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Assumptions of health problems after a nuclear accident.. Acute radiation poisoning 急 性 放 射 線 障 害 Chronic radiation exposure leading to cancer 慢 性 被 ば

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(1)

What is health impact of a nuclear accident?

Time to reconsider what to monitor

原発災害の健康被害とは?

「何」をモニタリングすべきかの再考

Sae

Ochi, MD, MPH, PhD

Department of Internal Medicine, Soma Central Hospital

Clinical research fellow, Imperial College London

(2)

Assumptions of health problems

after a nuclear accident..

原発災害と健康災害の思い込み

•  Acute radiation poisoning

 急性放射線障害

•  Chronic radiation exposure leading to cancer

 慢性被ばくと悪性腫瘍

•  Managed by health professionals

 専門家に任せるべき問題

•  Problems limited in the affected area

 被災地のみの問題

However: health impact following the accident was much larger than that of radiation.

しかし:原発事故による健康被害>>放射線被害 The number of the victims are still increasing 被災者は現在も増え続けている

Monitoring is a key to prevent further health deterioration at disaster area. それらを把握するためのモニタリングは非常に重要

(3)

2okm: ‘no-entry zone’ 警戒区域

20-30km: ‘evacuation zone in case of emergency’;

people were recommended to stay at home 避難準備 区域:屋内退避指示

30-50km: ‘planned evacuation zone’ 計画的避難区域

Case1: Impact of the settlement of evacuation zone

例1:避難区域設定による健康被害

Data from: Ministry of Education, Culture, Sports, Science and Technology

80km

30km 20km

Scientifically ‘reasonable’, but in the real world..

科学的には正しい。しかし現実には

àAll who could evacuate left the place 移動手段のある人は皆避難

àNo supply within 50km  50km圏内の流通は停止

àThe most vulnerable were left without food 弱者が食料もなく放置

“ I did death investigation for a month after the disaster…several elderlies apparently died from starvation or dehydration at home..”---a medical docter 震災後1か月の間に、自宅で衰弱死しているお年寄りを何人も見ました―検死医

(4)

Case 2. Impact of evacuating care homes

例2:長期療養施設の健康被害

Evacuation cause physical and mental stress..

 避難行動が高齢者に与える精神・身体ストレス

Traveling a long distance

 長距離移動

Evacuating without adequate equipment

(Water, mattress, clothes, etc.)

 十分な装備(水

マットレス

防寒具など)なしの移動

Sudden change of environment

 急激な環境変化

Non-smooth handover

between the facilities

 申し送りの不充分

A retrospective study targeting 5 care homes in

Minamisoma City

1

 このような背景を元に、南相馬市から避難した5つの長

期療養施設を調査

1. Nomura S, Gilmour S, Tsubokura M, Yoneoka D, Sugimoto A, et al. (2013) Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study. PLoS ONE 8(3): e60192. doi: 10.1371/

(5)

Time series trend of death in elderly homes. Dotted

line indicates the time of the earthquake (11/3/2011)

死亡率の時系列変化:点線が震災時

Nomura S, Gilmour S, Tsubokura M, Yoneoka D, Sugimoto A, et al. (2013) Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study. PLoS ONE 8(3): e60192. doi: 10.1371/ journal.pone.0060192

(6)

Estimated pre- and post-earthquake

survival.

震災前後の生存曲線の比較

Nomura S, Gilmour S, Tsubokura M, Yoneoka D, Sugimoto A, et al. (2013) Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study. PLoS ONE 8(3): e60192. doi: 10.1371/ journal.pone.0060192

(7)

Case 3. Impact among ‘healthy’ elderly at temporary housings

3.「健康な」高齢者の仮設住宅生活による健康被害

Cause of health deterioration may include..

健康被害の原因

Immobility  不動

  Loss of job 失業

  Poor living condition 狭い居住環境

Poor access to healthy foods & exercise

 健康な食生活や運動の不足

  Increased car dependency 車への依存

Deterioration of mental status

 精神状態の悪化

  Poor living condition 住環境

  Loss of family members 家族の喪失

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  Gender Control Temporary

housings Coef. 95% C.I. p

Grip strength (kg)

握力 Male 32.2 35.2 1.62 0.92 2.32 <0.01

Female 21.3 23.7 1.29 0.88 1.70 <0.01

      % OR 95% C.I. p

Open-eyed one leg standing

(<15 sec)

Male 31% 64% 5.2 2.97 9.21 <0.01 Female 30% 66% 5.4 3.43 8.49 <0.01

Physical condition among the elderly at temporary

housings (2012)

 仮設住宅の高齢者の身体能力

Residents at temporary housing showed

stronger grip, but worse stability

仮設住宅の住民は握力が高く下肢筋力が低

い結果

(9)

Persistent health deterioration among

the residents at temporary housings

仮設住宅の健康被害はまだ続いている

Male Female Control* (N=70) Temporary housing (N=78) p p’ ** Control N=85 Temporary housing N=104 p p’ * ⊿BMI*** -0.41 0.17 <0.01 <0.01 -0.28 0.45 <0.01 <0.01 ⊿HbA1c* -0.21 0.28 0.01 0.02 0.01 0.06 0.74 0.8 Improved Obesity**** 10% 0% <0.01 0.02 8% 1% <0.01 0.03

*Control: residents in Fukushima who stayed their home Control: 自宅に留まった相馬市の住民

** p’ : controlled for age *** ⊿: value in 2012 – value in 2011 were calculated for individual ⊿:2012年の値から2011年の値を引いたモノ *** Improved obesity: proportion of those who were obese in 2011 and not obese in 2012

(10)

Summary

 要約

Health impact due to the nuclear accident is much larger than that

of radiation.

原発による健康被害は放射線被害よりはるかに大きい。

By focusing only on radiation, many victims could be ignored.

 放射線にのみ囚われることにより、他の健康被害が無視される可

能性

Monitoring broader aspects of health is essential for

evidence-informed policy making.

 より広い健康アウトカムを評価することが、適切なエビデンスに

基づく政策へもつながる。

To broaden our perspectives, multidisciplinary management is

essential.

(11)

Acknowledgement 謝辞

Soma Central Hospital

Soma local government 相馬市役所

Soma health centre 相馬市保健センター

Tokyo University Global Health Policy 東京大学Global Health Policy Tokyo University Social Communication System for Advanced Medical Technology 東京大学医科学研究所

Houei-kai Hospital  豊栄会メンバー

Minamisoma City Hospital 南相馬市立病院

All the residents in Soma and Minamisoma City 相馬市・南相馬市の皆様

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