Diabetes, Prediabetes, and the Risk of a Composite Outcome of Long-term Sickness Absence and Pre-retirement Death Due to Physical Disorders.

BACKGROUND: Diabetes and prediabetes have been linked with morbidity or mortality from cardiovascular disease, cancer, or other physical disorders among working-age populations, but less is known about outcomes directly related to labor loss (eg, Tlong-term sickness absence [LTSA] or pre-retirement death due to physical disorders).This prospective study aimed to examine the association of diabetes and prediabetes with the risk of a composite outcome of LTSA and pre-retirement death due to physical disorders. The present study also examined the associations of severe outcomes (LTSA or death) due to specific physical disorders or injuries/external causes in relation to diabetes and prediabetes. METHODS: Data were derived from the Japan Epidemiology Collaboration on Occupational Health study. A total of 60,519 workers from 12 companies were followed for 8 years. Diabetes and prediabetes were defined based on the American Diabetes Association criteria. A Cox proportional hazards regression model was used to examine the association between diabetes/prediabetes and severe outcomes due to physical disorders or injuries/external causes. RESULTS: The adjusted hazard ratios of severe outcomes due to all physical disorders were 1.22 (95% confidence interval [CI], 1.02-1.45) and 2.32 (95% CI, 2.04-2.64) for prediabetes and diabetes, respectively. In cause-specific analyses, an increased risk was observed for severe outcomes due to cancers, cardiovascular diseases, diseases of the musculoskeletal system, and injuries/external causes in relation to either or both diabetes and prediabetes. CONCLUSION: Diabetes and prediabetes were associated with an increased risk of severe outcomes due to physical disorders or injuries/external causes among Japanese workers.

Correction: 12-year observation of tweets about rubella in Japan: A retrospective infodemiology study.

[This corrects the article DOI: 10.1371/journal.pone.0285101.].

Trends in Participation in Rubella Antibody Testing among Working-Aged Men during Annual Health Check-Ups from 2019 to 2022 in Japan.

In 2019, the Japanese government established a scheme for rubella antibody testing of men born between 1962 and 1978 during workplace health check-ups. However, the use of vouchers for rubella antibody testing was limited. Health check-up data analyses are needed to determine the reason why rubella antibody testing is not widely used. In this study, we aimed to describe changes in rubella antibody test-taking behavior during health check-ups during the first 3 years of the rubella catch-up campaign in Japan. In 2019, 2020, and 2021 (2020 in some areas) vouchers were sent to men born during the fiscal years 1972-1978, 1966-1971, and 1962-1965, respectively. We calculated the prevalence in men born between 1962 and 1978 who underwent rubella antibody testing during mandatory health check-ups under the Industrial Health and Safety Act. Rubella antibody testing uptake was relatively high (approximately 15%) in all three age groups soon after the distribution of the vouchers and then declined to below 2% during the second and third years. Further population-based approaches with continuous public engagement are required in workplaces to effectively promote and expand the rubella vaccination program in Japan.

Parent Willingness to Pay for School Feeding Programs in Junior High Schools in Malang Regency, Indonesia.

In Indonesia, school feeding programs have not been established nationally due to the government's limited budget. To examine the possibility of copayment for school feeding programs, parents' intentions to use the school feeding programs and their willingness to pay (WTP) for these programs should be considered. We conducted an online questionnaire survey among the parents of junior high school students in all five public junior high schools in the Kepanjen District of Malang Regency, East Java Province, Indonesia. We used the contingent valuation method to elicit parents' WTP for school feeding and calculated the price elasticity of school feeding. Factors associated with the WTP were examined using logistic regression analysis. Of the 940 participants, 90% intended to use school feeding programs, and 30% were willing to pay Rp 15,000 (USD 1.05) or higher per meal. Of the 944 students (participants' children), all but two students consumed meals or snacks at school, with 74% consuming foods three or more times daily. Higher WTP for school feeding was associated with frequent food consumption at school, higher income, and a better perception of meals at school. In contrast, lower WTP was associated with more household members. Most parents intended to use school feeding programs with certain WTP irrespective of the price of school feeding. Therefore, school feeding in Indonesia might be expanded through copayment.

12-year observation of tweets about rubella in Japan: A retrospective infodemiology study.

Although rubella is an infectious disease that can be prevented by vaccination, there have been periodic epidemics in Japan, mainly among adult males. One of the reasons for this is the lack of interest in vaccination among the target adult male population. To clarify the reality of the discussion about rubella and provide basic resource for enlightening activities for rubella prevention, we collected and analyzed Twitter posts about rubella in Japanese between January 2010 and May 2022. We examined time series, number of tweets per account, tweeted contents, and retweet network. We found that the weekly number of rubella reports and the number of Twitter posts fluctuate simultaneously. During the 2018 rubella epidemic, the number of tweets increased due to the start of the rubella routine vaccination program and the use of cartoons to raise awareness. While 80% of the accounts posted three times or fewer during the period, some accounts posted multiple times per day for more than 12 years. Medical terms such as vaccines and antibodies were frequently used in the tweet contexts. In the retweet activity, a variety of actors, including mass media, medical professionals, and even rubella sufferers, contributed to disseminate rubella-related information.

Association between exposure to secondhand aerosol from heated tobacco products and respiratory symptoms among current non-smokers in Japan: a cross-sectional study.

OBJECTIVES: To investigate the association between secondhand-aerosol exposure from heated tobacco products (HTPs) and respiratory symptoms among current non-smokers. DESIGN: Cross-sectional study. SETTING: Internet survey conducted between 8 and 26 February 2021 in Japan. PARTICIPANTS: Non-smoking respondents at the survey aged 15-80 years. EXPOSURE: Self-reported secondhand-aerosol exposure. PRIMARY AND SECONDARY OUTCOMES: We defined asthma/asthma-like symptoms as a primary outcome and persistent cough as a secondary outcome. We examined the association between secondhand-aerosol exposure from HTPs and respiratory symptoms (asthma attacks/asthma-like symptoms and persistent cough). The prevalence ratio (PR) and 95% CI were calculated by using weighted, multivariable 'modified' Poisson regression models. RESULTS: Of the 18 839 current non-smokers, 9.8% (95% CI 8.2% to 11.7%) and 16.7% (95% CI 14.8% to 18.9%) of those who were exposed to secondhand aerosols reported asthma attacks/asthma-like symptoms and persistent cough, whereas 4.5% (95% CI 3.9% to 5.2%) and 9.6% (95% CI 8.4% to 11.0%) of those who were not, respectively. Secondhand-aerosol exposure was associated with respiratory symptoms (asthma attacks/asthma-like symptoms: PR 1.49, 95% CI 1.21 to 1.85; persistent cough: PR 1.44, 95% CI 1.21 to 1.72) after adjusting for covariates. CONCLUSION: Secondhand-aerosol exposure from HTPs was associated with both asthma attacks/asthma-like symptoms and persistent cough. These results provide policymakers with meaningful information in the regulation of HTP use for the protection of current non-smokers.

The spread of heated tobacco product (HTP) use across various subgroups during 2015-16 and 2017-18 in Japan.

BACKGROUND: Heated tobacco product (HTP) use has increased substantially between 2016 and 2017 in Japan. This study aims to clarify how HTP use (IQOS, Ploom, and glo) spread across the different combustible cigarette smoking statuses during 2015-16 and 2017-18 in Japan. METHODS: We compared the two periods of (i) 2015 to 2016 (N = 5,366) and (ii) 2017 to 2018 (N = 3,422) from a longitudinal study randomly sampling members from the Japan "Society and New Tobacco" Internet Survey (JASTIS). Multivariable logistic regression models for current HTP use in the previous 30 days by combustible cigarette smoking status in the previous year were used adjusting for socio-demographic factors. RESULTS: HTP use increased by 10 times in the 2017-18 cohort compared with the 2015-16 cohort according to the adjusted odds ratio (95% confidence interval) for current HTP use as 10.2 (7.03-14.8). According to smoking status, significantly higher adjusted ORs (95% CIs) of current HTP use for the after period were observed: 2.60 (1.37-4.94) for never smokers, 7.82 (3.64-16.8) for former smokers, 21.1 (5.73-77.9) for current smokers with intention to quit, and 17.0 (9.58-30.3) for current smokers without intention to quit. CONCLUSION: During 2015 to 2018 in Japan, HTP use dramatically increased in all subgroups except for never smokers.

Metabolic Syndrome and the Increased Risk of Medically Certified Long-term Sickness Absence: A Prospective Analysis Among Japanese Workers.

BACKGROUND: Metabolic syndrome (MetS) has been associated with various chronic diseases that may lead to long-term sickness absence (LTSA), but there is lacking information on the direct association between MetS and LTSA. The present study aimed to investigate the all-cause and cause-specific associations between MetS and the risk of medically certified LTSA among Japanese workers. METHODS: We recruited 67,403 workers (57,276 men and 10,127 women), aged 20-59 years from 13 companies in Japan during their health check-ups in 2011 (11 companies) and 2014 (2 companies), and we followed them for LTSA events (≥30 consecutive days) until March 31, 2020. MetS was defined according to the Joint Interim Statement. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and its 95% confidence intervals (CIs) for LTSA associated with MetS and its components. RESULTS: During 408,324 person-years of follow-up, 2,915 workers experienced LTSA. The adjusted HR for all-cause LTSA was 1.54 (95% CI, 1.41-1.68) among those with MetS compared to those without MetS. In cause-specific analysis, HRs associated with MetS significantly increased for LTSA due to overall physical disorders (1.76); cardiovascular diseases (3.16); diseases of the musculoskeletal system and connective tissue (2.01); cancers (1.24); obesity-related cancers (1.35); mental, behavioral, and neurodevelopmental disorders (1.28); reaction to severe stress and adjustment disorders (1.46); and external causes (1.46). The number of MetS components were also significantly associated with increased LTSA risk. CONCLUSION: MetS was associated with an increase in the risk of LTSA due to various diseases among Japanese workers.

Evaluation of caudal vena cava size using computed tomography in dogs under general anesthesia.

This study investigated the association between caudal vena cava (CVC) size and circulatory dynamics in dogs using computed tomography (CT) under general anesthesia. The subjects were 104 dogs who had undergone CT under general anesthesia in the past. The ratio of short diameter of the CVC to aortic diameter (CVCS/Ao) and the ratio of long to short diameter of the CVC (CVCL/CVCS) in the thorax and abdomen, respectively, were calculated using factors such as mean blood pressure (MBP), shock index (SI), anemia, hypoproteinemia, presence of intra-abdominal mass, and cardiac disease. There was a significant but negligible negative correlation between CVCS/Ao and MBP. In contrast, no significant correlation was found between CVC size and SI. The low MBP group had significantly higher CVCS/Ao of the thorax than the normal MBP group. The group with intra-abdominal mass had significantly lower CVCS/Ao of the abdomen than the group without intra-abdominal mass. The group with cardiac disease had significantly lower CVCL/CVCS of the thorax than the group without cardiac disease. In multiple regression analysis, low MBP, cardiac disease, intra-abdominal mass, and anemia were significant factors for CVCS/Ao of the thorax, CVCL/CVCS of the thorax, CVCS/Ao of the abdomen, and CVCL/CVCS of the abdomen, respectively. In conclusion, CVC size assessment using CT in dogs under general anesthesia is influenced by various factors.

Association between Heated Tobacco Product Use during Pregnancy and Fetal Growth in Japan: A Nationwide Web-Based Survey.

Combustible cigarette smoking impacts fetal growth during pregnancy. However, the risk associated with heated tobacco products (HTPs) remains unclear. This nationwide cross-sectional study investigated whether HTP use during pregnancy is associated with small for gestational age (SGA) outcomes among 5647 post-delivery women with singleton pregnancies, which were divided into four groups: lifetime never-smokers, former smokers before pregnancy, and current smokers for each of the tobacco products during pregnancy (sole HTP and sole combustion smokers). Information on the prevalence of SGA, defined as birth weight and height below the 10th percentile, was retrieved from the Maternal and Child Health Handbooks of post-delivery women. Using logistic regression, the association between sole HTP smokers during pregnancy and SGA, adjusted for covariates, with lifetime never-smokers as reference, was investigated. The prevalence was: current sole HTP smokers during pregnancy, 1.8% (102/5647); and SGA, 2.9% (164/5647). Sole HTP smokers during pregnancy had a higher prevalence of SGA (5.9% [6/102] vs. 2.7% [111/4144]) with an adjusted odds ratio (OR) of 2.50 (95% confidence interval [CI], 1.03-6.05) than lifetime never-smokers. Among sole combustion smokers, the adjusted OR for SGA was 1.95 (95% CI, 0.81-4.67). In Japan, HTP smoking during pregnancy may be associated with an increased risk for SGA.

The impact of coronavirus disease 2019 (COVID-19) in Japanese companion animal clinics.

The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous impact on people's lives throughout the world. A cross-sectional study was conducted to clarify the influence of COVID-19 on Japanese companion animal clinics. A self-administered electronic questionnaire regarding the incidence of COVID-19, hygiene management, the influence on clinical service and employment, and mental stress of staff was conducted for workers in animal clinics between 1 May and 10 June 2021. Questions concerning the hygiene management before the occurrence of COVID-19, under the first state of emergency, and at the time of the survey were asked using the Likert scale. Kessler 6 (K6) was used as an indicator of mental distress. In total, 430 individuals responded. Of these, 4.9% experienced COVID-19 infection in staff. Hygiene management was strengthened, but no particular practice was statistically associated with the occurrence of COVID-19 cases in staff. In Nakaya's variation of Scheffe's paired comparison, the highest prioritized goal in the clinics was the prevention of nosocomial infection with COVID-19. The prevalence of serious mental illness (K6 >=13) was 11.1% (95% confidence interval: 6.3-18.6%). Multivariable negative binomial regression found four risk factors for psychological distress: veterinary nurse (P=0.016 with veterinarians and P<0.01 with other staff), female (P=0.004), fear of infection at work (P<0.001), and stress by refraining from going out (P<0.001). Directors of clinics are recommended to take care of female veterinary nurses for distress.

Evaluation of Renal Blood Flow in Dogs during Short-Term Human-Dose Epoprostenol Administration Using Pulsed Doppler and Contrast-Enhanced Ultrasonography.

Prostacyclin is an in vivo bioactive substance that regulates renal blood flow (RBF). Information regarding how epoprostenol, a prostacyclin preparation, affects RBF in dogs is lacking. We investigated the effects of short-term epoprostenol administration on RBF in six healthy dogs under anesthesia by administering it intravenously at human doses-2, 5, and 10 ng/kg/min for 20 min. RBF was evaluated before and during epoprostenol administration using pulsed Doppler ultrasonography, and renal perfusion was evaluated using contrast-enhanced ultrasonography. Effects on renal and systemic circulation were evaluated by measuring systolic arterial, mean arterial, diastolic arterial, pulmonary arterial, mean right atrial, and pulmonary capillary wedge pressures; heart rate; and cardiac output. Kruskal-Wallis and Bonferroni multiple comparison tests and Spearman's rank correlation coefficient were used for statistical analyses. As epoprostenol dosage increased, the peak systolic and end diastolic velocity of the renal artery, maximum and minimum venous flow velocities of the interlobular and renal veins, and heart rate all tended to increase, although not significantly. Our results indicate that human-dose epoprostenol administration in dogs does not cause significant changes in renal or systemic circulation. However, the human doses used may have been too low to produce a clinical effect in dogs.

Diabetes, prediabetes, and long-term sickness absence due to mental disorders: Japan Epidemiology Collaboration on Occupational Health Study.

OBJECTIVES: To investigate the association of diabetes and prediabetes with long-term sickness absence (LTSA) due to mental disorders or specific mental disorders. METHODS: A prospective cohort study was conducted using data from the Japan Epidemiology Collaboration on Occupational Health Study. A total of 62,065 workers who received health check-ups in 2011 (nine companies) or 2014 (two companies) and were followed up to March 31, 2020 were included in this study. Diabetes status was defined based on the American Diabetes Association criteria, and diabetes was differentiated into diabetes with/without anti-diabetic treatment for additional analysis. A Cox proportional hazards regression model was used to investigate these associations. RESULTS: During maximum 8-year follow-up period, 1024 participants underwent LTSA due to mental disorders. The adjusted hazard ratio (aHR) and corresponding 95% confidence interval (CI) of LTSA due to all mental disorders were 1.10 (0.88-1.38) and 1.45 (1.07-1.98) for prediabetes and diabetes, respectively. Diabetic individuals with/without treatment were both at a high risk of LTSA due to mental disorders. For specific mental disorders, diabetes was associated with a higher risk of LTSA due to reaction to severe stress and adjustment disorders (aHR = 3.02, 95% CI = 2.01-4.52) while it was marginally associated with LTSA due to depressive episode (aHR = 1.25, 95% CI = 0.98-1.60). Prediabetes was also associated with LTSA due to reaction to severe stress and adjustment disorders (aHR = 1.41, 95% CI = 1.08-1.84). CONCLUSIONS: The present study suggests the importance of screening diabetes status and providing psychological support for decreasing the risk of LTSA due to mental disorders within working populations.

Maximum volume of nasal administration using a mucosal atomization device without aspiration in Japanese White rabbits.

Recently, a mucosal atomization device (MAD) has been applied in veterinary medicine. In the present study, the maximum volume of nasal atomization without aspiration using MAD was examined in eight healthy female Japanese White (JW) rabbits. Each rabbit had their head and neck examined by computed tomography before and after nasal atomization with four different doses (0.15, 0.3, 0.45, and 0.6 ml per nostril) of diluted contrast medium (1:2 mixture of iohexol and saline). This was done under general anesthesia by an intramuscular administration of alfaxalone 2.5 mg/kg, medetomidine 40 µg/kg, and butorphanol 0.4 mg/kg, with a 7-day washout period between each treatment. The diluted contrast medium was distributed in the nasal cavity, external nares, and/or oral cavity in all rabbits receiving each treatment. The intranasal distribution volumes of the contrast medium were 287 (250-333) mm3 [median (interquartile range)] for 0.15 ml, 433 (243-555) mm3 for 0.3 ml, 552 (356-797) mm3 for 0.45 ml, and 529 (356-722) mm3 for 0.6 ml of treatment. The intranasal distribution volume for 0.15 ml treatment tended to be lower than that for 0.6 ml treatment (P=0.083). The contrast medium was deposited in the trachea in one rabbit (12.5%) and four rabbits (50%) receiving treatments of 0.45 and 0.6 ml per nostril, respectively. The maximum volume of nasal atomization without aspiration into the trachea was 0.3 ml per nostril for the JW rabbits.

The Prevalence of COVID-19 Vaccination and Vaccine Hesitancy in Pregnant Women: An Internet-based Cross-sectional Study in Japan.

BACKGROUND: Reluctance of people to receive recommended vaccines is a growing concern, as distribution of vaccines is considered critical to ending the COVID-19 pandemic. There is little information regarding pregnant women's views toward coronavirus vaccination in Japan. Therefore, we investigated the vaccination rate and reasons for vaccination and vaccine hesitancy among pregnant women in Japan. METHODS: We conducted a cross-sectional study involving 1,791 pregnant women using data from the Japan "COVID-19 and Society" Internet Survey, conducted from July to August 2021, and valid response from 1,621 respondents were analyzed. We defined participants with vaccine hesitancy as those who identified with the statement "I do not want to be vaccinated" or "I want to 'wait and see' before getting vaccinated." Multivariate Poisson regression analysis was used to investigate the factors contributing to vaccine hesitancy. RESULTS: The prevalence of vaccination and vaccine hesitancy among pregnant women was 13.4% (n = 217) and 50.9% (n = 825), respectively. The main reasons for hesitancy were concerns about adverse reactions and negative effects on the fetus and breastfeeding. Vaccine hesitancy was significantly associated with the lack of trust in the government (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.03-1.54). Other factors, such as age, educational attainment, and state of emergency declaration, were not associated with vaccine hesitancy. CONCLUSIONS: COVID-19 vaccination is not widespread among pregnant women in Japan, although many vaccines have been shown to be safe in pregnancy. Accurate information dissemination and boosting trust in the government may be important to address vaccine hesitancy among pregnant women.

Non-High-Density Lipoprotein Cholesterol and Risk of Cardiovascular Disease: The Japan Epidemiology Collaboration on Occupational Health Study.

AIMS: We aimed to investigate the association between non-high-density lipoprotein cholesterol (non-HDL-C) levels and the risk of cardiovascular disease (CVD) and its subtypes. METHODS: In this contemporary cohort study, we analyzed the data of 63,814 Japanese employees aged ≥ 30 years, without known CVD in 2012 and who were followed up for up to 8 years. The non-HDL-C level was divided into 5 groups: ＜110, 110-129, 130-149, 150-169, and ≥ 170 mg/dL. The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) for CVD and its subtypes associated with each non-HDL-C group, considering 130-149 mg/dL as the reference group. RESULTS: During the study period, 271 participants developed CVD, including 78 myocardial infarctions and 193 strokes (102 ischemic strokes, 89 hemorrhagic strokes, and 2 unknowns). A U-shaped association between non-HDL-C and stroke was observed. In the analysis of stroke subtypes, the multivariable-adjusted HR (95% CI) for hemorrhagic stroke was 2.61 (1.19-5.72), 2.02 (0.95-4.29), 2.10 (1.01-4.36), and 1.98 (0.96-4.08), while that for ischemic stroke was 1.54 (0.77-3.07), 0.91 (0.46-1.80), 0.73 (0.38-1.41), and 1.50 (0.87-2.56) in the ＜110, 110-129, 150-169, and ≥ 170 mg/dL groups, respectively. Individuals with elevated non-HDL-C levels had a higher risk of myocardial infarction. CONCLUSIONS: High non-HDL-C levels were associated with an increased risk of myocardial infarction. Moreover, high and low non-HDL-C levels were associated with a high risk of stroke and its subtypes among Japanese workers.

Diagnosis-specific Cumulative Incidence of Return-to-work, Resignation, and Death Among Long-term Sick-listed Employees: Findings From the Japan Epidemiology Collaboration on Occupational Health Study.

BACKGROUND: While it is essential to understand how long is sufficient for return-to-work when designing paid sick-leave systems, little attempt has been done to collect cause-specific information on when and how many of sickness absentees returned to work, became unemployed, or passed away. METHODS: We studied the first sick-leave episode of ≥30 consecutive days in those ≤55 years of age during 2012-2013 among employees of 11 Japanese private companies (n = 1,209), which were followed until 2017. Overall and disease-specific cumulative incidences of return-to-work, resignations, and deaths were estimated using competing risk analysis. RESULTS: During the 3.5-year period (follow-up rate: 99.9%), 1,014 returned to work, 167 became unemployed, and 27 died. Overall, return-to-work occurred within 1 year in 74.9% of all absentees and in 89.3% of those who successfully returned to work. Resignation occurred within 1 year in 8.7% of all absentees and in 62.9% of all subjects who resigned. According to ICD-10 chapters, the cumulative incidence of return-to-work ranged from 82.1% for mental disorders (F00-F99) to 95.3% for circulatory diseases (I00-I99). The cumulative incidence of return-to-work due to mental disorders ranged from 66.7% in schizophrenia (F20) to 95.8% in bipolar affective disorders (F31). Death was rarely observed except for cases of neoplasms (C00-D48), of which the cumulative incidence of death reached 14.2% by 1.5 years. CONCLUSION: Return-to-work and resignations occurred commonly within 1 year of sick leave among long-term sickness absentees in the Japanese private companies. Our findings may assist occupational physicians and employers in developing effective social protection schemes.

Mid-to-caudal partial hemipelvectomy with limb preservation for ischial tumor in a dog.

A 10-year-old spayed female Golden Retriever was referred for hindlimb lameness. A firm mass was palpated over the right caudal pelvis. Computed tomography revealed an osteolytic bone region and an associated periosteal reaction in the ischium, including the acetabulum. The histological diagnosis was sarcoma of unknown origin. A mid-to-caudal partial hemipelvectomy was performed to remove the mass. Femoral head and neck osteotomy was performed to allow hindlimb preservation. Following surgery, the dog regained satisfactory hindlimb use over time and was alive for 821 days with no recurrence or metastatic disease. This report indicates that mid-to-caudal partial hemipelvectomy with femoral head and neck osteotomy is technically feasible and allows for tumor control with preservation of the hindlimb and its function.

Disrupted care during the COVID-19 state of emergency and productivity loss attributed to presenteeism in workers: a nationwide cross-sectional study.

OBJECTIVES: The COVID-19 pandemic has caused medical care delays and avoidance around the globe. However, little is known about the relationship between disrupted care and productivity loss attributed to presenteeism during the COVID-19 pandemic. We aimed to investigate whether disrupted care during the COVID-19 state of emergency was associated with health status and productivity loss. METHODS: We used data from a nationwide, cross-sectional, Internet-based, self-administered survey. We performed multiple logistic regression analysis on data from 14 545 participants to investigate the associations among variables related to disrupted care, health status and the Work Functioning Impairment Scale, with a cut-off of 21 points. RESULTS: Participants who experienced exacerbation of underlying disease (adjusted OR (aOR) 2.84; 95% CI 2.28 to 3.53) or any type of disrupted care were more likely to show low productivity at work. Experiencing disruptions in routine and non-routine clinical settings (aOR 4.64; 95% CI 3.64 to 5.92 and aOR 6.29; 95% CI 4.74 to 8.34, respectively), and running out of drugs (aOR 6.13; 95% CI 4.60 to 8.18) were strongly associated with exacerbation of underlying disease. CONCLUSIONS: Workers who experienced disrupted care were much more likely to show productivity loss. Exacerbation of underlying disease is one possible pathway through which disrupted care could affect productivity loss attributed to presenteeism. Our study provides evidence of the importance of early diagnosis and continuous treatment of non-COVID-19 patients to enable them to remain healthy and continue to work during the pandemic.