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      Study Protocol for the Fukushima Health Management Survey Translated title: 福島県における県民健康管理調査プロトコール

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          Abstract

          Background

          The accidents that occurred at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on 11 March 2011 have resulted in long-term, ongoing anxiety among the residents of Fukushima, Japan. Soon after the disaster, Fukushima Prefecture launched the Fukushima Health Management Survey to investigate long-term low-dose radiation exposure caused by the accident. Fukushima Medical University took the lead in planning and implementing this survey. The primary purposes of this survey are to monitor the long-term health of residents, promote their future well-being, and confirm whether long-term low-dose radiation exposure has health effects. This report describes the rationale and implementation of the Fukushima Health Management Survey.

          Methods

          This cohort study enrolled all people living in Fukushima Prefecture after the earthquake and comprises a basic survey and 4 detailed surveys. The basic survey is to estimate levels of external radiation exposure among all 2.05 million residents. It should be noted that internal radiation levels were estimated by Fukushima Prefecture using whole-body counters. The detailed surveys comprise a thyroid ultrasound examination for all Fukushima children aged 18 years or younger, a comprehensive health check for all residents from the evacuation zones, an assessment of mental health and lifestyles of all residents from the evacuation zones, and recording of all pregnancies and births among all women in the prefecture who were pregnant on 11 March. All data have been entered into a database and will be used to support the residents and analyze the health effects of radiation.

          Conclusions

          The low response rate (<30%) to the basic survey complicates the estimation of health effects. There have been no cases of malignancy to date among 38 114 children who received thyroid ultrasound examinations. The importance of mental health care was revealed by the mental health and lifestyle survey and the pregnancy and birth survey. This long-term large-scale epidemiologic study is expected to provide valuable data in the investigation of the health effects of low-dose radiation and disaster-related stress.

          Translated abstract

          【背景】

          2011年3月11日の東日本大震災に引き続いて起こった福島第一原子力発電所の事故により、福島県民は長期間にわたる不安状態に陥っている。福島県は、震災直後に、事故による慢性の低線量被ばくによる健康影響を評価するため「県民健康管理調査」を開始した。福島県立医科大学はこの調査の企画、及び、実施の中心となった。本調査の第一の目的は、長期にわたり住民の健康を評価すること、住民の将来の幸福に寄与すること、そして、慢性の低線量被ばくによる健康影響があるかどうかを検証することである。 本報告は、「県民健康管理調査」の理論的根拠と実施状況を報告するものである。

          【方法】

          本コホート調査は地震後に福島に居住しているすべての住民が対象となっており、調査は基本調査と4つの詳細調査から成り立っている。基本調査は全住民205万人の外部被ばく線量を評価するものである。内部被ばく線量は、ホールボディカウンターを用いて福島県が評価することになった。詳細調査は、福島県の18歳以下のすべての子供を対象とした超音波検査による「甲状腺検査」、避難区域のすべての住民を対象とした「健康診査」、及び、避難区域のすべての住民を対象とした「こころの健康度と生活習慣に関する調査」、及び、県内において3月11日時点で妊娠していたすべての女性における妊娠と出産に関する「妊産婦調査」から成り立っている。すべてのデータはデータベースに集められ、住民の支援、及び、被ばくによる健康影響の分析のために用いられる。

          【結論】

          基本調査は30%に満たない低い回答率のため、健康影響の評価は難しい可能性がある。甲状腺の超音波検査を現時点までに受診した38,114人の子供たちの中に、甲状腺がんは認められなかった。「こころの健康度と生活習慣に関する調査」及び、「妊産婦調査」により、こころの健康管理の重要性が明らかになった。この長期の大規模疫学調査は、低線量被ばくと災害関連のストレスによる健康影響の調査として価値あるデータを提供することが期待されている。

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          Most cited references26

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          To determine the validity of a two-question case-finding instrument for depression as compared with six previously validated instruments. The test characteristics of a two-question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments, using the Quick Diagnostic Interview Schedule as a criterion standard for the diagnosis of major depression. Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center. Five hundred thirty-six consecutive adult patients without mania or schizophrenia. Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient questionnaire, both the long and short forms of the Center for Epidemiologic Studies Depression Scale, both the long and short forms of the Book Depression Inventory, the Symptom-Driven Diagnostic System for Primary Care, the Medical Outcomes Study depression measure, and the Quick Diagnostic Interview Schedule. The prevalence of depression, as determined by the standardized interview, was 18% (97 of 536). Overall, the case-finding instruments had sensitivities of 89% to 96% and specificities of 51% to 72% for diagnosing major depression. A positive response to the two-item instrument had a sensitivity of 96% (95% confidence interval [CI], 90-99%) and a specificity of 57% (95% CI 53-62%). Areas under the receiver operating characteristic curves were similar for all of the instruments, with a range of 0.82 to 0.89. The two-question case-finding instrument is a useful measure for detecting depression in primary care. It has similar test characteristics to other case-finding instruments and is less time-consuming.
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            The Strengths and Difficulties Questionnaire (SDQ) is a short screening instrument which addresses the positive and negative behavioral attributes of infants, children and adolescents. The SDQ is widely used to evaluate child developmental disabilities, psychological and psychiatric conditions or disorders in Japan. However, we did not have normative data for the Japanese version until now. To establish the community-based data and properties for the Japanese version, we collected and evaluated parent ratings of a total of 2899 Japanese children aged 4-12 years, including 1463 boys and 1436 girls. Statistical evaluation of psychometric properties included a factor analysis verifying the proposed scale structure, an assessment of scale homogeneities, and the determination of age, gender and relationship of each difficulties scale, or prosocial scale. The total difficulties score in boys (8.70 +/- 5.03) was higher than in girls (7.86 +/- 4.88). Based on the distributions of SDQ scores observed in the Japanese community sample, recommended bandings identifying normal, borderline, and abnormal (clinical ranges) were defined for each scale, and some gender difference was found in some difficulties and prosocial SDQ scores. After evaluating parent ratings obtained in a community-based sample, the Japanese SDQ was shown to possess favorable psychometric properties. Thus, the Japanese translation of this popular and versatile instrument seems to be approximately as reliable and useful as the original English questionnaire.
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              A 25 year retrospective review of the psychological consequences of the Chernobyl accident.

              The Chernobyl Forum Report from the 20th anniversary of the Chernobyl nuclear power plant disaster concluded that mental health effects were the most significant public health consequence of the accident. This paper provides an updated review of research on the psychological impact of the accident during the 25 year period since the catastrophe began. First responders and clean-up workers had the greatest exposure to radiation. Recent studies show that their rates of depression and post-traumatic stress disorder remain elevated two decades later. Very young children and those in utero who lived near the plant when it exploded or in severely contaminated areas have been the subject of considerable research, but the findings are inconsistent. Recent studies of prenatally exposed children conducted in Kiev, Norway and Finland point to specific neuropsychological and psychological impairments associated with radiation exposure, whereas other studies found no significant cognitive or mental health effects in exposed children grown up. General population studies report increased rates of poor self-rated health as well as clinical and subclinical depression, anxiety, and post-traumatic stress disorder. Mothers of young children exposed to the disaster remain a high-risk group for these conditions, primarily due to lingering worries about the adverse health effects on their families. Thus, long-term mental health consequences continue to be a concern. The unmet need for mental health care in affected regions remains an important public health challenge 25 years later. Future research is needed that combines physical and mental health outcome measures to complete the clinical picture. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                J Epidemiol
                J Epidemiol
                JE
                Journal of Epidemiology
                Japan Epidemiological Association
                0917-5040
                1349-9092
                5 September 2012
                25 August 2012
                2012
                : 22
                : 5
                : 375-383
                Affiliations
                [01] [1 ]Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan [1 ]福島県立医科大学放射線医学県民健康管理センター
                [02] [2 ]Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan [2 ]福島県立医科大学医学部公衆衛生学講座
                [03] [3 ]Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan [3 ]福島県立医科大学医学部小児科学講座
                [04] [4 ]Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan [4 ]広島大学原爆放射線医科学研究所
                [05] [5 ]Department of Diagnostic Pathology, School of Medicine, Fukushima Medical University, Fukushima, Japan [5 ]福島県立医科大学医学部病理病態診断学
                [06] [6 ]National Institute of Radiological Sciences, Chiba, Japan [6 ]放射線医学総合研究所
                [07] [7 ]The Radiation Effects Research Foundation, Hiroshima, Japan [7 ]放射線影響研究所
                Author notes
                Address for correspondence. Dr. Seiji Yasumura, Department of Public Health, Fukushima Medical University School of Medicine, Hikariga-oka 1, Fukushima 960-1295, Japan (e-mail: yasumura@ 123456fmu.ac.jp ).
                Article
                JE20120105
                10.2188/jea.JE20120105
                3798631
                22955043
                a6f87ed0-bc15-4351-bb2b-c40a01f5236a
                © 2012 Japan Epidemiological Association.

                This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 28 May 2012
                : 22 July 2012
                Categories
                Special Article

                cohort study,radiation,disaster,thyroid gland,mental health
                cohort study, radiation, disaster, thyroid gland, mental health

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