Change in Alcohol Use during the Prolonged COVID-19 Pandemic and Its Psychosocial Factors: A One-Year Longitudinal Study in Japan

This study investigated changes in alcohol use and its related psychosocial factors during the COVID-19 pandemic in Japan. Two online surveys were completed by participants between 15 and 20 June 2021 (phase 1) and 13 and 30 May 2022 (phase 2). A total of 9614 individuals participated in both phases (46% women, mean age = 50.0 ± 13.1 years) and a repeated three-way analysis of variance and multinomial logistic regression analysis were conducted. These data analyses showed that the presence of hazardous alcohol use at phase 2 was predicted by being male and unmarried, having a higher annual household income and age, having a larger social network, and displaying fewer COVID-19 prevention behaviors at phase 1. Further, the presence of potential alcoholism at phase 2 was predicted by being male, being more anxious, having a larger social network, exercising more, showing a deterioration of economic status, having more difficulties owing to a lack of daily necessities, having less healthy eating habits, and showing fewer COVID-19 prevention behaviors at phase 1. These findings suggest that psychological problems and increased work (or academic) and economic difficulties were associated with severe alcohol problems during a later stage of the COVID-19 pandemic.

Change in Alcohol Use during the Prolonged COVID-19 Pandemic and Its Psychosocial Factors: A One-Year Longitudinal Study in Japan.

This study investigated changes in alcohol use and its related psychosocial factors during the COVID-19 pandemic in Japan. Two online surveys were completed by participants between 15 and 20 June 2021 (phase 1) and 13 and 30 May 2022 (phase 2). A total of 9614 individuals participated in both phases (46% women, mean age = 50.0 ± 13.1 years) and a repeated three-way analysis of variance and multinomial logistic regression analysis were conducted. These data analyses showed that the presence of hazardous alcohol use at phase 2 was predicted by being male and unmarried, having a higher annual household income and age, having a larger social network, and displaying fewer COVID-19 prevention behaviors at phase 1. Further, the presence of potential alcoholism at phase 2 was predicted by being male, being more anxious, having a larger social network, exercising more, showing a deterioration of economic status, having more difficulties owing to a lack of daily necessities, having less healthy eating habits, and showing fewer COVID-19 prevention behaviors at phase 1. These findings suggest that psychological problems and increased work (or academic) and economic difficulties were associated with severe alcohol problems during a later stage of the COVID-19 pandemic.

Negative impact of behavior restriction amidst a clustered COVID-19 infection on immobility syndrome in older patients negative for COVID-19: report from a chronic care hospital in Japan.

Previous studies have reported on associations between immobility syndrome and the COVID-19 pandemic. However, little is known about the aggravation of this syndrome in older patients negative for COVID-19 infection amidst behavior restriction due to a clustered COVID-19 infection. Patients hospitalized one month before a clustered COVID-19 infection occurred in our hospital were recruited. Rehabilitation therapy was suspended for 25 days during behavior restriction. The ability of daily living of the patients was evaluated with the functional independence measure and Barthel index. Chronological changes in the functional independence measure and Barthel index scores were evaluated monthly, beginning one month before the clustered COVID-19 infection to one month after re-initiation of rehabilitation therapy. Patients with minimum scores in the functional independence measure (18) and Barthel index (0) prior to the clustered COVID-19 infection were excluded. Functional independence measure scores of 73 older patients and the Barthel index scores of 48 patients were analyzed. The mean total functional independence measure score amidst the behavior restriction significantly changed from 36.3 to 35.1 (p = 0.019), while statistical significance was not detected in the mean motor subtotal (from 21.6 to 20.9 with p = 0.247) or cognitive subtotal functional independence measure scores (from 14.6 to 14.2 with p = 0.478). During the behavior restriction, the mean Barthel index scores declined from 25.8 to 23.2 without statistical significance (p = 0.059). Behavior restriction due to a clustered COVID-19 infection may aggravate immobility syndrome in older patients who are negative for COVID-19.

Magnetic Resonance Imaging Scan of the Brain After Mild COVID-19 Infection.

PURPOSE: There have been several reports of central nervous system impairments associated with severe coronavirus disease 2019 (COVID-19) infection on head magnetic resonance imaging and angiography (MRI/A). However, head MRI/A is rarely performed in mild cases, and there have been few reports on intracranial changes after COVID-19 infection in these cases. Here, we report a comparative examination of the findings seen in common head MRI/A sequences in mild cases of COVID-19. METHODS: Of the 15,376 patients who underwent head MRI/A examination called "Brain Dock" between June 2020 and June 2021, 746 patients who received a COVID-19 antibody test were evaluated. Positive and negative patients were comparatively examined for head MRI/A findings such as cerebral white matter lesions, ischemic changes, cerebral microbleeds, cerebral aneurysms, arterial stenosis, sinusitis, and other abnormal findings. RESULTS: Overall, 31 (4.2%) patients were COVID-19 positive, and all of them had mild infections not requiring hospitalization. There was no significant difference in patient characteristics and head MRI/A findings between positive and negative patients. All positive patients showed no particular abnormalities in the nasal findings such as olfactory bulb atrophy or thickening of the olfactory mucosa. CONCLUSION: Intracranial lesions in mild patients do not show a clear difference from those in negative patients. This indicates that findings seen in common MRI/A sequences of severe patients are not likely in mild patients, supporting that there is relatively no damage to the central nervous system in mild patients.

Socio-economic and behavioral characteristics associated with COVID-19 vaccine hesitancy under a declared state of emergency in Japan.

Evidence regarding coronavirus disease 2019 vaccination indicates that some people hesitate to be vaccinated, and previous studies demonstrate the variables that influence hesitancy to vaccinate. However, they have not limited the target population to areas where infection is prominent. This study aimed to clarify the characteristics of people living in these areas who hesitate to be vaccinated and recommend effective approaches to encourage vaccination. The survey was conducted online between February 24 and March 1, 2021, during which the 2nd state of emergency was declared in Japan. The analytic sample comprised 17,582 unvaccinated individuals (mean age â€‹= â€‹48.6 â€‹± â€‹13.8, range â€‹= â€‹18-90 years). The t-test results indicate that current or past treatment for physical illness exerted a strong influence on vaccine hesitancy (ds â€‹= â€‹0.30). Similarly, multiple regression analyses revealed that understanding the importance and necessity for preventive behaviors had the greatest influence on the intention to vaccinate (ߠ​= â€‹0.48). Regarding recommendations to promote willingness to be vaccinated, our findings indicated that clear explanation of the reasons for the necessity for these behaviors and collaboration between representatives of various communities would effectively encourage vaccination.

Correction: The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study.

[This corrects the article DOI: 10.2196/32694.].

Mental health and social isolation under repeated mild lockdowns in Japan.

The influence of repeated lockdowns on mental health and social isolation is unknown. We conducted a longitudinal study of the influence of repeated mild lockdowns during two emergency declarations in Japan, in May 2020 and February 2021. The analyses included 7893 people who participated in all online surveys. During repeated mild lockdowns, mental and physical symptoms decreased overall, while loneliness increased and social networks decreased. Subgroup analyses revealed that depression and suicidal ideation did not decrease only in the younger age group (aged 18-29 years) and that younger and middle-aged people (aged 18-49 years), women, people with a history of treatment for mental illness, and people who were socially disadvantaged in terms of income had higher levels of mental and physical symptoms at all survey times. Additionally, comprehensive extraction of the interaction structure between depression, demographic attributes, and psychosocial variables indicated that loneliness and social networks were most closely associated with depression. These results indicate that repeated lockdowns have cumulative negative effects on social isolation and loneliness and that susceptible populations, such as young people and those with high levels of loneliness, require special consideration during repeated lockdown situations.

The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study.

BACKGROUND: Lockdowns and stay-at-home orders announced internationally for COVID-19 have led to physical and social distancing, with reports of many individuals experiencing social isolation (SI) and loneliness. Although the emergency declaration in Japan was declared as a "mild" lockdown requested by the government without penalties for violations, the lockdown measures, including SI, had several influences on people's lives and mental health as in other countries. Furthermore, Japan declared a state of emergency multiple times; thus, it is necessary to examine the influence of the transition of SI caused by repeated emergency declarations and the deterioration of mental health associated with these changes. OBJECTIVE: This study longitudinally investigated the transition of SI and its related factors during the mild lockdown under 2 declared states of emergency in Japan and analyzed psychosocial characteristics by extracting clusters where people with specific transition patterns of SI predominated. METHODS: We collected data on 7893 inhabitants (3694 [46.8%] women, 49.6 [SD 13.7] years old) living in the 7 prefectures where the initial emergency declaration was applied. The investigations took place online in the final phase of the first and second states of emergency: phase 1 (between May 11 and 12, 2020) and phase 2 (between February 24 and 28, 2021). Nonparametric Bayesian coclustering was used to visualize the exhaustive interaction structure between the transition pattern of SI and the psychosocial variables. RESULTS: There were no improvements in social networks and loneliness between the 2 phases, although psychological distress significantly improved and depression slightly decreased. Overall, 3868 (49%) of the 7893 participants remained socially isolated through phases 1 and 2, and 947 (12%) were socially isolated in phase 2, even though they were not socially isolated in phase 1. More participants experienced persistent SI in unmarried, childless, and low-household-income groups. The persistent-SI group had fewer cohabitants than other transition pattern groups. The nonparametric Bayesian coclustering results showed that most clusters, including participants without SI throughout phases 1 and 2, had healthy behaviors, more interactions, good relationships, and less loneliness and psychological stress. Furthermore, the cluster in which relationships deteriorated in phase 1 recovered in phase 2. Comparatively, the clusters with SI throughout phases 1 and 2 were divided into clusters with increased loneliness and psychological stress; clusters were close to participants' average scores in this study. The clusters with increased loneliness and psychological stress were notable for deteriorating relationships and less online interaction. CONCLUSIONS: This study revealed the actual state of transition of SI and related psychological, social, and behavioral factors under repeated declarations of a state of emergency. These results should help construct intervention methods that fit individual characteristics of people in SI during a pandemic.

Ideal Test Time for Coronavirus Disease 2019 Contact Tracing.

Background: Epidemiological contact tracing is a powerful tool to rapidly detect SARS-CoV-2 infection in persons with a close contact history with COVID-19-affected patients. However, it remains unclear whom and when should be PCR tested among the close contact subjects. Methods: We retrospectively analyzed 817 close contact subjects, including 144 potentially SARS-CoV-2-infected persons. The patient characteristics and contact type, duration between the date of the close contact and specimen sampling, and PCR test results in PCR positive and negative persons were compared. Results: We found that male gender {adjusted odds ratio 1.747 [95% confidence interval (CI) 1.180-2.608]}, age ≥ 60 [1.749 (95% CI 1.07-2.812)], and household contact [2.14 (95% CI 1.388-3.371)] are independent risk factors for close contact SARS-CoV-2 infection. Symptomatic subjects were predicted 6.179 (95% CI 3.985-9.61) times more likely to be infected compared to asymptomatic ones. We could observe PCR test positivity between days 1 and 17 after close contact. However, no subject could be found with a Ct-value <30, considered less infective, after day 14 of close contact. Conclusions: Based on our results, we suggest that contact tracing should be performed on the high-risk subjects between days 3 and 13 after close contacts.

Alcohol Use and Its Related Psychosocial Effects during the Prolonged COVID-19 Pandemic in Japan: A Cross-Sectional Survey.

We conducted a large-scale survey in the Japanese population, about one year after the initial declaration of the state of emergency, to investigate alcohol use under the prolonged coronavirus disease 2019 (COVID-19) pandemic and its related psychosocial and demographic characteristics. The survey was conducted online between 15 and 20 June 2021. A total of 11,427 participants were included in the analysis (48.5% female, 48.82 ± 13.30 years, range = 20-90 years). Compared with females, males were more prevalent in the hazardous user and the potential alcoholism group and were less prevalent in the no alcohol-related problem group. However, the prevalence of potential alcoholism among the participants in our study was higher than that previously reported. This trend was particularly pronounced in women. The presence of potential alcoholism was related to a deteriorated psychological status, particularly depression and anxiety, and various difficulties in their daily lives due to the COVID-19 pandemic. In the future, intervention methods and systems should be developed to provide optimal assistance to people with psychological problems who are vulnerable to alcohol-related problems during the COVID-19 pandemic, while conducting further long-term follow-up studies.

A Rare Case of COVID-19 Pneumonia Concomitant with Bleeding from Acute Gastric Mucosal Lesions.

A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19) pneumonia. Twenty-six days after admission, he experienced hematemesis despite improvement in his respiratory symptoms. Contrast-enhanced computed tomography revealed edematous stomach wall thickening with neither ischemic findings in the gastric wall nor obstruction of the gastric artery. Emergent esophagogastroduodenoscopy showed diffuse dark-red mucosa accompanied by multiple easy-bleeding, irregularly shaped ulcers throughout almost the whole stomach without active bleeding or visible vessels. The clinical course, including the endoscopic findings, progressed favorably with conservative treatment. COVID-19 pneumonia can present with acute gastric mucosal lesion, which may be induced by microvascular thrombosis due to COVID-19-related coagulopathy.

Evaluation of a combination protocol of CT-first triage and active telemedicine methods by a selected team tackling COVID-19: An experimental research study.

BACKGROUND: Many health care workers around the world tackled with COVID-19, however sadly, the infection of many medical care workers were reported. To reduce the risk of infection, we launched selected team (Team COVID) of non-specialists and brought in active telemedicine method and computed tomography (CT)-first protocol. We describe our actual practice and the health status of medical doctors dealing with COVID-19 patients. METHODS: Between April 17, 2020 and May 24, 2020, 10 doctors worked with COVID-19 patients as part of Team COVID. The Team COVID doctors used a CT-first triage protocol for outpatients and telemedicine for inpatients and outpatients. We evaluated paired serum-specific antibodies for SARS-CoV-2 at the initial and end of the study duration and PCR results for SARS-CoV-2 at the end of the study duration. Furthermore, 36-item short-form of the Medical Outcome Study Questionnaire (SF-36) at the beginning and end of the study period were evaluated. RESULTS: Ten doctors worked as Team COVID: seven internal medicine doctors and three surgeons. During the study period, Team COVID treated 165 individuals in the outpatient clinic and isolated hospitalized patients for 315 person-days. There were no positive results of serum-specific antibody testing and PCR testing for SARS-CoV-2 in Team COVID doctors. Furthermore, the SF-36 showed no deterioration in physical and mental QOL status. No in-hospital infection occurred during the study period. CONCLUSIONS: The Team COVID fulfilled the treatment using the active telemedicine and CT-first triage protocol without in hospital infection and excess stress. The combination strategy seems acceptable for both the protection and stress relief among the medical staff.

Social isolation and its psychosocial factors in mild lockdown for the COVID-19 pandemic: a cross-sectional survey of the Japanese population.

OBJECTIVE: This study investigated the sociodemographic, behavioural and psychological characteristics of socially isolated individuals during the 'mild lockdown' period of COVID-19 in Japan. DESIGN: A cross-sectional study. SETTING: The seven prefectures where the emergency declaration was first applied in Japan. PARTICIPANTS: We collected data on 11 333 individuals (52.4% women, 46.3±14.6 years) living in the seven prefectures where the emergency declaration was first applied. The online survey was performed between 11 May and 12 May 2020, in the final phase of the state of emergency. PRIMARY OUTCOME MEASURES: Lubben Social Network Scale (LSNS-6) RESULTS: We found that male sex (95% CI 1.60 to 1.98), middle age (95% CI 1.55 to 1.93) and lower income (eg, annual household income <2.0 million: 95% CI 2.29 to 3.54) predicted social isolation; being a student was a protective factor against social isolation (95% CI 0.26 to 0.62). In the comparisons of each item of the LSNS-6 by sociodemographic characteristics, men were more likely to have fewer people to talk to about their personal problems (95% CI -0.37 to -0.28) and to seek help from (95% CI -0.39 to -0.30), and the middle-aged group had a lower social network of friends. Additionally, social isolation was associated with decreased online interaction with familiar people (95% CI -1.28 to -1.13) and decreased optimistic thinking under mild lockdown (95% CI -0.97 to -0.86). CONCLUSIONS: We identified the sociodemographic and psychological characteristics associated with social isolation under mild lockdown. These results are expected to be a useful resource for identifying which groups may require intervention to improve their social interactions in order to preserve their mental health during the pandemic.

Real-world evaluation of a computed tomography-first triage strategy for suspected Coronavirus disease 2019 in outpatients in Japan: An observational cohort study.

ABSTRACT: The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs 1037.0 minutes, P < .001).Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.

Severe acute respiratory syndrome coronavirus 2 prevalence in saliva and gastric and intestinal fluid in patients undergoing gastrointestinal endoscopy in coronavirus disease 2019 endemic areas: Prospective cross-sectional study in Japan.

OBJECTIVES: Gastrointestinal endoscopy (GIE) is useful for the early detection and treatment of many diseases; however, GIE is considered a high-risk procedure in the coronavirus disease 2019 (COVID-19) pandemic era. This study aimed to explore the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity in saliva and gastrointestinal fluids to which endoscopy medical staff are exposed. METHODS: The study was a single-center cross-sectional study. From June 1 to July 31, 2020, all patients who underwent GIE at Yokohama City University Hospital were registered. All patients provided 3 mL of saliva. For upper GIE, 10 mL of gastric fluid was collected through the endoscope. For lower GIE, 10 mL of intestinal fluid was collected through the endoscope. The primary outcome was the positive rate of SARS-CoV-2 in saliva and gastrointestinal fluids. We also analyzed serum-specific antibodies for SARS-CoV-2 and patients' background information. RESULTS: A total of 783 samples (560 upper GIE and 223 lower GIE samples) were analyzed. Polymerase chain reaction (PCR) on saliva samples did not show any positive results in either upper or lower GIE samples. However, 2.0% (16/783) of gastrointestinal fluid samples tested positive for SARS-CoV-2. No significant differences in age, sex, purpose of endoscopy, medication, or rate of antibody test positivity were found between PCR positive and PCR negative cases. CONCLUSIONS: Asymptomatic patients, even those with no detectable virus in their saliva, had SARS-CoV-2 in their gastrointestinal tract. Endoscopy medical staff should be aware of infection when performing procedures. The study was registered as UMIN000040587.

The Psychological Impact of 'Mild Lockdown' in Japan during the COVID-19 Pandemic: A Nationwide Survey under a Declared State of Emergency.

This study examined the psychological distress caused by non-coercive lockdown (mild lockdown) in Japan. An online survey was conducted with 11,333 people (52.4% females; mean age = 46.3 ± 14.6 years, range = 18-89 years) during the mild lockdown in the seven prefectures most affected by COVID-19 infection. Over one-third (36.6%) of participants experienced mild-to-moderate psychological distress (Kessler Psychological Distress Scale [K6] score 5-12), while 11.5% reported serious psychological distress (K6 score ≥ 13). The estimated prevalence of depression (Patient Health Questionnaire-9 score ≥ 10) was 17.9%. Regarding the distribution of K6 scores, the proportion of those with psychological distress in this study was significantly higher when compared with the previous national survey data from 2010, 2013, 2016, and 2019. Healthcare workers, those with a history of treatment for mental illness, and younger participants (aged 18-19 or 20-39 years) showed particularly high levels of psychological distress. Psychological distress severity was influenced by specific interactional structures of risk factors: high loneliness, poor interpersonal relationships, COVID-19-related sleeplessness and anxiety, deterioration of household economy, and work and academic difficulties. Even when non-coercive lockdowns are implemented, people's mental health should be considered, and policies to prevent mental health deterioration are needed. Cross-disciplinary public-private sector efforts tailored to each individual's problem structure are important to address the mental health issues arising from lockdown.

Physical Exercise and Immune System in the Elderly: Implications and Importance in COVID-19 Pandemic Period.

Physical exercise is seen as the main ally for health promotion, preventing and protecting the organism from several diseases. According to WHO, there is a tendency of constant growth in the elderly population in the coming years. The regular practice of exercises by the elderly becomes relevant to minimize the deleterious effects of the aging process and to increase the fitness index. Recently, the world population started a confrontation against Corona Virus Disease (COVID-19), which is the most significant public health challenge globally. Although social isolation is a reasonable measure in an attempt to stop contamination by COVID-19, this measure has limited the ability of individuals to exercise outdoors or in gyms and health clubs, which increased the risk of developing chronic illnesses related to a sedentary lifestyle. The critical point is that the recent recommendations on exercise prescription to combat the potentially harmful effects of COVID-19 failure to adequately address resistance exercise interventions as home-based exercise strategy. Thus, in this paper, we discussed the physical exercise as medicine if the training status is enough to protect the elderly against COVID-19 infection, about the role of physical activity on immunosuppression. Possible risks for COVID-19 infection, and the old training methods, such as no-load resistance training as possible resistance exercise strategies and high-intensity interval training, as new proposals of home-based exercise interventions, could perform during the current COVID-19 pandemic.

A real-time survey on the psychological impact of mild lockdown for COVID-19 in the Japanese population.

To deter the spread of the coronavirus disease 2019 (COVID-19), many countries have imposed a lockdown with restrictions. On 7 April 2020, the Japanese government declared a state of emergency over the COVID-19 outbreak. Japan was in "mild lockdown" which was not enforceable and non-punitive with the declaration. We conducted an online survey to investigate factors associated with psychological distress in the "mild lockdown" under a declared state of emergency for COVID-19. We collected data on 11,333 inhabitants (52.4% women, 46.3 ± 14.6 years) living in the seven prefectures where the declaration was first applied. The investigation dates of this study, 11 and 12 May 2020, were in the final phase of the state of emergency. The survey was conducted in real-time to minimize participants' recall bias. In addition to psychological inventories often used worldwide, the questionnaires used in this survey included lifestyle and stress management items related to COVID-19 and various socio-demographic items including occupation (e.g. healthcare worker) or income.