Masao Ichikawa

Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study.

Objectives To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest. Design Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score. Setting Japan’s nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010. Participants Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT. Main outcome measures Overall and neurologically intact survival at one month or at discharge, whichever was earlier. Results After propensity matching, pre-hospital administration of adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT. Conclusions Pre-hospital administration of adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal.

Reconsidering the Effects of Blue-light Installation for Prevention of Railway Suicides

BACKGROUND A recent preliminary communication suggested that the calming effect of blue lights installed at the ends of railway platforms in Japan reduced suicides by 84%. This estimate is potentially misleading from an epidemiological point of view and is reconsidered in the present study. METHODS Governmental data listing all railway suicide attempts in Japan from April 2002 to March 2012 were used to investigate the proportion of suicide attempts within station premises, where blue lights are potentially installed, and at night, when they would be lit. For those suicide attempts within station premises, we also estimated the proportion that occurred at the ends of the platforms at night. RESULTS Of 5841 total reported suicide attempts, 43% occurred within the station premises, 43% occurred at night (from 18:00 to 05:59), and 14% occurred both within the station premises and at night. Of the 2535 attempts within station premises, 32% occurred at night and 28% at most were at the end of a platform at night. LIMITATIONS The exact proportion of nighttime suicide attempts at the ends of railway platforms was not calculable. Nonetheless, the proportion of suicide attempts that is potentially preventable by blue lights should be less than our conservative estimate. CONCLUSIONS The installation of blue lights on platforms, even were they to have some effect in preventing railway suicides at night, would have a much smaller impact than previously estimated.

Car seatbelt use during pregnancy in Japan: determinants and policy implications

Context: Pregnant women are exempted from the current seatbelt legislation in Japan despite the fact that seatbelt use is essential to reduce the risk of fatalities for these women and their fetuses in car crashes. Objective: To examine factors that might influence seatbelt use during pregnancy. Methods: A cross sectional study, with data collected via an anonymous, self administered questionnaire at obstetric clinics in suburban areas of Japan. Altogether 880 pregnant women receiving prenatal care in July 2001 were recruited. The relative effects of factors that might influence seatbelt use during pregnancy were estimated using logistic regression analysis. Results: Almost 70%–80% of pregnant women were consistent seatbelt wearers before pregnancy but seatbelt compliance was reduced by about half at 20 weeks or more gestation. Only 20% had received information on maternal seatbelt use, with one third reporting that seatbelt use is beneficial during pregnancy. Those who perceived that maternal seatbelt use is beneficial tended to maintain use, but daily car users and those who knew that they were exempted from seatbelt legislation were more likely to reduce use. Conclusions: Knowledge of the legislative exemption for pregnant women, misunderstanding of the benefits, and daily car use contributed to the reduction in seatbelt use after pregnancy.

Feasibility of standardized injury surveillance and reporting: a comparison of data from four Asian nations

Background: To address the increasing number of injuries in developing countries, the World Health Organization (WHO) encourages the establishment of hospital-based surveillance systems and systematic data collection. Although a computerized system is preferable in terms of efficiency, many developing countries have difficulty accessing the appropriate resources. Objectives: To assess the possibility of comparing and sharing data among countries, and then to discuss the possibility of establishing an international data management system through the internet. Methods: A point-by-point comparison of data directories from injury surveillance systems in Thailand, Cambodia, Sri Lanka, and Japan was conducted using guidelines published by WHO as the standard. Results: Thailand, Cambodia, and Sri Lanka used data items that are comparable to each other and to WHO guidelines, with few, readily amenable, differences. The Japanese system used quite different data items. Conclusions: Data comparability suggests the feasibility of a global data management system that can store data from various countries. Such a system, if made accessible over the internet, would benefit resource-constrained countries by providing them with a ready-made framework to implement a surveillance system at low cost.

Population strategies and high-risk-individual strategies for road safety in Japan

OBJECTIVES We examined road safety policies and trends in road traffic injuries (RTIs) in Japan between 1970 and 2008 from the viewpoints of population and high-risk-individual approaches to see what lessons can be learned from the example of a country that experienced a decline in RTIs following comprehensive road safety policies. METHODS We reviewed research papers and policy documents, obtained from relevant ministries, decade by decade. We obtained data on RTIs from police and from vital statistics. RESULTS Japan started the Fundamental Traffic Safety Program to combat the increase in RTIs, and succeeded in reducing both RTI mortality and morbidity rates in the 1970s by implementing vast road safety improvements, using population approaches with a particular focus on protecting the most vulnerable population groups at that time. However, RTIs increased again in the 1980s because of increasing traffic volume. In the 1990s and 2000s, safety policies targeted at high-risk driving behaviors succeeded in reducing RTI mortality rates but failed to change morbidity rates. CONCLUSIONS To achieve a safer road environment, more emphasis is required on population approaches that reduce risk among the whole population, with a balance between population and high-risk-individual approaches.

Effects of Increasing Child Restraint Use in Reducing Occupant Injuries Among Children Aged 0–5 Years in Japan

Objectives: In Japan, child restraint use among preschool children started to increase before compulsory child restraint use for children aged 0–5 years was introduced by legislation in April 2000. This study determined the effects of increased child restraint use in reducing motor vehicle occupant injuries among children aged 0–5 years. Methods: We obtained monthly police data of child vehicle occupant injuries from 1990 to 2009. We calculated monthly ratios of morbidity rates per population of children aged 0–5 years to those of children aged 6–9 years. Time trends of the morbidity rate ratios were analyzed using a joinpoint regression model to determine whether there were trend changes in child occupant injuries and when they occurred if there were trend changes. Results: The morbidity rate ratios showed a slightly increasing trend of 0.03% per month (95% confidence interval [CI], −0.02% to 0.09%) until the change-point in December 1997 (95% CI, July 1996 to January 1999), which then changed to a decreasing trend of −0.14% per month (95% CI, −0.16 to −0.11), with an overall trend change of −0.17% (95% CI, −0.23 to −0.11). No change-point was identified in or around April 2000 when compulsory restraint use was introduced. Conclusions: The present study used comparative indicators relative to age groups that were not covered by the legislation and showed that a decreasing trend of occupant morbidity among children aged 0–5 years started before the introduction of compulsory restraint use. This change probably reflects the prelegislative voluntary increase in child restraint use.

Seatbelt legislation in Japan: high risk driver mortality and seatbelt use

Objectives: To clarify why seatbelt legislation did not achieve the expected reduction in mortality in Japan. Location and background: Seatbelt legislation was enacted in Japan in September 1985 and penalties were introduced in November 1986. Methods: The driver deaths per vehicle km traveled (D/VKT) were calculated to adjust for changes in traffic volume. Decreases in D/VKT were compared with the reduction expected after legislation. The association between percentage changes of driver D/VKT, seatbelt use rate, and seatbelt non-use rate were explored. Deaths of passengers, pedestrians, and cyclists were also examined. Mortality data were obtained from vital statistics, traffic volume figures from the Ministry of Land, Infrastructure, and Transport, and seatbelt use rates from the National Police Agency. Results: Although the decrease in D/VKT after the law was enforced was larger than the absolute number of deaths, it was far less than predicted. The percentage decrease in seatbelt non-use rate showed the strongest correlation with the percentage decrease in driver mortality. Mortality did not increase among other road users after the law was enacted. Conclusion: Accurate evaluation of the effect of seatbelt legislation must take into account changes in traffic volume. The selective recruitment hypothesis—that high risk drivers were less responsive to seatbelt legislation—fits well with the findings. There was no conclusive evidence supporting risk compensation—that is, an increase in injuries among other road users.

Effects of High-Profile Collisions on Drink-Driving Penalties and Alcohol-Related Crashes in Japan

Background Japanese road traffic law was amended in 2002 and 2007 to increase the penalties for drink-driving in response to media coverage, publicity campaigns, and debates following high-profile alcohol-related motor-vehicle crashes in 1999 and 2006. Objective To test the hypothesis that the proportion of crashes involving drink-driving started to decline before the law amendments, because of changes in social norms and driver behaviour after the high-profile crashes. Methods In order to assess the impact of the cases in 1999 and 2006, time-series analyses were used to examine the trends in the proportion of crashes involving drink-driving, and whether there were abrupt changes in the level or slope at the expected time points, using monthly police data for the period between January 1995 and December 2008. Results In 1999, the proportion of alcohol-related fatal crashes in which the driver had a blood alcohol concentration (BAC) ≥0.5 mg/ml started to decline with a slope change of −0.09 percentage points per month (95% CI −0.15 to −0.03) but no level change, whereas there were no changes for drivers with a BAC <0.5. In 2006, the trends for drivers with a BAC ≥0.5 or <0.5 showed significant level declines of −3.1 (−5.0 to −1.2) and −1.7 (−2.5 to −0.9) percentage points, respectively, but no slope changes. Conclusions Media coverage of high-profile crashes, and subsequent publicity campaigns and debates might have altered social norms and driver behaviour, reducing the proportion of alcohol-related crashes before the introduction of more severe penalties for drink-driving.

Drowning deaths among Japanese children aged 1-4 years: different trends due to different risk reductions

Drowning, once by far the most important external cause of child deaths in Japan,1 has reduced more rapidly than other injuries. Drowning mortality of children aged 1–4 years decreased from 45.4 per 100 000 in 1955, 4.5 times higher than that of traffic injuries, to 1.6 per 100 000 (ranking next to traffic injuries) in 2000. We could have achieved this by two main approaches: (1) environmental modification to reduce exposure to open water where most outdoor drownings occur2 and (2) health education to reduce risk of bathtub drowning, which causes most of the domestic drownings.2,3 To know how these approaches contributed to the mortality reduction, we separately examined the trends of outdoor and domestic drowning mortality among children aged 1–4 years. Data on drowning deaths …

Roadside observation of secondary school students' commuting to school in Vientiane, Laos

To investigate modes of secondary school students’ commuting to school and their unsafe driving practices in Laos, we conducted a roadside observation in front of the gate of a selected school in central Vientiane in December 2011. Of the 544 students observed, the majority came to school on foot (43%), followed by motorcycle (36%), and bicycle (14%). Of the 195 students who commuted by motorcycle, 45 (23%) drove it themselves. Of the 150 students who commuted as pillion riders, 35 (23%) were driven by a student or another child driver. The prevalence of helmet use among students (3%) was much lower than adults (66%). It was common for adult drivers to wear a helmet but to leave student pillion riders unhelmeted on the same motorcycle. Carrying two or three pillion riders was also often observed. The study revealed the necessity for measures to promote safe travel to school.