SARS-CoV-2 co-detection with other respiratory pathogens-descriptive epidemiological study.

BACKGROUND: Co-detection of respiratory pathogens with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is poorly understood. This descriptive epidemiological study aimed to determine the effect of the interaction of different respiratory pathogens on clinical variables. METHODS: We retrospectively reviewed the results of comprehensive multiplex polymerase chain reaction (PCR) testing from November 2020 to March 2023 to estimate respiratory pathogen co-detection rates in Shinjuku, Tokyo. We evaluated the interactions of respiratory pathogens, particularly SARS-CoV-2, between observed and expected co-detection. We estimated the trend of co-detection with SARS-CoV-2 in terms of age and sex and applied a multiple logistic regression model adjusted for age, testing period, and sex to identify influencing factors between co-detection and single detection for each pathogen. RESULTS: Among 57,746 patients who underwent multiplex PCR testing, 10,516 (18.2%) had positive for at least one of the 22 pathogens. Additionally, 881 (1.5%) patients were confirmed to have a co-detection. SARS-CoV-2 exhibited negative interactions with adenovirus, coronavirus, human metapneumovirus, parainfluenza virus, respiratory syncytial virus, and rhino/enterovirus. SARS-CoV-2 co-detection with other pathogens occurred most frequently in patients of the youngest age group (0-4 years). A multiple logistic regression model indicated that younger age was the most influential factor for SARS-CoV-2 co-detection with other respiratory pathogens. CONCLUSION: The study highlights the prevalence of SARS-CoV-2 co-detection with other respiratory pathogens in younger age groups, necessitating further exploration of the clinical implications and severity of SARS-CoV-2 co-detection.

Knee Extensor Muscle Strength Associated with the Onset of Depression in Older Japanese Women: The Otassha Study.

We examined whether knee extensor muscle strength can predict the onset of depressive symptoms in older Japanese women living in Tokyo. A baseline comprehensive geriatric examination was conducted to evaluate isometric knee extensor muscle strength and depressive symptoms (using Geriatric Depression Scale [GDS]) in 2017-2019. A free of neurological disease participants received a series of follow-up examinations following an initial evaluation. A GDS score of ≥5 during follow-up marked the onset of depressive symptoms. A logistic regression model was established after adjustment of baseline GDS score for variables including age, body mass index, smoking, alcohol consumption, comorbidities, working status, hobbies, volunteering, years of education, and dietary variety. Of the 1845 recruited individuals, 1409 were eligible to be targeted for follow-up. Among them, 768 women provided two-year follow-up data and contributed the final analysis. After covariate adjustments, the odds ratios (95% confidence interval) for depressive symptoms were 0.68 (0.39, 1.20) and 0.48 (0.26, 0.91) for the middle and highest tertiles of muscle strength, respectively, using the lowest tertile as reference. A dose-response association between muscle strength and depression (p = 0.022) was identified. This study suggests an inverse dose-response relationship between knee extensor muscle strength and the onset of depressive symptoms in older Japanese women.

Incidence, risk factors, and impact of post-return of spontaneous circulation events in patients with out-of-hospital cardiac arrest: A population-based study in Tokyo, Japan.

AIM: Patients with the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) are unstable and often experience rearrest, after which ROSC may be reattained. This study investigated the incidence and risk factors of post-ROSC events (rearrest and subsequent reattainment of ROSC) and their impact on outcomes in patients with prehospital ROSC following OHCA. METHODS: Patients with OHCA and prehospital ROSC were identified from the Tokyo Fire Department database between 1 January 2018 and 31 December 2022. The factors associated with post-ROSC events and their impact on 1-month favourable neurological outcome (cerebral performance category scale: 1 or 2) were assessed using multivariable logistic regression analysis. RESULTS: Overall, 64,000 individuals experienced OHCA, and 6,190 (9.7%) had ROSC. Rearrest was confirmed in 28.4% of patients with ROSC, and was associated with age, time of emergency call, location of cardiac arrest, dispatcher instruction regarding cardiopulmonary resuscitation, first recorded cardiac rhythm, bystander cardiopulmonary resuscitation, defibrillation by a bystander, response time, and prehospital interventions. ROSC reattainment was confirmed in 34.5% of patients with rearrest and associated with the first recorded cardiac rhythm and defibrillation by a bystander. Patients without rearrests had the highest proportion of favourable neurological outcomes, followed by those with solved and unsolved rearrests (38.6% vs. 22.4% and 4.4%, P < 0.001). The difference remained significant after adjustment for confounders. CONCLUSION: This study revealed population-based incidence and risk factors of post-ROSC events. Rearrest was common, leading to unfavourable neurological outcome; however, its deleterious impact may be mitigated by successful resuscitation efforts.

Risk Index of Regional Infection Expansion of COVID-19: Moving Direction Entropy Study Using Mobility Data and Its Application to Tokyo.

BACKGROUND: Policies, such as stay home, bubbling, and stay with your community, recommending that individuals reduce contact with diverse communities, including families and schools, have been introduced to mitigate the spread of the COVID-19 pandemic. However, these policies are violated if individuals from various communities gather, which is a latent risk in a real society where people move among various unreported communities. OBJECTIVE: We aimed to create a physical index to assess the possibility of contact between individuals from diverse communities, which serves as an indicator of the potential risk of SARS-CoV-2 spread when considered and combined with existing indices. METHODS: Moving direction entropy (MDE), which quantifies the diversity of moving directions of individuals in each local region, is proposed as an index to evaluate a region's risk of contact of individuals from diverse communities. MDE was computed for each inland municipality in Tokyo using mobility data collected from smartphones before and during the COVID-19 pandemic. To validate the hypothesis that the impact of intercommunity contact on infection expansion becomes larger for a virus with larger infectivity, we compared the correlations of the expansion of infectious diseases with indices, including MDE and the densities of supermarkets, restaurants, etc. In addition, we analyzed the temporal changes in MDE in municipalities. RESULTS: This study had 4 important findings. First, the MDE values for local regions showed significant invariance between different periods according to the Spearman rank correlation coefficient (>0.9). Second, MDE was found to correlate with the rate of infection cases of COVID-19 among local populations in 53 inland regions (average of 0.76 during the period of expansion). The density of restaurants had a similar correlation with COVID-19. The correlation between MDE and the rate of infection was smaller for influenza than for COVID-19, and tended to be even smaller for sexually transmitted diseases (order of infectivity). These findings support the hypothesis. Third, the spread of COVID-19 was accelerated in regions with high-rank MDE values compared to those with high-rank restaurant densities during and after the period of the governmental declaration of emergency (P<.001). Fourth, the MDE values tended to be high and increased during the pandemic period in regions where influx or daytime movement was present. A possible explanation for the third and fourth findings is that policymakers and living people have been overlooking MDE. CONCLUSIONS: We recommend monitoring the regional values of MDE to reduce the risk of infection spread. To aid in this monitoring, we present a method to create a heatmap of MDE values, thereby drawing public attention to behaviors that facilitate contact between communities during a highly infectious disease pandemic.

Psychotic experiences and dissociation in adolescents: Within-person analysis in the Tokyo teen cohort.

Although many cross-sectional studies showed that psychotic experiences (PEs) and dissociation were closely related, the longitudinal association between them remains unknown. Therefore, the aim of the current study was to examine the longitudinal association of these two symptoms throughout adolescence, under the hypothesis that these two symptoms are bidirectionally associated. Data were obtained from a population-based cohort, the Tokyo Teen Cohort study (TTC; N = 3171). PEs and dissociation were assessed at 10, 12, 14, and 16 years of age. PEs were assessed using a total score from five-item self-report questionnaires derived from the Diagnostic Interview Schedule for Children (DISC-C). Dissociation was assessed using subscale scores of the Child Behavior Checklist (CBCL) completed by primary caregivers. We examined the longitudinal relationship between PEs and dissociation using the random intercept cross-lagged panel model (RI-CLPM). The within-person component of the RI-CLPM revealed no significant cross-lagged effect of dissociation on PEs at any time point. On the other hand, there was a significant (p < 0.05) association between PEs at age 14 and dissociation at age 16 (ß = 0.106, 95 % CI 0.047-0.165). The between-person component revealed a significant time-invariant relationship between the two symptoms (ß = 0.324, 95 % CI 0.239-0.410). The longitudinal relationship between PEs and dissociation was limited at the within-person level, whereas the between-person correlation was significant. The only significant longitudinal pathway was from PEs to dissociation, suggesting that PEs may be a predictor of dissociation in mid-adolescence.

Wrestling injuries during the 2016 Rio and 2020 Tokyo Olympic Games.

OBJECTIVES: To evaluate and compare the injuries of Olympic wrestlers during the 2016 Rio and 2020 Tokyo Olympic Games held in August 2021 due to the COVID-19 pandemic. METHODS: In this descriptive epidemiological study, injury report forms were used to collect and analyse injury data during the competitions. RESULTS: During 410 matches in the Rio Olympic Games, 21 injuries were recorded among 346 wrestlers (112=women), a rate of 5.1 injuries/100 bouts and 6.1 injuries/100 athletes. During 322 matches in the Tokyo Olympic Games, 28 injuries were recorded among 287 wrestlers (96=women), with 8.7 injuries/100 bouts and 9.8 injuries/100 athletes. However, these apparent differences in injury rates between Tokyo and Rio were not statistically significant (injuries/bout: p=0.057, 95% CI: 0.31 to 1.02; injuries/athlete: p=0.087, 95% CI: 0.33 to 1.08). Mild injuries comprised the greatest proportion of injuries in both Olympic Games. Severe injuries accounted for 0%, 16.7% and 36.4% of injuries in Greco-Roman, Freestyle and Women's wrestling, respectively. CONCLUSION: Most wrestling injuries in the 2016 Rio and 2020 Tokyo Olympic Games were mild skin injuries in the head and face regions due to direct body contact during standing positions in the 1/8-final round of wrestling competitions. No critical injury was observed during the recent Olympic Games. Attention should be drawn to preventing upper limb joint dislocations as common severe injuries in both Olympic Games. While not statistically significant, the Tokyo Games, after the COVID-19 pandemic, witnessed a higher injury occurrence than the Rio Games.

Epidemiology of Syphilis in Tokyo from 2019 to 2022: a Descriptive Epidemiological Study.

In recent years, the incidence of syphilis in Tokyo has increased. This descriptive epidemiological study aimed to elucidate the status of syphilis within the city. Data regarding age, sex, disease stage, and presumed sexual partners of patients with syphilis reported in Tokyo were compiled and analyzed. A total of 9,419 patients with syphilis were diagnosed between 2019 and 2022. A sharp rise was observed in the number of reported cases from 2021 to 2022. Between 2020 and 2022, the number of women in their 20s who developed syphilis rapidly increased by more than 3-fold. Furthermore, the number of pregnant women with syphilis increased the end of 2022. Despite a rapid increase in the number of young women with syphilis, the incidence of congenital syphilis has remained stable. This stability may be attributed to the early detection of syphilis during pregnancy, facilitated by the high rate of antenatal checkups in Tokyo. However, the growing incidence of syphilis among young women could potentially lead to a rise congenital syphilis cases in the future. Therefore, public health strategies should include educational initiatives targeting high-risk populations and adolescents, along with early and appropriate testing and treatment to prevent the progression of syphilis.

Monitoring the ventilation of living spaces to assess the risk of airborne transmission of infection using a novel Pocket CO2 Logger to track carbon dioxide concentrations in Tokyo.

We employed carbon dioxide (CO2) concentration monitoring using mobile devices to identify location-specific risks for airborne infection transmission. We lent a newly developed, portable Pocket CO2 Logger to 10 participants, to be carried at all times, for an average of 8 days. The participants recorded their location at any given time as cinema, gym, hall, home, hospital, other indoors, other outgoings, pub, restaurant, university, store, transportation, or workplace. Generalized linear mixed model was used for statistical analysis, with the objective variable set to the logarithm of CO2 concentration. Analysis was performed by assigning participant identification as the random effect and location as the fixed effect. The data were collected per participant (seven males, four females), resulting in a total of 12,253 records. Statistical analysis identified three relatively poorly ventilated locations (median values > 1,000 ppm) that contributed significantly (p < 0.0001) to CO2 concentrations: homes (1,316 ppm), halls (1,173 ppm), and gyms (1005ppm). In contrast, two locations were identified to contribute significantly (p < 0.0001) to CO2 concentrations but had relatively low average values (<1,000 ppm): workplaces (705 ppm) and stores (620 ppm). The Pocket CO2 Logger can be used to visualize airborne infectious transmission risk by location to help guide recommendation regarding infectious disease policies, such as restrictions on human flow and ventilation measures and guidelines. In the future, large-scale surveys are expected to utilize the global positioning system, Wi-Fi, or Bluetooth of an individual's smartphone to improve ease and accuracy.

The Association between Menstrual Symptoms and Presenteeism: A Cross-Sectional Study for Women Working in Central Tokyo.

Menstrual symptoms lower women's work performance, but to what extent one's performance declines during the perimenstrual periods is unclear. This cross-sectional study evaluated relative presenteeism by the severity of menstrual symptoms in working women. Participants included women who joined a health promotion event in Tokyo. The severity of PMS and symptoms during menstruation were categorized based on their frequency, and the outcome variable was relative presenteeism as the ratio of work performance during the perimenstrual periods to that during the inter-menstrual period. An analysis of variance (ANOVA) was performed. Of the 312 participants, 238 were eligible, 50% of whom claimed severe symptoms in either PMS or during menstruation. Participants were divided into four groups (1) without severe menstrual symptoms, (2) severe PMS alone, (3) severe symptoms during menstruation alone, and (4) both severe PMS and symptoms during menstruation-and the mean relative presenteeism was 91% (standard deviation (SD) 23), 69% (SD 21), 76% (SD 16), and 69% (SD 27), respectively (p < 0.01). A between-group comparison revealed statistically significant differences in relative presenteeism, when group (1) served as the criterion for comparisons (p < 0.01). This study demonstrates that severe PMS alone, as well as both severe PMS and symptoms during menstruation, particularly decreased work performance.

Muscle injuries in athletics during the 2020 Tokyo Olympic Games: differences between heats and finals.

BACKGROUND: The aim of this study was to analyze muscle injuries and their related risk factors during the Athletics events of the 2020 Tokyo Olympic Games including the differences in muscle injury rates between heats and finals. METHODS: We included and analyzed in this study muscle injuries diagnosed by either magnetic resonance imaging, ultrasound, or physical examinations by at least two physicians, from Athletics athletes participating at the 2020 Tokyo Olympic Games. Data from electronic medical records, including sex, nationality, event, and the round (heat vs. final) during which the muscle injury occurred and the air temperature in the stadium, measured every five minutes during the competition were extracted. RESULTS: Among the 1631 athletes who competed, a total of 36 athletes (20 males and 16 females) were diagnosed with a muscle injury during the 2020 Tokyo Olympic Games. Among them, 24 occurred during heats (1.47 per 100 athletes) and 12 during finals (2.20 per 100 athletes) (P=0.25). Logistic regression analysis revealed that the geographic region of athletes' origin was a factor associated with muscle injury, with the highest muscle injury rate being in athletes from Africa (odds ratio [OR]=4.74, 95% confidence interval [CI]) = 1.75 to 12.82) and North America (OR=3.02, 95%CI=1.27 to 7.20). For male athletes, competing in finals was a risk factor to sustain a muscle injury (OR=2.55, 95%CI=1.01 to 6.45). CONCLUSIONS: During the 2020 Olympic Games, muscle injury rate was higher in finals than in heats, reaching statistical significance in male athletes.

The Tokyo 2020 and Beijing 2022 Olympic Games held during the COVID-19 pandemic: planning, outcomes, and lessons learnt.

The COVID-19 pandemic profoundly affected all mass gatherings for sporting and religious events, causing cancellation, postponement, or downsizing. On March 24, 2020, the Japanese Government, the Tokyo Organising Committee of the Olympic and Paralympic Games, and the International Olympic Committee decided to postpone the Tokyo 2020 Olympic and Paralympic Games until the summer of 2021. With the emergence of SARS-CoV-2, the potential creation of a superspreading event that would overwhelm the Tokyo health system was perceived as a risk. Even with a delayed start date, an extensive scale of resources, planning, risk assessment, communication, and SARS-CoV-2 testing were required for the Games to be held during the COVID-19 pandemic. The effectiveness of various mitigation and control measures, including the availability of vaccines and the expansion of effective testing options, allowed event organisers and the Japanese Government to successfully host the rescheduled 2020 Tokyo Olympic Games from July 23 to Aug 8, 2021 with robust safety plans in place. In February and March, 2022, Beijing hosted the 2022 Winter Olympic Games as scheduled, built on the lessons learnt from the Tokyo Games, and developed specific COVID-19 countermeasure plans in the context of China's national framework for the plan called Zero COVID. Results from the testing programmes at both the Tokyo and Beijing Games show that the measures put in place were effective at preventing the spread of COVID-19 within the Games, and ensured that neither event became a COVID-19-spreading event. The extensive experience from the Tokyo and Beijing Olympic Games highlights that it is possible to organise mass gatherings during a pandemic, provided that appropriate risk assessment, risk mitigation, and risk communication arrangements are in place, leaving legacies for future mass gatherings, public health, epidemic preparedness, and wider pandemic response.

Surveillance of seasonal influenza viruses during the COVID-19 pandemic in Tokyo, Japan, 2018-2023, a single-center study.

Introduction: COVID-19 pandemic led to significant reductions in influenza detection worldwide, fueling debates on whether influenza truly ceased circulating in communities. The number of influenza cases decreased significantly in Japan, raising concerns about the potential risk of decreased immunity to influenza in the population. Our single-center study aimed to investigate influenza trends before and during the COVID-19 pandemic in Tokyo, Japan. Materials and Methods: This cross-sectional study included patients of all ages who visited Tokyo Shinagawa Hospital between April 1, 2018, and March 31, 2023. Influenza and COVID-19 tests were conducted using Quick Navi-Flu2 and polymerase chain reaction (PCR). We analyzed data from before and during the COVID-19 epidemic, based on patient background, hospitalization, and deaths, collected from medical records. Results: A total of 12 577 influenza tests were conducted, with approximately 100 tests consistently performed each month even in the influenza off-season. Throughout the observation period, 962 positive cases were identified. However, no cases were observed for 27 months between March 2020 and November 2022. Influenza A cases were reobserved in December 2022, followed by influenza B cases in March 2023, similar to the influenza incidence reports from Tokyo. The positivity rate during the 2022-2023 winter season was lower than before the COVID-19 epidemic and decreased in elderly patients, with no hospitalizations or deaths observed. Conclusion: This single-center study provided actual trend data for influenza patients before and during COVID-19 outbreaks in Tokyo, which could offer insights into the potential impact and likelihood of influenza virus infection in Japan.

[Characteristics and courses of COVID-19 in patients from the first through fifth waves of the disease: Focused on a single public health center in Tokyo, Japan].

Objective　Coronavirus disease 2019 (COVID-19) became a global public health threat, and local public health centers in Japan implemented an infectious disease response to support patients. The response was subsequently modified to meet the needs for each of the five waves of infection. The study aim was to analyze the characteristics and courses of the disease in patients with COVID-19 at a single public health center. The study period included the first through fifth waves of the disease.Methods　We utilized a descriptive epidemiological design in this study and data of patients with COVID-19 from one administrative district in Tokyo, Japan. We analyzed age, gender, nationality, symptoms at diagnosis, the route of infection, the recovery environment, and associated morbidity intervals, including case fatality rate, days from symptom onset to diagnosis, days from diagnosis to hospitalization, and recovery time for each of the first through fifth waves.Results　From February 2020 to November 2021, 11,252 patients were diagnosed with COVID-19. Specifically, in the first wave, 151 patients were diagnosed, followed by 803 in the second wave, 2,406 in the third wave, 1,480 in the fourth wave, and 6,412 in the fifth wave. Hospitalization was the primary recovery environment during the first wave, while home recovery became the primary approach from the third wave onward. The case fatality rate was highest during the first wave, likely because of limited testing and treatment options for severe cases. The median time from onset to diagnosis was seven days in the first wave, significantly longer than for the other waves. The median time from diagnosis to hospitalization was one day in the first through fourth waves but three days in the fifth wave. The extension of this interval suggests that hospitalization was delayed in this wave as the number of severe patients increased rapidly, likely because of the novel COVID-19 variant.Conclusion　This study of patients testing positive for COVID-19 provides valuable insights into the characteristics and courses of the pandemic within this district. These findings can inform regarding the development of effective strategies to manage the ongoing COVID-19 pandemic and other future emerging infectious diseases.

Alcohol and toxicological factors influencing fatal falls from height in the Greater Tokyo Area: a retrospective study.

Falls from height pose a significant public health concern in urban regions, including the highly urbanized Greater Tokyo Area. The Japanese population is characterized by high rates of suicide and psychoactive drug usage, underscoring the importance of investigating these attributes in falls from height. This study aimed to retrospectively analyze the alcohol and toxicological aspects influencing falls from height in the Greater Tokyo Area between 2014 and 2022 and compare the findings with existing reports on other populations. In total, 75 cases of falls from height and 159 cases of natural deaths were included. Consistent with previous findings, Fisher's exact test revealed a predominance of males (66.67%, 50/75) and young adults (57.33%, 43/75) in falls from height. Multivariate logistic regression analysis identified antidepressant usage as the most significant risk factor within the target population, while younger individuals under alcohol influence constituted another high-risk group. Notably, contradictory to other populations, female individuals involved in fatal falls in the Greater Tokyo Area exhibited a higher frequency of alcohol consumption than males (48.00%, 12/25 vs. 26.00%, 13/50), and most of them were associated with suicide (83.33%, 10/12). These findings elucidate the population characteristics that pose a high risk for fatal falls from height in Japan and can serve as a reference for other Asian populations residing in similar megacities.

COVID-19 infection risk assessment and management at the Tokyo 2020 Olympic and Paralympic Games: A scoping review.

The Tokyo 2020 Olympic and Paralympic Games was one of the largest international mass-gathering events held after the beginning of coronavirus disease 2019 (COVID-19) pandemic. In this scoping review, we extracted papers discussing COVID-19 risk assessment or management at the Tokyo 2020 Games to determine the nature of studies that were conducted. Among the 75 papers obtained from two search engines (PubMed and ScienceDirect) and four papers collected from hand-searches, 30 papers were extracted. Only eight papers performed both COVID-19 prior risk assessment and quantitative evaluation of effectiveness measures, highlighting the importance of rapid, solution-focused risk assessment. Furthermore, this review revealed that the findings regarding the spread of COVID-19 infection to citizens in the host country were inconsistent depending on the assessment methods and that assessments of the spread of infection outside the host country were lacking.

Current status and therapeutic strategy of acute acalculous cholecystitis: Japanese nationwide survey in the era of the Tokyo guidelines.

PURPOSE: This study aimed to clarify the incidence, therapeutic modality, and prognosis of acute acalculous cholecystitis and to reveal its optimal treatment strategy. METHODS: As a project study of the Japanese Society for Abdominal Emergency Medicine, we performed a questionnaire survey of demographic data and perioperative outcomes of acute acalculous cholecystitis treated between January 2018 and December 2020 from 42 institutions. RESULTS: In this study, 432 patients of acute acalculous cholecystitis, which accounts for 7.04% of acute cholecystitis, were collected. According to the Tokyo guidelines severity grade, 167 (38.6%), 202 (46.8%), and 63 (14.6%) cases were classified as Grade I, II, and III, respectively. A total of 11 (2.5%) patients died and myocardial infarction/congestive heart failure was the only independent risk factor for in-hospital death. Cholecystectomy, especially the laparoscopic approach, had more preferable outcomes compared to their counterparts. The Tokyo guidelines flow charts were useful for Grade I and II severity, but in the cases with Grade III, upfront cholecystectomy could be suitable in some patients. CONCLUSIONS: The proportions of severity grade and mortality of acute acalculous cholecystitis were found to be similar to those of acute cholecystitis, and laparoscopic cholecystectomy is recommended as an effective treatment option. (UMIN000047631).

Rationale and design of Juntendo Sarcopenia Registration to explore the predictors and prognosis of sarcopenia and frailty in the elderly in TOKYO (JUSTICE-TOKYO).

AIM: This study aimed to clarify the prevalence, predictors, and prognosis of frailty and sarcopenia in both cross-sectional and longitudinal study of the real world. METHODS: The JUSTICE-TOKYO study is a single-center, prospective observational study of elderly patients. Patients aged ≥65 years who regularly visited our center were enrolled and followed up for 4 years (n = 1042). The diagnosis of sarcopenia and frailty in the enrolled patients was based on the criteria established by the Asian Working Group for Sarcopenia and Japanese version of the Cardiovascular Health Study criteria, respectively. The primary end point is the incidence of all-cause mortality and hospitalization for treatment. The secondary end points are clinically significant bleeding, cardiovascular events, strokes, malignancies, incidence of falling, fractures, pneumonia, and the onset of new dementia cases. RESULTS: A total of 1042 patients were enrolled in this study. The mean age of the cohort at baseline was 78.2 years, with 56% being women. Among the enrolled patients, 223 (21.4%) diagnosed with sarcopenia, 172 (16.5%) exhibited frailty, and 541 (51.9%) fell into the prefrailty category. CONCLUSIONS: The JUSTICE-TOKYO study provides valuable insights into the prevalence of sarcopenia and frailty among older adult outpatients in a real-world context and contributes to measures aimed at extending healthy life expectancy. Geriatr Gerontol Int 2024; 24: 168-172.

Assessing the COVID-19 vaccination program during the Omicron variant (B.1.1.529) epidemic in early 2022, Tokyo.

BACKGROUND: Many countries, including high-income nations, struggled to control epidemic waves caused by the Omicron variant (B.1.1.529), which had an antigenically distinct evolution. Evaluating the direct and indirect effects of vaccination during the Omicron waves is essential to assess virus control policies. The present study assessed the population impacts of a vaccination program during the sixth wave caused by BA.1 and BA.2 from January to May 2022, in Tokyo. METHODS: We analyzed the primary series and booster vaccination coverages and the confirmed cases stratified by vaccination history. We estimated the number of COVID-19 cases that were directly and indirectly prevented by vaccination. To estimate the direct impact, we used a statistical model that compared risks between unvaccinated and vaccinated individuals. A transmission model employing the renewal process was devised to quantify the total effect, given as the sum of the direct and indirect effects. RESULTS: Assuming that the reporting coverage of cases was 25%, mass vaccination programs, including primary and booster immunizations, directly averted 640,000 COVID-19 cases (95% confidence interval: 624-655). Furthermore, these programs directly and indirectly prevented 8.5 million infections (95% confidence interval: 8.4-8.6). Hypothetical scenarios indicated that we could have expected a 19% or 7% relative reduction in the number of infections, respectively, compared with the observed number of infections, if the booster coverage had been equivalent to that of the second dose or if coverage among people aged 10-49 years had been 10% higher. If the third dose coverage was smaller and comparable to that of the fourth dose, the total number of infections would have increased by 52% compared with the observed number of infections. CONCLUSIONS: The population benefit of vaccination via direct and indirect effects was substantial, with an estimated 65% reduction in the number of SARS-CoV-2 infections compared with counterfactual (without vaccination) in Tokyo during the sixth wave caused by BA.1 and BA.2.

Multisource surveillance conducted by the Tokyo Metropolitan Government during the Tokyo 2020 Olympic and Paralympic Games.

The Tokyo 2020 Olympic and Paralympic Games (the Games) were held from 23 July to 5 September 2021 in Tokyo, Japan, after a 1-year delay due to the coronavirus disease (COVID-19) pandemic. The Tokyo Metropolitan Government was responsible for monitoring and responding to infectious disease outbreaks other than COVID-19 during the Games. A multisource surveillance system was used from 1 July to 12 September 2021 for the early detection and rapid response to infectious diseases. This included routine notifiable disease surveillance, sentinel surveillance, syndromic surveillance, cluster surveillance, ambulance transfer surveillance and the Tokyo Infectious Alert system. Daily reports were disseminated summarizing the data collected from the multisource surveillance system. No case of infectious disease under the Tokyo Metropolitan Government system required a response during the Games. The multisource surveillance was useful for providing intelligence during the Games and, if required, could contribute to the early detection and rapid response to outbreaks during other mass gatherings. The system could be improved to overcome the challenges implied by the findings of this multisource surveillance.

Impact of the COVID-19 pandemic on surgical volume and outcomes in spine surgery: a multicentre retrospective study in Tokyo.

OBJECTIVES: To investigate the effect of the COVID-19 pandemic on surgical volume and outcomes in spine surgery. DESIGN: A retrospective cohort study using prospectively collected data. SETTING AND PARTICIPANTS: A total of 9935 patients who underwent spine surgery between January 2019 and December 2021 at eight high-volume spine centres in the Greater Tokyo metropolitan area were included. OUTCOME MEASURES: The primary outcome measures were the number of surgical cases, perioperative complications and patient-reported outcomes, including numerical rating scales for each body part, Euro quality of life 5-dimension (EQ5D), Neck Disability Index and Oswestry Disability Index (ODI). RESULTS: The total number of surgeries in 2020 and 2021 remained lower than that of 2019, with respective percentages of 93.1% and 95.7% compared with the prepandemic period, with a marked reduction observed in May 2020 compared with the same period in 2019 (56.1% decrease). There were no significant differences between the prepandemic and postpandemic groups in the incidence of perioperative complications, although the frequency of reoperation tended to be higher in the postpandemic group (3.04% vs 3.76%, p=0.05). Subgroup analysis focusing on cervical spine surgery revealed significantly worse preoperative EQ5D scores in the postpandemic group (0.57 vs 0.54, p=0.004). Similarly, in lumbar spine surgery, the postpandemic group showed higher levels of leg pain (5.7 vs 6.1 to 0.002) and worse ODI scores (46.2 vs 47.7 to 0.02). However, postoperative outcomes were not different between pre and post-pandemic groups. CONCLUSIONS: The COVID-19 pandemic has significantly impacted spinal surgeries in Japan, leading to a decrease in surgical volumes and changes in patient characteristics and surgical procedures. However, surgical outcomes remained comparable between the pre and postpandemic periods, indicating the resilience and adaptability of healthcare systems.