Managing noncommunicable diseases during the COVID-19 pandemic in Brazil: findings from the PAMPA cohort

Gender-dependent effect of physical activity on the risk of incident multimorbidity during the COVID-19 pandemic: Findings from the PAMPA cohort, Brazil

OBJECTIVES

We aimed to investigate the association between physical activity (PA) and the risk of incident multimorbidity in adults from southern Brazil during the COVID-19 pandemic.

STUDY DESIGN

Prospective Study.

METHODS

We analyzed data from the Prospective Study about Physical and Mental Health (PAMPA) cohort, a longitudinal study of adults living in southern Brazil. The baseline assessment occurred in June/July 2020, and further data collection occurred 6 and 12 months later. Participants with no multimorbidity (2 or more simultaneous chronic conditions) at baseline were included in the present analysis. PA weekly volume, status, type, and place were also assessed at baseline.

RESULTS

Over one year, 30.8 % of participants developed multimorbidity. Men participants, classified as physically active before or during the pandemic, had reduced risk of multimorbidity. Practicing PA at home reduced the risk in both genders, while PA at and out of home only reduced the risk in women participants. Endurance and combined activities reduced the risk among women, while strength activities reduced the risk in both genders.

CONCLUSIONS

PA reduced the risk of incident multimorbidity among adults in southern Brazil, with different parameters moderating this effect between genders.

Studies of physical activity and COVID-19 during the pandemic: an updated scoping review

BACKGROUND

This review is an update of the previous study aiming to identify the available evidence related to physical activity (PA) in the context of the coronavirus disease (COVID-19) pandemic.

METHODS

We searched 6 databases (PubMed, Embase, SPORTDiscus, Scopus, Web of Science, and CINAHL) in April 2024. Medical subject headings and keywords related to PA and COVID-19 were combined to conduct the online search, which covered the period from July 2020 to April 2024.

RESULTS

Overall, 49,579 articles were retrieved. After duplicate removal and title, abstract, and full-text screening, 1,976 articles were included in this update. Most of the studies were observational with a cross-sectional design (68.0%). Most of COVID-19 and PA studies came from high-income countries. Most studies explored the changes in PA levels due to the COVID-19 pandemic and its effects on mental health outcomes.

CONCLUSION

Research on PA and COVID-19 prioritized online approach and cross-sectional designs. Most of the evidence identified a decrease in PA levels due to social distancing measures.

Exercise as medicine! Physical activity mitigated the impact of the COVID-19 pandemic on depressive symptoms in adults with depression

We investigated the longitudinal association between physical activity (PA) and symptoms of depression and anxiety in people with depression during the COVID-19 pandemic. We used data from baseline (June 2020) to wave 3 (June 2021) of the PAMPA Cohort, an ambispective cohort with adults in south Brazil. The Hospital Anxiety and Depression Scale assessed depressive and anxiety symptoms in all waves. Participants reported frequency (minutes), type (aerobic, strength, combined), and place (out of home, at home) of physical activity at baseline. Generalized linear models were used to investigate the interaction between time and PA, adjusting for possible confounding variables. Subjective memory decline was assessed using multivariate Cox proportional hazard regression models to obtain adjusted hazard ratio (HR) and respective 95% confidence interval (CI). Participants (n = 424) with self-reported clinically diagnosed depression were included. We observed a non-linear increase trajectory of depression during the first year of the COVID-19 pandemic. PA was associated with a slower trajectory of depressive (slope: -1.89; 95%CI: -3.34, -0.43 points) but not anxiety (slope: -1.33; 95%CI: -2.93, 0.25 points) symptoms during the COVID-19 pandemic. Participants who continued physically active from pre-pandemic in wave 1 showed a lower risk of subjective memory decline during follow-up than those who persisted inactive in the same period (HR: 0.52; 95%CI: 0.30, 0.89). PA attenuated the impact of the COVID-19 pandemic on depressive symptoms in adults living with depression in south Brazil. Regularity of physical activity was associated with fewer depression and anxiety symptoms and a lower risk of subjective memory decline.

The impact of COVID-19 on the lives of Canadians with and without non-communicable chronic diseases: results from the iCARE Study

BACKGROUND

The COVID-19 pandemic and its prevention policies have taken a toll on Canadians, and certain subgroups may have been disproportionately affected, including those with non-communicable diseases (NCDs; e.g., heart and lung disease) due to their risk of COVID-19 complications and women due to excess domestic workload associated with traditional caregiver roles during the pandemic.

AIMS/OBJECTIVES

We investigated the impacts of COVID-19 on mental health, lifestyle habits, and access to healthcare among Canadians with NCDs compared to those without, and the extent to which women with NCDs were disproportionately affected.

METHODS

As part of the iCARE study ( www.icarestudy.com ), data from eight cross-sectional Canadian representative samples (total n = 24,028) was collected via online surveys between June 4, 2020 to February 2, 2022 and analyzed using general linear models.

RESULTS

A total of 45.6% (n = 10,570) of survey respondents indicated having at least one physician-diagnosed NCD, the most common of which were hypertension (24.3%), chronic lung disease (13.3%) and diabetes (12.0%). In fully adjusted models, those with NCDs were 1.18-1.24 times more likely to report feeling lonely, irritable/frustrated, and angry 'to a great extent' compared to those without (p's < 0.001). Similarly, those with NCDs were 1.22-1.24 times more likely to report worse eating and drinking habits and cancelling medical appointments/avoiding the emergency department compared to those without (p's < 0.001). Moreover, although there were no sex differences in access to medical care, women with NCDs were more likely to report feeling anxious and depressed, and report drinking less alcohol, compared to men with NCDs (p's < 0.01).

CONCLUSION

Results suggest that people with NCDs in general and women in general have been disproportionately more impacted by the pandemic, and that women with NCDs have suffered greater psychological distress (i.e., feeling anxious, depressed) compared to men, and men with NCDs reported having increased their alcohol consumption more since the start of COVID-19 compared to women. Findings point to potential intervention targets among people with NCDs (e.g., prioritizing access to medical care during a pandemic, increasing social support for this population and mental health support).

Identifying and understanding the care pathway of patients with atrial fibrillation in Brazil and the impact of the COVID-19 pandemic: A mixed-methods study

BACKGROUND

Atrial fibrillation (AF) is a major risk factor for stroke. To enable improvements to AF diagnosis and follow-up care, understanding current patient pathways and barriers to optimal care are essential. We investigated the patient care pathways and their drivers, and the impact of the COVID-19 pandemic on patient pathways in a middle-income country setting, Brazil.

METHODS

This mixed-methods study in São Paulo, included adults (≥18y) with AF from 13 primary/secondary healthcare facilities. Surveys using baseline, follow-up (administered ≥two months after baseline) and COVID-19 questionnaires (quantitative), and three focus group discussions (FGDs) were conducted. Minimum sample size for the quantitative component was 236 and we aimed to reach saturation with at least three FGDs for the qualitative component. Descriptive statistics were used for quantitative data and a content analysis was used for qualitative data to identify themes related to AF diagnosis and follow-up care.

RESULTS

267 participants completed the baseline questionnaire: 25% were diagnosed in primary care, 65% in an emergency or inpatient department. At follow-up (n = 259), 31% visited more than one facility for AF care, and 7% had no follow-up. Intervals between international normalised ratio (INR) tests were increased during the pandemic, and the number of healthcare visits and availability of medication were reduced. Seventeen patients participated in three FGDs and revealed that AF diagnosis often occurred following a medical emergency and patients often delay care-seeking due to misconceptions about AF symptoms. Long waiting times, doctor/patient interactions and health system factors, such as doctor availability and the referral system, influence where participants visited for follow-up care.

CONCLUSIONS

Lack of public awareness and underdeveloped primary healthcare lead to delayed diagnosis, which impacts clinical outcomes and excess patient and healthcare system costs. Health system, care-provider, and pandemic factors disrupt timely and effective continuity of care.

Care seek behavior for low back pain in southern Brazil during the COVID-19 pandemic: a panel data analysis

BACKGROUND

During the COVID-19 pandemic, people with low back pain (LBP) might have avoided seeking care for their pain. We aimed to investigate how the COVID-19 pandemic has affected LBP care seeking behavior among adults.

METHODS

Data from four assessments of the PAMPA cohort were analyzed. Participants who reported experiencing LBP during wave one both before and during social restrictions (n = 1,753 and n = 1,712, respectively), wave two (n = 2,009), and wave three (n = 2,482) were included. We asked participants about sociodemographic, behavioral, and health factors and outcomes related to LBP. Poisson regression analyses were conducted, and data are presented as prevalence ratios (PR) and respective 95% confidence interval (95%CI).

RESULTS

Overall, care seeking behavior decreased by half in the first months of restrictions, from 51.5% to 25.2%. Although there was an increase in care seeking behavior observed in the other two assessments (nearly 10 and 16 months after restrictions), it was insufficient to reach pre-pandemic levels. In the first months of restrictions, a similar scenario was observed for specific care, such as general practitioner and exercise professional care, with proportions of pre-pandemic levels reached after 10 and 16 months. Women were more likely to seek care for LBP 10 and 16 months after restrictions (PR 1.30 95%CI 1.11; 1.52, PR 1.22 95%CI 1.06; 1.39, respectively). Also, those participants who worked, were physically active, and reported pain-related disability and high pain levels were more likely to seek care at all time points assessed.

CONCLUSION

Overall, care-seeking behavior for LBP significantly decreased in the first months of restrictions and increased in the following months; however, this behavior remained lower than pre-pandemic levels.

What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region

OBJECTIVE

This article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic.

SETTING

Information on public sector primary care services for NCDs, and related technical inputs from 35 countries in the Americas region are provided.

PARTICIPANTS

All Ministry of Health officials managing a national NCD programme, from a WHO Member State in the Americas region, were included throughout this study. Government health officials from countries that are not WHO Member States were excluded.

OUTCOME MEASURES

The availability of evidence-based NCD guidelines, essential NCD medicines and basic technologies in primary care, cardiovascular disease risk stratification, cancer screening and palliative care services were measured in 2019, 2020 and 2021. NCD service interruptions, reassignments of NCD staff during the COVID-19 pandemic and mitigation strategies to reduce disruptions for NCD services were measured in 2020 and 2021.

RESULTS

More than 50% of countries reported a lack of comprehensive package of NCD guidelines, essential medicines and related service inputs. Extensive disruptions in NCD services resulted from the pandemic, with only 12/35 countries (34%), reporting that outpatient NCD services were functioning normally. Ministry of Health staff were largely redirected to work on the COVID-19 response, either full time or partially, reducing the human resources available for NCD services. Six of 24 countries (25%) reported stock out of essential NCD medicines and/or diagnostics at health facilities which affected service continuity. Mitigation strategies to ensure continuity of care for people with NCDs were deployed in many countries and included triaging patients, telemedicine and teleconsultations, and electronic prescriptions and other novel prescribing practices.

CONCLUSIONS

The findings from this regional survey suggest significant and sustained disruptions, affecting all countries regardless of the country's level of investments in healthcare or NCD burden.

Quality of Life and Adherence to Healthcare Services During the COVID-19 Pandemic: A Cross-Sectional Analysis

Purpose

To determine the relationship of various domains of quality of life (QoL) with healthcare adherence during the COVID-19 pandemic in Saudi Arabia.

Methods

The study sample comprised 795 participants among which 203 had a current diagnosis of any major NCDs, including cardiovascular diseases, diabetes mellitus, asthma, chronic pulmonary diseases, and chronic psychiatric illnesses and a control group of 592 participants who had no NCD. Participants completed an online survey questionnaire which obtained data on socio-demographic variables, types of NCDs, and healthcare adherence during the year 2020, the period during which Saudi Arabia underwent the first two waves of the COVID-19 pandemic. World Health Organization Quality of Life (WHOQOL-BREF) assessed the QoL in four domains physical, psychological, social and environmental and used standard scores in the analysis. GraphPad Prism 5 and SPSS 25V were employed for the statistical analysis. Bar graphs and frequency distribution tables present descriptive data. Bivariate and multivariate logistic regression analyses were computed to determine the significance of the relationship between QoL and healthcare adherence.

Results

Almost equal proportions of participants with NCDs (n=109/203; 54%) and without NCDs (n=327/592; 55%) demonstrated nonadherence to their regular healthcare during the COVID-19 pandemic (χ2=0.14; p=0.71). Patients with NCDs experienced lower quality of life in the psychological, social and environmental domains of QoL (p<0.05). Results from the multivariate regression analysis showed that female gender (AOR=1.52; p<0.05) psychological QoL (AOR=1.99; p<0.05), social QoL (AOR=1.98; p<0.05) and environmental QoL (AOR=1.95; p<0.05) significantly relate with adherence to healthcare.

Conclusion

Psychological, social and environmental may influence healthcare adherence among patients with NCDs during pandemics and should be focused on while devising future healthcare policy and interventions.

O uso do core set da CIF para avaliação de pacientes com distúrbios cardiorrespiratórios

Introdução: A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) categoriza a saúde e deficiência do indivíduo considerando a funcionalidade e os fatores contextuais. No entanto, a CIF apresenta muitas categorias que dificultam o seu uso diário e, por isso, foram criados os core sets. Entre os diversos core sets propostos, existe um core set para condições cardiorrespiratórias pós-agudas. Objetivo: classificar os pacientes com alterações cardíacas, respiratórias e mistas, assistidos ambulatoriais por meio de um core sets para esta população, além de verificar se existem diferenças entre os grupos na aplicação deste core set. Métodos: Foram avaliados indivíduos com diagnóstico clínico de doenças cardiorrespiratórias em acompanhamento fisioterapêutico ambulatorial para reabilitação cardiopulmonar. A amostra foi dividida em três grupos: cardíacos, respiratórios e mistos. Os pacientes foram avaliados por meio da versão abreviada do core set para condições cardiorrespiratórios pós-agudas, funcionalidade, força de preensão palmar e dos músculos respiratórios. Resultados: A amostra foi composta por 67 indivíduos alocados de acordo com seu comprometimento. Verificou-se que apenas as funções de energia e impulso, cardíaca e de ingestão, estrutura do sistema respiratório e a atividade andar apresentaram respostas significativamente diferentes entres os grupos. Pacientes com distúrbios respiratórios, cardíacos e mistos apresentam perfis funcionais semelhantes, porém as categorias com diferença desse perfil foram as relacionadas ao sistema respiratório, atividades e funções relacionadas ao aumento da demanda metabólica como andar. Conclusão: Assim é possível afirmar que o core set auxilia a identificar as disfunções dos pacientes sem depender se sua disfunção é cardíaca, respiratória ou mista que pode ser uma ferramenta utilizada no meio clínico.

Incidence of multimorbidity and associated factors during the COVID-19 pandemic in Brazil: a cohort study

BACKGROUND

Due to the coronavirus disease 2019 (COVID-19) pandemic, access to healthcare services may have become difficult, which may have led to an increase in chronic diseases and multimorbidity.

OBJECTIVES

To assess the incidence of multimorbidity and its associated factors among adults living in the state of Rio Grande do Sul, Brazil.

DESIGN AND SETTING

Cohort study conducted in Rio Grande do Sul, Brazil.

METHODS

We included data from the two waves of the Prospective Study About Mental and Physical Health (PAMPA). Data were collected via online questionnaires between June and July 2020 (wave 1) and between December 2020 and January 2021 (wave 2). Multimorbidity was defined as the presence of two or more diagnosed medical conditions.

RESULTS

In total, 516 individuals were included, among whom 27.1% (95% confidence interval, CI: 23.5-31.1) developed multimorbidity from wave 1 to 2. In adjusted regression models, female sex (hazard ratio, HR: 1.97; 95% CI: 1.19-3.24), middle-aged adults (31-59 years) (HR: 1.78; 95% CI: 1.18-2.70) and older adults (60 or over) (HR: 2.41; 95% CI: 1.25-4.61) showed higher risk of multimorbidity. Back pain (19.4%), high cholesterol (13.3%) and depression (12.2%) were the medical conditions with the highest proportions reported by the participants during wave 2.

CONCLUSION

The incidence of multimorbidity during a six-month period during the COVID-19 pandemic was 27.1% in the state of Rio Grande do Sul, Brazil.

Physical activity trajectory in the first 10 months of the COVID-19 pandemic in Southern Brazil: a follow-up study

Background

A continuous tracking of the PA level during the COVID-19 pandemic is important to understand how people’s behaviour has varied along time. The aim of this study was to evaluate the physical activity (PA) trajectory over the first 10 months of the COVID-19 pandemic in the south of Brazil.

Methods

Data from three timepoints of the PAMPA Cohort were used, as follows: (1) pre-COVID-19 (retrospective); (2) Jun/Jul 2020; (3) Dec 2020/Jan 2021. Self-reported PA practice, frequency, duration, as well as place where activities were performed (at or out of home) were assessed.

Results

A reduction in any (from 68.7 to 47.7%), sufficient (from 41.5 to 22.1%) and out of home PA (from 59.4 to 30.1%) was observed from the first (pre-COVID-19) to the second (Jun/Jul 2020) timepoint, followed by an increase in the third timepoint (Dec 2020/Jan 2021) (60.1%, 37.9%, and 54.3% for any, sufficient, and out of home PA, respectively). The PA trajectory was similar, regardless of sex, educational level or income. Only any (p = 0.0007) and sufficient (p = 0.0012) PA showed significant interaction with time by sex. Female participants were less likely to engage in any (OR 0.45 95% CI 0.26; 0.77) and sufficient PA (OR 0.40 95% CI 0.24; 0.66).

Conclusion

During the first 10 months of COVID-19 pandemic there was a marked fluctuation on PA pattern in adults from southern Brazil. An ongoing tracking of PA behaviour during COVID-19 pandemic is important to understand how this behaviour varies. Public policies should focus on increasing PA in a higher standard than pre-COVID levels.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00450-0.

Analysis of the impact of coronavirus disease 19 on hospitalization rates for chronic non-communicable diseases in Brazil

BACKGROUND

The coronavirus disease (COVID-19) pandemic has impacted health services and healthcare systems worldwide. Studies have shown that hospital admissions for causes related to chronic non-communicable diseases (NCDs) have decreased significantly during peak pandemic periods. An analysis of the impact of the COVID-19 pandemic on hospital admissions for NCDs is essential to implement disability and mortality mitigation strategies for these groups. Therefore, this study aimed to analyze the impact of the COVID-19 pandemic on hospital admissions for NCDs in Brazil according to the type of NCD, sex, age group, and region of Brazil.

METHODS

This is an ecological study conducted in Brazil. Data on hospital admissions from January 1, 2017 to May 31, 2021 were extracted from the Unified Health System's Hospital Admissions Information System. The hospital admission rates per 100,000 thousand inhabitants were calculated monthly according to the type of NCD, sex, age group, and region of Brazil. Poisson regression models were used to analyze the impact of the COVID-19 pandemic on the number of hospital admissions. In this study, the pre-pandemic period was set from January 1, 2017 to February 29, 2020 and the during-pandemic from March 1, 2020 to May 31, 2021.

RESULTS

There was a 27.0% (95.0%CI: -29.0; -25.0%) decrease in hospital admissions for NCDs after the onset of the pandemic compared to that during the pre-pandemic period. Decreases were found for all types of NCDs-cancer (-23.0%; 95.0%CI: -26.0; -21.0%), diabetes mellitus (-24.0%; 95.0%CI: -25.0%; -22.0%), cardiovascular diseases (-30.0%; 95.0%CI: -31.0%; -28.0%), and chronic respiratory diseases (-29.0%; 95.0%CI: -30.0%; -27.0%). In addition, there was a decrease in the number of admissions, regardless of the age group, sex, and region of Brazil. The Northern and Southern regions demonstrated the largest decrease in the percentage of hospital admissions during the pandemic period.

CONCLUSIONS

There was a decrease in the hospitalization rate for NCDs in Brazil during the COVID-19 pandemic in a scenario of social distancing measures and overload of health services.

First and second COVID-19 waves in Brazil: A cross-sectional study of patients' characteristics related to hospitalization and in-hospital mortality

Background

Background The second wave of the COVID-19 pandemic was more aggressive in Brazil compared to other countries around the globe. Considering the Brazilian peculiarities, we analyze the in-hospital mortality concerning socio-epidemiological characteristics of patients and the health system of all states during the first and second waves of COVID-19.

Methods

We performed a cross-sectional study of hospitalized patients with positive RT-PCR for SARS-CoV-2 in Brazil. Data was obtained from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and comprised the period from February 25, 2020, to April 30, 2021, separated in two waves on November 5, 2020. We performed a descriptive study of patients analyzing socio-demographic characteristics, symptoms, comorbidities, and risk factors stratified by age. In addition, we analyzed in-hospital and intensive care unit (ICU) mortality in both waves and how it varies in each Brazilian state.

Findings

Between February 25, 2020 and April 30, 2021, 678 235 patients were admitted with a positive RT-PCR for SARS-CoV-2, with 325 903 and 352 332 patients for the first and second wave, respectively. The mean age of patients was 59·65 (IQR 48·0 - 72·0). In total, 379 817 (56·00%) patients had a risk factor or comorbidity. In-hospital mortality increased from 34·81% in the first to 39·30% in the second wave. In the second wave, there were more ICU admissions, use of non-invasive and invasive ventilation, and increased mortality for younger age groups. The southern and southeastern regions of Brazil had the highest hospitalization rates per 100 000 inhabitants. However, the in-hospital mortality rate was higher in the northern and northeastern states of the country. Racial differences were observed in clinical outcomes, with White being the most prevalent hospitalized population, but with Blacks/Browns (Pardos) having higher mortality rates. Younger age groups had more considerable differences in mortality as compared to groups with and without comorbidities in both waves.

Interpretation

We observed a more considerable burden on the Brazilian hospital system throughout the second wave. Furthermore, the north and northeast of Brazil, which present lower Human Development Indexes, concentrated the worst in-hospital mortality rates. The highest mortality rates are also shown among vulnerable social groups. Finally, we believe that the results can help to understand the behavior of the COVID-19 pandemic in Brazil, helping to define public policies, allocate resources, and improve strategies for vaccination of priority groups.

Funding

Coordinating Agency for Advanced Training of Graduate Personnel (CAPES) (C.F. 001), and National Council for Scientific and Technological Development (CNPq) (No. 309537/2020-7).

Association between specific types of physical activity during the COVID-19 pandemic and the risk of subjective memory decline: findings from the PAMPA Cohort

OBJECTIVES

This study aimed to identify the effects of different physical activities practised during the time period when COVID-19 social distancing measures were in place on the risk of subjective memory decline in adults.

STUDY DESIGN

Retrospective cohort study.

METHODS

Data from the Prospective Study about Mental and Physical Health (PAMPA), a state-level (Rio Grande do Sul, Brazil), online-based cohort study, were analysed. Respondents were asked to rate their memory before COVID-19 social distancing measures were implemented (retrospectively) and on the day that the survey was completed. Subjective memory decline was defined as a perceived worsening of memory function during COVID-19 social distancing compared with the pre-pandemic period. The types of physical activity practised before and during COVID-19 social distancing measures were assessed.

RESULTS

Data from 2319 adults were included. Out-of-home endurance, muscle strengthening, combined endurance and muscle strengthening, and stretching activities reduced the risk of subjective memory decline during the pandemic. In terms of physical activities practised at home, only muscle strengthening did not protect against subjective memory decline. Participants who sustained any type of physical activity at home during the COVID-19 pandemic showed a reduced risk for subjective memory decline.

CONCLUSIONS

Physical activity, regardless of the type of activity and location performed, during the time period when COVID-19 social distancing measures were in place can mitigate the effects of the pandemic on subjective memory decline.

The Significance of Observing the Risk of Non-communicable Diseases after Large-scale Disasters and Communicable Disease Epidemics

Non-communicable diseases (NCDs) are a global challenge, accounting for 71% of all deaths worldwide. The spread of coronavirus disease 2019 (COVID-19) and past huge disasters have affected the prevention and treatment of NCDs and require urgent action. In this narrative review, I will discuss several reports on the risk of NCDs during past disasters and propose possible future directions. Hypertension, the most common NCD, carries a high risk of death due to cerebrovascular, renal, and other complications. Effective use of information and communication technology-based telemedicine is necessary to manage the risk of cardiovascular diseases during disasters and pandemics. We observed the cumulative incidence of metabolic syndrome in subjects from tsunami-affected areas. We found that moving into prefabricated temporary housing was a risk factor for a higher incidence of metabolic syndrome in elderly females. Our follow-up of 1,009 subjects showed a slight, but significant, increase in HbA1c values after a state of emergency was introduced, even though the lockdown was not as stringent as in other countries. In a study elucidating the prevalence of wheezing and eczema symptoms and the associated factors after the Great East Japan Earthquake, psychological effects, such as depression and self-reported posttraumatic stress disorder, were observed, particularly in people with allergic diseases. In recent years, new birth cohort studies have been initiated to complement the studies designed to collect information across multiple generations, such as the Lifelines study in the Netherlands and the Avon Longitudinal Study of Parents and Children (ALSPAC) study in the UK. It is desirable to assess the effects of COVID-19 to complement the existing cohort studies in Japan as well.