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1.
Medicine (Baltimore) ; 99(1): e18687, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895836

RESUMO

The impact of time of day or day of week on the survival of emergency trauma patients is still controversial. The purpose of this study was to evaluate the outcomes of these patients according to time of day or day of week of emergency admission by using data from the nationwide Japan Trauma Data Bank (JTDB).This study enrolled 236,698 patients registered in the JTDB database from 2004 to 2015, and defined daytime as 09:00 AM to 16:59 PM and nighttime as 17:00 PM to 08:59 AM, weekdays as Monday to Friday, and weekends as Saturday, Sunday, and national holidays. The outcome measures were death in the emergency room (ER) and discharge to death.In total, 170,622 patients were eligible for our analysis. In a multivariable logistic regression adjusted for confounding factors, both death in the ER and death at hospital discharge were significantly lower during the daytime than at nighttime (623/76,162 [0.82%] vs 954/94,460 [1.01%]; adjusted odds ratio [AOR] 0.79; 95% confidence interval [CI] 0.71-0.88 and 5765/76,162 [7.57%] vs 7270/94,460 [7.70%]; AOR 0.88; 95% CI 0.85-0.92). In contrast, the weekdays/weekends was not significantly related to either death in the ER (1058/114,357 [0.93%] vs 519/56,265 [0.92%]; AOR 0.95; 95% CI 0.85-1.06) or death at hospital discharge (8975/114,357 [7.85%] vs 4060/56,265 [7.22%]; AOR 1.02; 95% CI 0.97-1.06).In this population of emergency trauma patients in Japan, both death in the ER and death at hospital discharge were significantly lower during the daytime than at night, but the weekdays/weekends was not associated with outcomes of these patients.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Adulto , Idoso , Serviços Médicos de Emergência/normas , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
J Cardiol ; 75(1): 97-104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31350130

RESUMO

BACKGROUND: The use of public-access automated external defibrillators (AEDs) has become common in Japan. To provide a strategy for appropriate public-access AED deployment, we assessed public-access defibrillation (PAD) by laypersons and the outcomes following out-of-hospital cardiac arrest (OHCA) among adult patients by location of arrest. METHODS: From a nationwide, prospective, population-based registry of patients after OHCA in Japan, we enrolled adult patients with bystander-witnessed OHCA of medical origin in public locations between 2013 and 2015. The primary outcome measure was one-month favorable neurological outcome defined by cerebral performance category 1 or 2. Factors associated with favorable neurological outcome after ventricular fibrillation (VF) were assessed by multivariable logistic regression analysis. RESULTS: A total of 20,970 adult bystander-witnessed OHCAs of medical origin occurred in public locations. Of those, the proportions of PAD by location were: 13.1% (757/5761) in public areas, 15.9% (333/2089) at workplaces, 26.0% (544/2095) in recreation/sports areas, 36.1% (112/310) in educational institutions, and 5.8% (241/4151) on streets/highways. In a multivariable analysis of VF arrests, both bystander cardiopulmonary resuscitation [adjusted odds ratio (AOR), 1.78; 95% confidence interval (CI), 1.54-2.07] and PAD (AOR, 2.33; 95% CI, 2.05-2.66), and emergency medical service (EMS) response time (AOR, 0.89; 95% CI, 0.87-0.90) were associated with improved outcomes. Earlier PAD initiated by bystanders before EMS arrival was also associated with better outcomes after OHCA. CONCLUSIONS: In Japan, where public-access AEDs are well-disseminated, the PAD program worked effectively for adult OHCA of medical origin occurring in public locations. Notably, the proportions of PAD differed substantially according to specific public locations.

3.
Medicine (Baltimore) ; 98(51): e18315, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860982

RESUMO

The incidence of breast cancer among Japanese women is substantially increasing. This study evaluated the effects of reproductive and lifestyle factors with respect to breast cancer overall and separately among pre- and postmenopausal women using data from the Three-Prefecture Cohort Study of Japan.A total of 33,410 women aged 40 to 79 years completed a self-administered questionnaire, which included items about menstrual and reproductive history and other lifestyle factors. The follow-up period was from 1984 to 1992 in Miyagi and 1985 to 2000 in Aichi Prefectures. We used Cox proportional hazards regression models to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) after adjusting for confounding factors.After 9.8 mean years of follow-up, 287 cases of breast cancer were recorded. In the overall analysis, later menarche (≥16 years) and parity were significantly associated with a decreased risk of breast cancer, with HRs of 0.69 (95% CI 0.48-0.99) and 0.72 (95% CI 0.52-0.99), respectively. Further, there was a significant decline in the risk of breast cancer with increasing number of birth among parous women (P for trend = .010). On the contrary, a family history of breast cancer in the mother was significantly associated with an increased risk of breast cancer (HR 3.22, 95% CI 1.52-6.84). Analyses based on menopausal status at baseline indicated that height (≥160 cm) and weight (≥65 kg) were significantly associated with an increased risk of postmenopausal breast cancer, with HRs of 1.34 (95% CI 0.72-2.50) and 3.13 (95% CI 1.75-5.60), respectively. Risk associated with BMI significantly differs by menopausal status.Our findings suggest the important role of reproductive factors in the development of breast cancer in Japanese women; however, body mass index (BMI) may have different effects on breast cancer in Japanese women compared with western women.


Assuntos
Neoplasias da Mama/etiologia , Adulto , Idoso , Índice de Massa Corporal , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Estilo de Vida , Anamnese , Menarca , Pessoa de Meia-Idade , Paridade , Fatores de Risco , Inquéritos e Questionários
4.
Artigo em Inglês | MEDLINE | ID: mdl-31478074

RESUMO

PURPOSE: Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among trauma patients. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan. METHODS: This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. We included trauma patients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. The main endpoint was the occurrence of meningitis during hospitalization. Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy. RESULTS: Among 60,390 head injury patients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio [AOR] 2.158 [95% confidence interval (CI) 1.401-3.325]), decompressive craniectomy (AOR 2.123 [95% CI 1.506-2.993]), external ventricular drainage (AOR 1.843 [95% CI, 1.157-2.935]), CSF leakage (AOR 3.328 [95% CI 2.205-5.022]), and basilar skull fracture (AOR 1.651 [95% CI 1.178-2.314]). CONCLUSIONS: In this population of trauma patients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis.

5.
Eur J Epidemiol ; 34(10): 917-926, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31392470

RESUMO

The aim of our study was to assess the association between green tea consumption and all-cause and cause-specific mortality in a pooled analysis of eight Japanese population-based cohort studies. Pooled hazard ratios (HR) and 95% confidence intervals (CI), derived from random effects models, were used to evaluate the associations between green tea consumption, based on self-report at baseline, and risk of all-cause and cause-specific mortality. During a mean follow-up of 17.3 years, among 313,381 persons, 52,943 deaths occurred. Compared with individuals who consumed < 1 cup/day, those in the highest consumption category (≥ 5 cups/day) had a decreased risk of all-cause mortality [the multivariate-adjusted HR was 0.90 (95% CI 0.87-0.94) for men and 0.82 (0.74-0.90) for women]. A similar inverse association was observed for heart disease mortality [HR 0.82 (0.75-0.90) for men, and 0.75 (0.68-0.84) for women], and cerebrovascular disease mortality [HR 0.76 (0.68-0.85) for men, and 0.78 (0.68-0.89) for women]. Among women, green tea consumption was associated with decreased risk of total cancer mortality: 0.89 (0.83-0.96) for the 1-2 cups/day category and 0.91 (0.85-0.98) for the 3-4 cups/day category. Results for respiratory disease mortality were [HR 0.75 (0.61-0.94)] among 3-4 cup daily consumers and [HR 0.66 (0.55-0.79)] for ≥ 5 cups/day. Higher consumption of green tea is associated with lower risk for all-cause mortality in Japanese, especially for heart and cerebrovascular disease. Moderate consumption decreased the risk of total cancer and respiratory disease mortality in women.


Assuntos
Causas de Morte , Mortalidade , Neoplasias/etiologia , Chá , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Neoplasias/epidemiologia , Estudos Prospectivos , Doenças Respiratórias/mortalidade , Fatores de Risco , Fatores Sexuais
6.
J Orthop Sci ; 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31255455

RESUMO

BACKGROUND: Shoulder and elbow examinations for pitchers have been performed in Japan's National High School Baseball Invitational Tournaments (NHSBITs) and National High School Baseball Championships (NHSBCs) since 1993. However, for years the results have not been analyzed. The purpose of this study was to evaluate changes in the condition of shoulders and/or elbows of pitchers from 1993 to 2016. MATERIALS AND METHODS: Pitchers in NHSBITs and NHSBCs, 1994-2016, were examined together with those who received a trial examination (Trial) in the NHSBC 1993. Shoulder and elbow symptoms were comprehensively graded into five categories; none, mild, moderate, severe and dysfunction. Standard plain radiographs of the shoulder and elbow were obtained. Average Annual Percent Changes (AAPCs) in the percentages of pitchers with symptoms and positive radiographic findings were analyzed. RESULTS: The percentages of pitchers with moderate or worse symptoms in the shoulder or elbow were 14.6% and 13.8%, respectively, in the Trial, 1.1% and 1.1% in NHSBITs and 1.3% and 2.0% in NHSBCs. The AAPC of pitchers with a symptomatic shoulder in NHSBITs was reduced over the study period, at -3.36% (P < 0.05), but that in NHSBCs was unchanged at -1.01%. The AAPCs of pitchers with a symptomatic elbow in NHSBITs and in NHSBCs decreased, at -3.13% and -3.33%, respectively (P < 0.05), while that of pitchers with residual apophyseal fragmentation at the ulnar collateral ligament insertion increased at +2.79% (P < 0.05). The decreased percentages of symptomatic pitchers suggest that joint condition is well controlled in high school days; however, the increased frequency of radiographic findings suggests the necessity of protection against overuse in younger players. CONCLUSIONS: The percentages of pitchers with symptomatic shoulders and elbows in NHSBITs and those with symptomatic elbows in NHSBCs have decreased over the 23 years. However, the increased frequency of residual medial humeral epicondyle apophyseopathy should be noted.

7.
Resuscitation ; 143: 165-172, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302105

RESUMO

OBJECTIVES: This study aimed to evaluate whether intra-aortic balloon pump (IABP) use in nontraumatic out-of-hospital cardiac arrest (OHCA) patients who achieved return of spontaneous circulation (ROSC) is associated with favorable neurological outcome after OHCA. BACKGROUND: The association between the IABP use in OHCA patients and favorable neurological outcome has not been extensively evaluated. METHODS: The Comprehensive Registry of Intensive Cares for OHCA Survival (CRITICAL) study, a multicenter, prospective observational registry in Osaka, Japan, included consecutive nontraumatic OHCA patients aged ≥18 years who achieved ROSC from July 2012 to December 2016. The primary outcome was 1-month survival with favorable neurological outcome. Logistic regression analysis was used to evaluate the association between the IABP use or non-IABP use and favorable neurological outcome using one-to-one propensity score (PS) matching analysis. RESULTS: Among the 2894 eligible patients, 10.4% used IABP, and 89.6% did not use IABP. In all patients, the proportion of 1-month survival with favorable neurological outcome was higher in the IABP use group than in the non-IABP use group (30.7% [92/300] vs. 13.2% [342/2594]). However, in PS-matched patients, the proportions of 1-month survival with favorable neurological outcome were almost consistent, and there were no significant differences between the IABP use group and the non-IABP use group (37.3% [59/158] vs. 41.1% [65/158]; adjusted odds ratio, 0.97; 95% confidence interval, 0.48-1.96). CONCLUSIONS: In this population, the current PS matching analysis did not reveal any association between the IABP use and 1-month survival with favorable neurological outcome among adult patients with ROSC after OHCA.

8.
JAMA Netw Open ; 2(5): e195111, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31150086

RESUMO

Importance: Bystander interventions are a factor for improving survival of out-of-hospital cardiac arrest (OHCA), but it is hypothesized that girls and women experiencing OHCA may be less likely to receive bystander interventions than boys and men. Objective: To investigate sex disparities in receiving public-access automated external defibrillator (AED) pad application and bystander-initiated cardiopulmonary resuscitation (CPR) among students who experienced OHCA in school settings. Design, Setting, and Participants: This nationwide cohort study used the Stop and Prevent Cardiac Arrest, Injury, and Trauma in Schools (SPIRITS) database to link databases from 2 nationally representative registries-the Injury and Accident Mutual Aid Benefit System of the Japan Sport Council and the All-Japan Utstein Registry of the Fire and Disaster Management Agency. Students from elementary schools (ages 6-12 years), junior high schools (ages 12-15 years), high schools (ages 15-21 years), and technical colleges (ages 15-21 years) who experienced nontraumatic OHCA involving attempted resuscitation by emergency medical service personnel or bystanders in school settings from April 1, 2008, to December 31, 2015, were included. Data analysis was performed from January 5, 2019, to April 11, 2019. Exposures: Sex and school level. Main Outcomes and Measures: Application of public-access AED pads or initiation of CPR by a bystander. Results: A total of 232 students who experienced OHCA with nontraumatic causes in school settings (mean [SD] age, 14.5 [2.9] years; 175 [75.4%] male) were included. In multivariable analysis of the full cohort of students who experienced OHCA, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (36 of 57 female students [63.2%] received AED pad application vs 141 of 175 male students [80.6%]; adjusted odds ratio [OR], 0.44; 95% CI, 0.20-0.97; P = .04). In the subgroup analysis of students who experienced OHCA in high schools or technical schools, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (10 of 18 female students [55.6%] vs 84 of 101 male students [83.2%]; adjusted OR, 0.26; 95% CI, 0.08-0.87; P = .03). Among the full cohort, 48 of 57 female students (84.2%) and 151 of 175 male students (86.3%) received CPR from bystanders (adjusted OR, 0.81; 95% CI, 0.30-2.22), and there were no significant differences in receiving bystander-initiated CPR between sexes, irrespective of school level. Conclusions and Relevance: Among students who experienced OHCA in schools in Japan, female sex was associated with lower odds of receiving public-access AED pad application compared with male sex.

9.
Eur Heart J Acute Cardiovasc Care ; : 2048872619848883, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31081678

RESUMO

BACKGROUND: Little is known about the association between serum potassium level on hospital arrival and neurological outcome after out-of-hospital cardiac arrest (OHCA). We investigated whether the serum potassium level on hospital arrival had prognostic indications for patients with OHCA. METHODS: This prospective, multicenter observational study conducted in Osaka, Japan (CRITICAL study) enrolled consecutive patients with OHCA transported to 14 participating institutions from 2012 to 2016. We included adult patients aged ⩾18 years with OHCA of cardiac origin who achieved return of spontaneous circulation and whose serum potassium level on hospital arrival was available. Based on the serum potassium level, patients were divided into four quartiles: Q1 (K ⩽3.8 mEq/L), Q2 (3.8< K⩽4.5 mEq/L), Q3 (4.5< K⩽5.6 mEq/L) and Q4 (K >5.6 mEq/L). The primary outcome was one-month survival with favorable neurological outcome, defined as cerebral performance category scale 1 or 2. RESULTS: A total of 9822 patients were registered, and 1516 of these were eligible for analyses. The highest proportion of favorable neurological outcome was 44.8% (189/422) in Q1 group, followed by 30.3% (103/340), 11.7% (44/375) and 4.5% (17/379) in the Q2, Q3 and Q4 groups, respectively ( p<0.001). In the multivariable analysis, the proportion of favorable neurological outcome decreased as the serum potassium level increased ( p<0.001). CONCLUSIONS: High serum potassium level was significantly and dose-dependently associated with poor neurological outcome. Serum potassium on hospital arrival would be one of the effective prognostic indications for OHCA achieving return of spontaneous circulation.

10.
Resuscitation ; 140: 150-158, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31075289

RESUMO

BACKGROUND: Our objective was to assess the characteristics such as public-access defibrillation (PAD) by laypersons and the outcomes after pediatric out-of-hospital cardiac arrest by location in the PAD era. METHODS: From a nationwide, prospective, population-based registry of out-of-hospital cardiac arrest patients in Japan, we enrolled consecutive pediatric patients aged ≤17 years before emergency medical service (EMS) arrival between 2013 and 2015. The primary outcome measure was 1-month survival, with favorable neurologic outcome defined as cerebral performance category 1 or 2. Factors associated with favorable neurologic outcome were assessed using multivariable logistic regression analysis. RESULTS: Among 3991 eligible pediatric out-of-hospital cardiac arrests, the proportion of PAD was 0.2% (5/2888) at residence, 1.6% (2/125) in public areas, 0.9% (3/321) on streets/highways, 21.6% (11/51) at recreation/sports event areas, 46.1% (82/178) at education institutions, and 1.2% (5/428) in others. In the multivariable analysis, arrest witnessed by family members (adjusted odds ratio [AOR], 5.25; 95% confidence interval [CI], 3.22-8.58) and nonfamily members (AOR, 2.45; 95% CI, 1.26-4.77), first documented ventricular fibrillation (AOR, 12.29; 95% CI, 7.08-21.35), PAD (AOR, 2.63; 95% CI, 1.23-5.62), and earlier EMS response time (AOR for 1-min increment, 0.88; 95% CI, 0.81-0.94) were associated with improving outcome. As for locations, recreation/sports event areas (AOR, 3.43; 95% CI, 1.17-10.07) and education institutions (AOR, 3.03; 95% CI, 1.39-6.63) were also associated with favorable neurologic outcome. CONCLUSIONS: In Japan, where public-access automated external defibrillators are well disseminated, characteristics such as PAD and outcomes for pediatric out-of-hospital cardiac arrest before EMS arrival differed substantially by location.

11.
Artigo em Inglês | MEDLINE | ID: mdl-31119320

RESUMO

PURPOSE: The aim of this study was to evaluate the association between the implementation of pelvic angiography (PA) and outcome in emergency pediatric patients with pelvic fracture. METHODS: We extracted data on pelvic fracture patients aged ≤ 19 years between 2004 and 2015 from a nationwide trauma registry in Japan. The main outcome was hospital mortality. We assessed the relationship between implementation of PA and hospital mortality using one-to-one propensity-score-matching analysis to reduce potential confounding effects in comparing the PA group with the non-PA group. RESULTS: In total, 1351 patients were eligible for our analysis, with 221 patients (16.4%) included in the PA group and 1130 patients (83.6%) included in the non-PA group. For all patients, the proportion of hospital mortality was higher in the PA group than in the non-PA group [13.6% (30/221) vs 7.1% (80/1130), crude odds ratio (OR) 2.062 (95% confidence interval (CI), 1.318-3.224); p = 0.002]. In the propensity-score-matched patients, the proportion of hospital mortality was lower in the PA group than in the non-PA group [10.5% (22/200) vs 18.2% (38/200), p = 0.027]. This finding was confirmed in both the multivariable logistic regression model [adjusted OR 0.392 (95% CI, 0.171-0.896); p = 0.026] and the conditional logistic regression model [conditional OR 0.484 (95% CI, 0.261-0.896); p = 0.021]. CONCLUSION: The implementation of PA was significantly associated with lower hospital mortality among emergency pediatric patients with pelvic fractures compared with the non-implementation of PA.

12.
J Epidemiol ; 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31105089

RESUMO

BackgroundLittle is known about the characteristics of emergency patients transported to hospital while participating in sports activity. Hence, we identified characteristics of emergency patients transported to hospital by emergency medical service (EMS) while participating in sports activity in Osaka City.MethodsPopulation-based ambulance records of Osaka Municipal Fire Department were reviewed. All sports-related emergency transport cases (i.e., patients experiencing external injury or illness during/immediately after participation in sports activity and then transported to hospital by the EMS) were enrolled, including both athletes and recreational sports participants. The study was performed from January 1, 2013 to December 31, 2015. Data of patient characteristics were described according to the type of sports.ResultsDuring the study, 661,190 patients required emergency transport in Osaka city; 2,642 (0.4%) were sports-related emergency transport, including 2,453 external injuries and 298 illnesses. Overall, 79.0% of patients were men and 44.4% were less than 18 years. Emergency transport during ball games accounts for the majority of cases (71.5%, 1888/2642), including baseball (n=380), soccer (n=368), and futsal (n=209). The leading diagnosis/symptom of external injury was fracture/bone contusion (n=701) and that of illness was heatstroke/dehydration (n=184). Serious acute illness, such as sudden cardiac arrest, accounted for 0.6% (16/2751) of all accidents, with half of them (n=8) related to long-distance running.ConclusionCharacteristics of sports-related accidents widely varied by type of sports. Measures to prevent serious accidents during sports activities should be established based on the information on patient characteristics of each type of sports.

13.
Resuscitation ; 140: 93-97, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31129227

RESUMO

BACKGROUND: It is recommended globally that shocks by automated external defibrillators (AEDs) should be delivered immediately when a shockable out-of-hospital cardiac arrest (OHCA) occurs. However, the actual time-interval from collapse to first shock by public-access AED and its impact on subsequent outcome has not been extensively investigated in real-world settings. METHODS: OHCA data from 2013 to 2015 were obtained from the All-Japan Utstein Registry. Bystander-witnessed OHCA patients with shockable rhythm who were shocked by public-access AED in public locations were included. The primary endpoint was 1-month survival with favourable neurological outcome, and the association between time-interval from collapse to first shock by public-access AED and subsequent outcome was assessed. RESULTS: During the study period, 28% (2282/8126) of bystander-witnessed OHCA cases with shockable rhythm were shocked by public-access AED in public locations. The proportion of OHCA patients who were shocked by public-access AED within 5 min from collapse was 58% (1323/2282). Among these patients, the proportion of 1-month survival with favourable neurological outcome was 62% (815/1317). The proportion significantly decreased with increased time from collapse to shock by public-access AED (48% for 6-10 min, 38% for 11-15 min, 30% for 16-20 min, and 7% for 21-25 min; p-for-trend <0.001), and no patient survived if shock delivery occurred more than 26 min after OHCA. CONCLUSION: In Japan, earlier shock by public-access AED led to better outcome after bystander-witnessed OHCA with shockable rhythm in public locations. However, the proportion of OHCA patients who received early shock was still low in public locations.

14.
Resuscitation ; 139: 33-40, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30953710

RESUMO

BACKGROUND: Sudden cardiac death during exercise or sports is an important problem among young athletes and non-athletes. An understanding of the epidemiological features of sports-related out-of-hospital cardiac arrest (OHCA) among children is crucial for planning approaches for prevention and better outcomes of paediatric OHCAs. We assessed the characteristics and outcomes of sports-related OHCA among children at schools in Japan to prevent sports-related paediatric OHCA at schools. METHODS: The Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a nationwide, prospective, observational study linking databases of two nationally representative registries. Data on the characteristics and outcomes of sports-related paediatric OHCA at schools in Japan were obtained from these databases. RESULTS: Between 2008 and 2015, 188 sports-related paediatric OHCAs due to presumed cardiac origin occurred. The greatest proportion of OHCA during or after sports was due to long-distance running (21.8%), followed by soccer/futsal (13.3%), basketball (12.2%), and baseball/rubber-ball baseball (11.2%). We also assessed the association between prehospital factors and one-month survival with favourable neurological outcome after sports-related OHCA. The proportions of ventricular fibrillation as the first documented rhythm, bystander cardiopulmonary resuscitation (CPR), and public-access defibrillation (PAD) were 87.8%, 87.2%, and 63.3%, respectively. Compared with the non-PAD group, the adjusted odds ratio (95% confidence interval) of the PAD group was 3.64 (1.78-7.45). CONCLUSIONS: In Japan, 188 schoolchildren experienced OHCAs of cardiac origin occurring during or after sports activity at schools during the 8-year period. Increasing PAD is essential to enhance better neurological outcome after sports-related OHCA among students.

15.
Prev Med ; 123: 270-277, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30951734

RESUMO

Coffee consumption is increasing globally. We aimed to assess the effect of coffee consumption on the risk of all-cause and cause-specific mortality in a pooled analysis of eight population-based cohort studies in Japan (Japan Cohort Consortium). Data came from eight Japanese cohort studies (144,750 men and 168,631 women). During a mean follow-up time of 17 years, 52,943 deaths occurred. More specifically, 19,495 cancer deaths, 7321 deaths due to heart disease, 6387 cerebrovascular, 3490 respiratory disease and 3382 injuries and accidents. A random effects model was applied to obtain pooled hazard ratios (HRs) and 95% confidence intervals (95%CIs). In both sexes, coffee consumption up to 5 cups/day was overall protective in relation to all-cause mortality, with the association attenuating in the highest category of coffee consumption (≥5 cups/day). In men, a similar inverse association was observed for major causes of mortality except cancer. In women, coffee consumption decreased the risk for mortality due to heart disease in the 1-2 cups/day category, but increased the risk in the ≥5 cups/day category. Coffee consumption was not associated with cancer in both sexes. Results were similar among male current smokers and female never-smokers. Based on available data, this pooled analysis suggests that coffee consumption under five cups per day may be beneficial for reducing the risk of mortality due to major causes.

16.
JAMA Netw Open ; 2(3): e191011, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30924892

RESUMO

Importance: Out-of-hospital cardiac arrest (OHCA) is a major public health issue, and in recent years, the number of OHCAs among the elderly population, aged 65 years or older, has significantly increased in developed countries. Objective: To evaluate the demographic and clinical characteristics and outcomes of patients 65 years or older who experienced OHCA based on the location-public, residential, or nursing home-where it occurred in Japan. Design, Setting, and Participants: This prospective, nationwide, population-based cohort study used information collected by the All-Japan Utstein Registry to examine data from 293 615 patients 65 years or older who experienced OHCA during the period from January 2013 to December 2015 in Japan. Data analyses were conducted from June to July 2018. Main Outcomes and Measures: The primary outcome was 1-month survival with a favorable outcome that was defined as a cerebral performance category score of 1 or 2 (1, good cerebral performance; 2, moderate cerebral disability; 3, severe cerebral disability; 4, coma or vegetative state; and 5, death or brain death). Multivariable logistic regression analyses were conducted to examine favorable outcome by location. Results: A total of 233 511 patients with OHCA were included in the final analysis; 29 911 (12.8%) occurred in a public location, 157 087 (67.3%) at a residential location, and 46 513 (19.9%) at a nursing home. The median age of the patients was 83.0 years (interquartile range, 76.0-88.0 years), and the proportion of men was 53.1% (124 108 of 233 511). The proportion of favorable neurologic outcomes was 4.5% (1351 of 29 911) in public locations, 1.0% (1555 of 157 087) in residential locations, and 0.6% (301 of 46 513) in nursing homes. Patients with cardiac arrests in public locations had a significantly higher likelihood of achieving a favorable neurologic outcome than those in residential locations (adjusted odds ratio, 1.36; 95% CI, 1.25-1.48), whereas those in nursing homes were less likely to achieve a favorable neurologic outcome (adjusted odds ratio, 0.62; 95% CI, 0.54-0.72). However, this difference in outcomes among patients based on location decreased with age. Conclusions and Relevance: The outcomes of patients 65 years or older after OHCA differed by the location of the cardiac arrest. These outcomes may be improved by updating existing response measures across all locations.


Assuntos
Parada Cardíaca Extra-Hospitalar , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Masculino , Casas de Saúde , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos , Logradouros Públicos
17.
Circ J ; 83(4): 757-766, 2019 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-30853684

RESUMO

BACKGROUND: Coffee, which contains various bioactive compounds, is one of the most popular beverages. Further accumulation of evidence is needed, however, to confirm whether coffee consumption would be effective in preventing cardiovascular disease in the general Japanese population. Methods and Results: We evaluated the association between coffee consumption frequency (never, sometimes, 1-2 cups/day, 3-4 cups/day and ≥5 cups/day) and mortality from all causes, heart disease, and cerebrovascular disease, in 39,685 men and 43,124 women aged 40-79 years at baseline, in a 3-prefecture cohort study. The coffee consumption frequency was assessed on questionnaire. Cox proportional hazards regression modeling was used to assess the association between coffee consumption frequency and all-cause and cardiovascular disease mortality with adjustment for potential confounders. During 411,341 and 472,433 person-years in men and women, respectively, a total of 7,955 men and 5,725 women died. Coffee consumption frequency was inversely associated with all-cause mortality in both genders (P for trend<0.001). In addition, the risks of mortality from cerebrovascular disease in men (P for trend<0.001), and heart disease in women (P for trend=0.031) were inversely associated with coffee consumption. CONCLUSIONS: In this Japanese population, coffee drinking has a preventive effect on all-cause and on cardiovascular mortality in men and/or women.

18.
BMJ Open ; 9(1): e025350, 2019 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-30700488

RESUMO

OBJECTIVE: Although it is important to assess prehospital factors associated with traffic crash fatalities to decrease them as a matter of public health, such factors have not been fully revealed. METHODS: Using data from the Japanese Trauma Data Bank, a large hospital-based trauma registry in Japan, we retrospectively analysed traffic crash patients transported to participating facilities that treated patients with severe trauma from 2004 to 2015. This study defined registered emergency patients whose systolic blood pressure was 0 mm Hg or heart rate was 0 bpm at hospital arrival as being in prehospital cardiopulmonary arrest (CPA). Prehospital factors associated with prehospital CPA due to traffic crash were assessed with multivariable logistic regression analysis. RESULTS: In total, 66 243 patients were eligible for analysis. Of them, 3390 (5.1%) patients were in CPA at hospital arrival. A multivariable logistic regression model showed the following factors to be significantly associated with prehospital CPA: ages 60-74 years (adjusted OR (AOR) 1.256, 95% CI 1.142 to 1.382) and ≥75 years (AOR 1.487, 95% CI 1.336 to 1.654), male sex (AOR 1.234, 95% CI 1.139 to 1.338), night-time (AOR 1.575, 95% CI 1.458 to 1.702), weekend including holiday (AOR 1.078, 95% CI 1.001 to 1.161), rural area (AOR 1.181, 95% CI 1.097 to 1.271), back seat passenger (AOR 1.227, 95% CI 0.985 to 1.528) and pedestrian (AOR 1.754, 95% CI 1.580 to 1.947) as types of patients. CONCLUSION: In this population, factors associated with prehospital CPA due to a traffic crash were elderly people, male sex, night-time, weekend/holiday, back seat passenger, pedestrian and rural area. These fundamental data may be of help in reducing and preventing traffic crash deaths.

19.
Am J Cardiol ; 123(7): 1060-1068, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30654927

RESUMO

Although majority of out-of-hospital cardiac arrests (OHCAs) occur in private residential locations, that is, at home, the details of emergency patients with OHCAs occurring at home have not been sufficiently investigated at the national level. We obtained data of OHCA cases from the All-Japan Utstein Registry, including detailed information of the location of cardiac arrest. Cases of OHCA occurring at home from 2013 to 2015 were included. Patient characteristics and outcomes after OHCA were described based on the location of cardiac arrest. During the 3-year study period, a total of 212,722 cases of OHCA were documented at home (186,219 in detached houses and 26,503 in multiple dwelling houses), and it accounted for 65.0% of all OHCA cases in Japan. The majority of OHCAs occurred in the living room/bedroom (67.7%), followed by the bathroom (12.9%), entrance/corridor (5.3%), and toilet (4.8%). The characteristics of OHCA at home, widely varied by location of cardiac arrest and residence type. The proportion of bystander-initiated cardiopulmonary resuscitations was less than half at all locations and ranged from 27.9% to 47.1%. The proportion of public-access defibrillation was also low regardless of the location of arrest and ranged from 0.0% to 0.2%. Consequently, the proportion of 1-month survival with favorable neurological outcome was low regardless of the location of arrest and ranged from 0.3% to 2.3%. In conclusion, OHCA occurrence at home accounted for approximately 2/3 of all OHCA cases in Japan, but their outcomes were extremely poor regardless of the location of cardiac arrest.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Vigilância da População , Sistema de Registros , Idoso , Reanimação Cardiopulmonar , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/terapia , Taxa de Sobrevida/tendências
20.
Acute Med Surg ; 6(1): 12-24, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30651993

RESUMO

Aim: To describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in-hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan. Methods: The Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on-scene emergency medical service personnel and has been accumulating all ambulance records. Since January 2015, medical institutions have obtained information on the diagnosis and outcome of patients transported to medical institutions, and the ORION system merged these data with ambulance records including smartphone app data. Results: From January 2015 to December 2016, 753,301 eligible patients were registered. The mean age was 58.7 years, and 51.5% of patients were male. After hospital arrival, 39.7% were hospitalized, 58.2% were discharged from hospital, 1.1% changed hospital, and 1.0% died. The most common diagnoses were injury, poisoning, and certain other consequences of external causes. Among the hospitalized patients, 29.2% were continuously hospitalized, 59.0% discharged, 5.2% changed hospital, and 5.8% were dead at 21 days after hospitalization. The most common confirmed diagnosis was diseases of the circulatory system. Conclusion: Using the ORION system developed and operated by Osaka Prefecture since January 2015, we described the epidemiological data of all emergency patients transported to emergency hospitals. Analysis using the ORION database in the future could lead to improvements in the emergency transport system and patient outcomes.

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