Prolonged infective SARS-CoV-2 omicron variant shedding in a patient with diffuse large B cell lymphoma successfully cleared after three courses of remdesivir.

We report a case of prolonged shedding of the infective SARS-CoV-2 omicron variant BA.1.1.2 in a 79-year-old male patient with diffuse large B-cell lymphoma, after receiving chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The patient was admitted to our hospital in late March 2022 for the sixth course of R-CHOP chemotherapy. Initially, the patient tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using an in-hospital loop-mediated amplification assay with a nasopharyngeal swab, both on the day of admission and three days later. However, the patient developed fever and was diagnosed with coronavirus disease (COVID-19) six days after admission and was suspected to have contracted the infection in the ward. Viral shedding continued for more than three months, with confirmed viral infectivity. As compared to the original Wuhan-Hu-1/2019 strain, amino acid substitutions including S36 N in non-structural protein (NSP)2, S148P, S1265del and L1266I in NSP3, G105D in NSP4, G496S, A831V, or V987F in spike protein, and I45T in open-reading frame (ORF)9b were randomly detected in isolated viruses. Although the patient had received two doses of the BNT162b2 vaccine approximately six months earlier and the third dose on day 127 after the infection, both serum anti-spike and anti-nuclear protein IgG and IgM tests were negative at day 92, 114, and 149 after the infection. The patient finally cleared the virus after the third course of remdesivir and did not have further recurrence.

Impact of Unexpected In-House Major COVID-19 Outbreaks on Depressive Symptoms among Healthcare Workers: A Retrospective Multi-Institutional Study.

The coronavirus disease 2019 (COVID-19) has significantly affected the mental health of healthcare workers (HCWs). The authors have provided psychosocial support to HCWs working in typical hospitals and nursing homes in Fukushima Prefecture, Japan, where major COVID-19 outbreaks have occurred since December 2020. This study retrospectively examines depressive symptoms before psychosocial interventions among HCWs working at typical hospitals and nursing homes experiencing in-house major COVID-19 outbreaks. We have offered psychosocial support in eight hospitals and nursing homes, obtaining data on the mental health status of 558 HCWs using the Patient Health Questionnaire-9. The study's results indicate that 29.4% of HCWs have exhibited moderate or higher depressive symptoms, and 10.2% had suicidal ideation. Multiple logistic regression analysis showed that being a nurse was associated with higher depressive symptoms and suicidal ideation compared to other HCWs. In addition, multiple logistic regression analysis of Polymerase Chain Reaction-positive HCWs showed that being a nurse and the number of COVID-19-related symptoms was associated with high depressive symptoms. These results suggest that HCWs in typical hospitals and nursing homes experiencing major COVID-19 outbreaks are more likely to exhibit severe depressive symptoms, which may worsen if infected with COVID-19. This study's findings expand the current understanding of HCWs' depressive symptoms and the importance of psychosocial support during unexpected major outbreaks in healthcare facilities.

[Evidence-based fracture prevention through preventing falls: evidence around prevention of hip fracture among the elderly with dementia].

There have been various studies on the prevention of falls and fractures in the elderly, from which we should select and implement effective prevention measures. The present report reviewed systematic review, meta-analysis and randomized controlled trial studies to give evidence-based recommendations for the fracture prevention.

[Preventive strategy of fall for the prevention of fractures in older people: a review of the evidence].

This review aims to examine the effectiveness of fall-related strategies for fracture prevention among elderly population. Previous studies were reviewed using PubMed and Japan Centra Revuo Medicina databases. Our five research questions concerned prediction of fracture using history of accidental falls, fracture risk management, and effectiveness of exercise programs, home modification and usage of hip protector. We used "accidental falls" and "fractures" as search strategies. Obtained results were as follows: a) History of falls predicts future hip fracture. b) Exercise programs including balance training have positive effects for fracture prevention. c) Fracture risk evaluation and management reduce the number of hip fractures among elderly population. d) Environmental hazard assessment and necessary home modification are effective in preventing fractures especially among elderly population with the history of falls. e) The hip protector is a beneficial device for the prevention of hip fractures among elderly people at high risk of falling.

[A review of intervention studies for prevention of falls in older people].

Falls are a well-known cause of hip fracture leading to hospitalization and bedridden status among older people. Intervention programs for prevention of falls in the elderly may therefor have considerable benefits in reducing disability and health care costs. The available literature on intervention programs to prevent falls by older people was here reviewed, using the Medline and Japana Centra Revuo Medicina databases for 1990 to 2000. The strategy used for the search was "falls of accident falls, intervention or intervention study, and cost or cost-effectiveness". Various types of interventions targeting both community dwelling and institutionalized elderly have been reported from western countries: home modification, exercise programs, and medical and behavioral interventions individualized according to the person's risk factors. Many internal and external risk factors of falls have been identified, and it has been proven that interventions to reduce these risk factors lower the incidence of falls and are cost-effective. Programs and services for the prevention of falls have been carried out in different regions of Japan, but few reports evaluated their effectiveness. Further implementation of falls prevention program should be accompanied by promotion of research in the efficacy area in Japan.

[Epidemiology of falling].

It has been only some 10 years since the study of falls among old people was initiated in Japan. The incidence of falls depends on age, sex, health condition including underlying diseases, and extrinsic factors (e.g. living environment). The incidence of falls among community-dwelling elderly in Japan varies from approximately 10 to 25%, however, that among the elderly people in medical or care institutions is approximately 20 to 35%, being lower than that in US and European countries. The incidence of falls was higher in women than in men, and that it increased sharply with advancing age. Fall experience within one year preceding the survey was one of the major significant predicting factors. The available literature showed that exercise programs have beneficial effects. The exercises need to be regular and sustainable.