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Simple Summary: Lockdowns and health service disruptions during the COVID-19 pandemic led to concerns about a potential decrease in essential health screenings, even after the pandemic. It is crucial to understand how the pandemic affected women's participation in breast cancer screenings in Japan and whether getting the COVID-19 vaccine influenced their participation rates. We analyzed data from over 6110 women aged 40 to 74 years from a large online survey conducted in 2021 and 2022. Our findings showed that the number of women getting screened for breast cancer did not decrease after the pandemic. Moreover, women who were vaccinated against COVID-19 were more likely to attend their screenings compared to those who were not vaccinated. This result aligns with the observation that vaccinated individuals tend to be more proactive about their health. There is limited information on whether the COVID-19 pandemic was associated with decreased breast cancer screening uptake and if COVID-19 vaccination was associated with an increase in screening uptake. Our study explored the uptake of breast cancer screening in Japan after the COVID-19 pandemic and assessed its association with the COVID-19 vaccination. We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), a web-based prospective cohort survey, and we included 6110 women without cancer history who were aged 40 to 74 years that participated in the 2012 and 2022 surveys. We examined the regular breast cancer screening uptake before and after the pandemic and employed a multivariable Poisson regression model to seek any association between COVID-19 vaccination and screening uptake. Of 6110, 38.2% regularly participated in screening before the pandemic and 46.9% did so after the pandemic. Individuals unvaccinated due to health reasons (incidence rate ratio (IRR) = 0.47, 95% CI: 0.29–0.77, p = 0.003) and for other reasons (IRR = 0.73, 95% CI: 0.62–0.86, p < 0.001) were less likely to undergo screening compared to fully vaccinated individuals. There was no long-term decrease in breast cancer screening uptake after the pandemic in Japan. Vaccination was linked to increased uptake, but there was no dose relationship. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relationship between family uncertainty and family quality of life (QOL) during the recovery period of patients with cerebrovascular disease in Japan, and the factors that influence family uncertainty. Methods: Data were collected from copies of patient medical files and interviews with family members of 85 patients admitted to two rehabilitation wards in Japan. Family uncertainty was measured using the Japanese version of the Managing Uncertainty in Illness Scale–Family Member form (MUIS-FM) and family QOL using the World Health Organization Five Well-Being Index (WHO-5). Multiple linear regression analysis was applied to investigate associated factors. Results: WHO-5 score was significantly negatively associated with MUIS-FM score (β = − 0.236, p = 0.03); other factors associated with MUIS-FM score were the Care Shared Decision-Making Questionnaire for care providers score (β = − 0.384, p < 0.001), Short Intolerance of Uncertainty Scale score (β = 0.296, p = 0.001), and history of surgical treatment (β = 0.199, p = 0.032). Conclusions: Family QOL could be improved by reducing family uncertainty. It is also suggested that promoting shared decision-making between healthcare providers and patients' families may help reduce family uncertainty. It is necessary to take into account not only family intolerance of uncertainty but also uncertainty that varies by type of acute care provided. [ABSTRACT FROM AUTHOR]

The occurrence of Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA) in a sub-catchment of the Yodo River Basin, a representative water system of a drinking water source in Japan, was investigated. The chromogenic enzyme-substrate medium method was used for the detection of S. aureus and MRSA by the presence or absence of antimicrobials in the medium for viable bacteria in a culture-based setting. The contributions of S. aureus and MRSA from wastewater to the rivers were estimated based on mass flux-based analysis, and quantitative microbial risk assessment (QMRA) was further conducted for S. aureus and MRSA in river environments. The mean abundance of S. aureus and MRSA was 31 and 29 CFU/mL in hospital effluent, 124 and 117 CFU/mL in sewage treatment plant (STP) influent, 16 and 13 CFU/mL in STP effluent, and 8 and 9 CFU/mL in river water, respectively. Contribution of the pollution load derived from the target STP effluent to river water ranged from 2% to 25%. The QMRA showed that to achieve the established health benchmarks, the drinking water treatment process would need to yield 1.7 log10 and 2.9 log10 inactivation in terms of infection risk and disability-adjusted life year (DALY) indexes, respectively. These findings highlight the link between medical environment and the importance of environmental risk management for antimicrobial-resistant bacteria in aquatic environments. [ABSTRACT FROM AUTHOR]

In this study, we aimed to use the loss of happy life expectancy (LHpLE), an indicator that enables risk assessment considering wellbeing, to compare the risks of environmental carcinogenic chemicals in Japan. First, we surveyed Japanese people to determine their emotional happiness by age and sex and evaluated whether cancer incidence reduced emotional happiness. Questionnaires were administered to a general population panel and a panel of patients with cancer in 2022, recruiting a predetermined number of responses of 5000 and 850, respectively. Second, using the survey data, LHpLE was calculated for radon, arsenic, and fine particulate matter (aerodynamic diameter <2.5 μm; PM 2.5) and compared to psychological distress, considering increased mortality and decreased emotional happiness due to these risks. We discovered no significant decrease in emotional happiness due to cancer incidence and no significant associations between emotional happiness and cancer type, history, or stage. LHpLE was calculated to be 6.4 × 10−3 years for radon, 2.6 × 10−3 years for arsenic, 1.1 × 10−2 years (2012 exposure) and 8.6 × 10−4 years (2020 exposure) for PM 2.5 , and 9.7 × 10−1 years for psychological distress. The fraction of losses caused by these carcinogenic chemicals to HpLE exceeded 10−5, suggesting that risk reduction for these chemicals is important in environmental policies. The LHpLE indicator allows for comparing different types of risks, such as environmental chemicals and psychological distress. This is the first study to compare chemical risks using the LHpLE indicator. [Display omitted] • We evaluated whether cancer incidence reduced emotional happiness. • We estimated the loss of happy life expectancy for environmental chemicals. • Cancer incidence did not reduce emotional happiness. • The loss of happy life expectancy exceeded 10−4 years for radon, arsenic, and PM 2.5 • The loss of happy life expectancy was 1 year for psychological distress. [ABSTRACT FROM AUTHOR]

The article discusses the importance of establishing a global wastewater surveillance consortium for pandemic preparedness. Wastewater surveillance is a cost-effective method for assessing COVID-19 infection, as infected individuals shed the virus into sewer systems. The article highlights a study in Japan that found a strong correlation between the concentration of SARS-CoV-2 RNA in wastewater and the number of reported cases. Wastewater surveillance can also be used to identify specific variants of the virus. The article proposes incorporating wastewater surveillance into international and regulatory frameworks, such as the WHO, to create a global infectious disease surveillance system. The EU is already establishing an international wastewater monitoring consortium, but more countries need to participate for it to be effective. The consortium could share experiences and protocols and support monitoring in low-income countries. [Extracted from the article]

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Disasters can hinder access to health information among cancer patients. However, little is known regarding overall health information exposure (HIE), its barriers and its impacts on attitudes toward healthcare among cancer patients in the long-term aftermath of disasters. The aims of this study were threefold: assess the extent of HIE; identify associations between family composition and a non-engagement with HIE; and examine the effects of HIE on attitudes toward healthcare among local cancer patients—5 years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Fukushima, Japan. We conducted self-administered surveys with all cancer and non-cancer surgery department outpatients at Minamisoma Municipal General Hospital (MMGH), Minamisoma City, from October 2016 to January 2017. In total, 404 patients (263 cancer patients and 141 non-cancer patients) voluntarily participated in the study. The results revealed that a regular level of HIE occurred among 90.5% of the cancer patients. In cancer patients, family composition was not significantly associated with HIE, and HIE was not associated with attitude toward healthcare. In conclusion, most cancer patients visiting the MMGH surgical department were regularly engaged in HIE. [ABSTRACT FROM AUTHOR]

Background: As a result of the Fukushima Daiichi nuclear power plant accident, many residents evacuated and were exposed to changes in their living environment and socioeconomic status, and to persistent stressors. Past studies have suggested the potential for these circumstances to contribute to long-term changes to population health. Objective: The objective of this study was to gain a better understanding of long-term health effects of evacuation, by evaluating the risk of non-communicable diseases among evacuees from Minamisoma City (one of the closest municipalities to the power plant) until 2017. Methods: The study evaluated data from annual health check-ups for residents aged 40–74 years covered by National Health Insurance (who are largely self-employed) from 2010 to 2017 administered by Minamisoma City. Diabetes, hyperlipidemia, and hypertension were defined from the results of blood sampling. Annual changes in age-adjusted prevalence were estimated by evacuation scenario. We also performed an inverse-probability weighting (IPW) analysis to adjust for baseline covariates in 2010 and estimated the differences in the risk of diabetes, hyperlipidemia, and hypertension by evacuation scenario as of the 2017 health check-up in reference to the no-evacuation group. Results: A total of 1,837 individuals were considered in this study. Regardless of evacuation scenario, there was statistical evidence suggesting an upward and a downward trend in diabetes and hypertension from 2010 to 2017, respectively, while hyperlipidemia showed no remarkable change. IPW analyses demonstrated that disease risks in 2017 did not differ significantly among people with different evacuation scenarios. Conclusions: Region-specific factors played an important role in the health effects of the evacuation. Our findings have important implications for the need of an assessment of the health effects of evacuations in more localized manner. Further research in this area will strengthen the communities' preparedness for future disasters that require mass evacuation. [ABSTRACT FROM AUTHOR]

Interactive communication and the ability to consider feedback are critical for linking health professionals and the community. Goto and colleagues developed and conducted health literacy training workshops for public health nurses after the 2011 nuclear accident in Fukushima to improve their communication skills. The present study aimed to examine the association between past workshop attendance and nurses' attitudes toward feedback from community residents. We conducted a questionnaire survey with 723 public health nurses in Fukushima and analyzed differences in feedback acceptance, work environment, basic characteristics, and health literacy levels between health literacy workshop attendees and non-attendees. Among 582 respondents, 19.4% were past attendees and showed a higher likelihood of accepting feedback from community residents (amount: adjusted odds ratio [aOR] = 1.87, 95% confidence interval [CI]: 1.21–2.88; specificity: aOR = 1.69, 95%CI: 1.09–2.61; satisfaction: aOR = 2.34, 95%CI: 1.50–3.65) than did non-attendees after adjusting for other variables. Furthermore, work engagement was associated with positive feedback acceptance (amount: aOR = 1.43, 95%CI: 1.03–1.98; specificity: aOR = 1.57, 95%CI: 1.12–2.20; satisfaction: aOR = 1.97, 95%CI: 1.38–2.81). We note the importance of creating a better work environment as well as a training system at the organizational level that encourages public health nurses to learn about health literacy and to improve their communication skills. This could improve professional/community relationships, increase the accessibility of health information for the public, and ultimately improve community health. [ABSTRACT FROM AUTHOR]

Purpose: Although mental health problems such as depression after disasters have been reported, positive psychological factors after disasters have not been examined. Recently, the importance of positive affect to our health has been recognised. We therefore investigated the frequency of laughter and its related factors among residents of evacuation zones after the Great East Japan Earthquake of 2011.Methods: In a cross-sectional study on 52,320 participants aged 20 years and older who were included in the Fukushima Health Management Survey in Japan's fiscal year 2012, associations of the frequency of laughter with changes in lifestyle after the disaster, such as a changed work situation, the number of family members, and the number of address changes, and other sociodemographic, psychological, and lifestyle factors were examined using logistic regression analysis. The frequency of laughter was assessed using a single-item question: "How often do you laugh out loud?"Results: The proportion of those who laugh almost every day was 27.1%. Multivariable models adjusted for sociodemographic, psychological, and lifestyle factors demonstrated that an increase in the number of family members and fewer changes of address were significantly associated with a high frequency of laughter. Mental health, regular exercise, and participation in recreational activities were also associated with a high frequency of laughter.Conclusion: Changes in lifestyle factors after the disaster were associated with the frequency of laughter in the evacuation zone. Future longitudinal studies are needed to examine what factors can increase the frequency of laughter. [ABSTRACT FROM AUTHOR]

[Display omitted] • EPISENS-M consists of RNA extraction from membrane, RT-preamplification, and qPCR. • EPISENS-M enables sensitive detection of SARS-CoV-2 RNA from wastewater. • SARS-CoV-2 RNA concentrations in wastewater correlated well with the reported cases. • A mathematical model was developed for predicting reported COVID-19 cases via WBE. • EPISENS-M with the mathematical model enables reliable prediction of reported cases. Wastewater-based epidemiology (WBE) has the potential to predict COVID-19 cases; however, reliable methods for tracking SARS-CoV-2 RNA concentrations (C RNA) in wastewater are lacking. In the present study, we developed a highly sensitive method (EPISENS-M) employing adsorption-extraction, followed by one-step RT-Preamp and qPCR. The EPISENS-M allowed SARS-CoV-2 RNA detection from wastewater at 50 % detection rate when newly reported COVID-19 cases exceed 0.69/100,000 inhabitants in a sewer catchment. Using the EPISENS-M, a longitudinal WBE study was conducted between 28 May 2020 and 16 June 2022 in Sapporo City, Japan, revealing a strong correlation (Pearson's r = 0.94) between C RNA and the newly COVID-19 cases reported by intensive clinical surveillance. Based on this dataset, a mathematical model was developed based on viral shedding dynamics to estimate the newly reported cases using C RNA data and recent clinical data prior to sampling day. This developed model succeeded in predicting the cumulative number of newly reported cases after 5 days of sampling day within a factor of √ 2 and 2 with a precision of 36 % (16/44) and 64 % (28/44), respectively. By applying this model framework, another estimation mode was developed without the recent clinical data, which successfully predicted the number of COVID-19 cases for the succeeding 5 days within a factor of √ 2 and 2 with a precision of 39 % (17/44) and 66 % (29/44), respectively. These results demonstrated that the EPISENS-M method combined with the mathematical model can be a powerful tool for predicting COVID-19 cases, especially in the absence of intensive clinical surveillance. [ABSTRACT FROM AUTHOR]

Okinawa Island is located in the southern region of Japan and has a population of 1.22 million. Okinawa Prefectural Enterprise Bureau (OPEB) supplies 410,000m³/d of water to 24 municipalities. Although OPEB uses multiple water resources including dam reservoirs and groundwater, increased water demand resulted in occasional water shortages until a seawater desalination plant (40,000m³/d) started operations in 1997. In this study, a model was developed to simulate the water supply system of Okinawa Island using precipitation and OPEB operational data from 2009 to evaluate the role of the desalination plant in reducing risks associated with drought and power consumption of the plant. The simulation results indicate that without the desalination plant, the dam reservoir storage falls below 50% for 70 days, whereas with the desalination plant, storage remains above 50%. If the plant was operated at full capacity, the dam reservoir storage increased by 17.2% after 1 year of simulation time. However, the desalination plant consumes 4.5-14.7 times more electricity per unit volume of water than other water resources. Although the desalination plant plays an important role in avoiding water shortage in Okinawa Island, operational protocols to minimize power consumption need to be developed further using simulation models such as the one developed in this study. [ABSTRACT FROM AUTHOR]

Abstract: The release of radioactive materials from the Fukushima nuclear power plant after the Great East Japan Earthquake on 11 March 2011 poses health risks. In this study, the intake of iodine 131 (I-131) in drinking water and foods (milk, dairy products, and vegetables) by citizens of Tokyo was estimated. The effects of countermeasures (restrictions on the distribution of foods and the distribution of bottled water for infants) on reducing intake were also evaluated. The average thyroid equivalent doses without countermeasures from 21 March 2011 were 0.42mSv in adults, 1.49mSv in children, and 2.08mSv in infants. Those with countermeasures were 0.28, 0.97, and 1.14mSv respectively, reductions of 33%, 35%, and 45%. Drinking water contributed more to intake by adults and children than foods. The intake of I-131 within the first 2weeks was more than 80% of the estimated intake, owing to its short half-life, indicating that rapid countermeasures are important in reducing intake. The average risks of cancer incidence and mortality due to I-131 for infants were estimated to be 3×10−5 and 0.2×10−5, respectively, lower than the annual risks of traffic accidents, naturally occurring radioactive material (potassium 40), and environmental pollutants such as diesel exhaust particles. [Copyright &y& Elsevier]

While the occurrence of pharmaceuticals and personal care products (PPCPs) in groundwater has typically been reported in bank filtration sites, irrigated fields, septic tanks, and sewage disposal practices, fewer studies have been conducted in highly urbanized areas, where infiltration of treated or untreated sewage is not supposed to be a source of groundwater recharge. Furthermore, little is known about the occurrence of various kinds of PPCPs in relation to microbial indicators in groundwater from different types of aquifers. Thus, we examined the city-wide occurrence of selected PPCPs (diethyltoluamide, crotamiton, ethenzamide, propyphenazone, carbamazepine, and caffeine) and E. coli in 50 groundwaters from unconfined aquifers (<30 m in depth) and confined aquifers (up to 500 m in depth) in Tokyo, where unintended groundwater contamination could take place due to decrepit sewer networks. PPCPs were detected in unconfined aquifers and springs (23/34 samples, 68%), and in confined aquifers (7/16 samples, 44%). Compared with published results for sewage influents, concentrations of PPCPs, excluding caffeine, were generally 1-2 orders of magnitude lower, while in some samples concentrations were quite comparable. The high occurrence rate of PPCPs, even in confined aquifers, indicated that such aquifers are not always protected from pollution by sewage near the land surface. Among the PPCPs analyzed, carbamazepine and crotamiton were most frequently detected, which would appear to be owing to their high persistence, combined with the high concentration of crotamiton in sewage. Crotamiton was detected in all four E. coli-positive groundwaters, and thus may potentially serve as a precautionary indicator of E. coli contamination. Using carbamazepine as a sewage marker, we estimated that 0.8%-1.7% of the dry-weather flow of sewage was leaking out into the unconfined aquifers. [ABSTRACT FROM AUTHOR]

Abstract: N-nitrosodimethylamine (NDMA), a disinfection byproduct of water and wastewater treatment processes, is a potent carcinogen. We investigated its occurrence and the potential for its formation by chlorination and by chloramination in ground water and river water in Tokyo. To characterize NDMA precursors, we revealed their molecular weight distributions in ground water and river water. We collected 23 ground water and 18 river water samples and analyzed NDMA by liquid chromatography-tandem mass spectrometry. was evaluated by chlorinating water samples with free chlorine for 24 h at pH 7.0 while residual free chlorine was kept at 1.0–2.0 mgCl2/L. was evaluated by dosing water samples with monochloramine at 140 mgCl2/L for 10 days at pH 6.8. NDMA precursors and dissolved organic carbon (DOC) were fractionated by filtration through 30-, 3-, and 0.5 kDa membranes. NDMA concentrations were <0.5–5.2 ng/L (median: 0.9 ng/L) in ground water and <0.5–3.4 ng/L (2.2 ng/L) in river water. NDMA concentrations in ground water were slightly lower than or comparable to those in river water. Concentrations of were not much higher than concentrations of NDMA except in samples containing high concentrations of NH3 and NDMA precursors. The increased NDMA was possibly caused by reactions between NDMA precursors and monochloramine unintentionally formed by the reaction between free chlorine and NH3 in the samples. NDMA precursors ranged from 4 to 84 ng-NDMA eq./L in ground water and from 11 to 185 ng-NDMA eq./L in river water. Those in ground water were significantly lower than those in river water, suggesting that NDMA precursors were biodegraded, adsorbed, or volatilized during infiltration. The molecular weight of NDMA precursors in river water was dominant in the <0.5 kDa fraction, followed by 0.5–3 kDa. However, their distribution was inconsistent in ground water: one was dominant in the <0.5 kDa fraction, and the other in 0.5–3 kDa. Molecular weight distributions of NDMA precursors were very different from those of DOC. This is the first study to reveal the widespread occurrence and characterization of NDMA precursors in ground water. [Copyright &y& Elsevier]

Abstract: Samples of polyethylene pellets were collected at 30 beaches from 17 countries and analyzed for organochlorine compounds. PCB concentrations in the pellets were highest on US coasts, followed by western Europe and Japan, and were lower in tropical Asia, southern Africa and Australia. This spatial pattern reflected regional differences in the usage of PCBs and was positively correlated with data from Mussel Watch, another monitoring approach. DDTs showed high concentrations on the US west coast and in Vietnam. In Vietnam, DDT was predominant over its metabolites (DDE and DDD), suggesting the principal source may be current usage of the pesticide for malaria control. High concentrations of pesticide HCHs were detected in the pellets from southern Africa, suggesting current usage of the pesticides in southern Africa. This study demonstrates the utility and feasibility of the International Pellet Watch approach to monitor POPs at a global scale. [Copyright &y& Elsevier]

Perfluorinated surfactants (PFSs) in groundwater were analyzed to reveal their distribution and sources. Sixteen groundwater and spring samples were collected from the Tokyo metropolitan area, and nine PFSs, including perfluorooctane- sulfonate (PFOS) and perfluorooctanoate (PFOA), were analyzed by liquid chromatography-tandem mass spectrometry. A column test using artificial street runoff was also performed to study their behavior. PFSs were detected in all groundwater samples, some at concentrations comparable to those in wastewater and street runoff, suggesting widespread contamination of groundwater by PFSs. In particular, PFOS was more abundant in groundwater than in rivers, wastewater, and street runoff. This was attributed to its production from the degradation of its precursors, as supported by the column test. The occurrence of short-chain perfluorocarboxylates (PFCAs) in groundwater was also consistent with the results of the column test, showing that limited amounts of short-chain PFCAs were removed by soil, as the efficiency of removal increased with the chain length. We evaluated the contributions of PFCAs from wastewater and surface runoff to groundwater by using two indicators, the long/(short + long) ratio and the even/(even + odd) ratio. Both ratios showed good agreement in their calculated contributions in heavily contaminated groundwater where breakthroughs likely occurred. Wastewater and surface runoff contributed to 54-86% and 16-46% of PFCAs, respectively, in groundwater. [ABSTRACT FROM AUTHOR]

Perfluorinated surfactants (PFSs) in wastewater and street runoff in Japan were measured to determine their pathways of travel and utility as indicators of each to water environments. Among PFS species, perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorononanoate (PFNA) were dominant in wastewater. PFS concentrations were higher in secondary effluents than in influents, possibly because of biodegradation of their precursors. This was supported by a significant correlation between concentration increases of PFOA and PFNA. Biodegradation of the same precursors probably produced mainly PFOA and secondarily PFNA. Concentrations of perfluorocarboxylates (PFCAs), especially longer- and even-chain PFCAs, in street runoff were equal to or higher than those in wastewater influents and secondary effluents, but PFOS concentrations were lower in street runoff. This result suggests that street runoff potentially contaminates water environments with PFCAs. In street runoff, perfluorodecanoate (PFDA), perfluoroundecanoate (PFUA), and perfluorododecanoate (PFDDA) were abundant along with PFOA and PFNA. PFS profiles in street runoff were significantly different from those in wastewater samples, suggesting that relative proportions of PFSs can be useful as indicators. Four ratios – PFOA/PFOS, PFNA/PFOS, long-chain/(short-chain+long-chain), and even-chain/(even-chain+odd-chain) – were proposed to evaluate the contributions of PFSs from wastewater and street runoff to water environments. [Copyright &y& Elsevier]

We investigated perfluorinated surfactants (PFSs) in size-fractionated street dust to identify their occurrence, contributions from traffic, and potential routes of entry into waters. Street dust was collected from residential areas and heavily trafficked areas in Tokyo and sorted into fine (<63μm) and coarse fractions (63–2000μm). Five PFS species were analyzed by liquid chromatography–tandem mass spectrometry: perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorodecanoate (PFDA), and perfluoroundecanoate (PFUA). In fine fractions, PFS contents were significantly higher in heavily trafficked street dust than in residential street dust, but in coarse fractions, no significant differences were observed. Additionally, in heavily trafficked areas, PFS contents were significantly higher in fine fractions than in coarse fractions, but in residential areas, no significant differences were observed. PFS compositions differed between size fractions, not locations, indicating differences in sources between size fractions. Fine particles from traffic contributed to PFSs in street dust. Street dust possibly acts as the origin of PFSs in street runoff and eventually enters waters. This is the first report of PFSs in street dust. [Copyright &y& Elsevier]

We analyzed perfluorinated surfactants (PFSs) in 20 river samples and 5 wastewater secondary effluent samples in Japan to reveal their occurrence and sources. Nine PFS species were determined: perfluorooctanesulfonate (PFOS), perfluorooctane sulfonamide (FOSA), perfluoroheptanoate (PFHpA), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorodecanoate (PFDA), perfluoroundecanoate (PFUA), perfluorododecanoate (PFDDA), and perfluorotridecanoate (PFTDA). PFSs were detected in all rivers, revealing nationwide contamination of rivers. In particular, 11 out of 20 river samples exceeded New Jersey guidance for PFOA in drinking water (40 ng/L). PFOS, PFHpA, PFOA, and PFNA were major species in Japan. Concentrations of PFOS, PFHpA, and PFNA in rivers were strongly correlated with population density, suggesting that the chemicals were derived from urban activities. PFOA showed a significant but weak correlation. We used crotamiton, a marker of sewage effluent, for further source analysis. Concentrations of PFOS, PFHpA, and PFNA were strongly correlated with those of crotamiton, and plots of secondary effluents fell near the regression lines of rivers, indicating that the PFOS, PFHpA, and PFNA in rivers were derived from sewage effluent On the other hand, PFOA was found at remarkably high levels (54-192 ngIL) in seven river samples containing low levels of crotamiton, suggesting that it was derived from nonsewage point sources, as well as sewage effluent The total fluxes of sewage-derived PFOS, PFHpA, PFOA, and PFNA from Japan were estimated to be 3.6, 2.6,5.6, and 2.6 t/year, respectively. This is the first report to identify PFOA in several rivers, derived from nonsewage point sources, by using a marker of sewage effluent. [ABSTRACT FROM AUTHOR]

Trust in governments and public institutions as a determinant of public health outcomes has gained increased attention since the COVID-19 pandemic. Provided historically low confidence in vaccines in Japan, investigating the role of trust in information sources and actual COVID-19 vaccination uptake behavior will be invaluable for future vaccine promotion policymaking. Therefore, the objective of this study was to elucidate the determinants of COVID-19 vaccination uptake and evaluate the relationship between trust in different information sources and COVID-19 vaccination behavior in Japan. For this study, we leveraged a longitudinal series of web-based surveys of 19,174 individuals in Japan conducted between 2021 and 2022 which asked questions regarding a wide range of sociodemographic and psychographic characteristics related to the COVID-19 pandemic. Determinant analysis for vaccination (at least one dose of a COVID-19 vaccine) was conducted via multiple logistic regression, and odds ratios (OR) with 95% confidence intervals (CI) were estimated. After adjustment for sociodemographic determinants of vaccine uptake, aggregate trust in the systems and institutions of vaccine approval (OR: 1.42, 95% CI: 1.30–1.56), and trust in information about the COVID-19 pandemic coming from government sources (OR: 1.27, 95% CI: 1.12–1.44) were found to be consistently powerful predictors of COVID-19 vaccination. Trust in media sources including traditional media (OR: 1.21, 95% CI: 1.07–1.36), and the internet (OR: 0.77, 95% CI: 0.66–0.89) had significant and opposing effects. Our findings support the broader hypothesis that trust in governments and public health institutions remains a powerful determinant for COVID-19 vaccine uptake in Japan. We also found that vaccination decision-making is a multifactorial process that includes the synthesis of trust in public institutions and media, and its interaction with psychosocial determinants such as prosociality and health literacy. We hope to apply this study's findings towards future vaccine programs for contagious diseases. [ABSTRACT FROM AUTHOR]

Recovery Colleges (RCs) are mental health learning communities, operated in 28 countries across cultures. However, the RC operational model is informed by Western countries sharing similar cultural characteristics such as individualism and short-term orientation. How RC operational model needs to be adapted to non-Western culture remains unknown. We investigated how RCs are introduced to the public in two countries with contrasting cultural characteristics: Japan (collectivism, long-term) and England (individualism, short-term). Corpus-based discourse analysis on 22,827 words from promotional texts (13 RCs in Japan, 61 in England) revealed that both countries emphasised mental illness lived experiences. In Japan, the focus was on the relational and long-term aspects of recovery. In England, the focus was on personal learning and skill acquisition. People attending RCs in Japan may anticipate experiencing collectivistic and long-term elements, which are viewed unfavourably in the operational model. Findings suggest refinements to the operational model to include under-represented cultural characteristics. [ABSTRACT FROM AUTHOR]

A previous report indicated that evacuation owing to the government order after the Fukushima disaster impacted the health status of older people; however, the association between living in evacuation areas and independence in their daily lives was unclear. This study examined the hypothesis that people who were forced to evacuate their homes were more likely to need long-term care (LTC). Historical cohort study. Older individuals (n = 13,934) in Minamisoma, Fukushima Prefecture, Japan, part of which was designated as an evacuation area. Background and certification data from April 2012 to December 2016 were extracted. Logistic regression analysis with sex stratification was performed to examine the association between certification of care levels 1-5 and living in evacuation areas. In total, 18,178 Minamisoma residents aged ≥65 years who had not received LTC certification as of March 11, 2011, were eligible for follow-up. Of these, 4244 residents without a certificate of residence by June 1, 2016, were excluded. Of 13,934 residents followed up, 1553 (11.1%) were newly certified as care levels 1-5. Certification of care levels 1-5 was associated with living in evacuation areas [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.20-2.18] and living alone at the time of the disaster (OR 2.58, 95% CI 1.92-3.47) in men and living alone at the time of the disaster (OR 1.35, 95% CI 1.15-1.59) in women. Living in evacuation areas and living alone were associated with LTC certification. In evacuation areas, individuals with family members were more likely to be certified compared with those in nonevacuation areas. Among residents in evacuation areas, several individuals with family members experiencing family structure changes might need LTC. Preventive measures (including group relocation) may be beneficial for those being evacuated following a disaster. [ABSTRACT FROM AUTHOR]

Radiation disasters pose distinctive medical challenges, requiring diverse care approaches. Beyond radiation exposure assessment, addressing health impacts due to lifestyle changes, especially among vulnerable populations, is vital. Evacuation orders issued in radiation-affected areas introduce unique healthcare dynamics, with their duration significantly influencing the recovery process. Understanding evolving patient demographics and medical needs after lifting evacuation orders is crucial for post-disaster care planning. Minamisoma Municipal Odaka Hospital, located 13 to 20 km from Fukushima Daiichi Nuclear power plant in a post-evacuation zone, was greatly affected by the Great East Japan Earthquake and subsequent radiation disaster. Data were retrospectively collected from patient records, including age, gender, visit date, diagnoses, and addresses. Patient records from April 2014 to March 2020 were analyzed, comparing data before and after the July 2016 evacuation order lift. Data was categorized into pre and post-evacuation order lifting periods, using International Classification of Diseases, Tenth Edition codes, to identify the top diseases. Statistical analyses, including χ-square tests, assessed changes in disease distributions. Population data for Odaka Ward and Minamisoma City fluctuated after lifting evacuation orders. As of March 11, 2011, Odaka Ward had 12,842 residents (27.8% aged 65+ years), dropping to 8406 registered residents and 2732 actual residents by April 30, 2018 (49.7%). Minamisoma City also saw declines, with registered residents decreasing from 71,561 (25.9%) to 61,049 (34.1%). The study analyzed 11,100 patients, mostly older patients (75.1%), between 2014 and 2020. Post-lifting, monthly patient numbers surged from an average of 55.2 to 213.5, with female patients increasing from 33.8% to 51.7%. Disease patterns shifted, with musculoskeletal cases declining from 23.8% to 13.0%, psychiatric disorders increasing from 9.3% to 15.4%, and trauma-related cases decreasing from 14.3% to 3.9%. Hypertension (57.1%) and dyslipidemia (29.2%) prevailed post-lifting. Urgent cases decreased from 1.3% to 0.1%. This study emphasizes the importance of primary care in post-evacuation zones, addressing diverse medical needs, including trauma, noncommunicable diseases, and psychiatric disorders. Changing patient demographics require adaptable healthcare strategies and resource allocation to meet growing demands. Establishing a comprehensive health maintenance system tailored to these areas' unique challenges is crucial for future disaster recovery efforts., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Radioactively contaminated soil from the Fukushima Daiichi nuclear power station accident in 2011 is required by law to be finally disposed of outside Fukushima Prefecture by 2045. To gain public acceptance of this policy, it is essential to promote understanding and nationwide discussion. We conducted a web-based survey of 2000 people in Japan to examine public attitudes toward final disposal of the contaminated soil outside Fukushima Prefecture. Results show that policy approval was negatively correlated with perceived risk of a final disposal site, sense of inequity associated with building a final disposal site near residential areas, and values that are absolutely non-negotiable or protected from trade-offs with other values (protected values). Policy approval was positively correlated with high levels of interest in the Fukushima accident and subjective knowledge of decontamination and the policy. Respondents' comments and opinions about the policy indicated that respondents who approved of the policy accepted burden sharing, while those who disapproved were unconvinced by the rationale behind disposal outside Fukushima Prefecture and were dissatisfied by the lack of information disclosure and transparency. While the government's efforts to disseminate information about the current status and future of Fukushima have been effective to a certain extent, they are insufficient to achieve widespread public understanding of the policy. Our results indicate that attention needs to be paid to procedural fairness and explanations of risks., (© 2024. The Author(s).)

Mass gathering events in Japan have gradually mitigated their novel coronavirus disease (COVID-19) control regulations, along with a minimum infection risk. The Japan Professional Football League (J.League) conducted pilot surveys on holding events with chant cheers. In this commentary, we introduce the collaborative efforts based on scientific knowledge among experts, J.League, and their fans. We performed risk assessment in advance, by updating a previously developed model. We further observed the average proportion of masks worn, chant cheering time of participants, and CO 2 levels in the stand. The number of new COVID-19 cases in an event with 5,000 chant cheering participants and 35,000 non-chant cheering participants was estimated to be 1.02 times of an event, with 40,000 non-chant cheering participants. The average proportion of masks worn during the game was 98.9 %, for chant cheer participants. The chant cheering participants spent 50.0-51.1 % of their time chant cheering. Monitored average CO 2 levels were ≤ 540 ppm, suggesting high ventilation rates in the stand. The high proportion of masks worn represents the willingness of norm-conscious fans to cooperate in regular recovery of the sport. This has proved to be one of the successful models for future mass gathering events., (Copyright © 2023. Published by Elsevier Ltd.)

Despite being one of the world's largest pharmaceutical markets, interactions between Japanese physicians and pharmaceutical companies often remain opaque. Importantly, potential conflicts of interest associated with these interactions can compromise patient care and increase costs. We conducted an online survey of Japanese physicians to elucidate perspectives on pharmaceutical company promotional activities and how these influence physician prescribing patterns. Anticipating that physicians might downplay their reliance on, or the value of, pharmaceutical company-provided information, the survey incorporated a direct questioning method and an unmatched count technique (UCT) to identify hidden perceptions on factors likely to influence prescribing. Overall, 1080 eligible physicians participated. Of these, 105 (9.7%) self-identified as hospital directors or managers. Surprisingly, nearly twice as many participants responding to direct questioning (18.9%) versus those responding to the UCT (10.1%) asserted that information provided by pharmaceutical companies was important when prescribing medicine. Hospital directors or managers (adjusted odds ratio [adjOR] 2.56, 95% confidence interval [95% CI]: 1.00-6.54, reference = physician without title) and frequent interactions with pharmaceutical sales representatives (adjOR 5.96, 95% CI: 1.88-18.9, reference = rare interaction) significantly valued the information from sales representatives and sponsored lectures when considering prescribing decisions. Additionally, 77.1% of respondents believed that sales representatives provide fair, neutral, or relatively honest and unbiased information about their products. Few Japanese physicians acknowledged the influence of industry-provided information on prescribing patterns. Our study uniquely applies two distinct question formats, providing a novel approach to understanding the depth of physician-industry relationships and the effectiveness of various survey methodologies., (© 2024 John Wiley & Sons Ltd.)

Background: During a global infectious disease pandemic such as the coronavirus disease 2019 (COVID-19), individuals' infection prevention/risk-taking behaviours are likely to differ depending on their health literacy and beliefs regarding the disease. To effectively promote infection prevention behaviours, it is necessary to enable information dissemination and risk communication that consider individuals' health literacy and beliefs. In this study, we exploratorily characterised segments based on individual health literacy and beliefs regarding COVID-19 among the Japanese during the early stage of the COVID-19 pandemic, and investigated whether infection prevention/risk-taking behaviours and fear of COVID-19 differed among these segments., Methods: In this study, we conducted two web-based longitudinal surveys in Japan (PHASE 1, 1-30 November 2020, 6,000 participants; PHASE 2, 1-31 December 2020, 3,800 participants). We characterised segments of the target population using cluster analysis on health literacy and beliefs regarding COVID-19 obtained in PHASE 1. We further investigated the associations between the clusters and infection prevention/risk-taking behaviours and fear of COVID-19, obtained from PHASE 2., Results: Five clusters were identified: 'Calm/hoax denial', 'Hoax affinity/threat denial', 'Minority/indifference', 'Over vigilance', and 'Optimism'. There were significant differences in infection prevention/risk-taking behaviours and fear of COVID-19 among the five clusters. The belief in susceptibility to infection, rather than affinity for hoaxes and conspiracy theories, was coherently associated with infection prevention/risk-taking behaviours and fear of infection across clusters. This study provides foundational knowledge for creating segment-specific public messages and developing interactive risk communication to encourage infection prevention behaviours., Competing Interests: The authors declare there are no competing interests., (©2024 Yagihashi et al.)

The medical situation during disasters often differs from that at usual times. Disasters can lead to significant mortality that can be difficult to monitor. The types of disaster-related deaths are largely unknown. In this study, we conducted a survey to categorize the disaster-related deaths caused by a radiation disaster. A total of 520 people living in Minamisoma City, Fukushima Prefecture, at the time of the Fukushima Daiichi Nuclear Power Plant accident, who were certified to have died due to disaster-related causes were surveyed. We divided the participants into those who were at home at the time of the earthquake and those who were in hospitals or facilities when the disaster struck and conducted a hierarchical cluster analysis of the two groups. Disaster-related deaths could be divided into seven groups for those who were at home at the time of the disaster and five groups for those who were in hospitals or facilities at the time of the disaster. Each group showed different characteristics, such as "the group with disabilities," "the group receiving care," and "the group with depression," and it became evident that not only uniform post-disaster support, but support tailored to the characteristics of each group is necessary., (© 2024. The Author(s).)

TEPCO's Fukushima Daiichi nuclear power plant accident prompted extensive decontamination work. The decontaminated soil and incinerated ash generated by the process are scheduled for final disposal by March 2045 outside Fukushima Prefecture. The final disposal is unprecedented worldwide. Clarifying their acceptability will contribute to the final disposal of decontaminated soil and incinerated ash, as well as add knowledge about the perceived risk of low-concentration radioactive waste. A questionnaire survey was conducted to assess the psychological factors influencing final disposal acceptability. The results of the structural equation modeling demonstrated stable results, with risk perception decreasing acceptability, social benefits increasing acceptability, and personal benefits having limited impact. The initiative for the final disposal of decontaminated soil and incinerated ash can facilitate the reconstruction of Fukushima Prefecture after the disaster. Trust and intergenerational expectations are critical factors influencing the acceptability of this disposal. The responses were classified based on the relevance of moral norms using cluster analysis and moral foundations. The influence of each element on acceptability varied depending on the cluster. Trust was identified as the most influential factor in acceptability, regardless of the level of importance placed on moral norms., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Tetsuo Yasutaka reports financial support was provided by Taiheiyo Consultant Co Ltd. Kosuke Shirai reports a relationship with Mitsubishi Research Institute Inc that includes: employment. Kazuo Yamada reports a relationship with Taiheiyo Cement Corporation that includes: employment. Tetsuo Yasutaka and Michio Murakami reports a relationship with Mitsubishi Research Institute Inc that includes: consulting or advisory., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Little is known about how crises might affect the long-term uptake of breast cancer screening programs. This study aimed to clarify the long-term trend of breast cancer screening program uptake in Minamisoma City following the 2011 Triple Disaster in Fukushima, Japan (earthquake, tsunami, and nuclear disaster), and to evaluate the factors associated with this uptake. This study retrospectively analyzed data from the Basic Resident Registry and Breast Cancer Screening Program in Minamisoma City following the Triple Disaster. We calculated the annual breast cancer screening uptake rate for women aged 40-74 years who were of an even-numbered age at the end of each fiscal year and the incidence of at least one instance of uptake of the breast cancer screening initiative during the biennial intervals. We further performed cross-sectional and longitudinal regression analyses for the biannual screening uptake and investigated its associated factors. Breast cancer screening participation rates were 19.8% and 18.2% in 2009 and 2010, respectively. They decreased to 4.2% in 2011, and gradually increased thereafter, reaching the pre-disaster level of 20.0% in 2016. Similar but longer decrease of the uptake was observed in the biannual screening uptake rate. No pre-disaster screening uptake between 2009 and 2010, those living alone, or those who were evacuated, were factors that were found to be associated with non-uptake of the breast cancer screening program following the 2011 disaster. This study showed a long-term decline in breast cancer screening uptake in the area affected by the Triple Disaster, which was the most severe among those under evacuation, those who were isolated, and those without previous uptake. The insights emerging from this study could be used to increase awareness of this issue and establish potential countermeasures., (© 2023. The Author(s).)

Objective: Those affected by the Fukushima disaster have reported a decline in well-being. Although listening to music is expected to promote well-being, no study has revealed this association after a disaster. This study's objective is to clarify the association between well-being and music listening habits in the aftermath of the Fukushima disaster., Methods: A self-report online survey was conducted with 420 residents who were asked to rate 5 types of well-being: life satisfaction, positive emotion, negative emotion, psychological distress, and mental health changes after the Fukushima disaster. To meet inclusion criteria, the participants had to be research company monitors between the ages of 20 and 59 and living in Fukushima Prefecture at the time of the survey. Their music listening habits (eg, recent favorite music) and demographic information (eg, evacuation experience due to the disaster: 20.7%) were also collected. We examined the associations between well-being and music listening habits by univariate analysis followed by a logistic analysis with an adjustment for covariates., Results: Positive emotions were significantly associated with any type of music listening habits that participants practiced. We also observed gender and age differences between the associations., Conclusion: This study provides foundational insights into the role of music in improving post-disaster well-being.

Objectives: Rapid antigen tests have been used to prevent the spread of the COVID-19; however, there have been concerns about their decreased sensitivity to the Omicron variant. In this study, we assessed the sensitivity and specificity of the rapid antigen test compared with the PCR test among the players and staff members of the Japan Professional Football League and clubs. Furthermore, we evaluated the relationship between the sensitivity and the duration from the onset of symptoms to testing or vaccine status., Design: This was a retrospective observational study., Methods: We used 656 results from both the rapid antigen and PCR tests for COVID-19 using samples collected on the same day from 12 January to 2 March 2022, during the Omicron variant outbreak in Japan., Results: The sensitivity of the rapid antigen test compared with the PCR test was 0.63 (95% CI: 0.53 to 0.73) and the specificity was 0.998 (95% CI: 0.995 to 1.000). There were no significant associations between the sensitivity and the duration from the onset of symptoms to testing (including asymptomatic cases in the category) or vaccination status (p>0.05) with small effect sizes (Cramer's V or φ: ≤0.22)., Conclusions: Even during the Omicron outbreak, the sensitivity of the rapid antigen tests did not depend on the duration from the onset of symptoms to testing., Competing Interests: Competing interests: HS and TI received salaries from the Japan Professional Football League. WN and TY have received financial support from the Japan Professional Football League, the Yomiuri Giants, Tokyo Yakult Swallows, the Japan Professional Basketball League and the Kao Corporation in the context of measures at mass-gathering events. MM, MK, WN, TY and SI have attended the New Coronavirus Countermeasures Liaison Council jointly established by the Nippon Professional Baseball Organization and the Japan Professional Football League as experts without any reward. WN and TY were/are advisors to the Japan National Stadium and Japan Professional Football League. The data used in this study were provided from the Japan Professional Football League. Otherwise, these institutions had no role in study design. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of any institution., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Prejudice related to the coronavirus disease 2019 (COVID-19) is a social issue worldwide. A possible psychological factor that promotes prejudice is the belief in just deserts (BJD) regarding individuals infected with COVID-19 ( i.e. , the belief that the infected individual deserves to be infected). The BJD is based on the belief in immanent justice. It is reportedly higher in Japan than in other countries. Therefore, we conducted a cross-sectional study to investigate the BJD among Japanese individuals and clarify its associations with demographic factors or infection-related and socio-psychological characteristics. To this end, we conducted an online questionnaire survey in Japan from August 7-8, 2020, with 1,207 respondents aged 20-69 years. We performed screening to exclude inappropriate responses. We investigated the association between the BJD and demographic factors such as gender and age. We also investigated the association between the BJD and infection-related and socio-psychological characteristics, including risk perception of COVID-19 infection and human rights restrictions ( i.e. , the degree of agreement with government restrictions on individuals' behavior during emergencies). Among the surveyed items, human rights restrictions showed a strong association with BJD, followed by risk perception of COVID-19 infection. Men had a slightly higher BJD than women. Our study is significant in that it is the first to investigate the items associated with the BJD, thereby providing foundational information for revising individual perceptions of justice related to COVID-19 and solving prejudice-related issues., Competing Interests: The authors declare there are no competing interests., (©2022 Murakami et al.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to be present in sewage, and wastewater-based epidemiology has attracted much attention. However, the physical partitioning of SARS-CoV-2 in wastewater and the removal efficiency of treatment systems require further investigation. This study aimed to investigate the detectability and physical partitioning of SARS-CoV-2 in wastewater and assess its removal in a large-scale septic tank employing anaerobic, anoxic, and oxic processes in a sequential batch reactor, which was installed in a coronavirus disease 2019 (COVID-19) quarantine facility. The amount of SARS-CoV-2 RNA in wastewater was determined with polyethylene glycol (PEG) precipitation followed by quantitative polymerase chain reaction (qPCR), and the association of SARS-CoV-2 with wastewater solids was evaluated by the effect of filtration prior to PEG precipitation (pre-filtration). The amount of SARS-CoV-2 RNA detected from pre-filtered samples was substantially lower than that of samples without pre-filtration. These results suggest that most SARS-CoV-2 particles in wastewater are associated with the suspended solids excluded by pre-filtration. The removal efficiency of SARS-CoV-2 in the septic tank was evaluated based on the SARS-CoV-2 RNA concentrations in untreated and treated wastewater, which was determined by the detection method optimized in this study. Escherichia coli and pepper mild mottle virus (PMMoV) were also quantified to validate the wastewater treatment system's performance. The mean log 10 reduction values of SARS-CoV-2, E. coli, and PMMoV were 2.47 (range, 2.25-2.68), 2.81 (range, 2.45-3.18), and 0.66 (range, 0.61-0.70), respectively, demonstrating that SARS-CoV-2 removal by the wastewater treatment system was comparable to or better than the removal of fecal indicators. These results suggest that SARS-CoV-2 can be readily removed by the septic tank. This is the first study to determine the removal efficiency of SARS-CoV-2 in a facility-level sequencing batch activated sludge system., Competing Interests: Declaration of competing interest Ryo Iwamoto, Ken-ichi Setsukinai, and Hiroyuki Kobayashi are employees of Shionogi & Co., Ltd. Masaaki Kitajima received research funding and patent royalties from Shionogi & Co., Ltd. Satoshi Okabe received research funding from Shionogi & Co., Ltd. Kiyoshi Yamaguchi, Chisato Arakawa, Hiroki Ando, Eiji Haramoto, Kotoe Katayama, Takuya Yamagishi, Sumire Sorano, Michio Murakami, Shigeru Kyuwa, and Seiya Imoto have no competing interests to declare., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: individual preventive behaviors are one of the key measures needed to prevent the spread of COVID-19. This study sought to identify the factors associated with the adoption of COVID-19 preventive measures, focusing specifically on information sources., Methods: we conducted a nationally representative cross-sectional survey of 30,053 Japanese adults in February 2021. The survey asked about socioeconomic, health-related, and psychological characteristics, attitudes toward immunization, and the use of information sources regarding COVID-19. We have constructed multivariable logistic regression to estimate the factors associated with the adoption of three preventive measures: 3Cs avoidance, hand hygiene and respiratory hygiene., Results: socioeconomic variables, psychological variables, and the use of information sources are significantly associated with the adoption of preventive measures. The more information sources one uses, the more likely one is to adopt preventive measures. Trust in healthcare professionals is positively associated with adopting preventive measures. On the other hand, negative correlations between trust in social media and preventive behaviors were observed., Conclusions: encouraging access to multiple information sources, utilizing communication channels, and modifying messaging according to target groups are essential to promote COVID-19 preventive measures.

We developed an environmental exposure model to estimate the coronavirus disease 2019 (COVID-19) risk among participants at outdoor music festivals and validated the model using two real events-one in Japan (Event 1) and one in Spain (Event 2). Furthermore, we considered a hypothetical situation in which Event 1 was held but enhanced measures were implemented to evaluate the extent to which the risk could be reduced by additional infection control measures, such as negative antigen tests on the day of the event, wearing of masks, disinfection of environmental surfaces, and vaccination. Among 7,392 participants, the total number of already- and newly-infected individuals who participated in Event 1 according to the new model was 47.0 (95% uncertainty interval: 12.5-185.5), which is in good agreement with the reported value (45). The risk of infection at Event 2 (1.98 × 10 -2 ; 95% uncertainty interval: 0.55 × 10 -2 -6.39 × 10 -2 ), calculated by the model in this study, was also similar to the estimated value in the previous epidemiological study (1.25 × 10 -2 ). These results for the two events in different countries highlighted the validity of the model. Among the additional control measures in the hypothetical Event 1, vaccination, mask-wearing, and disinfection of surfaces were determined to be effective. Based on the combination of all measures, a 94% risk reduction could be achieved. In addition to setting a benchmark for an acceptable number of newly-infected individuals at the time of an event, the application of this model will enable us to determine whether it is necessary to implement additional measures, limit the number of participants, or refrain from holding an event., Competing Interests: Tetsuo Yasutaka reports a relationship with Kao Corporation, Nippon Professional Baseball Organization, Yomiuri Giants, Tokyo Yakult Swallows, the Japan Professional Football League, and the Japan Professional Basketball League: funding grants. There are no patents to disclose. This study was conducted as part of a comprehensive research project, comprising members from two private companies, Kao Corporation and NVIDIA Corporation, Japan. No authors in this study belong to these companies. Michio Murakami, Seiya Imoto, and Tetsuo Yasutaka have attended the new coronavirus countermeasures liaison council jointly established by the Nippon Professional Baseball Organization and Japan Professional Football League as experts without any rewards. Tetsuo Yasutaka is an advisor to the Japan National Stadium and Japan Professional Football League. Other authors declare no competing interests., (©2022 Murakami et al.)

Large-scale decontamination work has been carried out in the aftermath of the Fukushima Daiichi nuclear power station accident in Japan in 2011. The soil that was removed and the wastes that were generated during the decontamination will be finally disposed of outside Fukushima Prefecture by 2045. To ensure successful and socially acceptable implementation of this final disposal process, it is essential to have a good understanding of what is considered important by the public. We used a choice-based conjoint analysis in the form of a web-based questionnaire to examine the relative importance of several factors in the choice of the final disposal sites of the removed soil and incinerated ash of the wastes. The questionnaires covered four attributes and 12 levels, namely the distance between the disposal site and a person's residential area, procedural fairness (decision process), distributive fairness (direct mitigation of inequity through multiple siting locations), and the volume and radioactivity of the substances to be disposed. Responses were received from 4000 people nationwide, excluding Fukushima residents. The results showed that the respondents gave high importance to choosing sites that were far from residential areas and to the two types of fairness, especially distributive fairness. The respondents showed no preference for the volume and radioactivity. This indicates that the public cares about the fairness of the siting for the final disposal sites and feels uncomfortable with plans for a final disposal site located close to them. Distributive fairness is necessary to pursue consensus in addition to procedural fairness., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: T.Y. received financial support from a private company, Taiheiyo Consultant Co., LTD for the web-based survey costs. K.S. was provided support in the form of salaries from a private company, Mitsubishi Research Institute, Inc. K.Y. was provided support in the form of salaries from a private company, Taiheiyo Cement Corporation. T.Y. and M.M. received financial support from a private company, Mitsubishi Research Institute, Inc. for meetings and hearings unrelated to this study. Other authors declare no competing interests. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of any institution. This does not alter our adherence to PLoS ONE policies on sharing data and materials.

We developed a mobile application (app) to help communication between support providers and residents who have returned from evacuation after the Fukushima nuclear power plant accident. Surveys were conducted among returning residents and support providers in coastal areas of Fukushima Prefecture, from which application functions and layout were decided. App functions were included to estimate external exposure, monitor health, and facilitate interactive health counseling.

Colorectal cancer (CRC) screening is a well-established cancer screening method, and its effectiveness depends on maintaining a high participation rate in the target population. In this study, we analyzed the trends in CRC screening participation rates over 10 years in Minamisoma City, where residents were forced to evacuate after the 2011 triple disaster in Fukushima, Japan. The immunochemical fecal occult blood test is provided as municipal CRC screening. We calculated the annual CRC screening participation rate and analyzed the factors associated with participation in screening. Overall, 4069 (12.3%) and 3839 (11.7%) persons participated in CRC screening in 2009 and 2010, respectively; however, the number decreased significantly to 1090 (3.4%) in 2011 when the earthquake occurred. Over the following 3 years, the rate gradually recovered. Multivariable logistic analysis showed that age < 65 years, living alone, and evacuation were significant associated factors for non-participation after 2011 (p < 0.05). In conclusion, the CRC screening participation rate decreased significantly during the Great East Japan Earthquake but recovered over the next 3 years. Further analysis of factors preventing CRC screening participation and research on the long-term effects of its post-disaster decline are important to consider in assessing the need for intervention in post-disaster cancer screening., (© 2021. The Author(s).)

Digital tools are increasingly used for health promotion, but their utility during recovery from a nuclear disaster has yet to be established. This study analysed differences in knowledge, attitude, and practice (KAP) toward digital tools for radiation protection and health promotion, and preferences for specific application functions, among cohorts living within and outside areas affected by the Fukushima Daiichi nuclear power station (FDNPS) accident. A needs assessment was conducted by internet survey, and responses from those affected (N = 86) and not affected (N = 253) were compared and quantified by an adjusted odds ratio (aOR), using logistic regression analyses. KAP toward the radiation-related application in the affected group had an aOR of 1.95 (95% confidence interval (CI) = 1.12-3.38) for knowledge, and 5.71 (CI = 2.55-12.8) for practice. Conversely, toward the health-related application, the aOR of the affected group was 0.50 (CI = 0.29-0.86). The preference in the affected group was significantly lower for two application functions related to radiation measurement and two health-related functions (one about the effects of radiation in general and another about personal health advice in general): aOR range 0.43-0.50. Development of specific applications incorporating the findings from this survey was intended to foster a locally appropriate eHealth environment during recovery from the FDNPS accident.

After Japan's major nuclear accident in 2011, approximately 150,000 Fukushima residents were ordered to evacuate. Beginning in 2015, the evacuation orders have been systematically lifted. However, the health impacts of allowing residents to return to homes in areas previously uninhabitable due to nuclear radiation remain poorly understood.Declaring radiation levels to be safe does not necessarily eliminate the concerns of residents about the effects of radiation exposure. Rebuilding medical, welfare, and commercial infrastructure and services takes time. Nontangible community elements, such as mutually dependent social networks, also require time to be re-established. Nevertheless, the Japanese government prioritizes policies that encourage evacuees to return home as soon as it is safe to do so.Post-disaster evacuation situations and subsequent return home pose substantial-and as yet relatively unknown-mental and physical health threats for those affected, especially those in vulnerable groups, such as the sick, the elderly, and children.Here we report a case of an elderly female evacuee with dementia, who was prevented from returning home after her hometown evacuation order was lifted, began exhibiting marked behavioral abnormalities. Loss of emotional ties that were created while she was housed in temporary accommodation appeared to be a critical contributing factor.

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., (© 2021 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.)

The health status of healthy decontamination workers employed after the Fukushima nuclear disaster remains unclear. This study aimed to evaluate the prevalence of non-communicable diseases among such workers. In this observational study, questionnaires on lifestyle and social factors were administered as part of a health promotion program for decontamination workers in 2016 in Minamisoma City, Fukushima. The questionnaires and health check-up results were compared with those of the 2016 National Health and Nutrition Examination Survey (NHANES) in Japan. Overall, 123 male decontamination workers were enrolled; 93 (75.6%) were drinkers, and 84 (68.3%) were current smokers. The age-adjusted prevalence (95% confidence interval) of hypertension, dyslipidemia, diabetes mellitus, and obesity were 27.2% (20.1-34.4%), 30.4% (22.6-38.2%), 11.3% (5.5-17.1%), and 49.0% (39.0-58.9%), respectively. The age-adjusted prevalence in the NHANES were 32.8% (31.1-34.5%), 16.1% (14.5-17.6%), 7.0% (6.2-7.7%), and 31.2% (29.9-32.5%), respectively. The prevalence of obesity, dyslipidemia, binge drinking, and smoking were higher in healthy male decontamination workers than in the general population. Decontamination workers in disaster-struck areas may have higher risks of developing non-communicable diseases, possibly due to their original health status. Continuous monitoring of their health status and proper interventions are warranted., (© 2021. The Author(s).)

Infection control at nursing homes is a top priority to address the COVID-19 pandemic because people who are the most vulnerable to the pathogen live in close contact. Currently, control measures specifically for nursing homes often ignore under-resourced condition of the facilities. To make guidelines assuming realistic conditions, an expert meeting with 16 members established the key challenges in nursing homes, the basics of infection control, and the major transmission routes. A list of existing guidance was compiled and each item in the list was peer-reviewed by eight experts considering three aspects: significance, scientific validity, and feasibility. Factors related to the nursing home environment, the nature of SARS-CoV-2 transmission, and patient characteristics were identified as the causes of difficulties in infection control at nursing homes. To develop realistic prevention measures in under-resourced condition such as nursing homes, we may need to accept there are no perfect control measures that can achieve zero risk. Instead, the guidelines are based on the concept of deep defense, and practical checklists with 75 items were established. The evaluation of nursing homes by independent organizations using the checklists would be helpful to achieve sustainable infection control.

After the accident at the Fukushima nuclear power plant in 2011, caused by the Great East Japan Earthquake, some evacuees had no one to consult despite many local care providers offering assistance. This study identified the characteristics of individuals who did not receive consultations and the relevant determinants, and proposed the available measures to address this issue. Altogether, 32,699 participants aged 16 years or older and residing in the disaster area at Fukushima were surveyed. Those with no one to consult showed a significantly higher prevalence of psychological distress (16.2%, p < 0.001) and drinking problems (21.5%, p < 0.001). Multivariate analysis revealed that these behaviors were associated with the middle age group (i.e., 40-64 years old) (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.16-1.46), men (OR = 2.46; 95% CI, 2.27-2.66), bad financial circumstances (OR = 2.11; 95% CI, 1.96-2.27), and living alone (OR = 1.53; 95% CI, 1.39-1.68). This research verifies that people with such characteristics were more likely to be isolated and vulnerable to psychiatric problems, such as depression. We suggest that it is integral for local care providers to recognize those who have no one to consult and provide targeted support.

The purpose of this study was to identify the needs of stakeholders in developing a mobile application (MP) to be used by returning residents and providers of healthcare and medical/social services. The needs assessment of the residents revealed that among the elderly, ownership of smartphones and tablets was low and they were less likely to use the applications themselves.

There is little information on the radiation dose levels of returnees to areas once designated as legal no-go zones, after evacuation orders were lifted subsequent to the 2011 Fukushima Daiichi nuclear power plant incident. This study used individual radiation dosimeter monitoring and a location history survey to conduct the most recent dose assessment of external exposure among returnees to former no-go zones. We specifically determined correlation and agreement between external doses and the air dose rate in residential areas and quantified both uncertainty and population variability of the observed data using Monte Carlo (MC) simulation methods. A total of 239 voluntary participants across ten municipalities were analysed; their representativeness of all affected municipal populations was confirmed in terms of air dose rate distribution in residential areas. We found that individual doses were statistically significantly correlated with the air dose rate based on government airborne monitoring. This implies that airborne monitoring can provide sufficient information for understanding dose levels among such returnees. The MC simulations demonstrated that the mean of the annual dose in 2019 (including natural background doses) was 0.93 (95% uncertainty interval 0.53-1.76) mSv, with limited variation between municipalities. As of 2019, this implies that doses from external exposure were very low among returnees and would be associated with a very low likelihood of physical effects according to current scientific consensus. However, these results should be taken with caution due to several study limitations, including selection and participation biases. Regardless, its findings will enhance societal debates about how both individual-dose and government airborne monitoring practices should operate in the future and how the government can improve the public outlook for radiation doses in incident-affected areas.