daiichi Nuclear Power Plant accident in Japan, Fukushima Prefecture has started the Fukushima Health Management Survey Project for the purpose of long-term health care administration and medical early diagnosis/treatment for the prefectural residents. Especially on a basis of the lessons learned from the Chernobyl accident, both thyroid examination and mental health care are critically important irrespective of the level of radiation exposure. There are considerable differences between Chernobyl and Fukushima regarding radiation dose to the public, and it is very difficult to estimate retrospectively internal exposure dose from the short-lived radioactive iodines. Therefore, the necessity of thyroid ultrasound examination in Fukushima and the intermediate results of this survey targeting children will be reviewed and discussed in order to avoid any misunderstanding or misinterpretation of the high detection rate of childhood thyroid cancer., Radiation Protection Dosimetry, 171(1), pp.41-46; 2016