Akihito Hagihara

Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest

CONTEXT Epinephrine is widely used in cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA). However, the effectiveness of epinephrine use before hospital arrival has not been established. OBJECTIVE To evaluate the association between epinephrine use before hospital arrival and short- and long-term mortality in patients with cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Prospective, nonrandomized, observational propensity analysis of data from 417 188 OHCAs occurring in 2005-2008 in Japan in which patients aged 18 years or older had an OHCA before arrival of emergency medical service (EMS) personnel, were treated by EMS personnel, and were transported to the hospital. MAIN OUTCOME MEASURES Return of spontaneous circulation before hospital arrival, survival at 1 month after cardiac arrest, survival with good or moderate cerebral performance (Cerebral Performance Category [CPC] 1 or 2), and survival with no, mild, or moderate neurological disability (Overall Performance Category [OPC] 1 or 2). RESULTS Return of spontaneous circulation before hospital arrival was observed in 2786 of 15,030 patients (18.5%) in the epinephrine group and 23,042 of 402,158 patients (5.7%) in the no-epinephrine group (P < .001); it was observed in 2446 (18.3%) and 1400 (10.5%) of 13,401 propensity-matched patients, respectively (P < .001). In the total sample, the numbers of patients with 1-month survival and survival with CPC 1 or 2 and OPC 1 or 2, respectively, were 805 (5.4%), 205 (1.4%), and 211 (1.4%) with epinephrine and 18,906 (4.7%), 8903 (2.2%), and 8831 (2.2%) without epinephrine (all P <.001). Corresponding numbers in propensity-matched patients were 687 (5.1%), 173 (1.3%), and 178 (1.3%) with epinephrine and 944 (7.0%), 413 (3.1%), and 410 (3.1%) without epinephrine (all P <.001). In all patients, a positive association was observed between prehospital epinephrine and return of spontaneous circulation before hospital arrival (adjusted odds ratio [OR], 2.36; 95% CI, 2.22-2.50; P < .001). In propensity-matched patients, a positive association was also observed (adjusted OR, 2.51; 95% CI, 2.24-2.80; P < .001). In contrast, among all patients, negative associations were observed between prehospital epinephrine and long-term outcome measures (adjusted ORs: 1-month survival, 0.46 [95% CI, 0.42-0.51]; CPC 1-2, 0.31 [95% CI, 0.26-0.36]; and OPC 1-2, 0.32 [95% CI, 0.27-0.38]; all P < .001). Similar negative associations were observed among propensity-matched patients (adjusted ORs: 1-month survival, 0.54 [95% CI, 0.43-0.68]; CPC 1-2, 0.21 [95% CI, 0.10-0.44]; and OPC 1-2, 0.23 [95% CI, 0.11-0.45]; all P < .001). CONCLUSION Among patients with OHCA in Japan, use of prehospital epinephrine was significantly associated with increased chance of return of spontaneous circulation before hospital arrival but decreased chance of survival and good functional outcomes 1 month after the event.

Association between variants of mast cell chymase gene and serum IgE levels in eczema.

851 school children aged at 12–13 years including 145 with eczema were tested for genetic association to a mast cell chymase (MCC) genetic variant. MCC genotypes showed a strong association with eczema, but not with asthma and rhinitis. This association is strongest in eczematous children with lower serum total IgE levels. Independent of IgE responsiveness when total serum IgE of less than 500 IU/ml, MCC variants may play an important role in inflammatory skin disorders.

Geographic prediction of tuberculosis clusters in Fukuoka, Japan, using the space-time scan statistic

BackgroundTuberculosis (TB) has reemerged as a global public health epidemic in recent years. Although evaluating local disease clusters leads to effective prevention and control of TB, there are few, if any, spatiotemporal comparisons for epidemic diseases.MethodsTB cases among residents in Fukuoka Prefecture between 1999 and 2004 (n = 9,119) were geocoded at the census tract level (n = 109) based on residence at the time of diagnosis. The spatial and space-time scan statistics were then used to identify clusters of census tracts with elevated proportions of TB cases.ResultsIn the purely spatial analyses, the most likely clusters were in the Chikuho coal mining area (in 1999, 2002, 2003, 2004), the Kita-Kyushu industrial area (in 2000), and the Fukuoka urban area (in 2001). In the space-time analysis, the most likely cluster was the Kita-Kyushu industrial area (in 2000). The north part of Fukuoka Prefecture was the most likely to have a cluster with a significantly high occurrence of TB.ConclusionThe spatial and space-time scan statistics are effective ways of describing circular disease clusters. Since, in reality, infectious diseases might form other cluster types, the effectiveness of the method may be limited under actual practice. The sophistication of the analytical methodology, however, is a topic for future study.

Are lifetime prevalence of impetigo, molluscum and herpes infection really increased in children having atopic dermatitis?

BACKGROUND Cutaneous infections such as impetigo contagiosum (IC), molluscum contagiosum (MC) and herpes virus infection (HI) appear to be associated with atopic dermatitis (AD), but there are no reports of concrete epidemiological evidence. OBJECTIVE We evaluated the association of childhood AD with these infections by conducting a population-based cross-sectional study. METHODS Enrolled in this study were 1117 children aged 0-6 years old attending nursery schools in Ishigaki City, Okinawa Prefecture, Japan. Physical examination was performed by dermatologists, and a questionnaire was completed on each childs history of allergic diseases including AD, asthma, allergic rhinitis and egg allergy, and that of skin infections including IC, MC and HI, as well as familial history of AD. RESULTS In 913 children (AD; 132), a history of IC, MC or HI was observed in 45.1%, 19.7%, and 2.5%, respectively. Multiple logistic regression analysis revealed that the odds of having a history of IC were 1.8 times higher in AD children than in non-AD children. Meanwhile, a history of MC was significantly correlated to the male gender, but not to a personal history of AD. As for HI, we found no correlated factors in this study. CONCLUSIONS The lifetime prevalence of IC was indeed higher in young children with a history of AD.

Media suicide-reports, Internet use and the occurrence of suicides between 1987 and 2005 in Japan

BackgroundPrevious investigations regarding the effects of suicide reports in the media on suicide incidence in Japan have been limited and inconclusive and, although Internet use has greatly increased, its influence on suicide is completely unknown. Thus, the relationship between newspaper articles about suicide, Internet use, and the incidence of suicide in Japan was examined.MethodsA linear model was fitted to time series data from January 1987 to March 2005 (218 months).ResultsConsistent with previous findings, the number of newspaper articles about suicide was a predictor of suicide among both male and female subjects. Internet use was also a predictor of suicide among males, probably because males spent more time online than females.ConclusionBecause this is the first, preliminary study examining the association between Internet use and suicide, further research is required to verify the present findings.

Effects of weather variability on infectious gastroenteritis.

Although multiple combinations of weather variability may contribute to an increased incidence of infectious gastrointestinal disease, few studies have investigated the association between weather variability and cases of infectious gastroenteritis. We acquired data for infectious gastroenteritis cases and weather variability in Fukuoka, Japan, from 1999 to 2007 and used time-series analysis to assess the effects of weather variability on infectious gastroenteritis cases, adjusting for confounding factors. In total, 422,176 infectious gastroenteritis cases were reported during the 9-year study period. The weekly number of infectious gastroenteritis cases increased by 7.7% (95% CI 4.6-10.8) for every 1 degrees C increase in the average temperature and by 2.3% (95% CI 1.4-3.1) for every 1% decrease in relative humidity. From 1999 to 2007, infectious gastroenteritis cases increased significantly with increased average temperature and decreased relative humidity in Fukuoka, Japan.

Impact of weather factors on Mycoplasma pneumoniae pneumonia

Background: Although multiple combinations of weather factors may contribute to an increased incidence of Mycoplasma pneumoniae pneumonia, few studies have investigated the association between weather factors and cases of M pneumoniae pneumonia. Methods: Data on cases of M pneumoniae pneumonia and weather factors in Fukuoka, Japan from 1999 to 2007 were obtained and time-series analysis was used to assess the effects of weather variables on M pneumoniae pneumonia cases, adjusting for confounding factors. A total of 13 056 M pneumoniae pneumonia cases were reported during the 9-year study period, of which 12 234 (93.7%) were under 15 years of age. Results: The weekly number of M pneumoniae pneumonia cases increased by 16.9% (95% CI 11.3% to 22.8%) for every 1°C increase in the average temperature and by 4.1% (95% CI 2.7% to 5.5%) for every 1% increase in relative humidity. Conclusions: From 1999 to 2007, cases of M pneumoniae pneumonia increased significantly with increased average temperature and relative humidity in Fukuoka, Japan.

Spatial and temporal dynamics of influenza outbreaks.

Background: Annual influenza epidemics occur worldwide, resulting in considerable morbidity, mortality, and economic burden. Despite this regular occurrence, few studies have systematically examined the regional spatiotemporal patterns of influenza outbreaks. Methods: Weekly incidence data for influenza cases in Fukuoka Prefecture (Japan) from 29 August 2005 to 3 June 2007 (n = 113,503) were geocoded at sentinel medical institutions (mainly pediatric hospitals and clinics). Space-time permutation scan statistics were then used to identify weekly temporal and spatial clusters of reported cases of influenza during the 2006–2007 influenza season. Results: In the early phase of the influenza season, clusters were detected in the Fukuoka and Kitakyushu urban areas. The clusters then diffused gradually and spread into the rural areas of Fukuoka Prefecture. After a period of middle- to large-scale epidemic, the outbreak gradually waned. Conclusions: Based on the permutation model, space-time permutation scan statistics can play an important role in detecting influenza outbreaks at an early stage and identifying the spatiotemporal patterns of geographic spread.

Association between asthma and an intragenic variant of CC16 on chromosome 11q13

The β subunit of high affinity immunoglobulin E (IgE) receptor (FceRIβ) and the Clara cell derived inflammatory molecule, CC16 have been cited as candidate genes for atopic asthma on chromosome 11q13. A genetic association study was performed with an intragenic microsatellite repeat of CC16 gene on chromosome 11q12–13 in relation to atopic and non‐atopic asthma. Whereas variants of FceRIβ at chromosome 11q13 show association with atopy and asthma, no significant association was found between asthma and CC16 genotypes irrespective of atopic status. These data support the candidacy of FcsRIβ rather than CC16 for the atopic asthma locus on chromosome 11q.

Poor adherence to medication as assessed by the Morisky Medication Adherence Scale-8 and low satisfaction with treatment in 237 psoriasis patients

Previously we assessed the medication adherence for oral and topical remedies by a translated Japanese version of the Morisky Medication Adherence Scale‐8 (MMAS‐8) together with socioeconomic backgrounds in 3096 Japanese dermatological patients, and found the medication adherence, especially to topical drugs, was poor in these patients. In order to elucidate the disease‐specific sociomedical factors, we further sub‐analyzed the medication adherence in 237 psoriasis patients and compared it with that in other dermatological diseases such as atopic dermatitis, urticaria or tinea. This study was conducted among patients registered in monitoring system and 3096 eligible patients were enrolled. Our web‐based questionnaire included the following items such as age, sex, annual income, main health‐care institution, experience of effectiveness by oral or topical medication, overall satisfaction with treatment, and MMAS‐8 for oral or topical medication. Mean adherence score by MMAS‐8 was 5.2 for oral and 4.3 for topical medication. More patients with psoriasis used a university hospital and fewer used a private clinic compared with those with the other skin disease patients. Experience of drug effectiveness by oral medication and overall satisfaction with treatment was lower in psoriasis patients than in other patients. In oral medication, significantly better adherence was observed in those of higher age and with higher annual income. The adherence to medication, especially to topical drugs, was poor in 237 psoriasis patients. We speculated that some severe psoriasis patients were not sufficiently treated systemically and were resistant to topical therapy, leading to poor adherence.