Acute effect of the COVID-19 pandemic on emergency transportation due to acute alcoholic intoxication: a retrospective observational study

BACKGROUND@#The COVID-19 pandemic has caused changes in people's drinking habits and the emergency management system for various diseases. However, no studies have investigated the pandemic's impact on emergency transportation for acute alcoholic intoxication. This study examines the effect of the pandemic on emergency transportation due to acute alcoholic intoxication in Kochi Prefecture, Japan, a region with high alcohol consumption.@*METHODS@#A retrospective observational study was conducted using data of 180,747 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-squared tests and multiple logistic regression analyses were performed. The association between emergency transportation and alcoholic intoxication was examined. The differences between the number of transportations during the voluntary isolation period in Japan (March and April 2020) and the same period for 2016-2019 were measured.@*RESULTS@#In 2020, emergency transportations due to acute alcoholic intoxication declined by 0.2%, compared with previous years. Emergency transportation due to acute alcoholic intoxication decreased significantly between March and April 2020, compared with the same period in 2016-2019, even after adjusting for confounding factors (adjusted odds ratio 0.67; 95% confidence interval 0.47-0.96).@*CONCLUSIONS@#This study showed that lifestyle changes due to the COVID-19 pandemic affected the number of emergency transportations; in particular, those due to acute alcoholic intoxication decreased significantly.

A descriptive study of solitary death in Yokohama City

BACKGROUND@#The solitary death rate in Japan is expected to continue increasing because of its growing super-aged society and the rapid growth of home care in the country. To accurately determine the actual status of solitary deaths, we used a novel analysis method of combining vital statistics and ambulatory care information in Yokohama City.@*METHODS@#Data of persons who died at home in 2013 were obtained from death certificate notifications. We also obtained the emergency transportation records that matched the cases of these death certificate notifications. Then, we gathered information regarding age, gender, marital status, and cause of death for the matched cases.@*RESULTS@#There were 1890 "suspected unnatural deaths," in which most solitary deaths could be included, among all citizens who died at home (n = 4847). We were able to match 1503 of these cases with emergency transportation records. These 1503 cases were divided into two groups, "solitary death" (n = 349) and "un-solitary death" (n = 1154) according to the postmortem interval until finding (PMI-f). Pearson's χ tests conducted for the two groups revealed that there were significant differences regarding the proportion of persons who were elderly, unmarried, male, and had a hepatic disease and senility. A logistic regression analysis also showed that an increased likelihood of a prolonged PMI-f was associated with males and an unmarried status with hepatic diseases.@*CONCLUSIONS@#Unmarried, male sex, and liver diseases are independent risks for solitary death in Yokohama City.

Impact of Temperature in Summer on Emergency Transportation for Heat-Related Diseases in Japan / 中华医学杂志(英文版)

<p><b>Background</b>In Japan, the demand for emergency transportation for people with heat-related illness has recently increased. The purpose of this study was to investigate the relationship between incidents of heat-related illness and the daily maximum temperature.</p><p><b>Methods</b>The daily maximum temperatures in Japan's 11 districts over the past 10 years were classified into four categories, with cutoff points at the 50, 75, 95, and higher than 95percentiles. We then conducted a logistic regression analysis of emergency transportation demand in each temperature category by age group, using the 50percentile as the reference category for each area.</p><p><b>Results</b>There were 42,931 cases of emergency transportation due to heat-related diseases during the study period. Classified by age, 12.5%, 43.4%, and 44.1% of cases involved children, adults, and elderly people, respectively. The analysis showed that the number of cases of emergency transportation for people with heat-related diseases (per 100,000 people; corresponding to a 1.0°C increase in the daily maximum temperature) was 0.016-0.106 among children (24.9-169.9 children required emergency transportation for heat-related diseases), from 0.013 to 0.059 among adults (19.8-98.2 adults required emergency transportation), and from 0.045 to 0.159 among elderly persons (30.0-145.4 elderly people required emergency transportation). The risk was highest for elderly persons, followed by children and finally adults. Cases of emergency transportation due to heat-related illness increased by 2.4-8.9 times when the daily maximum temperature was approximately 1.5°C above the mean daily maximum temperature. In fact, the daily maximum temperature had a larger effect than the daily relative humidity level on emergency transportation for people with heat-related diseases.</p><p><b>Conclusion</b>Public health organizations and health-care services should support elderly people and children, two high-risk groups for heat-related diseases.</p>

Rural physicians’ scope of practice on remote islands: A case report of severe pneumonia that required overnight artificial airway management / Journal of Rural Medicine

<p><b>Objective:</b> To clarify the scope of practice on rural islands of Okinawa.</p><p><b>Patient:</b> A 59-year-old man presented to our clinic with shortness of breath. He was intubated due to acute respiratory failure caused by severe pneumonia. We could not transfer him owing to bad weather, and had to continue patient care in the clinic for more than 24 hours.</p><p><b>Discussion:</b> In remote regions, rural physicians may require a broad scope of practice from primary to tertiary care, in addition to preventive and end-of-life care.</p><p><b>Conclusion:</b> This case illustrates the current state of emergency care and unique scope of practice on rural islands of Okinawa.</p>