Impact of the COVID-19 Pandemic on Health Check-ups in 2021 and 2022: A Nationwide Follow-up Survey of Healthcare Facilities in Japan Society of Ningen Dock

Introduction

Preventive programs, including screenings for cancer and diabetes, were disrupted globally due to the coronavirus disease 2019 (COVID-19) pandemic in 2020. We previously conducted a nationwide survey to investigate the initial impact of the pandemic on health check-ups; however, the impact in the second and third years of the pandemic has not yet been elucidated. Here, we conducted a follow-up survey targeting healthcare facilities to evaluate the impact of the pandemic until the end of 2022.

Methods

A questionnaire survey was conducted between December 15, 2022, and February 10, 2023, targeting member facilities of Japan Society of Ningen Dock. The survey consisted of two parts. Part I comprised a web-based questionnaire, in which the facilities were asked about their commitment to COVID-19-related care, precautions against COVID-19, and whether the pandemic had a negative financial impact on the management of health check-ups. In Part II, the facilities were asked about the number of examinees who underwent health check-ups between 2019 and 2022, the proportion of those who needed and adhered to follow-up visits, and the number of cancer cases found between 2019 and 2021.

Results

Of the 1,343 eligible facilities, 885 participated (response rate: 65.9%). The observation that the number of people undergoing mandatory check-ups increased while those undergoing nonmandatory check-ups (e.g., cancer screenings by local governments) decreased in 2021, compared with that of 2019, persisted into 2022. Approximately 60% of the facilities reported a negative financial impact on the management of health check-ups, even in 2022.

Conclusions

In 2022, the pandemic's detrimental effects on health check-ups persisted.

Impact of the COVID-19 Pandemic on Health Check-ups: A Nationwide Questionnaire Survey in 639 Healthcare Facilities in Japan Society of Ningen Dock

INTRODUCTION

Health check-ups have been disrupted worldwide by the COVID-19 pandemic, especially at its beginning. In Japan, undergoing annual check-ups is mandatory for full-time employees of all ages, while those other than full-time employees are entitled to undergo nonmandatory cancer screenings and specific health check-ups. To evaluate the impact of the COVID-19 pandemic on health check-ups, we conducted a nationwide questionnaire survey targeting healthcare facilities.

METHODS

A questionnaire survey was conducted between December 10, 2021, and January 28, 2022. Healthcare facilities were eligible if they were members of Japan Society of Ningen Dock and could respond via email. The monthly and yearly numbers of examinees undergoing mandatory or nonmandatory check-ups in 2020 and 2021 were compared with those in 2019. The proportions of examinees requiring follow-up visits and adhering to follow-up visits were compared between 2020 and 2019. Precautions taken against COVID-19 were also investigated.

RESULTS

Of the 1,299 eligible facilities, 639 participated (response rate, 49.2%). Health check-up services were suspended in 484 (75.7%) facilities for a median duration of 5 (interquartile range [IQR]: 4-8) weeks. A total of 19,861,230 and 21,748,125 examinees underwent health check-ups in 591 facilities in 2020 and 2021, respectively, 10.0% and 1.4% less than the numbers in 2019. The number of examinees undergoing health check-ups decreased by a median of 8.3% (IQR: -14.6 to -3.1) in 2020 compared to that in 2019, with the largest decrease of 70.3% (IQR -87.9 to -48.5) in May. Although the number of examinees undergoing mandatory check-ups increased in 2021 compared with that in 2019, the number of those undergoing nonmandatory check-ups remained low.

CONCLUSIONS

While people eligible for mandatory check-ups were adherent to check-ups in 2021, those ineligible for mandatory check-ups seemed less adherent. Public health efforts to encourage these people to adhere to check-ups during the pandemic are required.

Switching from entecavir to tenofovir disoproxil fumarate for HBeAg-positive chronic hepatitis B patients: a phase 4, prospective study

BACKGROUND

Tenofovir disoproxil fumarate (TDF) is widely used and recommended as first-line treatment for patients infected with the hepatitis B virus (HBV). However, current data are limited regarding the efficacy and safety of switching to TDF for the treatment of chronic hepatitis B in hepatitis B e-antigen (HBeAg)-positive patients who are virologically suppressed with another nucleos(t)ide analogue. The primary objective of this study was to evaluate the hepatitis B surface antigen (HBsAg) reduction potential of switching from entecavir (ETV) to TDF at week 48 in HBeAg-positive chronic hepatitis B patients with undetectable serum HBV-DNA.

METHODS

In this multicenter, single-arm, open-label, phase 4 clinical study, 75 participants currently treated with ETV 0.5 mg once daily were switched to TDF 300 mg once daily for 96 weeks.

RESULTS

At week 48, 3/74 participants (4%) achieved 0.25 log₁₀ reduction of HBsAg levels from baseline (the primary endpoint). Mean HBsAg reduction was -0.14 log₁₀ IU/mL and 12% (9/74) achieved 0.25 log₁₀ reduction by 96 weeks. No participants achieved HBsAg seroclearance. HBsAg reduction at weeks 48 and 96 was numerically greater in participants with higher alanine aminotransferase levels (≥ 60 U/L). Seventeen participants (25%) achieved HBeAg seroclearance up to week 96. No participants experienced viral breakthrough. All drug-related adverse events (18 participants [24%]) were mild in intensity, including an increase in urine beta-2-microglobulin (15 participants [20%]).

CONCLUSIONS

In conclusion, HBsAg reduction was limited after switching from ETV to TDF in this study population. Further investigation is warranted to better understand the clinical impact of switching from ETV to TDF. ClinicalTrials.gov: NCT03258710 registered August 21, 2017. https://clinicaltrials.gov/ct2/show/NCT03258710?term=NCT03258710&draw=2&rank=1.

IFN-λ3 as a host immune response in acute hepatitis E virus infection

BACKGROUND AND AIM

Hepatitis E virus (HEV) is mainly transmitted orally, either waterborne or zoonotic foodborne. Intestinal viruses such as rotavirus are known to induce type III interferon (IFN) in the gastrointestinal (GI) tract where type III IFN dominantly functions in comparison with type I IFN. Therefore, the aim of this study is to investigate the significance of type III IFN (IFN-λ3) in acute hepatitis E.

METHODS

IFN-λ3 and HEV RNA levels in the sera of patients with acute HEV infection and in the supernatant of HEV-inoculated cells were measured, using an in-house high-sensitivity method and reverse transcription-polymerase chain reaction, respectively.

RESULTS

High serum IFN-λ3 levels were found in the early phase of acute HEV infection, which normalized after resolution. Interestingly, serum IFN-λ3 levels correlated well with serum HEV RNA titers in the same sera, both of which showed the peak before the robust increase of transaminases. In vitro experiments demonstrated that HEV replicated well in the cells with little IFN-λ3 induction (Caco-2, A549) and recombinant IFN-λ3 inhibited HEV replication in a dose-dependent manner. In contrast, in HT-29 cells, a colon cancer cell line, HEV poorly replicated and induced IFN-λ3 in a titer-dependent manner.

CONCLUSIONS

These clinical and experimental observations suggest that HEV induced IFN-λ3 as a host innate immune response, which may play a protective role against HEV.

Efficacy and safety of glecaprevir/pibrentasvir in Japanese patients with chronic genotype 2 hepatitis C virus infection

Glecaprevir (nonstructural protein 3/4A protease inhibitor) and pibrentasvir (nonstructural protein 5A inhibitor) (G/P), a coformulated once-daily, all oral, ribavirin (RBV)-free, direct-acting antiviral regimen, was evaluated for safety and efficacy in hepatitis C virus genotype 2 (GT2)-infected Japanese patients, including those with compensated cirrhosis. CERTAIN-2 is a phase 3, open-label, multicenter study assessing the safety and efficacy of G/P (300/120 mg) once daily in treatment-naive and interferon ± RBV treatment-experienced Japanese patients without cirrhosis but with GT2 infection. Patients were randomized 2:1 to receive 8 weeks of G/P (arm A) or 12 weeks of sofosbuvir (400 mg once daily) + RBV (600-1000 mg weight-based, twice daily) (arm B). The primary endpoint was noninferiority of G/P compared to sofosbuvir + RBV by assessing sustained virologic response at posttreatment week 12 (SVR12) among patients in the intent-to-treat population. SVR12 was also assessed in treatment-naive and interferon ± RBV treatment-experienced patients with GT2 infection and compensated cirrhosis who received G/P for 12 weeks in the CERTAIN-1 study. A total of 136 patients were enrolled in CERTAIN-2. SVR12 was achieved by 88/90 (97.8%) patients in arm A and 43/46 (93.5%) patients in arm B. No patient in arm A experienced virologic failure, while 2 did in arm B. The primary endpoint was achieved. In CERTAIN-1, 100% (18/18) of GT2-infected patients with compensated cirrhosis achieved SVR12. Treatment-emergent serious adverse events were experienced by 2 patients without cirrhosis in each arm and no patient with cirrhosis. Conclusion: The results demonstrate high efficacy and favorable tolerability of G/P in GT2-infected Japanese patients. (Hepatology 2018;67:505-513).

[Clinical efficacy of adalimumab for a postoperative marginal ulcer in gastrointestinal Behçet disease]

A 63-year-old woman with Behçet disease presented with epigastric pain due to refractory gastric ulcers. Examinations indicated that these ulcers were caused by gastrointestinal Behçet disease. Steroid therapy proved ineffective, so we gave 5mg/kg of infliximab. However, since the patient responded poorly to the treatment the infliximab was discontinued and a total gastrectomy was performed. After surgery, a marginal ulcer developed and infliximab was again administered. Although this brought about improvement in the conditions of the marginal ulcer, infusion-related hypersensitivities in the patient caused polyarthralgia. We therefore discontinued the infliximab treatment and began 40 mg of adalimumab every other week. After 3 months of the new treatment, the patient's marginal ulcer completely healed and her epigastric pain disappeared. This case suggests that adalimumab may be as useful as infliximab for treating refractory gastrointestinal Behçet disease.

[Osteoclast-like giant cell tumor (OGCT) of the liver: report of a case]

A 57-year-old man presented with jaundice. Abdominal computed tomography showed a 10-cm left hepatic lobe heterogeneous solid mass with low attenuated areas in the mass, multiple liver metastases and lung metastasis. Serology for hepatitis B and C were negative. Serum alpha-fetoprotein, CEA and CA19-9 were normal. The patient died a few weeks later of progressive liver failure and an autopsy was performed. Histologically, the tumor consisted of sarcomatoid mononuclear cells and osteoclast-like giant cells. The liver tissue surrounding the tumor showed no cirrhotic pattern. The osteoclast-like giant cells were uniformly and strongly immunoreactive with CD68. The mononuclear cells demonstrated expression of vimentin but were negative for CAM5.2. The MIB-1 index was 20% for the mononuclear cells. In conclusion, the histopathological diagnosis revealed an osteoclast-like giant cell tumor of the liver.

Transpupillary thermotherapy for treatment of exudative age-related macular degeneration in Japanese patients

PURPOSE

To report the therapeutic outcome of transpupillary thermotherapy (TTT) for subfoveal choroidal neovascularizarion (CNV) in brown retina using a diode-laser with the setting of lower energy level compared to the previous studies on light-pigmented Caucasian patients.

METHODS

A total of 19 subfoveal CNVs in 18 patients were treated with TTT. The power of diode-laser was set 160 mW for 1.2 mm beam, 270 mW for 2.0 mm beam, and 400 mW for 3.0 mm beam, and the laser was delivered for 1 min through a slit-lamp mounted-delivery system. Patients were followed up for a mean of 8.8 months (4-12 months). Visual acuity and the fundus change as judged by funduscopic examination and simultaneous fluorescein and indocyanine green angiography were evaluated. Visual acuity was measured by a Japanese standard Landolt visual acuity chart and converted to logarithm of the minimal angle resolution (log MAR) visual acuity for statistical analysis. Improvement or decline in vision was defined as change of more than 0.2 in log MAR visual acuity.

RESULTS

In eyes with minimally classic or occult only CNV, visual acuity improved in two eyes (18%) stabilized in seven eyes (64%) and worsened in two eyes (18%). In eyes with predominantly classic CNV, visual acuity improved in two eyes (25%), stabilized in four eyes (50%) and worsened in two eyes (25%). In all, 15 (84%) eyes of all studied subjects had improvement in exudation. Two (11%) and one (5%) eye(s) were noted to have a significant post-treatment haemorrhage and retinal pigment epithelial tear, respectively.

CONCLUSION

In patients with brown retinal colour, the treatment outcome of TTT was comparable to that of light-pigmented Caucasian patients with approximately half the laser power energy. Further randomized control studies are warranted.

Relationship of regional adiposity to serum leptin level in nonobese Japanese type 2 diabetic male patients

BACKGROUND

The aim of the present study was to investigate the relationships between serum leptin levels and regional adipose fat area, BMI, and the measures of variables including serum insulin in nonobese Japanese type 2 diabetic patients.

METHODS

A total of 121 nonobese Japanese type 2 diabetic patients [aged 35 to 83 years, body mass index (BMI) (15.4 to 26.8 kg/m(2))] were studied. They all were male patients. In conjunction with serum leptin level, BMI, glycosylated hemoglobin (HbA(1c)), and fasting concentrations of plasma glucose and serum insulin and lipids (triglycerides, total and HDL cholesterol) were measured.

RESULTS

Univariate regression analysis showed that serum leptin levels were positively correlated to subcutaneous (r=0.566, P<0.0001) and visceral (r=0.481, P<0.001) fat area in our diabetic patients. Furthermore, serum leptin levels were positively correlated to serum insulin (r=0.517, P<0.0001), BMI (r=0.428, P<0.0001), serum triglycerides (r=0.279, P<0.005), and age (r=0.225, P<0.05). There was, however, no relationship between serum leptin levels and measures of other variables including total and HDL cholesterol. Multiple regression analyses showed that serum leptin levels were predicted by subcutaneous fat area (F=5.92, P<0.0001) and serum insulin level (F=5.60, P<0.0001), which explained 29.0% of the variability of serum leptin concentrations in our nonobese Japanese type 2 diabetic male patients. Visceral fat area, BMI, serum triglycerides, and age, however, were not independently associated with serum leptin levels in our patients.

CONCLUSIONS

These results indicate that serum leptin levels are reflective of subcutaneous fat area in nonobese Japanese type 2 diabetic male patients.