The great East Japan earthquake and out-of-hospital cardiac arrest

From N Engl J Med, Kitamura, T., Kiyohara, K., Sakai, and Iwami, T., The Great East Japan Earthquake and Out-of-Hospital Cardiac Arrest., 369, 22 Copyright ? 2013 Massachusetts Medical Society. Reprinted with permission.Correspondenc

Changes in the SF-8 scores among healthy non-smoking school teachers after the enforcement of a smoke-free school policy: a comparison by passive smoke status

<p>Abstract</p> <p>Background</p> <p>The effects of the enforcement of a smoke-free workplace policy on health-related quality of life (HRQOL) among a healthy population are poorly understood. The present study was undertaken to examine the effects of the enforcement of a smoke-free school policy on HRQOL among healthy non-smoking schoolteachers with respect to their exposure to passive smoke.</p> <p>Methods</p> <p>Two self-reported questionnaire surveys were conducted, the first before and the second after the enforcement of a total smoke-free public school policy in Nara City. A total of 1534 teachers were invited from 62 schools, and their HRQOL was assessed using six domains extracted from the Medical Outcomes Survey Short Form-8 questionnaire (SF-8): general health perception (GH), role functioning-physical (RP), vitality (VT), social functioning (SF), mental health (MH), and role functioning-emotional (RE). The participants were divided into two groups according to their exposure to environmental tobacco smoke (ETS) at baseline: participants not exposed to ETS at school (non-smokers), and participants exposed to ETS at school (passive smokers). Changes in each SF-8 score were evaluated using paired t-tests for each group, and their inter-group differences were evaluated using multiple linear regression analyses adjusted for sex, age, school type, managerial position, and attitude towards a smoke-free policy.</p> <p>Results</p> <p>After ineligible subjects were excluded, 689 teachers were included in the analyses. The number of non-smokers and passive smokers was 447 and 242, respectively. Significant changes in SF-8 scores were observed for MH (0.9; 95% confidence interval [CI], 0.2-1.5) and RE (0.7; 95% CI, 0.0-1.3) in non-smokers, and GH (2.2; 95% CI, 1.2-3.1), VT (1.8; 95% CI, 0.9-2.7), SF (2.7; 95% CI, 1.6-3.8), MH (2.0; 95% CI, 1.0-2.9), and RE (2.0; 95% CI, 1.2-2.8) in passive smokers. In the multiple linear regression analyses, the net changes in the category scores of GH (1.8; 95% CI, 0.7-2.9), VT (1.4, 95% CI, 0.3-2.5), SF (2.5; 95% CI, 1.1-3.9), MH (1.2; 95% CI, 0.1-2.4) and RE (1.6; 95% CI, 0.5-2.7) in passive smokers significantly exceeded those in non-smokers.</p> <p>Conclusions</p> <p>A smoke-free school policy would improve the HRQOL of healthy non-smoking teachers who are exposed to ETS.</p

Relief of Chronic Shoulder and Neck Pain by Electro-Acupuncture and Transcutaneous Electrical Nervous Stimulation: A Randomized Crossover Trial

Abstract Background: Chronic neck and shoulder pain is common and disabling. Objective: The aim of this study was to compare the effectiveness of electro-acupuncture and transcutaneous electrical stimulation (TENS) for relief of shoulder and neck pain. Materials and Methods: Design: This was a randomized crossover trial. Subjects: Ninety patients were enrolled, with a mean age of 34 years, and with females slightly outnumbering males. All subjects completed the study. Intervention: For electro-acupuncture, acupuncture needles were placed in four different acupoints in the trapezius muscle and each subject underwent a 15-minute session of low-frequency electrical stimulation. TENS treatment was similar and used as an active comparator, with a 2-week washout period between treatments. Outcome Measures: The primary outcome was reduction in pain as measured by a 100?cm visual analogue scale. Secondary outcomes included quality-of-life (QoL) measures. Results: Electro-acupuncture produced significantly greater reduction in pain than TENS did the first 2 days after treatment (p=0.001 and p=0.003, respectively), with pain decreasing from 56 to 33 and 34 versus from 55 to 42 and 42. Electro-acupuncture also produced a significant improvement in the vitality subscale of the Short Form-36. No adverse effects or carryover effect were detected. Conclusions: The results of this study offer preliminary evidence for the comparative effectiveness of electro-acupuncture over TENS for the acute relief of chronic shoulder and neck pain in adults.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98448/1/acu%2E2011%2E0824.pd

Characteristics and outcomes of emergency patients with self-inflicted injuries: A report from ambulance records in Osaka City, Japan

Background: Few studies have evaluated the actual situations of emergency patients with self-inflicted injuries treated by emergency-medical-service (EMS) personnel. Methods: This study retrospectively reviewed population-based ambulance records in Osaka City, Japan, between January 2010 and December 2012, and enrolled emergency patients who suffered from self-inflicted injuries such as poisoning by drugs or gas, cutting/piercing skin, jumping from heights, hanging, and drowning. The endpoint was the annual incidence per 100,000 populations in Osaka City of emergency patients who presented with self-inflicted injuries by age and sex. Their outcomes including deaths at the scene and hospital arrival were also evaluated. Results: During the study period, a total of 8,671 patients with 9,424 incidents of self-inflicted injuries were documented. The annual incidence of self-inflicted injuries was higher among women than men in the whole population and in the age group =50 years (49.0 versus 68.9, P < 0.001). The total number of self-inflicted deaths was 1,564 (16.6 %), and the overall proportion of self-inflicted deaths was greater among men than women (32.2 % [1075/3340] vs. 7.5 % [451/6027], P < 0.001). The proportion of self-inflicted hanging was 76.7 % [1142/1489], followed by poisoning by carbon monoxide at 57.1 % [56/98] and jumping to death at 47.6 % [254/534]. Discussion: Using large-scale EMS records, we investigated characteristics and outcomes of emergency patients with self-inflicted injuries treated by EMS personnel. Our findings suggested the gender paradox that the proportion of self-inflicted deaths was higher among men than women, while the proportion of non-fatal self-inflicted injuries was higher among women than among men, particularly in the group aged <=49 years. Our findings showing the importance of the prevention for self-inflicted injuries as well as the gender paradox of self-inflicted injuries will provide important epidemiological information to improve psychiatric cares in prehospital emergency settings. Conclusions: In the total population, the annual incidence of self-inflicted injuries responded to by EMS personnel was higher among women than among men. However, the proportion of self-inflicted deaths was greater among men than women, and the most frequent manner among deceased patients was by hanging.Matsuyama, T., Kitamura, T., Kiyohara, K. et al. Characteristics and outcomes of emergency patients with self-inflicted injuries: a report from ambulance records in Osaka City, Japan. Scand J Trauma Resusc Emerg Med 24, 68 (2016). https://doi.org/10.1186/s13049-016-0261-

Influence of COVID-19 pandemic on bystander interventions, emergency medical service activities, and patient outcomes in out-of-hospital cardiac arrest in Osaka City, Japan

Background: The coronavirus disease (COVID-19) pandemic may have negatively affected bystander interventions, emergency medical service (EMS) personnel activities, and patient outcomes after out-of-hospital cardiac arrest (OHCA). This study assessed bystander interventions, EMS activities, and patient outcomes during the COVID-19 pandemic era and compared them with those during the non-COVID-19 pandemic era in Osaka City, Japan, where public-access automated external defibrillators (AEDs) are well established. Methods: We conducted this population-based cohort study that included all cases with non-traumatic OHCA treated by EMS personnel and excluded cases with no resuscitation attempt, traumatic cases, cases occurring in healthcare facilities, or cases witnessed by EMS personnel. Data were compared between the COVID-19 pandemic period (February 1, 2020 to July 31, 2020) and the non-COVID-19 pandemic period (February 1, 2019 to July 31, 2019). Results: During the study periods, 1687 patients were eligible for analyses (COVID-19: n = 825; non-COVID-19: n = 862). Patients with OHCA during the COVID-19 pandemic period were significantly less likely to receive bystander cardiopulmonary resuscitation (CPR) (COVID-19: 33.0%; non-COVID-19: 41.3%; p < 0.001) and public-access AED pad application (COVID-19: 2.9%; non-COVID-19: 6.1%; p = 0.002) compared with patients during the non-COVID-19 pandemic period. There were no significant differences in 1-month survival with favorable neurological outcomes between the two periods (COVID-19: 4.6%; non-COVID-19: 6.1%; p = 0.196). Conclusion: The COVID-19 pandemic period did not affect patient outcomes after OHCA but changed bystander behaviors in Osaka City, Japan

Trends and characteristics of severe road traffic injuries in children: a nationwide cohort study in Japan

Purpose: The purpose of this study was to evaluate temporal trends of characteristics of severe road traffic injuries in children and identify factors associated with mortality using a nationwide database in Japan. Methods: We performed a retrospective analysis of Japan Trauma Data Bank (JTDB) from 2004 to 2018. We included patients with traffic injuries under the age of 18 who were hospitalized. The primary outcome was in-hospital mortality. We evaluated trends in characteristics and assessed factors associated with in-hospital mortality using a logistic regression analysis. Results: A total of 4706 patients were analyzed. The most common mechanism of injury was bicycle crash (34.4%), followed by pedestrian (28.3%), and motorcycle crash (21.3%). The overall in-hospital mortality was 11.2%. We found decreasing trends in motorcycle crash and in-hospital mortality and increasing trends in rear passenger seats in cars over the 15-year period. The following factors were associated with in-hospital mortality: car crash (aOR 1.69, 95%CI 1.18–2.40), pedestrian (aOR 1.50, 95%CI 1.13–1.99), motorcycle crash (aOR 1.42, 95%CI 1.03–1.95) [bicycle crash as a reference]; concomitant injuries to head/neck (aOR 5.06, 95%CI 3.81–6.79), thorax (aOR 2.34, 95%CI 1.92–2.87), abdomen (aOR 1.74, 95%CI 1.29–2.33), pelvis/lower-extremity (aOR 1.57, 95%CI 1.23–2.00), spine (aOR 3.01, 95%CI 2.02–4.43); and 5-year increase in time period (aOR 0.80, 95%CI 0.70–0.91). Conclusions: We found decreasing trends in motorcycle crash and in-hospital mortality, increasing trends in rear passenger seats in cars over the 15-year period, and factors associated with in-hospital mortality such as type of mechanisms and concomitant injuries. Strengthening child road safety measures, particularly for rear passenger seats in vehicles, is imperative to enhance our dedication to injury prevention.The version of record of this article, first published in European Journal of Trauma and Emergency Surgery, is available online at Publisher’s website: https://doi.org/10.1007/s00068-023-02372-

Delay of computed tomography is associated with poor outcome in patients with blunt traumatic aortic injury a nationwide observational study in Japan

Katayama, Yusuke MD, PhD; Kitamura, Tetsuhisa MD, DrPHb; Hirose, Tomoya MD, PhDa,c; Kiguchi, Takeyuki MD, PhD; Matsuyama, Tasuku MD, PhDe; Sado, Junya PhDb; Kiyohara, Kosuke DrPH; Izawa, Junichi MD, DrPH; Tachino, Jotaro MD; Ebihara, Takeshi MD; Yoshiya, Kazuhisa MD, PhD; Nakagawa, Yuko MD, PhD; Shimazu, Takeshi MD, PhDa Delay of computed tomography is associated with poor outcome in patients with blunt traumatic aortic injury, Medicine: August 2018 - Volume 97 - Issue 35 - p e12112 doi: 10.1097/MD.000000000001211

Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: Nationwide cohort study

Objective To determine survival associated with advanced airway management (AAM) compared with no AAM for adults with out-of-hospital cardiac arrest. Design Cohort study between January 2014 and December 2016. Setting Nationwide, population based registry in Japan (All-Japan Utstein Registry). Participants Consecutive adult patients with out-of-hospital cardiac arrest, separated into two sub-cohorts by their first documented electrocardiographic rhythm: shockable (ventricular fibrillation or pulseless ventricular tachycardia) and non-shockable (pulseless electrical activity or asystole). Patients who received AAM during cardiopulmonary resuscitation were sequentially matched with patients at risk of AAM within the same minute on the basis of time dependent propensity scores. Main outcome measures Survival at one month or at hospital discharge within one month. Results Of the 310 620 patients eligible, 8459 (41.2%) of 20 516 in the shockable cohort and 121 890 (42.0%) of 290 104 in the non-shockable cohort received AAM during cardiopulmonary resuscitation. After time dependent propensity score sequential matching, 16 114 patients in the shockable cohort and 236 042 in the non-shockable cohort were matched at the same minute. In the shockable cohort, survival did not differ between patients with AAM and those with no AAM: 1546/8057 (19.2%) versus 1500/8057 (18.6%) (adjusted risk ratio 1.00, 95% confidence interval 0.93 to 1.07). In the non-shockable cohort, patients with AAM had better survival than those with no AAM: 2696/118 021 (2.3%) versus 2127/118 021 (1.8%) (adjusted risk ratio 1.27, 1.20 to 1.35). Conclusions In the time dependent propensity score sequential matching for out-of-hospital cardiac arrest in adults, AAM was not associated with survival among patients with shockable rhythm, whereas AAM was associated with better survival among patients with non-shockable rhythm.Izawa Junichi, Komukai Sho, Gibo Koichiro, Okubo Masashi, Kiyohara Kosuke, Nishiyama Chika et al. Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: nationwide cohort study. BMJ 2019; 364 :l43

In-hospital extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest: an analysis by time-dependent propensity score matching using a nationwide database in Japan

院外心停止患者における膜型人工肺を活用した蘇生 --膜型人工肺を活用した蘇生と生存率向上との関連--. 京都大学プレスリリース. 2023-11-21.BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) has been proposed as a rescue therapy for patients with refractory cardiac arrest. This study aimed to evaluate the association between ECPR and clinical outcomes among patients with out-of-hospital cardiac arrest (OHCA) using risk-set matching with a time-dependent propensity score. METHODS: This was a secondary analysis of the JAAM-OHCA registry data, a nationwide multicenter prospective study of patients with OHCA, from June 2014 and December 2019, that included adults (≥ 18 years) with OHCA. Initial cardiac rhythm was classified as shockable and non-shockable. Patients who received ECPR were sequentially matched with the control, within the same time (minutes) based on time-dependent propensity scores calculated from potential confounders. The odds ratios with 95% confidence intervals (CI) for 30-day survival and 30-day favorable neurological outcomes were estimated for ECPR cases using a conditional logistic model. RESULTS: Of 57, 754 patients in the JAAM-OHCA registry, we selected 1826 patients with an initial shockable rhythm (treated with ECPR, n = 913 and control, n = 913) and a cohort of 740 patients with an initial non-shockable rhythm (treated with ECPR, n = 370 and control, n = 370). In these matched cohorts, the odds ratio for 30-day survival in the ECPR group was 1.76 [95%CI 1.38-2.25] for shockable rhythm and 5.37 [95%CI 2.53-11.43] for non-shockable rhythm, compared to controls. For favorable neurological outcomes, the odds ratio in the ECPR group was 1.11 [95%CI 0.82-1.49] for shockable rhythm and 4.25 [95%CI 1.43-12.63] for non-shockable rhythm, compared to controls. CONCLUSION: ECPR was associated with increased 30-day survival in patients with OHCA with initial shockable and even non-shockable rhythms. Further research is warranted to investigate the reproducibility of the results and who is the best candidate for ECPR