Characteristics associated with influenza vaccination uptake in pregnancy: a retrospective cohort study.

BACKGROUND: Pregnant women are at increased risk from influenza, yet maternal influenza vaccination levels remain suboptimal. AIM: To estimate associations between sociodemographic and health characteristics and seasonal influenza vaccination uptake among pregnant women, and to understand trends over time to inform interventions to improve vaccine coverage. DESIGN AND SETTING: Retrospective cohort study using linked electronic health records of women in North West London with a pregnancy overlapping an influenza season between September 2010 and February 2020. METHOD: A multivariable mixed-effects logistic regression model was used to identify associations between characteristics of interest and the primary outcome of influenza vaccination. RESULTS: In total, 451 954 pregnancies, among 260 744 women, were included. In 85 376 (18.9%) pregnancies women were vaccinated against seasonal influenza. Uptake increased from 8.4% in 2010/11 to 26.4% in 2017/18, dropping again to 21.1% in 2019/20. Uptake was lowest among women aged 15-19 years (11.9%; reference category) or ≥40 years (15.2%; odds ratio [OR] 1.17, 95% confidence interval [CI] = 1.10 to 1.24); of Black (14.1%; OR 0.55, 95% CI = 0.53 to 0.57) or unknown ethnicity (9.9%; OR 0.42, 95% CI = 0.39 to 0.46); who lived in more deprived areas (OR least versus most deprived [reference category] 1.16, 95% CI = 1.11 to 1.21); or with no known risk factors for severe influenza. CONCLUSION: Seasonal influenza vaccine uptake in pregnant women increased in the decade before the COVID-19 pandemic, but remained suboptimal. Targeted approaches are recommended to reducing inequalities in access to vaccination and should focus on women of Black ethnicity, younger and older women, and women living in deprived areas.

How did the first covid-19 lockdown affect general practitioner contacts with children and young people?

AimsTo examine the impact of the covid-19 pandemic on total, face to face and remote general practitioner (GP) contacts with children and young people aged under 25 years in England before and after the first lockdown in the United Kingdom (March to June 2020).MethodsLongitudinal trends analysis using electronic health records from the nationally representative Clinical Practice Research Datalink Aurum database. We included all children and young people aged <25 years registered with a GP anytime during the study period (January 2015 to October 2020). We assigned their GP contacts according to their age (years) on the date of the contact: <1, 1-4, 5-9, 10-14, 15-19, 20-24.Our main outcomes were total, face-to-face and remote weekly contacts with a GP. Secondary outcomes were weekly contacts with GPs for respiratory illnesses (upper respiratory tract infections, lower respiratory tract infections and asthma) and common non-transmissible conditions (urinary tract infections, diabetes, epilepsy and appendicitis). For all outcomes, we compared the number of contacts during the first UK lockdown (March to June 2020) with the mean number of contacts for comparable weeks from 2015 to 2019.ResultsOur study population included 4 307 120 million children and young people who had 47 607 765 GP contacts. Total GP contacts fell by 40.7% (95% CI: 40.7, 40.8) during the first lockdown compared with previous years. Children aged 1-14 years had greater falls in total contacts (>50%) compared with infants and those aged 15-24 years. Face-to-face contacts fell by 88.3% (95% CI: 88.2, 88.4) for all ages. The greatest falls in face-to-face contacts occurred among children aged 1-14 (> 90%), whereas face-to-face contacts with infants fell by 76.8% (95% CI: 76.6, 77.0). Remote contacts more than doubled, increasing most in infants (over 2.5 fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote and fell by 31%.ConclusionChildren and young people’s contact with GPs fell, particularly for face-to-face assessment during the first pandemic lockdown, with notably fewer contacts for respiratory illnesses. This change reflects a combination of altered healthcare seeking behaviour, lower prevalence of some conditions (notably fewer respiratory illnesses due to fewer social contacts), and changes in service provision. A major shift from face-to-face to remote contacts for common non-transmissible conditions mitigated overall falls.

Access to and use of contraceptive care during the first COVID-19 lockdown in the UK: a web-based survey.

BACKGROUND: The first wave of lockdown measures to control the COVID-19 pandemic in the UK resulted in suspension of 'non-essential' services, including contraceptive care. AIM: To examine women's perceptions and experiences of contraceptive care in the UK during the first lockdown. DESIGN & SETTING: A cross-sectional survey during the lockdown period from March-June 2020. METHOD: An online questionnaire was designed asking women aged 16-54 years their experiences of contraceptive care during lockdown. Questions were based on Maxwell's evaluation framework on access, acceptability, relevance or appropriateness, and equity. It was promoted on social media from 27 May-9 June 2020. A descriptive analysis was conducted of quantitative data and thematic analysis of free-text data. RESULTS: In total, 214 responses were analysed. General practice was the source of contraception for 43.4% (n = 49) and 52.3% (n = 34) of responders before and during the lockdown, respectively. The study found 55.1% (n = 118) of responders, including regular and new users, were uncertain where or how to get contraception during the pandemic. Responders reported reduced access to contraception during lockdown, and some thought sexual health clinics and general practices were closed. Remote consultations and electronic prescriptions facilitated contraceptive access for some responders. Long-acting reversible contraception (LARC) was unavailable in some areas owing to restrictions, and alternatives were not acceptable to those who used methods for non-contraceptive benefits to treat medical conditions; for example, menorrhagia. CONCLUSION: The study highlighted the need for better information and signposting for contraception during lockdown. Contraception, including LARC, should be reframed as an essential service with robust signposting for pandemic planning and beyond.

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study.

OBJECTIVES: To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING: All National Health Service (public) hospitals in England. PARTICIPANTS: All people in England aged <25 years. OUTCOME MEASURES: Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS: Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS: COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.

Impact of COVID-19 on primary care contacts with children and young people in England: longitudinal trends study 2015-2020.

BACKGROUND: The NHS response to COVID-19 altered provision and access to primary care. AIM: To examine the impact of COVID-19 on GP contacts with children and young people (CYP) in England. DESIGN AND SETTING: A longitudinal trends analysis was undertaken using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum database. METHOD: All CYP aged <25 years registered with a GP in the CPRD Aurum database were included. The number of total, remote, and face-to-face contacts during the first UK lockdown (March to June 2020) were compared with the mean contacts for comparable weeks from 2015 to 2019. RESULTS: In total, 47 607 765 GP contacts with 4 307 120 CYP were included. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 years had greater falls in total contacts (≥50%) compared with infants and those aged 15-24 years. Face-to-face contacts fell by 88%, with the greatest falls occurring among children aged 1-14 years (>90%). Remote contacts more than doubled, increasing most in infants (over 2.5-fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote contacts, mitigating the total fall (31%). CONCLUSION: During the COVID-19 pandemic, CYP's contact with GPs fell, particularly for face-to-face assessments. This may be explained by a lower incidence of respiratory illnesses because of fewer social contacts and changing health-seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.

Characteristics of frequently attending children in hospital emergency departments: a systematic review.

OBJECTIVE: To summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently. SETTING: Hospital EDs. PARTICIPANTS: Children <21 years, attending hospital EDs frequently. PRIMARY OUTCOME MEASURES: Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year. RESULTS: We included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a 'frequent ED' usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis. CONCLUSIONS: The review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.

Identifying local authority need for, and uptake of, school-based physical activity interventions in England – a cluster analysis using routine data

BackgroundSchools in England need effective, simple interventions to address shortfalls in children’s physical activity. Areas in England where physical activity is low among children may particularly benefit from school-based physical activity interventions. Further, stark geographical inequalities for children’s physical activity exist and have widened during Covid-19 lockdowns. The Daily Mile (TDM) is a school-based running programme that has been widely adopted across England. However, there is limited evidence of its equitability and whether it reaches children in most need. We aimed to i) identify local authorities in England with the highest need for children’s physical activity promotion and ii) determine whether TDM reaches schools in areas of high need.MethodsThis was a cross-sectional study linking routinely collected data from a range of sources including the Active Lives Surveys and national datasets. Characteristics of need were identified following a literature review to identify determinants of children’s physical activity. Our assessment of local authority ‘need’ included measures of children and adult’s physical activity and excess weight, children’s mental health needs, access and utilisation of outdoor space for exercise, and deprivation. We grouped local authorities using a hierarchical cluster analysis. The optimal number of clusters for our data was three clusters. We estimated the association between ‘need’ and registration to TDM with a Poisson regression.ResultsWe identified three distinct clusters of need for children’s physical activity interventions representing 4.5 million primary school children. High-need, medium- need, and low- need local authorities included 24%, 56% and 20% of 123 upper-tier English local authorities respectively. Schools in local authorities of high-need were more likely to be registered to TDM (IRR: 1.25, 95%CI:1.12–1.39) compared with schools in low-need local authorities, where registration to TDM ranged from one in five schools in the low-need cluster to one in four in the high-need cluster.ConclusionOur study suggests that TDM is an equitable intervention reaching schools in areas with the highest need. Areas of highest need are concentrated in particular areas in England, for example the North East. Matching public health interventions to the needs of the population is more efficient and equitable than blanket policies directed at whole populations. This identification of clusters of local authorities that share patterns of need may guide shared learning between local authorities that share similar challenges and contextual features.

Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data.

BACKGROUND: Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs. AIM: To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals. METHOD: We analysed the Hospital Episode Statistics dataset for April 2014-March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups. RESULTS: One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively). CONCLUSION: One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.

Schools and COVID-19: Reopening Pandora's box?

Schools in countries across the world are reopening as lockdown to slow progression of COVID-19 is eased. The UK government ordered school closures in England from March 20, 2020, later than the rest of Europe. A temporary and limited return for some year groups was trialled from June 2020. Teachers, school governors, the public and doctors have openly challenged the decision. The UK government has struggled to provide enough detailed information to convince the public, teachers and health practitioners, that effective systems for protection, including test, trace and isolate, are in place to prevent and manage outbreaks in schools. Risks of infection on reopening to children, staff and families must be weighed against the harms of closure to children's education and social development. The potential consequences, if the re-opening of schools is managed badly, is subsequent waves of COVID-19 infection leading to more deaths, further school closures and prolonged restrictions, losing any ground gained thus far. This article weighs the evidence for risks and benefits of reopening schools during the pandemic.