Compliance Trajectory and Patterns of COVID-19 Preventive Measures, Japan, 2020-2022

Prophylaxis against Pneumocystis jirovecii pneumonia and toxoplasmosis with low-dose Trimethoprim-sulfamethoxazole (cotrimoxazole 20/100 mg) in heart transplant patients. The PAPTO-LOCO observational comparative study

OBJECTIVES

Practice concerning post-transplant Pneumocystis prophylaxis remains heterogeneous. SXT benefits must be balanced with frequent toxicity. We aimed to assess whether a low-dose SXT strategy might limit toxicities while maintaining an undisrupted prophylaxis compared with a standard dose in a retrospective cohort of heart transplant population.

METHODS

Patients undergoing heart transplant from two distinct centres, receiving daily SXT 20/100 mg versus daily SXT 80/400 mg between 2018 and 2020, were retrospectively included in the study. Demographic, immunosuppression and survival characteristics were collected to ensure group comparability. The occurrence of adverse effects and the rate of SXT discontinuation were compared between the two groups.

RESULTS

Overall, 359 patients were recruited in the study, 108 patients for the standard-dose group and 251 patients for the low-dose group. The leading cause of prophylaxis discontinuation was cytopenia. We observed significantly more discontinuation in the standard-dose compared with the low-dose group (24.1% and 6.4%, respectively, P < 0.001). No patient with ongoing prophylaxis presented Pneumocystis pneumonia or toxoplasmosis during the 2-year follow-up. Two Pneumocystis infections in the low-dose group occurred during prophylaxis breaks. The rate of toxoplasmosis seroconversion was similar in both groups.

CONCLUSIONS

This retrospective study suggests that a low-dose SXT Pneumocystis prophylaxis strategy might offer a more favourable safety/efficacy profile than standard-dose prophylaxis after heart transplantation. These results should be confirmed in an interventional trial. Caution remains for toxoplasmosis serology D+/R- profiles.

Excess mortality during and after the COVID-19 emergency in Japan: a two-stage interrupted time-series design

Summary

Background

The COVID-19 pandemic has had unprecedented impacts on mortality worldwide. This study aimed to estimate excess all-cause mortality in Japan from 2020 to 2023, stratified by age, sex and prefecture, to assess the evolving impact of the pandemic, particularly in the latter years. The study period extends beyond Japan ending the public health emergency.

Methods

Using national vital statistics data from 2015 to 2023, we employed a two-stage interrupted time series analysis to estimate excess mortality during the COVID-19 pandemic (2020-2023) compared with the prepandemic period (2015-2019). Models were adjusted for seasonality, long-term trends, temperature and influenza activity. We calculated excess deaths during (14 January 2020 to 7 May 2023) and after (8 May 2023 to 31 December 2023) the COVID-19 emergency.

Results

Japan experienced 219 516 excess deaths (95% empirical CI (eCI) 138 142 to 301 590) during the study period, corresponding to 3.7% (95% eCI 2.33 to 5.09) excess mortality. Excess mortality was negative in 2020 (-1.67%, 95% eCI -2.76 to -0.55), becoming positive in 2021 (2.19%, 95% eCI 0.9 to 3.49) and peaking in 2022 (7.55%, 95% eCI 5.96 to 9.13) before declining in 2023 (5.76%, 95% eCI 4.29 to 7.24). The <60 age group consistently showed the highest percentage excess mortality. Males had slightly higher excess mortality than females. By 2022, all prefectures exhibited positive excess mortality. The relative risk peaked in late 2022, with a smaller peak in summer 2023, coinciding with the post-emergency period. Comparing this post-emergency period with prior years shows the highest percentage excess mortality in 2022. Rural prefectures, and those with lower influenza cases, showed reduced excess mortality during the latter and post-emergency period.

Conclusion

Despite initial success in mitigating excess deaths, Japan saw increasing excess mortality as the pandemic progressed, with continued elevation post-emergency. The varying impact across age groups and time highlights the complex factors affecting mortality. This study's findings underline the importance of continuous monitoring of excess mortality as a key indicator for public health dynamics.

Changes in Healthcare Utilization in Japan in the Aftermath of the COVID-19 Pandemic: A Time Series Analysis of Japanese National Data Through November 2023

INTRODUCTION

The COVID-19 pandemic precipitated substantial disruptions in healthcare utilization globally. In Japan, reduced healthcare utilization during the pandemic's early phases had been documented previously. However, few studies have investigated the impact of the pandemic's later stages (2022-2023) on healthcare utilization rates, particularly in the Japanese context.

METHODS

We employed a quasi-Poisson regression model, adapted from the FluMOMO framework, to analyze temporal trends in Japanese healthcare utilization throughout the pandemic until November 2023. We estimated inpatient and outpatient volumes and hospital length of stay by bed type (general and psychiatric).

RESULTS

In general hospital beds, inpatient volumes remained significantly below pre-pandemic levels for every month until November 2023, with a reduction of 7.8 percent in 2023 compared to pre-pandemic levels. Psychiatric inpatient volumes, which had been declining before the pandemic, continued this downward trend, with the average occupancy rate decreasing by approximately 5.3% to 81.3% in 2023 compared to pre-pandemic levels. Significantly reduced outpatient volumes for both general and psychiatric care, in addition to prolonged lengths of hospital stay for psychiatric beds, were observed sporadically for several months in 2022 and 2023, persisting beyond the cessation of state of emergency and quasi-state of emergency declarations.

CONCLUSION

The COVID-19 pandemic fundamentally altered healthcare utilization patterns in Japan. We observed a sustained reduction in general and psychiatric inpatient volumes relative to pre-pandemic baselines nationwide. The prolonged impact on healthcare utilization patterns, persisting beyond emergency measures, warrants continued monitoring of service delivery.

Changes in the Utilization of Outpatient and Visiting Dental Care and Per-attendance Care Cost by Age Groups During COVID-19 Pandemic Waves in Japan: A Time-series Analysis From the LIFE Study

BACKGROUND

The influence of the coronavirus disease 2019 (COVID-19) pandemic on dental care utilization may have differed according to individual characteristics or type of dental care provision. This study aimed to evaluate the changes in dental care utilization and per-attendance costs by age group and type of dental care during the COVID-19 pandemic in Japan.

METHODS

This time-series study used healthcare insurance claims data from 01/07/2019 to 09/27/2021 (143 weeks) from nine municipalities in Japan. Dental care utilization rate per week and average dental care cost per attendance by age groups (0-19 years/20-64 years/65-74 years/≥75 years) and types of dental care (outpatient/visiting) were used as outcome variables. COVID-19 pandemic waves in Japan were used as predictors: 1st (03/23/2020-05/17/2020), 2nd (06/22/2020-09/27/2020), 3rd (10/26/2020-02/21/2021), 4th (02/22/2021-06/07/2021), and 5th (07/05/2021-09/13/2021) waves. Fixed-effects models were employed to estimate the proportional changes.

RESULTS

In the fixed-effects model, we observed large declines in dental care utilization during the 1st (17.0-22.0%) and 2nd waves (3.0-13.0%) compared to the non-pandemic wave period in all age groups. In contrast, the average dental care cost per attendance increased in all age groups by 5.2-8.6% during the 1st wave.

CONCLUSION

During the initial wave of the COVID-19 pandemic in Japan, dental care utilization decreased in all age groups, whereas the average dental care cost per attendance increased. The COVID-19 pandemic may have changed the dental care provision pattern towards less frequent and more concentrated dental care to avoid the risk of infection.

Coping, connection appraisal, and well-being during COVID-19 in the U.S., Japan, and Mexico

Introduction

The COVID-19 pandemic has affected nearly every facet of life, constituting a "new normal" and prompting an ongoing collective psychological crisis. People's ways of coping with the pandemic and corresponding well-being are of particular research interest; however, these constructs have largely been examined using deductive quantitative approaches, deficit-based lenses, and mononational samples.

Methods

The current mixed-methods study used inductive-sequential (QUAL → QUAN) approaches to explore positive coping strategies (approach coping style and COVID-related connection appraisal) and well-being (loneliness, distress, and happiness) across individuals from the United States, Japan, and Mexico. Qualitative data were gathered from N = 141 U.S., Japanese, and Mexican adults to examine how people perceived connection during the pandemic.

Results

Qualitative analyses illuminated common themes in which people appraised the pandemic as an opportunity for connection and strengthened interpersonal relationships. Quantitative measures, including a newly-developed questionnaire on COVID-related connection appraisal, were then administered to a separate sample of N = 302 adults in the U.S, Japan, and Mexico to assess associations among approach coping style, COVID-related connection appraisal, and well-being outcomes (loneliness, distress, happiness). Quantitative analyses found significant associations among approach coping style, COVID-related connection appraisal, and all well-being outcomes. Of note, these associations did not differ by country. COVID-related connection appraisal mediated the relationship between approach coping style and two well-being outcomes (loneliness and happiness).

Discussion

Findings point to approach coping style and connection appraisal as pathways for resilience and growth in the face of global suffering.