Associations of COVID-19 vaccination during pregnancy with adverse neonatal and maternal outcomes: A systematic review and meta-analysis.

Objectives: The low COVID-19 vaccine uptake rate among pregnant women is mainly due to safety concerns about COVID-19 vaccines due to limited safety evidence. Our goal was to evaluate the safety of COVID-19 vaccination during pregnancy with up-to-date evidence. Methods: A comprehensive search of MEDLINE, EMBASE, the Cochrane Library, and clinicaltrials.gov was performed on April 5th, 2022, and updated on May 25th, 2022. Studies evaluating the association of COVID-19 vaccination during pregnancy with adverse maternal and neonatal outcomes were included. Two reviewers independently performed the risk of bias assessment and data extraction. Inverse variance random effect meta-analyses were performed to pool outcome data. Results: Forty-three observational studies were included. COVID-19 vaccination [96,384 (73.9%) BNT162b2, 30,889 (23.7%) mRNA-1273, and 3,172 (2.4%) other types] during pregnancy [23,721 (18.3%) in the first trimester, 52,778 (40.5%) in the second trimester, and 53,886 (41.2%) in the third trimester].was associated with reduced risks of stillbirth or neonatal death (OR, 0.74; 95% CI, 0.60-0.92). Sensitivity analysis restricted to studies in participants without COVID-19 showed that the pooled effect was not robust. COVID-19 vaccination during pregnancy was not associated with congenital anomalies (OR, 0.83; 95% CI, 0.63-1.08), preterm birth (OR, 0.98; 95% CI, 0.90-1.06), NICU admission or hospitalization (OR, 0.94; 95% CI, 0.84-1.04), an Apgar score at 5 min <7 (OR, 0.93; 95% CI, 0.86-1.01), low birth weight (OR, 1.00; 95% CI, 0.88-1.14), miscarriage (OR, 0.99; 95% CI, 0.88-1.11), cesarean delivery (OR, 1.07; 95% CI, 0.96-1.19), or postpartum hemorrhage (OR, 0.91; 95% CI, 0.81-1.01). Conclusions: COVID-19 vaccination during pregnancy was not associated with any of the adverse neonatal or maternal outcomes studied. Interpretation of study findings is limited by the types and timing of vaccination. The vaccinations in our study received during pregnancy were primarily mRNA vaccines administered in the second and third trimester. Future RCTs and meta-analysis are warranted to evaluate the efficacy and long-term effects of the COVID-19 vaccines. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022322525, identifier: PROSPERO, CRD42022322525.

Association Between Ideal Cardiovascular Health and Executive Function in Chinese Primary School Children.

Aims: Little information exists on the associations of cardiovascular health, a new metric proposed by the American Heart Association, and executive function, particularly in children. We aimed to explore this topic. Methods: We studied 3,798 children aged 6-12 years from 5 schools in Guangzhou, China. The executive function of children was evaluated using parent reports of the Behavioral Rating Inventory of Executive Function, which included 2 composite indexes and 8 subscale scores. We calculated the number of ideal cardiovascular health (range: 0-7) based on smoking, body mass index, physical activity (PA), diet, blood pressure, cholesterol, and glucose. A generalized linear mixed model was used to assess the association of the number of ideal cardiovascular health metrics and executive function. Results: Compared with children exhibiting 1-3 ideal cardiovascular health metrics, decreases of 1.37-2.63 points (indicating better performance) in metacognition index and its 5 subscale indexes (initiate, working memory, plan/organize, organization of materials, and monitor) were observed in children who attained 5 or 6-7 ideal metrics (all p for trend <0.001). Ideal diet and ideal PA were independently associated with lower indexes of behavioral regulation and metacognition. Conclusions: The number of ideal cardiovascular health was positively associated with performance of executive function in children.

Prevalence of Visual Impairment Among Students Before and During the COVID-19 Pandemic, Findings From 1,057,061 Individuals in Guangzhou, Southern China.

BACKGROUND: Visual impairment (VI) is a growing public health concern among students as a result of the COVID-19 pandemic. OBJECTIVE: This study investigated the change in VI before and during the pandemic among students. METHODS: Data on 547,864 and 497,371 students were obtained from the Guangzhou Survey on Students' Constitution and Health (GSSCH) collected in October 2019 and October 2020, respectively. VI was defined as the unaided distance visual acuity lower than 20/25 Snellen equivalent (LogMAR 0.10) in the worse eye. Change in VI based on age and sociodemographic variables were evaluated by chi-square test for trend as appropriate. Comparisons of different categorical variables were tested by contingency tables-based chi-square test. We have further analysis of the students who went through both of the 2019 and 2020 examinations for evaluating the VI incidence during the COVID-19 pandemic. RESULTS: More than 1,045,235 students were involved in our study, among whom 271,790 (54.65%) out of 497,371 students in Guangzhou suffered from VI during the COVID-19 compared with 293,001(53.48%) visually impaired students (total tested participants = 547,864) before the COVID-19 pandemic. During the pandemic, the overall prevalence of VI actually showed an increased age tendency and reached the highest level in the 17 [80.04%, 95%Confidence interval (CI):79.53 to 80.54%] and the 18 (79.64, 95%CI: 79.06 to 80.23%) age groups. Rapid growth was detected among students aged between 9 and 16 years old (raised by 46.21) while older students were more likely to get moderate and severe VI than younger ones. Students involved in more screen-based activities [(64.83%, 2019); (66.59%, 2020)] appeared to have a higher prevalence of VI than those involved in less [(49.17%, 2019); (49.26%, 2020)]. CONCLUSION: A rising trend of VI among students was detected before and during the COVID-19 pandemic. Moreover, the pandemic appeared to be associated with a rapid VI shift in younger and boy populations. Potential danger may arise when public health emergencies occur in the school, and more effort should be made to improve students' vision.

Current status and correlates of screen time among children in Guangdong during the COVID-19 pandemic

Objective To investigate the current status of online classes, screen time and its influencing factors among primary school students in Guangdong during the 2019 novel coronavirus pandemic. Methods Using the convenience sampling method, a total of 5 266 pupils aged 6-12-years-old from Guangzhou, Zhanjiang, and Zhongshan participated in the online questionnaire. ANOVA or chi-square tests were performed to compare differences in online classes and screen time between grades, and multinomial Logistic regression was performed to analyze the correlates of recreational screen time. Results The prevalence of prolonged recreational screen time was 42.2% and 55.2% on weekdays and weekends, respectively. Recreational screen time increased by 40.31 min/d on weekdays and 33.07 min/d on weekends, compared to usual school semesters. The average duration of an online class was (26.07+or-9.62) min, which totaled (110.41+or-51.98)min per day. Sex, grade, being the only child, and parents' education levels were identified as the influencing factors of prolonged recreational screen time. Children who practiced moderate levels (weekdays: OR=1.27;weekends: OR=1.40;P < 0.05) or lower levels of physical activity (weekdays: OR=1.86;weekend: OR=1.84;P < 0.05) were at a higher risk of prolonged recreational screen time than those who practiced more vigorous physical activity. Children whose parents limited their screen time to a moderate (weekdays: OR=1.61, P < 0.05) or lower level (weekdays: OR=1.32, P < 0.05) had a higher risk of prolonged recreational screen time than those with a higher frequency. Children with parents' recreational screen time 2 h/d had a higher risk of prolonged recreational screen time than the reference group;children who exhibited moderate to vigorous levels of physical activity < 1 h/d (weekdays: OR=1.31, P < 0.05), and those used electronic devices for learning 1-2 h/d (weekdays: OR=2.65;weekend: OR=2.65;P < 0.05) or for 2 h/d (weekdays: OR=4.05, weekend: OR=5.24, P < 0.05) were at a higher risk of prolonged recreational screen time than the reference group. Conclusion During the COVID-19 pandemic, the level of screen time among children in Guangdong was high. Behavioral monitoring and targeted interventions are needed to promote children's health.

Emotional and behavioral problems and determinants among primary and middle school students aged 6 to 17-year-old in Guangdong Province during the COVID-19 pandemic

Objective: To gain a better understanding of the emotional and behavioral problems associated determinants of primary and middle school students from Guangdong Province during the COVID-19 pandemic, so as to provide a basis for developing targeted intervention strategies.

Progression to fibrosing diffuse alveolar damage in a series of 30 minimally invasive autopsies with COVID-19 pneumonia in Wuhan, China.

AIMS: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), infection has been deemed as a global pandemic by the World Health Organisation. While diffuse alveolar damage (DAD) is recognised to be the primary manifestation of COVID-19 pneumonia, there has been little emphasis on the progression to the fibrosing phase of DAD. This topic is of great interest, due to growing concerns regarding the potential long-term complications in prolonged survivors. METHODS AND RESULTS: Here we report a detailed histopathological study of 30 autopsy cases with COVID-19 virus infection, based on minimally invasive autopsies performed between February and March, 2020. The mean age was 69 years, with 20 (67%) males and 10 (33%) females and frequent (70.0%) underlying comorbidities. The duration of illness ranged from 16 to 82 (median = 42) days. Histologically, the most common manifestation was diffuse alveolar damage (DAD) in 28 (93.3%) cases which showed predominantly acute (32%), organising (25%) and/or fibrosing (43%) patterns. Patients with fibrosing DAD were one decade younger (P = 0.034) and they had a longer duration of illness (P = 0.033), hospitalisation (P = 0.037) and mechanical ventilation (P = 0.014) compared to those with acute DAD. Patients with organising DAD had a longer duration of illness (P = 0.032) and hospitalisation (P = 0.023) compared to those with acute DAD. CONCLUSIONS: COVID-19 pneumonia patients who develop DAD can progress to the fibrosing pattern. While we observed fibrosing DAD in fatal cases, whether or not surviving patients are at risk for developing pulmonary fibrosis and the frequency of this complication will require further clinical and radiological follow-up studies.

Pathological Findings in the Testes of COVID-19 Patients: Clinical Implications.

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), involves multiple organs. Testicular involvement is largely unknown. OBJECTIVE: To determine the pathological changes and whether SARS-CoV-2 can be detected in the testes of deceased COVID-19 patients. DESIGN, SETTING, AND PARTICIPANTS: Postmortem examination of the testes from 12 COVID-19 patients was performed using light and electron microscopy, and immunohistochemistry for lymphocytic and histiocytic markers. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the virus in testicular tissue. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Seminiferous tubular injury was assessed as none, mild, moderate, or severe according to the extent of tubular damage. Leydig cells in the interstitium were counted in ten 400× microscopy fields. RESULTS AND LIMITATIONS: Microscopically, Sertoli cells showed swelling, vacuolation and cytoplasmic rarefaction, detachment from tubular basement membranes, and loss and sloughing into lumens of the intratubular cell mass. Two, five, and four of 11 cases showed mild, moderate, and severe injury, respectively. The mean number of Leydig cells in COVID-19 testes was significantly lower than in the control group (2.2 vs 7.8, p < 0.001). In the interstitium there was edema and mild inflammatory infiltrates composed of T lymphocytes and histiocytes. Transmission EM did not identify viral particles in three cases. RT-PCR detected the virus in one of 12 cases. CONCLUSIONS: Testes from COVID-19 patients exhibited significant seminiferous tubular injury, reduced Leydig cells, and mild lymphocytic inflammation. We found no evidence of SARS-CoV-2 virus in the testes in the majority (90%) of the cases by RT-PCR, and in none by electron microscopy. These findings can provide evidence-based guidance for sperm donation and inform management strategies to mitigate the risk of testicular injury during the COVID-19 disease course. PATIENT SUMMARY: We examined the testes of deceased COVID-19 patients. We found significant damage to the testicular parenchyma. However, virus was not detected in testes in the majority of cases.