The primary goal of this study is to examine the effectiveness of a community-based multimodal intervention program for suicide prevention in regions where the suicide rate was relatively high compared to control regions. The secondary goal was to explore the effectiveness of a community-based multimodal intervention program for suicide prevention in highly populated regions.

NOCOMIT-J is a community-based large-scale non-randomized controlled trial, involving seven intervention regions with accompanying control regions, all with populations of statistically sufficient size. The program consists of

1. 1) Establishing social support networks in the public health system for suicide prevention and mental health promotion;

2. 2) A primary prevention measures of awareness campaign for the public and key personnel;

3. 3) Secondary prevention measures for screening, counseling and outreach services for high-risk individuals;

4. 4) After-care for individuals bereaved by suicide;

5. 5) Suicide prevention measures especially for individuals with mental illness and work-related problems.

This study protocol was reviewed and approved by the Central Ethics Committee of the J-MISP. Additionally, the regional leaders obtained written authorization from the local governors.

The intervention started in July 2006, and continued for 3.5 years. Participants are Japanese and foreign residents living in the intervention and control regions, a total of population of 2,120,000 individuals.

Because treatment and prevention of suicide are complex and encompass many factors, success will need multi-sector collaboration. We hope that the results of NOCOMIT-J will help to develop effective strategies to reduce future suicide rate. (ClinicalTrials.gov: NCT00737165)

A history of previous suicide attempt is a potent risk factor for suicide later on. Crisis intervention initiated at emergency medical facilities for suicide attempters are considered important components for suicide prevention. The primary aim of this trial is to examine the effectiveness of an extensive intervention for suicide attempters in prevention of recurrent suicidal behavior, as compared with standard intervention.

ACTION-J is a single blinded randomized controlled trial. In this trial, case management intervention were provided at 19 emergency medical facilities in Japan. After psychiatric evaluation and psychological education, subjects were randomly assigned to either a group receiving continuous case management or standard care. Suicidal ideation, depressive symptoms, and general health condition were evaluated as secondary measures. The stratified logrank test based on allocation factors will be performed for all eligible participants in the intent-to-treat analysis. The study protocol was reviewed and approved by the Central Ethics Committee of the J-MISP. The protocol was also reviewed and approved by the On-site Research Ethics Committee at each participating hospital.

The intervention was initiated in July 2006. By December 2009, 914 subjects were randomized. Subject follow-up continued for 1.5 to 5 years, till the end of June 2011. ACTION-J would provide valuable information on suicide attempters and may develop effective case management to reduce future risk for suicide attempters. (ClinicalTrials.gov: NCT00736918.)

Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.

We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.

16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).

PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.

To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.

Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.

A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).

The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.

Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

To determine the characteristics of acute phase nystagmus in patients with cerebellar lesions, and to identify a useful indicator for differentiating central lesions from peripheral lesions.

Acute phase nystagmus and the appearance of neurological symptoms were retrospectively investigated in 11 patients with cerebellar stroke.

At the initial visit, there were no patients with vertical nystagmus, direction-changing gaze evoked nystagmus or pure rotatory nystagmus. There were four cases with no nystagmus and seven cases with horizontal nystagmus at the initial visit. There were no neurological symptoms, except for vertigo and hearing loss, in any cases at the initial visit. The direction and type of nystagmus changed with time, and neurological symptoms other than vertigo appeared subsequently to admission.

It is important to observe the changes in nystagmus and other neurological findings for the differential diagnosis of central lesions.

To evaluate the effectiveness of tympanostomy tube placement in controlling symptoms of intractable Ménière's disease.

Fifteen patients with intractable Ménière's disease underwent tympanostomy tube placement in the affected ear. Post-operative changes in vertigo attacks and hearing level were recorded, and were evaluated according to American Academy of Otolaryngology–Head and Neck Surgery criteria.

At 12 months after treatment, 3 patients (20 per cent) showed complete control of vertigo, 7 (47 per cent) showed substantial control and 2 (13 per cent) showed limited control; 3 patients (20 per cent) required other treatment. At 24 months after treatment, 7 patients (47 per cent) showed complete control of vertigo, 3 (20 per cent) showed substantial control and 1 (7 per cent) showed limited control; 1 patient required other treatment 15 months after tympanostomy tube placement.

There is no definite pathophysiological explanation for the effect of tympanostomy tube placement in reducing vertigo attacks. This treatment is not effective for all patients with intractable Ménière's disease. However, tympanostomy tube placement might be an additional surgical therapeutic option to consider prior to contemplating other, more invasive treatments.

Using American bullfrog models under normal conditions and under vestibular dysfunction, we investigated whether mechanical vibration applied to the ear could induce otoconial dislodgement.

Vibration was applied to the labyrinth of the bullfrog using a surgical drill. The time required for the otoconia to dislodge from the utricular macula was measured. Vestibular dysfunction models were created and the dislodgement time was compared with the normal models. The morphology of the utricular macula was also investigated.

In the normal models, the average time for otoconial dislodgement to occur was 7 min and 36 s; in the vestibular dysfunction models, it was 2 min and 11 s. Pathological investigation revealed that the sensory hairs of the utricle were reduced in number and that the sensory cells became atrophic in the vestibular dysfunction models.

The otoconia of the utricle were dislodged into the semicircular canal after applying vibration. The time to dislodgement was significantly shorter in the vestibular dysfunction models than in the normal models; the utricular macula sustained significant morphological damage.

To examine the clinical features, age and gender distribution of patients, treatment methods, and outcomes of benign paroxysmal positional vertigo.

This paper reports a review of 357 patients treated for this condition at a single institution over a duration of 5 years. Patients with posterior canal benign paroxysmal positional vertigo were divided into two groups: one group underwent the Epley manoeuvre and the other received medication. The lateral canal canalolithiasis patients were also divided into two groups: one underwent the Lempert manoeuvre and the other received medication. Lastly, the lateral canal cupulolithiasis patients were treated with medication and non-specific physical techniques.

For patients with posterior canal benign paroxysmal positional vertigo, resolution time was significantly shorter in the Epley manoeuvre group than in the medication group. For the lateral canal canalolithiasis patients, resolution time was significantly shorter in the Lempert manoeuvre group than in the medication group. Resolution time was significantly longer in the lateral canal cupulolithiasis patients than in the other patients. The average age of patients increased with the number of recurrences, as did predominance in females. Average age and rate of sensorineural hearing loss were significantly higher in patients with intractable benign paroxysmal positional vertigo compared with those in the curable benign paroxysmal positional vertigo group.

To investigate what kinds of stimuli are effective in detaching otoconia from the cupula in three experimental models of cupulolithiasis.

Three experimental models of cupulolithiasis were prepared using bullfrog labyrinths. Three kinds of stimuli were applied to the experimental models. In experiment one (gravity), the labyrinth preparation was placed so that the cupula-to-crista axis was in the horizontal plane with the canal side in the downward position. In experiment two (sinusoidal oscillation), the labyrinth preparation was placed 3 cm from the rotational centre of a turntable, which was sinusoidally rotated with a rotational cycle of 1 Hz and a rotational angle of 30°. In experiment three (vibration), mechanical vibration was applied to the surface of the bony capsule around the labyrinth using a surgical drill.

In experiments one, two and three, the otoconial mass was respectively detached in 2 out of 10 labyrinth preparations, none of the labyrinth preparations, and all of the labyrinth preparations.

Vibration was the most effective stimulus for detaching the otoconia from the cupula in these experimental models of cupulolithiasis.