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.

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.

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.

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.

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.].

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.

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.

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.

Medical visits and health-care expenditures of patients attending orthopedic clinics during the COVID-19 pandemic in Japan: LIFE Study

BACKGROUND

The first state of emergency for coronavirus disease 2019 (COVID-19) in Japan was imposed from April to May 2020. During that period, people were urged to avoid non-essential outings, which may have reduced their access to health care.

METHODS

Using health-care claims data from a city in Fukuoka prefecture, Japan, we conducted a retrospective cohort study of the state of emergency's impact on patients' medical visits to orthopedic clinics and their associated health-care expenditures. These measures were compared between 2019 and 2020 using a year-over-year analysis and unpaired t-tests.

RESULTS

The analysis showed that medical visits in 2020 significantly decreased by 23.7% in April (P < 0.01) and 17.6% in May (P < 0.01) when compared with the previous year. Similarly, monthly outpatient health-care expenditure significantly decreased by 2.4% (P < 0.01) in April 2020 when compared with April 2019. In contrast, the health-care expenditure per capita per visit significantly increased by 1.5% (P < 0.01) in June 2020 (after the state of emergency was lifted) when compared with June 2019.

CONCLUSION

As orthopedic clinics in Japan are reimbursed using a fee-for-service system, the increases in per capita expenditures after the state of emergency may be indicative of physician-induced demand. However, we posit that it is more likely that a post-emergency increase in anti-inflammatory and analgesic treatments for spondylopathies, low back pain and sciatica induced a temporary rise in these expenditures.

COVID-19 Effects on Income and Dental Visits: A Cross-sectional Study

OBJECTIVES

In April 2020, the Japanese government declared a state of emergency owing to the outbreak of the novel coronavirus disease (COVID-19) pandemic, which resulted in reduced workforce and job losses. Furthermore, income is one of the most consistent predictors of dental visits. Therefore, this study examined the association between income changes and dental clinic visits during the COVID-19 state of emergency in Japan.

METHODS

An online, self-reported cross-sectional survey about health activities including dental visits during the first COVID-19 state of emergency was conducted in Osaka, Japan (June 23 to July 12, 2020). Among participants with toothaches, the assessment for the association between "refrained from visiting a dentist despite wanting treatment for toothache during the state of emergency (refrained treatment)" and income changes before and after the state of emergency using a multivariate Poisson regression model adjusted for sex, age, self-rated health, frequency of regular dental visits, and employment status.

RESULTS

Among 27,575 participants, 3,895 (14.1%) had toothaches, and 1,906 (6.9%) reported refrained treatment. Among people with decreased income (n = 8,152, 29.6% of overall participants), the proportions of the refrained treatment group were 8.0% (income decreased by 1%-49%), 9.9% (50%-99% decreased), and 9.1% (100% decreased). Among participants with toothache, after adjusting for all variables, compared with participants with no income change, we observed significantly higher prevalence ratios (PRs) for refrained treatment in those who experienced a decreased income owing to COVID-19 (1%-49% decrease: PR = 1.08; 95% confidence interval [CI], 1.005-1.17; 50%-99% decrease: PR = 1.18; 95% CI, 1.06-1.32; 100% decrease: PR = 1.18; 95% CI, 1.04-1.33).

CONCLUSION

Decreased income was associated with refrained dental treatment during the COVID-19 state of emergency in Osaka, Japan. The economic damage related to the COVID-19 pandemic could lead to oral health inequalities.

KNOWLEDGE TRANSFER STATEMENT

Our study found that individuals with decreased income owing to COVID-19 before and after the state of emergency showed significantly higher prevalence ratios for refraining from visiting a dentist despite wanting treatment for toothache. We believe that our study makes a significant contribution because it provides novel, basic data that economic damages related to the COVID-19 pandemic might expand to oral health inequalities.

Analysis of Presentation and Outcomes in Acute Limb Ischemia Patients During COVID-19 State of Emergency

BACKGROUND

During the COVID-19 pandemic, cardiovascular patients were found to be presenting to hospitals with myocardial infarctions and cerebrovascular accidents at progressed disease states. We noticed a parallel in acute limb ischemia (ALI) patients presenting during Massachusetts' COVID-19 State of Emergency declaration. We question whether patients developed a hesitancy to seek medical attention at hospitals due to fear of COVID-19. Our objective was to compare acuity of ALI, interventions, and limb survival in patients presenting before, during, and after a state of emergency.

METHODS

Four timeframes were set to compare patients presenting peri-2020 COVID-19 State of Emergency and patients presenting during a pre-pandemic era at a tertiary, academic institution. A reference period from 2019, Pre-State of Emergency period, State of Emergency period, and Post-State of Emergency period were designated. Patient characteristics, interventions, and outcomes data were collected. Unpaired t-test, ANOVA, and Chi-square statistical analyses were used.

RESULTS

A total of 95 patients presenting with ALI were identified. Compared to Reference group, state of emergency group had more patients presenting with Rutherford Class III, 12.9% vs 35%, and less patient presenting with Class I, 45.1% vs 0%, P = .02. State of emergency group had more delayed presentations with ≥6 hours after symptom onset, 45% vs 85%, P = .01. Above-knee amputations were performed in 20% of patients during state of emergency and 31.6% for Post-State of Emergency, vs 6.5% in the Reference group; P = .03. There was no difference in intensive care unit admission, length of stay, or mortality between patients from different groups.

CONCLUSION

During a state of emergency, ALI patients were noted to present later from symptom onset, have greater disease severity, and more likely to undergo amputations. We suspect delay in presentation and limb lost to be attributed to reluctance to seek immediate medical attention.

[Dental care behavior and related factors during the COVID-19 state of emergency in Japan]

Objectives　In response to the spread of SARS-CoV-2, a state of emergency was declared in Japan on April 7, 2020, and in the same month, Japan's Ministry of Health, Labor, and Welfare informed dentists of the need to postpone non-emergency dental care. The purpose of this study was to identify the patients who refrained from dental care during the state of emergency in April 2020, and to clarify their personal characteristics.Methods　A total of 1,335 patients who visited 28 dental clinics in Saitama in September 2020 completed survey questionnaires; of these, 1,227 valid responses were received. Among those who sought dental care under the state of emergency, those who did not visit a dental clinic comprised the "refrained group" and those who visited the dental clinics comprised the "visited group".Results　Multivariate logistic regression analysis showed that the odds ratios for the "refrained group" were 1.69 (95%Cl: 1.12-2.55) for females, 2.91 (95%Cl: 1.88-4.49) for those younger than 65 years, 1.71 (95%Cl: 1.04-2.82) for those that visited the dental clinic less than once a month, and 7.12 (95%Cl: 4.56-11.11) for those who did not have an appointment during the state of emergency.Conclusion　In conclusion, 35% of patients in this study refrained from visiting the dental clinic during the state of emergency. The related factors for refraining from dental care were being females, middle-aged (<65 years), visiting the dental clinic less than once a month, and not having an appointment during the COVID-19 state of emergency.

Impact of the COVID-19 pandemic on biologic treatment in psoriasis patients: A single-center retrospective study in Japan

The impact of the COVID-19 pandemic on biologic treatment for psoriasis in Japan remains to be elucidated. This study aimed to investigate changes in biologic treatment and patients' behavior of visiting our department, especially in psoriasis patients treated with biologics before and during the pandemic. Data were collected from medical records retrospectively. The numbers of new psoriasis patients before (2019) and during (2020) the pandemic were compared. Patients' behavior of visiting our department was evaluated. The number of new psoriasis patients who visited our department in 2020 decreased by 35.7% compared with that in 2019. The reduction rate of new patients with psoriasis vulgaris was 49.3%, whereas the numbers of new patients with psoriatic arthritis (PsA) and generalized pustular psoriasis (GPP) were almost the same in 2019 and 2020. The number of patients who newly initiated biologics did not decrease in 2020 compared with that in 2019. As of January 1, 2020, 215 psoriasis patients were treated with biologics. Six patients (2.8%) discontinued biologics treatment possibly due to COVID-19 in 2020. Among 212 patients with good adherence to visiting our department in the previous year, 24 patients (11.3%) refrained from their visits for at least 1 month. In most cases, refrainment was observed in April and May when the first state of emergency was in effect in Japan. In conclusion, the COVID-19 pandemic hindered patients from visiting our department. However, its impact on patients who needed intensive care, such as patients with PsA and GPP, and psoriasis patients treated with biologics, was limited.

Decrease in Social Zeitgebers Is Associated With Worsened Delayed Sleep-Wake Phase Disorder: Findings During the Pandemic in Japan

BACKGROUND

Delay in sleep-wake rhythms was observed in the general population during the coronavirus disease 2019 (COVID-19) pandemic. Patients with delayed sleep-wake phase disorder (DSWPD) may have also experienced exacerbation of symptoms, but no studies have investigated this topic. In this study, we aimed to retrospectively examine the changes in symptoms of outpatients with DSWPD both before and during the pandemic and to identify the factors associated with the exacerbation of sleep-wake rhythms.

METHODS

We included outpatients with DSWPD aged 16 years or older who visited the outpatient clinic due to sleep disorders between January and September 2020. Decreased social zeitgebers was defined as a reduction of 50% or more in the frequency of commuting to school or work during the COVID-19 pandemic. The severity of DSWPD was assessed using the clinical global impressions - severity of illness (CGI-S) at two points: before and during the pandemic. We defined the worsened, unchanged, and improved groups as those whose CGI-S scores worsened by at least one point, remained unchanged, and improved by at least one point, respectively. Multivariate logistic regression analysis was performed to determine the factors associated with worsened DSWPD symptoms.

RESULTS

Sixty patients with DSWPD were eligible for this study. Even before the pandemic, patients who were unemployed or did not attend school tended to show more severe DSWPD symptoms. During the pandemic, 27 patients belonged to the worsened group; 28 patients, unchanged group; and 5 patients, improved group. Decreased social zeitgebers (odds ratio [OR] = 6.668, 95% confidence interval [CI]: 1.653-26.891, p < 0.05) and comorbid mood disorders (OR = 8.876, 95% CI: 1.714-45.974, p < 0.05) showed independent significant associations with the worsening of DSWPD symptoms.

CONCLUSIONS

During the pandemic, the symptoms of DSWPD tended to worsen. The obtained findings emphasize the importance of social zeitgebers, suggesting the need for external motivation in DSWPD treatment.

The Effects of Stress on Glycemic Control Brought on by Changes in Social Conditions Due to COVID-19

Objective The stress brought on by changes in social conditions due to COVID-19 is diverse. However, there have been no studies examining the relationship between the type of stress felt by an individual due to such changes in social conditions and the degree of change in HbA1c, prompting us to conduct this study. Methods We conducted a collaborative study at two diabetes clinics. A total of 1,000 subjects responded to the questionnaire. Data on HbA1c and body weight before and after the declaration of the state of emergency were collected. Results We conducted a questionnaire on some stressors, but when comparing the two groups with respect to whether or not they felt stress from each item, only "school closures for children," seemed to be associated with a significant difference in the amount of change in HbA1c. In the stressed group, i.e. the group of parents who experienced stress due to their children's schools being closed, the HbA1c value changed from 7.30±0.78 to 7.30±1.13 (p=0.985). By contrast, in the unstressed group, the HbA1c value significantly decreased from 7.28±0.98 to 7.06±0.85 (p<0.001). In addition, as a result of comparing the amount of change between the 2 groups, a significant decrease was observed in the unstressed group compared with the stressed group (p=0.032). There was no significant difference in body weight change between the two groups. Conclusion Stress that cannot be avoided by one's own will, such as school closures for children, may affect glycemic control.

The COVID-19 Outbreak in North Africa: A Legal Analysis

North African nations, especially Egypt, Algeria, and Morocco, have been heavily affected by COVID-19 if compared to other African countries. Governments in North Africa took proactive legal measures to manage the virus threat, safeguarding population health, but also triggering repressive and invasive mechanisms that in some cases jeopardized basic freedoms and rights. This work will analyze comparatively the anti-COVID-19 legislations, pointing out how the legislative measures mirrored the level of transition of democracy, the opacity of some regimes, exploitation of the pandemic to foster repressive control, and highlighting the weakness of new democratic institutions unprepared to balance health security and democracy.

Selected social impacts and measures resulting from the Covid-19 epidemic in the Czech Republic on the specific example of the South Bohemian Region

The study of selected social impacts as a result of the COVID-19 epidemic is focused on an interdisciplinary approach in the Czech Republic in dealing with this crisis situation. The virus first appeared in early December 2019 in China, and on 1 March, the first positive person in the Czech Republic was confirmed. The Ministry of Health and subsequently the Government of the Czech Republic took relatively strict epidemiological measures in connection with the development of the epidemic in China, subsequently in individual countries of the European Union and in other countries throughout the world. In order to effectively implement epidemiological measures, the Government declared a state of emergency for the Czech Republic due to health threats in connection with the proof of occurrence of coronavirus SARS CoV-2 from 14.00 on 12 March 2020 for 30 days. The state of emergency was then extended until 17 May 2020. The aim of the article is to investigate the emerging solutions and impacts of the COVID-19 epidemic on selected spheres of society in the Czech Republic in the period from March to April 2020, focusing on specific procedures in the South Bohemian Region. As part of the epidemiological measures, it was necessary to address the situation of socially disadvantaged groups, such as the homeless or those ordered out due to domestic violence. The case study examined the provision of care for homeless people and those ordered out due to domestic violence who were diagnosed with COVID-19 and were not hospitalised or quarantined. In practice, crisis management tools in conjunction with epidemiological approaches have proven to be effective and usable. The examples show that, despite the complexity of the situation, regional and local governments have found a way to implement the necessary measures to mitigate the impact on local society and the community.

"L'ENFER, C'EST LES AUTRES": Proximity as an Ethical Problem during COVID-19

During the COVID-19 emergency, people around the world are debating concepts like physical distancing, lockdown, and sheltering in place. The ethical significance of proximity-that is, closeness or farness as ethical qualities of relations (Strathern 2020)-is thus being newly troubled across a range of habits, practices, and personal relationships. Through five case studies from Australia, Ireland, New Zealand, South Africa, and the United States, contributors to this Colloquy shed light on what the hype of the pandemic often conceals: the forms of ethical reflection, reasoning, and conduct fashioned during the pandemic.

BE KIND: Negotiating Ethical Proximities in Aotearoa/New Zealand during COVID-19

Citizens do not merely respond to states of emergency; in democratic societies, they help constitute them. This essay analyzes New Zealanders' engagements in ethical reasoning during the country's first COVID-19 lockdown. Specifically, I examine how we can understand a variety of public responses to emergency measures-including breaching regulations, threatening rule-breakers, sealing off neighborhoods, and recasting citizen-returnees as "strangers"-as negotiations of ethical proximities focused on keeping appropriately close that which is thought should be near, and keeping distanced that deemed best held afar.

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 Re 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 Re 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.

Impact of non-pharmaceutical interventions for the COVID-19 pandemic on emergency department patient trends in Japan: a retrospective analysis

Aim

The coronavirus disease (COVID‐19) pandemic massively impacted emergency department (ED) visits. The unavailability of specific therapies or vaccines has made non‐pharmaceutical interventions (NPIs) an alternative strategy for COVID‐19. We assessed the impact of NPIs (nationwide school closures and state of emergency) on ED visits during the COVID‐19 pandemic in Japan.

Methods

This retrospective study compared the trends in ED visits from 1 January to 25 May, 2020 (during the pandemic) with the average during 2015–2019 (before the pandemic). The primary end‐point was the change in the number of ED visits during the COVID‐19 pandemic with those from before the pandemic, with the NPI application stratified across four periods in 2020: Period 0 (1–15 January), no COVID‐19 cases detected in Japan; Period I (16 January–1 March), initial COVID‐19 outbreak; Period II (2 March–15 April), nationwide school closures; Period III (16 April–25 May), state of emergency.

Results

Compared with before the pandemic, the number of walk‐in ED visits significantly decreased by 23.1%, 12.4%, and 24.0% (4,047 versus 3,111; 3,211 versus 2,813; and 3,384 versus 2,573; P < 0.001 for all) in Periods I, II, and III, respectively. The number of ambulance ED visits during the pandemic significantly increased by 8.3% in Period I (1,814 versus 1,964, P = 0.002), whereas there was no significant change in Periods II and III with 2.7% and −3.1% (1,547 versus 1,589 and 1,389 versus 1,346; P = 0.335 and P = 0.284, respectively).

Conclusions

The application of an NPI during the COVID‐19 pandemic could have significantly reduced patient attendance in the ED.

The COVID-19 policymaking under the auspices of parliamentary constitutional review: The case of Finland and its implications

This article explores the dynamic interaction of emergency policies and parliamentary constitutional review in the early policy response to the COVID-19 outbreak in Finland. A thorough analysis of the official records of Parliament's Constitutional Law Committee shows how the Government's use of delegated emergency powers raised particular concerns about inter-institutional transparency during the state of emergency. These findings prompt an enquiry into whether delegated emergency powers and the related quest for centralized transparency-led accountability produced a rupture in the theory of complex multicentric policymaking. This analysis suggests that policy process research can play an important role in exposing the more subtle and longitudinal effects of emergency policies on democratic governance.

Has COVID-19 affected the number and severity of visits to a traumatology emergency department?

Aims

To assess the impact of the declaration of the state of emergency due to the COVID-19 pandemic on the number of visits to a traumatology emergency department (ED), and on their severity.

Methods

Retrospective observational study. All visits to a traumatology ED were recorded, except for consultations for genitourinary, ocular and abdominal trauma and other ailments that did not have a musculoskeletal aetiology. Visit data were collected from March 14 to April 13 2020, and were subsequently compared with the visits recorded during the same periods in the previous two years.

Results

The number of visits dropped from a mean of 3,212 in 2018 to 2019 to 445 in 2020. Triage 1 to 3 level visits rose from 21.6% in 2018 to 2019% to 40.4% in 2020, meaning a reduction in minor injury visits and an increase in major ones. There was a relative reduction of 13.2% in femoral fractures in the elderly. The rate of justified visits rose from 22.3% to 48.1%.

Conclusion

A marked drop in the total number of visits to our traumatology ED was observed, as well as a relative increase in major injury visits and a relative fall in the minor ones.Cite this article: Bone Joint Open 2020;1-10:617-620.

The Media Spectacle of a Techno-City: COVID-19 and the South Korean Experience of the State of Emergency

This essay provides a critical observation of the South Korean government's distinctive management of COVID-19 with particular reference to the state of emergency. It reveals that the success of South Korea's handling of the pandemic is largely attributed by a majority of Western media to the efficient deployment of both information and communication technologies and Confucian collectivism, two components that seem contradictory yet not incompatible under the rubric of techno-Orientalism. Analyzing the intensification of surveillance and the rapid datafication of society, this essay argues that the current state of emergency is not a breakdown of normality but a continuation of the state of crisis and disaster that rules a developing country like South Korea. In doing so, the essay seeks to facilitate a critical discussion about a new mode of democracy in the era of pandemic that increasingly grapples with tensions between individual freedom and public health.

The impact of the coronavirus disease 2019 pandemic on the utilisation of emergency urological services

OBJECTIVES

To compare the number of patients attending the Urology Emergency Department (ED) of the Centro Hospitalar Universitário do Porto (CHUP), as well as their demographic characteristics, the reasons for admission, the clinical severity under the Manchester triage system (MTS), and the need for emergency surgery or hospitalisation, during the coronavirus disease 2019 (COVID-19) pandemic and the equivalent period in 2019.

PATIENTS AND METHODS

Data were collected from patients attending the Urology ED of the CHUP over 3 weeks, from 11 March to 1 April 2020, and from the same period in the previous year (from 11 March to 1 April 2019).

RESULTS

During the pandemic, 46.4% fewer patients visited our urological ED (122 vs 263). There was no significant difference in the mean age or the number of old patients (aged ≥65 years) between the two periods. However, significantly fewer female patients sought emergency urological services during the COVID-19 pandemic period (32.7% vs 14.8%, P < 0.05). No significant differences were noted between different clinical severity groups under the MTS. In 2019, significantly less patients required hospitalisation. The most common reasons for admission, during both periods, were haematuria, renal colic and urinary tract infections. The authors recognise that the study has several limitations, namely, those inherent to its retrospective nature.

CONCLUSION

COVID-19 significantly influenced people's urological care-seeking behaviour. Understanding the present situation is helpful for predicting future urological needs. Based on the results of this study, we have reason to speculate that people's requirements for urological services might grow explosively in the post-COVID-19 period. There should be further studies about the real state of long-term urological services and the consequences that this pandemic may have in terms of morbimortality not directly related to the severe acute respiratory syndrome coronavirus 2.

The decision: Relations to oneself, authority and vulnerability in the field of selective abortion

This article is about selective abortion. It concentrates on the existential, moral and social conditions that arise when pregnant women, using prenatal diagnosis (PND), are told that there is something seriously wrong with the foetuses that they are carrying. This is characterised as a micro state of emergency, where both normal cognitive categories and normative orders are dissolved. The analyses are anchored in the womens' own presentations and understandings of the processes and dilemmas related to the abortion decisions, and our most important empirical materials are interviews with women who have experienced them. Our main ambition is to show the relation between some important dimensions of the situation in which the abortion decision has to be made, and the special kind of authority on behalf of the women that presents itself. Of equal importance is the vulnerability of the pregnant women, resulting in a co-production of the women as both Sovereigns and Homo Sacer in the decision situation. We also analyse some of the experienced relations between the women and the foetuses, and how the women constitute themselves as moral subjects, with a particular emphasis on the motifs of sacrifice and self-sacrifice. It is a central argument in the article that we have to understand the specificity of the decision situation, without reducing it either to other phases (before or after) of the total processes of PND and selective abortion, or to general discourses of disability or normality. The specificity of the situation in which the abortion decision is made is a pivotal point in society's regulation (in a broad sense) of the field and in the constitution of the regime of selective abortion.