Madoka Inoue

Infant feeding practices and breastfeeding duration in Japan: A review

The Japanese health system places great emphasis on healthy development. However, the prevalence of Exclusive Breastfeeding at one month postpartum between 1980 and 2005 has remained unchanged, fluctuating between 42% and 49%. At the same time, the Any Breastfeeding prevalence has gradually increased from about 80% to 95%. In 2010, the latest national breastfeeding report showed that ‘exclusive’ and ‘any’ breastfeeding rates have improved. However, as the World Health Organization (WHO) definition of breastfeeding practices was not used in this study or in other national surveys, it is difficult to interpret these latest results. While the Japanese government has launched several promotion projects, there have been few studies and reviews of risk factors that influence breastfeeding duration. The objectives of this review were to summarise the factors that have influenced the duration of breastfeeding in Japan to provide information relevant to breastfeeding promotion programs. A search of electronic databases in Japanese and English was undertaken up to 2011. The inclusion criteria for this review were studies that focused on infant feeding practices and targeted Japanese mothers, fathers, or health professionals, but excluded mothers’ friends and peer groups. In total, 12 articles were selected for the final analysis. Smoking status, low birth weight of infants and maternal perceptions of insufficient breast milk supply were negative influences on breastfeeding duration, while support from husbands/partners is associated with continued breastfeeding. Some factors that have been found to be associated with breastfeeding in other countries, including maternal age, family income, maternal educational levels, and living with grandparents of infants have not been confirmed in Japan. While the national breastfeeding rates were higher than other countries of similar health status, inconsistent knowledge of breastfeeding benefits and inappropriate hospital practices remain in Japan may be associated with increased the use of infant formula and reduced breastfeeding duration. Most of the studies reviewed were cross-sectional in design, with only a limited number of cohort studies. Also many published studies used small sample sizes. Cohort studies of infant feeding practices with larger sample sizes are required to monitor trends in rates and risk factors for breastfeeding outcomes.

Introducing Solid Foods to Infants in the Asia Pacific Region

For infants’ optimal growth and development, the introduction of nutritionally suitable solid foods at the appropriate time is essential. However, less attention has been paid to this stage of infant life when compared with studies on breastfeeding initiation and duration. The practice of introducing solid foods, including the types of foods given to infants, in the Asia Pacific region was reviewed. In total nine studies using the same questionnaire on infant feeding practices were analysed to gain a better understanding of trends in the introduction of solid foods in this region. All studies showed less than optimal duration of exclusive breastfeeding indicating an earlier time of introduction of solid foods than recommended by the WHO. Most mothers commonly used rice or rice products as the first feed. In many studies, the timing of introducing solid foods was associated with breastfeeding duration. Compared with the Recommended Nutrient Intakes for infants aged above six months, rice/rice products are of lower energy density and have insufficient micronutrients unless they have been fortified. Although the timing of introducing solid foods to infants is important in terms of preventing later health problems, the quality of the foods should also be considered. Recommendations to improve the introduction of solid foods include measures to discourage prelacteal feeding, facilitating breastfeeding education and providing better information on healthier food choices for infants.

Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia from 1997 to 2014

AIM This study aims to describe and compare traumatic and medical out-of-hospital cardiac arrest (OHCA) occurring in Perth, Western Australia, between 1997 and 2014. METHODS The St John Ambulance Western Australia (SJA-WA) OHCA Database was used to identify all adult (≥ 16 years) cases. We calculated annual crude and age-sex standardised incidence rates (ASIRs) for traumatic and medical OHCA and investigated trends over time. RESULTS Over the study period, SJA-WA attended 1,354 traumatic OHCA and 16,076 medical OHCA cases. The mean annual crude incidence rate of traumatic OHCA in adults attended by SJA-WA was 6.0 per 100,000 (73.9 per 100,000 for medical cases), with the majority resulting from motor vehicle collisions (56.7%). We noted no change to either incidence or mechanism of injury over the study period (p>0.05). Compared to medical OHCA, traumatic OHCA cases were less likely to receive bystander cardiopulmonary resuscitation (CPR) (20.4% vs. 24.5%, p=0.001) or have resuscitation commenced by paramedics (38.9% vs. 44.8%, p<0.001). However, rates of bystander CPR and resuscitation commenced by paramedics increased significantly over time in traumatic OHCA (p<0.001). In cases where resuscitation was commenced by paramedics there was no difference in the proportion who died at the scene (37.2% traumatic vs. 34.3% medical, p=0.17), however, fewer traumatic OHCAs survived to hospital discharge (1.7% vs. 8.7%, p<0.001). CONCLUSIONS Despite temporal increases in rates of bystander CPR and paramedic resuscitation, traumatic OHCA survival remains poor with only nine patients surviving from traumatic OHCA over the 18-year period.

Description of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry

The present study aimed to describe and examine similarities and differences in the current service provision and resuscitation protocols of the ambulance services participating in the Aus‐ROC Australian and New Zealand out‐of‐hospital cardiac arrest (OHCA) Epistry. Understanding these similarities and differences is important in identifying ambulance service factors that might explain regional variation in survival of OHCA in the Aus‐ROC Epistry.

Incidence, characteristics and survival outcomes of out‐of‐hospital cardiac arrest in children and adolescents between 1997 and 2014 in Perth, Western Australia

The present study was to describe the trends in the incidence, characteristics and survival of paediatric out‐of‐hospital cardiac arrest (OHCA) over an 18 year period.

Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: Results from the Aus-ROC Epistry

INTRODUCTION The aim of this study was to investigate regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. METHODS This was a population-based cohort study of OHCA using data from the Aus-ROC Australian and New Zealand OHCA Epistry over the period of 01 January 2015-31 December 2015. Seven ambulance services contributed data to the Epistry with a capture population of 19.8 million people. All OHCA attended by ambulance, regardless of aetiology or patient age, were included. RESULTS In 2015, there were 19,722 OHCA cases recorded in the Aus-ROC Epistry with an overall crude incidence of 102.5 cases per 100,000 population (range: 51.0-107.7 per 100,000 population). Of all OHCA cases attended by EMS (excluding EMS-witnessed cases), bystander CPR was performed in 41% of cases (range: 36%-50%). Resuscitation was attempted (by EMS) in 48% of cases (range: 40%-68%). The crude incidence for attempted resuscitation cases was 47.6 per 100,000 population (range: 34.7-54.1 per 100,000 population). Of cases with attempted resuscitation, 28% survived the event (range: 21%-36%) and 12% survived to hospital discharge or 30 days (range: 9%-17%; data provided by five ambulance services). CONCLUSION In the first results of the Aus-ROC Australian and New Zealand OHCA Epistry, significant regional variation in the incidence, characteristics and outcomes was observed. Understanding the system-level and public health drivers of this variation will assist in optimisation of the chain of survival provided to OHCA patients with the aim of improving outcomes.

Association between ambulance dispatch priority and patient condition

To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition.

Lower chest compression fraction associated with ROSC in OHCA patients with longer downtimes

AIM To investigate the relationship between chest compression fraction (CCF) and survival outcomes in OHCA, including whether the relationship varied based upon downtime from onset of arrest to provision of cardiopulmonary resuscitation (CPR) by emergency medical services (EMS). METHODS Data from resuscitations performed by St John Ambulance Western Australia (SJA-WA) paramedics between July 2014 and June 2016 was captured using the Q-CPR feedback device. Logistic regression analysis was used to study the relationship between CCF and return of spontaneous circulation (ROSC). Various lengths of Q-CPR data were used ranging from the first 3min to all available episode data. Cases were subsequently divided into groups based upon downtime; ≤15min, >15min and unknown. Univariate and multivariable logistic regression analyses were performed in each group. RESULTS There were 341 cases eligible for inclusion. CCF >80% was significantly associated with decreased odds of ROSC compared to CCF≤80% (aOR: 0.49, 95%CI: 0.28-0.87). This relationship remained significant whether the first 3min of data was used, the first 5min or all available episode data. Among the group with a downtime >15min, CCF was significantly lower for those who achieved ROSC compared to those who did not (mean (SD): 73.01 (12.99)% vs. 83.05 (9.38)% p=0.002). The adjusted odds ratio for achieving ROSC in this group was significantly less with CCF>80% compared to CCF≤80% (aOR: 0.06, 95%CI: 0.01-0.38). CONCLUSION We demonstrated an inverse relationship between CCF and ROSC that varied depending upon the time from arrest to provision of EMS-CPR.

The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol

Introduction Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch. Methods and analysis A dataset of OHCA calls and their corresponding metadata will be analysed from an interdisciplinary perspective, combining linguistic analysis and health services research. The calls will be transcribed and coded for linguistic and interactional variables and then used to answer a series of research questions about the recognition of OHCA and the delivery of basic life-support instructions to bystanders. Linguistic analysis of calls will provide a deeper understanding of the interactional dynamics between caller and call-taker which may affect recognition and dispatch for OHCA. Findings from this research will translate into recommendations for modifications of the protocols for ambulance dispatch and provide directions for further research. Ethics and dissemination The study has been approved by the Curtin University Human Research Ethics Committee (HR128/2013) and the St John Ambulance Western Australia Research Advisory Group. Findings will be published in peer-reviewed journals and communicated to key audiences, including ambulance dispatch professionals.

15 The importance of staying on the call: recognition of cardiac arrest after initial dispatch

Aim We compared survival in out-of-hospital cardiac arrest (OHCA) cases recognised at initial dispatch (“primary recognition”) with those subsequently recognised as OHCA ?(“secondary recognition”) and those not recognised as OHCA (“non-recognition”). Methods We analysed cases of paramedic-confirmed OHCA in Perth, Western Australia (WA), from January 2014 to December 2015. We excluded traumatic OHCA, paramedic-witnessed arrests, and cases where paramedics did not attempt resuscitation. Emergency ambulance calls in WA are processed using the Medical Priority Dispatch System, via ProQA software. We analysed the ProQA data of each call for the presence of OHCA-specific dispatch codes (including code revisions) and call-taker instructions for cardiopulmonary resuscitation (CPR). Results Among 1430 cases of OHCA, 84% (n=1195) were recognised by call-takers as OHCA. Of the 1195 recognised cases, 32% (n=386) were identified through secondary recognition. Survival to 30 days was significantly higher among cases with secondary recognition (13.2%) than among cases with primary recognition (7.9%) and non-recognised cases (7.7%) (p=0.008). More than half of all cases of secondary recognition were initially dispatched as Unconscious/Fainting patient. Conclusion Nearly one third of call-taker recognition of OHCA occurs after initial dispatch. The higher survival probability of patients recognised by secondary recognition is consistent with those patients arresting more recently relative to the timing of the call. For many cases of OHCA, the call-taker’s ability to stay on the call and remain alert to the possibility of OHCA may strengthen the chain of survival. Conflict of interest A. Whiteside and D. Brink receive full salary support, and P. Bailey, M. Inoue and J. Finn receive partial salary support from St John Ambulance. Funding Funding for this research was received from an Australian NHMRC (National Health and Medical Research Centre) Partnership Project: #1076949 ‘Improving ambulance dispatch to time-critical emergencies’. J. Finn. and J. Bray receive partial salary support from the NHMRC ‘Aus-ROC’ Centre for Research Excellence #1029983. J. Bray receives salary support from an NHMRC/NHF (National Heart Foundation) Early Career Fellowship.