1
|
Nomura S, Tsubokura M, Ozaki A, Murakami M, Hodgson S, Blangiardo M, Nishikawa Y, Morita T, Oikawa T. Towards a Long-Term Strategy for Voluntary-Based Internal Radiation Contamination Monitoring: A Population-Level Analysis of Monitoring Prevalence and Factors Associated with Monitoring Participation Behavior in Fukushima, Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040397. [PMID: 28397769 PMCID: PMC5409598 DOI: 10.3390/ijerph14040397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 11/22/2022]
Abstract
Following Japan’s 2011 Fukushima nuclear incident, we assessed voluntary-based monitoring behavior in Minamisoma City—located 10–40 km from the Fukushima nuclear plant—to inform future monitoring strategies. The monitoring in Minamisoma included occasional free of charge internal-radiation-exposure measurements. Out of around 70,000 individuals residing in the city before the incident, a total of 45,788 residents (female: 52.1%) aged ≥21 were evaluated. The monitoring prevalence in 2011–2012 was only 30.2%, and this decreased to 17.9% in 2013–2014. Regression analyses were performed to estimate factors associated with the monitoring prevalence and participation behavior. The results show that, in comparison with the age cohort of 21–30 years, the cohort of 71–80 and ≥81 years demonstrated significantly lower monitoring prevalence; female residents had higher monitoring prevalence than male residents; those who were living in evacuation zones at the time of the incident had higher monitoring prevalence than those who lived outside any of the evacuation zones; for those living outside Fukushima and neighboring Prefectures post-incident monitoring prevalence decreased significantly in 2013–2014. Our findings inform the discussion on the concepts of radiation risk perception and accessibility to monitoring and societal decision-making regarding the maintenance of the monitoring program with low monitoring prevalence. We also stress the possibility that the monitoring can work both to check that internal contamination levels are within acceptable limits, and as a risk communication tool, alleviating individuals’ concern and anxiety over radiation contamination.
Collapse
Affiliation(s)
- Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Masaharu Tsubokura
- Department of Radiation Protection, Minamisoma Municipal General Hospital, 2-54-6 Takami-cho, Haramachi-ku, Minamisoma, Fukushima 975-0033, Japan.
| | - Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takami-cho, Haramachi-ku, Minamisoma, Fukushima 975-0033, Japan.
| | - Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima 960-1295.
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan.
| | - Susan Hodgson
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
| | - Marta Blangiardo
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
| | - Yoshitaka Nishikawa
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida-Konoe, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Tomohiro Morita
- Department of Radiation Protection, Soma Central Hospital, 3-5-18 Okinouchi, Soma, Fukushima 976-0016, Japan.
| | - Tomoyoshi Oikawa
- Department of Radiation Protection, Minamisoma Municipal General Hospital, 2-54-6 Takami-cho, Haramachi-ku, Minamisoma, Fukushima 975-0033, Japan.
| |
Collapse
|
2
|
Legleye S, Pennec S, Monnier A, Stephan A, Brouard N, Bilsen J, Cohen J. Surveying End-of-Life Medical Decisions in France: Evaluation of an Innovative Mixed-Mode Data Collection Strategy. Interact J Med Res 2016; 5:e8. [PMID: 26892632 PMCID: PMC4777884 DOI: 10.2196/ijmr.3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 03/06/2015] [Accepted: 07/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Monitoring medical decisions at the end of life has become an important issue in many societies. Built on previous European experiences, the survey and project Fin de Vie en France (“End of Life in France,” or EOLF) was conducted in 2010 to provide an overview of medical end-of-life decisions in France. Objective To describe the methodology of EOLF and evaluate the effects of design innovations on data quality. Methods EOLF used a mixed-mode data collection strategy (paper and Internet) along with follow-up campaigns that employed various contact modes (paper and telephone), all of which were gathered from various institutions (research team, hospital, and medical authorities at the regional level). A telephone nonresponse survey was also used. Through descriptive statistics and multivariate logistic regressions, these innovations were assessed in terms of their effects on the response rate, quality of the sample, and differences between Web-based and paper questionnaires. Results The participation rate was 40.0% (n=5217). The respondent sample was very close to the sampling frame. The Web-based questionnaires represented only 26.8% of the questionnaires, and the Web-based secured procedure led to limitations in data management. The follow-up campaigns had a strong effect on participation, especially for paper questionnaires. With higher participation rates (63.21% and 63.74%), the telephone follow-up and nonresponse surveys showed that only a very low proportion of physicians refused to participate because of the topic or the absence of financial incentive. A multivariate analysis showed that physicians who answered on the Internet reported less medication to hasten death, and that they more often took no medical decisions in the end-of-life process. Conclusions Varying contact modes is a useful strategy. Using a mixed-mode design is interesting, but selection and measurement effects must be studied further in this sensitive field.
Collapse
Affiliation(s)
- Stephane Legleye
- Institut National d'études Démographiques, Department of Survey and Sampling, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
3
|
Abstract
ABSTRACTThis paper examines some demographic and medical factors associated with the likelihood of residing in a care home during the last month of life for persons aged 70 and over in France and, if so, of remaining in the care home throughout or being transferred to hospital. The data are from the Fin de vie en France (End of Life in France) survey undertaken in 2010. During the last month of life, very old people are more likely to be living in a care home but are not less likely to be transferred to hospital. Medical conditions and residential trajectories are closely related. People with dementia or mental disorders are more likely to live in a care home and, if so, to stay there until they die. Compared to care homes, a more technical and medication-based approach is taken in hospitals and care home residents who are transferred to hospital more often receive medication while those remaining in care homes more often receive support from a psychologist. In hospitals as in care homes, few older persons had recourse to advance directives and hospice programmes were not widespread. Promoting these two factors may help to increase the quality of end of life and facilitate an ethical approach to end-of-life care.
Collapse
|
4
|
Tsiantou V, Moschandreas J, Bertsias A, Papadakaki M, Saridaki A, Agius D, Alper Z, Faresjo T, Klimkova M, Martinez L, Samoutis G, Vlček J, Lionis C. General Practitioners' intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project. Health Policy 2015; 119:1265-74. [PMID: 26188356 DOI: 10.1016/j.healthpol.2015.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/01/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
The aim of this paper is to explore general practitioners' (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs' prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary.
Collapse
Affiliation(s)
- Vasiliki Tsiantou
- Department of Health Economics, National School of Public Health, 196 Alexandras Avenue, 11521 Athens, Greece; Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Greece.
| | - Joanna Moschandreas
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion 71003, Crete, Greece.
| | - Antonis Bertsias
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Greece.
| | - Maria Papadakaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Greece.
| | - Aristoula Saridaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Greece.
| | - Dominic Agius
- Mediterranean Institute of Primary Care, 19, Triqir-Rand, Attard, Malta.
| | - Zuleyha Alper
- University of Uludag, Faculty of Medicine Department of Family Practice, Department of Medical Education, Bursa, Turkey; Turkish Association of Family Physicians, (TAHUD), Turkey.
| | - Tomas Faresjo
- Department of Medicine and Health/Community Medicine General Practice, Faculty of Health Sciences, Linkoping University, SE-581 83 Linkoping, Sweden.
| | - Martina Klimkova
- Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Czech Republic.
| | - Luc Martinez
- Sorbonne Universités, UPMC University Paris 06, INSERM, UMR_S 1136, Institute Pierre Louis of Epidemiologie and Public Health, Team EPAR, F-75013 Paris, France; Société Française de Médecine Générale, 141, avenue de Verdun, 92130 ISSY LES MOULINEAUX, France.
| | - George Samoutis
- St George's, University of London medical programmedelivered in Cyprus by the University of Nicosia Medical School, Cyprus.
| | - Jiří Vlček
- Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Czech Republic.
| | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Greece.
| |
Collapse
|