九州大学 研究者情報
論文一覧
永田 高志(ながた たかし) データ更新日:2020.06.23

助教 /  医学研究院 先端医療医学部門 先端医療医学


原著論文
1. Takashi Nagata, Stephanie N. Rosborough, Michael J. Vanrooyen, Shuichi Kozawa, Takashi Ukai, Shinichi Nakayama, Express railway disaster in amagasaki
A review of urban disaster response capacity in Japan, Prehospital and disaster medicine, 10.1017/S1049023X0000399X, 21, 5, 345-352, 2006.01, [URL], Introduction: On the morning of 25 April 2005, a Japan Railway express train derailed in an urban area of Amagasaki, Japan. The crash was Japan's worst rail disaster in 40 years.This study chroniclesthe rescue efforts and highlights the capacity of Japan's urban disaster response.Methods: Public reports were gathered from the media, Internet, government, fire department, and railway company. Four key informants, who were close to the disaster response, were interviewed to corroborate publicdata and highlight challenges facing the response.Results: The crash left 107 passengers dead and 549 injured. First responders, most of whom were volunteers, were helpful in the rescue effort, and no lives were lost due to transport delays or faulty triage. Responders criticized an early decision to withdraw rescue efforts, a delay in heliport set-up, the inefficiency of the information and instruction center, and emphasized the need for training in confined space medicine. Communication and chain-of-command problems created confusion at the scene.Conclusions: The urban disaster response to the train crash in Amagasaki was rapid and effective.The KobeEarthquake and other incidents sparked changes that improved disaster preparedness in Amagasaki. However, communication and cooperation among responders were hampered, as in previous disasters, by the lack of a structured command system. Application of an incident command system may improve disaster coordination in Japan..
2. Takashi Nagata, David Hemenway, Melissa J. Perry, The effectiveness of a new law to reduce alcohol-impaired driving in Japan, Japan Medical Association Journal, 49, 11-12, 365-369, 2006.11, Objectives: To estimate the impact of a new traffic law targeting alcohol-impaired driving in Japan. Methods: Japan passed a new traffic law in June 2002 with the aim of reducing the incidence of alcohol-impaired driving by reducing the permissible blood alcohol level and increasing penalties. Using data collected from police reports, the number of traffic fatalities and injuries for 7 months in the pre-law period (June 2001 to December 2001) and the same 7 months in the post-law period (June 2002 to December 2002) were compared. Results: Traffic fatalities decreased 7.8% and traffic fatalities involving alcohol-impaired driving decreased 26.7% after the introduction of the new traffic law. Traffic fatalities had been falling since 1993, but fell substantially faster after the law was passed. Conclusions: This study indicates that large, immediate public health benefits resulted from the implementation of the 2002 alcohol-impaired driving law in Japan..
3. Takashi Nagata, S. Setoguchi, D. Hemenway, M. J. Perry, Effectiveness of a law to reduce alcohol-impaired driving in Japan, Injury Prevention, 10.1136/ip.2007.015719, 14, 1, 19-23, 2008.02, [URL], Objective: To estimate the effect of a new road traffic law against alcohol-impaired driving in Japan. Methods: Japan passed a new road traffic law in June 2002 intended to reduce alcohol-impaired driving by decreasing the permissible blood alcohol level and by increasing penalties. Using data collected from police reports, the number of traffic fatalities and injuries were analyzed by time series. Results: Simple comparisons of the average of all severe traffic injuries, traffic fatalities, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven showed reductions after enactment of the new road traffic law in June 2002. The rate of alcohol-related traffic fatalities per billion kilometers driven decreased by 38% in the post-law period. In segmented regression analyses with adjustment for baseline trends, seasonality, and autocorrelation, all traffic injuries, severe traffic injuries, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven declined significantly from baseline after the new traffic law. Conclusion: Large, immediate public health benefits resulted from the new road traffic law in Japan..
4. Takashi Nagata, S. Setoguchi, D. Hemenway, M. J. Perry, Effectiveness of a law to reduce alcohol-impaired driving in Japan (Inj Prev) (2008) 14, 19-23, Injury Prevention, 10.1136/ip.2007.015719.corr1, 14, 4, 280, 2008.08, [URL].
5. Masami Ishii, Takashi Nagata, Emergency medicine in Japan, Japan Medical Association Journal, 52, 4, 211-213, 2009.07.
6. Takashi Nagata, Hajime Uno, Melissa J. Perry, Clinical consequences of road traffic injuries among the elderly in Japan, BMC Public Health, 10.1186/1471-2458-10-375, 10, 2010.07, [URL], Background. Road traffic injuries among the elderly have recently become a public health issue; therefore, we investigated the clinical characteristics of such injuries among the elderly in Japan. Methods. A retrospective study was performed using data from a medium-sized hospital emergency department. Data were extracted from medical records for one year, and patients were categorized into groups ages 18-64, 65-74 and 75+. Variables included demographic characteristics, injury circumstances, and nature of injury. Univariate and bivariate descriptive statistical analyses were performed, and multivariate logistic regression was used to evaluate injury severity and hospital admission by age groups. Results. A total of 1,656 patients were studied. Patients aged 65+ had more chest wall injury, intracranial injury, lower extremity fracture, and intrathoracic injury than patients aged 18-64. Conclusions. Injury circumstances and nature of injuries associated with traffic incidents showed different patterns by age groups, particularly among the elderly..
7. Takashi Nagata, Ayako Takamori, Yoshinari Kimura, Akio Kimura, Makoto Hashizume, Shinji Nakahara, Trauma center accessibility for road traffic injuries in Hanoi, Vietnam, Journal of Trauma Management and Outcomes, 10.1186/1752-2897-5-11, 5, 1, 2011.09, [URL], Background: Rapid economic growth in Vietnam over the last decade has led to an increased frequency of road traffic injury (RTI), which now represents one of the leading causes of death in the nation. Various efforts toward injury prevention have not produced a significant decline in the incidence of RTIs. Our study sought to describe the geographic distribution of RTIs in Hanoi, Vietnam and to evaluate the accessibility of trauma centers to those injured in the city.Methods: We performed a cross-sectional study using Hanoi city police reports from 2006 to describe the epidemiology of RTIs occurring in Hanoi city. Additionally, we identified geographic patterns and determined the direct distance from injury sites to trauma centers by applying geographical information system (GIS) software. Factors associated with the accessibility of trauma centers were evaluated by multivariate regression analysis.Results: We mapped 1,271 RTIs in Hanoi city. About 40% of RTIs occurred among people 20-29 years of age. Additionally, 63% of RTIs were motorcycle-associated incidents. Two peak times of injury occurrence were observed: 12 am-4 pm and 8 pm-0 am. "Hot spots" of road traffic injuries/fatalities were identified in the city area and on main highways using Kernel density estimation. Interestingly, RTIs occurring along the two north-south main roads were not within easy access of trauma centers. Further, fatal cases, gender and injury mechanism were significantly associated with the distance between injury location and trauma centers.Conclusions: Geographical patterns of RTIs in Hanoi city differed by gender, time, and injury mechanism; such information may be useful for injury prevention. Specifically, RTIs occurring along the two north-south main roads have lower accessibility to trauma centers, thus an emergency medical service system should be established..
8. Masami Ishii, Takashi Nagata, Katsuhito Aoki, Japan Medical Association's actions in the Great Eastern Japan Earthquake, World Medical and Health Policy, 10.2202/1948-4682.1210, 3, 4, 2011.12, [URL], A complex disaster struck eastern Japan on March 11, 2011. The Great Eastern Japan Earthquake consisted of a large-scale earthquake, tsunami, and nuclear accident and resulted in extensive damage and loss of life. In response to the disaster, the Japan Medical Association (JMA) initiated the dispatch of disaster medical teams, JMATs, to affected areas through prefectural medical associations. JMA relief efforts did not end with coordinating JMAT operations: autopsies, medical supply transport, and advocating for healthcare for evacuees and survivors were other major efforts of the JMA following "3.11". The JMA's healthcare support in Fukushima and other prefectures was unique and effective. However, the JMA recognizes the need for continued planning and preparation for disaster response and relief because of Japan's high risk for future disasters. Thus, current priorities of the JMA are the restoration of the healthcare system in disaster-affected areas and preparation for future disasters..
9. Akihito Hagihara, Manabu Hasegawa, Takeru Abe, Takashi Nagata, Yoshifumi Wakata, Shogo Miyazaki, Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest, JAMA - Journal of the American Medical Association, 10.1001/jama.2012.294, 307, 11, 1161-1168, 2012.03, [URL], 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 anOHCAbefore 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..
10. Takashi Nagata, Yoshinari Kimura, Masami Ishii, Use of a geographic information system (GIS) in the medical response to the Fukushima nuclear disaster in Japan, Prehospital and disaster medicine, 10.1017/S1049023X1200060X, 27, 2, 213-215, 2012.04, [URL], The Great East Japan Earthquake occurred on March 11, 2011. In the first 10 days after the event, information about radiation risks from the Fukushima Daiichi nuclear plant was unavailable, and the disaster response, including deployment of disaster teams, was delayed. Beginning on March 17, 2011, the Japan Medical Association used a geographic information system (GIS) to visualize the risk of radiation exposure in Fukushima. This information facilitated the decision to deploy disaster medical response teams on March 18, 2011..
11. Takeru Abe, Takashi Nagata, Manabu Hasegawa, Akihito Hagihara, Life support techniques related to survival after out-of-hospital cardiac arrest in infants, Resuscitation, 10.1016/j.resuscitation.2012.01.024, 83, 5, 612-618, 2012.05, [URL], Aim of the study: The incidence rate of out-of-hospital cardiac arrest (OHCA) among infants is high; however, little is known about effective life-support for this group. Thus, we examined factors related to 1-month survival after OHCA among infants. Methods: All infant OHCA cases occurring between 2005 and 2008 in Japan were extracted from the National Utstein Registry. Split-half random sampling and signal detection analysis were used to identify the effective factors on 1-month survival after OHCA. Results: The mutual interaction of life support techniques and other factors were identified and used to divide the study population into five subgroups. A witness to the cardiac arrest, rescue breathing administered by a bystander, and less than 18. min to hospital arrival or a witness to the arrest, no rescue breathing and less than 7. min for the ambulance to arrive at the scene were found to be related to higher survival after OHCA in infants. The survival proportions for these subgroups were 44.83% (95% CI: 25.58-64.08) and 19.18% (95% CI: 14.64-23.72), respectively. Conclusion: The probability of survival after OHCA in infants may be improved by a bystander witnessing the arrest and providing the rescue breathing at the first sight of arrest..
12. Akihito Hagihara, Takeru Abe, Takashi Nagata, In reply, JAMA - Journal of the American Medical Association, 10.1001/jama.2012.5944, 308, 1, 30-31, 2012.07, [URL].
13. Takashi Nagata, Ayako Takamori, Hans Yngve Berg, Marie Hasselberg, Comparing the impact of socio-demographic factors associated with traffic injury among older road users and the general population in Japan, BMC Public Health, 10.1186/1471-2458-12-887, 12, 1, 2012.10, [URL], Background: The increasing number of older road users represents a public health issue because older individuals are more susceptible to traffic injury and mortality than the general population. This study investigated the association between socio-demographic factors and traffic injury and traffic mortality for the general population and among older road users in Japan. Methods. An ecological study was conducted using national data in Japan. Multivariate regression methods were applied to investigate the association of traffic injury and traffic mortality for the general population and among older road users with significant demographic, economic, road traffic, and medical/cultural factors. Results: Income per capita, total road length, and alcohol consumption per person were significantly associated with traffic injury and traffic mortality both for the general population and among older road users in Japan. Income per capita and alcohol consumption per person were negatively associated with traffic mortality for both groups. Meanwhile, for both groups, income per capita was positively associated with traffic injury, while total road length and alcohol consumption per person were negatively associated with traffic injury. Conclusions: The effects of socio-demographic factors on traffic injury and traffic mortality in Japan were similar for both the general population and older road users. The study results suggest that injury preventive measures designed for the general population will be beneficial also for older road users in Japan..
14. Takashi Nagata, John Halamka, Shinkichi Himeno, Akihiro Himeno, Hajime Kennochi, Makoto Hashizume, Using a cloud-based electronic health record during disaster response
a case study in Fukushima, March 2011., Unknown Journal, 10.1017/S1049023X1300037X, 28, 4, 383-387, 2013.01, [URL], Following the Great East Japan Earthquake on March 11, 2011, the Japan Medical Association deployed medical disaster teams to Shinchi-town (population: approximately 8,000), which is located 50 km north of the Fukushima Daiichi nuclear power plant. The mission of the medical disaster teams sent from Fukuoka, 1,400 km south of Fukushima, was to provide medical services and staff a temporary clinic for six weeks. Fear of radiation exposure restricted the use of large medical teams and local infrastructure. Therefore, small volunteer groups and a cloud-hosted, web-based electronic health record were implemented. The mission was successfully completed by the end of May 2011. Cloud-based electronic health records deployed using a "software as a service" model worked well during the response to the large-scale disaster..
15. Akihito Hagihara, Manabu Hasegawa, Takeru Abe, Yoshifumi Wakata, Takashi Nagata, Yoshihiro Nabeshima, Prehospital Lactated Ringer's Solution Treatment and Survival in Out-of-Hospital Cardiac Arrest
A Prospective Cohort Analysis, PLoS Medicine, 10.1371/journal.pmed.1001394, 10, 2, 2013.03, [URL], Background: No studies have evaluated whether administering intravenous lactated Ringer's (LR) solution to patients with out-of-hospital cardiac arrest (OHCA) improves their outcomes, to our knowledge. Therefore, we examined the association between prehospital use of LR solution and patients' return of spontaneous circulation (ROSC), 1-month survival, and neurological or physical outcomes at 1 month after the event. Methods and Findings: We conducted a prospective, non-randomized, observational study using national data of all patients with OHCA from 2005 through 2009 in Japan. We performed a propensity analysis and examined the association between prehospital use of LR solution and short- and long-term survival. The study patients were ≥18 years of age, had an OHCA before arrival of EMS personnel, were treated by EMS personnel, and were then transported to hospitals. A total of 531,854 patients with OHCA met the inclusion criteria. Among propensity-matched patients, compared with those who did not receive pre-hospital intravenous fluids, prehospital use of LR solution was associated with an increased likelihood of ROSC before hospital arrival (odds ratio [OR] adjusted for all covariates [95% CI] = 1.239 [1.146-1.339] [p<0.001], but with a reduced likelihood of 1-month survival with minimal neurological or physical impairment (cerebral performance category 1 or 2, OR adjusted for all covariates [95% CI] = 0.764 [0.589-0.992] [p = 0.04]; and overall performance category 1 or 2, OR adjusted for all covariates [95% CI] = 0.746 [0.573-0.971] [p = 0.03]). There was no association between prehospital use of LR solution and 1-month survival (OR adjusted for all covariates [95% CI] = 0.960 [0.854-1.078]). Conclusion: In Japanese patients experiencing OHCA, the prehospital use of LR solution was independently associated with a decreased likelihood of a good functional outcome 1 month after the event, but with an increased likelihood of ROSC before hospital arrival. Prehospital use of LR solution was not associated with 1-month survival. Further study is necessary to verify these findings. Please see later in the article for the Editors' Summary..
16. Masami Ishii, Takashi Nagata, The Japan medical association's disaster preparedness
Lessons from the great east japan earthquake and tsunami, Disaster Medicine and Public Health Preparedness, 10.1017/dmp.2013.97, 7, 5, 507-512, 2013.10, [URL], A complex disaster, the Great East Japan Earthquake of March 11, 2011, consisted of a large-scale earthquake, tsunami, and nuclear accident, resulting in more than 15 000 fatalities, injuries, and missing persons and damage over a 500-km area. The entire Japanese public was profoundly affected by 3/11. The risk of radiation exposure initially delayed the medical response, prolonging the recovery efforts. Japan's representative medical organization, the Japan Medical Association (JMA), began dispatching Japan Medical Association Teams (JMATs) to affected areas beginning March 15, 2011. About 1400 JMATs comprising nearly 5500 health workers were launched. The JMA coordinated JMAT operations and cooperated in conducting postmortem examination, transporting large quantities of medical supplies, and establishing a multiorganizational council to provide health assistance to disaster survivors. Importantly, these response efforts contributed to the complete recovery of the health care system in affected areas within 3 months, and by July 15, 2011, JMATs were withdrawn. Subsequently, JMATs II have been providing long-term continuing medical support to disaster-affected areas. However, Japan is at great risk for future natural disasters because of its Pacific Rim location. Also, its rapidly aging population, uneven distribution of and shortage of medical resources in regional communities, and an overburdened public health insurance system highlight the need for a highly prepared and effective disaster response system. (Disaster Med Public Health Preparedness. 2013;7:507-512).
17. Akihito Hagihara, Manabu Hasegawa, Takeru Abe, Takashi Nagata, Yoshihiro Nabeshima, Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest
A prospective cohort analysis, PloS one, 10.1371/journal.pone.0084424, 9, 1, 2014.01, [URL], The presence of a physician seems to be beneficial for pre-hospital cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest. However, the effectiveness of a physician's presence during CPR before hospital arrival has not been established. We conducted a prospective, non-randomized, observational study using national data from out-of-hospital cardiac arrests between 2005 and 2010 in Japan. We performed a propensity analysis and examined the association between a physician's presence during an ambulance car ride and short- and long-term survival from out-of-hospital cardiac arrest. Specifically, a full non-parsimonious logistic regression model was fitted with the physician presence in the ambulance as the dependent variable; the independent variables included all study variables except for endpoint variables plus dummy variables for the 47 prefectures in Japan (i.e., 46 variables). In total, 619,928 out-of-hospital cardiac arrest cases that met the inclusion criteria were analyzed. Among propensity-matched patients, a positive association was observed between a physician's presence during an ambulance car ride and return of spontaneous circulation (ROSC) before hospital arrival, 1-month survival, and 1-month survival with minimal neurological or physical impairment (ROSC: OR = 1.84, 95% CI 1.63-2.07, p = 0.00 in adjusted for propensity and all covariates); 1-month survival: OR = 1.29, 95% CI 1.04-1.61, p = 0.02 in adjusted for propensity and all covariates); cerebral performance category (1 or 2): OR = 1.54, 95% CI 1.03-2.29, p = 0.04 in adjusted for propensity and all covariates); and overall performance category (1 or 2): OR = 1.50, 95% CI 1.01-2.24, p = 0.05 in adjusted for propensity and all covariates). A prospective observational study using national data from out-of-hospital cardiac arrests shows that a physician's presence during an ambulance car ride was independently associated with increased short- and long-term survival..
18. Takashi Nagata, Takeru Abe, Eiichiro Noda, Manabu Hasegawa, Makoto Hashizume, Akihito Hagihara, Factors associated with the clinical outcomes of paediatric out-of-hospital cardiac arrest in Japan, BMJ open, 10.1136/bmjopen-2013-003481, 4, 2, 2014.03, [URL], Objectives: To better understand and predict clinical outcomes of paediatric out-of-hospital cardiac arrest (OHCA). Design: A population-based, observational study. Setting: The National Japan Utstein Registry. Participants: 2900 children aged 5-17 years who experienced OHCA and received resuscitation by emergency responders. Signal detection analysis using 17 variables was applied to identify factors associated with OHCA outcomes; the primary endpoint was cerebral performance category (CPC) 1 or 2. A validation study was conducted to verify the model. Results: OHCA was identified as cardiac origin in 706 participants and non-cardiac origin in 2194 participants. Rates of CPC 1 or 2 for cardiac and non-cardiac causes were 20% and 6.4%, respectively. Cardiac origin arrest was categorised following signal detection into six subgroups defined by public automated external defibrillator use, defibrillation by emergency medical service, age, initial ECG rhythm and eye-witness to arrest; the ranges of CPC 1 or 2 in the six subgroups were between 87.5% and 0.7%. Non-cardiac origin arrest was categorised into four subgroups. Bystander rescue breathing was the most significant factor contributing to outcome; additionally, two other factors - eye-witness to arrest and age - were also significant. CPC 1 or 2 rates ranged between 38.5% and 4% across the four subgroups. Rates of CPC 1 or 2 in the validation study did not differ among any subgroup. Conclusions: For children who have OHCA from non-cardiac origin, bystander rescue breathing is mandatory to achieve CPC 1 or 2..
19. Manabu Hasegawa, Takeru Abe, Takashi Nagata, Daisuke Onozuka, Akihito Hagihara, The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 10.1186/s13049-015-0112-4, 23, 1, 2015.04, [URL], Background: The relationship between the number of pre-hospital defibrillation shocks and treatment outcome in patients with out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF) is unknown currently. We examined the association between the number of pre-hospitalization defibrillation shocks and 1-month survival in OHCA patients. Methods: We conducted a prospective observational study using national registry data obtained from patients with OHCA between January 1, 2009 and December 31, 2012 in Japan. The study subjects were ≥ 18-110 years of age, had suffered from an OHCA before arrival of EMS personnel, had a witnessed collapse, had an initial rhythm that was shockable [VF/ventricular tachycardia (pulseless VT)], were not delivered a shock using a public automated external defibrillator (AED), received one or more shocks using a biphasic defibrillator by EMS personnel, and were transported to a medical institution between January 1, 2009 and December 31, 2012. There were 20,851 OHCA cases which met the inclusion criteria during the study period. Signal detection analysis was used to identify the cutoff point in the number of prehospital defibrillation shocks most closely related to one-month survival. Variables related to the number of defibrillations or one-month survival in OHCA were identified using multiple logistic regression analysis. Results: A cutoff point in the number of pre-hospital defibrillation shocks most closely associated with 1-month OHCA survival was between two and three (Χ2 = 209.61, p < 0.0001). Among those patients who received two shocks or less, 34.48% survived for at least 1 month, compared with 24.75% of those who received three shocks or more. The number of defibrillations (odds ratio [OR] = 1.19, 95% CI: 1.03, 1.38), OHCA origin (OR = 2.81, 95% CI: 2.26, 3.49), use of ALS devices (OR = 0.68, 95% CI: 0.59, 0.79), use of epinephrine (OR = 0.33, 95% C: 0.28, 0.39), interval between first defibrillation and first ROSC (OR = 1.45, 95% CI: 1.18, 1.78), and chest compression (OR = 1.21, 95% CI: 1.06, 1.38) were associated significantly with 1-month OCHA survival. Conclusions: The cutoff point in the number of defibrillations of patients with OHCA most closely related to one-month survival was between 2 and 3, and the likelihood of non-survival 1 month after an OHCA was increased when ≥3 shocks were needed. Further studies are needed to verify this finding..
20. Akihito Hagihara, Daisuke Onozuka, Takashi Nagata, Takeru Abe, Manabu Hasegawa, Yoshihiro Nabeshima, Ambulance dispatches from unaffected areas after the Great East Japan Earthquake
Impact on emergency care in the unaffected areas, Disaster Medicine and Public Health Preparedness, 10.1017/dmp.2015.92, 9, 6, 609-613, 2015.06, [URL], Objective Although dispatching ambulance crews from unaffected areas to a disaster zone is inevitable when a major disaster occurs, the effect on emergency care in the unaffected areas has not been studied. We evaluated whether dispatching ambulance crews from unaffected prefectures to those damaged by the Great East Japan Earthquake was associated with reduced resuscitation outcomes in out-of-hospital cardiac arrest (OHCA) cases in the unaffected areas. Methods We used the Box-Jenkins transfer function model to assess the relationship between ambulance crew dispatches and return of spontaneous circulation (ROSC) before hospital arrival or 1-month survival after the cardiac event. Results In a model whose output was the rate of ROSC before hospital arrival, dispatching 1000 ambulance crews was associated with a 0.474% decrease in the rate of ROSC after the dispatch in the prefectures (p=0.023). In a model whose output was the rate of 1-month survival, dispatching 1000 ambulance crews was associated with a 0.502% decrease in the rate of 1-month survival after the dispatch in the prefectures (p=0.011). Conclusions The dispatch of ambulances from unaffected prefectures to earthquake-stricken areas was associated with a subsequent decrease in the ROSC and 1-month survival rates in OHCA cases in the unaffected prefectures..
21. Takashi Nagata, Alan K. Lefor, Manabu Hasegawa, Masami Ishii, Favipiravir
A New Medication for the Ebola Virus Disease Pandemic, Disaster Medicine and Public Health Preparedness, 10.1017/dmp.2014.151, 9, 1, 79-81, 2015.10, [URL], The purpose of this report is to advocate speedy approval and less stringent regulations for the use of experimental drugs such as favipiravir in emergencies. Favipiravir is a new antiviral medication that can be used in emerging viral pandemics such as Ebola virus, 2009 pandemic influenza H1N1 virus, Lassa fever, and Argentine hemorrhagic fever. Although favipiravir is one of the choices for the treatment of patients with Ebola virus, several concerns exist. First, a clinical trial of favipiravir in patients infected with the Ebola virus has not yet been conducted, and further studies are required. Second, favipiravir has a risk for teratogenicity and embryotoxicity. Therefore, the Ministry of Health, Welfare and Labor of Japan has approved this medication with strict regulations for its production and clinical use. However, owing to the emerging Ebola virus epidemic in West Africa, on August 15, 2014, the Minister of Health, Welfare and Labor of Japan approved the use of favipiravir, if needed..
22. Tomohiko Akahoshi, H. Sugimori, Noriyuki Kaku, Kentaro Tokuda, Takashi Nagata, E. Noda, M. Morita, Makoto Hashizume, Yoshihiko Maehara, Comparison of recombinant human thrombomodulin and gabexate mesylate for treatment of disseminated intravascular coagulation (DIC) with sepsis following emergent gastrointestinal surgery
a retrospective study, European Journal of Trauma and Emergency Surgery, 10.1007/s00068-014-0478-4, 41, 5, 531-538, 2015.10, [URL], Purpose: Recombinant thrombomodulin (rTM) has been available in Japan since 2008, but there is concern about its association with postoperative hemorrhage. The efficacy and safety of rTM were examined in patients with disseminated intravascular coagulation (DIC) caused by a septic condition after gastrointestinal surgery. Methods: Forty-two patients were emergently admitted to the intensive care unit after emergent gastrointestinal surgery in Kyushu University Hospital from May 2008 to April 2013. Of these patients, 22 had DIC (defined as an acute DIC score ≥4). All but three patients received treatment with gabexate mesylate (GM) (n = 9) or rTM (n = 10). The causes of sepsis were peritonitis with colorectal perforation, anastomotic leakage, and intestinal necrosis. Acute DIC score, sepsis-related organ failure assessment score, platelet count, and a variety of biochemical parameters were compared between rTM and GM recipients after treatment administration. Results: There were no significant differences between the groups for any parameter except C-reactive protein levels. The CRP level tended to be lower in the rTM group than in the GM group. Acute DIC score in the rTM group resolved significantly earlier than that in the GM group. No patient stopped the administration of rTM because of postoperative bleeding. Conclusion: rTM may be an effective therapeutic drug for the treatment of septic patients with DIC following emergent gastrointestinal surgery..
23. Takashi Nagata, Masami Ishii, Preparedness for ebola virus disease, Japan Medical Association Journal, 57, 5-6, 289, 2015.12.
24. Takashi Nagata, Sumito Yoshida, Manabu Hasegawa, Mayo Ojino, Shinichi Murata, Masami Ishii, International Medical Teams of the Japan Medical Association
A Framework for Foreign Medical Teams, Disaster Medicine and Public Health Preparedness, 10.1017/dmp.2015.109, 10, 1, 4-5, 2016.02, [URL].
25. Takashi Nagata, The significance of iJMAT
A new framework for international disaster medicine support, Japan Medical Association Journal, 59, 1, 19-24, 2016.07.
26. , Masamine Jimba, Yoshitaka Kasahara, Akira Akagami, Sho Hashimoto, Masayuki Hatae, Shigehito Ishiguro, Tsutomi Kikuchi, Naoki Kondo, Izumi Maruyama, Chiaki Mukai, Takashi Nagata, Takashi Nagata, Toshio Osakabe, Nobuyoshi Shimizu, Shigeru Suganami, Taro Yamamoto, Eiji Hinoshita, Hiroyuki Yamaya, The challenges of Japanese community medicine from the global health perspective, Japan Medical Association Journal, 59, 2-3, 59-76, 2016.09.
27. Akihito Hagihara, Daisuke Onozuka, Takashi Nagata, Manabu Hasegawa, Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated, American Journal of Emergency Medicine, 10.1016/j.ajem.2017.07.018, 36, 1, 73-78, 2017, [URL], Background: The effects and relative benefits of advanced airway management and epinephrine on patients with out-of-hospital cardiac arrest (OHCA) who were defibrillated are not well understood. Methods: This was a prospective observational study. Using data of all out-of-hospital cardiac arrest cases occurring between 2005 and 2013 in Japan, hierarchical logistic regression and conditional logistic regression along with time-dependent propensity matching were performed. Outcome measures were survival and minimal neurological impairment [cerebral performance category (CPC) 1 or 2] at 1. month after the event. Results: We analyzed 37,873 cases that met the inclusion criteria. Among propensity-matched patients, advanced airway management and/or prehospital epinephrine use was related to decreased rates of 1-month survival (adjusted odds ratio 0.88, 95% confidence interval 0.80 to 0.97) and CPC (1, 2) (adjusted odds ratio 0.56, 95% confidence interval 0.48 to 0.66). Advanced airway management was related to decreased rates of 1-month survival (adjusted odds ratio 0.89, 95% confidence interval 0.81to 0.98) and CPC (1, 2) (adjusted odds ratio 0.54, 95% confidence interval 0.46 to 0.64) in patients who did not receive epinephrine, whereas epinephrine use was not related to the outcome measures. Conclusions: In defibrillated patients with OHCA, advanced airway management and/or epinephrine are related to reduced long-term survival, and advanced airway management is less beneficial than epinephrine. However, the proportion of patients with OHCA who responded to an initial shock was very low in the study subjects, and the external validity of our findings might be limited..
28. Akihito Hagihara, Daisuke Onozuka, Manabu Hasegawa, Takashi Nagata, Takeru Abe, Yoshihiro Nabeshima, Resuscitation outcomes of reproductive-age females who experienced out-of-hospital cardiac arrest, European heart journal. Acute cardiovascular care, 10.1177/2048872616633879, 6, 2, 121-129, 2017.03, [URL], BACKGROUND: Although some studies have shown that women in their reproductive years have better resuscitation outcomes of out-of-hospital cardiac arrest (OHCA), conflicting results and methodological problems have also been noted. Thus, we evaluated the resuscitation outcomes of OHCA of females by age.
METHODS: This was a prospective observational study using registry data from all OHCA cases between 2005 and 2012 in Japan. The subjects were females aged 18-110 years who suffered an out-of-hospital cardiac arrest. Logistic regression analyses were performed using total and propensity-matched patients.
RESULTS: There were 381,123 OHCA cases that met the inclusion criteria. Among propensity-matched patients, females aged 18-49 and 50-60 years of age had similar rates of return of spontaneous circulation before hospital arrival and 1-month survival (all p>0.60). In contrast, females aged 18-49 years of age had significantly lower rates of 1-month survival with minimal neurological impairment than did females aged 50-60 years of age (after adjusting for selected variables: Cerebral Performance Category scale 1 or 2 (CPC (1, 2)), OR=0.45, p=0.020; Overall Performance Category scale 1 or 2 (OPC (1, 2)): OR=0.42, p= 0.014; after adjustment for all variables: CPC (1, 2), OR=0.27, p= 0.008; OPC (1, 2), OR=0.29, p=0.009).
CONCLUSION: Women of reproductive age did not show improved resuscitation outcomes in OHCA. Additionally, women in their reproductive years showed worse neurological outcomes one month after the event, which may be explained by the negative effects of estrogen. These findings need to be verified in further studies..
29. Akihito Hagihara, Daisuke Onozuka, Manabu Hasegawa, Takashi Nagata, Takeru Abe, Yoshihiro Nabeshima, Resuscitation outcomes of reproductive-age females who experienced out-of-hospital cardiac arrest, European Heart Journal: Acute Cardiovascular Care, 10.1177/2048872616633879, 6, 2, 121-129, 2017.03, [URL], BACKGROUND: Although some studies have shown that women in their reproductive years have better resuscitation outcomes of out-of-hospital cardiac arrest (OHCA), conflicting results and methodological problems have also been noted. Thus, we evaluated the resuscitation outcomes of OHCA of females by age.
METHODS: This was a prospective observational study using registry data from all OHCA cases between 2005 and 2012 in Japan. The subjects were females aged 18-110 years who suffered an out-of-hospital cardiac arrest. Logistic regression analyses were performed using total and propensity-matched patients.
RESULTS: There were 381,123 OHCA cases that met the inclusion criteria. Among propensity-matched patients, females aged 18-49 and 50-60 years of age had similar rates of return of spontaneous circulation before hospital arrival and 1-month survival (all p>0.60). In contrast, females aged 18-49 years of age had significantly lower rates of 1-month survival with minimal neurological impairment than did females aged 50-60 years of age (after adjusting for selected variables: Cerebral Performance Category scale 1 or 2 (CPC (1, 2)), OR=0.45, p=0.020; Overall Performance Category scale 1 or 2 (OPC (1, 2)): OR=0.42, p= 0.014; after adjustment for all variables: CPC (1, 2), OR=0.27, p= 0.008; OPC (1, 2), OR=0.29, p=0.009).
CONCLUSION: Women of reproductive age did not show improved resuscitation outcomes in OHCA. Additionally, women in their reproductive years showed worse neurological outcomes one month after the event, which may be explained by the negative effects of estrogen. These findings need to be verified in further studies..
30. Akihito Hagihara, Daisuke Onozuka, Manabu Hasegawa, Takashi Nagata, Takeru Abe, Yoshihiro Nabeshima, Resuscitation outcomes of reproductive-age females who experienced out-of-hospital cardiac arrest, European Heart Journal: Acute Cardiovascular Care, 10.1177/2048872616633879, 6, 2, 121-129, 2017.03, [URL], BACKGROUND: Although some studies have shown that women in their reproductive years have better resuscitation outcomes of out-of-hospital cardiac arrest (OHCA), conflicting results and methodological problems have also been noted. Thus, we evaluated the resuscitation outcomes of OHCA of females by age.
METHODS: This was a prospective observational study using registry data from all OHCA cases between 2005 and 2012 in Japan. The subjects were females aged 18-110 years who suffered an out-of-hospital cardiac arrest. Logistic regression analyses were performed using total and propensity-matched patients.
RESULTS: There were 381,123 OHCA cases that met the inclusion criteria. Among propensity-matched patients, females aged 18-49 and 50-60 years of age had similar rates of return of spontaneous circulation before hospital arrival and 1-month survival (all p>0.60). In contrast, females aged 18-49 years of age had significantly lower rates of 1-month survival with minimal neurological impairment than did females aged 50-60 years of age (after adjusting for selected variables: Cerebral Performance Category scale 1 or 2 (CPC (1, 2)), OR=0.45, p=0.020; Overall Performance Category scale 1 or 2 (OPC (1, 2)): OR=0.42, p= 0.014; after adjustment for all variables: CPC (1, 2), OR=0.27, p= 0.008; OPC (1, 2), OR=0.29, p=0.009).
CONCLUSION: Women of reproductive age did not show improved resuscitation outcomes in OHCA. Additionally, women in their reproductive years showed worse neurological outcomes one month after the event, which may be explained by the negative effects of estrogen. These findings need to be verified in further studies..
31. Takashi Nagata, Takeru Abe, Manabu Hasegawa, Akihito Hagihara, Factors associated with the outcome of out-of-hospital cardiopulmonary arrest among people over 80 years old in Japan, Resuscitation, 10.1016/j.resuscitation.2017.01.014, 113, 63-69, 2017.04, [URL], Aim To determine if termination of resuscitation should be considered for older individuals, we sought to identify factors associated with clinical outcome following out-of-hospital cardiac arrest (OHCA) in people ≥80 years old and over. Methods A prospective, population-based, observational study was conducted for ≥80-year-old individuals who experienced out-of-hospital cardiac arrest and to whom resuscitation was provided by emergency responders between January 1, 2005 and December 31, 2012 (n = 377,577). The primary endpoint was 1-month survival. Signal detection analysis was applied to estimate predictive factors among 17 variables. Results Among all out-of-hospital cardiac arrest cases, 59.4% were of cardiac origin, and 1-month survival rate was 3.3%. Following signal detection analysis, cases of both cardiac and non-cardiac origin were categorized into three subgroups defined by return of spontaneous circulation (ROSC) and epinephrine use. One-month survival ranged between 1.2 and 41.0% for the three subgroups of cardiac origin and between 2.0 and 41.1% for the three subgroups of non-cardiac origin. Conclusions ROSC was the most significant predictor of 1-month survival among patients with cardiac and non-cardiac OHCA who were ≥80 years old. Absence of ROSC might be an important factor to the termination of resuscitation rule for OHCA in individuals who are ≥80 years old..
32. Mayo Ojino, Sumito Yoshida, Takashi Nagata, Masami Ishii, Makoto Akashi, First Successful Pre-Distribution of Stable Iodine Tablets under Japan's New Policy after the Fukushima Daiichi Nuclear Accident, Disaster Medicine and Public Health Preparedness, 10.1017/dmp.2016.125, 11, 3, 365-369, 2017.06, [URL], Stable iodine tablets are effective in reducing internal exposure to radioactive iodine, which poses a risk for thyroid cancer and other conditions. After the Fukushima Daiichi nuclear power plant accident, the Japanese government shifted its policy on stable iodine tablet distribution from after-the-fact to before-the-fact and instructed local governments to pre-distribute stable iodine tablets to residents living within a 5-km radius of nuclear facilities. The nation's first pre-distribution of stable iodine tablets was carried out in June and July of 2014 in Kagoshima Prefecture. Health surveys were conducted so that the medication would not be handed out to people with the possibility of side effects. Of the 4715 inhabitants in the area, 132 were found to require a physician's judgment, mostly to exclude risks of side effects. This was considered important to prevent the misuse of the tablets in the event of a disaster. The importance of collective and individualized risk communication between physicians and inhabitants at the community health level was apparent through this study. Involvement of physicians through the regional Sendai City Medical Association was an important component of the pre-distribution. Physicians of the Sendai City Medical Association were successfully educated by using the Guidebook on Distributing and Administering Stable Iodine Tablets prepared by the Japan Medical Association and Japan Medical Association Research Institute with the collaboration of the National Institute of Radiological Sciences and the Japanese government. Thus, the physicians managed to make decisions on the dispensing of stable iodine tablets according to the health conditions of the inhabitants. All physicians nationwide should be provided continuing medical education on stable iodine tablets..
33. Takashi Nagata, Takeru Abe, Ayako Takamori, Yoshinari Kimura, Akihito Hagihara, Factors associated with the occurrence of injuries requiring hospital transfer among older and working-age pedestrians in Kurume, Japan, BMC Public Health, 10.1186/s12889-017-4456-8, 17, 1, 2017.06, [URL], Background: Pedestrian injuries among older people tend to occur near their residence. However, knowledge regarding whether distance travelled from home to the injury site or road environmental/socioeconomic factors affect injury severity remains limited. Methods: A cross-sectional study was performed using injury registry data from the Kurume City Fire Department, Japan. Distance travelled from home was determined with geographic information system (GIS) software. Data were analyzed for potential association with injury occurrence and severity, with stratification by age. Signal detection analysis using 10 variables was applied to identify factors associated with the occurrence of severe pedestrian injuries. Results: Among the 545 adult pedestrian injuries reviewed, the factors associated with the occurrence of severe pedestrian injuries for older people and working-age people were evaluated, focusing on the effect of the network distance travelled from home to injury site. Network distance travelled from home to injury site was not associated with the occurrence of severe pedestrian injuries among older people. By applying signal detection analysis, for older people, higher socioeconomic status, wider road width per lane, and higher aging rate in the residential area were significant factors, and for working-age pedestrians, longer network distance travelled between injury place and their residential area and a higher aging rate in the residential area were significantly associated. Conclusions: To reduce severe pedestrian injuries among older people, improvement of road infrastructure in areas with wider roads, higher socioeconomic status and higher aging rates is required..
34. Akihito Hagihara, Daisuke Onozuka, Junko Ono, Takashi Nagata, Manabu Hasegawa, Age × Gender Interaction Effect on Resuscitation Outcomes in Patients With Out-of-Hospital Cardiac Arrest, American Journal of Cardiology, 10.1016/j.amjcard.2017.05.003, 120, 3, 387-392, 2017.08, [URL], Although an interaction between gender and age has been shown to influence resuscitation outcomes in patients with out-of-hospital cardiac arrest (OHCA), this interaction has not been investigated in Asian populations. In this prospective, observational study, data from all cases of OHCA in Japan between 2005 and 2012 were obtained from the Japanese National Registry. We determined the relative excess risk due to interaction and the ratio of odds ratios (ORs) to assess the interaction effect of gender and age on the incidence of return of spontaneous circulation (ROSC) before hospital arrival, 1-month survival, and neurologically intact survival 1 month after OHCA. Male gender was associated with decreased ROSC and lower 1-month survival rates in patients with OHCA of presumed cardiac origin. Older age was associated with lower 1-month and neurologically intact survival rates in male patients with OHCA of presumed cardiac and noncardiac origin and with increased ROSC in male patients with OHCA of presumed cardiac origin. The relative excess risk due to interaction for ROSC in patients with OHCA of presumed cardiac origin was statistically significant (OR 0.19, 95% confidence interval [CI] 0.06 to 0.32). The ratio of ORs for ROSC was statistically significant in patients with OHCA of presumed cardiac origin (OR 1.25, 95% CI 1.05 to 1.47) and of noncardiac origin (OR 0.40, 95% CI 0.17 to 0.92). In conclusion, the interaction effect between age and gender on ROSC was positive in OHCA cases of presumed cardiac origin and negative in those of noncardiac origin..
35. Takashi Nagata, Shinkichi Himeno, Akihiro Himeno, Manabu Hasegawa, Alan Kawarai Lefor, Makoto Hashizume, Yoshihiko Maehara, Masami Ishii, Successful Hospital Evacuation after the Kumamoto Earthquakes, Japan, 2016, Disaster Medicine and Public Health Preparedness, 10.1017/dmp.2016.180, 11, 5, 517-521, 2017.10, [URL], Two major earthquakes struck Kumamoto Prefecture in Japan in April 2016. Disaster response was immediately provided, including disaster medical services. Many hospitals were damaged and patients needed immediate evacuation to alternative facilities. The hospital bed capacity of Kumamoto Prefecture was overwhelmed, and transportation of more than 100 patients was needed. Hospital evacuation was carried out smoothly with the coordinated efforts of multiple agencies. The overall operation was deemed a success because patients were transported in a timely manner without any significant adverse events. Upon repair of facilities in Kumamoto Prefecture, patients were returned safely to their previous facilities. The management of inpatients after this natural disaster in Kumamoto Prefecture can serve as a model for hospital evacuation with multi-Agency coordination in the future. Future efforts are needed to improve interfacility communications immediately following a natural disaster. (Disaster Med Public Health Preparedness..
36. Akihito Hagihara, Daisuke Onozuka, Junko Ono, Takashi Nagata, Manabu Hasegawa, Interaction of defibrillation waveform with the time to defibrillation or the number of defibrillation attempts on survival from out-of-hospital cardiac arrest, Resuscitation, 10.1016/j.resuscitation.2017.11.053, 122, 54-60, 2018.01, [URL], Aim Early biphasic defibrillation is effective in out-of-hospital cardiac arrest (OHCA) cases. In the resuscitation of patients with OHCA, it is not clear how the defibrillation waveform interacts with the time to defibrillation to influence patient survival. The second, and any subsequent, shocks need to be administered by an on-line physician in Japan. Thus, we investigated the interaction between the defibrillation waveform and time to or the number of defibrillation on resuscitation outcomes. Methods This prospective observational study used data for all OHCAs that occurred between 2005 and 2014 in Japan. To investigate the interaction effect between the defibrillation waveform and the time to defibrillation or the number of defibrillations on the return to spontaneous circulation (ROSC), 1-month survival, and cerebral performance category (CPC) (1, 2), we assessed the modifying effects of the defibrillation waveform and the time to or the number of defibrillation on additive scale (i.e., the relative excessive risk due to interaction, RERI) and multiplicative scale (i.e., ratio of odds ratios (ORs)). Results In total, 71,566 cases met the inclusion criteria. For the measure of interaction between the defibrillation waveform and the time to defibrillation, ratio of ORs for ROSC was 0.84 (0.75–0.94), implying that the effect of time to first defibrillation on ROSC was negatively modified by defibrillation waveform. For the interaction between the defibrillation waveform and the number of defibrillations, RERI and ratio of ORs for CPC (1, 2) was −0.25 (−0.47 to −0.06) and 0.79 (0.67–0.93), respectively. It is implied that the effect of number of defibrillation on CPC (1, 2) was negatively modified by defibrillation waveform. Conclusions An increased number of defibrillations was associated with a decreased ROSC in the case of biphasic and monophasic defibrillation, while an increased number of defibrillations was related to an increased 1-month survival rate and CPC (1, 2) only in the case of biphasic defibrillation. When two or more defibrillations were performed, a biphasic waveform was more effective in terms of long-term survival than a monophasic waveform..
37. Akihito Hagihara, Daisuke Onozuka, Takashi Nagata, Manabu Hasegawa, “Reply to letter, More questions than answers - advanced life support interventions for out of hospital cardiac arrest”, American Journal of Emergency Medicine, 10.1016/j.ajem.2017.11.065, 36, 3, 500-501, 2018.03, [URL].
38. Akihito Hagihara, Daisuke Onozuka, Takashi Nagata, Manabu Hasegawa, "Reply to letter, More questions than answers - advanced life support interventions for out of hospital cardiac arrest", American Journal of Emergency Medicine, 10.1016/j.ajem.2017.11.065, 36, 3, 500-501, 2018.03, [URL].
39. Akihito Hagihara, Daisuke Onozuka, Hidetoshi Shibuta, Manabu Hasegawa, Takashi Nagata, Dispatcher-assisted bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest, International Journal of Cardiology, 10.1016/j.ijcard.2018.04.067, 2018.04, [URL], INTRODUCTION: Bystander cardiopulmonary resuscitation (CPR) is critical to the survival of patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether bystander CPR with or without dispatcher assistance is more effective or why. Thus, we evaluated the association between dispatcher-assisted bystander CPR (vs. bystander CPR without dispatcher assistance) and survival of patients with OHCA.
METHODS: This is a retrospective, nonrandomized, observational study using national registry data for all OHCAs. We performed a propensity analysis. Patients with OHCA of cardiac origin were 18-100 years of age and received bystander chest compression in Japan between 2005 and 2014. Outcome measures were bystander rescue breathing, return of spontaneous circulation (ROSC) before hospital arrival, and survival and Cerebral Performance Category (CPC) 1 or 2 at 1 month after the event.
RESULTS: During the study period, 1,176,351 OHCAs occurred, and 87,400 cases met the inclusion criteria. Among propensity-matched patients, a negative association was observed between dispatcher-assisted bystander CPR and outcome measures in a fully-adjusted model [odds ratio (OR) (95% CI) for ROSC = 0.87 (0.78-0.97), P < 0.05; OR (95% CI) for 1-month survival = 0.81 (0.65-1.00), P < 0.05; OR (95% CI) for CPC 1 or 2 = 0.64 (0.43-0.93), P < 0.05]. OR of survival for dispatcher-assisted bystander CPR tended to decrease as the emergency medical services response time increased.
CONCLUSIONS: Survival benefit was less for dispatcher-assisted bystander CPR with dispatcher assistance than without dispatcher assistance. Low quality is hypothesized to be the cause of the reduced benefit..
40. Akihito Hagihara, Daisuke Onozuka, Manabu Hasegawa, Shogo Miyazaki, Takashi Nagata, Grand Sumo Tournaments and Out-of-Hospital Cardiac Arrests in Tokyo, Journal of the American Heart Association, 10.1161/JAHA.118.009163, 7, 14, 2018.07, [URL], BACKGROUND: Sumo wrestling is a demanding sport. Although watching sumo wrestling may have cardiovascular effects, no studies of this relationship have been performed. Thus, we aimed to evaluate the association between sumo wrestling tournaments and the rate of out-of-hospital cardiac arrests.
METHODS AND RESULTS: We counted the daily number of patients aged 18 to 110 years who had an out-of-hospital cardiac arrest of presumed-cardiac origin in the Tokyo metropolis between 2005 and 2014. A Poisson regression was used to model out-of-hospital cardiac arrests of presumed-cardiac origin per day. Exposure days were the days on which a sumo tournament was held and broadcast, whereas control days were all other days. Events that occurred on exposure days were compared with those that occurred on control days. Risk ratios for out-of-hospital cardiac arrests on Grand Sumo tournaments days compared with control days were estimated. In total, 71 882 out-of-hospital cardiac arrests met the inclusion criteria. We recorded a 9% increase in the occurrence of out-of-hospital cardiac arrests on the day of a sumo tournament compared with control days. In patients aged 75 to 110 years, we found a 13% increase in the occurrence of out-of-hospital cardiac arrests on the day of a sumo tournament compared with control days.
CONCLUSIONS: We found a significant increase in the occurrence of out-of-hospital cardiac arrests on the days of sumo tournaments compared with control days in the Tokyo metropolis between 2005 and 2014. Further studies are needed to verify these initial findings on sumo tournaments and cardiovascular events..
41. Yuri Hosokawa, Takashi Nagata, Manabu Hasegawa, Inconsistency in the standard of care-toward evidence-based management of exertional heat stroke, Frontiers in Physiology, 10.3389/fphys.2019.00108, 10, FEB, 2019.01, [URL], Tokyo 2020 Summer Olympics are projected to experience environmental heat stress that surpasses the environmental conditions observed in the Atlanta (1996), Athens (2004), Beijing (2008), and Rio (2016) Summer Olympics. This raises particular concerns for athletes who will likely to be exposed to extreme heat during the competitions. Therefore, in mass-participation event during warm season, it is vital for the hosting organization to build preparedness and resilience against heat, including appropriate treatment, and management strategies for exertional heat stroke (EHS). However, despite the existing literature regarding the evidence-based management of EHS, rectal thermometry and whole-body cold-water immersion are not readily accepted by medical professionals outside of the sports, and military medicine professionals. Current Japanese medical standard is no exception in falling behind on evidence-based management of EHS. Therefore, the first aim of this paper is to elucidate the inconsistency between the standard of care provided in Japan for EHS and what has been accepted as the gold standard by the scientific literature. The second aim of this paper is to provide optimal EHS management strategies that should be implemented at the Tokyo 2020 Summer Olympics from organizational level to maximize the safety of athletes and to improve organizational resilience to heat. The risk of extreme heat is often neglected until a catastrophic incidence occurs. It is vital for the Japanese medical leadership and athletic communities to reexamine the current EHS management strategies and implement evidence-based countermeasure for EHS to expand the application of scientific knowledge..
42. Nagata Takashi, Lefore Alan, Hasegawa Manabu, Favipiravir, a new medication for the Ebola virus disease pandemic, Disaster Medicine and Public Health Preparedness, 2014.11.
43. Nagata Takashi, Prehospital Lactated Ringer's Solution Treatment and Survival in Out-of-Hospital Cardiac Arrest: A Prospective Cohort Analysis., Plos Medicine , 308, 1, e1001394, 2013.01.

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