Diversity of Concerns in Recovery after a Nuclear Accident: A Perspective from Fukushima

Due to the likelihood of physical and mental health impacts following the unprecedented accident at the Fukushima Dai-ichi Nuclear Power Plant, the Fukushima prefectural government decided to conduct the Fukushima Health Management Survey to assist in the long-term health management of residents. This included thyroid ultrasound examination for all children in Fukushima. For appropriate evaluation of ultrasound screening of the thyroid, it is important to understand its reference data of thyroid findings in children in general. In order to analyze the frequencies of specific thyroid findings, we conducted ultrasound screening of the thyroid by the same procedures as used in Fukushima in 4,365 children, aged 3 to 18 years, from three Japanese prefectures. Overall, thyroid cysts were identified in 56.88% and thyroid nodules in 1.65% of the participants. Thyroid cysts and nodules with a maximum diameter of more than 5 mm were identified in 4.58% and 1.01%, respectively, and age-adjusted prevalences were 3.82% and 0.99%, respectively. Although the prevalence of cysts and nodules varied among the examination areas, no significant differences were observed among the three examination areas in the prevalence of cysts and nodules with a maximum diameter of more than 5 mm. Also, the prevalence of thyroid cysts and nodules, especially those with a maximum diameter of more than 5 mm, significantly increased with age, and showed a female predominance. We also identified ectopic thymus (1.95%), diffuse goiter (1.40%), ultimobranchial body (0.73%), lymph node swelling (0.21%) and thyroid agenesis (0.05%). This is the first ultrasound description of the age-adjusted prevalence of thyroid cysts and nodules, or of the prevalence of abnormalities other than cysts and nodules, such as ectopic thymus, in relation to age, in the general Japanese child population. We contend that this can provide relevant information for the Fukushima Health Management Survey and future population studies. Show more

The psychosocial consequences of disasters have been studied for more than 100 years. The most common mental health consequences are depression, anxiety, post-traumatic stress disorder, medically unexplained somatic symptoms, and stigma. The excess morbidity rate of psychiatric disorders in the first year after a disaster is in the order of 20%. Disasters involving radiation are particularly pernicious because the exposure is invisible and universally dreaded, and can pose a long-term threat to health. After the Chernobyl disaster, studies of clean-up workers (liquidators) and adults from contaminated areas found a two-fold increase in post-traumatic stress and other mood and anxiety disorders and significantly poorer subjective ratings of health. Among liquidators, the most important risk factor was severity of exposure. In general population samples, the major risk factor was perceived exposure to harmful levels of radiation. These findings are consistent with results from A-bomb survivors and populations studied after the Three Mile Island nuclear power plant accident. With regard to children, apart from findings from ecological studies that lack direct data on radiation or other teratologic exposures and local studies in Kiev, the epidemiologic evidence suggests that neither radiation exposure nor the stress of growing up in the shadow of the accident was associated with emotional disorders, cognitive dysfunction, or impaired academic performance. Thus, based on the studies of adults, the Chernobyl Forum concluded that mental health was the largest public health problem unleashed by the accident. Since mental health is a leading cause of disability, physical morbidity, and mortality, health monitoring after radiation accidents like Fukushima should include standard measures of well-being. Moreover, given the comorbidity of mental and physical health, the findings support the value of training non-psychiatrist physicians in recognizing and treating common mental health problems like depression in Fukushima patients. Show more