I軸とII軸を並存する自殺企図患者に対するアサーティブケースマネージメントによる介入の効果：無作為化比較試験の二次解析

Background: Most suicide attempters suffer from psychiatric disorders, which are often comorbid with personality disorders. The effects of intervention on patients who have attempted suicide with comorbid Axis I and II diagnoses have not been fully elucidated. We evaluated whether assertive case management can reduce the repetition of suicidal behaviours in patients who had attempted suicide with comorbid Axis I and II diagnoses. Methods: This study was a secondary analysis of a randomised controlled trial investigating whether assertive case management could reduce the repetition of suicide attempts, compared with enhanced usual care. Subjects were divided into those who had comorbid Axis I and II diagnoses (Axis I + II group), and those who had an Axis I diagnosis without Axis II comorbidity (Axis I group). Outcome measures were compared between patients receiving a case management intervention and patients receiving enhanced usual care, as allocated. The primary outcome measure was the incidence proportion of the first episode of recurrent suicidal behaviour at 6 months after randomisation. We calculated risk ratios (RR) with 95% confidence intervals (CI) at 6 months and 12 months after randomisation of patients in the Axis I and Axis I + II groups. Results: Of 914 enrolled patients, 120 (13.1%) were in the Axis I + II group, and 794 (86.9%) were in the Axis I group. Assertive case management was significantly effective for the Axis I group on the primary outcome at 6 months (risk ratio [RR] 0.51, 95% confidence intervals [CI] 0.31 to 0.84). The RR of the Axis I + II group was 0.44 (95% CI 0.14 to 1.40). Conclusions: Assertive case management not only had an effect on patients who had attempted suicide with only Axis I disorders but may also have a similar effect on patients with comorbid Axis I and II disorders.博士（医学）・乙第1503号・令和3年3月15日© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data

Impact of the COVID-19 pandemic on pediatric out-of-hospital cardiac arrest outcomes in Japan

Abstract This study investigates the impact of the COVID-19 pandemic on pediatric out-of-hospital cardiac arrest (OHCA) outcomes in Japan, aiming to address a critical research gap. Analyzing data from the All-Japan Utstein registry covering pediatric OHCA cases from 2018 to 2021, the study observed no significant changes in one-month survival, neurological outcomes, or overall performance when comparing the pre-pandemic (2018–2019) and pandemic (2020–2021) periods among 6765 cases. However, a notable reduction in pre-hospital return of spontaneous circulation (ROSC) during the pandemic (15.1–13.1%, p = .020) was identified. Bystander-initiated chest compressions and rescue breaths declined (71.1–65.8%, 22.3–13.0%, respectively; both p < .001), while bystander-initiated automated external defibrillator (AED) use increased (3.7–4.9%, p = .029). Multivariate logistic regression analyses identified factors associated with reduced pre-hospital ROSC during the pandemic. Post-pandemic, there was no noticeable change in the one-month survival rate. The lack of significant change in survival may be attributed to the negative effects of reduced chest compressions and ventilation being offset by the positive impact of widespread AED availability in Japan. These findings underscore the importance of innovative tools and systems for safe bystander cardiopulmonary resuscitation during a pandemic, providing insights to optimize pediatric OHCA care

Basic Performance Evaluation of a Radiation Survey Meter That Uses a Plastic-Scintillation Sensor

After the Fukushima nuclear power plant accident in 2011, many types of survey meters were used, including Geiger–Müller (GM) survey meters, which have long been used to measure β-rays. Recently, however, a novel radiation survey meter that uses a plastic-scintillation sensor has been developed. Although manufacturers’ catalog data are available for these survey meters, there have been no user reports on performance. In addition, the performance of commercial plastic-scintillation survey meters has not been evaluated. In this study, we experimentally compared the performance of a plastic-scintillation survey meter with that of a GM survey meter. The results show that the two instruments performed very similarly in most respects. The GM survey meter exhibited count losses when the radiation count rate was high, whereas the plastic-scintillation survey meter remained accurate under such circumstances, with almost no count loss at high radiation rates. For measurements at background rates (i.e., low counting rates), the counting rates of the plastic-scintillation and GM survey meters were similar. Therefore, an advantage of plastic-scintillation survey meters is that they are less affected by count loss than GM survey meters. We conclude that the plastic-scintillation survey meter is a useful β-ray measuring/monitoring instrument

Evaluation of Lens Doses among Medical Staff Involved in Nuclear Medicine: Current Eye Radiation Exposure among Nuclear-Medicine Staff

The International Commission on Radiological Protection has lowered the annual equivalent eye-lens dose to 20 mSv. Although occupational exposure can be high in nuclear medicine (NM) departments, few studies have been conducted regarding eye-lens exposure among NM staff. This study aimed to estimate the annual lens doses of staff in an NM department and identify factors contributing to lens exposure. Four nurses and six radiographers performing positron emission tomography (PET) examinations and four radiographers performing radioisotope (RI) examinations (excluding PET) were recruited for this study. A lens dosimeter was attached near the left eye to measure the 3-mm-dose equivalent; a personal dosimeter was attached to the left side of the neck to measure the 1-cm- and 70-µm-dose equivalents. Measurements were acquired over six months, and the cumulative lens dose was doubled to derive the annual dose. Correlations between the lens and personal-dosimeter doses, between the lens dose and the numbers of procedures, and between the lens dose and the amounts of PET drugs (radiopharmaceuticals) injected were examined. Wilcoxon’s signed-rank test was used to compare lens and personal-dosimeter doses. The estimated annual doses were 0.93 ± 0.13 mSv for PET nurses, 0.71 ± 0.41 mSv for PET radiographers, and 1.10 ± 0.53 mSv for RI radiographers. For PET nurses, but not for PET or RI radiographers, there was a positive correlation between the numbers of procedures and lens doses and between amounts injected and lens doses. There was a significant difference between the lens and personal-dosimeter doses of PET nurses. The use of protective measures, such as shielding, should prevent NM staff from receiving lens doses > 20 mSv/year. However, depending on the height of the protective shield, PET nurses may be unable to assess the lens dose accurately using personal dosimeters