小池 創一

INTRODUCTION: The relationship between collapse to emergency medical service (EMS) cardiopulmonary resuscitation (CPR) interval and outcome has been well documented. However, most studies have only analyzed cases of cardiac origin and Vf (ventricular fibrillation)/pulseless VT (ventricular tachycardia). We sought to examine all causes of cardiac arrest and analyze the relationship between collapse-to-EMS CPR interval and outcome in a nationwide sample using an out-of-hospital cardiac arrest (OHCA) registry. METHODS: This was a retrospective observational study based on a nationwide OHCA patient registry in Japan between 2005 and 2008 (n = 431,968). We included cases where collapse was witnessed by a bystander and where collapse and intervention time were recorded (n = 109,350). Data were collected based on the Utstein template. One-month survival and neurologically favorable one-month survival were used as outcome measures. Logarithmic regression and logistic regression were used to examine the relation between outcomes and collapse-to-EMS CPR interval. RESULTS: Among collapse-to-EMS CPR intervals between 3 and 30 minutes, the logarithmic regression equation for the relationship with one-month survival was y = -0.059 ln(x) + 0.21, while that for the relationship with neurologically favorable one-month survival was y = -0.041 ln(x) + 0.13. After adjusting for potential confounders in the logistic regression analysis for all intervals, longer collapse-to-EMS CPR intervals were associated with lower rates of one-month survival (odds ratio (OR) 0.93, 95% confidence interval (CI): 0.93 to 0.93) and neurologically favorable one-month survival (OR 0.89, 95% CI 0.89 to 0.90). CONCLUSIONS: Improving the emergency medical system and CPR in cases of OHCA is important for improving the outcomes of OHCA.

原著The purpose of this study was to compare the long-term care services in municipalities before and after the introduction of Long-term Care Insurance for the elderly (LTCI) in April 2000, Questionnaires were sent to all municipalides in Japan in November 1999 (before the introduction of (LTCI) and in 2001(after the introduction of LTCI). The questions included the level of care needed for the elderly, the type of service (home or institution-based), and other factors related to the implementation of LTCI. Two hundred and sixty-five municipalities responded to both questionnaires were analyzed in this study. The proportion of elderly who needed care, the pmportion of elderly at care need level 5, and the average care-need level among certified increased and became less variable afterthe introduction of LTCl, In addition, there was a higher correlation between the proportion of elderly who needed care and the number of beds for long-term care per elderly population after the introduction of LTCI. The standardization of eligibility criteria and the changes in the financing system for care for the elderly served as background of these changes. These findings demonstrate that the introduction of LTCI had a significant impact on care for the elderly in municipalities in Japan.