Emergence Of Japan Research Articles

Living and working environments are important determinants of glycemic control in patients with diabetes during the COVID-19 pandemic: A retrospective observational study.

AimTo investigate (1) the association of lifestyle changes and living and working conditions with glycemic control and (2) whether treatment was intensified appropriately in patients with diabetes under the first COVID‐19 state of emergency in Japan.Materials and MethodsA total of 321 participants were included. Participants completed a questionnaire regarding lifestyle changes, including diet, physical activity, and living and working conditions during the COVID‐19 pandemic. The change in hemoglobin A1c (HbA1c) levels was estimated before (June 1, 2019 to August 31, 2019) and during (June 1, 2020 to August 31, 2020) the pandemic. Factors associated with changes in HbA1c levels were examined by multiple linear regression analysis. The proportion of patients who received treatment intensification for diabetes was compared between before and during the pandemic.ResultsThere was no significant change in HbA1c levels before the pandemic and during the pandemic (7.13 ± 0.98% vs 7.18 ± 1.01%, P = 0.186). Teleworking (estimate 0.206, P = 0.004) and living with a dog (estimate −0.149, P = 0.038) were significantly associated with changes in HbA1c levels after adjusting for covariates. There was no significant difference in the proportion of patients who received treatment intensification for diabetes during the pandemic and before the pandemic in either the elderly or non‐elderly patients.ConclusionsOverall glycemic control did not worsen during the pandemic. Nonetheless, environmental factors, including telework, were found to influence glycemic control in patients with diabetes. Further studies are needed to clarify whether the COVID‐19 pandemic could affect treatment intensification for diabetes.

Perceptions of the COVID-19 Pandemic and Anxiety-Relieving Behaviors after the Lifting of the First State of Emergency in Japan: Comparing International Students from Mainland China and Others

Perceptions of the COVID-19 Pandemic and Anxiety-Relieving Behaviors after the Lifting of the First State of Emergency in Japan: Comparing International Students from Mainland China and Others

Association between household income and dietary changes in young children during the COVID-19 state of emergency in Japan from April to May 2020

Association between household income and dietary changes in young children during the COVID-19 state of emergency in Japan from April to May 2020

Effects of the COVID-19 pandemic on heart failure hospitalizations in Japan: interrupted time series analysis.

AimsThe Coronavirus Disease 2019 (COVID‐19) pandemic has had unprecedented effects on health care utilization for acute cardiovascular diseases. Although hospitalizations for acute coronary syndrome decreased during the COVID‐19 pandemic, there is a paucity of data on the trends and management of heart failure (HF) cases. Furthermore, concerns have been raised that angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase susceptibility to COVID‐19. This study aimed to elucidate changes in HF hospitalizations from the COVID‐19 state of emergency in Japan and investigated changes in the prescription of ACEIs and ARBs, and in‐hospital mortality.Methods and resultsWe performed an interrupted time series analysis of HF hospitalizations in Japan to verify the impacts of the COVID‐19 state of emergency. Changes in the weekly volume of HF hospitalizations were taken as the primary outcome measure. Between 1 April 2018 and 4 July 2020, 109 429 HF cases required admission. After the state of emergency, an immediate decrease was observed in HF cases per week [−3.6%; 95% confidence interval (CI): −0.3% to −6.7%, P = 0.03]. There was no significant change in the prescription of ACEIs or ARBs after the state of emergency (4.2%; 95% CI: −0.3% to 8.9%, P = 0.07). The COVID‐19 pandemic had no effect on in‐hospital mortality among HF patients (5.3%; 95% CI: −4.9% to 16.6%, P = 0.32).ConclusionsWe demonstrated a decline in HF hospitalizations during the COVID‐19 pandemic in Japan, with no clear evidence of a negative effect on the prescription of ACEIs and ARBs or in‐hospital mortality.

The Association of Work-related Stress According to the Demand-Control Model With Aggravation of Pre-existing Disease During the First State of COVID-19 Emergency in Japan.

BackgroundThe job environment has changed a lot during the period of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to investigate the association between work-related stress and aggravation of pre-existing disease in workers during the first state of COVID-19 emergency in Japan.MethodsData were obtained from a large internet survey conducted between August 25 and September 30, 2020 in Japan. Participants who reported that they had a job as well as current history of disease(s) (ie, pre-existing conditions) were included (n = 3,090). Aggravation of pre-existing disease during the state of emergency was self-reported. Work-related stress from April 2020 (since the state of COVID-19 emergency) was assessed according to a job demand–control model. Multivariable logistic regression models were used to analyze the association.ResultsAggravation of pre-existing diseases was reported by 334 participants (11%). The numbers of participants with high demand and low control were 112 (18%) and 100 (14%), respectively. Compared to medium demand, high demand was significantly associated with aggravation of pre-existing diseases (odds ratio 1.77; 95% confidence interval, 1.30–2.42). Low control compared to medium control was also significantly associated with aggravation of pre-existing diseases (odds ratio 1.39; 95% confidence interval, 1.02–1.92).ConclusionWork-related stress during the first state of COVID-19 emergency was associated with aggravation of pre-existing disease during that period.

JCOA The Japanese Clinical Orthopaedic Association the questionnaire survey on the physical changes after the self-restraint of outdoor activities with the COVID-19 crisis- corona locomo and corona stress

BackgroundProblems with COVD-19 are not limited to the infection itself, but also include the secondary health damage arising from the prolonged self-restraint, which has affected all age groups in the Japanese population. Numerous studies have reported clear evidence of the secondary health damage.Published reports cover a wide range of damages, from locomotive dysfunction caused by decreased physical activity to decreased cognitive function and changes in eating and oral functions, and further to decreased opportunities for social participation. Such damage can also lead to worsening of so-called frailty.Under this circumstance, orthopedic surgeons conducted a questionnaire survey to determine the physical changes observed after the start of the COVD-19 self-restraint period. In this article, we report findings of the survey, along with some literature considerations. MethodsThe survey was started two months after the state of emergency in Japan was lifted, July 20 to August 12, 2020 (16 days total). And the analysis was conducted by simple and cross tabulation. ResultsValid responses to the questionnaire were obtained from 12,254 participants. Approximately 40% of the subjects felt a lack of physical strength (Corona stress), with the percentage peaking in high school, in the elderly it remained rather below average. On the other hand, locomotive dysfunction (Corona locomo) increased with age, independent of physical activity, and was not correlated with Corona stress. ConclusionsJapanese citizens need to change their behaviors for the purpose of improving their exercise and lifestyle habits towards shifting to a new lifestyle norm. Looking ahead to the ``With Corona’’ era, it is considered necessary by selecting a tailor-made training method suitable for each age group.

1503The association of work-related stress with aggravation of pre-existing disease during COVID-19 emergency in Japan

Abstract Background The job environment has changed since the sweeping of coronavirus disease 2019 (COVID-19) pandemic. The current study aimed to investigate the association between work-related stress and aggravation of pre-existing disease among workers during the first state of COVID-19 emergency in Japan. Methods Data were obtained from Japan COVID-19 and Society Internet Survey (JACSIS) conducted between August 25 and September 30, 2020. Participants who reported had a job as well as current history of disease(s) (i.e., pre-existing conditions) were included (n = 3090). Work-related stress since the state of COVID-19 emergency (April 2020) was assessed according to the job demand-control model. Aggravation of pre-existing disease during the state of emergency was self-reported. Multivariable logistic regression models were adopted to demonstrate the association. Results 334 (11%) participants reported with aggravation of pre-existing diseases. The numbers of participants with high demand and low control were 112 (18%) and 100 (14%), respectively. Compared to medium demand, high demand was significantly associated with aggravation of pre-existing diseases (odds ratio: 1.67, 95% confidence interval: 1.20-2.28). Low control was significantly associated with aggravation of pre-existing diseases (odds ratio: 1.41, 95% confidence interval: 1.02-1.95) compared to medium control. Conclusions Work-related stress during the first state of COVID-19 emergency was associated with aggravation of pre-existing disease during that period. Key messages Eleven percent of the working participants with pre-existing diseases reported its aggravation during the first state of COVID-19 emergency in Japan. Job strain characterized by high job demand and low job control was associated with aggravation of pre-existing disease.

The short-term effect of COVID-19 pandemic on disability, pain intensity, psychological status, and exercise habits in patients with chronic pain.

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has affected the lives of people worldwide. The first declaration of a state of emergency in Japan, based on the Act on Special Measures for the Prevention and Control of the Novel Coronavirus, was issued from 16 April 2020 to 14 May 2020 to reduce person-to-person contact. Restrictions on going out, participating in community activities, and visiting hospitals were in place. This study investigates the short-term effects of the COVID-19 pandemic on patients with chronic pain.MethodsThis study included outpatients with chronic pain undergoing treatment at the Pain Center of Nara Medical University Hospital. The patients had completed questionnaires for a disability during the study period, from 1 July to 30 September 2019 (baseline), 1 October to 31 December 2019 (pre-pandemic), and 1 July to 30 September 2020 (during the pandemic). The questionnaire covered changes in disability, pain intensity, health-related quality of life (QOL), anxiety, depression, catastrophic thinking, and the presence/absence of exercise habits at baseline, pre-pandemic, and during the pandemic.ResultsOf the 245 eligible patients, there was no significant disability difference between baseline, pre-pandemic, and during the pandemic (p = 0.14). Similarly, pain intensity, health-related QOL, anxiety, depression, and the presence/absence of exercise habits did not significantly differ between baseline, pre-pandemic, and during the pandemic either. The current study observed significant differences in terms of catastrophic thinking (p = 0.02).ConclusionThe effects of the COVID-19 pandemic on patients with chronic pain were not apparent in the short-term.Clinical trail registration: UMIN000043174

Errors and uncertainties associated with the use of unconventional activity data for estimating CO2 emissions: the case for traffic emissions in Japan

CO2 emissions from fossil fuel combustion (FFCO2) are conventionally estimated from fuel used (as activity data (AD)) and CO2 emissions factor. Recent traffic emission changes under the impact of the COVID-19 pandemic have been estimated using emerging non-fuel consumption data, such as human mobility data that tech companies reported as AD, due to the unavailability of timely fuel statistics. The use of such unconventional activity data (UAD) might allow us to provide emission estimates in near-real time; however, the errors and uncertainties associated with such estimates are expected to be larger than those of common FFCO2 inventory estimates, and thus should be provided along with a thorough evaluation/validation of the methodology and the resulting estimates. Here, we show the impact of COVID-19 on traffic CO2 emissions over the first six months of 2020 in Japan. We calculated CO2 monthly emissions using fuel consumption data and assessed the emission changes relative to 2019. Regardless of Japan’s soft approach to COVID-19, traffic emissions significantly declined by 23.8% during the state of emergency in Japan (April–May). We also compared relative emission changes among different estimates available. Our analysis suggests that UAD-based emission estimates during April and May could be biased by −19.6% to 12.6%. We also used traffic count data for examining the performance of UAD as a proxy for traffic and/or CO2 emissions. We found the assumed proportional relationship between traffic changes and CO2 emissions was not enough for estimating emissions with accuracy, and moreover, the traffic-based approach failed to capture emission seasonality. Our study highlighted the challenges and difficulties in repurposing data, especially ones with limited traceability/reproducibility, for modeling human activities and assessing the impact on the environment, and the importance of a thorough error and uncertainty assessment before using these data in policy applications.

Measuring Public Concern About COVID-19 in Japanese Internet Users Through Search Queries: Infodemiological Study.

BackgroundCOVID-19 has disrupted lives and livelihoods and caused widespread panic worldwide. Emerging reports suggest that people living in rural areas in some countries are more susceptible to COVID-19. However, there is a lack of quantitative evidence that can shed light on whether residents of rural areas are more concerned about COVID-19 than residents of urban areas.ObjectiveThis infodemiology study investigated attitudes toward COVID-19 in different Japanese prefectures by aggregating and analyzing Yahoo! JAPAN search queries.MethodsWe measured COVID-19 concerns in each Japanese prefecture by aggregating search counts of COVID-19–related queries of Yahoo! JAPAN users and data related to COVID-19 cases. We then defined two indices—the localized concern index (LCI) and localized concern index by patient percentage (LCIPP)—to quantitatively represent the degree of concern. To investigate the impact of emergency declarations on people's concerns, we divided our study period into three phases according to the timing of the state of emergency in Japan: before, during, and after. In addition, we evaluated the relationship between the LCI and LCIPP in different prefectures by correlating them with prefecture-level indicators of urbanization.ResultsOur results demonstrated that the concerns about COVID-19 in the prefectures changed in accordance with the declaration of the state of emergency. The correlation analyses also indicated that the differentiated types of public concern measured by the LCI and LCIPP reflect the prefectures’ level of urbanization to a certain extent (ie, the LCI appears to be more suitable for quantifying COVID-19 concern in urban areas, while the LCIPP seems to be more appropriate for rural areas).ConclusionsWe quantitatively defined Japanese Yahoo users’ concerns about COVID-19 by using the search counts of COVID-19–related search queries. Our results also showed that the LCI and LCIPP have external validity.

Abusive and positive parenting behavior in Japan during the COVID-19 pandemic under the state of emergency

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic has changed the lives of children and parents, raising concerns about child maltreatment. ObjectiveWe examined the prevalence of abusive parenting behavior during the pandemic of the COVID-19 and its relations with physical, psychological, and social factors and positive parenting behavior. Participants and settingAn online survey was performed during the COVID-19 state of emergency in Japan. Participants were 5344 parents of children aged 0–17 years. MethodsWe conducted an anonymous online survey using multiple platforms, including websites of child-related organizations and social networking services (SNS). Multiple logistic regression analyses were performed to identify factors associated with abusive behavior. ResultsOne-fifth of parents reported abusive behaviors, whereas over 80% of parents reported positive parenting behaviors (e.g., empathizing with a child). Abusive parenting behaviors were associated with longer screen time (6+ hours per day: OR, 1.44; 95%CI, 1.05–1.98), poor maternal mental health (K6 = 13+: OR, 2.23; 95%CI, 1.71–2.89), and the occurrence of domestic violence (OR, 4.54; 95%CI, 3.47–5.95). Positive parenting behaviors, especially showing empathy, were associated with lower risks of abusive behaviors (OR, 0.51: 95%CI, 0.39–0.66). ConclusionsPositive parenting behavior is essential to the prevention of child maltreatment during the COVID-19 pandemic.

Physical and Mental Functions of Cardiovascular Diseased Patients Decrease During the State of Emergency Initiated by the COVID-19 Pandemic in Japan.

We aimed to examine the differences in life-space mobility and quality of life (QoL) of patients with cardiovascular disease (CVD) between the pre- and postnationwide state of emergency initiated by the Coronavirus disease 2019 (COVID-19) pandemic in Japan and to show the factors associated with the decrease in life-space mobility and QoL in these patients. We undertook a longitudinal study of 20 out of 51 consecutive CVD patients with coronary artery disease (CAD) who met the study criteria. We used the Life-Space Assessment (LSA) tool to evaluate Life-space mobility and assessed QoL with the five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L) in Japanese. The LSA scores and EQ-5D-5L QoL score decreased significantly from the pre- to postnationwide state of emergency in Japan (p < 0.01). ΔLSA was significantly positively associated with body mass index and significantly negatively associated with knee extensor muscle strength and pre-LSA score (p < 0.05). There were no significant relationships between ΔLSA and ΔEQ- 5D-5L QoL scores and between ΔEQ-5D-5L QoL scores and patient characteristics. The policies promoted to address the state of emergency in Japan might affect life-space mobility and QoL of CAD patients. Moreover, CAD patients in Japan who were not obese and maintained their physical function and activity tended to refrain from activity during the period between the pre- and post-nationwide state of emergency. Clarification of the effects of the COVID-19 pandemic on the relationship between living space motility and QoL in CAD patients will require further study.

Modelling Analysis of COVID-19 Transmission and the State of Emergency in Japan.

To assess the effectiveness of the containment strategies proposed in Japan, an SEIAQR (susceptible-exposed-infected-asymptomatic-quarantined-recovered) model was established to simulate the transmission of COVID-19. We divided the spread of COVID-19 in Japan into different stages based on policies. The effective reproduction number and the transmission parameters were determined to evaluate the measures conducted by the Japanese Government during these periods. On 7 April 2020, the Japanese authority declared a state of emergency to control the rapid development of the pandemic. Based on the simulation results, the spread of COVID-19 in Japan can be inhibited by containment actions during the state of emergency. The effective reproduction number reduced from 1.99 (before the state of emergency) to 0.92 (after the state of emergency). The transmission parameters were fitted and characterized with quantifiable variables including the ratio of untracked cases, the PCR test index and the proportion of COCOA app users (official contact confirming application). The impact of these variables on the control of COVID-19 was investigated in the modelling analysis. On 8 January 2021, the Japanese Government declared another state of emergency. The simulated results demonstrated that the spread could be controlled in May by keeping the same strategies. A higher intensity of PCR testing was suggested, and a larger proportion of COCOA app users should reduce the final number of infections and the time needed to control the spread of COVID-19.

Changes in Smoking Behavior Since the Declaration of the COVID-19 State of Emergency in Japan: A Cross-sectional Study From the Osaka Health App.

BackgroundIn April 2020, the Japanese government declared a state of emergency due to the COVID-19 pandemic, and infection control measures, including requests to work from home and stay-at-home restrictions, were introduced. This study examined changes in smoking behavior during the COVID-19 state of emergency.MethodsAn online cross-sectional survey was conducted in Osaka, Japan. To assess differences in smoking behavior among 5,120 current smokers before and after the declaration of a state of emergency, prevalence ratios (PRs) for two outcomes, increased smoking and quitting smoking, were calculated using multivariable Poisson regression, adjusting for potential covariates.ResultsWe found 32.1% increased the number of cigarettes smoked and 11.9% quit smoking. After adjustment for all variables, we found risk factors for COVID-19 (men and older age group) had both significantly higher PR for quitting smoking (men: PR 1.38; 95% confidence interval [CI], 1.17–1.62) and participants aged ≥65 years: PR 2.45; 95% CI, 1.92–3.12) and significantly lower PR of increased smoking (men: PR 0.85; 95% CI, 0.78–0.93 and participants ≥65 years: PR 0.38; 95% CI, 0.29–0.49). Additionally, respondents working from home or living alone had significantly higher PR for increased smoking (working from home: PR 1.29; 95% CI, 1.17–1.41 and living alone: PR 1.23; 95% CI, 1.10–1.38) and respondents who changed from cigarettes to heated tobacco products (HTPs) had significantly lower PR for quitting smoking (PR 0.150; 95% CI, 0.039–0.582).ConclusionsWe suggest people who have high-risk factors for COVID-19 might change their smoking behavior for the better, while people who work from home or live alone might change their smoking behavior for the worse, during the COVID-19 state of emergency. Additionally, changing from smoking cigarettes to using HTPs makes smokers less likely to quit.

Trajectories of frailty, physical function, and physical activity levels in elderly patients with heart failure: impacts of interruption and resumption of outpatient cardiac rehabilitation due to COVID-19.

During the nationwide state of emergency, many hospitals could not provide outpatient cardiac rehabilitation for cardiac disease patients in order to minimize coronavirus disease 2019 (COVID-19) incidence. The purpose of this study was to examine the trajectories of frailty, physical function and physical activity levels due to interruption and resumption of outpatient cardiac rehabilitation by COVID-19 in elderly heart failure patients. Fifteen patients who did not attend outpatient cardiac rehabilitation during the state of emergency but resumed it after the state of emergency were included. Frailty, physical function and physical activity levels were assessed with the Kihon checklist (KCL), various tests including short physical performance battery (SPPB), and life space assessment (LSA), respectively. Objective parameters were measured at three points; before and after the nationwide state of emergency in Japan and 3 months after resuming outpatient cardiac rehabilitation. The post-state of emergency KCL score was significantly higher than the pre-state of emergency score (P = 0.03), whereas there was no significant difference in KCL between post-state of emergency and 3 months after cardiac rehabilitation resumption. SPPB and LSA scores did not change significantly between pre- and post-state of emergency. The changes in LSA from post-state of emergency to 3 months after cardiac rehabilitation resumption tended to correlate with changes in KCL (r = −0.71, P = 0.11). We demonstrated that frailty status deteriorated significantly in elderly heart failure patients whose outpatient cardiac rehabilitation was interrupted due to COVID-19. In addition, the frailty status showed no significant improvement after 3 months of resuming cardiac rehabilitation.

Study on the effects of changes in lifestyle of patients with diabetes on glycaemic control before and after the declaration of the state of emergency in Japan.

ObjectiveTo investigate the actual conditions of changes in lifestyle and treatment status of patients with diabetes before and after the declaration of the state of emergency issued in response to the novel coronavirus.MethodsThis study was a collaborative study in two diabetes clinics. A total of 1000 subjects responded to the questionnaire. In addition, data on HbA1c and body weight before and after the declaration of the state of emergency were collected.ResultsHbA1c levels significantly decreased from 7.28 ± 0.97% before the declaration of the state of emergency to 7.07 ± 0.86% after the declaration (p < 0.001). A significant decrease in HbA1c levels was also noted in both T2DM and T1DM. A factorial analysis of the change in HbA1c levels found that a high HbA1c level before the declaration was the most influential factor that made the HbA1c level more likely to decrease, with such factors including a good amount of exercise. A positive correlation with change in body weight was noted. Factors that made the HbA1c level less likely to decrease included stress felt about school closures for children, increased opportunities to eat out, increased food consumption, and refraining from exercise to avoid the “Three Cs” (crowded places, close-contact settings, and confined and enclosed spaces).ConclusionIn the absence of serious economic stagnation or completely disrupted distribution, patients are allowed time to do what they like and can probably improve their glycaemic control status if they see this time as an opportunity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13340-021-00505-6.

Diabetes management by either telemedicine or clinic visit improved glycemic control during the coronavirus disease 2019 pandemic state of emergency in Japan.

The purpose of this retrospective cohort study at a Tokyo diabetes clinic was to evaluate the effect of telemedicine and clinic visit on glycated hemoglobin (HbA1c) during the coronavirus disease 2019 state of emergency. The effect of telemedicine and clinic visit during the emergency period on the post‐emergency measured HbA1c was evaluated by multiple regression models and logistic regression models adjusted for age, sex, type of diabetes, pre‐emergency HbA1c and body mass index, and body mass index change during the emergency period. Among 2,727 patients who visited the clinic before and after the emergency period, the interval between clinic visits during the emergency period was significantly associated with HbA1c improvement. Telemedicine and clinic visit were independently associated with HbA1c improvement when pre‐emergency HbA1c was ≥7%. In conclusion, clinic visit and telemedicine during the coronavirus disease 2019 emergency period were both independently effective in HbA1c improvement in Japanese diabetes patients who had insufficient HbA1c control.

Assessment of Pediatric Admissions for Kawasaki Disease or Infectious Disease During the COVID-19 State of Emergency in Japan

The development of Kawasaki disease (KD) has been suggested to be associated with droplet- or contact-transmitted infection; however, its triggers and transmission modes remain to be determined. Under an epidemic of SARS-CoV-2, the COVID-19 state of emergency in Japan served as a nationwide social experiment to investigate the impact of quarantine or isolation on the incidence of KD. To assess the role of droplet or contact transmission in the etiopathogenesis of KD. This multicenter, longitudinal, cross-sectional study was conducted from 2015 to 2020 at Fukuoka Children's Hospital and 5 adjacent general hospitals. The number of admissions for KD and infectious diseases were analyzed. Participants were pediatric patients admitted to the participating hospitals for KD or infectious diseases. Quarantine and isolation owing to the COVID-19 state of emergency. The primary end points were the ratios of patients with KD to patients with respiratory tract or gastrointestinal infections admitted from April to May in 2015 to 2019 and 2020. A Poisson regression model was used to analyze them. The study participants included 1649 patients with KD (median [interquartile range] age, 25 [13-43] months; 901 boys [54.6%]) and 15 586 patients with infectious disease (data on age and sex were not available for these patients). The number of admissions for KD showed no significant change between April and May in 2015 to 2019 vs the same months in 2020 (mean [SD], 24.8 [5.6] vs 18.0 [4.0] admissions per month; 27.4% decrease; adjusted incidence rate ratio [aIRR], 0.73; 95% CI, 0.48-1.10; P = .12). However, the number of admissions for droplet-transmitted or contact-transmitted respiratory tract infections (mean [SD], 157.6 [14.4] vs 39.0 [15.0] admissions per month; 75.3% decrease; aIRR, 0.25; 95% CI, 0.17-0.35; P < .001) and gastrointestinal infections (mean [SD], 43.8 [12.9] vs 6.0 [2.0] admissions per month; 86.3% decrease; aIRR, 0.14; 95% CI, 0.04-0.43; P < .001) showed significant decreases between April and May in 2015 to 2019 vs the same months in 2020 (total, 12 254 infections). Thus, the ratio of KD to droplet- or contact-transmitted respiratory tract and gastrointestinal infections incidence in April and May 2020 was significantly increased (ratio, 0.40 vs 0.12; χ21 = 22.76; P < .001). In this study, the significantly increased incidence of KD compared with respiratory tract and gastrointestinal infections during the COVID-19 state of emergency suggests that contact or droplet transmission is not a major route for KD development and that KD may be associated with airborne infections in most cases.

The quality of life of children with neurodevelopmental disorders and their parents during the Coronavirus disease 19 emergency in Japan

This study aimed to reveal how the COVID-19 stay-at-home period has affected the quality of life (QOL) of children with neurodevelopmental disorders and their parents and to identify possible factors that enabled them to maintain their QOL. We enrolled 136 school-aged children (intellectual quotient ≥ 50) and their parents and administered QOL questionnaires to assess the maladaptive behavior of the children; depression, anxiety, and stress of the parents; and activities of their daily lives. The relationship between their QOL and clinical features was examined. The decrease in QOL of children and parents was associated with the mother’s limited job flexibility. Decreased QOL was also associated with changes in the sleep rhythms of the children. Maladaptive behaviors in children were associated with parental stress. However, maintained QOL of some families who faced these same conditions of job stress and sleep disorders was associated with less parental stress, less parental depression and anxiety, and milder maladaptive behavior in children. Both mothers with limited job flexibility and changes in the sleep rhythm of children were associated with reduced QOL of children and their parents. Low parental stress was associated with decreased maladaptive behavior in children and with maintained QOL of the family.

Influences of remote exercise training for community-dwelling older adults in Japan during the COVID-19 pandemic.

[Purpose] The coronavirus disease (COVID-19) pandemic has caused sudden lifestyle changes. This study aimed to determine the limitations in activity and the influences of remote exercise training on community-dwelling older adults during a state of emergency in Japan. [Participants and Methods] In May 2020, during the COVID-19 state of emergency, we carried out a mail survey of community-dwelling older adults who had previously participated in a disability prevention program in Ami town, Ibaraki, Japan. The mail included a brochure on exercises and a DVD. The attached exercise program was comprised of 10 different exercises, which could be conducted in approximately 30 minutes. [Results] Of the 191 older adults, 73 responded to this survey (38.2%), of which 42 (58.5%) participants had decreased outdoor exercise activity, and 50 (68.5%) decreased the amount of time spent on physical activities during the COVID-19 state of emergency. There were significant reductions (19.2–22.5%) in the perceived exercise load for each posture after two weeks of remote exercise training with DVD (n=26). [Conclusion] Our results suggested that the remote exercise training with the brochure and DVD may be effective. Since this study involved a small number of participants, future studies should involve larger populations.