The impact of COVID-19 pandemic on the provision of ambulatory care for patients with chronic neurological diseases in Japan: evaluation of an administrative claims database

BackgroundThe COVID-19 pandemic has affected not only the emergency medical system, but also patients regular ambulatory care. The number of patients visiting outpatient internal medicine clinics decreased during March-April 2020 compared to 2019. Moreover, the ban on telephone re-examination for outpatient clinics in lieu of ambulatory care for chronic diseases has been lifted since March 2020. In this context, we investigate the impact of the COVID-19 pandemic on ambulatory care at Japanese outpatient clinics for patients with chronic neurological diseases during the first half of 2020. MethodsWe collected data from the administrative claims database by DeSC Healthcare. Serial changes in the frequency of subsequent outpatient visits to clinics or hospitals (excluding large hospitals with beds >200) for chronic ambulatory care of epilepsy, migraine, Parkinsons disease (PD), and Alzheimers disease were measured. We also evaluated the utilization rate of telephone re-examination at outpatient clinics. ResultsSince April 2020, the monthly count of outpatient clinic visits for epilepsy or PD decreased slightly but significantly. The use of telephone re-examination was facility-dependent, and it was used in less than 5% of all outpatient clinic visits for the examined neurological diseases in May 2020. The utilization rate of telephone re-examination was not associated with age or the neurological diseases of interest. ConclusionThe impact of the COVID-19 pandemic on ambulatory care for several chronic neurological diseases may have been relatively limited, in terms of the frequency or type of outpatient visit, during the first half of 2020 in Japan.

Need of care in interpreting Google Trends-based COVID-19 infodemiological study results: potential risk of false-positivity

ObjectiveGoogle Trends (GT) is being used as an epidemiological tool to study coronavirus disease (COVID-19) by identifying keywords in search trends that are predictive for the COVID-19 epidemiological burden. However, many of the earlier GT-based studies include potential statistical fallacies by measuring the correlation between non-stationary time sequences without adjusting for multiple comparisons or the confounding of media coverage, leading to concerns about the increased risk of obtaining false-positive results. In this study, we aimed to apply statistically more favorable methods to validate the earlier GT-based COVID-19 study results. MethodsWe extracted the relative GT search volume for keywords associated with COVID-19 symptoms, and evaluated their Granger-causality to weekly COVID-19 positivity in eight English-speaking countries and Japan. In addition, the impact of media coverage on keywords with significant Granger-causality was further evaluated using Japanese regional data. ResultsOur Granger causality-based approach largely decreased (by up to approximately one-third) the number of keywords identified as having a significant temporal relationship with the COVID-19 trend when compared to those identified by the Pearson correlation-based approach. "Sense of smell" and "loss of smell" were the most reliable GT keywords across all the evaluated countries; however, when adjusted with their media coverage, these keyword trends did not Granger-cause the COVID-19 positivity trends (in Japan). ConclusionOur results suggest that some of the search keywords reported as candidate predictive measures in earlier GT-based COVID-19 studies may potentially be unreliable; therefore, caution is necessary when interpreting published GT-based study results.

Study on the limitation for detecting anaerobic threshold by respiratory frequency. Under the condition of exercise-entrained breathing is minimized / 体力科学

Under the condition that entrainment between breathing rate and exercise rhythm was minimized. The limitation for deciding anaerobic threshold (AT) by respiratory frequency (f) was studied. Ten healthy subjects (5 male and 5 female) have volunteered to take part in two incremental cycle exercises (male : 30 watt/2 min, 50 rpm ; female : 20 watt/2 min, 50 rpm) . The subjects were either sedentary or active and performed tests under two different condi-tions. The different conditions are explained below.<BR>1) Condition M : Use a metronome to maintain pedalling frequency so entrainment would easily occur.<BR>2) Condition S : Use a tachometer to maintain pedalling frequency so entrainment would not easily occur.<BR>Oxygen uptake (VO<SUB>2</SUB>) at AT were determined by two different methods. The first method was to detect the point of non-linear increase in minute ventilation (VE) and carbon dioxide output (VCO<SUB>2</SUB>) and then to increase detection in the ventilatory equivalent for O<SUB>2</SUB> (VE/VO<SUB>2</SUB>) without increasing the ventilatory equivalent for CO<SUB>2</SUB> (VE/VCO<SUB>2</SUB>) (AT-V) . The second method was to detect inflection in f by multisegment linear regression (AT-CF) . There were no significant differences between AT-V (condition M : 26.0±6.2, condition S : 26.4±6.0 m<I>l</I>/kg/ min) and AT-CF (condition M : 31.6±10.2, condition S : 24.7±10.0 m<I>l</I>/kg/min) . A significant positive correlation between AT-V and AT-CF was observed in condition S (r=0.850, p< 0.05), but not in condition M (r=0.563, p>0.05) . The error between AT-V and AT-CF had individual variations. An error within±5% was observed in only 4 out of 10 subjects. These results suggested that even though the ability to detect AT using f is superior in condition S, f is an inadequate indicator for the AT, though the exercise entrained breathing is minimized.

Circadian rhythms in gas exchange kinetics at the onset of moderate bicycle exercise / 体力科学

Circadian rhythms (diurnal variations) in many physiological parameters have been reported. However, there are no data on gas exchange kinetics at the onset of exercise. The purpose of this study was to establish whether there are circadian rhythms in gas exchange kinetics at the onset of exercise.<BR>Six male subjects performed 120W exercise on a cycle ergometer for 7 min in the morning (AM; 7: 30-8: 30) and evening (PM; 16: 30-17: 30) . Rectal temperature (Tr) and mean skin temperature (T<SUB>sk</SUB>) at rest were significantly higher PM than AM, the differences being 0.9±0.2°C and 0.7±0.2°C, respectively. Respiratory and circulatory parameters at rest and during exercise were not different between AM and PM. The time constants of oxygen uptake (Vo<SUB>2</SUB>), carbon dioxide output (Vco<SUB>2</SUB>), minute ventilation (V<SUB>E</SUB>), heart rate (HR), and oxygen pulse (Vo<SUB>2</SUB>/HR) showed the same results. There was no relationship between temperature parameters (Tr, T<SUB>sk</SUB>) and the time constants.<BR>It is suggested that circadian rhythms reflected by the change in body temperature do not have any effect on gas exchange kinetics at the onset of moderate bicycle exercise.