Details of a Researcher - Nomura, Shuhei

Papers - Nomura, Shuhei

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Impact of travel restrictions on importation of novel coronavirus infection: An effective distance approach

Shoi Shi, Shiori Tanaka, Ryo Ueno, Stuart Gilmour, Yuta Tanoue, Takayuki Kawashima, Shuhei Nomura, Hiroaki Miyata, Daisuke Yoneoka

Bulletin of the World Health Organization 2020.03

Accepted

Implementing a sustainable health insurance system in Cambodia: a study protocol for developing and validating an efficient household income-level assessment model for equitable premium collection.

Haruyo Nakamura, Floriano Amimo, Siyan Yi, Sovannary Tuot, Tomoya Yoshida, Makoto Tobe, Shuhei Nomura

International journal for equity in health 19 ( 1 ) 17 - 17 2020.01

Accepted

BACKGROUND: As elsewhere in low- and middle-income countries, due to limited fiscal resources, universal health coverage (UHC) remains a challenge in Cambodia. Since 2016, the National Social Security Fund (NSSF) has implemented a social health insurance scheme with a contributory approach for formal sector workers. However, informal sector workers and dependents of formal sector workers are still not covered by this insurance because it is difficult to set an optimal amount of contribution for such individuals as their income levels are inestimable. The present study aims to develop and validate an efficient household income-level assessment model for Cambodia. We aim to help the country implement a financially sustainable social health insurance system in which the insured can pay contributions according to their ability. METHODS: This study will use nationally representative data collected by the Cambodia Socio-Economic Survey (CSES), covering the period from 2009 to 2019, and involving a total of 50,016 households. We will employ elastic net regression analysis, with per capita disposable income based on purchasing power parity as the dependent variable, and individual and community-level socioeconomic and demographic characteristics as independent variables. These analyses aim to create efficient income-level assessment models for health insurance contribution estimation. To fully capture socioeconomic heterogeneity, sub-group analyses will be conducted to develop separate income-level assessment models for urban and rural areas, as well as for each province. DISCUSSION: This research will help Cambodia implement a sustainable social health insurance system by collecting optimal amount of contributions from each socioeconomic group of the society. Incorporation of this approach into existing NSSF schemes will enhance the country's current efforts to prevent impoverishing health expenditure and to achieve UHC.

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The trajectories of local food avoidance after the Fukushima Daiichi nuclear plant disaster: A five-year prospective cohort study

Yoshitake Takebayashi, Michio Murakami, Shuhei Nomura, Tomoyoshi Oikawa, MasaharuTsubokura

International Journal of Disaster Risk Reduction 46 101513 2020.01

Assessing the quality of cause of death data in six high-income countries: Australia, Canada, Denmark, Germany, Japan and Switzerland.

Lene Mikkelsen, Kim Moesgaard Iburg, Tim Adair, Thomas Fürst, Michael Hegnauer, Elena von der Lippe, Lauren Moran, Shuhei Nomura, Haruka Sakamoto, Kenji Shibuya, Annelene Wengler, Stephanie Willbond, Patricia Wood, Alan D Lopez

International journal of public health 65 ( 1 ) 17 - 28 2020.01

Accepted

OBJECTIVES: To assess the policy utility of national cause of death (COD) data of six high-income countries with highly developed health information systems. METHODS: National COD data sets from Australia, Canada, Denmark, Germany, Japan and Switzerland for 2015 or 2016 were assessed by applying the ANACONDA software tool. Levels, patterns and distributions of unusable and insufficiently specified "garbage" codes were analysed. RESULTS: The average proportion of unusable COD was 18% across the six countries, ranging from 14% in Australia and Canada to 25% in Japan. Insufficiently specified codes accounted for a further 8% of deaths, on average, varying from 6% in Switzerland to 11% in Japan. The most commonly used garbage codes were Other ill-defined and unspecified deaths (R99), Heart failure (I50.9) and Senility (R54). CONCLUSIONS: COD certification errors are common, even in countries with very advanced health information systems, greatly reducing the policy value of mortality data. All countries should routinely provide certification training for hospital interns and raise awareness among doctors of their public health responsibility to certify deaths correctly and usefully for public health policy.

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Reducing childhood malnutrition in Bangladesh: the importance of addressing socio-economic inequalities.

Md Rashedul Islam, Md Shafiur Rahman, Md Mahfuzur Rahman, Shuhei Nomura, Angela de Silva, Pulani Lanerolle, Jenny Jung, Md Mizanur Rahman

Public health nutrition 23 ( 1 ) 72 - 82 2020.01

Accepted, ISSN 1368-9800

OBJECTIVE: To obtain projections of the prevalence of childhood malnutrition indicators up to 2030 and to analyse the changes of wealth-based inequality in malnutrition indicators and the degree of contribution of socio-economic determinants to the inequities in malnutrition indicators in Bangladesh. Additionally, to identify the risk factors of childhood malnutrition. DESIGN: Cross-sectional study. A Bayesian linear regression model was used to estimate trends and projections of malnutrition. For equity analysis, slope index, relative index and decomposition in concentration index were used. Multilevel logistic models were used to identify risk factors of malnutrition. SETTING: Household surveys in Bangladesh from 1996 to 2014. PARTICIPANTS: Children under the age of 5 years. RESULTS: A decreasing trend was observed for all malnutrition indices. In 1990, predicted prevalence of stunting, wasting and underweight was 55·0, 15·9 and 61·8 %, respectively. By 2030, prevalence is projected to reduce to 28·8 % for stunting, 12·3 % for wasting and 17·4 % for underweight. Prevalence of stunting, wasting and underweight were 34·3, 6·9 and 32·8 percentage points lower in the richest households than the poorest households. Contribution of the wealth index to child malnutrition increased over time and the largest contribution of pro-poor inequity was explained by wealth index. Being an underweight mother, parents with a lower level of education and poorer households were the key risk factors for stunting and underweight. CONCLUSIONS: Our findings show an evidence-based need for targeted interventions to improve education and household income-generating activities among poor households to reduce inequalities and reduce the burden of child malnutrition in Bangladesh.

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Limited alignment of publicly competitive disease funding with disease burden in Japan.

Shuhei Nomura, Daisuke Yoneoka, Shiori Tanaka, Ryoko Makuuchi, Haruka Sakamoto, Aya Ishizuka, Haruyo Nakamura, Anna Kubota, Kenji Shibuya

PloS one 15 ( 2 ) e0228542 2020

Accepted

OBJECTIVE: The need to align investments in health research and development (R&D) with public health needs is one of the most important public health challenges in Japan. We examined the alignment of disease-specific publicly competitive R&D funding to the disease burden in the country. METHODS: We analyzed publicly available data on competitive public funding for health in 2015 and 2016 and compared it to disability-adjusted life year (DALYs) in 2016, which were obtained from the Global Burden of Disease (GBD) 2017 study. Their alignment was assessed as a percentage distribution among 22 GBD disease groups. Funding was allocated to the 22 disease groups based on natural language processing, using textual information such as project title and abstract for each research project, while considering for the frequency of information. RESULTS: Total publicly competitive funding in health R&D in 2015 and 2016 reached 344.1 billion JPY (about 3.0 billion USD) for 32,204 awarded projects. About 49.5% of the funding was classifiable for disease-specific projects. Five GDB disease groups were significantly and relatively well-funded compared to their contributions to Japan's DALY, including neglected tropical diseases and malaria (funding vs DALY = 1.7% vs 0.0%, p<0.01) and neoplasms (28.5% vs 19.2%, p<0.001). In contrast, four GDB disease groups were significantly under-funded, including cardiovascular diseases (8.0% vs 14.8%, p<0.001) and musculoskeletal disorders (1.0% vs 11.9%, p<0.001). These percentages do not include unclassifiable funding. CONCLUSIONS: While caution is necessary as this study was not able to consider public in-house funding and the methodological uncertainties could not be ruled out, the analysis may provide a snapshot of the limited alignment between publicly competitive disease-specific funding and the disease burden in the country. The results call for greater management over the allocation of scarce resources on health R&D. DALYs will serve as a crucial, but not the only, consideration in aligning Japan's research priorities with the public health needs. In addition, the algorithms for natural language processing used in this study require continued efforts to improve accuracy.

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Low dose of external exposure among returnees to former evacuation areas: a cross-sectional all-municipality joint study following the 2011 Fukushima Daiichi nuclear power plant incident.

Shuhei Nomura, Michio Murakami, Wataru Naito, Tetsuo Yasutaka, Toyoaki Sawano, Masaharu Tsubokura

Journal of radiological protection : official journal of the Society for Radiological Protection 40 ( 1 ) 1 - 18 2019.12

Accepted, ISSN 0952-4746

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.

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A Comparative Survival Analysis Between Evacuees and Nonevacuees Among Dialysis Patients in Fukushima Prefecture After Japan's 2011 Fukushima Nuclear Incident.

Shuhei Nomura, Yukie Matsuzaki, Yuko Sato, Jyunko Takasaki, Yuki Sonoda, Hiroaki Shimmura, Yuko Kodama

Disaster medicine and public health preparedness 13 ( 5-6 ) 898 - 904 2019.12

Accepted, ISSN 1935-7893

OBJECTIVE: There has been little research on the health consequences of evacuation in the disaster context. A comparative analysis of survival between evacuated and nonevacuated hospital dialysis patients was conducted following Japan's Fukushima Dai-ichi nuclear power plant incident, which occurred on March 11, 2011. METHODS: The study included 554 patients (mean age: 70.9) receiving dialysis therapy at one of the Tokiwakai Group hospitals-all of which are located in and around Iwaki City, approximately 50 km from the Fukushima nuclear plant-as of the incident date. The patients' survival after the incident was tracked until March 3, 2017. Significant differences in mortality rates between postincident evacuees and nonevacuees were tested using the Bayesian survival analysis with Weibull multivariate regression. RESULTS: Out of 554 dialysis patients, 418 (75.5%) were evacuated after the incident. The postincident mortality rate (adjusted for covariates) of evacuees was not statistically significantly different from that of nonevacuees. The hazard ratio was 1.17 (95% credible intervals: 0.77-1.74). CONCLUSIONS: If performed in a well-planned manner with satisfactory arrangements for appropriate selection of evacuees and their transportation, evacuation could be a reasonable option, which might save more lives of vulnerable people.

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Radiation doses and decontamination effects in Minamisoma city: airborne and individual monitoring after the Fukushima nuclear accident.

Michio Murakami, Shuhei Nomura, Masaharu Tsubokura, Yoshitake Takebayashi, Kana Yamamoto, Tomoyoshi Oikawa

Journal of radiological protection : official journal of the Society for Radiological Protection 39 ( 4 ) N27-N35 - N35 2019.10

Accepted, ISSN 0952-4746

After the Fukushima accident, airborne monitoring was implemented to measure airborne radiation. We examined the relationships between airborne and individual radiation monitoring and clarified the use of airborne monitoring to evaluate the effects of decontamination on residents' received doses. We used the air dose rate data from four airborne monitors conducted between 2013 and 2016, and the dose data from four individual monitors (in which a total of 18 392 adults and 3650 children participated), conducted in Minamisoma City during the same period. We examined the Pearson correlation coefficients between the airborne and individual monitoring data and estimated exposure ratios (ERs; ratios of individual dose to air dose rates) among adults and children. We also estimated the effects of decontamination on residents' doses based on airborne monitoring data, adjusting this for timing and dosing through propensity score matching, which were then compared to individual monitoring data. There were significant correlations between airborne and individual monitoring doses among adults and children, and more than 80% of residents showed a good estimation-observation agreement within a factor of two. The median of ERs was 0.304 and 0.250 among adults and children, respectively. There was a significant difference between the two. Effects of decontamination on residents' doses estimated from airborne monitoring were significantly lower than those estimated from individual monitoring. These findings suggest that airborne monitoring can be used to estimate representative radiation doses within residential areas. It may be a useful tool for enhancing communication among stakeholders and supporting individual and policy decisions; however, it is less sensitive for evaluating individual effects of decontamination than individual monitoring. Combined use of airborne and individual monitoring also showed a lower median of ERs in children than in adults and in a Japanese government's model, possibly due to prioritised decontamination for children and differences between their behavioral patterns.

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Risk factors and regional variations of malnutrition among children under 5 in Myanmar: cross-sectional analyses at national and subnational levels.

Hnin Thiri Khaing, Shuhei Nomura, Daisuke Yoneoka, Peter Ueda, Kenji Shibuya

BMJ open 9 ( 9 ) e030894 2019.09

Accepted

OBJECTIVE: The levels, distributions of child malnutrition and its potential risk factors are not very well known in Myanmar. The objectives included in this study were: to estimate the current national and subnational prevalence of four types of malnutrition (stunting, wasting, underweight and overweight) among children under 5 in Myanmar; to identify potential risk factors associated with each type of malnutrition and to investigate how the identified risk factors' distributions explained the regional disparities in malnutrition prevalence. DESIGN/METHODS: Data from the Myanmar Demographic and Health Survey 2015-2016 were used to estimate the prevalence of four types of malnutrition at both national and subnational levels (15 regions). Logistic regression models were applied to examine the association between each type of malnutrition and its risk factors, including child's factors, parental social status and household conditions. The risk factor-adjusted prevalence of the malnutrition was estimated at the subnational level based on the estimated parameters from the regression models. RESULTS: The national prevalence of stunting, wasting, underweight and overweight in children under 5 was estimated to be 29.1% (95% CI 27.7% to 30.6%), 6.8% (6.0% to 7.6%), 18.3% (17.0% to 19.5%) and 1.5% (1.1% to 1.9%), respectively. Substantial regional variations in the prevalence of each type of malnutrition were observed. Several risk factors of each type of malnutrition were identified, including low birth weight (LBW) and inadequate maternal nutritional status. Except for overweight, regional variations largely persisted even after adjustment for the risk factors investigated. CONCLUSION: The prevalence of malnutrition among children under 5 is still high in Myanmar, most commonly stunting. Targeted interventions aimed at prevention of LBW, improving the maternal nutritional status, in addition to other sociodemographic conditions should be encouraged urgently. Further research is necessary to investigate the potential sources of regional variation in prevalence of malnutrition among children under 5 in the country.

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Breast Cancer Provider Interval Length in Fukushima, Japan, After the 2011 Triple Disaster: A Long-Term Retrospective Study.

Akihiko Ozaki, Shuhei Nomura, Claire Leppold, Masaharu Tsubokura, Toyoaki Sawano, Manabu Tsukada, Tomohiro Morita, Tetsuya Tanimoto, Shigehira Saji, Shigeaki Kato, Kazue Yamaoka, Yoshinori Nakata, Hiromichi Ohira

Clinical breast cancer 20 ( 2 ) e127-e150 2019.09

Accepted

BACKGROUND: Minimizing the interval from symptom onset to treatment commencement is essential for a favorable outcome among breast cancer (BC) patients. This study examined whether provider interval (time elapsed from first consultation to treatment initiation) lengthened among BC patients after Japan's 2011 earthquake, tsunami, and nuclear disaster in Fukushima. Factors associated with the length of postdisaster interval and whether the interval was associated with BC stage were also investigated. PATIENTS AND METHODS: So-so District (study site) was an area damaged by the 2011 disasters. Data of all BC patients who made their first medical consultation and received initial treatment at the core medical institutions in the area 5 years before or after the disaster were extracted from patient medical records. We used several regression approaches to fulfill our study objectives. RESULTS: We included 263 (140 predisaster and 123 postdisaster) patients. After adjustment for covariates, the interval did not significantly change after the disaster compared to before the disaster. Those with 4 or 5 cohabiting family members experienced a shorter interval after the disaster than those with 0 or 1 cohabiting family members (relative length, 0.47; 95% confidence interval, 0.28-0.78). Those with an interval of > 60 days had lower odds of stage III or IV cancer after the disaster than those with an interval of < 30 days (odds ratio, 0.09; 95% confidence interval, 0.01-0.84). CONCLUSION: Overall, provider interval did not lengthen after the disaster. However, those with fewer cohabiting family members might have experienced a longer total interval. Cancer stage may not necessarily reflect the influence of interval on patient outcome.

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Impact of decontamination on individual radiation doses from external exposure among residents of Minamisoma City after the 2011 Fukushima Daiichi nuclear power plant incident in Japan: a retrospective observational study.

Masaharu Tsubokura, Michio Murakami, Yoshitake Takebayashi, Shuhei Nomura, Kyoko Ono, Akihiko Ozaki, Toyoaki Sawano, Yurie Kobashi, Tomoyoshi Oikawa

Journal of radiological protection : official journal of the Society for Radiological Protection 39 ( 3 ) 854 - 871 2019.09

Accepted, ISSN 0952-4746

Following the Fukushima incident, radiation doses from external exposure accounted for the majority of the total doses. Although countermeasures are being implemented, with the aim of reducing radiation exposure, little information is available on the effects of decontamination on individual doses among the residents of radioactively contaminated areas. To evaluate the effectiveness of the decontamination measures in reducing individual doses, and to examine the influence of the timing of decontamination and the district, data were analysed for 18 392 adults and 3 650 children in Minamisoma City, Fukushima, who participated in a voluntary screening programme using individual radiation dosimeters (Glass Badge) between June 2013 and September 2016. The dose reduction rates (DRR) were calculated for one year by comparing the first and last three-month measurement results between areas with and without decontamination. Using a regression approach and Monte Carlo simulation, the dose reduction rate by decontamination eliminating the effect of physical decay (DRRd') was also estimated as a function of the timing of the decontamination and the dose at the time of starting the decontamination. The annual DRR in areas with decontamination for both adults and children were significantly higher than those in areas without decontamination, depending on the timing of decontamination: 31%-36% for 2013-14 for adults in decontamination areas and 33%-35% for children in decontamination areas, compared to 12%-23% and 13%-23% for adults and children in areas without decontamination, respectively. There was a positive correlation between DRRd' and individual doses, and DRRd' was estimated at 30%-40% for adults and children with doses of 3 mSv y-1 in 2013 and 2014. This study demonstrated that decontamination does lower individual doses from external exposure. The higher the dose at the time of starting the decontamination, the greater the dose reduction rate by decontamination, regardless of the timing of the decontamination. Our study confirms that decontamination was useful for high-dose areas in the later phases of the incident.

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Internal exposure risk due to radiocesium and the consuming behaviour of local foodstuffs among pregnant women in Minamisoma City near the Fukushima nuclear power plant: a retrospective observational study.

Kana Yamamoto, Shuhei Nomura, Masaharu Tsubokura, Michio Murakami, Akihiko Ozaki, Claire Leppold, Toyoaki Sawano, Morihito Takita, Shigeaki Kato, Yukio Kanazawa, Hiroshi Anbe

BMJ open 9 ( 7 ) e023654 2019.07

Accepted

OBJECTIVES: This study aimed to evaluate the internal cesium (Cs) level among pregnant women in Minamisoma City (the area straddling the evacuation zones) over a 5-year period after Japan's 2011 Fukushima nuclear accident and assess the status and transition of their food-acquiring preferences during this period. DESIGN: A retrospective observational study of a screening along with a questionnaire survey. SETTING: This study was conducted in an obstetrics and gynaecology service in Minamisoma City in Fukushima, Japan. PARTICIPANTS: Participants included pregnant women who applied for the voluntary internal radiation exposure screening programme. PRIMARY AND SECONDARY OUTCOME MEASURES: Internal radiation exposure was evaluated using the whole-body counter (WBC) in the screening programme. Data from a food acquisition preference questionnaire administered to the participants were analysed and compared across the 5-year period after adjusting for covariates. RESULTS: Overall, 804 screening programmes were conducted with 579 participants during the study period. All participants had internal contamination levels below the detection limit of the WBC unit (220 and 250 Bq/body for Cs-134 and Cs-137, respectively). Based on the most conservative assumption, their maximum annual effective doses by Cs-134 and Cs-137 together were estimated at 16 µSv/year. Contrary to limited internal contamination risks and counter-dose initiatives by the government, a considerable number of pregnant women were still concerned about consuming potentially contaminated local food products when purchasing them at supermarkets between 2012 (78.4%) and 2015 (75.0%). CONCLUSIONS: Health effects from post-accident internal radiation exposure were likely to be insignificant in pregnant women. National/local action is urgently needed to promote scientific understanding in pregnant women regarding limited internal exposure risks from local food products in the market. However, few mothers chose to participate in the internal radiation exposure screening programme, and thus, caution is required in interpreting the results of analyses.

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Long-term trends of hospital admissions among patients with cancer following the 2015 earthquake: a single institution observational study in Kathmandu, Nepal.

Anup Uprety, Akihiko Ozaki, Asaka Higuchi, Bikal Ghimire, Toyoaki Sawano, Kenji Tsuda, Shuhei Nomura, Claire Leppold, Masaharu Tsubokura, Tetsuya Tanimoto, Yogendra Prasad Singh

BMJ open 9 ( 6 ) e026746 2019.06

Accepted

OBJECTIVES: Little is known regarding how natural disasters affect patients with cancer in low-income and middle-income countries. The objective of the present study was to assess the impact of the 2015 Nepal earthquake on the admission of patients with cancer at a core medical institution in Kathmandu. DESIGN, SETTING AND PARTICIPANTS: We considered all 3520 cancer patient admissions to Tribhuvan University Teaching Hospital, from 25 April 2013 to 24 April 2017 (2 years before and 2 years after the earthquake). OUTCOME MEASURES: The number of cancer patient admissions was calculated for each month. Using a negative binomial model, we estimated the incidence rate ratio (IRR) for admission numbers each month after the earthquake compared with the pre-earthquake baseline and investigated chronological change. RESULTS: The total admission number in the first month after the earthquake was decreased compared with that of the predisaster baseline (IRR=0.66, 95% CI 0.43 to 1.00), which largely reflected decreased admissions of patients from outside of the most disaster-affected districts. From the second month, the admission number consistently exceeded the predisaster baseline for the remaining postdisaster period. In contrast to the month of the disaster, the continuation of increased admissions was most prominent among those from outside of the most affected districts. CONCLUSIONS: After a transient decrease immediately following the 2015 Nepal earthquake, there was a long-term increase in cancer patient admissions in a core hospital in Kathmandu. These changes were seen most prominently in patients from outside the most disaster affected areas.

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Low dose from external radiation among returning residents to the former evacuation zone in Minamisoma City, Fukushima Prefecture.

Shuhei Nomura, Tomoyoshi Oikawa, Masaharu Tsubokura

Journal of radiological protection : official journal of the Society for Radiological Protection 39 ( 2 ) 548 - 563 2019.06

Accepted, ISSN 0952-4746

After the 2011 Fukushima Daiichi nuclear power plant accident, evidence on the real-life conditions of returnees to areas once designated as legal no-go zones, including their radiation dose levels, is scarce. In the present study, using a radiation dosimeter and lifestyle survey, we evaluated the lifestyle characteristics and dose levels in 2017 from external exposure among those who returned to the no-go zones after the evacuation orders were lifted. A total of 112 returnees to Odaka district, Minamisoma City, Fukushima Prefecture, were considered and compared to 266 non-returnees. The proportion of participants with annual additional doses from external exposure above 1 mSv was 7.0% for returnees, and 7.3% and 4.2% for non-returnees living in other districts or outside of the city, respectively. Although caution is required given the very small sample sizes, this implies that as of 2017 doses from external exposure among returnees in Odaka were very low and by scientific consensus would be associated with a very low likelihood of physical effects. We also found that while returnees were older on average than non-returnees, they had similar life conditions (i.e. occupation and time spent outdoors). It should be particularly emphasised that the expected lifetime doses from the incident in addition to the natural background dose are a very small among returnees. This study contributes to enhancing societal debates and risk communication regarding how government can provide returnees with the support they need, improve their outlook for radiation doses, and continue to improve crucial infrastructure in former no-go zones so that communities can be rebuilt.

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Worsening Health Status among Evacuees: Analysis of Medical Expenditures after the 2011 Great East Japan Earthquake and Nuclear Disaster in Fukushima.

Makoto Hasegawa, Michio Murakami, Shuhei Nomura, Yoshitake Takebayashi, Masaharu Tsubokura

The Tohoku journal of experimental medicine 248 ( 2 ) 115 - 123 2019.06

Accepted, ISSN 0040-8727

After Fukushima disaster in 2011, the health status of the region's residents deteriorated. We analyzed the health status, care needs, and access to health services among evacuees and non-evacuees using healthcare expenditure (for self-employed and unemployed individuals aged < 75 years) and long-term care expenditure (mainly for individuals aged ≥ 65 years). Fukushima Prefecture was divided into four areas according to their evacuation status: non-EOAs (municipalities that did not include evacuation order areas (EOAs)); EOAs/non-EOAs (municipalities that included both EOAs and non-EOAs); short-term EOAs (municipalities where the EOA designation was lifted in most areas by fiscal year (FY) 2011); and long-term EOAs (municipalities where most EOA designations remained in place until the end of FY 2015). Increases in expenditure on healthcare and long-term care per capita in short-term and long-term EOAs were greater in FY 2015 than the average values in FYs 2008-2010. The increases in expenditure were higher in short-term and long-term EOAs than those in non-EOAs and EOAs/non-EOAs. The increases in dental health expenditure were attributed to enhanced accessibility to dental health facilities. Furthermore, the evacuations contributed to increases in healthcare and long-term care expenditure, independent of aging and improved accessibly to health facilities. Possible explanations for these increases include the poor health status of the evacuees following the evacuations, reduced availability of informal care provided by family members and neighbors, and reduced patient copayments. The findings highlight the necessity of health promotion among evacuees.

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Trends in heterosexual inexperience among young adults in Japan: analysis of national surveys, 1987-2015.

Cyrus Ghaznavi, Haruka Sakamoto, Daisuke Yoneoka, Shuhei Nomura, Kenji Shibuya, Peter Ueda

BMC public health 19 ( 1 ) 355 - 355 2019.04

Accepted, ISSN 1471-2458

BACKGROUND: It has been suggested that an increasing number of Japanese adults remain sexually inexperienced; however, no study has assessed this issue using nationally representative data. METHODS: We used data from seven rounds of the National Fertility Survey of Japan, 1987-2015, and included adults aged 18-39 years (18-34 years in the 1987 survey) in the analyses (sample size 11,553-17,850 [1987-2010]; response rate 70.0-92.5%). For each survey year, sex and age group, we estimated the age-adjusted prevalence of heterosexual inexperience, defined as reporting no experience of sexual intercourse with someone of the opposite sex. We used logistic regression, adjusted for age, to identify factors associated with heterosexual inexperience in the 2010 survey. Information about same-sex sexual experience was not available. RESULTS: Between 1992 and 2015, the age-standardized prevalence of heterosexual inexperience in adults aged 18-39 years increased from 21.7 to 24.6% for women (p-values for linear and quadratic trend < 0.05) and from 20.0 to 25.8% for men (p-values for trend < 0.05). Among those aged 30-34 years, the prevalence was 6.2% in 1987 and 11.9% in 2015 for women (p-values for trend ≥0.05) and 8.8% (1987) and 12.7% (2015) for men (p-values for trend ≥0.05). Among those aged 35-39 years, prevalence increased from 4.0% in 1992 to 8.9% in 2015 among women (p-values for trend < 0.05). The corresponding numbers for men in the same age group were 5.5 and 9.5%, respectively (p-values for trend ≥0.05). Among men aged 25-39 years, unemployment, temporary/part-time employment and lower income were associated with heterosexual inexperience. CONCLUSIONS: The proportion of young Japanese adults with no experience of heterosexual intercourse had increased in the past two decades. Among adults in their thirties, around one in ten had no heterosexual experience. Unemployment, temporary/part-time employment and low income were associated with heterosexual inexperience among men. Further research is needed on the factors contributing to and the potential public health and demographic implications of the high proportion of the Japanese population that remains sexually inexperienced well into adult age.

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JAPAN: EFFECTIVE SMOKEFREE LAWS URGENTLY NEEDED

Nomura Shuhei, Sakamoto Haruka

TOBACCO CONTROL 28 ( 2 ) 123 - 124 2019.03

Accepted, ISSN 0964-4563

Trends in comparative efficacy and safety of malaria control interventions for maternal and child health outcomes in Africa: a study protocol for a Bayesian network meta-regression exploring the effect of HIV and malaria endemicity spectrum.

Floriano Amimo, Troy D Moon, Anthony Magit, Jahit Sacarlal, Ben Lambert, Shuhei Nomura

BMJ open 9 ( 2 ) e024313 2019.02

Accepted, ISSN 2044-6055

INTRODUCTION: Unprecedented global efforts to prevent malaria morbidity and mortality in sub-Saharan Africa have saved hundreds of thousands of lives across the continent in the last two decades. This study aims to determine how the comparative efficacy and safety of available malaria control interventions intended to improve maternal and child health outcomes have changed over time considering the varied epidemiological contexts on the continent. METHODS: We will review all randomised controlled trials that investigated malaria control interventions in pregnant women in sub-Saharan Africa and were published between January 1980 and December 2018. We will subsequently use network meta-regression to estimate temporal trends in the relative and absolute efficacy and safety of Intermittent Preventive Treatments, Intermittent Screening and Treatments, Insecticide-treated bed nets, and their combinations, and predict their ranking according to their relative and absolute efficacy and safety over time. Our outcomes will include 12 maternal and 7 child mortality and morbidity outcomes, known to be associated with either malaria infection or control. We will use intention-to-treat analysis to derive our estimates and meta-regression to estimate temporal trends and the effect modification by HIV infection, malaria endemicity and Plasmodium falciparum resistance to sulfadoxine-pyrimethamine, while adjusting for multiple potential confounders via propensity score calibration. PROSPERO REGISTRATION NUMBER: CRD42018095138.

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Change of access to emergency care in a repopulated village after the 2011 Fukushima nuclear disaster: a retrospective observational study.

Yoshitaka Nishikawa, Masaharu Tsubokura, Yoshimitsu Takahashi, Shuhei Nomura, Akihiko Ozaki, Yuko Kimura, Tomohiro Morita, Toyoaki Sawano, Tomoyoshi Oikawa, Takeo Nakayama

BMJ open 9 ( 2 ) e023836 2019.02

Accepted, ISSN 2044-6055

OBJECTIVES: Sustaining emergency care access is of great concern. The aim of this study is to evaluate access to emergency care in a repopulated village following the 2011 Fukushima disaster. DESIGN: This research was a retrospective observational study. The primary outcome measure was total emergency medical services (EMS) time. A Bayesian time series analysis was performed to consider local time series trend and seasonality. SETTING: The residents in Kawauchi Village, Fukushima, Japan were forced to evacuate after the 2011 Fukushima disaster. As the radiation dose was an acceptable level, the residents began the process of repopulation in April 2012. PARTICIPANTS: This study included patients transported by EMS from January 2009 to October 2015. Patients transported during the evacuation period (from March 2011 to March 2012) were excluded. RESULTS: A total of 781 patients were transferred by EMS (281 patients before the disaster, 416 after repopulation and 84 during the evacuation period). A Bayesian time series analysis revealed an increase in total EMS time, from the first request call to arrival at a hospital of 21.85 min (95% credible interval 14.2-29.0, Bayesian one-sided tail-area probability p=0.001). After the disaster, 42.3% of patients were transported to a partner hospital. CONCLUSIONS: Total EMS time increased after repopulation of the area affected because of a massive number of hospital closures. Proactive partnerships would be a possible countermeasure in the affected areas after a major disaster.

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