95 research outputs found

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

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    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

    Lifestyle Pathways Affecting Children’s Mental Health in Japan during the COVID-19 Pandemic

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    The recent prolonged COVID-19 pandemic has worsened the daily lives of preschoolers and elementary school children worldwide. Although these changes may have affected their mental health, the full picture still remains unknown. Since March 2020, Japan has intermittently experienced several COVID-19 waves. This survey was conducted between February and March 2022. In this study, we investigated the pathways by which specific lifestyle factors (such as exercise, sleep, diet, and life skills) affect physical/psychosocial health (PPH) in 1183 preschoolers (3–5 years old) and 3156 elementary school children (6–11 years old) in Toyama Prefecture, Japan. These pathways were examined using a path analysis. Consequently, “life skills” was found to be the factor most strongly associated with PPH in both preschoolers and elementary school children (p p < 0.001). The results of the current study may be helpful for early interventions (around the start of elementary school) at home and at school to improve children’s mental health during the COVID-19 pandemic

    Effect of treatment modality and cerebral vasospasm agent on patient outcomes after aneurysmal subarachnoid hemorrhage in the elderly aged 75 years and older.

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    OBJECTIVE:We sought to examine whether the effect of treatment modality and drugs for cerebral vasospasm on clinical outcomes differs between elderly and non-elderly subarachnoid hemorrhage (SAH) patients in Japan. METHODS:We analyzed the J-ASPECT Study Diagnosis Procedure Combination database (n = 17,343) that underwent clipping or coiling between 2010 and 2014 in 579 hospitals. We stratified patients into two groups according to their age (elderly [≥75 years old], n = 3,885; non-elderly, n = 13,458). We analyzed the effect of treatment modality and anti-vasospasm agents (fasudil hydrochloride, ozagrel sodium, cilostazol, statin, eicosapentaenoic acid [EPA], and edaravone) on in-hospital poor outcomes (mRS 3-6 at discharge) and mortality using multivariable analysis. RESULTS:The elderly patients were more likely to be female, have impaired levels of consciousness and comorbidity, and less likely to be treated with clipping and anti-vasospasm agents, except for ozagrel sodium and statin. In-hospital mortality and poor outcomes were higher in the elderly (15.8% vs. 8.5%, 71.7% vs. 36.5%). Coiling was associated with higher mortality (odds ratio 1.43, 95% confidence interval 1.2-1.7) despite a lower proportion of poor outcomes (0.84, 0.75-0.94) in the non-elderly, in contrast to no effect on clinical outcomes in the elderly. A comparable effect of anti-vasospasm agents on mortality was observed between non-elderly and elderly for fasudil hydrochloride (non-elderly: 0.20, 0.17-0.24), statin (0.63, 0.50-0.79), ozagrel sodium (0.72, 0.60-0.86), and cilostazol (0.63, 0.51-0.77). Poor outcomes were inversely associated with fasudil hydrochloride (0.59, 0.51-0.68), statin (0.84, 0.75-0.94), and EPA (0.83, 0.72-0.94) use in the non-elderly. No effect of these agents on poor outcomes was observed in the elderly. CONCLUSIONS:In contrast to the non-elderly, no effect of treatment modality on clinical outcomes were observed in the elderly. A comparable effect of anti-vasospasm agents was observed on mortality, but not on functional outcomes, between the non-elderly and elderly

    Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States

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    Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14–0.57, p<0.001) and triptans for menstrual migraine (OR 0.50, 95% CI 0.28–0.91, p=0.025) were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians. Keywords: Migraine, Preventive medication, Primary care physician, The National Ambulatory Medical Care Surve

    Public preventive awareness and preventive behaviors during a major influenza epidemic in Fukui, Japan

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    Background: As an influenza epidemic poses a serious public health threat, it is important for the public to adopt behaviors that effectively prevent influenza infection. Methods: In the winter of 2009, by using a structured questionnaire, we conducted an Internet survey with respect to residents (n = 2788) in Fukui prefecture, Japan. The main aim is to obtain information about effective prevention, factors related to preventive awareness and behaviors during the influenza epidemic. A factor analysis and linear regression models were used in the analysis. Results: Three types of preventive awareness were identified by factor analysis: “avoidance of influenza infection,” “awareness of the benefits of mask use,” and “awareness of the need for a rapid diagnosis.” Gender, age, residence, being medical person and being vaccinated were related to these preventive awareness and behaviors. Avoidance of influenza Infection was related to all preventive behavior, awareness of the benefits of mask use was related to hand disinfectant use, and awareness of the need for a rapid diagnosis was related to avoidance of face touch, gargling and attention to health care, respectively. Conclusion: Three types of preventive awareness during the influenza epidemic were emerged, and were related to preventive behaviors against influenza infection. Keywords: Infection, Influenza, Epidemic, Preventive awareness, Preventive behavio

    Factors associated with the occurrence of injuries requiring hospital transfer among older and working-age pedestrians in Kurume, Japan

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    Abstract Background Pedestrian injuries among older people tend to occur near their residence. However, knowledge regarding whether distance travelled from home to the injury site or road environmental/socioeconomic factors affect injury severity remains limited. Methods A cross-sectional study was performed using injury registry data from the Kurume City Fire Department, Japan. Distance travelled from home was determined with geographic information system (GIS) software. Data were analyzed for potential association with injury occurrence and severity, with stratification by age. Signal detection analysis using 10 variables was applied to identify factors associated with the occurrence of severe pedestrian injuries. Results Among the 545 adult pedestrian injuries reviewed, the factors associated with the occurrence of severe pedestrian injuries for older people and working-age people were evaluated, focusing on the effect of the network distance travelled from home to injury site. Network distance travelled from home to injury site was not associated with the occurrence of severe pedestrian injuries among older people. By applying signal detection analysis, for older people, higher socioeconomic status, wider road width per lane, and higher aging rate in the residential area were significant factors, and for working-age pedestrians, longer network distance travelled between injury place and their residential area and a higher aging rate in the residential area were significantly associated. Conclusions To reduce severe pedestrian injuries among older people, improvement of road infrastructure in areas with wider roads, higher socioeconomic status and higher aging rates is required

    Analysis of Japanese Articles about Suicides Involving Charcoal Burning or Hydrogen Sulfide Gas

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    It is well known that certain types of media reports about suicide can result in imitative suicides. In the last two decades, Japan has experienced two suicide epidemics and the subsequent excessive media coverage of these events. However, the quality of the media suicide reports has yet to be evaluated in terms of the guidelines for media suicide coverage. Thus, the present study analyzed Japanese newspaper articles (n = 4007) on suicides by charcoal burning or hydrogen sulfide gas between 11 February 2003 and 13 March 2010. The suicide reports were evaluated in terms of the extent to which they conformed to the suicide reporting guidelines. The mean violation scores were 3.06 (±0.7) for all articles, 3.2 (±0.8) for articles about suicide by charcoal burning, and 2.9 (±0.7) for articles about suicide by hydrogen sulfide (p &lt; 0.001). With the exception of not following several recommendations, newspaper articles about suicide have improved in quality, as defined by the recommendations for media suicide coverage. To prevent imitative suicides based on media suicide reports, individuals in the media should try not to report suicide methods and to make attempts to report the poor condition of suicide survivors
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