After the Fukushima nuclear disaster of 2011—is Japan better prepared—perhaps not

In 2011, a huge earthquake followed by a devastating tsunami seriously damaged the Fukushima-Daiichi nuclear power plant. In a poignant article previously published in the QJM, doctors in the local hospital at Fukushima told their story of professionalism in the most trying of times.1 In November 2016, a significant earthquake again struck Fukushima, and resulted in tsunamis across the Eastern coast of Japan. Dr Ozaki and colleagues at Minamisoma Municipal General Hospital, Fukushima reported that while this second earthquake was associated with a relatively small number of injuries, it provided an opportunity to assess whether lessons had been learned previously to improve the preparedness of the healthcare system to withstand a nuclear accident. They strongly make the point that should a nuclear accident recur—they have significant concerns in relation to preparedness of Japan’s health care system at both a national and local level. They highlight two areas of concern—firstly, the lack of a clear strategy for the provision of resources and efficient evacuation of patients requiring ongoing medical care and secondly, the planning for the provision and maintenance of adequate medical manpower and infrastructure within the containment area. The authors highlight that it has been 5 years since the triple disaster, yet the recent earthquake and tsunamis highlight that Japan’s health care system is still not fully prepared for any future nuclear events. Prescription drug addiction and in particular opioid addiction is currently generating media interest. President Donald Trump has recently declared the opioid epidemic in the USA as a ‘national emergency’.2 It is therefore timely that the QJM publishes a review on codeine dependence. The journal has been at the forefront in publishing seminal articles on the evolving epidemiology of substance abuse.3,4 Kimergard and colleagues utilized a web-based survey technique to enhance our understanding of the current demographics of codeine use. The use of prescription opiates has trebled over the last 10 years or so. In their analysis of codeine-dependant usage, they highlight the factors associated with (i) becoming dependent on opiates, (ii) codeine ‘shopping’ and (iii) help-seeking to manage codeine use. I recommend this article to our readers. Fasting is an integral part of many worlds’ religions. Fasting during Ramadan is one of the five pillars of the Islamic faith. It involves abstaining from eating and drinking during daylight hours. In a study published by Sagy and colleagues, they found that over a 10-year period during Ramadan, 25% of presentations within their health care region with renal colic were from patients of the Islamic faith. This is on a background Muslim population of 18.5% in the studied region. When the effect of ambient temperature was removed, significantly increased presentations of renal colic were found, particularly in the first 2 weeks of Ramadan. Would welcome our readers’ views on this issue.