BACKGROUND: A comprehensive understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring under school supervision is lacking. We aimed to comprehensively describe the characteristics and outcomes of OHCA among students in elementary schools, junior high schools, high schools, and technical colleges in Japan. METHODS: OHCA data from 2008-2021 were obtained from the SPIRITS study, which provides a nationwide database of OHCAs occurring under school supervision across Japan. We included cases in which resuscitation was attempted by emergency medical service personnel or bystanders. The cases were classified into three groups based on their etiology: cardiac, non-cardiac, and traumatic origin. The primary outcome was one-month survival with favorable neurological outcomes, defined as a Glasgow-Pittsburgh cerebral performance category of 1 or 2. The demographic characteristics, event details, and outcomes were compared across the three groups by using χ² tests for categorical variables and one-way analyses of variance for continuous variables. RESULTS: During the 14-year study period, 602 OHCA cases were confirmed, with 430 (71.4%) classified as cardiac, 91 (15.1%) as non-cardiac, and 81 (13.5%) as traumatic origin. Non-cardiac and traumatic cases were less likely to be witnessed at the time of arrest (46.2% and 42.0%, respectively) than cardiac cases (82.6%; p < 0.001). Initiation of cardiopulmonary resuscitation by bystanders was less common in non-cardiac and traumatic cases (62.6% and 42.0%, respectively) than that in cardiac cases (82.8%; p < 0.001). The delivery of defibrillation using public-access automated external defibrillators was also significantly less frequent in non-cardiac (3.3%) and traumatic cases (6.2%) than that in cardiac cases (59.8%; p < 0.001). Ventricular fibrillation (VF) as the first documented rhythm was observed in 77.9% of cardiac cases but was much less common in non-cardiac (5.5%) and traumatic cases (8.6%; p < 0.001). One-month survival with favorable neurological outcomes was significantly lower in non-cardiac (6.6%) and traumatic cases (0%) than that in cardiac cases (50.2%; p < 0.001). CONCLUSIONS OHCAs of cardiac origin were more frequently associated with VF and had relatively good prognoses. In contrast, OHCAs of non-cardiac and traumatic origins consistently resulted in poor outcomes, highlighting the critical importance of prevention strategies to reduce the occurrence of these incidents.
Out-of-Hospital Cardiac Arrest/etiology* ; Humans ; Japan/epidemiology* ; Male ; Female ; Child ; Students/statistics & numerical data* ; Schools/statistics & numerical data* ; Adolescent ; Cardiopulmonary Resuscitation/statistics & numerical data* ; Emergency Medical Services/statistics & numerical data* ; Epidemiologic Studies

BACKGROUND: Difficulty awakening is a common concern among adolescents and contributes to school absenteeism. Although cross-sectional studies suggest that commuting times, internet usage, and sleep disturbances are associated with school attendance problems, few have specifically focused on adolescents. We aimed to examine the factors contributing to school absenteeism due to difficulty awakening in Japanese high school students. METHODS: In this longitudinal cohort study, data were prospectively collected between 2016 and 2018 from 54 high schools in a prefecture of Western Japan. Tenth-grade students (n = 6,121) without tardiness (n = 5,812) or absences (n = 5,946) at baseline were recruited. The outcome of interest was school absenteeism due to difficulty awakening, which included both tardiness and absences (≥2 days/month). Cox proportional hazards models were used to assess the associations between commuting time and lifestyle factors after adjusting for confounders. RESULTS: The incidence rates of tardiness and absences due to difficulty awakening were 19.3 and 9.6 per 1,000 person-years, respectively. Common risk factors for absenteeism included prolonged internet usage (≥5 h) and dissatisfaction with school. Protective factors for school tardiness included study time and participation in extracurricular sports activities (both ≥2 h). Long commuting time (≥1 h) was associated with a higher risk of school absences. CONCLUSIONS Long commuting times, prolonged internet usage, and poor school satisfaction increased the risk of school absenteeism due to difficulty awakening. Promoting academic engagement and extracurricular activities may help reduce absenteeism. Interventions that increase school satisfaction, such as providing learning opportunities outside of school, supporting extracurricular activities, and improving the school environment, may be effective prevention strategies.
Humans ; Absenteeism ; Japan/epidemiology* ; Adolescent ; Male ; Female ; Prospective Studies ; Schools/statistics & numerical data* ; Students/psychology* ; Longitudinal Studies ; Risk Factors ; Transportation/statistics & numerical data* ; East Asian People

OBJECTIVES: The prevalence of overweight and obesity among children and adolescents continues to rise, becoming one of the most serious global public health issues of the 21st century. Given the differing growth and development environments between urban and rural children, associated risk factors also vary. This study aims to explore the distribution characteristics and influencing factors of overweight and obesity among urban and rural primary and secondary school students in Hunan Province, providing scientific evidence for targeted interventions. METHODS: A stratified, randomized cluster sampling method was used to select participants. A total of 197 084 students from primary and secondary schools across 14 prefectures in Hunan Province underwent physical examinations and questionnaire surveys. Population and spatial distribution characteristics of overweight and obesity were analyzed. Spatial distribution maps and spatial autocorrelation analyses were conducted using ArcGIS. Multivariate Logistic regression was used to identify influencing factors for overweight and obesity. RESULTS: The overall overweight and obesity rates among students in Hunan Province were 14.7% and 10.9%, respectively. Both rates were higher in urban areas than in rural counties (16.0% vs 13.9% for overweight; 12.1% vs 10.2% for obesity). Among both urban and rural students, boys had higher rates of overweight and obesity than girls. Higher-grade students had a higher overweight rate but a lower obesity rate than lower-grade students. In urban areas, the overweight and obesity rates of Han Chinese primary and secondary school students are lower than those of ethnic minority students (both P<0.05). In rural areas, the obesity rate of Han primary and secondary school students is lower than that of ethnic students (P<0.05). Across cities and prefectures, urban overweight and obesity rates ranged from 14.7% to 18.7% and 8.4% to 20.6% respectively, while rural rates ranged from 10.9% to 17.2% and 6.6% to 13.7% respectively. Spatial autocorrelation analysis revealed high-value clusters of overweight/obesity in urban areas of Changde and Zhangjiajie, and in rural areas of Loudi, Huaihua, and Shaoyang. Multivariate Logistic regression showed that gender, school stage, ethnicity, frequency of fresh vegetable intake, and sleep duration were associated with overweight and/or obesity in both urban and rural students. In urban students, frequency of fried food and fresh fruit intake, breakfast habits, physical activity on weekdays and holidays, and screen time on computers were also significant. In rural students, TV viewing time and sedentary duration were additional relevant factors. CONCLUSIONS The situation of overweight and obesity among primary and secondary school students in Hunan Province remains concerning. Greater attention should be paid to regions with high-value clusters of overweight/obesity, and targeted interventions should be developed based on urban-rural differences in influencing factors.
Humans ; China/epidemiology* ; Adolescent ; Male ; Female ; Rural Population/statistics & numerical data* ; Child ; Overweight/epidemiology* ; Students/statistics & numerical data* ; Urban Population/statistics & numerical data* ; Risk Factors ; Prevalence ; Obesity/epidemiology* ; Surveys and Questionnaires ; Pediatric Obesity/epidemiology* ; Schools

OBJECTIVES: The detection rate of scoliosis among school-aged children has been rising annually, varying by region, and has become a major public health concern affecting both physical and mental health. Its onset is multifactorial, and early screening combined with targeted interventions can alter disease progression. This study aims to investigate the prevalence and influencing factors of scoliosis among primary and secondary school students in Hunan Province, providing scientific evidence for targeted prevention strategies. METHODS: A stratified, randomized cluster sampling method was used to select 281 401 students from 14 prefecture-level cities in Hunan Province for scoliosis screening, physical examination, and questionnaire survey. The chi-square test was used for group comparisons, and trend chi-square test analyzed differences in screening positive rate by age. A multilevel regression model was applied to identify influencing factors, and ArcGIS was used to visualize spatial distribution patterns of scoliosis. RESULTS: The overall screening positive rate for scoliosis among Hunan students was 1.61%. Urban areas had a significantly higher rate than rural counties (2.81% vs 0.98%; P<0.01). The rate was equal between boys and girls (1.61% each). Underweight students had a higher rate than those with normal weight, overweight, or obesity (P<0.01). Stratified by age, urban students aged 6-18 years consistently showed higher positive rates than rural peers (P<0.001). No significant gender differences were observed at most ages (all P>0.05), except at age 11, where the females had a higher rate (1.28% vs 1.02%; P=0.048). After age 11, underweight students exhibited significantly higher positive rates than those with normal or higher BMI(all P<0.05). Across all groups, urban/rural, male/female, underweight/normal/overweight/obese, the scoliosis rate increased with age. By region, the screening positive rate ranged from 0.38% to 3.36%, with the top three being Chenzhou (3.36%), Xiangtan (2.78%), and Hengyang (2.71%), while the lowest was Xiangxi Tujia and Miao Autonomous Prefecture (0.38%). Multilevel regression analysis revealed that age (OR=1.160, 95% CI 1.135 to 1.186) and urban residence (OR=2.497, 95% CI 1.946 to 3.205) were positively associated with scoliosis risk (both P<0.01). Conversely, female gender (OR=0.931, 95% CI 0.874 to 0.993), normal nutritional status (OR=0.751, 95% CI 0.671 to 0.840), overweight (OR=0.513, 95% CI 0.447 to 0.590), obesity (OR=0.418, 95% CI 0.358 to 0.489), and engaging in ≥ 60 minutes of moderate-to-vigorous physical activity 2 to 4 days (OR=0.928, 95% CI 0.865 to 0.996) or 5 to 7 days per week (OR=0.912, 95% CI 0.833 to 0.998) were negatively associated with scoliosis risk (all P<0.05). CONCLUSIONS The prevalence of scoliosis among primary and secondary school students in Hunan Province is relatively high and is significantly associated with age, gender, urban-rural status, nutritional condition, and physical activity frequency. Targeted interventions and enhanced monitoring in high-risk regions and populations are essential to prevent and control scoliosis.
Humans ; Scoliosis/epidemiology* ; Male ; Female ; Adolescent ; China/epidemiology* ; Prevalence ; Child ; Students/statistics & numerical data* ; Rural Population/statistics & numerical data* ; Urban Population/statistics & numerical data* ; Surveys and Questionnaires ; Risk Factors ; Thinness/epidemiology*

BACKGROUND: Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates. METHODS: Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being. RESULTS: 86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = -0.096, 95% CI -0.176, -0.033), multiple ACEs (β = -0.338, 95% CI -0.498, -0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being. CONCLUSIONS Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.
Adolescent ; Adult ; Adverse Childhood Experiences/statistics & numerical data* ; Cross-Sectional Studies ; Female ; Health Status ; Humans ; Latent Class Analysis ; Male ; Mental Health/statistics & numerical data* ; Models, Psychological ; Prevalence ; Stress, Psychological/psychology* ; Students/statistics & numerical data* ; Universities ; Young Adult

BACKGROUND: Regional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors' workload, wages, and popularity among medical students by city population sizes. METHODS: We targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents' monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital's information and each hospital's website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance. RESULTS: The average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas. CONCLUSIONS Hospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians' working conditions in Japan, and such disparities need to be corrected.
Cities/statistics & numerical data* ; Geography ; Hospitals, Teaching/statistics & numerical data* ; Japan ; Physicians/statistics & numerical data* ; Population Density ; Salaries and Fringe Benefits/statistics & numerical data* ; Students, Medical/psychology* ; Workload/statistics & numerical data*

BACKGROUND: Suicidal behaviors are seriously social issues among adolescents in the world. Exposed to smoking and being bullied are risk factors of suicidal behaviors. The present study was aimed to examine the interaction of smoking and being bullied on suicidal behaviors among Chinese adolescents. METHODS: A total of 18,900 students were involved in the questionnaire study, in four cities of China from November 2017 to January 2018. Suicidal behaviors, smoking, and being bullied were measured by self-reported validated instruments. Chi-square tests and logistic regression were used to analyze the associations of suicidal ideation (SI)/suicidal plan (SP)/suicidal attempt (SA), smoking, and being bullied. RESULTS: The prevalence of smoking, being bullied, SI/SP/SA, were 3.1%, 20.6%, 26.4%, 13.2%, and 5.2% respectively. Interaction analysis indicated that being bullied was associated with a greater increase in the likelihood of suicidal behaviors for adolescents with smoking than for those without smoking. CONCLUSIONS These finding suggest that smoking exacerbates the association between being bullied and suicidal behaviors. Future research should explore how and why smoking appears to more bully-victims than for those without smoking and how to mitigate it.
Adolescent ; Adolescent Behavior/psychology* ; Bullying/psychology* ; Child ; China/epidemiology* ; Cross-Sectional Studies ; Humans ; Prevalence ; Smoking/psychology* ; Students/statistics & numerical data* ; Suicidal Ideation

BACKGROUND: School closure is one of the main policies of global health care strategies performed worldwide. Despite all benefits, there might be some threats for younger groups spending their time in quarantine. This study aims to determine the impacts of lockdown and school closure on children's major lifestyle aspects, especially their leisure and sleep pattern during the COVID-19 pandemic. METHODS: For the purpose of this study, an online questionnaire was distributed from 14th to 31st of March 2020 among the schools and students from the first grade to the 12th grade (before university) in Fars province, southern Iran. The questionnaire consisted of five sections which included data regarding the students' general information, activity priorities, adherence to quarantine, attitude toward school closure, and sleep patterns. RESULTS: In our study, 20,697 filled questionnaires were received from the participants with an average age of 13.76 years; 29.7% of them were male, 80.6% were from urban areas, and 83.3% were from public schools. The overall first preference of students during school closure was mobile and computer games (30.1%), followed by studying (26.6%) and watching television (13.8%). Our results demonstrated that the majority of students adhered to social distancing and there was also a significant correlation among education levels and desire for schools to be closed till the end of the semester (P = 0.015). Also, regarding sleep patterns, the majority (53.5%) had above 12 h of sleep throughout the day. CONCLUSION It seems that lockdown following COVID-19 pandemic has changed various aspects of the students' lifestyle remarkably, especially by increasing screen time and even sleep duration and pattern. We believe that certain strategies should be implemented by the Health and Educational Ministry to control not only the visible side effects of the quarantine period, but also the collateral consequences on their psychological and mental health.
Adolescent ; COVID-19/psychology* ; Child ; Female ; Humans ; Iran/epidemiology* ; Life Style ; Male ; Quarantine/statistics & numerical data* ; SARS-CoV-2 ; Schools ; Sleep Hygiene ; Students/statistics & numerical data* ; Surveys and Questionnaires

BACKGROUND: This study aimed to develop an education system using DVD video-based teaching materials or web-based learning to reduce sexual violence among teens in Japan. METHODS: During the first stage, June 2018 to March 2019, an education program using DVD video teaching materials was carried out at three high schools and four universities with research consent from the director of the facility. From 1337 high school students and first- and second-year university students, subjects in their teen years were targeted for analysis. A survey was conducted at baseline and after the DVD video teaching. During the second stage, November 2019 to March 2020, web-based learning using improved video teaching materials was developed and carried out. From the adolescents who participated in the web-based learning, subjects in their teen years were targeted for analysis. A survey was conducted at baseline and after the web-based learning. RESULTS: In the first stage, 876 students consented to and participated in the education using DVD video teaching materials and baseline and after surveys (collection rate 65.5%). Among these, the number of respondents in their teens both baseline and after education was 705 persons (valid response rate 80.4%). In the second stage, the number of respondents in their teens both baseline and after education was 250 respondents in their teens who received web-based learning using the improved video teaching materials (valid response rate 87.1%). The improvement effect of the two programs was observed in attitudes that lead to physical violence, attitudes that lead to mental violence, attitudes that promote healthy conflict resolution, and dangerous attitudes that lead to sexual violence from persons in the community or through the Internet. The web-based learning program achieved an improvement of preventive attitudes toward sexual violence. CONCLUSIONS The education program using DVD video teaching materials or web-based learning may help prevent sexual violence among teens in Japan.
Adolescent ; Compact Disks ; Female ; Humans ; Internet ; Japan ; Male ; Sex Offenses/statistics & numerical data* ; Students ; Teaching Materials ; Video Recording

BACKGROUND: The 2019 novel coronavirus disease (COVID-19) emerges in China, which spreads rapidly and becomes a public health emergency of international concern. Chinese government has promptly taken quarantine measures to block the transmission of the COVID-19, which may cause deleterious consequences on everyone's behaviors and psychological health. Few studies have examined the associations between behavioral and mental health in different endemic areas. This study aimed to describe screen time (ST), physical activity (PA), and depressive symptoms, as well as their associations among Chinese college students according to different epidemic areas. METHODS: The study design is cross-sectional using online survey, from 4 to 12 February 2020, 14,789 college students accomplished this online study, participants who did not complete the questionnaire were excluded, and finally this study included 11,787 college students from China. RESULTS: The average age of participants was 20.51 ± 1.88 years. 57.1% of the college students were male. In total, 25.9% of college students reported depression symptoms. ST > 4 h/day was positively correlated with depressive symptoms (β = 0.48, 95%CI 0.37-0.59). COVID-19ST > 1 h/day was positively correlated with depressive symptoms (β = 0.54, 95%CI 0.43-0.65), compared with COVID-19ST ≤ 0.5 h/day. Compared with PA ≥ 3 day/week, PA < 3 day/week was positively associated with depression symptoms (β = 0.01, 95%CI 0.008-0.012). Compared with low ST and high PA, there was an interaction association between high ST and low PA on depression (β = 0.31, 95%CI 0.26-0.36). Compared with low COVID-19ST and high PA, there was an interaction association between high COVID-19ST and low PA on depression (β = 0.37, 95%CI 0.32-0.43). There were also current residence areas differences. CONCLUSIONS Our findings identified that high ST or low PA was positively associated with depressive symptoms independently, and there was also an interactive effect between ST and PA on depressive symptoms.
Adult ; COVID-19/psychology* ; China/epidemiology* ; Cross-Sectional Studies ; Depression/etiology* ; Exercise ; Female ; Humans ; Male ; Mental Health/statistics & numerical data* ; Screen Time ; Students/psychology* ; Time Factors ; Universities ; Young Adult