Preventive effect of aripiprazole once monthly on rehospitalization for bipolar disorder: A multicenter 1-year retrospective mirror image study.

AIM: We conducted a 1-year retrospective mirror-image study to investigate the effect of aripiprazole once monthly (AOM) on rehospitalization for bipolar disorder. METHODS: Participants were recruited from psychiatric emergency and acute care hospitals in western Japan. We included 39 participants with bipolar disorder who had been administered AOM for at least 1 year with no missing medical records during the observational period. The primary outcomes were rehospitalization rate, number of rehospitalizations, total hospitalization days, and time to rehospitalization in the context of overall psychiatric readmissions. The significance level was set at p < 0.05. RESULTS: AOM significantly reduced the rehospitalization rate from 23/39 (59%) to 7/39 (18%) (p = 0.001). The number of rehospitalizations decreased significantly from a mean of 0.85 per person-year to 0.41 per person-year (p = 0.048). The total hospitalization days significantly decreased from a mean of 34.9 days to 14.4 days (p = 0.008). AOM significantly prolonged the time to rehospitalization (p < 0.001). CONCLUSION: This study found that AOM reduces overall psychiatric rehospitalization for bipolar disorder based on data from 1 year before and after AOM administration in the real-world setting. Future studies should examine the robustness and persistence of the rehospitalization preventive effect of AOM with larger sample sizes and longer observation periods beyond 1 year.

Correction: Nabeshima, Y., et al. Analysis of Japanese Articles about Suicides Involving Charcoal Burning or Hydrogen Sulfide Gas. Int. J. Environ. Res. Public Health 2016, 13, 1013.

We wish to make the following three corrections to the published paper [...].

Resuscitation outcomes of reproductive-age females who experienced out-of-hospital cardiac arrest.

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.

Analysis of Japanese Articles about Suicides Involving Charcoal Burning or Hydrogen Sulfide Gas.

It is well known that certain types of media reports about suicide can result in imitative suicides. In the last two decades, Japan has experienced two suicide epidemics and the subsequent excessive media coverage of these events. However, the quality of the media suicide reports has yet to be evaluated in terms of the guidelines for media suicide coverage. Thus, the present study analyzed Japanese newspaper articles (n = 4007) on suicides by charcoal burning or hydrogen sulfide gas between 11 February 2003 and 13 March 2010. The suicide reports were evaluated in terms of the extent to which they conformed to the suicide reporting guidelines. The mean violation scores were 3.06 (±0.7) for all articles, 3.2 (±0.8) for articles about suicide by charcoal burning, and 2.9 (±0.7) for articles about suicide by hydrogen sulfide (p < 0.001). With the exception of not following several recommendations, newspaper articles about suicide have improved in quality, as defined by the recommendations for media suicide coverage. To prevent imitative suicides based on media suicide reports, individuals in the media should try not to report suicide methods and to make attempts to report the poor condition of suicide survivors.

Ambulance Dispatches From Unaffected Areas After the Great East Japan Earthquake: Impact on Emergency Care in the Unaffected Areas.

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.

Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest: a prospective cohort analysis.

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.

The impact of newspaper reporting of hydrogen sulfide suicide on imitative suicide attempts in Japan.

PURPOSE: An analysis model based on monthly or fortnight data is inadequate to precisely evaluate the impact of media reporting of suicide on suicide rates as well as the time lag from exposure to the report of a suicide. Thus, we used daily time-series data and examined the association between newspaper articles on suicide and suicide attempts in Japan. METHODS: The Box-Jenkins transfer function model was applied to daily time-series data for the period March 27-May 21, 2008. RESULTS: Newspaper articles on suicide using hydrogen sulfide at (t - 1) were related to suicide attempts at (t) (ps < 0.001 and 0.05). Newspaper articles on suicides using hydrogen sulfide on the front page at (t - 1) were related to suicide attempts at (t) (p < 0.00). The magnitude of the impact of newspaper articles about suicide at (t - 1) or (t - 3) on "copy-cat" suicide attempts became greater as the number of news articles violating the media suicide recommendations increased. CONCLUSIONS: The time lag between exposure to newspaper reports of suicide and attempts was 1 or 3 days, and the magnitude of the impact of front page articles was about four times as great as that of suicide articles in general.

Predicting the length of hospital stay of psychiatry patients using signal detection analysis.

In Japan, the length of hospital stay (LOS) at psychiatric institutions often exceeds a year, and factors related to such stays have been identified. However, we do not know how multiple patient, hospital, and physician factors interact to determine LOS. Patient data were collected from a psychiatric hospital in Osaka, Japan. We developed subgroups, which were determined by interactions related to LOS using signal detection theory. In acute or emergency wards, five factors related to LOS were identified, and subjects were categorized into six subgroups. The indices obtained by the five factors ranged 2.49-3.47 for odds ratio, 0.47-0.84 for sensitivity, 0.40-0.76 for specificity, and 0.52-0.71 for positive predictive value. In general wards, five factors related to LOS were identified, and subjects were categorized into six subgroups. The indices obtained by the five factors ranged 3.02-5.36 for odds ratio, 0.58-0.86 for sensitivity, 0.37-0.68 for specificity, and 0.85-0.92 for positive predictive value. Psychiatrists who have been practicing longer in acute or emergency wards appear to have significantly longer stay of patients, and older or more severe patients tend to be in need of longer inpatient care. Our results provide findings that may be helpful in decreasing LOS at psychiatric hospitals.

Prehospital lactated ringer's solution treatment and survival in out-of-hospital cardiac arrest: a prospective cohort analysis.

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.