Wide-Awake Local Anesthesia No Tourniquet (WALANT) for Flexor Tendon Repairs as Change in Practice During the COVID-19 Pandemic: A Retrospective Cohort Study With Outcomes

Background: The coronavirus disease 2019 (COVID-19) pandemic forced many changes. In our unit, there was a significant shift from traditional anesthesia (TA) which included general or regional anesthesia, to Wide-Awake Local Anesthesia No Tourniquet (WALANT) for the treatment of flexor tendon injuries. Zones I and II injuries have always been a challenge. The primary aim of this study is to compare the 12-week range of motion (ROM) flexor tendon repair outcomes between the TA group and wide-awake (WA) group patients. The secondary aim is to compare the complications and the follow-up rate between the two groups. Methods: All patients who underwent a primary finger flexor tendon repair in zone I or II without tendon graft for closed avulsions or open lacerations between April 2020 and March 2021 were included in the study. Electronic medical records were reviewed to record demographics, follow-up, ROM outcomes and complications. Results: Forty-four patients with 49 injured fingers were in the WA group, and 24 patients with 37 injured fingers were in the TA group. A complete follow-up with 12-week ROM outcomes was available for 15 patients with 16 injured fingers in the WA group and nine patients with 13 injured fingers in the TA group. Excellent to good outcomes in the WA group were reported in 56% of the cases versus 31% in the TA group, although the difference was not statistically significant. There were similar complications in both groups, with an overall rupture rate of 11.6%, a tenolysis rate of 3.5% and a reoperation rate of 9.3%. Complete 12-week follow-up was completed by 41% of patients overall after taking tendon ruptures into account. Conclusions: This is one of the first studies comparing zones I and II flexor tendon ROM outcomes between WA anesthesia and TA. Overall, there was a trend toward superior ROM outcomes in the WA group, with similar complication rates in both groups. The difference between ROM outcomes was not statistically significant and the small sample size undermined the strength of the study. To provide stronger evidence, better-designed prospective studies are suggested that would compare WA techniques with TA techniques.

COVAX - Time to reconsider the strategy and its target.

COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review.

The decline of paid overtime working in Britain

The share of paid‐for overtime hours within total paid‐for hours worked in Britain has declined from 5.4% to 2.0% between 1997 and 2020. We investigate this decline, focussing on its distribution across full‐time (f/t) and part‐time males and females and across 19 one‐digit industries. It is established that f/t males are dominant in the decline both of overtime working and overtime hours. We explore the implications of the decline on the share of overtime pay within total pay as well as on the gender pay gap. We test for economic, structural and cyclical influences on overtime working via a two‐part regression model that allows us to differentiate between the incidence of overtime working and weekly overtime hours of overtime employees. We examine how paid‐for overtime has varied with collective bargaining coverage, low pay, the 2008 financial crisis, the arrival of Covid‐19, job mobility and the public/private sector dichotomy. Combined marginal effects of changes in the incidence of overtime working and weekly overtime hours are also provided. The influence of the decline of collective bargaining in the last two decades on overtime working is highlighted using Blinder–Oaxaca decompositions.

Social, health and economic impact of COVID-19: Healthy Ageing In Scotland (HAGIS) - a protocol for a mixed-methods study.

INTRODUCTION: Public health responses to the COVID-19 pandemic have reaped adverse physical, psychological, social and economic effects, with older adults disproportionally affected. Psychological consequences of the pandemic include fear, worry and anxiety. COVID-19 fear may impact individuals' mitigation behaviours, influencing their willingness to (re)engage in health, social and economic behaviours. This study seeks (1) to develop a robust and evidence-based questionnaire to measure the prevalence of COVID-19 fear among older adults (aged ≥50) in Scotland and (2) to examine the impact of COVID-19 fear on the willingness of older adults to (re)engage across health, social and economic domains as society adjusts to the 'new normal' and inform policy and practice. METHODS AND ANALYSIS: This mixed-method study includes a large-scale multimodal survey, focus groups and interviews with older adults (aged ≥50) living in Scotland, and an email-based 'e-Delphi' consultation with professionals working with older adults. The COVID-19 fear scale was developed and validated using exploratory and confirmatory factor analyses. Survey data will be analysed using descriptive and inferential statistics. Thematic analysis will be used to analyse qualitative data. Survey and qualitative findings will be triangulated and used as the starting point for an 'e-Delphi' consensus consultation with expert stakeholders. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the University of Stirling for multimodal survey development, fieldwork methodology and data management. Anonymised survey data will be deposited with the UK Data Service, with a link provided via the Gateway to Global Ageing. Qualitative data will be deposited with the University of Stirling online digital repository-DataSTORRE. A dedicated work package will oversee dissemination via a coproduced project website, conference presentations, rapid reports and national and international peer-reviewed journal articles. There is planned engagement with Scottish and UK policy makers to contribute to the UK government's COVID-19 recovery strategy.

Impact of COVID-19 on the physical activity, quality of life and mental health of adolescent athletes: a 2-year evaluation of over 17 000 athletes.

PURPOSE: To evaluate the changes in mental health, quality of life (QOL) and physical activity (PA) among adolescent athletes during the COVID-19 pandemic as organised sports resumed. METHODS: Adolescent athletes completed surveys including demographic and sport participation information, 7-item Generalized Anxiety Disorder, 9-item Patient Health Questionnaire, Pediatric Quality of Life Inventory and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale in May 2020 following COVID-19-related sport cancellations (Spring20) and after returning to sports in May 2021 (Spring21). The groups were balanced by inverse propensity score weighting and compared using analysis of variance models and ordinal regression models. RESULTS: 17 421 participants were included (Spring20=13 002; Spring21=4419; 16.2±1.2 years; 53% female). Anxiety was significantly lower (better) in Spring21 (Spring20=7.0, 95% CI 6.9 to 7.1; Spring21=4.9, 95% CI 4.8 to 5.0, p<0.001), as was the prevalence of moderate to severe anxiety (Spring20=29.4%, Spring21=17.1%, p<0.001). Depression was significantly improved in Spring21 (Spring20=7.6, 95% CI 7.5 to 7.7; Spring21=4.6, 95% CI 4.5 to 4.8, p<0.001), as was the prevalence of moderate to severe depression (Spring20=32.2%, Spring21=15.4%, p<0.001). Athletes in Spring21 reported higher QOL (Spring20=79.6, 95% CI 79.3 to 79.9; Spring21=84.7, 95% CI 84.4 to 85.0, p<0.001) and increased levels of PA (Spring20=13.8, 95% CI 13.6 to 13.9; Spring21=22.7, 95% CI 22.6 to 22.9, p<0.001). CONCLUSION: Early COVID-19 sports restrictions were associated with worsening mental health in adolescents. In 2021, after returning to sports, athletes reported significant improvements in mental health, QOL and PA, although mental health adversities remain an important priority.

A Multi-year Assessment of Sport Participation During the COVID-19 Pandemic on the Health of Adolescent Athletes.

CONTEXT: Sport cancellations early in the COVID-19 pandemic had a significant negative impact on the health of US adolescents. The impact of restarting sports during the COVID-19 pandemic has not been described. OBJECTIVE: To identify the impact of sport participation on the health of adolescents before and during the COVID-19 pandemic. DESIGN: Cross-sectional study. SETTING: Sample recruited via social media. PATIENTS OR OTHER PARTICIPANTS: Wisconsin adolescent athletes. MAIN OUTCOME MEASURE(S): Participants provided information regarding their age, sex, sports participation and completed the Patient Health Questionnaire-9 Item (PHQ-9) to assess depressive symptoms, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS-PFABS) to measure physical activity (PA) and the Pediatric Quality of Life Inventory 4.0 (PedsQL) to measure Quality of Life (QoL). METHODS: Data were collected in spring 2021 (Spring21) (n=1906 age=16.0±1.2, female=49%), when interscholastic sports had fully resumed, and were compared to similar cohorts of adolescent athletes at two different time points that included 1) spring 2020 (Spring20) (n=3243, age=16.2±1.2, female=58%), when sports were cancelled, and 2) 2016-2018 (PreCOVID-19) prior to the pandemic (n=5231, age=15.7±1.1, female=65%). Comparisons were made via ANOVA models and ordinal regressions with age and sex as covariates. RESULTS: The prevalence of moderate to severe depression was lower in Spring21 than Spring20, but higher than PreCOVID-19 (PreCOVID-19=5.3%, Spring20=37.8%, Spring21=22.8%, p<0.001). PA levels (mean [95%CI] were higher in Spring21 than Spring20 but lower than PreCOVID-19 (PreCOVID-19=23.1 [22.7, 23.5]), Spring20=13.5 [13.3, 13.7], Spring21=21.9 [21.6, 22.2]. Similarly, QoL scores were higher in Spring21 than Spring20 but lower than PreCOVID-19 (PreCOVID-19=92.8 [92.5, 93.1]) Spring20=80.7 [80.3, 81.1], Spring21=84.3 [83.8, 84.8]). CONCLUSIONS: Though sports have restarted, clinicians should be aware that physical activity, mental health, and QoL are still significantly affected by the ongoing pandemic in adolescent athletes.

Psychosocial Benefits of Sport Participation During COVID-19 Are Only Partially Explained by Increased Physical Activity.

CONTEXT: Although the return to sports during COVID-19 has been associated with improvements in quality of life (QOL) and mental health, it is unknown whether these benefits are primarily due to increases in physical activity (PA). OBJECTIVE: The purpose of this study was to determine whether PA increases were responsible for the improvements in mental health and QOL among adolescents who returned to sport during the COVID-19 pandemic. DESIGN: Cross-sectional. SETTING: Wisconsin secondary schools. PARTICIPANTS: 559 adolescent athletes (15.7+1.2 yrs., female = 43.6%) from 44 schools completed a survey in October 2020. MAIN OUTCOME MEASURES: Demographic information, whether they had returned to sport participation (no [DNP], yes [PLY]), school instruction type, anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), QOL (Pediatric Quality of Life Inventory 4.0), and PA (Hospital for Special Surgery Pediatric Functional Activity Brief Scale). Mediation analysis assessed whether the relationship between sport status and anxiety, depression, and QOL was mediated by PA. RESULTS: Of the 559 total athletes included, 171 (31%) athletes had returned to play, while 388 had not. PLY athletes had significantly lower anxiety (3.6±0.4 v 8.2±0.6, p<0.001) and depression (4.2±0.4 v 7.3±0.6, p<0.001), and significantly higher QOL (88.1±1.0 v 80.2±1.4, p<0.001) and PA (24.0±0.5 v 16.3±0.7, p<0.001). PA explained a significant, but small proportion of the difference in depression (22.1%, p=0.02) and QOL (16.0%, p=0.048) between PLY and DNP athletes, but not anxiety (6.6%, p=0.20). CONCLUSIONS: Increased PA is only responsible for a small portion of the improvements in depression and QOL among athletes who returned to sports. This suggests that most of the mental health benefits of sport participation for adolescents during the COVID-19 pandemic are independent of the benefits of increased PA.

STRESS TESTING THE FISCAL FRAMEWORK

The part of the UK fiscal framework which determines how UK government funding is allocated across the four home nations has undergone profound change since 2012, given tax and social security devolution. The UK government's post-Brexit plans for regional development funding, state aid, regulation and trade negotiations have led to significant disagreements about the nature of the devolved fiscal and constitutional settlement. And the COVID-19 pandemic provided a major shock to a fiscal system with limited flexibility for the Scottish, Welsh and Northern Irish devolved governments. This paper reviews the changes and challenges faced during these reforms and policy shocks. We find that: tensions about reforms to funding arrangements reflect the inconsistency of principles guiding the reforms;that the UK government's post-Brexit plans do reduce the policy autonomy of the devolved governments, but reflect powers central governments often have in even highly decentralised countries;and that temporary changes to rules and the nature of the COVID-19 pandemic prevented a subnational fiscal crisis, but that more systematic change may make the system more robust to future shocks. This suggests that a review of the principles underpinning the UK's subnational fiscal and economic policies would be highly worthwhile.

COVID-19 vaccine delivery: an opportunity to set up systems for the future.

The race to develop safe and effective SARS-COV-2 vaccines has moved with unprecedented speed. There are now multiple promising candidates seeking emergency use authorization from the United States Food and Drug Administration and a host of candidates positioned for approval worldwide. Attention has now turned to allocation, distribution and verification of these vaccines, yet this focus exposes that the underlying infrastructure for global delivery and monitoring is threadbare and unevenly distributed. This presents both a barrier and an opportunity to deploy sustainable infrastructure. Major global stakeholders must convene quickly, collaborate, and collectively invest in global standards, legal models, common vocabularies and interoperable biometric-supported digital health technologies. As the COVID-19 vaccine effort scales, governments, private sector and NGOs have the chance to place lasting resources needed for equitable and effective delivery that can pay dividends into the future.

The Impact of COVID-19 Related School Closures and SPORT CANCELLATIONS on the Health of Adolescent Athletes

Background: In March 2020, schools were closed to in-person teaching and interscholastic sports cancelled in an attempt to slow the spread of the COVID-19. Child health experts have stated that school closures may have profound psychosocial consequences for students and need further study. Hypothesis/Purpose: To identify how COVID-19 related school closures and sport cancellations impacted the health of adolescent athletes. Methods: Adolescent athletes in Wisconsin were recruited via social media to complete an online survey in May 2020 while schools were closed to in-person teaching and interscholastic and club sports were cancelled. Assessments included the: General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. PHQ-9, PFABS and PedsQL scores were compared with historical data (HD) of Wisconsin adolescent athletes (N = 5,231) collected during normal school and sport operations in the years 2016–2018. Results: A total of 3,243 (58% female, Age = 16.1+1.2 yrs., grades 9 – 12) participated in the study. May 2020 participants reported higher (worse) PHQ-9 scores than the HD participants (mean: 8.0 (95%CI: 7.8, 8.2) vs 3.3 (3.1, 3.5), p < 0.001) as well as a higher prevalence of moderate to severe levels of depression (32.9% vs 9.7%, p < 0.001). May 2020 Participants also reported lower (worse) PFABS scores (mean: 12.2 (95%CI: 11.9, 12.5) vs 24.7 (24.5, 24.9) p < 0.001) and lower (worse) PedsQL total scores compared to athletes in the HD group (78.4 (78.0, 78.8) vs. 90.9 (90.5, 91.3) p < 0.001). Females in May 2020 reported increased moderate and severe anxiety percentages than the males in May 2020 (27.7% vs 22.3%, p < 0.001). Conclusions: COVID-19 related school closures and sport cancellations in Wisconsin were associated with increased anxiety and depression as well as decreased physical activity and quality of life in adolescent athletes. The potential negative health impacts of prolonged school closures and sport cancellations should be taken into account when evaluating steps to limit the spread of COVID-19.

High School Sports During the COVID-19 Pandemic: The Effect of Sport Participation on the Health of Adolescents.

CONTEXT: During the fall of 2020, some high schools across the United States allowed their students to participate in interscholastic sports while others cancelled or postponed their sport programs due to concerns regarding COVID-19 transmission. What effect this has had on the physical and mental health of adolescents is unknown. OBJECTIVE: To identify the effect of playing a sport during the COVID-19 pandemic on the health of student-athletes. DESIGN: Cross-sectional study. SETTING: Sample recruited via email. PATIENTS OR OTHER PARTICIPANTS: A total of 559 Wisconsin high school athletes (age = 15.7 ± 1.2 years, female = 43.6%, male = 56.4%) from 44 high schools completed an online survey in October 2020. A total of 171 (30.6%) athletes played (PLY) a fall sport, while 388 (69.4%) did not play (DNP). MAIN OUTCOME MEASURE(S): Demographic data included sex, grade, and sport(s) played. Assessments were the General Anxiety Disorder-7 Item for anxiety, Patient Health Questionnaire-9 Item for depression, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale for physical activity, and the Pediatric Quality of Life Inventory 4.0 for quality of life. Univariable comparisons between the 2 groups were made via t tests or χ2 tests. Means for each continuous outcome measure were compared between groups using analysis-of-variance models that controlled for age, sex, teaching method (virtual, hybrid, or in person), and the percentage of students eligible for free or reduced-price lunch. RESULTS: The PLY group participants were less likely to report moderate to severe symptoms of anxiety (PLY = 6.6%, DNP = 44.1%, P < .001) and depression (PLY = 18.2%, DNP = 40.4%, P < .001). They also demonstrated higher (better) Pediatric Functional Activity Brief Scale scores (PLY = 23.2 [95% CI = 22.0, 24.5], DNP = 16.4 [95% CI = 15.0, 17.8], P < .001) and higher (better) Pediatric Quality of Life Inventory total scores (PLY = 88.4 [95% CI = 85.9, 90.9], DNP = 79.6 [95% CI = 76.8, 82.4], P < .001). CONCLUSIONS: Adolescents who played a sport during the COVID-19 pandemic described fewer symptoms of anxiety and depression and had better physical activity and quality-of-life scores compared with adolescent athletes who did not play a sport.

The U-shape of Happiness in Scotland

We examine well-being in Scotland using micro data from the Scottish Health Survey and the UK Annual Population Surveys. We find evidence of a midlife low in Scotland in well-being at around age fifty using a variety of measures of both happiness and unhappiness. We confirm that higher consumption of fruit and vegetables is associated with higher levels of happiness in Scotland. We compare this with evidence for England from the Health Survey of England. The decline in well-being between youth and midlife is comparable in size to the loss of a spouse or of a job and around half of the fall in well-being in the COVID-19 lockdown. We also find a mid-life peak in suicides in Scotland. Despite higher mortality and suicide rates in Scotland than in England, paradoxically we find that the Scots are happier than the English. Northern Ireland is the happiest of the four home countries. We also find evidence of U-shapes in England, Wales and Northern Ireland in the mid to late forties.

Relative Burdens of the COVID-19, Malaria, Tuberculosis, and HIV/AIDS Epidemics in Sub-Saharan Africa.

COVID-19 has had considerable global impact; however, in sub-Saharan Africa, it is one of several infectious disease priorities. Prioritization is normally guided by disease burden, but the highly age-dependent nature of COVID-19 and that of other infectious diseases make comparisons challenging unless considered through metrics that incorporate life-years lost and time lived with adverse health. Therefore, we compared the 2020 mortality and disability-adjusted life-years (DALYs) lost estimates for malaria, tuberculosis, and HIV/AIDS in sub-Saharan African populations with more than 12 months of COVID-19 burden (until the end of March 2021) by applying known age-related mortality to United Nations estimates of the age structure. We further compared exacerbations of disease burden predicted from the COVID-19 public health response. Data were derived from public sources and predicted exacerbations were derived from those published by international agencies. For sub-Saharan African populations north of South Africa, the estimated recorded COVID-19 DALYs lost in 2020 were 3.7%, 2.3%, and 2.4% of those for tuberculosis, HIV/AIDS, and malaria, respectively. Predicted exacerbations of these diseases were greater than the estimated COVID-19 burden. Including South Africa and Lesotho, COVID-19 DALYs lost were < 12% of those for other compared diseases; furthermore, the mortality of compared diseases were dominant in all age groups younger than 65 years. This analysis suggests the relatively low impact of COVID-19. Although all four epidemics continue, tuberculosis, HIV/AIDS, and malaria remain far greater health priorities based on their disease burdens. Therefore, resource diversion to COVID-19 poses a high risk of increasing the overall disease burden and causing net harm, thereby further increasing global inequities in health and life expectancy.

The U-shape of Happiness in Scotland

Abstract We examine well-being in Scotland using micro data from the Scottish Health Survey and the UK Annual Population Surveys. We find evidence of a midlife nadir or zenith in Scotland in well-being at around age fifty using a variety of measures of both happiness and unhappiness. We confirm that higher consumption of fruit and vegetables is associated with higher levels of happiness in Scotland. We compare this with evidence for England from the Health Survey of England. The decline in well-being between youth and midlife is comparable in size to the loss of a spouse or of a job and around half of the fall in well-being in the COVID-19 lockdown. We also find a mid-life peak in suicides in Scotland. Despite higher mortality and suicide rates in Scotland than in England, paradoxically we find that the Scots are happier than the English. Northern Ireland is the happiest of the four home countries. We also find evidence of U-shapes in England, Wales and Northern Ireland in the mid to late forties.

Changes in the Health of Adolescent Athletes: A Comparison of Health Measures Collected Before and During the COVID-19 Pandemic.

CONTEXT: In spring 2020, schools closed to in-person teaching and sports were cancelled to control the transmission of COVID-19. The changes that affected the physical and mental health among young athletes during this time remain unknown. OBJECTIVE: To identify changes in the health (mental health, physical activity, and quality of life) of athletes that occurred during the COVID-19 pandemic. DESIGN: Cross-sectional study. SETTING: Sample recruited via social media. PATIENTS OR OTHER PARTICIPANTS: A total of 3243 Wisconsin adolescent athletes (age = 16.2 ± 1.2 years, 58% female) were surveyed in May 2020 (During COVID-19). Measures for this cohort were compared with previously reported data for Wisconsin adolescent athletes (n = 5231; age = 15.7 ± 1.2 years, 47% female) collected in 2016 to 2018 (PreCOVID-19). MAIN OUTCOME MEASURE(S): Demographic information included sex, grade, and sport(s) played. Health assessments included the Patient Health Questionnaire-9 Item to identify depression symptoms, the Pediatric Functional Activity Brief Scale to gauge physical activity, and the Pediatric Quality of Life Inventory 4.0 to evaluate health-related quality of life. Univariable comparisons of these variables between groups were conducted via t or χ2 tests. Means and 95% CIs for each group were estimated using survey-weighted analysis-of-variance models. RESULTS: Compared with preCOVID-19 participants, a larger proportion of During COVID-19 participants reported moderate to severe levels of depression (9.7% versus 32.9%, P < .001). Scores of the During COVID-19 participants were 50% lower (worse) on the Pediatric Functional Activity Brief Scale (mean [95% CI] = 12.2 [11.9, 12.5] versus 24.7 [24.5, 24.9], P < .001) and the Pediatric Quality of Life Inventory 4.0 compared with the PreCOVID-19 participants (78.4 [78.0, 78.8] versus 90.9 [90.5, 91.3], P < .001). CONCLUSIONS: During the COVID-19 pandemic, adolescent athletes described increased symptoms of depression, decreased physical activity, and decreased quality of life compared with adolescent athletes in previous years.

Mental Health, Physical Activity, and Quality of Life of US Adolescent Athletes During COVID-19-Related School Closures and Sport Cancellations: A Study of 13 000 Athletes.

CONTEXT: In the spring of 2020, US schools closed to in-person teaching and sports were cancelled to control the transmission of coronavirus disease 2019 (COVID-19). It is critical to understand the mental and physical health of adolescent athletes during this time. OBJECTIVE: To describe the health of athletes during COVID-19-related school closures and sport cancellations. DESIGN: Cross-sectional study. SETTING: A national sample recruited via social media. PATIENTS OR OTHER PARTICIPANTS: A total of 13 002 US adolescent athletes (age = 16.3 ± 1.2 years, females = 52.9%, males = 47.0%) completed an anonymous online survey. MAIN OUTCOME MEASURE(S): Demographic information collected was sex, grade, sport(s) played, and zip code. Assessments used were the General Anxiety Disorder 7-Item for anxiety, Patient Health Questionnaire 9-Item for depression, the Pediatric Functional Activity Brief Scale for physical activity, and the Pediatric Quality of Life Inventory 4.0 for quality of life. Mental health, physical activity, and health-related quality-of-life variables were compared among sex, grade, sport(s) played, and poverty level using means and 95% confidence intervals (CIs) from the survey-weighted analysis of variance. RESULTS: Females reported a higher prevalence of moderate to severe anxiety symptoms (females = 43.7% versus males = 28.2%). The Pediatric Functional Activity Brief Scale score was highest (best) for grade 9 (mean = 14.5, 95% CI = 14.0, 15.0) and lowest for grade 11 (mean = 10.9, 95% CI = 10.5, 11.3). The prevalence of depression symptoms was highest in team sport (74.1%) and lowest in individual sport (64.9%) participants. The total Pediatric Quality of Life Inventory score was lowest (worst) for athletes from counties with the highest poverty levels (high: mean = 74.5, 95% CI = 73.7, 75.3; middle: mean = 78.9, 95% CI = 78.0, 79.8; and low: mean = 78.3, 95% CI = 77.4, 79.1). CONCLUSIONS: The health of US adolescents during the COVID-19-related school closures and sport cancellations varied to differing degrees depending on sex, grade level, type of sport participation, and level of poverty. Health policy experts should consider these findings in the future when creating and implementing policies to improve the health of adolescents in the United States.

Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic.

INTRODUCTION AND OBJECTIVES: The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population. METHODS: A prospective single-centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multidisciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020-15th May 2020) compared to pre-COVID-19 (18th of January 2020-17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed. RESULTS: Overall, there was a reduction in neurosurgical emergency referrals by 33.6% and operations by 55.6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75.2% of total, n=155) when compared to pre-COVID-19 (n = 198, 43.7% of total, p < 0.00001). In contrast to other published series, the 30-day perioperative mortality remained low (2.0%) with the majority of post-operative COVID-19-infected patients (n = 13) having underlying medical co-morbidities and/or suffering from post-operative complications. CONCLUSION: The capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology to run clinics and MDTs, restructuring patient pathways/facilities, and initiating the delivery of NHS care within private sector hospitals. Through this multi-modal approach we were able to minimize service disruptions, the complications, and mortality.

Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda.

The COVID-19 pandemic and public health "lockdown" responses in sub-Saharan Africa, including Uganda, are now widely reported. Although the impact of COVID-19 on African populations has been relatively light, it is feared that redirecting focus and prioritization of health systems to fight COVID-19 may have an impact on access to non-COVID-19 diseases. We applied age-based COVID-19 mortality data from China to the population structures of Uganda and non-African countries with previously established outbreaks, comparing theoretical mortality and disability-adjusted life years (DALYs) lost. We then predicted the impact of possible scenarios of the COVID-19 public health response on morbidity and mortality for HIV/AIDS, malaria, and maternal health in Uganda. Based on population age structure alone, Uganda is predicted to have a relatively low COVID-19 burden compared with an equivalent transmission in comparison countries, with 12% of the mortality and 19% of the lost DALYs predicted for an equivalent transmission in Italy. By contrast, scenarios of the impact of the public health response on malaria and HIV/AIDS predict additional disease burdens outweighing that predicted from extensive SARS-CoV-2 transmission. Emerging disease data from Uganda suggest that such deterioration may already be occurring. The results predict a relatively low COVID-19 impact on Uganda associated with its young population, with a high risk of negative impact on non-COVID-19 disease burden from a prolonged lockdown response. This may reverse hard-won gains in addressing fundamental vulnerabilities in women and children's health, and underlines the importance of tailoring COVID-19 responses according to population structure and local disease vulnerabilities.