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Concept: Prefectures of Japan


The Japanese government ordered the analysis of thousands of foods after the Fukushima nuclear accident to ascertain compliance with regulatory limits for anthropogenic radionuclides in food. Four hundred and fourty five samples from 11 prefectures exceeded the regulatory limits that were in force until 31 March 2011. The possibility of these 445 samples representing localized areas of high radiocesium concentration was investigated. The objective of this study was to determine the radiocesium activity ratio (134Cs/137Cs) in foods from each geographic area to possibly identify the radioactive signature of the four different reactors (i.e. four independent sources) in the distinct regions. The average 134Cs/137Cs activity ratio was 0.98+/-0.01 for all samples. However, no clear deviations from this value could be confirmed in the various regions. Since there was no statistically significant deviation in the radiocesium activity ratio, the releases from reactor No. 4 (carrying a significantly smaller activity ratio) are assumed to be small when compared with the other three reactor release. The individual radioisotopic signatures of reactors No. 1, 2, and 3 could not be identified in various Japanese regions using the food samples, indicating integral radiocesium contamination from these sources. Subsequent releases of fission products from the reactors (e.g. after possible criticalities reported in October 2011) proved to have no impact on the radiocesium activity ratio. A discussion of the development of the regulatory limits in Japan and Europe with regard to the current limits and radiological food safety are also included.

Concepts: Cabinet of Japan, Standard deviation, Radioactive decay, Food, Japan, Prefectures of Japan, Radioactive contamination, Government of Japan


Proteus mirabilis is a common cause of urinary tract infection. Wild-type P. mirabilis strains are usually susceptible to penicillins and cephalosporins, but occurrences of P. mirabilis producing extended-spectrum β-lactamases (ESBLs) have been recently reported. Here, we surveyed the prevalence of cefotaxime resistance among P. mirabilis strains at seven different hospitals in Kanagawa Prefecture, Japan, and investigated their molecular epidemiology to explain the mechanism of their spread. The prevalence of cefotaxime resistance among P. mirabilis increased annually, from 10.1 % in 1998 to 23.1 % in 2003, and increased drastically in 2004, exceeding 40 %. We collected 105 consecutive and non-duplicate cefotaxime-resistant P. mirabilis isolates (MIC 16 to >256 µg ml(-1)) from these hospitals from June 2004 to May 2005 and characterized their profile. PCR and sequence analysis revealed that all resistant strains produced exclusively CTX-M-2 β-lactamase. PFGE analysis identified 47 banding patterns with 83 % or greater similarity. These results indicated that a regional outbreak of P. mirabilis producing CTX-M-2 β-lactamase has occurred in Japan and suggest that the epidemic spread occurred within and across hospitals and communities by extended clonal strains. Plasmid analysis revealed that 44.8 % of plasmids harboured by bla(CTX-M-2) isolates had common profiles, encoding ISEcp1, IS26 and Int1, and belonged to incompatibility group T. Spread of the resistant isolates in Japan resulted from dissemination of narrow-host-range plasmids of the IncT group encoding bla(CTX-M-2). These findings indicate the rapidly developing problem of treating the species to prevent dissemination of ESBL producers.

Concepts: Urease, Honshū, Prefectures of Japan, Kanagawa Prefecture, Urinary tract infection, Proteus mirabilis, Plasmid, Epidemiology


Estimation of time changes in radiocaesium in foodstuffs is key to predicting the long term impact of the Fukushima accident on the Japanese diet. We have modelled >4000 measurements, spanning 50 years, of (137)Cs in foodstuffs and whole diet in Japan after nuclear weapons testing (NWT) and the Chernobyl accident. Broadly consistent long term trends in (137)Cs activity concentrations are seen between different agricultural foodstuffs; whole diet follows this general trend with remarkably little variation between averages for different regions of Japan. Model blind tests against post-NWT data for the Fukushima Prefecture showed good predictions for radiocaesium in whole diet, spinach and Japanese radish (for which good long term test data were available). For the post-Fukushima period to 2015, radiocaesium in the average diet followed a declining time trend consistent with that seen after NWT and Chernobyl. Data for different regions post-Fukushima show a high degree of mixing of dietary foodstuffs between regions: significant over-estimates of average dietary (137)Cs were made when it was assumed that only regionally-produced food was consumed. Predictions of mean committed effective internal doses from dietary (137)Cs (2011 to 2061) in non-evacuated parts of the Fukushima Prefecture show that average internal dose is relatively low. This study focused on average regional ingestion dose rates and does not attempt to make site specific predictions. However, temporal trends identified could form a basis for site specific predictions of long term activity concentrations in agricultural products and diet both outside and (to assess potential re-use) inside currently evacuated areas.

Concepts: Fukushima Prefecture, Prefectures of Japan, Tōhoku region, Time, Nuclear weapon, Honshū, Radioactive contamination, Japan


In the first paper of this series, we showed that the ratio c of individual dose to ambient dose did not change with time in Date City, Fukushima Prefecture, after the Fukushima Daiichi Nuclear Power Plant accident. The purpose of the present paper, the second in a series, is to estimate the lifetime doses of the Date City residents, based on continuous glass badge monitoring data, extrapolated by means of the ambient-dose-rate reduction function obtained from the airborne monitoring data. As a result, we found that the external exposure contribution to the mean additional lifetime dose of residents living in Date City is not expected to exceed 18 mSv. In addition, effects of decontamination on the reduction of individual doses were not evident. This method of combining individual doses and the ambient doses, as developed in this study, has made it possible to predict with reasonable certainty the lifetime doses of residents who continue to live in this radiologically contaminated area.

Concepts: Future, Prefectures of Japan, Effect, Date, Fukushima, Effectiveness, Nuclear power, Fukushima Prefecture, Arithmetic mean


The Pacific coast of the Tohoku region of Japan experiences repeated tsunamis, with the most recent events having occurred in 1896, 1933, 1960, and 2011. These events have caused large loss of life and damage throughout the coastal region. There is uncertainty about the degree to which seawalls reduce deaths and building damage during tsunamis in Japan. On the one hand they provide physical protection against tsunamis as long as they are not overtopped and do not fail. On the other hand, the presence of a seawall may induce a false sense of security, encouraging additional development behind the seawall and reducing evacuation rates during an event. We analyze municipality-level and sub-municipality-level data on the impacts of the 1896, 1933, 1960, and 2011 tsunamis, finding that seawalls larger than 5 m in height generally have served a protective role in these past events, reducing both death rates and the damage rates of residential buildings. However, seawalls smaller than 5 m in height appear to have encouraged development in vulnerable areas and exacerbated damage. We also find that the extent of flooding is a critical factor in estimating both death rates and building damage rates, suggesting that additional measures, such as multiple lines of defense and elevating topography, may have significant benefits in reducing the impacts of tsunamis. Moreover, the area of coastal forests was found to be inversely related to death and destruction rates, indicating that forests either mitigated the impacts of these tsunamis, or displaced development that would otherwise have been damaged.

Concepts: Miyagi Prefecture, Iwate Prefecture, Seawall, Pacific Ocean, Tōhoku region, Prefectures of Japan, Tsunami, Japan


We conducted ultrasound thyroid screening in cohort of 4,365 children aged between 3 to 18 years in three Japanese prefectures (Aomori, Yamanashi, and Nagasaki) using the same procedures as used in the Fukushima Health Survey. Forty-four children had nodules ≥ 5.1 mm in diameter or cysts ≥ 20.1 mm in diameter detected at the first screening, and 31 of these children underwent the second follow-up survey. We collected information from thyroid ultrasound examinations and final clinical diagnoses and re-categorized the thyroid findings after the second examination. Twenty children had nodules ≥ 5.1 mm in diameter or cysts ≥ 20.1 mm in diameter at the second examination; of these, one child was diagnosed with a thyroid papillary carcinoma and the remaining 19 children were diagnosed with possibly benign nodules such as adenomas, adenomatous nodules, and adenomatous goiters. A further 11 children were re-categorized as “no further examinations were required.” Our results suggest that ultrasound thyroid findings in children may change with a relatively short-term passing period, and that thyroid cancer may exist at a very low but certain frequency in the general childhood population.

Concepts: Tōhoku region, Types of cancer, Adenocarcinoma, Cancer, Child, Honshū, Japan, Prefectures of Japan


The Fukushima Health Management Survey (including the Basic Survey for external dose estimation and four detailed surveys) was launched after the Fukushima Dai-ichi Nuclear Power Plant accident. The Basic Survey consists of a questionnaire that asks Fukushima Prefecture residents about their behavior in the first four months after the accident; and responses to the questionnaire have been returned from many residents. The individual external doses are estimated by using digitized behavior data and a computer program that included daily gamma ray dose rate maps drawn after the accident. The individual external doses of 421,394 residents for the first four months (excluding radiation workers) had a distribution as follows: 62.0%, <1 mSv; 94.0%, <2 mSv; 99.4%, <3 mSv. The arithmetic mean and maximum for the individual external doses were 0.8 and 25 mSv, respectively. While most dose estimation studies were based on typical scenarios of evacuation and time spent inside/outside, the Basic Survey estimated doses considering individually different personal behaviors. Thus, doses for some individuals who did not follow typical scenarios could be revealed. Even considering such extreme cases, the estimated external doses were generally low and no discernible increased incidence of radiation-related health effects is expected.

Concepts: Honshū, Prefectures of Japan, Fukushima Prefecture, Tōhoku region, Nuclear physics, Nuclear power, Nuclear fission, Arithmetic mean


This study determined the current status of the incidence, management, and prognosis of stroke in Japan using a population-based stroke registry.Methods and Results:Shiga Stroke Registry is an ongoing population-based registry that covers approximately 1.4 million residents of Shiga Prefecture. Cases of acute stroke were identified using standard definitions through surveillance of both all acute-care hospitals with neurology/neurosurgery facilities and death certificates in 2011. A total of 2,956 stroke cases and 2,176 first-ever stroke cases were identified. The age- and sex-adjusted incidence rate for first-ever stroke using the 2013 European Standard Population as standard was per 100,000 person-years: 91.3 for ischemic stroke, 36.4 for intracerebral hemorrhage, and 13.7 for subarachnoid hemorrhage. It was estimated that approximately 220,000 new strokes occurred in 2011 in Japan. Among the 2,956 cases, most stroke patients underwent neuroimaging, 268 received surgical or endovascular treatment, and 2,158 had rehabilitation therapy; 78 patients received intravenous thrombolysis. A total of 1,846 stroke patients had died or were dependent at hospital discharge, and 390 died within 28 days of onset.

Concepts: Thrombolysis, Cerebral hemorrhage, Hospital, Time, Prefectures of Japan, Honshū, Subarachnoid hemorrhage, Stroke


Five years have passed since the Great East Japan Earthquake and the subsequent Fukushima Daiichi Nuclear Power Plant accident on 11 March 2011. Countermeasures aimed at human protection during the emergency period, including evacuation, sheltering and control of the food chain were implemented in a timely manner by the Japanese Government. However, there is an apparent need for improvement, especially in the areas of nuclear safety and protection, and also in the management of radiation health risk during and even after the accident. Continuous monitoring and characterisation of the levels of radioactivity in the environment and foods in Fukushima are now essential for obtaining informed consent to the decisions on living in the radio-contaminated areas and also on returning back to the evacuated areas once re-entry is allowed; it is also important to carry out a realistic assessment of the radiation doses on the basis of measurements. Until now, various types of radiation health risk management projects and research have been implemented in Fukushima, among which the Fukushima Health Management Survey is the largest health monitoring project. It includes the Basic Survey for the estimation of external radiation doses received during the first 4 months after the accident and four detailed surveys: thyroid ultrasound examination, comprehensive health check-up, mental health and lifestyle survey, and survey on pregnant women and nursing mothers, with the aim to prospectively take care of the health of all the residents of Fukushima Prefecture for a long time. In particular, among evacuees of the Fukushima Nuclear Power Plant accident, concern about radiation risk is associated with psychological stresses. Here, ongoing health risk management will be reviewed, focusing on the difficult challenge of post-disaster recovery and resilience in Fukushima.

Concepts: Coal, Nuclear safety, Government of Japan, Three Mile Island accident, Management, Prefectures of Japan, Chernobyl disaster, Nuclear power


The symposium entitled “Chernobyl +30, Fukushima +5: Lessons and Solutions for Fukushima’s Thyroid Question” was held in September, 2016 in Fukushima. The aim of the Symposium was to revisit and recapitulate evidence from the studies in Chernobyl in order to share multidisciplinary opinions and views on the likely reason for the high rate of thyroid cancer detected by the Thyroid Ultrasound Examination program in Fukushima Prefecture.

Concepts: Chernobyl disaster, Honshū, Prefectures of Japan, Fukushima Prefecture, Plato, Tōhoku region, Critical thinking