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: Pneumonia is a major global public health concern. Taking antioxidant nutrients has attracted attention for their potential role in reducing pneumonia mortality. Although studies in Western countries have evaluated this association, the current evidence remains controversial, and research in Asia remains limited. This cohort study investigated the association between dietary antioxidant nutrients intake and pneumonia mortality in Japanese population. METHODS: Data were collected from the Japan Public Health Center-based Prospective Study between 1995 and 1998, with follow-up until the end of 2018. The intake of antioxidant nutrients was assessed using a validated food-frequency questionnaire. The Cox proportional hazard model was employed to calculate hazard ratios (HRs) and p-trends for pneumonia mortality, adjusting for potential confounding factors including age, area, body mass index, smoking status, alcohol intake, physical activity, postmenopausal status, occupation, coffee intake, green tea intake, antihypertensive medication use, vitamin-supplement use, and total energy intake. RESULTS: The analysis included data from 39,850 men and 46,705 women. Over a median follow-up of 20.8 years, 813 men and 477 women died from pneumonia. The multivariable model revealed that a higher intake of cryptoxanthin (p-trend = 0.027 in men; 0.019 in women), lycopene (p-trend = 0.016 in women), vitamin C (p-trend = 0.022 in men), and vitamin E (p-trend = 0.031 in women) was significantly associated with a reduction in pneumonia mortality. CONCLUSIONS Higher dietary intake of cryptonxanthin, lycopene, and vitamins C and E was associated with a low risk of pneumonia mortality in Japanese adults.
Humans ; Male ; Japan/epidemiology* ; Female ; Prospective Studies ; Middle Aged ; Pneumonia/mortality* ; Antioxidants/administration & dosage* ; Diet/statistics & numerical data* ; Aged ; Adult ; Nutrients ; East Asian People

Objective: We investigated the possible association between lower serum lactate to albumin ratio upon hospital arrival and out-of-hospital cardiac arrest (OHCA) outcome. Methods: Records from the Japanese Association for Acute Medicine–Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry were used for this multicenter observational study. Enrolled patients were ≥18 years old with OHCA of medical etiology who were hospitalized after spontaneous circulation returned between June 1, 2014, and December 31, 2021. We excluded those with missing data or those who failed to meet predefined inclusion criteria. The primary outcome was a cerebral performance category scale of 1 or 2 which indicated 30-day survival with favorable neurological outcome. Patients were divided into quartiles based on serum lactate to albumin ratios. The multivariable logistic regression analysis included adjustment for multiple factors. Results: Data from 4,413 patients were analyzed. The primary outcome was achieved by 558 of 1,104 patients (50.5%) in the first quartile (lactate to albumin ratio, ≤2.23), 240 of 1,111 patients (21.6%) in the second quartile (lactate to albumin ratio >2.23–3.39), 96 of 1,096 patients (8.8%) in the third quartile (lactate to albumin ratio >3.39–4.70), and 24 of 1,102 patients (2.2%) in the fourth quartile (lactate to albumin ratio, >4.70). Adjusted odds ratios (95% confidence intervals) for the primary outcome in the second, third, and fourth quartile compared with the first quartile were 0.33 (0.26–0.42), 0.19 (0.14–0.26), and 0.07 (0.04–0.11), respectively. Conclusion A statistically significant association between categorization in the lower lactate to albumin ratio quartile group and favorable neurological outcome after OHCA was identified.

BACKGROUND: The association between meat, fish, or fatty acid intake and acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) has been investigated in a few studies, and the results were inconsistent. In addition, most studies are mainly based on the United States and European countries, in which the dietary patterns differ from that in Asia. Therefore, the risk of AML/MDS from meat, fish, or fatty acid intake in Asia requires further exploration. The aim of this study was to investigate the association between AML/MDS incidence and meat, fish, or fatty acid intake using the Japan Public Health Center-based prospective study. METHODS: The present study included 93,366 participants who were eligible for analysis and followed up from the 5-year survey date until December 2012. We estimated the impact of their intake on AML/MDS incidence using a Cox proportional hazards model. RESULTS: The study participants were followed up for 1,345,002 person-years. During the follow-up period, we identified 67 AML and 49 MDS cases. An increased intake of processed red meat was significantly associated with the incidence of AML/MDS, with a hazard ratio of 1.63 (95% confidence interval, 1.03-2.57) for the highest versus lowest tertile and a P_trend of 0.04. Meanwhile, the intake of other foods and fatty acids was not associated with AML/MDS. CONCLUSION In this Japanese population, processed red meat was associated with an increased incidence of AML/MDS.
Animals ; Japan/epidemiology* ; Prospective Studies ; Incidence ; Public Health ; Meat/adverse effects* ; Fatty Acids/adverse effects* ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes/epidemiology*

Objective：It is often difficult to provide effective functional training in patients with severe attention deficit caused by organic damage to the brain. Herein, we report a case of attention deficit in a patient with subarachnoid hemorrhage, which was successfully treated by virtual reality (VR)-guided rehabilitation.Methods：A 71-year-old woman was transferred to our hospital for rehabilitation after a subarachnoid hemorrhage. The patient suffered from severe attention deficit. She was unable to follow instructions from therapists and was unable to concentrate on rehabilitation tasks. We attempted VR-guided rehabilitation using mediVR KAGURA (mediVR, Toyonaka, Japan) in order to improve her attention deficit. The training was performed approximately 20 min every weekday, for 4 months in a 360-degree VR environment, with no background image initially. The difficulties in physical and cognitive tasks were adjusted by focusing on the size, range of appearance, and falling speed of each task object, so that even patients with severe attention deficit could respond to these tasks appropriately.Results：After the above-mentioned VR-guided training, the trail making test A, behavioral inattention test, and moss attention rating scale were improved from 300 s (could not complete the test）to 100 s, 119 to 133, and 55 to 98, respectively. In addition, in the clinical assessment for attention, the time required for visual obliteration tests was significantly shortened, and clinical symptoms associated with attention deficit were also improved clinically.Conclusion：VR-guided rehabilitation has the potential to be used as a new therapeutic approach to improve attention deficit.

Objective：It is often difficult to provide effective functional training in patients with severe attention deficit caused by organic damage to the brain. Herein, we report a case of attention deficit in a patient with subarachnoid hemorrhage, which was successfully treated by virtual reality (VR)-guided rehabilitation.Methods：A 71-year-old woman was transferred to our hospital for rehabilitation after a subarachnoid hemorrhage. The patient suffered from severe attention deficit. She was unable to follow instructions from therapists and was unable to concentrate on rehabilitation tasks. We attempted VR-guided rehabilitation using mediVR KAGURA (mediVR, Toyonaka, Japan) in order to improve her attention deficit. The training was performed approximately 20 min every weekday, for 4 months in a 360-degree VR environment, with no background image initially. The difficulties in physical and cognitive tasks were adjusted by focusing on the size, range of appearance, and falling speed of each task object, so that even patients with severe attention deficit could respond to these tasks appropriately.Results：After the above-mentioned VR-guided training, the trail making test A, behavioral inattention test, and moss attention rating scale were improved from 300 s (could not complete the test) to 100 s, 119 to 133, and 55 to 98, respectively. In addition, in the clinical assessment for attention, the time required for visual obliteration tests was significantly shortened, and clinical symptoms associated with attention deficit were also improved clinically.Conclusion：VR-guided rehabilitation has the potential to be used as a new therapeutic approach to improve attention deficit.