Hypertension treatment status and ultrasonic cardiography findings in temporary housing residents after the Kumamoto earthquake: a cross-sectional study

Background: We aimed to investigate and report the relationship between hypertension treatment status and cardiac functions among temporary housing residents after the Kumamoto earthquake. Material and methods: Ultrasonic cardiography examinations were conducted for 56 residents at temporary housing complexes in Minami Aso village in Kumamoto Prefecture in December 2016. The subjects were divided into the following three groups according to the incidence of hypertension and the antihypertensive treatment status: normal (without hypertension), treated, and untreated. Subsequently, their cardiac functions were compared. Results: Age and BMI were found to be positive predictors for hypertension. Moreover, age, LAVI, and LVMI tended to be higher in the untreated group than in the treated group. Moderate or severe mitral regurgitation was significantly more common in the untreated group than in the treated group. Conclusions: Controlling blood pressure may help to prevent new cardiac diseases (e.g., valve regurgitation) among survivors after a major disaster. In addition, for survivors who are  severely affected by psychological stress, improving the mental stress support system may be an effective measure to reduce health problems

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era