Changes in cerebrovascular disease-related deaths and their location during the COVID-19 pandemic in Japan.

OBJECTIVE: The COVID-19 pandemic placed an enormous strain on healthcare systems and raised concerns for delays in the management of patients with acute cerebrovascular events. In this study, we investigated cerebrovascular excess deaths in Japan. STUDY DESIGN: Vital mortality statistics from January 2012 to May 2022 were obtained from the Japanese Ministry of Health, Labour and Welfare. METHODS: Using quasi-Poisson regression models, we estimated the expected weekly number of cerebrovascular deaths in Japan from January 2020 through May 2022 by place of death. Estimates were calculated for deaths in all locations, as well as for deaths in hospitals, in geriatric health service facilities, and at home. The age subgroups of ≥75 and <75 years were also considered. Weeks with a statistically significant excess of cerebrovascular deaths were determined when the weekly number of observed deaths exceeded the upper bound of 97.5% prediction interval. RESULTS: Excess deaths were noted in June 2021 and became more pronounced from February 2022 onward. The trend was notable among those aged ≥75 years and for those who died in hospitals. With respect to the location of deaths, the excess was significant in geriatric health services facilities from April 2020 to June 2021, whereas no evidence of excess hospital deaths was observed during the same period. CONCLUSIONS: Beginning in the late 2021, excess cerebrovascular deaths coincided with the spread of the Omicron variant and may be associated with increased healthcare burden. In 2020, COVID-19 altered the geography of cerebrovascular deaths, with fewer people dying in hospitals and more dying in geriatric health service facilities and at home.

Epidemiology of post-COVID conditions beyond 1 year: a cross-sectional study.

OBJECTIVE: The aim of this study was to investigate the epidemiology of post-COVID conditions beyond 12 months and identify factors associated with the persistence of each condition. STUDY DESIGN: This was a cross-sectional questionnaire-based survey. METHODS: We conducted the survey among patients who had recovered from COVID-19 and visited our institute between February 2020 and November 2021. Demographic and clinical data and data regarding the presence and duration of post-COVID conditions were obtained. We identified factors associated with the persistence of post-COVID conditions using multivariable linear regression analyses. RESULTS: Of 1148 surveyed patients, 502 completed the survey (response rate, 43.7%). Of these, 393 patients (86.4%) had mild disease in the acute phase. The proportion of participants with at least one symptom at 6, 12, 18, and 24 months after symptom onset or COVID-19 diagnosis was 32.3% (124/384), 30.5% (71/233), 25.8% (24/93), and 33.3% (2/6), respectively. The observed associations were as follows: fatigue persistence with moderate or severe COVID-19 (ß = 0.53, 95% confidence interval [CI] = 0.06-0.99); shortness of breath with moderate or severe COVID-19 (ß = 1.39, 95% CI = 0.91-1.87); cough with moderate or severe COVID-19 (ß = 0.84, 95% CI = 0.40-1.29); dysosmia with being female (ß = -0.57, 95% CI = -0.97 to -0.18) and absence of underlying medical conditions (ß = -0.43, 95% CI = -0.82 to -0.05); hair loss with being female (ß = -0.61, 95% CI = -1.00 to -0.22), absence of underlying medical conditions (ß = -0.42, 95% CI = -0.80 to 0.04), and moderate or severe COVID-19 (ß = 0.97, 95% CI = 0.41-1.54); depressed mood with younger age (ß = -0.02, 95% CI = -0.04 to -0.004); and loss of concentration with being female (ß = -0.51, 95% CI = -0.94 to -0.09). CONCLUSIONS: More than one-fourth of patients after recovery from COVID-19, most of whom had had mild disease in the acute phase, had at least one symptom at 6, 12, 18, and 24 months after onset of COVID-19, indicating that not a few patients with COVID-19 suffer from long-term residual symptoms, even in mild cases.

Health-System Introductory Pharmacy Practice Experience as an online course in the United States

Introductory Pharmacy Practice Experiences (IPPEs) provide early experiential education in the Doctor of Pharmacy (Pharm.D.) curriculum in the United States (US). In response to Oregon's 'Stay Home, Save Lives' executive order issued during the COVID-19 pandemic, an online health-system IPPE course was developed to simulate the practice experiences that have historically been conducted in person. This case study describes experience from the online health-system IPPE course offered for incoming second-year student pharmacists enrolled in a three-year Pharm.D. programme at Pacific University in Oregon, US. The goals of the course were: 1) to expose students to pharmacy practice common in health-system settings in the US;and 2) for students to earn 50 experiential clock hours through simulation activities. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

International Multicenter Study to Investigate the Performance of Urinary L-FABP in Predicting COVID-19 Severity

Background: Early detection of the illness trajectory in SARS-CoV-2 infected patients is crucial for patients and healthcare workers. A practical, non-invasive approach, with simple measurement for decision-making, is necessary for a pandemic to discriminate between high and low-risk patients, even though both may appear mild initially. Method(s): To determine COVID-19 disease severity within 10-days, distinguishing severe vs. moderate+mild and severe+moderate vs. mild, urinary L-type fatty acidbinding protein (L-FABP) was assayed less than four days after receiving a diagnosis. Severity was divided into mild (without oxygen), moderate (with oxygen) and severe (IMV/ECMO), and L-FABP within four days of diagnosis were used to predict severity within 10 days after onset. For risk prediction, urinary L-FABP was compared with interleukin-6. Next, the L-FABP point-of-care test (POCT) was further examined for its utility in risk screening in the international multicenter study. Result(s): Of the 224 participants in the study, 173 initially had a mild form. The AUC for a severe outcome was 96.3% in creatinine-adjusted L-FABP and 93.5% in net value. The AUC for a mild outcome was 85.0% and 84.9% net. The predictability of L-FABP for either a severe or mild outcome was superior to that of IL-6. Dynamics further showed better predictability of L-FABP than IL-6 during 10-days after onset. Finally, a multicenter-multicountry study confirmed the L-FABP POCT risk prediction of a severe outcome with an AUC of 88.9% and a mild outcome of 68.5%. Conclusion(s): Urinary L-FABP can predict the patient's risk of illness severity in COVID-19. L-FABP may detect severe cases more effectively and earlier than IL-6. L-FABP POCT is implementable for patient management.

Clinical features of COVID-19 patients with rebound phenomenon after corticosteroid therapy

Rational: Corticosteroid therapy plays a key role in the treatment of COVID-19 patients with respiratory failure. However, a rebound phenomenon after steroid cessation rarely occurs. Here, we investigated the clinical features of patients with rebound after steroid therapy. Methods: In total, 84 patients with COVID-19 treated with corticosteroids were enrolled and analysed retrospectively. A rebound was defined as when a patient’s respiratory status deteriorated after the cessation of corticosteroid therapy, without secondary bacterial infection. Results: Subjects in the rebound group were more likely to having severe respiratory failure than those in the non-rebound group. While the duration of steroid therapy was longer in the rebound group (8 days vs 10 days, p=0.0009), the dosage of steroid and the timing of the start or termination of steroid therapy did not show any differences between the two groups (p=0.17 and 0.68, respectively). The values of soluble interleukin-2 receptor (sIL-2R) at the baseline and the values of C reactive protein (CRP) or lactate dehydrogenase (LDH) at the end of steroid therapy were significantly higher in the rebound group (937 vs 1336 U/mL;p=0.002, 0.63 vs 3.96 mg/dL;p=0.01 and 278 vs 451 IU/mL;p=0.01, respectively). No patient in the rebound group suffered from thromboses, and the causes of death were exacerbation of COVID-19, ventilator-associated pneumonia or sepsis. The prediction model using baseline features for the rebound phenomenon included four variables of age >68 years, required supplemental oxygen >5 L/min, lymphocyte counts <792 /µL and sIL-2R >1146 U/mL. The discrimination ability of this model was 0.906 (0.755–0.968). Conclusion: These findings suggest that severe respiratory failure has a higher risk for the rebound phenomenon after the cessation of corticosteroids, and the values of sIL-2R, LDH and CRP are useful to assess the probability of developing rebound. A multivariate model was developed to predict rebound risk, which showed acceptable discrimination ability.

Development of a Polypharmacy-Based Outreach System for Pharmacist-Led Annual Wellness Visits

Introduction: Less than 20% of Medicare beneficiaries receive an Annual Wellness Visit (AWV) each year. Employing non-physician professionals to perform AWVs is one strategy to overcome the underutilization. Previous studies suggested polypharmacy as a way to operationalize pharmacy-led AWVs. However, the effectiveness of using a simple electronic medical record (EMR) outreach to recruit patients, with a goal of addressing medication-related problems (MRPs) and impacting quality measures, has not been fully investigated yet. Research Question or Hypothesis: Do numbers of polypharmacybased outreach correlate with numbers of pharmacist-led AWV appointments within a healthcare system? Study Design: Prospective cross-sectional study using EMR records Methods: Outreach was conducted from December 2021 to February 2022 by either pharmacists or non-pharmacist team members via EMR messaging in six primary care clinics. Targeted patients were: AWVeligible Medicare beneficiaries with ≥7 medications. Patients who were ≥90 years of age, had their last primary-care visit >1 year, or 'did not have an active EMR portal were excluded. The number of scheduled AWV visits were tracked as the primary outcome, and types of interventions made were collected for the secondary objective. Spearman correlation between the number of the outreach and AWV appointments was evaluated, using JMP Pro v.16, with significance level at 0.05. Results: The number of outreaches correlated to the number of AWVs scheduled (Spearman's rho=0.83, p=0.04) and MRPs identified (Spearman's rho=0.89, p=0.02). A total of 108 AWVs were conducted with 21 medications and 114 labs ordered, 15 referrals and 38 imaging/procedure placed, 16 vaccines given, 27 care gaps addressed, and 190 MRPs identified. Reported barriers to scheduling AWVs included appointment availability and COVID-related changes in workflow. Conclusion:The number of polypharmacy-based outreaches conducted was correlated with the number of pharmacist-led AWV appointments and MRPs identified during the visits. Although pharmacists have demonstrated proficiency at conducting AWVs, additional challenges were identified to operationalize pharmacyled AWVs.

Post COVID-19 condition of the Omicron variant of SARS-CoV-2.

OBJECTIVES: To investigate the prevalence of post coronavirus disease (COVID-19) condition of the Omicron variant in comparison to other strains. STUDY DESIGN: A single-center cross-sectional study. METHODS: Patients who recovered from Omicron COVID-19 infection (Omicron group) were interviewed via telephone, and patients infected with other strains (control group) were surveyed via a self-reporting questionnaire. Data on patients' characteristics, information regarding the acute-phase COVID-19, as well as presence and duration of COVID-19-related symptoms were obtained. Post COVID-19 condition in this study was defined as a symptom that lasted for at least 2 months, within 3 months of COVID-19 onset. We investigated and compared the prevalence of post COVID-19 condition in both groups after performing propensity score matching. RESULTS: We conducted interviews for 53 out of 128 patients with Omicron and obtained 502 responses in the control group. After matching cases with controls, 18 patients from both groups had improved covariate balance of the factors: older adult, female sex, obesity, and vaccination status. There were no significant differences in the prevalence of each post COVID-19 condition between the two groups. The number of patients with at least one post COVID-19 condition in the Omicron and control groups were 1 (5.6%) and 10 (55.6%) (p = 0.003), respectively. CONCLUSIONS: The prevalence of post Omicron COVID-19 conditions was less than that of the other strains. Further research with a larger sample size is needed to investigate the precise epidemiology of post COVID-19 condition of Omicron, and its impact on health-related quality of life and social productivity.

Epidemiological Factors Associated with COVID-19 Clusters in Medical and Social Welfare Facilities

The characteristics of coronavirus disease 2019 (COVID-19) clusters in medical and social welfare facilities and the factors associated with cluster size are still not yet fully understood. We reviewed COVID-19 cases in Japan identified from January 15 to April 30, 2020 and analyzed the factors associated with cluster size in medical and social welfare facilities. In this study, COVID-19 clusters were identified in 56 medical and 34 social welfare facilities. The number of cases in those facilities peaked after the peak of the general population. The duration of occurrence of new cases in clusters was positively correlated with the number of cases in both types of facilities (rho = 0.44, P < 0.001;and rho = 0.69, P < 0.001, respectively). However, the number of days between the first case in a prefecture and the onset of clusters was negatively correlated with the number of cases only in clusters in social welfare facilities (rho = 0.4, P = 0.004). Our results suggest that COVID-19 cases in those facilities were prevalent in the latter phase of the disease's community transmission, although the underlying mechanisms for such a trend could differ between medical and social welfare facilities.

Impact of the availability of care for patients with COVID-19 on nurses' progress in distance learning

In 2020, many nurses were confronted with heightened work-related and personal stressors imposed by the COVID-19 pandemic. As daily routines were upended, we wanted to understand the impact on nurses' participation in continuous learning. We retrospectively analyzed the learning logs of 194 nurses enrolled in a 12-month distance learning course, one cohort from March 2019 to February 2020 and one from March 2020 to February 2021 during the COVID-19 pandemic. The frequency of monthly logins for the COVID-19 pandemic cohort was compared for nurses with and without prior distance learning experience. Login frequency was also compared for nurses who cared directly for COVID-19 patients and those who did not. Monthly login frequency for March 2020 was significantly higher than for March 2019, while log in frequency for April 2020 was significantly lower than for April 2019. We attribute this to an increase in COVID-19 cases, hospitalizations, and deaths in April 2020. From March 2020 to August 2020, login frequency was significantly higher for nurses without previous distance learning experience, suggesting their distance learning strategies were not yet established. During September and October 2020, login frequency was significantly higher in the group with distance learning experience, from which we inferred active procrastination. We found no significant differences in the login frequencies of nurses who cared for COVID-19 patients and those who did not. The results of our study suggest that stressors imposed by the COVID-19 pandemic had a significant negative impact on distance learning progress. Screening in advance for previous distance learning experience and providing mentoring and learning supports are recommended to mitigate interference with distance learning progress during times of heightened professional and personal stress. © 2021 IEEE.

HLA-A∗11:01:01:01, HLAC∗ 12:02:02:01∼HLA-B∗52:01:02:02, age and sex are associated with severity of Japanese COVID-19 with respiratory failure

Coronavirus disease 2019 (COVID-19) was announced as an outbreak by the World Health Organization (WHO) in January 2020 and as a pandemic in March 2020. The majority of infected individuals have experienced no or only mild symptoms, ranging from fully asymptomatic cases to mild pneumonic disease. However, a minority of infected individuals develop severe respiratory symptoms. The objective of this study was to identify susceptible HLA alleles and clinical markers that can be used in risk prediction models for the early identification of severe COVID-19 among hospitalized COVID-19 patients. A total of 137 patients with mild COVID-19 (mCOVID-19) and 53 patients with severe COVID-19 (sCOVID-19) were recruited from the Center Hospital of the National Center for Global Health and Medicine (NCGM), Tokyo, Japan for the period of February-August 2020. High-resolution sequencing-based typing for eight HLA genes was performed using next-generation sequencing. In the HLA association studies, HLA-A∗11:01:01:01 [Pc = 0.013, OR = 2.26 (1.27-3.91)] and HLA-C∗12:02:02:01∼HLAB∗ 52:01:01:02 [Pc = 0.020, OR = 2.25 (1.24-3.92)] were found to be significantly associated with the severity of COVID-19. After multivariate analysis controlling for other confounding factors and comorbidities, HLAA∗ 11:01:01:01 [P = 3.34E-03, OR = 3.41 (1.50-7.73)], age at diagnosis [P = 1.29E-02, OR= 1.04 (1.01-1.07)] and sex at birth [P = 8.88E-03, OR= 2.92 (1.31-6.54)] remained significant. The area under the curve of the risk prediction model utilizing HLA-A∗11:01:01:01, age at diagnosis, and sex at birth was 0.772, with sensitivity of 0.715 and specificity of 0.717. To the best of our knowledge, this is the first article which describes associations of HLA alleles with COVID-19 at the 4-field (highest) resolution level. Early identification of potential COVID-19 could help clinicians prioritize medical utility and significantly decrease mortality from COVID-19.

Distansya: An IoT Platform to Physical Distancing Provision Notification

The research paper proposes a cheap implementation of social distancing measures that could be developed through cheap IOT sensors and existing pathogen blocking devices such as plastic face shields to combat the spread of COVID-19. The prototype system is fitted into the hard-plastic face shield with IoT sensors such as ultrasonic sensors, buzzer, and a battery controlled through an Arduino to be able to alert the surroundings of the area through the connected buzzer which activates if the user's interactions with others are detected to be too physically close and not in observance with the one-meter safety distance protocol appropriate for COVID-19 practice of social distancing. © 2021 ACM.

Factors Associated with Increased Caregiver Burden of Informal Caregivers during the COVID-19 Pandemic in Japan.

This study's objective was to explore the association between various factors and the increased caregiver burden of informal caregivers during the COVID-19 pandemic. On February, 2021, 700 informal caregivers completed an online survey. We assessed the change in caregiver burden during the COVID-19 pandemic. Among all caregiver participants, 287 (41.0%) complained of an increased caregiver burden due to the COVID-19 pandemic. The factors associated with increased caregiver burden were depressive symptoms in caregivers [odds ratio (OR), 2.20; 95% confidence interval (CI), 1.50-3.23], dementia (OR, 2.48; 95%CI, 1.07-5.73) and low Barthel Index scores (OR, 2.01; 95%CI, 1.39-2.90) in care receivers, care days (OR, 1.09; 95%CI, 1.01-1.17) and times (OR, 1.06; 95%CI, 1.01-1.10), and use of home care service (OR, 1.46; 95%CI, 1.01-2.10) and visiting care service (OR, 1.71; 95%CI, 1.20-2.45). These findings suggest we need to pay attention to the physical and mental health of both the care receivers and caregivers.

Descriptive study of COVID-19 outbreak among passengers and crew on Diamond Princess cruise ship, Yokohama Port, Japan, 20 January to 9 February 2020

An outbreak of coronavirus disease (COVID-19) occurred on the Diamond Princess cruise ship making an international journey, which led to quarantine of the ship at Yokohama Port, Japan. A suspected COVID-19 case was defined as a passenger or crew member who developed a fever or respiratory symptoms, and a confirmed COVID-19 case had laboratory-confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Between 3 and 9 February 2020, 490 individuals were tested for SARS-CoV-2 and 172 were positive (152) passengers (median age: 70 years;interquartile range (IQR): 64-75;males: 45%) and 20 crew (median age: 40 years;IQR: 35-48.5;males: 80%). Other than the Hong Kong-related index case, symptom onset for the earliest confirmed case was 22 January, 2 days after the cruise ship left port. Attack rates among passengers were similar across the decks, while beverage (3.3%, 2/61) and food service staff (5.7%, 14/245) were most affected. Attack rates tended to increase with age. A comprehensive outbreak response was implemented, including surveillance, provision of essential medical care, food and medicine delivery, isolation, infection prevention and control, sampling and disembarkation.