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.

IMPORTANCE Neurologically intact survival after out-of-hospital cardiac arrest (OHCA) has been increasing in Japan. However, associations between increased prehospital care, including bystander interventions and increases in survival, have not been well estimated. OBJECTIVE To estimate the associations between bystander interventions and changes in neurologically intact survival among patients with OHCA in Japan. DESIGN, SETTING, AND PARTICIPANTS Retrospective descriptive study using data from Japan's nationwide OHCA registry, which started in January 2005. The registry includes all patients with OHCA transported to the hospital by emergency medical services (EMS) and recorded patients' characteristics, prehospital interventions, and outcomes. Participants were 167 912 patients with bystander-witnessed OHCA of presumed cardiac origin in the registry between January 2005 and December 2012. EXPOSURES Prehospital interventions by bystander, including defibrillation using public-access automated external defibrillators and chest compression. MAIN OUTCOMES AND MEASURES Neurologically intact survival was defined as Glasgow-Pittsburgh cerebral performance category score 1 or 2 and overall performance category scores 1 or 2 at 1 month or at discharge. The association between the interventions and neurologically intact survival was evaluated. RESULTS From 2005 to 2012, the number of bystander-witnessed OHCAs of presumed cardiac origin increased from 17 882 (14.0 per 100 000 persons [95% CI, 13.8-14.2]) to 23 797 (18.7 per 100 000 persons [95% CI, 18.4-18.9]), and neurologically intact survival increased from 587 cases (age-adjusted proportion, 3.3% [95% CI, 3.0%-3.5%]) to 1710 cases (8.2% [95% CI, 7.8%-8.6%]). The rates of bystander chest compression increased from 38.6% to 50.9%, bystander-only defibrillation increased from 0.1% to 2.3%, bystander defibrillation combined with EMS defibrillation increased from 0.1% to 1.4%, and EMS-only defibrillation decreased from 26.6% to 23.5%. Performance of bystander chest compression, compared with no bystander chest compression, was associated with increased neurologically intact survival (8.4% [6594 survivors/78 592 cases] vs 4.1% [3595 survivors/88 720 cases]; odds ratio [OR], 1.52 [95% CI, 1.45-1.60]). Compared with EMS-only defibrillation (15.0% [6445 survivors/42 916 cases]), bystander-only defibrillation (40.7% [931 survivors/2287 cases]) was associated with increased neurologically intact survival (OR, 2.24 [95% CI, 1.93-2.61]), as was combined bystander and EMS defibrillation (30.5% [444 survivors/1456 cases]; OR, 1.50 [95% CI, 1.31-1.71]), whereas no defibrillation (2.0% [2369 survivors/120 653 cases]) was associated with reduced survival (OR, 0.43 [95% CI, 0.39-0.48]). CONCLUSIONS AND RELEVANCEIn Japan, between 2005 and 2012, the rates of bystander chest compression and bystander defibrillation increased and were associated with increased odds of neurologically intact survival.

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The post-migration detention of Afghan asylum seekers in Japan was independently related to their worsened mental health.

Objective:To examine the relationship between the perceived safety of specified road behaviors, self-described road behaviors, and pedestrian injury among adolescent students in Kathmandu, Nepal.Methods:A cross-sectional study was conducted among 1557 adolescents in grades 6–8 across 14 schools in Kathmandu using a self-administered questionnaire in 2003. A multiple logistic regression analysis was used to analyze the data.Results:Adolescents were more likely to suffer from pedestrian injury when they did not always “wait for green signals to cross the road”. There were no significant associations between road behaviors such as “looking both ways along the road before crossing” or “playing in the road or sidewalks” and pedestrian injury. Adolescents who “perceived it safe to cross the road from any point” or “did not perceive it to be safer to cross the road at a zebra crossing” were less likely to “look both ways” or “wait for green signals” before crossing the road. Adolescents who “perceived it to be safe to play in the road” were more likely to play in the road or sidewalk. Similarly, this study showed a positive association between road safety education and adolescents’ road crossing behaviors.Conclusion:Adolescents’ road behaviors, except for compliance with green signals, were not significantly associated with pedestrian injury. This suggests that a behavioral approach without modification of the traffic environment (such as provision of crossing signals) might not effectively prevent the occurrence of pedestrian injury in developing countries with poor traffic conditions.