Presenteeism and social interaction in the "new normal" in Japan: a longitudinal questionnaire study

BACKGROUND@#Although social interaction and social support during the "new normal" due to coronavirus disease 2019 (COVID-19) may be related to presenteeism, the effect between these factors has not been clear for Japanese workers. The aim of this study was to describe the presenteeism of Japanese workers with reference to social interaction and social support following the lifestyle changes due to COVID-19 and to assess whether social interaction and social support affected their presenteeism.@*METHODS@#The data were obtained from internet panel surveys from October 2020. Descriptive statistics were calculated, and multiple linear regression was conducted using the data from the first, fourth and fifth surveys, which were conducted during October to November 2020, July to August 2021, and September to October 2021, respectively. To measure presenteeism, questions from "absenteeism and presenteeism questions of the World Health Organization's Heath and Work Performance Questionnaire", short version in Japanese was utilized. Multiple linear regressions were conducted to investigate the effects of social interaction and social support-related factors on presenteeism.@*RESULTS@#A total of 3,407 participants were included in the analysis. The mean score of absolute presenteeism from the fifth survey was 58.07 (SD = 19.71). More time spent talking with family, a larger number of social supporters and a higher satisfaction level for social support were associated with a higher absolute presenteeism score.@*CONCLUSIONS@#Our results suggested that social support reduced the presenteeism of the Japanese workers during the "new normal" due to the COVID-19 pandemic. Social interaction with family also relieved presenteeism.

Impact of guidance on trends of steroid prescriptions for COVID-19 inpatients: an analysis of the nation-wide administrative database in Japan

Background: Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, guidance ("Japanese Guide") has been published by a working group of several academic societies and announced by the Ministry of Health, Labour, and Welfare. Steroids as a candidate treatment for COVID-19 were noted in the Japanese Guide. However, the prescription details for steroids, and whether the Japanese Guide changed its clinical practice, were unclear. This study aimed to examine the impact of the Japanese Guide on the trends in the prescription of steroids for COVID-19 inpatients in Japan. Methods: We selected our study population using Diagnostic Procedure Combination (DPC) data from hospitals participating in the Quality Indicator/Improvement Project (QIP). The inclusion criteria were patients discharged from hospital between January 2020 and December 2020, who had been diagnosed with COVID-19, and were aged 18 years or older. The epidemiological characteristics of cases and the proportion of steroid prescriptions were described on a weekly basis. The same analysis was performed for subgroups classified by disease severity. Results: The study population comprised 8603 cases (410 severe cases, 2231 moderate II cases, and 5962 moderate I/mild cases). The maximum proportion of cases prescribed with dexamethasone increased remarkably from 2.5% to 35.2% in the study population before and after week 29 (July 2020), when dexamethasone was included in the guidance. These increases were 7.7% to 58.7% in severe cases, 5.0% to 57.2% in moderate II cases, and 1.1% to 19.2% in moderate I/mild cases. Although the proportion of cases prescribed prednisolone and methylprednisolone decreased in moderate II and moderate I/mild cases, it remained high in severe cases. Conclusions: We showed the trends of steroid prescriptions in COVID-19 inpatients. The results showed that guidance can influence drug treatment provided during an emerging infectious disease pandemic.

Medium-term impacts of the waves of the COVID-19 epidemic on treatments for non-COVID-19 patients in intensive care units: a retrospective cohort study in Japan

BackgroundMaintaining critical care for non-Coronavirus-disease-2019 (non-COVID-19) patients is a key pillar of tackling the impact of the COVID-19 pandemic. This study aimed to reveal the medium-term impacts of the COVID-19 epidemic on case volumes and quality of intensive care for critically ill non-COVID-19 patients. MethodsAdministrative data were used to investigate the trends in case volumes of admissions to intensive care units (ICUs) compared with the previous years. Standardized mortality ratios (SMRs) of non-COVID-19 ICU patients were calculated in each wave of the COVID-19 epidemic in Japan. ResultsThe ratios of new ICU admissions of non-COVID-19 patients to those in the corresponding months before the epidemic: 21% in May 2020, 8% in August 2020, 9% in February 2021, and 14% in May 2021, approximately concurrent with the peaks in COVID-19 infections. The decrease was greatest for new ICU admissions of non-COVID patients receiving mechanical ventilation (MV) on the first day of ICU admission: 26%, 15%, 19%, and 19% in the first, second, third, and fourth waves, respectively. No statistically significant change in SMR was observed in any wave of the epidemic; SMRs were 0.990 (95% confidence interval (CI), 0.962-1.019), 0.979 (95% CI, 0.953-1.006), 0.996 (95% CI, 0.980-1.013), and 0.989 (95% CI, 0.964-1.014), in the first, second, third, and fourth waves of the epidemic, respectively. ConclusionsCompared to the previous years, the number of non-COVID-19 ICU patients continuously decreased over the medium term during the COVID-19 epidemic. The decrease in case volumes was larger in non-COVID-19 ICU patients initially receiving MV than those undergoing other initial treatments. The standardized in-hospital mortality of non-COVID-19 ICU patients did not change in any waves of the epidemic. EYWORDSIntensive care unit, COVID-19, mechanical ventilation, in-hospital mortality

Hospitalization of mild cases of community-acquired pneumonia decreased more than severe ones during the COVID-19 epidemic

ObjectiveThe epidemic of the coronavirus disease 2019 (COVID-19) has affected the entire health care systems. Our aim was to assess the impact of the COVID-19 epidemic on the number and severity of cases for community-acquired pneumonia (CAP) in Japan. MethodsUsing claims data from the Quality Indicator/Improvement Project (QIP) database, we included urgent cases of inpatients for CAP from August 1, 2018, to July 30, 2020. We compared the monthly ratio of inpatient cases from August 2018 to July 2019 and August 2019 to July 2020 as a year-over-year comparison. We also compared this ratio according to the severity score "A-DROP" and performed an interrupted time series analysis (ITS) to evaluate the impact of the COVID-19 epidemic on the monthly number of inpatient cases. ResultsA total of 67,900 inpatient cases for CAP in 262 hospitals were included. During the COVID-19 epidemic (defined as the period between March and July 2020), the number of inpatient cases for CAP drastically decreased during the epidemic compared with the same period in the past year (-48.1%), despite only a temporary reduction in the number of other urgent admissions. The number of inpatient cases decreased according to the severity of pneumonia. Milder cases showed a greater decrease in the year-over-year ratio than severe ones (mild -55.2%, moderate -45.8%, severe -39.4%, and extremely severe - 33.2%). The ITS analysis showed that the COVID-19 epidemic reduced the monthly number of inpatient cases for CAP significantly (estimated decrease: -1233 cases; 95% CI, -521 to -1955). ConclusionsOur study showed a significant reduction in the number of inpatient cases for CAP during the COVID-19 epidemic in Japan. The milder cases showed a greater decrease in the year-over-year ratio of the number of inpatient cases.

The relationship between new PCR positive cases and going out in public during the COVID-19 epidemic in Japan

Suppression of the first wave of COVID-19 in Japan is assumedly attributable to peoples increased risk perception by acquiring information from the government and media reports. In this study, going out in public amidst the spread of COVID-19 infections was investigated by examining new polymerase chain reaction (PCR) positive cases of COVID-19 and its relationship to four indicators of people going out in public (the people flow, the index of web searches for going outside, the number of times people browse restaurants, and the number of hotel guests), from the Regional Economic and Social Analysis System (V-RESAS). Two waves of COVID-19 infections were examined with cross-correlation analysis. In the first wave, all four indicators of going out reacted oppositely with the change in new PCR positive cases, showing a lag period of -1 to +6 weeks. In the second wave, the same relationship was only observed for the index of web searches for going outside. These results suggest that going out in public could not be described by new PCR positive cases alone in the second wave, even though they could explain people going out to some extent in the first wave.

Impact of the COVID-19 pandemic on infant and pediatric asthma: a multi-center survey using an administrative database in Japan

BackgroundLimited data are available on the relationship between infant and pediatric asthma and severe acute respiratory syndrome coronavirus 2 (COVID-19). Political limitations such as school closure may affect the treatment behavior of pediatric asthma. To investigate the trends of treatment behavior in the field of pediatrics during the COVID-19 pandemic. MethodsThis is a retrospective observational study using Diagnosis Procedure Combination (DPC) data from the Quality Indicator/Improvement Project (QIP) database. We identified children with asthma aged 15 years or younger who were patients from July 1, 2018, to June 30, 2020. The main outcome was a comparison between asthma patients treatment behavior before the COVID-19 pandemic and during the COVID-19 pandemic. We statistically tested the admission volume changes based on the discharge date after adjusting for seasonality through a Fourier term using an interrupted time-series analysis (ITS). ResultsWe identified 10,481 inpatients cases in 67 hospitals and 258,911 out-patients cases in 180 hospitals who were diagnosed with asthma. We performed ITS analysis for inpatients. The reduction in the number of patients during this period was estimated to be 232 (P=0.001). In addition, ITS analysis was performed for patients aged <3 years. The reduced number of patients during this period was estimated to be 155 (P<0.001). ConclusionsWe found that the number of pediatric asthma patients dramatically decreased during the COVID-19 pandemic. We need to continue research into the trends of pediatric asthma patients after the COVID-19 pandemic in Japan. Key MessagesThere are increasingly available data on the relationship between adults asthma and COVID-19. However, in the fields of pediatrics, limited data are available. Patients with moderate to severe asthma who needed hospitalization dramatically decreased during the COVID-19 pandemic. Besides, doctors prescribed nebulizers more than metered-dose inhalers by the clinical guideline recommendation. Our findings reinforce the value of political inventions, such as school closure reduced the number of asthma attacks in infants and school-age children.

IMPACT OF THE CORONAVIRUS DISEASE 2019 PANDEMIC ON SURGICAL VOLUME IN JAPAN: A COHORT STUDY USING ADMINISTRATIVE DATA

BackgroundInternationally, the Coronavirus Disease (COVID-19) pandemic has caused unprecedented challenges for surgical staff to minimise the exposure to COVID-19 or save medical resources without harmful outcomes for patients, in accordance with the statement of each surgical society. However, no research has empirically validated declines in Japanese surgical volume or compared decrease rates of surgeries during the COVID-19 pandemic. Material and MethodsWe extracted 672,772 available cases of patients aged > 15 years who were discharged between July 1, 2018, and June 30, 2020. After categorisation of surgery, we calculated descriptive statistics to compare the year-over-year trend and conducted interrupted time series analysis to validate the decline. ResultsThe year-over-year trend of all eight surgical categories decreased from April 2020 and reached a minimum in May 2020 (May: abdominal, 68.4%; thoracic, 85.8%; genitourinary, 78.6%; cardiovascular, 90.8%; neurosurgical, 69.1%; orthopaedic, 62.4%; ophthalmologic, 52.0%; ear/nose/throat, 27.3%). Interrupted time series analysis showed no significant trends in oncological and critical benign surgeries. ConclusionWe demonstrated and validated a trend of reduction in surgical volume in Japan using administrative data applying interrupted time series analyses. Low priority surgeries, as categorised by the statement of each society, showed obvious and statistically significant declines in case volume during the COVID-19 pandemic.

The impact of the coronavirus disease 2019 (COVID-19) outbreak on cancer practice in Japan: using an administrative database

BackgroundRecent researches reported the impact of the coronavirus disease 2019 (COVID - 19) pandemic on the clinical practice of specific type cancers. The aim of this study was to reveal the impact of the COVID-19 outbreak on the clinical practice of various cancers. MethodsWe included hospitalized patients aged 18 years or older diagnosed between July 2018 and June 2020 with one of the top 12 most common cancers in Japan (colon/rectum, lung, gastric, breast, bladder & urinary tract, pancreas, non-Hodgkin lymphoma, liver, prostate, esophagus, uterus, and gallbladder & biliary tract) using Diagnostic Procedure Combination data, an administrative database in Japan. The intervention was defined April 2020 based on a declaration of emergency from Japanese government. The change volume of number of monthly admissions with each cancer was tested by interrupted time series (ITS) analysis, and monthly cases with radical surgery or chemotherapy for each cancer were descripted. Results403,344 cases were included during the study period. The most common cancer was colon/rectum (20.5%), followed by lung (17.5%). In almost cancer cases, the number of admissions decreased in May 2020. In particular, colorectal, lung, gastric, breast, uterine, or esophageal cancer cases decreased by over 10%. The number of admissions with surgery or chemotherapy decreased in colorectal, lung, gastric, breast, uterine, or esophageal cancer. ITS analysis indicated that cases with gastric or esophageal cancer were affected more than other type of cancer. ConclusionsThe COVID-19 outbreak has a negative impact on the number of admission cases with cancer; the magnitude of impact varied by cancer diagnosis.

The decrease in hospitalizations for transient ischemic attack and ischemic stroke, especially in mild cases, during the COVID-19 epidemic in Japan.

Background and PurposeThe epidemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study was to assess the impact of the COVID-19 epidemic on hospital admissions for stroke in Japan. MethodsWe analyzed administrative (Diagnosis Procedure Combination) data for cases of inpatients aged 18 years and older who were diagnosed with stroke (ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, or subarachnoid hemorrhage (SAH)) and discharged from hospital during the period July 1, 2018 to June 30, 2020. The number of patients with each stroke diagnosis, various patient characteristics, and treatment approaches were compared before and after the epidemic. Changes in the trend of the monthly number of inpatients with each stroke diagnosis were assessed using interrupted time-series analyses. ResultsA total of 111,922 cases (ischemic stroke: 74,897 cases; TIA: 5,374 cases; hemorrhagic stroke: 24,779 cases; SAH: 6,872 cases) in 253 hospitals were included. The number of cases for all types of stroke decreased (ischemic stroke: -13.9%; TIA: -21.4%; hemorrhagic stroke: -9.9%; SAH: -15.2%) in April and May 2020, compared to the number of cases in 2019. Ischemic stroke and TIA cases, especially mild cases (modified Rankin Scale = 0), decreased, with a statistically significant change in trend between the before- and after-epidemic periods. ConclusionsThese data showed a marked reduction in the number of hospital admissions due to stroke during the COVID-19 epidemic. The change in Ischemic stroke and TIA cases, especially mild cases, was statistically significant.

Early impact of school closure and social distancing for COVID-19 on the number of inpatients with childhood non-COVID-19 acute infections in Japan

Many countries have implemented school closures as part of social distancing measures intended to control the spread of coronavirus disease 2019 (COVID-19). The aim of this study was to assess the early impact of nationwide school closure (March-May 2020) and social distancing for COVID-19 on the number of inpatients with major childhood infectious diseases in Japan. Using data from the Diagnosis Procedure Combination system in Japan, we identified patients aged 15 years or younger with admissions for a diagnosis of upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), influenza, gastrointestinal infection (GII), appendicitis, urinary tract infection (UTI), or skin and soft tissue infection (SSTI) between July 2018 and June 2020. Two periods were considered in the analysis: a pre- and a post-school-closure period. Changes in the trend of the weekly number of inpatients between the two periods were assessed using interrupted time-series analysis. A total of 75,053 patients in 210 hospitals were included. We found a marked reduction in the number of inpatients in the post-school-closure period, with an estimated reduction of 581 (standard error 42.9) inpatients per week (p < 0.001). The main part of the reduction was for pre-school children. Remarkable decreases in the number of inpatients with URI, LRTI, and GII were observed, while there were relatively mild changes in the influenza, appendicitis, UTI, and SSTI groups. We confirmed a marked reduction in the number of inpatients with childhood non-COVID-19 acute infections in the post-school-closure period.

The impact of the coronavirus disease 2019 (COVID-19) outbreak on hospital admissions for alcohol-related liver disease and pancreatitis: a time-series analysis

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, there have been health concerns related to alcohol use and misuse. Therefore, the World Health Organization cautioned that alcohol consumption during the pandemic might have a negative impact. The aim of this study was to examine the population-level change in cases of alcohol-related liver disease and pancreatitis that required admission during the COVID-19 outbreak. MethodsWe included patients aged 18 years or older who were hospitalized between July 2018 and June 2020 using Diagnostic Procedure Combination data, an administrative database in Japan, and counted the admission cases whose primary diagnosis was alcohol-related liver disease or pancreatitis. We defined the period from April 2020, when the Japanese government declared a state of emergency, as the beginning of the COVID-19 outbreak. The rate ratio (RR) of admissions with alcohol-related liver disease or pancreatitis per 1,000 admissions was tested using interrupted time series analysis. In addition, excess admissions for alcohol-related liver disease or pancreatitis were calculated. ResultsOverall admissions were 3,026,389 cases, and a total of 10,242 admissions for alcohol-related liver disease or pancreatitis occurred from 257 hospitals. The rate of admissions per 1,000 admissions during the COVID-19 outbreak period (April 2020 to June 2020) had a 1.2 times increase compared with the pre-outbreak period (July 2018 to March 2020) for cases of alcohol-related liver disease or pancreatitis (RR: 1.22, 95%Confidence interval [CI]: 1.12 to 1.33). The COVID-19 pandemic caused about 214.75 (95%CI: 178.78 to 249.72) excess admissions for alcohol-related liver disease or pancreatitis based on predictions from our model. ConclusionThe COVID-19 outbreak might have resulted in increased hospital admissions for alcohol-related liver disease or pancreatitis.

Economic impact of the first wave of the COVID-19 pandemic on acute care hospitals in Japan

BackgroundIn response to the coronavirus diseases 2019 (COVID-19) pandemic, the Japanese government declared a state of emergency on April 7, 2020. Six days earlier, the Japan Surgical Society had recommended postponing elective surgical procedures. Along with the growing public fear of COVID-19, hospital visits in Japan decreased. MethodsUsing claims data from the Quality Indicator/Improvement Project (QIP) database, this study aimed to clarify the impact of the first wave of the pandemic, considered to be from March to May 2020, on case volume and claimed hospital charges in acute care hospitals during this period. To make year-over-year comparisons, we considered cases from July 2018 to June 2020. ResultsA total of 2,739,878 inpatient and 53,479,658 outpatient cases from 195 hospitals were included. In the year-over-year comparisons, total claimed hospital charges decreased in April, May, June 2020 by 7%, 14%, and 5%, respectively, compared to the same months in 2019. Our results also showed that per-case hospital charges increased during this period, possibly to compensate for the reduced case volumes. Regression results indicated that the hospital charges in April and May 2020 decreased by 6.3% for hospitals without COVID-19 patients. For hospitals with COVID-19 patients, there was an additional decrease in proportion with the length of hospital stay of COVID-19 patients including suspected cases. The mean additional decrease per COVID-19 patients was estimated to 5.5 million JPY. ConclusionIt is suggested that the hospitals treating COVID-19 patients were negatively incentivized.

Challenges in the conduct of clinical research / 医学教育

The promotion of clinical research in Japan requires the establishment of a formal and systematic education and training program for clinicians to ensure they become effective clinician investigators. The first of its kind in Japan, a formal 1-year masters-degree-level training program (MCR course) was started at Kyoto University School of Medicine and Public Health. The first 28 students graduated in 2008, with most returning to their original clinical institutions. <br>1) As follow-up, we conducted a self-administered questionnaire survey of all 28 graduates (response rate, 86%) concerning the current status of clinical research and problems encountered at their institutions.<br>2) Almost 40% of respondents (n=24) reported &quot;no time&quot; or &quot;no research collaborators&quot; for clinical research.<br>3) Twenty respondents (83%) have attempted to promote clinical research at their hospital or workplace, but only 1 has received institutional support.<br>4) Over half of the respondents (54%) would like to be working in both clinical research and clinical practice at their hospital in the future (10-year timescale). Forty-two percent of respondents had a concrete image of the clinical researcher's career path. <br>5) Although open to improvement, the MCR program presents a concrete model for the education of clinical researchers. These findings suggest that promoting the conduct of clinical research requires the implementation of a support system and adjustment of personal and physical infrastructure.

The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data

<p><b>OBJECTIVES</b>With greater concern for efficient resource allocation and profiling of medical care, a case-mix classification was applied for the per-diem payment system in Japan. Many questions remain, one of which is the role of comorbidity and complication (CC) in grouping logic. We examined the association of the number of CC with the length of hospital stay (LOS) and hospital mortality as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDCs).</p><p><b>METHODS</b>This study was a secondary data analysis embedded in a government research project, including anonymous claims and clinical data during a 4-month period from July 2002. Every 19 MDC, LOS, hospital mortality or proportion of LOS high outliers was compared by the number of CC and presence of any procedures.</p><p><b>RESULTS</b>From 82 special function hospitals, 241,268 patients were enrolled in this study. Among all patients, 50.5% were identified without any CCs, 32.4% with one or two, 13.4% with three or four, and 3.7% with over five CCs. The overall mean LOS was 22.15 days and hospital mortality 26.05 cases per 1,000 admissions. In any MDC, LOS and the proportion of outliers increased as the number of CC rose. The mortality rate increased prominently in the respiratory system and the hematology system.</p><p><b>CONCLUSIONS</b>This study demonstrated that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. Further study will clarify the association of the weighted CC with resource use through controlling procedures specific for MDC.</p>

Effects of a Communication Program in Undergraduate Medical Education on Physician's Clinical Practice / 医学教育

This study examined the effectiveness of a communication program in undergraduate medical education in improving communication in physicians' clinical practice. The effectiveness of the program was assessed with a mail survey using self-rated questionnaires 9 years later. Ninety participants were follwed up in late 1994; 57.8% of them replied to the questionnaire. Of the respondents, 60% replied that programs concerned with active listening and role-playing had benefits on communicating with patients and families. In addition, 40% of respondents answered that case studies aimed at teaching comprehensive medicine with the team approach was effective in improving communication with co-medical staff. These results suggest that the communication program in undergraduate medical education is effective in improving clinical communication in clinical practice when students are highly motivated.