Impact of the COVID-19 pandemic on the treatment of acute cholangitis caused by choledocholithiasis: A single-center retrospective study in Japan.

Objectives: This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the treatment of acute cholangitis caused by choledocholithiasis. Methods: The Japanese government declared a state of emergency in April 2020 due to the COVID-19 pandemic. We retrospectively reviewed the medical records of 309 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis caused by choledocholithiasis between April 2017 and December 2022. Results: Patients were categorized into a pregroup (n = 134) and a postgroup (n = 175), depending on whether they were diagnosed before or after the state of emergency declaration. The total number of ERCP cases and the number of ERCP cases with endoscopic stone removals increased after the state of emergency declaration. Compared with the pregroup, the numbers of patients with performance status of 0-1 and surgically altered anatomy increased, whereas the numbers of patients taking oral antiplatelets or anticoagulants and those with cerebrovascular disease decreased in the postgroup. The number of single-stage endoscopic stone removals increased and hospital stays were significantly shorter in the postgroup. No differences in adverse event rates were detected between the two groups. Conclusions: Although our hospital provides tertiary care, the number of patients with cholangitis in good general condition and no underlying disease increased after the state of emergency declaration. The COVID-19 pandemic resulted in an increase in the number of single-stage endoscopic treatments and shortened hospital stays for patients with acute cholangitis caused by choledocholithiasis. No safety issues with ERCP were detected, even during the pandemic.

Trends in opioid toxicities among people with and without opioid use disorder and the impact of the COVID-19 pandemic in Ontario, Canada: A population-based analysis.

BACKGROUND: Across Canada, the COVID-19 pandemic occurred amidst an ongoing drug toxicity crisis. Although elevated rates of substance-related harms have been observed nationally, it remains unknown if the pandemic state of emergency led to disproportionate increases in opioid toxicities among people with opioid use disorder (OUD) compared to those without. METHODS: We conducted a population-based repeated cross-sectional time series analysis of fatal and non-fatal opioid toxicities between January 1, 2014, and December 31, 2021, in Ontario, Canada. We used interventional autoregressive integrated moving average models to examine the impact of the pandemic on monthly rates of opioid toxicities per 100,000 Ontario residents stratified by people with and without OUD. RESULTS: We identified 80,296 opioid toxicities of which 53.5 % occurred among people with OUD. Among 52,052 unique individuals, 60.5 % were male and 46.2 % were 25-44 years old. Between January 2014 and December 2021, the rate of opioid toxicities increased from 2.6 to 10.5 per 100,000 (rate ratio [RR]=4.07). The magnitude of this increase differed among people with OUD (0.8 to 7.4 per 100,000; RR=9.35) and without OUD (1.8 to 3.1 per 100,000; RR=1.74). We observed a significant ramp increase in the overall rate of opioid toxicities following the declaration of the pandemic emergency in March 2020 (+0.19 per 100,000 monthly, 95 % CI: 0.029, 0.36, p = 0.021). In a stratified analysis, we found a similar ramp increase among people with OUD (+0.19 per 100,000 monthly, 95 % CI: 0.10, 0.28, p < 0.001); however, this was not observed among people without OUD (p = 0.95). CONCLUSIONS: The rate of opioid toxicities accelerated across Ontario following the pandemic-related state of emergency, with the majority of this increase among people with OUD. The important differences observed among people with OUD compared with those without, highlights the critical need for improved access to harm reduction and treatment interventions among this population.

Evidence of policy learning in emergency declarations as communication tools in Australia.

Emergency declarations are important legal tools for the state to protect itself and its citizens during times of crisis. Such declarations permit the exercise of extraordinary powers to address an emergency or disaster. They present an opportunity to explore policy learning in crises, through the ability to examine emergency declaration instruments and the detail of post-emergency inquiries and reviews. This paper briefly assesses Australian law that provides for emergency declarations and places it in the context of theories of policy learning and change. Two case studies reveal evidence of policy learning in emergency declaration practice in Australia. There is an emerging practice of using declarations primarily or purely as tools to communicate the seriousness of an emergency. This policy learning has occurred both within and between jurisdictions, including the federal government. This paper also probes opportunities for future research on policy learning and emergency legislation, especially in relation to the COVID-19 pandemic.

Romanian dental students' learning experience related to lifestyle changes imposed by Covid-19 lockdown.

Background and aim: The SARS-CoV-2 outbreak in Romania was followed by the declaration of an Emergency State and the subsequent lockdown. As all the schools and universities ceased onsite activities, the teaching process continued exclusively online, on different platforms, such as Microsoft Teams or Zoom. Objectives: The aim of this cross-sectional study is to evaluate how the lifestyle changes imposed by the Covid-19 lockdown and online lectures influenced the learning experience of Romanian dental students, as their point of view could bring new information which might contribute to improving the teaching process. Methods: The questionnaire had 28 items, each with either a Likert Scale or a multiple-choice option and was distributed in April 2020, one month after implementation of circulation restrictions and social distancing. Results: Compared to classical teaching, we found that the online teaching process had a lower efficiency, with a higher satisfaction level for online courses, but lower for online practical teaching activities. The absence of human interaction was found to be detrimental to the teaching process. Conclusion: Despite the lower efficiency of online learning, it was a good alternative that helped students continue their education in the situation created by the outbreak of Covid-19. For higher learning efficiency, a compromise method consisting of online courses and onsite practical training could be a better alternative.

Investigating COVID-19 Pandemic Effects on Acute Pancreatitis Development-From the Perspective of Alcohol Sales (Consumption) in a Japanese Regional Hospital.

[Aim and Background] People's lifestyles changed considerably due to the coronavirus disease 2019 (COVID-19) pandemic. The number of patients with acute pancreatitis (AP) can be expected to decrease as alcohol consumption decreases. This study was conducted to assess COVID-19 pandemic effects on AP patients in a Japanese regional hospital. [Methods] Based on the first and second states of emergency declarations in Tochigi Prefecture, the survey periods were set as follows: period A, 16 April-14 May; period B, 15 May-13 January; period C, 14 January-7 February; and period D, 8 February-15 April. Using data acquired in 2017, 2018, 2019, and 2020, we retrospectively reviewed the number of patients admitted to our hospital with a diagnosis of AP, and their clinical characteristics. [Results] According to a National Tax Agency survey, the average alcohol sales per adult in Tochigi Prefecture were 71.3 L in 2017 before the pandemic, and 64.0 L in 2021 under the pandemic. The number of AP patients in 2020 was 38% lower than in 2017. Comparing 2017 with 2020, the number of alcoholic AP patients was lower in 2020 (p = 0.007). [Conclusions] The findings suggest that COVID-19-pandemic-related lifestyle changes contributed to the decrease in AP patients.

The disparity of utilization rate among specific groups for a rapid spreading telehealth application called LEBER during the COVID-19 state of emergency in Japan.

Objectives: The purpose of this research is to describe the social demographics and chief complaints of users of a free medical consultation application in Ibaraki Prefecture, where a free medical consultation application was released. Methods: The present study included users of a telehealth application in Ibaraki Prefecture between April 9 and May 17, 2020, during the state of emergency. User background characteristics were descriptively analyzed to clarify individual factors with the potential to act as barriers to equally using innovative solutions. Additionally, the age and consultation time distribution by sex were examined for those who used the application for COVID-19 and non-COVID-19 issues. Results: Most of the participants were in their thirties. Moreover, 72% were female, with most being in their thirties (86%) and the least being in their sixties (45%). The number of consultations was concentrated between 6 p.m. and 10 p.m., with the least between 1 a.m. and 5 a.m. The telehealth application users were mainly females in their thirties and forties. Conclusions: To prevent the widening of health disparities due to the rapid introduction of telehealth, further research is required to identify why the use of the application did not spread beyond the aforementioned user groups.

Corrigendum: Decrease in social zeitgebers is associated with worsened delayed sleep-wake phase disorder: findings during the pandemic in Japan.

[This corrects the article DOI: 10.3389/fpsyt.2022.898600.].

The total number of patients with any of four major fragility fractures decreased during the first wave of the COVID-19 epidemic in Japan, commencing before the state of emergency declaration, which was not as enforceable as lockdown.

Durin g the first wave of the COVID-19 epidemic, the total number of patients with any of the four major fragility fractures, including both inpatients and first-visit outpatients, began to decline shortly before the state of emergency was declared, rather than immediately after it was declared. PURPOSE: This study aimed to investigate the impact of public health measures in the first wave of the COVID-19 epidemic on the occurrence of major fragility fractures (MFFs). METHODS: Patients aged 50 years or older who were hospitalized or had an initial visit as an outpatient for an MFF, defined as a proximal femoral fracture (PFF), vertebral fragility fracture (VFF), distal radius fracture (DRF), or a proximal humeral fracture (PHF), were included in this study. Three-phase interrupted time-series analyses were performed to evaluate the impact of the voluntary event cancellation request in late February 2020 and the emergency declaration in early April 2020 on changes in the total number of patients, including inpatients and first-visit outpatients. RESULTS: A total of 166,560 patients with MFFs were included (92,767 PFFs, 26,158 VFFs, 33,869 DRFs, and 13,766 PHFs). From the end of February, in seven prefectures with high proportions of urbanization, decreasing trends were estimated for level changes and slope changes in the total number of patients with any of the four MFFs (level change: PFF; point estimate; - 13.5 (95% CI; - 43.4, 16.5), VFF; - 15.3 (- 32.2, 1.5), DRF; - 16.1 (- 39.9, 7.6), PHF; - 1.9 (- 13.6, 9.8), slope change: PFF; - 4.8 (- 14.0, 4.4), VFF; - 3.0 (- 8.1, 2.2), DRF; - 0.6 (- 7.9, 6.7), PHF; - 2.4 (- 6.0, 1.2)). CONCLUSION: The findings suggested that the total number of patients with any of the four MFFs did not begin to decline from early April 2020 after the state of emergency was declared but earlier, in late February 2020.

Association of depressive symptoms with Geriatric Locomotive Function Scale score in community-dwelling older adults living in the state of emergency.

BACKGROUND: Under the state of emergency, it has been reported that the amount of physical activity among community-dwelling older adults has decreased significantly due to refraining from going out, and there are strong concerns about the Geriatric Locomotive Function Scale and deterioration of mental health. Therefore, this study aimed to investigate whether the depressive state before the coronavirus disease 2019 (COVID-19) pandemic affected the 25-Geriatric Locomotive (GLFS) score during the COVID-19 pandemic among community-dwelling older adults. METHODS: The participants were 194 community-dwelling older adults (45 men, 149 women) with an average age of 75.5 ± 5.5 years who responded to a self-administered survey conducted three times (preliminary, second, and third) from before the 2018 COVID-19 pandemic to March 2021. Individuals with a score of ≥ 10 on the Geriatric Depression Scale 15 (GDS 15) were excluded. The survey items included the 25-question Geriatric Locomotive Function Scale (GLFS25), GDS 15, and other basic attributes. Those with scores of 5 to 9 on the GDS 15 and those with scores of 0 to 4 were assigned to the depressive symptoms (DS) group and the non-DS group, respectively. Statistical analysis was performed using two-way analysis of variance. The Mann-Whitney U test was used for comparisons between the groups. RESULTS: In total, 187 patients were included in the analysis, excluding 7 patients. GLFS 25 showed a significant increase in scores at the second and third time points compared with baseline, and a main effect was confirmed in both groups, with no interaction effect. The second time, the score was 10.0 ± 8.5 and 13.7 ± 10.5 in the non-DS and DS groups, respectively. The third time, the non-DS and DS groups scored 10.8 ± 10.5 and 14.9 ± 10.1 points, respectively, indicating a significant difference. CONCLUSIONS: Our results revealed that the increase in the GLFS 25 score in community-dwelling older adults during the COVID-19 pandemic was related to their DS during normal times before the pandemic. Evaluating such individuals and providing social support may effectively reduce the deterioration of the GLFS 25 score.

Evolutions of Self-Rated Health and Social Interactions during the COVID-19 Pandemic Affected by Pre-Pandemic Conditions: Evidence from a Four-Wave Survey.

The Coronavirus disease 2019 (COVID-19) pandemic has affected individuals' self-rated health (SRH) and social interactions, but their evolution during the pandemic needs further investigation. The present study addressed this issue using longitudinal data from 13,887 observations of 4177 individuals obtained from a four-wave nationwide, population-based survey conducted between January and February 2019 (before the pandemic) and November 2022. We compared the evolutions of SRH and social interactions during the pandemic between individuals who interacted with others before the pandemic and those who did not. Three noteworthy findings were obtained. First, deterioration in SRH in response to the declared state of emergency was concentrated on individuals with no pre-pandemic interaction with others. Second, SRH generally improved during the pandemic, although the improvement was more remarkable among previously isolated individuals. Third, the pandemic has promoted social interactions among previously isolated individuals and reduced such chances among those who previously interacted with others. These findings underscore the importance of pre-pandemic social interactions as key determinants of responding to pandemic-related shocks.

Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan.

Aim: In the current era of the coronavirus disease 2019 (COVID-19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID-19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID-19 case surges on EMS transport for patients with trauma during the COVID-19 states of emergency in Kobe, Japan. Methods: EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. Results: The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77-2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life-threatening group did not change. The number of request calls increased during the states of emergency. Conclusion: Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life-threatening group.

Impact of local COVID-19 alert levels on rhegmatogenous retinal detachment.

PURPOSE: To investigate the impact of the local alert levels regarding coronavirus disease 2019 (COVID-19) on the clinical patterns of rhegmatogenous retinal detachment (RRD) in Japan. STUDY DESIGN: Retrospective, single-center, consecutive case series. METHODS: We compared two groups of RRD patients, a COVID-19 pandemic group and a control group. Based on the local alert levels in Nagano, five periods during the COVID-19 pandemic were further analyzed: epidemic 1 (state of emergency), inter-epidemic 1, epidemic 2 (second epidemic duration), inter-epidemic 2, and epidemic 3 (third epidemic duration). Patients' characteristics, including symptoms' duration before visiting our hospital, macula status, and retinal detachment (RD) recurrence rate in each period, were compared with those in a control group. RESULTS: There were 78 patients in the pandemic group and 208 in the control group. The pandemic group had a longer duration of symptoms than the control group (12.0 ± 13.5 days vs. 8.9 ± 14.7 days, P = 0.0045). During the epidemic 1 period, patients had a higher rate of macula-off RRD (71.4% vs. 48.6%) and RD recurrence (28.6% vs. 4.8%) than the control group. This period also demonstrated the highest rates compared to all other periods in the pandemic group. CONCLUSION: During the COVID-19 pandemic, RRD patients significantly delayed visiting a surgical facility. They showed a higher rate of macula-off and recurrence compared to the control group during the state of emergency than during other periods of the COVID-19 pandemic, although the difference was not statistically significant due to the small sample size.

The use of a companion robot to improve depression symptoms in a community-dwelling older adult during the coronavirus disease 2019 state of emergency.

Objective: We investigated the impact of using a companion robot on the mental state of a community-dwelling older adult who was receiving home-visit rehabilitation services during the state of emergency for coronavirus disease 2019 (COVID-19). Methods: This case involved an 80-year-old woman with compression fractures of lumbar vertebrae 1 and 2. Her medical history included hypothyroidism, hypertension, dyslipidemia, and depression. The companion robot used was Smibi®, a healing baby robot that responds in various ways depending on how the user interacts with it. The patient interacted (e.g., hugging, conversing) with Smibi® for 30 minutes per day for 1 month, from April 2020 (immediately before the declaration of a state of emergency in Japan) to May 2020. The patient was evaluated with the Self-Rating Depression Scale (SDS) before and after using Smibi®. Results: The SDS score decreased from 37 points to 26 points after the use of Smibi®. The items related to diurnal variation, sleep, despair about the future, and dissatisfaction decreased by 2-3 points. Conclusion: Our findings suggest that interacting with Smibi® may improve depression in older adults who have been forced to refrain from going out due to the spread of COVID-19. Future studies with long-term follow-up and large sample sizes are required to confirm the effectiveness of companion robots in improving depression among community-dwelling older adults.

Impact of Japan's State of Emergency Due to the COVID-19 Pandemic on Trends in Diabetes Care: A Descriptive and Retrospective Study.

OBJECTIVE: This study examined the impact of Japan's state of emergency on trends in diabetes care during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: A descriptive and retrospective study. SETTING: Showa University Hospital, Japan. PARTICIPANTS: Patients with diabetes who received medical treatment from 2018 to 2020. Determinants of interest: Number of patients with diabetes visiting the hospital per week. To examine the impact of the Japan's state of emergency, the number of hospital visitations by patients with diabetes was summarized from 28 weeks of data for each year, from calendar week 8 to calender week 35. RESULTS: Compared with the mean of 2018 and 2019, no significant difference was found between the three periods (before, during, and after the state of emergency). However, the numbers of patients from both inside and outside Tokyo increased at 7 weeks after the state of emergency was lifted. CONCLUSIONS: A significant increase in the numbers of patients with diabetes was seen compared with the same period in 2018 and 2019, suggesting that the state of emergency may have hindered diabetes care. Therefore, patients with diabetes should receive continuous follow-up regarding their diabetes care, keeping a close eye on relvent measurements.

Has Covid-19 permanently changed online purchasing behavior?

This study examines how the COVID-19 pandemic has affected online purchasing behavior using data from a major online shopping platform in Japan. We focus on the effect of two measures of the pandemic, i.e., the number of positive COVID-19 cases and state declarations of emergency to mitigate the pandemic. We find that both measures promoted online purchases at the beginning of the pandemic, but in later periods, their effect faded. In addition, online purchases returned to normal after states of emergency ended, and the overall time trend in online purchases excluding the effects of the two measures was stable during the first two years of the pandemic. These results suggest that the effect of the pandemic on online purchasing behavior is temporary and will not persist after the pandemic. Supplementary Information: The online version contains supplementary material available at 10.1140/epjds/s13688-022-00375-1.

The disparity of utilization rate among specific groups for a rapid spreading telehealth application called LEBER during the COVID-19 state of emergency in Japan / Journal of Rural Medicine

Objectives: The purpose of this research is to describe the social demographics and chief complaints of users of a free medical consultation application in Ibaraki Prefecture, where a free medical consultation application was released.Methods: The present study included users of a telehealth application in Ibaraki Prefecture between April 9 and May 17, 2020, during the state of emergency. User background characteristics were descriptively analyzed to clarify individual factors with the potential to act as barriers to equally using innovative solutions. Additionally, the age and consultation time distribution by sex were examined for those who used the application for COVID-19 and non-COVID-19 issues.Results: Most of the participants were in their thirties. Moreover, 72% were female, with most being in their thirties (86%) and the least being in their sixties (45%). The number of consultations was concentrated between 6 p.m. and 10 p.m., with the least between 1 a.m. and 5 a.m. The telehealth application users were mainly females in their thirties and forties.Conclusions: To prevent the widening of health disparities due to the rapid introduction of telehealth, further research is required to identify why the use of the application did not spread beyond the aforementioned user groups.

Effect of COVID-19 infection related experiences on social behaviors when a state of emergency is declared: a cohort study.

BACKGROUND: Restricting the movement of the public to gathering places and limiting close physical contact are effective measures against COVID-19 infection. In Japan, states of emergency have been declared in specific prefectures to reduce public movement and control COVID-19 transmission. We investigated how COVID-19 infection related experiences including people with a history of infection, people with a history of close contact, and people whose acquaintances have been infected, affected self-restraint from social behaviors during the second state of emergency in Japan. METHODS: A prospective cohort study was conducted among workers aged 20-65 years using data from an internet survey. The baseline survey was conducted on December 22-25, 2020, and a follow-up survey was on February 18-19, 2021. There were 19,051 participants who completed both surveys and were included in the final analysis. We identified eight social behaviors: (1) eating out (4 people or fewer); (2) eating out (5 people or more); (3) gathering with friends and colleagues; (4) day trip; (5) overnight trip (excluding visiting home); (6) visiting home; (7) shopping for daily necessities; and (8) shopping for other than daily necessities. We set self-restraint regarding each social behavior after the second state of emergency was declared in January 2021 as the dependent variable, and COVID-19 infection related experiences as independent variables. Odds ratios were estimated using multilevel logistic regression analyses nested in the prefecture of residence. RESULTS: Significant differences by COVID-19 infection related experiences were identified: compared to people without COVID-19 related experiences, people with a history of COVID-19 were less likely self-restraint from most social behaviors. People whose acquaintance had been diagnosed with COVID-19 were significantly more likely to refrain from most social behaviors. There was no significant difference in any social behaviors for people with a history of close contact only. CONCLUSION: To maximize the effect of a state of emergency, health authorities should disseminate information for each person in the target population, taking into account potential differences related to the infection related experiences.

Pre-pandemic social isolation as a predictor of the adverse impact of the pandemic on self-rated health: A longitudinal COVID-19 study in Japan.

Many studies have found adverse effects of the coronavirus disease pandemic on health. Irrespective of being infected by the coronavirus, lockdowns and other measures to restrict mobility have worsened an individual's subjective health assessment. Unlike previous studies, this study examined how pre-pandemic social isolation (in the form of no interaction with others and having no social support) affected the impact of the pandemic on self-rated health in Japan. To this end, we estimated fixed-effects models using 4172 observations of 2086 individuals obtained from a three-wave Internet nationwide survey conducted in January/February 2019 and February 2020 (before the pandemic), in March 2021 (when the pandemic-related state of emergency was effective in four prefectures and just after it was lifted in six prefectures), and in October/November (a full month after the state of emergency was lifted in all prefectures). The state of emergency raised the probability of reporting poor health by 17.8 (95% confidence interval [CI]:1.9-33.8) percentage points among the participants who had not interacted with others before the pandemic, compared with only 0.7 (95% CI: -3.1-4.5) percentage points among other participants. Similar results were obtained in the absence of social support prior to the pandemic. In conclusion, pre-pandemic social isolation was detrimental to health, suggesting that policy measures are needed to avoid social isolation to increase the resilience of public health to external shocks.

Text mining analysis of newspaper editorials concerning the COVID-19 pandemic from a healthcare perspective.

Objective: This pilot study aimed to examine the content of Japanese newspaper editorials concerning the coronavirus disease 2019 (COVID-19) pandemic and its change over time using text mining analysis. Materials and Methods: The authors analyzed qualitative data from the editorials of five national and 12 regional newspapers on April 7 and 8, 2020 (first state of emergency) and January 8, 2021 (second state of emergency). All analyses were conducted using KH Coder version 3. Results: The co-occurrence network showed a low level of content diversity and a high degree of politicization in the COVID-19 news coverage. The top five high frequency words from the newspapers were "infection", "declaration", "healthcare", "government", and "emergency" at the first state of emergency, and were "declaration", "measures", "government", and "restaurant" at the second one. Conclusion: The results suggest a lack of detailed information and recommendations concerning the public health challenges of the COVID-19 pandemic in Japanese newspaper editorials, even one year after the first wave of the pandemic. This study provides a data-driven foundation for the effectiveness of newspapers in COVID-19 public health communications. The extent to which the quantity and quality of information from newly emerging communication channels, such as social media, influences public understanding of public health measures remains to be established.