Relationship between home environment and the prevalence of respiratory disease of infantile wheezing

幼児期の喘息・喘鳴の有病率を明らかにし,生活環境との関連を検討することを目的に,1.6 歳児,3歳児健診を受診した母親を対象に自記式質問紙調査を行った.調査内容は,ATS-DLD 日本版・改訂版を修正した20項目,家族歴,栄養法,住環境などの12項目,属性5項目であった.有効回収数899名(92.8%).① A市の喘息の有病率は,1.6歳児8.4%(95%信頼区間confidence interval(CI),5.9～10.8%),3歳児13.7%(95% CI,10.4～17.1%)であった.② 3歳児では喘息など診断あり群が,診断なし群より家族歴があり(p<0.05),55.3%が他のアレルギー疾患を合併していた.③ 1.6歳児は,母親の喫煙(p<0.05),祖母の喫煙(p<0.01)と有病とに関連を認めたが,部屋の絨毯使用や,ペット飼育との関連は認めなかった.これらから,家族は,ダニ対策は認識していても,喫煙が乳幼児に及ぼす影響を理解していないと考えた.今後,受動喫煙の広報や禁煙指導などを強化することで,喘息や喘鳴の有病率を低下させる可能性があると考える.This study aims at identifying the relationship between home environment and the prevalence of infantile wheezing symptoms. Mothers of young children aged 1.6 and 3 years were sampled. A questionnaire, prepared by the researcher, including 20 items based on the Japanese Revised Edition of the ATS-DLD, 12 items on family history, nutrition and dietary principles and home environment, and 5 items on demographic characteristics, was used for data gathering. Data from 899 (92.8%) samples were confirmed as appropriate for the analysis. ① The prevalence rate of infantile wheezing symptoms as revealed to be 8.4% (95% confidence interval (CI), 5.9～10.8%) in the 1.6 years cohort, and 13.7% (95% CI, 10.4～17.1%) in the 3 years cohort, respectively. ② A family history of wheezing symptoms on the paternal and / or maternal side, as well as a history of other allergic symptoms, were identified in the 3 years cohort with infantile wheezing symptoms. ③ A significant relationship was found between mother's and grandmother's smoking and infantile wheezing symptoms in the 1.6 year group (p<0.05), while carpet and pet revealed no significance. It was clearly identified that family members, including grandparents, were reluctant to recognize the relationship between their smoking and the prevalence of wheezing symptoms in their children. Thus, the development of appropriate strategies for family members to ‘stop smoking' in a household with infants and young children is inevitable

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