Change of human flourishing during the COVID-19 pandemic in Japan: Results from population-based U-CORONA study.

Longitudinal change in flourishing during the pandemic of COVID-19 would provide new insight to reveal determinants of well-being. We aimed to describe changes in flourishing during the COVID-19 pandemic in Japan and to examine the association of sex, age, education, and income with changes in flourishing. Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study conducted in October 2020 and November 2021 was used (n = 419 in 2020 and n = 478 in 2021, and n = 327 for both waves). Flourishing was assessed using a 12-item multidimensional flourishing scale including six domains. Change of flourishing was categorized into decreased, unchanged, and increased. Multinomial logistic regression was applied to longitudinal data to estimate the relative risk ratio of increase and decrease in flourishing scores. Cross-sectional analysis showed that the mean score of flourishing was approximately seven in both waves, with no sex differences, but older adults had higher scores than young-aged adults. We found that men were twice as likely to lose their flourishing scores as women and lower levels of education were associated with 2-3 times declining flourishing scores than higher levels of education. Age and income were not significantly associated with the change of flourishing. During the COVID-19 pandemic, flourishing declined, and men and lower-educated people were more vulnerable. In prolonged difficult situations, support for men and less educated people may contribute to the prevention of declining well-being in Japan.

Impacts of the COVID-19 pandemic exposure on child dental caries: Difference-in-differences analysis.

The impact of the coronavirus disease 2019 (COVID-19) pandemic on dental caries is unknown. We investigated the effect of the pandemic on child dental caries in Japan by comparing the increase in dental caries from fourth to sixth grade between two cohorts, COVID-19 exposed cohort, and COVID-19 unexposed cohort, using difference-in-difference analysis. A longitudinal data that followed elementary school children in Adachi City, Tokyo, was analyzed. The analysis consisted of two cohorts: those who were in fourth grade in 2016 and sixth grade in 2018 (COVID-19 unexposed cohort, N = 399) and those who were in fourth grade in 2018 and sixth grade in 2020 (COVID-19 exposed cohort, N = 3,082). Children's dental caries was examined by school dentists. A difference-in-difference analysis, adjusting for time-variant variables, i.e., household socioeconomic status, children's oral health behavior, and caregivers' psychological distress, was performed. In fourth grade, the number of Decayed, Missing, and Filled permanent Teeth (DMFT) was not different between the COVID-19 unexposed and exposed cohorts (mean = 0.241 and 0.242, respectively). In sixth grade, DMFT increased by 0.067 in the COVID-19 unexposed cohort and 0.180 in the COVID-19 exposed cohort. The interaction term of grade and cohorts for caries by difference-in-differences analysis showed that dental caries among the COVID-19 exposed cohort showed a significant increase in the number of dental caries by 0.116 (95% confidence interval 0.015, 0.216) compared to the COVID-19 unexposed cohort. Child dental caries slightly increased after the pandemic. Studies with longer follow-ups are needed to evaluate the impact of the pandemic on child dental caries.

Stressors and coping strategies among single mothers during the COVID-19 pandemic.

OBJECTIVES: Increased levels of stress have been reported among parents due to the factors associated with the COVID-19 pandemic. Although social support is known as a protective factor for the stressors, restrictions due to the pandemic could influence the provision and forms of social support. To date, few qualitative studies have examined the stressors and coping strategies in detail. In particular, the role of social support for single mothers during the pandemic remains largely unclear. The purpose of this study is to explore the stressors and coping strategies of single parents during the COVID-19 pandemic, with a focus on social support as a coping strategy. METHODS: In-depth interviews with 20 single mothers were conducted in Japan between October and November 2021. Data were deductively coded using thematic coding based on codes related to stressors and coping strategies, focusing on social support as a coping strategy. RESULTS: Most interviewees recognized additional stressors after the COVID-19 outbreak. Five stressors were mentioned by the participants: (1) fear of infection, (2) financial concerns, (3) stress caused by interactions with their children, (4) restrictions on childcare facilities, and (5) stress related to staying at home. The major coping strategies were (1) informal social support from family, friends, and coworkers, (2) formal social support from municipalities or nonprofit organizations, and (3) self-coping strategies. CONCLUSION: Single mothers in Japan recognized additional stressors after the COVID-19 outbreak. Our results support the importance of both formal and informal social support for single mothers, either in-person or online, to cope with stress during the pandemic.

Effectiveness of remdesivir with corticosteroids for COVID-19 patients in intensive care unit: A hospital-based observational study.

The effectiveness of remdesivir on survival in coronavirus disease 2019 (COVID-19), especially in cases treated in the intensive care unit (ICU), is controversial. We investigated the effectiveness of remdesivir with corticosteroids on the survival of COVID-19 patients in a real ICU clinical practice. For laboratory-confirmed COVID-19 patients admitted to the ICU of a tertiary hospital in Tokyo (April 2020-November 2021) and who received corticosteroids, the effectiveness of remdesivir for survival, stratified by interval length (within 9 or 10+ days), was retrospectively analyzed using Cox regression model. A total of 168 patients were included: 35 with no remdesivir use (control), 96 with remdesivir use within 9 days, and 37 with remdesivir use with an interval of 10+ days. In-hospital mortality was 45.7%, 10.4%, and 16.2%, respectively. After adjusting for possible covariates including comorbidities, laboratory data, oxygen demand, or level of pneumonia, remdesivir use within 9 days from symptom onset reduced mortality risk (hazard ratio [HR]: 0.10; 95% confidence interval (CI): 0.025-0.428) compared to the control group. However, remdesivir use with an interval of 10+ days showed no significant association with mortality (HR: 0.42; 95% CI: 0.117-1.524). Among COVID-19 patients who received corticosteroids in ICU, remdesivir use within 9 days from symptom onset was associated with reduced in-hospital mortality risk.

Association between Cooperative Attitude and High-Risk Behaviors on the Spread of COVID-19 Infection among Medical Students in Japan.

The impact of high-risk behaviors on the spread of COVID-19 infection among young people is an important problem to address. This study analyzed the association between cooperativeness and high-risk behaviors. We conducted a cross-sectional study among fourth-year medical students at Tokyo Medical and Dental University. The students were asked about cooperative attitude in a hypothetical situation of performing a task together with an unfamiliar classmate, who did not cooperate to complete the task previously. The response items were as follows: "cooperate", "don't want to cooperate and do it alone (non-cooperative)", and "don't want to cooperate and let the partner do it alone (punishment)". Eating out and vaccine hesitancy were also treated as high-risk behaviors. Poisson regression was used to investigate the association between cooperative attitude and each high-risk behavior, adjusted for demographics. Of the 98 students, 23 (23.5%), 44 (44.9%), and 31 (31.6%) students chose "noncooperative", "cooperative", and "punishment", respectively. Cooperative-type students exhibited 2.77-fold (PR: 2.77, 95% CI: 1.03-7.46), and punishment-type students exhibited 3.16-fold greater risk of eating or drinking out (PR: 3.16, 95% CI: 1.14-8.75) compared with those of the noncooperative type. Among medical students, the "cooperative" type and "punishment" type comprised the high-risk group for eating out during the pandemic.

Characteristics of Long COVID: Cases from the First to the Fifth Wave in Greater Tokyo, Japan.

PURPOSE: Approximately 25-60% of COVID-19 patients develop long-term sequelae of the condition known as long COVID. This study aimed to examine sociodemographic and clinical characteristics of long COVID in Japan. METHODS: The data of long COVID patients, defined as those who were symptomatic after 28 days from onset, were collected in an outpatient clinic in Tokyo, Japan between 6 January 2020 and 2 October 2021 (N = 1891). Information on age, sex, employment, infection waves, vaccination, impairment in activities of daily living, and symptoms were obtained from electronic medical records. We used linear regression to analyze the association of patients characteristics with performance status. RESULTS: The mean number of days from onset was 77.6 (SD: 71.3). Female, those who had their work hours reduced, on leave, dismissed or retired or not working, were associated with lower performance status. Fatigue, depressive symptom, brain fog, dyspnea, palpitation, body pain, loss of appetite, fever-but not headache, insomnia, loss of smell, loss of taste, hair loss, or cough-were associated with the lower performance status. CONCLUSION: Sex and employment status were associated with lower performance status in long COVID patients. Studies are needed to elucidate the full picture of the characteristics of long COVID patients.

Concerns and needs of people with intellectual disabilities and their caregivers during the COVID-19 pandemic in Japan.

BACKGROUND: People with intellectual disabilities (IDs) and their caregivers face difficulties during the COVID-19 pandemic. However, limited studies have comprehensively investigated their challenges, especially in Japan. We aimed to clarify the concerns and needs of people with IDs and their caregivers during the COVID-19 pandemic in Japan. METHOD: From March to August 2021, 27 in-depth interviews were conducted with principal caregivers of people with moderate to profound IDs in Japan. We then transcribed the interviews and conducted deductive coding using predetermined codes focused on their daily life difficulties. Inductive coding was used to ensure that no important themes were overlooked. RESULTS: We found four concerns and four needs among people with IDs and their caregivers as significant themes. CONCLUSIONS: Our results provide useful information for supporting people with IDs and their caregivers, especially among those who need medical or social care in accordance with the infection control and social-distancing policies.

Association between social capital and COVID-19 preventive behaviors: Country-level ecological study.

Background: The association between social capital and preventive behaviors against COVID-19 remains controversial. We examined the association between social capital and preventive behaviors against COVID-19 at country level. Methods: The data on country-level social capital (i.e., social trust, group affiliations, civic responsibility, and confidence in state institutions) was obtained from a previous literature based on World Value Survey. Preventive behaviors were calculated as the percentage of people in a country who took COVID-19 preventive behaviors (i.e., physical distancing, hand hygiene, and the use of face mask) from an international survey of Facebook users, from July to October 2020 (207 data points for 9 waves of 23 countries). The scores on social capital were standardized. The association was investigated with multilevel linear regression analysis. Results: High civic responsibility (per 1 standard deviation, SD) was associated with low percentage points of physical distancing (ß = -4.66, 95% confidence interval, CI: 7.23, -2.09), hand hygiene (ß = -2.88, 95% CI: 3.98, -1.78) and the use of face mask (ß = -3.95, 95% CI: 5.29, -2.62). Group affiliations were associated with high percentage points of physical distancing (ß = 2.96, 95% CI: 0.35, 5.58) and the use of face mask (ß = 1.80, 95% CI: 0.45, 3.16). Social trust had significant positive association with performing hand hygiene (ß = 1.22, 95% CI: 0.09, 2.35). Conclusions: These results suggested that in countries with higher levels of civic responsibility, preventive behaviors should be more intensified during a pandemic.

The Association between Types of COVID-19 Information Source and the Avoidance of Child Health Checkups in Japan: Findings from the JACSIS 2021 Study.

The coronavirus disease 2019 (COVID-19) pandemic can affect children's well-being through mothers' avoidance of health checkups for children due to media portrayal of the disease. This study investigated the association between the type of information source for COVID-19 received by mothers and the avoidance of their children's health checkups. The study was an online-based survey, and the participants comprised 5667 postpartum women with children aged under 2 years during the study period. We analyzed the analytic sample and three groups of women with children aged 0-3 months, 4-6 months, and 6 months or older according to the timing of children's health checkups in Japan. Among the participants, 382 women (6.7%) avoided their children's health checkups. Multivariate logistic regression analysis revealed that mothers with children over 6 months who used magazines as an information source about COVID-19 tended to avoid their children's health checkups (adjusted odds ratio (aOR): 3.19; 95% confidence interval (CI): 1.68-6.05) compared with those who did not. In contrast, those using public websites were less likely to avoid their children's health checkups (aOR 0.58, 95% CI 0.43-0.77). This study showed that specific types of information source on COVID-19 could have varying effects on mothers' decisions about their children's health checkups.

Association between Social Engagements and Stigmatization of COVID-19 Infection among Community Population in Japan.

In the face of unknown risks, including the coronavirus disease 2019 (COVID-19) pandemic, we tend to have stigmatized perceptions. The current study aimed to examine the association of social engagements with the level of stigmatization of COVID-19 infection among the general population. The data of 429 participants of the Utsunomiya COVID-19 seroprevalence neighborhood association (U-CORONA) study, a population-based cohort study conducted in Utsunomiya City, Japan, were analyzed. Their stigmatized perception of people with COVID-19 infection was evaluated via a questionnaire for the situation if they or others in their community were to get infected. The association between social engagements (community social capital, social network diversity, and social network size) and stigmatization were analyzed by a multiple linear regression model with generalized estimating equations. Overall, females reported a higher stigmatized perception of people with COVID-19 than males. Lower education and depressive symptoms were also positively associated with higher stigmatization, while age, household income, and comorbidities were not. People with higher community social capital reported lower stigmatization (B = -0.69, 95% CI = -1.23 to -0.16), while social network diversity and social network size did not show an association with stigmatization. We found an association between community social capital and stigmatization, suggesting that enhancing their community social capital, but not social network diversity and size, has the potential to mitigate the levels of stigmatization.

SARS-CoV-2 suppression and early closure of bars and restaurants: a longitudinal natural experiment.

Despite severe economic damage, full-service restaurants and bars have been closed in hopes of suppressing the spread of SARS-CoV-2 worldwide. This paper explores whether the early closure of restaurants and bars in February 2021 reduced symptoms of SARS-CoV-2 in Japan. Using a large-scale nationally representative longitudinal survey, we found that the early closure of restaurants and bars decreased the utilization rate among young persons (OR 0.688; CI95 0.515-0.918) and those who visited these places before the pandemic (OR 0.754; CI95 0.594-0.957). However, symptoms of SARS-CoV-2 did not decrease in these active and high-risk subpopulations. Among the more inactive and low-risk subpopulations, such as elderly persons, no discernible impacts are observed in both the utilization of restaurants and bars and the symptoms of SARS-CoV-2. These results suggest that the early closure of restaurants and bars without any other concurrent measures does not contribute to the suppression of SARS-CoV-2.

Association between Frequency of Conversations and Suicidal Ideation among Medical Students during COVID-19 Pandemic in Japan.

To mitigate the spread of COVID-19, universities in Japan shifted from face-to-face to online classes, which might have reduced social interaction and increased psychiatric problems among students. A self-report questionnaire was administered to fourth-year medical students in Tokyo in May 2021, during the fourth wave of the COVID-19 outbreak, to examine the association between the frequency of conversations and suicidal thoughts. The questionnaire assessed the frequency of conversations and, using part of the Mini International Neuropsychiatric Interview, suicidal ideation. Of the 113 students, 98 (86.7%) responded, of whom 20 (20.4%) had suicidal ideation. Poisson regression analysis revealed that those with less than 1 conversation per week and no conversations at all had a significantly higher risk of suicidal ideation than those with 3 conversations per week or more, after adjusting for personality, family relationship, income level, living alone, number of friends, gender, and age. These results indicate that less frequent conversations increased the risk of suicidal ideation among medical students. Mental health support for students needs to be strengthened if universities suspend face-to-face classes during a pandemic.

Association between Frequency of Conversations and Suicidal Ideation among Medical Students during COVID-19 Pandemic in Japan

To mitigate the spread of COVID-19, universities in Japan shifted from face-to-face to online classes, which might have reduced social interaction and increased psychiatric problems among students. A self-report questionnaire was administered to fourth-year medical students in Tokyo in May 2021, during the fourth wave of the COVID-19 outbreak, to examine the association between the frequency of conversations and suicidal thoughts. The questionnaire assessed the frequency of conversations and, using part of the Mini International Neuropsychiatric Interview, suicidal ideation. Of the 113 students, 98 (86.7%) responded, of whom 20 (20.4%) had suicidal ideation. Poisson regression analysis revealed that those with less than 1 conversation per week and no conversations at all had a significantly higher risk of suicidal ideation than those with 3 conversations per week or more, after adjusting for personality, family relationship, income level, living alone, number of friends, gender, and age. These results indicate that less frequent conversations increased the risk of suicidal ideation among medical students. Mental health support for students needs to be strengthened if universities suspend face-to-face classes during a pandemic.

Association of Paternity Leave with Impaired Father-Infant Bonding: Findings from a Nationwide Online Survey in Japan.

Although the number of fathers taking childcare leave is increasing, the impact of paternity leave on father-infant bonding remains to be fully investigated. This study aimed to assess the association between paternity leave and father-infant bonding among fathers with children under two years old. A cross-sectional study was performed using data from the Japan COVID-19 and Society Internet Survey study, a nationwide online survey conducted between July and August 2021 (N = 1194). Father-infant bonding was assessed by the Japanese version of the Mother-Infant Bonding Scale (MIBS-J), which comprised two subscales (lack of affection (LA), and anger and rejection (AR)), with a higher score denoting poor bonding. Four hundred (33.5%) fathers self-reported taking childcare leave. Paternity leave was associated with higher total MIBS-J score and AR score after adjusting for covariates (coefficient 0.51; 95% confidence interval (CI) 0.06-0.96, coefficient 0.26; 95% CI 0.03-0.49, respectively), but not with LA score (coefficient 0.10; 95% CI -0.13-0.34). There was no trend in the association between paternity leave and total MIBS-J score by children's age group (p for trend = 0.98). Paternity leave was associated with impaired bonding, especially with increased anger and rejection, among fathers with children under two years of age.

The Prevalence of COVID-19 Vaccination and Vaccine Hesitancy in Pregnant Women: An Internet-based Cross-sectional Study in Japan.

BACKGROUND: Reluctance of people to receive recommended vaccines is a growing concern, as distribution of vaccines is considered critical to ending the COVID-19 pandemic. There is little information regarding pregnant women's views toward coronavirus vaccination in Japan. Therefore, we investigated the vaccination rate and reasons for vaccination and vaccine hesitancy among pregnant women in Japan. METHODS: We conducted a cross-sectional study involving 1,791 pregnant women using data from the Japan "COVID-19 and Society" Internet Survey, conducted from July to August 2021, and valid response from 1,621 respondents were analyzed. We defined participants with vaccine hesitancy as those who identified with the statement "I do not want to be vaccinated" or "I want to 'wait and see' before getting vaccinated." Multivariate Poisson regression analysis was used to investigate the factors contributing to vaccine hesitancy. RESULTS: The prevalence of vaccination and vaccine hesitancy among pregnant women was 13.4% (n = 217) and 50.9% (n = 825), respectively. The main reasons for hesitancy were concerns about adverse reactions and negative effects on the fetus and breastfeeding. Vaccine hesitancy was significantly associated with the lack of trust in the government (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.03-1.54). Other factors, such as age, educational attainment, and state of emergency declaration, were not associated with vaccine hesitancy. CONCLUSIONS: COVID-19 vaccination is not widespread among pregnant women in Japan, although many vaccines have been shown to be safe in pregnancy. Accurate information dissemination and boosting trust in the government may be important to address vaccine hesitancy among pregnant women.

Association between Children's Engagement in Community Cultural Activities and Their Mental Health during the COVID-19 Pandemic: Results from A-CHILD Study.

Social learning experiences developed through engagement in community cultural activities can affect a child's development. Few studies have examined how children's engagement in community activities is related to their mental health. This study aimed to examine associations between children's participation in community cultural activities and their mental health. We targeted all sixth-grade children in all 69 primary schools in Adachi City, Tokyo, using the Adachi Child Health Impact of Living Difficulty (A-CHILD) study (n = 4391). Parents answered the validated Japanese version of the Strength and Difficulties Questionnaire (SDQ) to assess child mental health, the child's engagement in community cultural activities. The community activity in which children most frequently participated was local festivals. Participating in local festivals was significantly associated with lower behavioral difficulties (ß = -0.49, SE = 0.17, p = 0.005) and higher prosocial behaviors (ß = 0.25, SE = 0.07, p < 0.001) after adjusting for demographic variables, family social capital, and parent-child interactions. These results highlight the importance of children's engagement in community cultural activities for their mental health during the COVID-19 pandemic.

One year into COVID-19: What have we learned about child maltreatment reports and child protective service responses?

BACKGROUND: A year has passed since COVID-19 began disrupting systems. Although children are not considered a risk population for the virus, there is accumulating knowledge regarding children's escalating risk for maltreatment during the pandemic. OBJECTIVE: The current study is part of a larger initiative using an international platform to examine child maltreatment (CM) reports and child protective service (CPS) responses in various countries. The first data collection, which included a comparison between eight countries after the pandemic's first wave (March-June 2020), illustrated a worrisome picture regarding children's wellbeing. The current study presents the second wave of data across 12 regions via population data (Australia [New South Wales], Brazil, United States [California, Pennsylvania], Colombia, England, Germany, Israel, Japan, Canada [Ontario, Quebec], South Africa). METHOD: Regional information was gathered, including demographics, economic situation, and CPS responses to COVID-19. A descriptive analysis was conducted to provide an overview of the phenomenon. RESULTS: Across all of the countries, COVID-19 had a substantial negative impact on the operation of CPSs and the children and families they serve by disrupting in-person services. One year into the COVID-19 pandemic, new reports of CM varied across the regions.1 In some, the impact of COVID-19 on CPS was low to moderate, while in others, more significant changes created multiple challenges for CPS services. CONCLUSIONS: COVID-19 created a barrier for CPS to access and protect children. The dramatic variance between the regions demonstrated how social, economic and structural contexts impact both CM reports and CPS responses.