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1.
Tidsskr Nor Laegeforen ; 1412021 09 28.
Article in English, Norwegian | MEDLINE | ID: covidwho-1471042

ABSTRACT

BACKGROUND: We have obtained knowledge of how the COVID-19 pandemic affected the lives of adolescents immediately after the pandemic arrived in Norway. However, we know little about adolescents' experiences from the pandemic over time, and whether sociodemographic factors and infection rates at the municipality level play a role. MATERIAL AND METHOD: We used questionnaire data from 106 448 lower and upper secondary school pupils who took part in the Ungdata survey in 167 municipalities in the spring of 2021 (response rate 76 %). The adolescents' responses regarding their experiences during the pandemic were collated with statistics on infection rates at the municipality level. We performed a Chi-square test and multilevel analyses to investigate predictors of adolescents' experiences. RESULTS: A total of 49 % responded that the COVID-19 pandemic affected their lives in a partly or very negative direction. Many reported negative changes in peer relationships, family relationships and mental health, but some also reported positive changes. Girls, older adolescents, those with a low socioeconomic background and those living in municipalities with a higher prevalence of infection reported more negative consequences. INTERPRETATION: Most adolescents reported that the pandemic has had more negative than positive consequences. Girls, older adolescents, those with a low socioeconomic background and those living in municipalities with a higher rate of infection may be especially affected by the negative effects of the pandemic.


Subject(s)
COVID-19 , Pandemics , Adolescent , Female , Humans , Mental Health , SARS-CoV-2 , Surveys and Questionnaires
2.
MMWR Morb Mortal Wkly Rep ; 70(38): 1344-1348, 2021 Sep 24.
Article in English | MEDLINE | ID: covidwho-1468851

ABSTRACT

The Pfizer-BioNTech COVID-19 vaccine (BNT162b2) is a lipid nanoparticle-formulated, nucleoside mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. Vaccination with the Pfizer-BioNTech COVID-19 vaccine consists of 2 intramuscular doses (30 µg, 0.3 mL each) administered 3 weeks apart. In December 2020, the vaccine was granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) as well as an interim recommendation for use among persons aged ≥16 years by the Advisory Committee on Immunization Practices (ACIP) (1). In May 2021, the EUA and interim ACIP recommendations for Pfizer-BioNTech COVID-19 vaccine were extended to adolescents aged 12-15 years (2). During December 14, 2020-September 1, 2021, approximately 211 million doses of Pfizer-BioNTech COVID-19 vaccine were administered in the United States.* On August 23, 2021, FDA approved a Biologics License Application for use of the Pfizer-BioNTech COVID-19 vaccine, Comirnaty (Pfizer, Inc.), in persons aged ≥16 years (3). The ACIP COVID-19 Vaccines Work Group's conclusions regarding the evidence for the Pfizer-BioNTech COVID-19 vaccine were presented to ACIP at a public meeting on August 30, 2021. To guide its deliberations regarding the Pfizer-BioNTech COVID-19 vaccine, ACIP used the Evidence to Recommendation (EtR) Framework,† and incorporated a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.§ In addition to initial clinical trial data, ACIP considered new information gathered in the 8 months since issuance of the interim recommendation for Pfizer-BioNTech COVID-19 vaccine, including additional follow-up time in the clinical trial, real-world vaccine effectiveness studies, and postauthorization vaccine safety monitoring. The additional information increased certainty that benefits from prevention of asymptomatic infection, COVID-19, and associated hospitalization and death outweighs vaccine-associated risks. On August 30, 2021, ACIP issued a recommendation¶ for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Immunization/standards , Practice Guidelines as Topic , Adolescent , Adult , Advisory Committees , COVID-19/epidemiology , COVID-19 Vaccines/adverse effects , Centers for Disease Control and Prevention, U.S. , Drug Approval , Female , Humans , Male , United States/epidemiology , Vaccines, Synthetic/administration & dosage , Young Adult
3.
MMWR Morb Mortal Wkly Rep ; 70(38): 1332-1336, 2021 Sep 24.
Article in English | MEDLINE | ID: covidwho-1468850

ABSTRACT

Foodborne illnesses are a substantial and largely preventable public health problem; before 2020 the incidence of most infections transmitted commonly through food had not declined for many years. To evaluate progress toward prevention of foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food reported by 10 U.S. sites.* FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration. This report summarizes preliminary 2020 data and describes changes in incidence with those during 2017-2019. During 2020, observed incidences of infections caused by enteric pathogens decreased 26% compared with 2017-2019; infections associated with international travel decreased markedly. The extent to which these reductions reflect actual decreases in illness or decreases in case detection is unknown. On March 13, 2020, the United States declared a national emergency in response to the COVID-19 pandemic. After the declaration, state and local officials implemented stay-at-home orders, restaurant closures, school and child care center closures, and other public health interventions to slow the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Federal travel restrictions were declared (1). These widespread interventions as well as other changes to daily life and hygiene behaviors, including increased handwashing, have likely changed exposures to foodborne pathogens. Other factors, such as changes in health care delivery, health care-seeking behaviors, and laboratory testing practices, might have decreased the detection of enteric infections. As the pandemic continues, surveillance of illness combined with data from other sources might help to elucidate the factors that led to the large changes in 2020; this understanding could lead to improved strategies to prevent illness. To reduce the incidence of these infections concerted efforts are needed, from farm to processing plant to restaurants and homes. Consumers can reduce their risk of foodborne illness by following safe food-handling and preparation recommendations.


Subject(s)
COVID-19/epidemiology , Food Microbiology/statistics & numerical data , Food Parasitology/statistics & numerical data , Foodborne Diseases/epidemiology , Pandemics , Watchful Waiting , Adolescent , Child , Child, Preschool , Foodborne Diseases/microbiology , Foodborne Diseases/parasitology , Humans , Incidence , Infant , United States/epidemiology
4.
BMJ ; 374: n2324, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1467693
5.
Rev Colomb Psiquiatr (Engl Ed) ; 50(3): 189-198, 2021.
Article in English, Spanish | MEDLINE | ID: covidwho-1466864

ABSTRACT

BACKGROUND: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. METHODS: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. RESULTS: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. CONCLUSIONS: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.


Subject(s)
Anxiety/etiology , COVID-19/psychology , Depression/etiology , Health Personnel/psychology , Stress, Psychological/etiology , Students, Medical/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety/diagnosis , Anxiety/epidemiology , COVID-19/prevention & control , Depression/diagnosis , Depression/epidemiology , Female , Health Surveys , Humans , Logistic Models , Male , Middle Aged , Peru/epidemiology , Psychological Tests , Risk Factors , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Young Adult
8.
Am J Case Rep ; 22: e931570, 2021 Oct 12.
Article in English | MEDLINE | ID: covidwho-1464036

ABSTRACT

BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) has recently been described in children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This report describes 2 children with MIS-C who were initially diagnosed with toxic shock syndrome but who tested positive for SARS-CoV-2 infection on reverse transcription-polymerase chain reaction, supporting the diagnosis of MIS-C. CASE REPORT Case 1. A 7-year-old boy with fever, cough, and dyspnea was treated with oxygen, intravenous immunoglobulin (IVIG) infusion, and methylprednisolone and showed a worsening of clinical conditions, persistent fever, hypotension, and hematological parameters compatible with macrophage activation syndrome (MAS). Three intravenous boluses of methylprednisolone (30 mg/kg/day) were followed by a progressive resolution. Case 2. A 14-year-old girl with syncope, fever, diarrhea, oliguria, and increased creatinine levels required fluid infusion and correction of electrolyte imbalance. The increase of creatine phosphokinase (CPK), myoglobin, troponin, and creatine kinase-MB (CK-MB) was associated with grade I atrioventricular block and pericardial effusion. The patient showed myositis and severe muscular weakness, with hematological parameters compatible with MIS-C. She started IVIG and 3 intravenous boluses of methylprednisolone. However, bradycardia, tachypnea, severe hypotension, loss of consciousness, oliguria, bilateral ground-glass pneumonia, bilateral pleural, and peritoneal effusion, in the absence of thromboembolism, required treatment with furosemide, albumin, and enoxaparin, and was followed by a prompt resolution. CONCLUSIONS These 2 pediatric cases highlight the importance of SARS-CoV-2 testing in all patients with acute symptoms and signs of infection during the COVID-19 pandemic. As new variants of SARS-CoV-2 emerge, cases of MIS-C can become more prevalent, and pediatricians should be aware of diagnostic and management guidelines.


Subject(s)
COVID-19 , Shock, Septic , Adolescent , COVID-19 Testing , Child , Female , Humans , Male , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(9): 1059-1066, 2021 Sep 06.
Article in Chinese | MEDLINE | ID: covidwho-1463875

ABSTRACT

Objective: To study the characteristics and risk factors of psychological and behavioral problems of children and adolescents of different ages and genders in long-term home-schooling during the coronavirus disease-2019 pandemic. Further, to provide scientific basis for more targeted psychological intervention and coping strategies in the future. Methods: A cross-sectional survey using an online questionnaire was conducted on students aged 6-16 years old in five representative cities of North (Beijing), East (Shanghai), West (Chongqing), South (Guangzhou) and Middle (Wuhan) in China. In this study, the social behavior and psychological abnormalities which was defined as the positive of any dimension were investigated in multiple dimensions during long-term home-schooling. The influencing factors of psycho-behavioral problems were analyzed by Logistic regression, and the confounding factors were corrected with graded multivariable adjustment. Results: A total of 6 906 valid questionnaires were collected including 3 592 boys and 3 314 girls, of whom 3 626 were children (6-11 years old) and 3 280 were adolescents (12-16 years old). The positive detection rate of psychosocial-behavioral problems were 13.0% (900/6 906) totally, 9.6% (344/3 592) in boys and 16.8% (556/3 314) in girls respectively, and 7.3%(142/1 946) in boys aged 6-11, 14.0%(235/1 680) in girls aged 6-11, 12.3%(202/1 646) in boys aged 12-16, 19.6%(321/1 634) in girls aged 12-16 respectively. There were significant differences between the psychological problems group and the non-psychological problems group in gender, parent-offspring conflict, number of close friends, family income change, sedentary time, homework time, screen exposure time, physical activity, dietary problems (χ²=78.851, 285.264, 52.839, 26.284, 22.778, 11.024, 10.688, 36.814, 70.982, all P<0.01). The most common symptoms in boys aged 6-11 years were compulsive activity, schizoid and depression, in girls aged 6-11 years were schizoid/compulsive activity, hyperactivity and social withdrawal, in boys aged 12-16 years were hyperactivity, compulsive activity and aggressive behavior, and in girls aged 12-16 years were schizoid, anxiety/compulsive activity and depression/withdrawal, respectively. After graded multivariable adjustment, besides the common risk factors, homework time and online study time were the risk factors of 6-11 years old groups [boys OR(95%CI): 1.750 (1.32-2.32), 1.214(1.00-1.47), girls: 1.579(1.25-1.99), 1.222(1.05-1.42), all P<0.05], videogames time were the risk factors of 12-16 years old groups [ boys: 2.237 (1.60-3.13), girls: 1.272 (1.00-1.61), all P<0.05]. Conclusions: Some children and adolescents may have psychological and behavioral problems during long-term home-schooling. The psychological and behavioral manifestations differed in age and gender subgroups, which deserve special attention in each subgroups. Schools, families and specialists should actively provide precise psychological support and comprehensive intervention strategies according to special features and risk factors.


Subject(s)
COVID-19 , Adaptation, Psychological , Adolescent , Child , China , Cross-Sectional Studies , Female , Humans , Male , SARS-CoV-2
10.
Bull World Health Organ ; 99(10): 730-738, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1463418

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has affected children's risk of violence in their homes, communities and online, and has compromised the ability of child protection systems to promptly detect and respond to cases of violence. However, the need to strengthen violence prevention and response services has received insufficient attention in national and global pandemic response and mitigation strategies. In this paper, we summarize the growing body of evidence on the links between the pandemic and violence against children. Drawing on the World Health Organization's INSPIRE framework to end violence against children, we illustrate how the pandemic is affecting prevention and response efforts. For each of the seven INSPIRE strategies we identify how responses to the pandemic have changed children's risk of violence. We offer ideas for how governments, policy-makers, and international and civil society organizations can address violence in the context of a protracted COVID-19 crisis. We conclude by highlighting how the current pandemic offers opportunities to improve existing child protection systems to address violence against children. We suggest enhanced multisectoral coordination across the health, education, law enforcement, housing, child and social protection sectors. Actions need to prioritize the primary prevention of violence and promote the central role of children and adolescents in decision-making and programme design processes. Finally, we stress the continued need for better data and evidence to inform violence prevention and response strategies that can be effective during and beyond the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Adolescent , Child , Global Health , Humans , Pandemics/prevention & control , SARS-CoV-2 , Violence/prevention & control
11.
Orv Hetil ; 162(41): 1637-1642, 2021 10 10.
Article in Hungarian | MEDLINE | ID: covidwho-1463347

ABSTRACT

Összefoglaló. A COVID-19-járvány kényszeru tartós szociális távolságtartást idézett elo az emberek között, ami az egyéb mentális rendellenességek és mentálhigiénés következmények mellett egy sajátos pszichiátriai jelenségre, a hikikomori állapotra hívja fel a figyelmet. A hikikomori tartós és szélsoséges szociális visszahúzódással járó jelenség, melynek kidolgozott kritériumrendszere egyelore még nem található meg a mentális rendellenességeket osztályozó diagnosztikus kézikönyvekben. Kialakulásának pontos mechanizmusáról még keveset tudunk, de az állapot megjelenése és az internet térnyerése között egyes szerzok szoros kapcsolatot látnak. Klasszikusan az egyén egy társadalmi szempontból megalázó vagy elonytelenül alakuló helyzet következtében vonul vissza fokozatosan egy önként vállalt izolációba. Bár a külvilág nem teljesen érdektelen számukra, azonban a retraumatizáció elkerülése érdekében leginkább online követik a világ történéseit és tartanak kapcsolatot másokkal. A COVID-19-pandémia - különösen a lezárások következményeként elotérbe kerülo online életvitelhez kötodoen - jelentos mértékben hozzájárult az internet térnyeréséhez, miközben a valós társas kapcsolatok kényszeruen beszukültek. Ez a konstelláció jelentos kockázati tényezonek tekintheto a hikikomori szempontjából, amely hosszú távon a világjárvány egyik nem várt szövodménye lehet, különösen az adolescens és a fiatal felnott korosztályban. Orv Hetil. 2021; 162(41): 1637-1642. Summary. The COVID-19 pandemic forced prolonged social distancing between people. This, among other mental disorders and mental health consequences, highlights a specific psychiatric phenomenon: the hikikomori condition. The hikikomori is a phenomenon of persistent and extreme social withdrawal. The condition's established diagnostic set of criteria is not yet to be found in diagnostic manuals classifying mental disorders. Little is known about the exact mechanism of its development, but some authors see a close link between its emergence and the rise of the internet. Typically, the individual gradually withdraws into a voluntary isolation as a result of a socially humiliating or unfavourable situation. Although the outside world is not completely irrelevant to them, they tend to follow online the events of the world and they also keep in touch with others mostly online in order to avoid retraumatization. The COVID-19 pandemic, particularly in relation to the rise of online lifestyles as a consequence of lockdowns, has contributed significantly to the more and more frequent use of the internet, while real social contact has been inevitably reduced. This constellation can be seen as a major risk factor for hikikomori, which in the long term could be an unanticipated complication of the pandemic, especially in adolescents and young adults. Orv Hetil. 2021; 162(41): 1637-1642.


Subject(s)
COVID-19 , Mental Health , Adolescent , Communicable Disease Control , Humans , Pandemics , SARS-CoV-2 , Social Isolation , Young Adult
12.
Trials ; 22(1): 694, 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1463261

ABSTRACT

OBJECTIVES: It is currently thought that most-but not all-individuals infected with SARS-CoV-2 develop symptoms, but the infectious period starts on average 2 days before the first overt symptoms appear. It is estimated that pre- and asymptomatic individuals are responsible for more than half of all transmissions. By detecting infected individuals before they have overt symptoms, wearable devices could potentially and significantly reduce the proportion of transmissions by pre-symptomatic individuals. Using laboratory-confirmed SARS-CoV-2 infections (detected via serology tests [to determine if there are antibodies against the SARS-CoV-2 in the blood] or SARS-CoV-2 infection tests such as polymerase chain reaction [PCR] or antigen tests) as the gold standard, we will determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the following two algorithms to detect first time SARS-CoV-2 infection including early or asymptomatic infection: • The algorithm using Ava bracelet data when coupled with self-reported Daily Symptom Diary data (Wearable + Symptom Data Algo; experimental condition) • The algorithm using self-reported Daily Symptom Diary data alone (Symptom Only Algo; control condition) In addition, we will determine which of the two algorithms has superior performance characteristics for detecting SARS-CoV-2 infection including early or asymptomatic infection as confirmed by SARS-CoV-2 virus testing. TRIAL DESIGN: The trial is a randomized, single-blinded, two-period, two-sequence crossover trial. The study will start with an initial learning phase (maximum of 3 months), followed by period 1 (3 months) and period 2 (3 months). Subjects entering the study at the end of the recruitment period may directly start with period 1 and will not be part of the learning phase. Each subject will undergo the experimental condition (the Wearable + Symptom Data Algo) in either period 1 or period 2 and the control condition (Symptom Only Algo) in the other period. The order will be randomly assigned, resulting in subjects being allocated 1:1 to either sequence 1 (experimental condition first) or sequence 2 (control condition first). Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence. PARTICIPANTS: The trial will be conducted in the Netherlands. A target of 20,000 subjects will be enrolled. Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence. This results in approximately 6500 normal-risk individuals and 3500 high-risk individuals per sequence. Subjects will be recruited from previously studied cohorts as well as via public campaigns and social media. All data for this study will be collected remotely through the Ava COVID-RED app, the Ava bracelet, surveys in the COVID-RED web portal and self-sampling serology and PCR kits. More information on the study can be found in www.covid-red.eu . During recruitment, subjects will be invited to visit the COVID-RED web portal. After successfully completing the enrolment questionnaire, meeting eligibility criteria and indicating interest in joining the study, subjects will receive the subject information sheet and informed consent form. Subjects can enrol in COVID-RED if they comply with the following inclusion and exclusion criteria: Inclusion criteria: • Resident of the Netherlands • At least 18 years old • Informed consent provided (electronic) • Willing to adhere to the study procedures described in the protocol • Must have a smartphone that runs at least Android 8.0 or iOS 13.0 operating systems and is active for the duration of the study (in the case of a change of mobile number, the study team should be notified) • Be able to read, understand and write Dutch Exclusion criteria: • Previous positive SARS-CoV-2 test result (confirmed either through PCR/antigen or antibody tests; self-reported) • Current suspected (e.g. waiting for test result) COVID-19 infection or symptoms of a COVID-19 infection (self-reported) • Participating in any other COVID-19 clinical drug, vaccine or medical device trial (self-reported) • Electronic implanted device (such as a pacemaker; self-reported) • Pregnant at the time of informed consent (self-reported) • Suffering from cholinergic urticaria (per the Ava bracelet's user manual; self-reported) • Staff involved in the management or conduct of this study INTERVENTION AND COMPARATOR: All subjects will be instructed to complete the Daily Symptom Diary in the Ava COVID-RED app daily, wear their Ava bracelet each night and synchronize it with the app each day for the entire period of study participation. Provided with wearable sensor and/or self-reported symptom data within the last 24 h, the Ava COVID-RED app's underlying algorithms will provide subjects with a real-time indicator of their overall health and well-being. Subjects will see one of three messages, notifying them that no seeming deviations in symptoms and/or physiological parameters have been detected; some changes in symptoms and/or physiological parameters have been detected and they should self-isolate; or alerting them that deviations in their symptoms and/or physiological parameters could be suggestive of a potential COVID-19 infection and to seek additional testing. We will assess the intraperson performance of the algorithms in the experimental condition (Wearable + Symptom Data Algo) and control conditions (Symptom Only Algo). Note that both algorithms will also instruct to seek testing when any SARS-CoV-2 symptoms are reported in line with those defined by the Dutch national institute for public health and the environment 'Rijksinstituut voor Volksgezondheid en Milieu' (RIVM) guidelines. MAIN OUTCOMES: The trial will evaluate the use and performance of the Ava COVID-RED app and Ava bracelet, which uses sensors to measure breathing rate, pulse rate, skin temperature and heart rate variability for the purpose of early and asymptomatic detection and monitoring of SARS-CoV-2 in general and high-risk populations. Using laboratory-confirmed SARS-CoV-2 infections (detected via serology tests, PCR tests and/or antigen tests) as the gold standard, we will determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each of the following two algorithms to detect first-time SARS-CoV-2 infection including early or asymptomatic infection: the algorithm using Ava bracelet data when coupled with the self-reported Daily Symptom Diary data and the algorithm using self-reported Daily Symptom Diary data alone. In addition, we will determine which of the two algorithms has superior performance characteristics for detecting SARS-CoV-2 infection including early or asymptomatic infection as confirmed by SARS-CoV-2 virus testing. The protocol contains an additional twenty secondary and exploratory objectives which address, among others, infection incidence rates, health resource utilization, symptoms reported by SARS-CoV-2-infected participants and the rate of breakthrough and asymptomatic SARS-CoV-2 infections among individuals vaccinated against COVID-19. PCR or antigen testing will occur when the subject receives a notification from the algorithm to seek additional testing. Subjects will be advised to get tested via the national testing programme and report the testing result in the Ava COVID-RED app and a survey. If they cannot obtain a test via the national testing programme, they will receive a nasal swab self-sampling kit at home, and the sample will be tested by PCR in a trial-affiliated laboratory. In addition, all subjects will be asked to take a capillary blood sample at home at baseline (between month 0 and 3.5 months after the start of subject recruitment), at the end of the learning phase (month 3; note that this sampling moment is skipped if a subject entered the study at the end of the recruitment period), period 1 (month 6) and period 2 (month 9). These samples will be used for SARS-CoV-2-specific antibody testing in a trial-affiliated laboratory, differentiating between antibodies resulting from a natural infection and antibodies resulting from COVID-19 vaccination (as vaccination will gradually be rolled out during the trial period). Baseline samples will only be analysed if the sample collected at the end of the learning phase is positive, or if the subject entered the study at the end of the recruitment period, and samples collected at the end of period 1 will only be analysed if the sample collected at the end of period 2 is positive. When subjects obtain a positive PCR/antigen or serology test result during the study, they will continue to be in the study but will be moved into a so-called COVID-positive mode in the Ava COVID-RED app. This means that they will no longer receive recommendations from the algorithms but can still contribute and track symptom and bracelet data. The primary analysis of the main objective will be executed using the data collected in period 2 (months 6 through 9). Within this period, serology tests (before and after period 2) and PCR/antigen tests (taken based on recommendations by the algorithms) will be used to determine if a subject was infected with SARS-CoV-2 or not. Within this same time period, it will be determined if the algorithms gave any recommendations for testing. The agreement between these quantities will be used to evaluate the performance of the algorithms and how these compare between the study conditions. RANDOMIZATION: All eligible subjects will be randomized using a stratified block randomization approach with an allocation ratio of 1:1 to one of two sequences (experimental condition followed by control condition or control condition followed by experimentalcondition). Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence, resulting in approximately equal numbers of high-risk and normal-risk individuals between the sequences. BLINDING (MASKING): In this study, subjects will be blinded to the study condition and randomization sequence. Relevant study staff and the device manufacturer will be aware of the assigned sequence. The subject will wear the Ava bracelet and complete the Daily Symptom Diary in the Ava COVID-RED app for the full duration of the study, and they will not know if the feedback they receive about their potential infection status will only be based on the data they entered in the Daily Symptom Diary within the Ava COVID-RED app or based on both the data from the Daily Symptom Diary and the Ava bracelet. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): A total of 20,000 subjects will be recruited and randomized 1:1 to either sequence 1 (experimental condition followed by control condition) or sequence 2 (control condition followed by experimental condition), taking into account their risk level. This results in approximately 6500 normal-risk and 3500 high-risk individuals per sequence. TRIAL STATUS: Protocol version: 3.0, dated May 3, 2021. Start of recruitment: February 19, 2021. End of recruitment: June 3, 2021. End of follow-up (estimated): November 2021 TRIAL REGISTRATION: The Netherlands Trial Register on the 18th of February, 2021 with number NL9320 ( https://www.trialregister.nl/trial/9320 ) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.


Subject(s)
COVID-19 , Wearable Electronic Devices , Adolescent , COVID-19 Vaccines , Cross-Over Studies , Humans , Prospective Studies , Randomized Controlled Trials as Topic , SARS-CoV-2
13.
BMC Public Health ; 21(1): 1830, 2021 10 09.
Article in English | MEDLINE | ID: covidwho-1463243

ABSTRACT

BACKGROUND: Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. Resilience buffers against the negative impacts of life stressors on common internalizing psychopathology such as GAD. This study assesses the prevalence of GAD and examines the protective or compensatory effect of resilience against worry factors during the COVID-19 outbreak. METHODS: A cross-sectional online survey was conducted among Chinese citizens aged ≥18 years from January 31 to February 2, 2020. A total of 4827 participants across 31 provinces and autonomous regions of the mainland of China participated in this study. The Generalized Anxiety Disorder scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and a self-designed worry questionnaire were used to asses anxiety disorder prevalence, resilience level, and anxiety risk factors. Multivariable logistic regression was used to identify the associations of resilience and worry factors with GAD prevalence after controlling for other covariates. RESULTS: The prevalence of anxiety disorder was 22.6% across the 31 areas, and the highest prevalence was 35.4% in Hubei province. After controlling for covariates, the results suggested a higher GAD prevalence among participants who were worried about themselves or family members being infected with COVID-19 (adjusted odds ratio, AOR 3.40, 95%CI 2.43-4.75), worried about difficulty obtaining masks (AOR 1.92, 95%CI 1.47-2.50), worried about difficulty of distinguishing true information (AOR 1.65, 95%CI 1.36-2.02), worried about the prognosis of COVID-19 (AOR 2.41, 95%CI 1.75-3.33), worried about delays in working (AOR 1.71, 95%CI 1.27-.31), or worried about decreased income (AOR 1.45, 95%CI 1.14-1.85) compared with those without such worries. Additionally, those with a higher resilience level had a lower prevalence of GAD (AOR 0.59, 95%CI 0.51-0.70). Resilience also showed a mediating effect, with a negative influence on worry factors and thereby a negative association with GAD prevalence. CONCLUSION: It may be beneficial to promote public mental health during the COVID-19 outbreak through enhancing resilience, which may buffer against adverse psychological effects from worry factors.


Subject(s)
COVID-19 , Pandemics , Adolescent , Adult , Anxiety , Anxiety Disorders/epidemiology , China/epidemiology , Cross-Sectional Studies , Depression , Disease Outbreaks , Humans , Prevalence , SARS-CoV-2 , Surveys and Questionnaires
14.
BMJ Open ; 11(10): e053681, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1462973

ABSTRACT

INTRODUCTION: In Palestine (West Bank and Gaza), there have been more than 320 890 known cases of COVID-19, resulting in 3452 deaths. The detrimental effects of the virus can be seen in the nation's health, economy and government operations, leading to radical uncertainty that is exacerbated by the absence of any definitive treatment or vaccines. The level of knowledge about and trust in treatment and vaccination varies worldwide. This study aims to assess the willingness of Palestinians to receive a COVID-19 vaccine and their knowledge about such vaccines. METHODS: An online survey of adults over 18 years old (n=1080) was conducted in Palestine in October 2020. Using multivariate logistic regression, we identified correlates of participants' willingness to get a COVID-19 vaccine. RESULTS: We found that about 63% of participants were willing to get a COVID-19 vaccine. However, acceptance varied with the specific demographic variables that were investigated. Women, married participants and those aged 18-24 years are more likely to take the vaccine. Further, participants with good knowledge about the vaccine and its side effects are more willing to get the vaccine. CONCLUSION: The availability of a safe and effective COVID-19 vaccine in Palestine is crucial to decrease the burden of COVID-19 morbidity and mortality. In addition, to ensure a high vaccination rate, health awareness campaigns should target those who are not willing to get the vaccine, especially those who are more vulnerable and the elderly.


Subject(s)
COVID-19 , Vaccines , Adolescent , Adult , Aged , COVID-19 Vaccines , Cross-Sectional Studies , Female , Humans , SARS-CoV-2 , Vaccination
15.
Lang Speech Hear Serv Sch ; 52(3): 889-898, 2021 07 07.
Article in English | MEDLINE | ID: covidwho-1462048

ABSTRACT

Purpose The COVID-19 pandemic introduced new educational challenges for students, teachers, and caregivers due to the changed and varied learning environments, use of face masks, and social distancing requirements. These challenges are particularly pronounced for students with hearing loss who often require specific accommodations to allow for equal access to the curriculum. The purpose of this study was to document the potential difficulties that students with hearing loss faced during the pandemic and to generate recommendations to promote learning and engagement based on findings. Method A qualitative survey was designed to document the frequency of various learning situations (i.e., in person, remote virtual, and blended), examine the accessibility of technology and course content, and quantify hearing issues associated with safety measures and technology use in school-age students with hearing loss. Survey questions were informed from key educational issues reported in published articles and guidelines. The survey was completed by 416 educational personnel who work with students with hearing loss. Results Respondents indicated that most of their schools were providing remote or blended (in-person and remote) learning consisting of synchronous and asynchronous learning. Common accommodations for students with hearing loss were only provided some of the time with the exception of sign language interpreters, which were provided for almost all students who required them. According to the respondents, both students and caregivers reported issues or discomfort with the technology required for remote learning. Conclusion To ensure that students with hearing loss are provided equal access to the curriculum, additional accommodations should be considered to address issues arising from pandemic-related changes to school and learning practices including closed captioning, transcripts/notes, recordings of lectures, sign language interpreters, student check-ins, and family-directed resources to assist with technology issues.


Subject(s)
Education of Hearing Disabled , Hearing Loss , Learning , Teaching , Adolescent , COVID-19 , Child , Child, Preschool , Curriculum , Humans , Male , Masks , Pandemics , Persons With Hearing Impairments , Schools , Students
16.
Viruses ; 13(3)2021 03 16.
Article in English | MEDLINE | ID: covidwho-1457709

ABSTRACT

BACKGROUND: Efficacy for cervical cancer prevention of opportunistic HPV vaccination in post-pubertal girls is lower than in 11-year-olds. METHODS: Women born between 1986 and 1992 vaccinated at 15-25 years of age (at least one dose of 4-valent HPV vaccine) and screened at 24-27 years of age were included. Frequency of opportunistic vaccination, overall and by birth cohort, was calculated; screening outcomes were compared between vaccinated and unvaccinated women. RESULTS: Overall, 4718 (4.9%) HPV-vaccinated, and 91,512 unvaccinated, women were studied. The frequency of vaccination increased by birth cohort, ranging between 1.8% and 9.8%; age at vaccination decreased progressively by birth cohort (p < 0.0001). Participation in screening was 60.8% among vaccinated, and 56.6% among unvaccinated, women (p < 0.0001). Detection rates (DR) for high-grade lesions were lower in vaccinated women (2.11‰ vs. 3.85‰ in unvaccinated, for CIN3+, p = 0.24; 0.0‰ vs. 0.22‰ for cancer). The DR of CIN3+ increased with age at vaccination, scoring respectively 0.0‰, 0.83‰, and 4.68‰ for women vaccinated when they were 15-16, 17-20, and 21-25 years old (p = 0.17). CONCLUSIONS: In comparison to unvaccinated women, higher compliance with cervical cancer screening invitation and lower CIN3+ DR among vaccinated women was observed. Age at vaccination was inversely correlated to vaccination efficacy.


Subject(s)
Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/administration & dosage , Uterine Cervical Neoplasms/prevention & control , Adolescent , Adult , Early Detection of Cancer , Female , Humans , Italy/epidemiology , Mass Screening , Retrospective Studies , Young Adult
17.
J Eur Acad Dermatol Venereol ; 35(10): 2007-2021, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1455573

ABSTRACT

In the late 90s, a sharp increase of treatment failures of Trichomonas vaginalis (TV) infections with metronidazole (MTZ) was reported, representing a problem due to limited treatment options. We proposed to review the available evidence on the frequency of MTZ resistance by TV isolates and the relationship between treatment failure and in vitro resistance to MTZ. A systematic review based on the PRISMA guidelines was conducted by searching published studies in three different databases (PubMed, Scopus and Web of Science) up to December 2020. The extracted studies were uploaded to Covidence software; screening was guided based on inclusion and exclusion criteria. Additionally, different articles were included through other sources. For each article, study design, objectives, study population and key outcomes were summarized. We found 403 references from the databases and four extra studies. After duplicate removal and screening of title, abstract and full text, 27 studies were included. The selected studies were published between 1983 and 2019; all except one addressed only vaginal TV infection. We identified four major populations in vitro MTZ resistance: two studies evaluated female adolescents; other two assessed HIV-positive women. Fifteen studies considered MTZ resistance in newly diagnosed vaginal TV infection. Finally, eight articles studied in vitro susceptibility of isolates from women with clinical resistant trichomoniasis. High level of in vitro MTZ resistance was rare; low-moderate level was described in most of the cases. Although clinical resistance to MTZ of trichomoniasis was widely reported, there was a paucity of prospective controlled studies. Our review unveiled the need to standardize susceptibility testing, to define breakpoints for detection of MTZ-resistant isolates and to correlate with clinical outcome. It is important to establish criteria to define clinical resistance to MTZ. Such a consensus would foster the development of surveillance studies about clinical and microbiological response to MTZ treatment.


Subject(s)
Trichomonas Infections , Trichomonas Vaginitis , Trichomonas vaginalis , Adolescent , Drug Resistance , Female , Humans , Metronidazole/pharmacology , Prospective Studies , Trichomonas Infections/drug therapy , Trichomonas Vaginitis/drug therapy
18.
Fam Community Health ; 44(4): 257-265, 2021.
Article in English | MEDLINE | ID: covidwho-1455384

ABSTRACT

Amidst the COVID-19 pandemic, interest in using telehealth to increase access to health and mental health care has grown, and school transitions to remote learning have heightened awareness of broadband inequities. The purpose of this study was to examine access and barriers to technology and broadband Internet service ("broadband") among rural and urban youth. Washington State public school districts were surveyed about youth's access to technology (ie, a device adequate for online learning) and broadband availability in spring 2020. Availability of and barriers to broadband (ie, geography, affordability, and smartphone-only connectivity) were assessed across rurality. Among responding districts, 64.2% (n = 172) were rural and 35.8% (n = 96) were urban. Rural districts reported significantly fewer students with access to an Internet-enabled device adequate for online learning (80.0% vs 90.1%, P < .01). Access to reliable broadband varied significantly across geography (P < .01). Compared with their urban peers, rural youth face more challenges in accessing the technology and connectivity needed for remote learning and telehealth. Given that inadequate broadband infrastructure is a critical barrier to the provision of telehealth services and remote learning in rural areas, efforts to improve policies and advance technology must consider geographical disparities to ensure health and education equity.


Subject(s)
COVID-19 , Health Services Accessibility , Healthcare Disparities , Internet Access , Telemedicine , Adolescent , Humans , Internet , Pandemics , Rural Population , SARS-CoV-2 , Technology
19.
Lancet ; 398(10298): 391-402, 2021 07 31.
Article in English | MEDLINE | ID: covidwho-1454623

ABSTRACT

BACKGROUND: The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. METHODS: We used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60-84 years) as secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection-fatality ratios for SARS-CoV-2. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers. FINDINGS: Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000-1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. 1 562 000 children (1 299 000-1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10·2 per 1000 children), South Africa (5·1), Mexico (3·5), Brazil (2·4), Colombia (2·3), Iran (1·7), the USA (1·5), Argentina (1·1), and Russia (1·0). Numbers of children orphaned exceeded numbers of deaths among those aged 15-50 years. Between two and five times more children had deceased fathers than deceased mothers. INTERPRETATION: Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children. FUNDING: UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.


Subject(s)
COVID-19/mortality , Caregivers/supply & distribution , Child, Orphaned/statistics & numerical data , Models, Statistical , Adolescent , Adult , Aged , Child , Female , Global Health , Humans , Male , Middle Aged , Young Adult
20.
Clin Microbiol Infect ; 27(10): 1494-1501, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1454090

ABSTRACT

OBJECTIVES: To determine if commercially available mouthwash with ß-cyclodextrin and citrox (bioflavonoids) (CDCM) could decrease the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) salivary viral load. METHODS: In this randomized controlled trial, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR-positive patients aged 18-85 years with asymptomatic to mild coronavirus disease 2019 (COVID-19) symptoms for <8 days were recruited. A total of 176 eligible patients were randomly assigned (1:1) to CDCM or placebo. Three rinses daily were performed for 7 days. Saliva sampling was performed on day 1 at 09.00 (T1), 13.00 (T2) and 18.00 (T3). On the following 6 days, one sample was taken at 15.00. Quantitative RT-PCR was used to detect SARS-CoV-2. RESULTS: The intention-to-treat analysis demonstrated that, over the course of 1 day, CDCM was significantly more effective than placebo 4 hours after the first dose (p 0.036), with a median percentage (log10 copies/mL) decrease T1-T2 of -12.58% (IQR -29.55% to -0.16%). The second dose maintained the low median value for the CDCM (3.08 log10 copies/mL; IQR 0-4.19), compared with placebo (3.31 log10 copies/mL; IQR 1.18-4.75). At day 7, there was still a greater median percentage (log10 copies/mL) decrease in salivary viral load over time in the CDCM group (-58.62%; IQR -100% to -34.36%) compared with the placebo group (-50.62%; IQR -100% to -27.66%). These results were confirmed by the per-protocol analysis. CONCLUSIONS: This trial supports the relevance of using CDCM on day 1 (4 hours after the initial dose) to reduce the SARS-CoV-2 viral load in saliva. For long-term effect (7 days), CDMC appears to provide a modest benefit compared with placebo in reducing viral load in saliva.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/prevention & control , Mouthwashes/therapeutic use , SARS-CoV-2/drug effects , Adolescent , Adult , Aged , Antiviral Agents/chemistry , Asymptomatic Infections , COVID-19/transmission , Double-Blind Method , Female , Flavonoids/analysis , Flavonoids/therapeutic use , Humans , Intention to Treat Analysis , Male , Middle Aged , Mouthwashes/chemistry , SARS-CoV-2/isolation & purification , Saliva/virology , Viral Load/drug effects , Young Adult , beta-Cyclodextrins/analysis , beta-Cyclodextrins/therapeutic use
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