Association between work attendance when experiencing fever or cold symptoms and company characteristics and socioeconomic status in the COVID-19 pandemic in Japanese workers: a cross-sectional study

Objective: This study investigated the association between attending work while experiencing fever or cold symptoms and workers' socioeconomic background and company characteristics during the COVID-19 pandemic. Methods: A cross-sectional online survey was performed. Of a total of 33,302 participants, 3,676 workers who experienced fever or cold symptoms after April 2020 were included. The odds ratios (ORs) of attending work while sick associated with workers' socioeconomic background and company characteristics were evaluated using a multilevel logistic model. Results: The OR of attending work while sick associated with a lack of policy prohibiting workers from working when ill was 2.75 (95%CI: 2.28-3.20, P<0.001). Conclusion: This study suggests that clear company policies on work and illness can be effective for preventing employees from attending work while sick.

Prospective cohort study of socioeconomic status and subsequent unemployment under COVID-19 in Japan

Background: This study examined the relationship between socioeconomic status (SES) and subsequent unemployment. Methods: This prospective cohort study was conducted using a self-administrated questionnaire in Japan. SES, personal characteristics, and occupation of recruited workers were surveyed at baseline (December 22-25, 2020); subsequent unemployment was examined at follow-up (February 18-19, 2021). We determined the odds ratios (ORs) of unemployment for SES and other variables using a multilevel logistic model. Results: Among all 19,941 participants, 2.3% reported experience of unemployment through negative reasons. Multivariate analysis showed the OR and 95% confidence interval for unemployment associated with age to be 0.66 (0.47-0.92) for 30-39 years, 0.36 (0.25-0.51) for 40-49, 0.36 (0.25-0.53) for 50-59, and 0.43 (0.27-0.67) for more than 60 compared with 20-29 years. The association with annual household income was 2.96 (1.94-4.50) for <2 million yen and 1.51 (1.03-2.22) for 2-4 million yen compared with >10 million yen. The association with marital status was 1.43 (1.04-1.98) for bereaved/divorced compared with married (working spouse). The association with occupation was 1.75 (1.35-2.29) for temporary or contract employees and 2.11 (1.04-4.30) for agriculture, forestry, or fishing compared with general employees. The association with job type was 1.69 (1.34-2.15) for mainly manual labor. Conclusion: We observed a relationship between SES and subsequent unemployment under COVID-19. It is necessary to provide broad, ongoing support in the form of both short-term assistance and long-term job training and health care.

Gender differences in housework and childcare among Japanese workers during the COVID-19 pandemic.

Objectives: Although gender stereotypes regarding paid work and unpaid work are changing, most wives are responsible for taking care of the family and home in Japan. It is unclear how time spent on housework and childcare has changed between working men and women during the COVID-19 pandemic in Japan. The purpose of this study is to investigate how working men and women's responsibilities for housework and childcare changed during the COVID-19 pandemic in Japan depending on occupation, job type, and the number of employees in the workplace. Methods: A cross-sectional analysis (N=14,454) was conducted using data from an internet monitoring study (CORoNa Work Project), which was conducted in December 2020. A multilevel logistic model with nested prefectures of residence was conducted to estimate the odds ratio (OR) for change in time devoted to housework and childcare among men and women adjusting for age, household income, frequency of telecommuting, presence of spouse who work, occupation, job type, the number of employees in the workplace, and the incidence rate of COVID-19 by prefecture. Results: Regardless of occupation related factors, more women than men reported increased time spent on housework and childcare. Furthermore, women were significantly more likely to experience an increase in time spent on those activities than men (housework: OR 1.97 , 95% CI [1.75, 2.21], p < 0.001; childcare: OR 1.66, 95% CI [1.37, 2.02], p < 0.001). Conclusions: The time spent by women on housework and childcare increased significantly compared to men during the COVID-19 pandemic in Japan.

Prospective cohort study of workers diagnosed with COVID-19 and subsequent unemployment

Objectives: The purpose of this study was to investigate the relationships of workers being diagnosed with coronavirus disease 2019 (COVID-19) and being identified as close contacts of infected persons with unemployment in Japan. Methods: This was a prospective cohort study using questionnaires about COVID-19 administered to Japanese workers. A baseline survey conducted on December 22-25, 2020, was used to determine history of being diagnosed with COVID-19 or being identified as a close contact of an infected person. Unemployment since the baseline survey was ascertained with a follow-up survey on February 18 and 19, 2021. The odds ratios of unemployment were estimated using a multilevel logistic model with adjusted covariates nested in prefecture of residence. Results: Women (n=8,771) accounted for 44% of the total sample (n=19,941), and the mean age was 48.0 years. In terms of unemployment because of negative reasons, the multivariate analysis showed that the odds ratio of unemployment associated with being diagnosed with COVID-19 was 2.18 (95% CI: 1.05-4.55) and that the odds ratio associated with being identified as a close contact was 0.93 (95% CI: 0.29-2.95). Conclusions: There is an association between workers being diagnosed with COVID-19 and unemployment. Occupational health professionals should follow up closely with workers diagnosed with COVID-19 after they return to work to prevent them from becoming unemployed against their will.

The association between loneliness during the COVID-19 pandemic and psychological distress

The purpose of this study was to examine the association between loneliness and psychological distress during the COVID-19 pandemic in Japan. We conducted a cross-sectional, online study from 22 to 26 December 2020. A total of 27,036 participants, all employed at the time of the survey, were included in the analysis. Participants were asked if they felt loneliness in a single-item question. The Kessler 6 (K6) was used to assess psychological distress defined as K6 scores of 5 or higher, and 13 or higher. The odds ratios (ORs) of psychological distress associated with loneliness were estimated using a multilevel logistic model nested in the prefecture of residence, with adjustment for age, sex, marital status, equivalent income, educational level, smoking, alcohol consumption, job type, number of workplace employees, and cumulative incidence rate of COVID-19 in the prefecture. Communication with friends, acquaintances, and family was strongly associated with psychological distress, so we adjusted for these factors and eating meals alone. Results showed a significant association between loneliness and psychological distress (OR = 36.62, 95%CI = 32.95-40.69). Lack of friends to talk to, lack of acquaintances to ask for help, and lack of people to communicate with through social networking sites were all strongly associated with psychological distress, as were family time and solitary eating. Even after adjusting for these factors, loneliness was still strongly associated with psychological distress (OR = 29.36, 95%CI = 26.44-32.98). The association between loneliness during the COVID-19 pandemic and psychological distress indicates the need for intervention.

Factors Associated with Neonatal Mortality in Bangladesh: A Multilevel Analysis

This study aims at disentangling the influence of both individual and community level factors on neonatal death in Bangladesh. For analysis purpose, data are extracted from Bangladesh Demographic and Health Survey 2014. Bivariate analysis is used to examine the differentials in neonatal mortality by selected background variables of both levels. As the survey is based on a two-stage stratified sample of households, multilevel logistic regression model is used to analyze the cluster effect and to determine the factors associated with neonatal mortality. Multilevel logistic model confirmed that there exists clustering impact on neonatal death. Moreover, the study has suggested implementation of intervention addressing several individual and community level factors to ameliorate the current neonatal health scenario in Bangladesh. Dhaka Univ. J. Sci. 69(1): 15-21, 2021 (January)

Worries about COVID-19 infection and psychological distress at work and while commuting

ObjectiveThis study examined the relationship between worry about COVID-19 infection in general, in the workplace and while commuting to work and psychological distress in the midst of a rapid outbreak of COVID-19 in Japan.MethodsThis cross-sectional, internet monitor study was conducted on December 22– 26, 2020. Subjects were collected from throughout Japan. Out of a total of 33,302 participants, 26,841 people were included in the study after removing those providing fraudulent responses. The subjects were asked single-item questions about whether they were worried about COVID-19 infection in general, at work and while commuting to work. Kessler 6 (K6) was used to assess psychological distress. The odds ratios (ORs) of psychological distress associated with worry about infection were estimated using a multilevel logistic model nested in the prefecture of residence, with adjustment for sex, age, education, equivalent household income, occupation, number of business establishments, smoking status, alcohol consumption, frequency of telecommuting, use of public transportation, perceived assessment of workplace infection control efforts, presence of infection among acquaintances, and experience of being a close contact. Psychological distress was defined as a K6 score of 5 or higher and 13 or higher.ResultsMultivariate analysis showed that the OR of severe psychological distress associated with general worry about COVID-19 infection was 1.10 (95% CI 1.00–1.22). The OR was significantly higher in association with worry about infection in the workplace at 1.71 (95%CI 1.53–1.92) and worry about infection while commuting at 1.49 (95%CI 1.32–1.67).ConclusionsThe present study suggests the need for psychological intervention to reduce worry about infection in response to public mental health challenges associated with the COVID-19 pandemic.

Inpatient fluoroquinolone use in Veterans’ Affairs hospitals is a predictor of Clostridioides difficile infection due to fluoroquinolone-resistant ribotype 027 strains

Background:Reduction in the use of fluoroquinolone antibiotics has been associated with reductions in Clostridioides difficile infections (CDIs) due to fluoroquinolone-resistant strains.Objective:To determine whether facility-level fluoroquinolone use predicts healthcare facility-associated (HCFA) CDI due to fluoroquinolone-resistant 027 strains.Methods:Using a nationwide cohort of hospitalized patients in the Veterans’ Affairs Healthcare System, we identified hospitals that categorized >80% of CDI cases as positive or negative for the 027 strain for at least one-quarter of fiscal years 2011–2018. Within these facilities, we used visual summaries and multilevel logistic regression models to assess the association between facility-level fluoroquinolone use and rates of HCFA-CDI due to 027 strains, controlling for time and facility complexity level, and adjusting for correlated outcomes within facilities.Results:Between 2011 and 2018, 55 hospitals met criteria for reporting 027 results, including a total of 5,091 HCFA-CDI cases, with 1,017 infections (20.0%) due to 027 strains. Across these facilities, the use of fluoroquinolones decreased by 52% from 2011 to 2018, with concurrent reductions in the overall HCFA-CDI rate and the proportion of HCFA-CDI cases due to the 027 strain of 13% and 55%, respectively. A multilevel logistic model demonstrated a significant effect of facility-level fluoroquinolone use on the proportion of infections in the facility due to the 027 strain, most noticeably in low-complexity facilities.Conclusions:Our findings provide support for interventions to reduce use of fluroquinolones as a control measure for CDI, particularly in settings where fluoroquinolone use is high and fluoroquinolone-resistant strains are common causes of infection.

P1849ANALYSIS OF ASSOCIATION BETWEEN URBANIZATION AND REDUCED RENAL FUNCTION IN INDIAN POPULATION

Background and Aims While chronic kidney disease (CKD) is a growing public health concern in low- and middle-income countries, such as India, few studies have investigated the association between urbanization and the occurrence of CKD in those countries. METHODS We investigated the association between urbanization and estimated glomerular filtration rate (eGFR), an important CKD risk marker. Data came from the India Health and Nutrition Survey wave 2017, in which we collected fasting serum, individual and household data along with community level urbanization data, which was used to derive a study-specific urbanization measure, in 218 communities across fifteen states. A total of 8754 men and 8566 women participants aged 18 years or older were included in the analysis. Reduced renal function was defined as eGFR of less than 60 mL/min/1.73 m2 measured using serum creatinine concentration (mg/dL). RESULTS After adjusting for socio-demographic (e.g., age, education and household income), a sex-stratified multilevel logistic model revealed that living in a more urbanized community was associated with higher odds of reduced eGFR (odds ratio [OR] = 1.38 per one-standard deviation [SD] increase in the CHNS specific urbanization index, 95% confidence interval [CI] = 1.11-1.73 for men; OR = 1.35, 95% CI = 1.11-1.62 for women). After adjusting for behavioral variables (i.e., alcohol consumption, smoking, physical activity and diet), as well as obesity and cardiometabolic risk factors, the association was attenuated in men (OR = 1.25, 95% CI = 0.98-1.59), but remained statistically significant in women (OR = 1.24, 95% CI = 1.01-1.52). CONCLUSION Our findings suggest that living in an urban environment is linked with higher odds of reduced renal function independently of behavioral and cardiometabolic risk factors, which have been shown to increase along with urbanization.