International Journal of Public Health

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSBackgroundC_ST_ABSIt is now established that a significant proportion of adults experience persistent symptoms after SARS-CoV-2 infection. However, evidence for children and adolescents is still inconclusive. In this population-based study, we examine the proportion of children and adolescents reporting persistent symptoms after SARS-CoV-2 infection, as assessed by serological status, and compare this to a seronegative control group. MethodsWe conducted a serosurvey in June-July 2021, recruiting 660 children and adolescents from 391 households selected randomly from the Geneva population. We tested participants for anti-SARS-CoV-2 antibodies targeting the nucleocapsid (N) protein to determine previous infection. A parent filled a questionnaire including questions on COVID-19-related symptoms lasting at least 2 weeks. FindingsAmong children seropositive for anti-SARS-CoV-2 antibodies, the sex- and age-adjusted prevalence of symptoms lasting longer than two weeks was 18.3%, compared to 11.1% among seronegative children (prevalence difference ({Delta}aPrev)=7.2%, 95%CI:1.5-13.0). Main symptoms declared among seropositive children were fatigue (11.5%) and headache (11.1%). For 8.6% (aPrev, 95%CI: 4.7-12.5) of seropositives, these symptoms were declared to be highly limiting of daily activities. Adolescents aged 12-17 years had a higher adjusted prevalence of persistent symptoms (aPrev=29.1%, 95%CI:19.4-38.7) than younger children. Comparing seropositive and seronegative adolescents, the estimated prevalence of symptoms lasting over four weeks is 4.4% ({Delta}aPrev, 95%CI:-3.8-13.6). InterpretationA significant proportion of children aged 12 to 17 years had symptoms lasting over two weeks after SARS-CoV-2 infection, with an estimated prevalence of symptoms lasting over 4 weeks of 4.4% in this age group. This represents a large number of adolescents in absolute terms, and should raise concern in the context of unknown long-term evolution of symptoms. Younger children appear to experience long-lasting symptoms less frequently, as no difference was observed between the seropositive and seronegative sample. Further studies with larger samples sizes are needed. FundingSwiss Federal Office of Public Health, Geneva General Directorate of Health, HUG Private Foundation, SSPH+, Fondation des Grangettes.

Aims of the studyWe know little about the level of physical activity, respiratory physiotherapy practices, and nutritional status of people with primary ciliary dyskinesia (PCD), although these are important aspects of patients with chronic respiratory disease. We assessed physical activity, respiratory physiotherapy practices, and nutritional status among people with PCD in Switzerland, investigated how these vary by age, and identified factors associated with regular physical activity. MethodsWe sent a postal questionnaire survey to people with PCD enrolled in the Swiss PCD registry (CH-PCD), based on the standardised FOLLOW-PCD patient questionnaire. We collected information about physical activity, physiotherapy, respiratory symptoms, and nutritional status. We calculated the metabolic equivalent (MET) to better reflect the intensity of the reported physical activities. To assess nutritional status, we extracted information from CH-PCD and calculated participants body mass index (BMI). ResultsOf the 86 questionnaires we sent, 74 (86% response rate) were returned from 24 children and 50 adults. The median age at survey completion was 23 years [IQR (interquartile range) 15-51], and 51% were female. Among all 74 participants, 48 (65%) performed sports regularly. Children were vigorously active (median MET 9.1; IQR 7.9-9.6) and adults were moderately active (median MET 5.5; IQR 4.3-6.9). 59 participants (80%) reported performing some type of respiratory physiotherapy. However, only 30% of adults saw a professional physiotherapist compared with 75% of children. Half of the participants had normal BMI; one child (4%) and two adults (4%) were underweight. People who were regularly physically active reported seeing a physiotherapist more often. ConclusionsOur study is the first to provide patient-reported data about physical activity, respiratory physiotherapy, and nutrition among people with PCD. Our results highlight that professional respiratory physiotherapy, exercise recommendations, and nutritional advice are often not implemented in the care of people with PCD in Switzerland. Multidisciplinary care in specialised centres by teams including physiotherapists and nutrition consultants could improve the quality of life of people with PCD.

PurposeThe COVID-19 pandemic has had profound and multifaceted impacts on children and adolescents, exposing and deepening pre-existing inequalities while creating unique health, social, and educational challenges. In response to the limited evidence-based knowledge available, the SEROCoV-KIDS study was launched in 2021 as a prospective cohort and biobank to assess the pandemics effects on youth health and well-being. It focuses on the general population of Geneva, Switzerland, as well as subgroups with vulnerabilities, including prior SARS-CoV-2 infection, chronic health conditions, and socioeconomic disadvantage. ParticipantsA total of 2199 children and adolescents, aged 6 months to 17 years, from 1340 households were enrolled in the SEROCoV-KIDS cohort, 2048 from the general population and 151 from clinics (i.e., children with chronic health conditions). At baseline, between December 2021 and June 2022, participants provided blood samples for serological testing and for long-term storage in the biobank, while comprehensive questionnaires were completed by a referent adult and adolescents aged 14 and older. Five follow-up online assessments were conducted until October 2025, addressing physical and mental health, development, quality of life, health behaviors, family dynamics, and education-related topics. The quantitative findings of the cohort study were enriched by a cross-sectional qualitative study conducted between October 2023 and March 2024, focusing specifically on socioeconomically disadvantaged populations. Findings to dateIn the population-based sample, 66.3% of participants tested seropositive for anti-SARS-CoV-2 nucleocapsid antibodies at baseline, and 4.1% reported symptoms consistent with post-COVID condition. Most children were minimally or not at all affected by the pandemic, showing good mental health over time. However, 8% of participants reported a positive pandemic impact, whereas 8-13% experienced negative impacts, mainly due to disrupted routines and reduced social support. Health behaviors like physical activity and sleep remained largely stable over the study period. Higher screen time at baseline was associated with poorer well-being. Children with chronic health conditions or experiencing socioeconomic and family disadvantage were disproportionately affected in terms of the health and psychosocial consequences of the pandemic. Future plansSEROCoV-KIDS demonstrates the value of child-focused cohorts for understanding the consequences of major societal events and for guiding evidence-based policy. Our next priority is to secure funding to prolong follow-up of this cohort and to maintain systematic surveillance of children and adolescents, so that emerging findings can directly inform public health and education policy over the coming years. Strengths and limitations of this studyO_LIThis large population-based pediatric cohort provides insights into the health and well-being of children and adolescents aged 6 months to 17 years at baseline, during and after the COVID-19 pandemic (from December 2021 to October 2025). C_LIO_LIThis study integrates multifaceted findings on the general pediatric population and on subgroups of children with clinical and/or social vulnerabilities, combining quantitative and qualitative data to provide a deeper understanding of how the pandemic has affected their lives. C_LIO_LIThis unique pediatric cohort and its associated biobank offer a rare opportunity to advance future pediatric research in Switzerland and abroad. C_LIO_LIGeneralizability may be limited, as participating families tended to be more highly educated and somewhat more socioeconomically advantaged than the general Geneva population, despite nearly one-fifth reporting financial difficulties. C_LIO_LIThe study was designed in response to the pandemic, and individual-level pre-pandemic data are lacking, which limits direct comparisons over time, relying instead on parent-reported perception of changes and impacts. C_LI

The COVID-19 morbidities model has been widely used since 2020 to support Test and Trace and assess the cost-effectiveness of the COVID-19 vaccination programme. The current iteration of the Long COVID model covers several morbidities associated with COVID-19, which are essential to plan for elective care in the future and identify which services to prioritise. However, there are uncertainties in the model around the long-term health-related quality of life (HRQoL) impact of COVID-19, which is primarily based on data for severe COVID disease or hospitalised patients at present. The COVID-19 morbidities model requires updating to address gaps and reflect the latest HRQoL evidence. The aim of this rapid review was to provide updated HRQoL evidence for the COVID-19 morbidities model to better support decision-making in relation to COVID-19 policy. Thirteen primary studies were identified. People who had an initial mild COVID-19 illness or were not treated in hospital can have a decreased HRQoL post-COVID. However, the extent, severity, and duration of this is not consistent. The evidence on the long-term impact of a mild COVID-19 infection on HRQoL is uncertain. Implications for policy and practice include: O_LIAn initial mild COVID-19 illness can lead to a reduction in HRQoL and impaired mental health, but there is evidence indicating that patients can show significant recovery up to normal levels after one year. C_LIO_LIEmployers should be aware that employees may have prolonged experiences of impaired mental health, including anxiety, depression, and fatigue, following COVID-19 disease, even if their initial disease was mild (not hospitalised). C_LIO_LIPublic health agencies should make patients with mild COVID-19 disease aware of the potential for ongoing symptoms and ways to mitigate and manage them through raised awareness and education. C_LIO_LIHealth Boards should review their provision of long-COVID services in relation to the extent of impacts identified. C_LIO_LIBetter quality studies that report longitudinal follow-up data on HRQoL for a representative cohort of patients who have had mild COVID-19 are required. C_LI Funding statementThe Bangor Institute for Health and Medical Research, Bangor University was funded for this work by the Wales Covid-19 Evidence Centre, itself funded by Health & Care Research Wales on behalf of Welsh Government. Rapid Review DetailsO_ST_ABSReview conducted byC_ST_ABSBangor Institute for Health and Medical Research Rapid Review Team Review TeamO_LIDr Llinos Haf Spencer, l.spencer@bangor.ac.uk C_LIO_LIDr Annie Hendry, a.hendry@bangor.ac.uk C_LIO_LIMr Abraham Makanjuola, a.makanjuola@bangor.ac.uk C_LIO_LIMr Jacob Davies, j.davies@bangor.ac.uk C_LIO_LIMiss Kalpa Pisavadia, kalpa.pisavadia@bangor.ac.uk C_LIO_LIProfessor Dyfrig Hughes, d.a.hughes@bangor.ac.uk C_LIO_LIProfessor Deb Fitzsimmons, d.fitzsimmons@swansea.ac.uk C_LIO_LIProfessor Clare Wilkinson, c.wilkinson@bangor.ac.uk C_LIO_LIProfessor Rhiannon Tudor Edwards, r.t.edwards@bangor.ac.uk C_LI Review submitted to the WCEC inJuly 2022 Rapid Review report issued by the WCEC inAugust 2022 WCEC TeamAdrian Edwards, Ruth Lewis, Alison Cooper and Micaela Gal involved in drafting, Topline Summary, editing etc. This review should be cited asRR00040. Wales COVID-19 Evidence Centre. What is the long-term impact of COVID-19 on the Health-Related Quality of Life of individuals with mild symptoms (or non-hospitalised): A rapid review. July 2022. This report can be downloaded herehttps://healthandcareresearchwales.org/wales-covid-19-evidence-centre-report-library DisclaimerThe views expressed in this publication are those of the authors, not necessarily Health and Care Research Wales. The WCEC and authors of this work declare that they have no conflict of interest. TOPLINE SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal, and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/ question(s), extent of the evidence base, and type of analysis required for synthesis. Who is this summary for?The Department of Health and Social Care (DHSC), who have previously created a COVID-19 morbidities model to support the COVID-19 pandemic response. It will also inform Welsh Government policy through work conducted by the Technical Advisory Cell. Background / Aim of Rapid ReviewThe COVID-19 morbidities model has been widely used since 2020 to support Test and Trace and assess the cost-effectiveness of the COVID-19 vaccination programme. The current iteration of the Long COVID model covers several morbidities associated with COVID-19, which are essential to plan for elective care in the future and identify which services to prioritise. However, there are uncertainties in the model around the long-term health-related quality of life (HRQoL) impact of COVID-19, which is primarily based on data for severe COVID disease or hospitalised patients at present. The COVID-19 morbidities model requires updating to address gaps and reflect the latest HRQoL evidence. The aim of this Rapid Review was to provide updated HRQoL evidence for the COVID-19 morbidities model to better support decision-making in relation to COVID-19 policy. The latest edition of the model was published by the DHSC team in December 2020. The review focused on studies reporting on the long-term impact on HRQoL of patients who had experienced mild symptoms or were not treated in hospital. Inclusion was limited to studies that used validated HRQoL measures, which can be mapped onto EuroQol Quality of Life Measure - 5 dimensions (EQ-5D) and conducted in OECD countries. Two existing systematic reviews were used to identify relevant primary studies published before January 2021, with new searches focusing on the period between January 2021 to June 2022. Key FindingsThirteen primary studies were identified. Extent of the evidence baseO_LIMost studies (n=8) were cross-sectional surveys or reported on HRQoL outcomes at a single time point post-COVID (n=2). Only three studies (one of which was a case report) provided longitudinal follow-up data, which included changes from baseline or reported data at multiple time points. C_LIO_LIOnly two studies reported on HRQoL beyond six months follow-up: One study reported data at three months, six months, and twelve months follow-up and one study measured outcomes at six to eleven months. Five studies measured HRQoL at three months post COVID-19, one at four months, and one at five months. Three studies reported data at two months or less post COVID-19. C_LIO_LITwo studies (one was a case report) focused solely on patients with mild infection, whilst the remaining eleven studies also included patients with moderate or severe/critical COVID-19 illness. Three studies included participants categorised as non-hospitalised or hospitalised patients. twelve studies recruited patients attending outpatients or health care settings; one study recruited a general Swedish population who had a previous COVID-19 infection. C_LIO_LIThe studies were conducted in Turkey (n=2), Denmark (n=1), Sweden (n=1), USA (n=2), Chile (n=1), Ukraine (n=1), Mexico (n=1), Austria (n=2), and The Netherlands (n=2). No UK-based studies were identified. C_LI Recency of the evidence baseO_LIThree studies published in 2022 were conducted in 2021 (Akova & Gedikli, 2022; Bileviciute-Ljungar et al., 2022; Tanriverdi et al., 2022). C_LI Summary of resultsO_LIPeople who had an initial mild COVID-19 illness or were not treated in hospital can have a decreased HRQoL post-COVID. However, the extent, severity, and duration of this is not consistent. C_LI Best evidence availableO_LIHan et al., (2022) recruited outpatients who had mild initial COVID-19 disease and measured HRQoL at six to eleven months follow-up; 436/2092 (21%) outpatients responded to the survey. The findings indicated that the burden of persistent symptoms was significantly associated with poorer long-term health status, poorer quality of life, and psychological distress. C_LIO_LISiegerink et al., (2021) measured HRQoL at three months, six months, and twelve months follow-up, and recruited patients presenting at hospital with COVID-19, a proportion of whom were not hospitalised. At three months follow-up, 22% (n=9) of the non-hospitalised group reported abnormal Hospital Anxiety and Depression Scale (HADS) scores (cut-off at 16). After six months, this decreased to 16% (for n=4), and 14.8% at twelve months (n=4). C_LIO_LILabarca et al., (2021) reported a change from baseline in percentage satisfaction with HRQoL. They found 50% of the (n=18) mild (non-hospitalised) COVID-19 patients reported an individual change in HRQoL, categorised as a change of [≥] 10% on a Visual Analogue Scale (VAS) at four months follow-up. C_LI Policy ImplicationsO_LIAn initial mild COVID-19 illness can lead to a reduction in HRQoL and impaired mental health, but there is evidence indicating that patients can show significant recovery up to normal levels after one year. C_LIO_LIEmployers should be aware that employees may have prolonged experiences of impaired mental health, including anxiety, depression, and fatigue, following COVID-19 disease, even if their initial disease was mild (not hospitalised). C_LIO_LIPublic health agencies should make patients with mild COVID-19 disease aware of the potential for ongoing symptoms and ways to mitigate and manage them through raised awareness and education. C_LIO_LIHealth Boards should review their provision of long-COVID services in relation to the extent of impacts identified. C_LIO_LIBetter quality studies that report longitudinal follow-up data on HRQoL for a representative cohort of patients who have had mild COVID-19 are required. C_LI Strength of EvidenceO_LIThe evidence on the long-term impact of a mild COVID-19 infection on HRQoL is uncertain. C_LI

ObjectivesWe studied post-COVID-19 condition by investigating health-related quality of life and fatigue in the general Dutch population in the early phase of the pandemic, including symptomatic and asymptomatic infections among unvaccinated individuals. Methods(Still) unvaccinated participants aged [≥]15 years were selected from the February 2021 round of the nationwide seroepidemiological PIENTER Corona cohort study. We assessed associations between the time since serologically-identified SARS-CoV-2 infection and four outcome measures: health utility (Short-Form 6 Dimensions), mental health and physical health (Short Form Health Survey 12) and fatigue (Checklist Individual Strength subscale fatigue). Per outcome, cutoff points were selected at each 5% increment (5-75%) along the cumulative distribution of those uninfected. At each cutoff, multivariable logistic regression models (score below cutoff yes/no) were fitted adjusted for infection history, age, sex, education level, comorbidities, and restriction intensity. ResultsAt the cutoff of the lowest 15th percentile among uninfected, significant differences between uninfected (n=4,569) and infected [≤]4 months ago (n=351) were observed for health utility (OR [95%CI]: 1.6 [1.2-2.2]), physical health (1.9 [1.5-2.5]) and fatigue (1.6 [1.3-2.1]), but not for mental health (1.2 [0.9-1.6]). There were no significant differences between uninfected and infected >4 months ago (n=327) for all outcomes at any cutoff of the cumulative distribution, with post-hoc analysis showing a power to detect prevalence differences as low as 7%. ConclusionsIn the first year of the pandemic, data from this Dutch population-based seroepidemiological cohort showed that unvaccinated individuals with a SARS-CoV-2 infection [≤]4 months ago reported poorer health utility and physical health, and more severe fatigue compared to those uninfected. Interestingly, for those infected >4 months ago differences remained below the detection limit, suggesting a lower population prevalence of post-COVID-19 condition than currently found in literature for this period.

BackgroundControlled population-based studies on long-term health sequelae of SARS-CoV-2 can help to identify clinical signs specific to "Long COVID" and to evaluate this emerging public health challenge. AimTo examine prevalence differences of Long COVID-associated symptoms among adults with and without SARS-CoV-2 infection in Germany. MethodsThis population-based, retrospective study (11/2021-2/2022) included 7,683 working aged adults (18-65 years), a subset of the Corona Monitoring Nationwide study in Germany. Prior SARS-CoV-2 infection was defined based on self-reported PCR-confirmed infections and IgG-antibody dried blood spot testing. Participants answered a questionnaire including 19 common symptoms of Long COVID experienced in the six months preceding the survey. We estimated population-weighted prevalence of (1) individual symptoms, and (2) [&ge;]1 symptom, with and without impact on work ability, by infection status within strata of sex, age group, income and comorbidity. We calculated model-adjusted prevalence differences and the probability that symptoms among infected are attributable to infection. Results12 of 19 symptoms showed a significantly higher prevalence in infected than non-infected participants, including fatigue (27.5% versus 18.3%; p<0.001), concentration problems (22.2% vs. 13.1%; p<0.001), shortness of breath (15.6% vs. 7.5%; p<0.001), and smell and taste disorder (10% vs. 1.2%; p<0.001). [&ge;]1 symptom with impact on work ability was more prevalent following infection (16.0% vs. 12.2%; p=0.06) with a model-adjusted prevalence difference of 3.8% (95%-CI -0.5-8.0). ConclusionWe observed a rather small excess prevalence attributable to SARS-CoV-2 infection. However, the absolute number of persons places great demands on the health care system and may affect economic productivity.

ObjectivesLong COVID is a frequent post-infectious chronic condition that impacts quality of life and work performance. Whether individuals with comorbidities experience a greater functional impact of long COVID is unknown. We evaluated the functional impact of long COVID among healthcare workers (HCWs) with chronic cardiovascular diseases, chronic respiratory diseases, obesity, or a history of depression, and compared it with that of HCWs without comorbidities. MethodsWe conducted a cross-sectional study in Quebec, Canada. We compared self-reported long COVID cases to COVID-19-infected controls without long COVID on work ability, work functioning, health-related absenteeism, dyspnea-associated impairment, and psychological distress. We used inverse probability of exposure and robust Poisson regressions to estimate adjusted prevalence differences (aPD) and prevalence ratios. Comorbidity data were obtained from the Quebec integrated chronic disease surveillance system. ResultsA total of 3,754 and 8,439 HCWs with and without comorbidities, respectively, were included. Among HCWs with comorbidities, long COVID was associated with lower work ability, lower work functioning, more health-related long-term absenteeism, more dyspnea-associated impairment, and higher psychological distress (aPDs between 8% (95%CI: 5%-11%) for long-term absenteeism and 27% (95%CI: 22%-31%) for low work functioning). aPDs were greater among HCWs with comorbidities than among those without for low work ability (p=0.01 for interaction), for low work functioning (p=0.03), and for dyspnea-associated impairment (p<0.01). ConclusionLong COVID is associated with significant functional impairment among HCWs with pre-existing chronic conditions. What is already known on this topicPeople with comorbidities and those with long COVID both have affected work performance. What this study addsLong COVID is associated with a greater prevalence of low work ability, low work functioning, and dyspnea-associated impairment among workers with existing comorbidities than among those without. How this study might affect research, practice, or policyPublic health, employers, and physicians should give particular attention to the specific needs of individuals affected by long COVID who already have comorbidities. There is a need for targeted occupational health policies to reduce the functional impact of long COVID among workers with comorbidities.

BackgroundContact tracing has been one of the central non-pharmaceutical interventions implemented worldwide to try to control the spread of Sars-CoV-2, but its effectiveness strongly depends on its ability to detect contacts. MethodsWe analysed 166892 concomitant infections occurring at the same address from June 2020 until February 2022 using an extensive operational database of SARS-CoV-2 tests in Geneva and used permutations statistics to compare the total number of secondary infections occurring at the address with those reported through contact tracing. ResultsManual contact tracing captured on average 41% of the secondary infections, with variation in time from 23% during epidemic peaks to 60% during low epidemic activity. People living in wealthy neighbourhoods were less likely to report contacts (adjusted odds ratio (aOR): 1.6). People living in buildings, compared to people living in single house, were also less likely to report contacts than those living in houses, with an aOR of 1.1 to 3.1 depending on the variant, the size of the building and the presence of shops. This under-reporting of contacts in buildings decreased during periods of mandatory face masking and restriction of private gathering. ConclusionsContact tracing alone does not detect enough secondary infections to efficiently reduce the propagation of Sars-CoV-2. Public messages and outreach campaigns targeting specific populations, such as those in affluent areas, could enhance coverage. Additionally, measures like wearing face masks, improving ventilation, and implementing gathering restrictions should also be considered to reduce the number of infections occurring during interactions that may not be perceived as high risk.

Employment within healthcare settings can place a significant strain on the general wellbeing of staff, particularly during the winter. There is a link between health and wellbeing and the composition of the gut microbiota and daily supplementation with probiotics has been shown to stabilise/modulate the gut microbiota which may help support the health and wellbeing of healthcare workers. In this exploratory, single-arm, open-label, remotely-conducted study, National Health Service employees in Wales received a daily dose of probiotic for 8 weeks over the winter season and those volunteering to take part reported their perception of quality of life including sleep quality, energy levels and mood and their physical discomforts including bloating and muscle ache at weekly intervals throughout the intervention period (ClinicalTrials.gov: NCT05968209). Compared to the start of the study, their sleep quality significantly improved by 34.2%, their energy levels by 29.2% and their overall mood by 24.3% after 8 weeks of probiotic supplementation. Their general wellbeing had significantly improved by 16%. The prevalence of bloating decreased significantly from 75% at the start of the study to 42% by the study end, and muscle aches fell from 76% to 45%. The findings indicate that the wellbeing of healthcare workers over the winter months improved whilst receiving daily probiotic supplementation. Further work is required in a placebo-controlled, randomised, double-blind study.

Background/Objective: Seasonal upper respiratory tract infections (URTIs) are common in children and contribute to absenteeism and reduced quality of life. Over-the-counter treatments show limited efficacy and may cause adverse effects, thus warranting the need for natural alternatives. This study evaluated the efficacy of a whole-fruit supplement derived from boysenberry and apple (BerriQi) in reducing symptom severity and duration in school-aged children with URTIs using the Wisconsin Upper Respiratory Symptoms Survey for Kids (WURSS - K). Methods: In this double-blind, randomised, placebo-controlled study, 84 children aged 5 -13 years with URTI-associated school absence were assigned to receive BerriQi or placebo (two chewable tablets daily) for 14 days. Outcomes included the severity and duration of global illness, composite symptom and function scores. Results: Both groups showed progressive reductions in global illness severity, symptom, and function score over 14 days. However, the BerriQi group consistently reported lower scores across all outcomes. While global illness severity did not differ significantly between groups, total symptom severity was significantly reduced with BerriQi (P=0.04), and functional scores showed a trend toward improvement (P=0.05). The BerriQi group experienced fewer sick days compared with placebo (8 vs. 11 days) and demonstrated a higher likelihood of functional recovery (HR = 1.79, 95% CI: 1.09 - 2.91; P=0.02). Conclusions: These findings suggest that BerriQi may serve as a promising natural paediatric supplement for alleviating respiratory illness symptoms and supporting faster functional recovery, potentially reducing school absenteeism associated with upper respiratory tract infections (URTIs).

BackgroundThis study aims to understand how psychological distress is related to compliance with COVID-19 sanitary measures. In addition, we explored whether gender and socioeconomic status (i.e educational level and employment status) can modify this relationship. MethodsData from four European cohort studies (n=13,635), were analysed using an Individual Participant Data (IPD) meta-analytic approach. Mixed effect models were employed to examine associations between mental health difficulties and compliance with sanitary measures, as well as effect modification by socioeconomic status. Statistical models were additionally stratified by gender. ResultsWe found a statistically significant positive association between mental health difficulties and compliance with sanitary measures in women, while amongst men the statistically significant association observed was negative. Moreover, there was a statistically significant interaction between participants educational level and mental health difficulties amongst men only, indicating even lower compliance levels with COVID-19 sanitary measures amongst individuals with only primary schooling. ConclusionThe association between psychological distress and compliance with sanitary measures is complex - positive in women, negative in male. Men experiencing mental health difficulties, especially those with lower educational attainment, exhibit low levels of compliance with sanitary measures.

BackgroundThe COVID-19 pandemic is having a lasting impact on health and well-being. We compare current self-reported health, quality of life and symptom profiles for people with ongoing symptoms following COVID-19 to those who have never had COVID-19 or have recovered. MethodsA cohort study was established with participants from the REACT programme. A sample (N=800,000) of adults were contacted between August and December 2022 to complete a questionnaire about their current health and COVID-19 history. We used logistic regression to identify predictors of persistent symptoms lasting [&ge;]12 weeks following COVID-19. We fitted Accelerated Failure Time models to assess factors associated with rate of recovery from persistent symptoms. FindingsOverall, 276,840/800,000 (34.6%) of invited participants completed the questionnaire. Median duration of COVID-related symptoms (N=130,251) was 1.3 weeks (inter-quartile range 6 days to 2 weeks), with 7.5% and 5.2% reporting ongoing symptoms [&ge;]12 weeks and [&ge;]52 weeks respectively. Female sex, having [&ge;]1 comorbidity, more severe symptoms at time of COVID-19 and being infected when Wild-type variant was dominant were associated with higher probability of symptoms lasting [&ge;]12 weeks. Longer time to recovery in those with persistent symptoms was found for females, people with comorbidities, living in more deprived areas, current smokers and for Wild-type compared to later variants. Mental health and health-related quality of life were significantly worse among participants with ongoing persistent COVID-19 symptoms compared with those who had never had COVID-19 or had recovered. InterpretationAlthough COVID-19 is usually of short duration, some adults experience persistent and burdensome illness. FundingThis work is independent research funded by the National Institute for Health and Care Research (NIHR) (REACT Long COVID (REACT-LC) (COV-LT-0040)). This research is part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (UKRI) (MC_PC_20029). The views expressed in this publication are those of the author(s) and not necessarily those of NIHR or UKRI.

BackgroundPost-COVID-19 condition (PCC) is a global health concern with a profound impact on physical, mental, and social health, potentially leading to stress. This study compared perceived stress levels between adults with PCC and those without PCC (non-PCC). Additionally, environmental (societal, community, interpersonal) and individual factors were explored for their association with stress. MethodsCross-sectional questionnaire data from participants with SARS-CoV-2 infection were obtained from the prospective PRIME post-COVID cohort (2022). PCC was defined as feeling unrecovered ([&ge;] 3 months) after SARS-CoV-2 infection. Associations between societal, community, interpersonal and individual factors and the outcome perceived stress (measured by the Perceived Stress Scale 14; PSS-14) were assessed in PCC and non-PCC using logistic regressions, adjusted for gender and age. ResultsIn total, 3275 participants were included (PCC: n=1044, non-PCC: n=2231). PCC had higher perceived stress scores (mean{+/-} SE: 20.75{+/-} 0.27) than non-PCC (mean{+/-} SE: 15.65{+/-} 0.19), adjusted for age and gender (p<0.001). Factors associated with more perceived stress included lower neighborhood livability and cohesion (societal level), higher absenteeism and presenteeism (community level), less social support, less dense and diverse social network (interpersonal level), being female, having co-morbidities, post-exertional malaise, orthostatic intolerance, loneliness, and lower coping score (individual level). These factors and their effect-sizes were largely comparable between PCC and non-PCC, but nearly all were more prevalent in PCC compared to non-PCC group. ConclusionAdults with PCC perceived higher stress levels compared to adults without PCC, which may be attributable to higher prevalences of a multitude of stress-associated environmental and individual factors.

Previous research has categorised symptoms of COVID-19 / Long COVID into 12 thematic areas including: fever, myalgia, fatigue, impaired cognitive function, and that COVID-19 survivors had reduced levels of physical function, activities of daily living, and health-related quality of life. Our aim was to review the evidence for interventions or best practice to support people with Long COVID, or similar post-viral conditions characterised by fatigue, to return to normal activities. Evidence was included from guidelines, systematic reviews (SR), and primary studies. The primary studies focussed on Long COVID (LC) indicated that there should be a needs-based focus to care for those with LC. Consideration should be given to individuals living with LC in the same way as people with disabilities are accommodated in terms of workplace adjustment. Two SRs indicated that non-pharmaceutical interventions (NPIs) for patients with LC or chronic fatigue syndrome could help improve function for activities of daily life. However, the third, most recent SR, concluded that there is a lack of robust evidence for NPIs. LC fatigue management methods may be beneficial under certain conditions. One SR reported work capability as an outcome however they did not find any studies which evaluated the impact of interventions on return to work/ normal life. One primary study, on individuals with CFS, described a written self-management programme. Following this intervention there was an 18% increase in the number of patients in employment. Policy and practice implications: Long COVID is still being established as a post-viral condition with many symptoms. Patient-centred treatment options such as occupational therapy, self-management therapy and talking therapy may be considered in the same way as for other debilitating conditions. Return-to-work accommodations are needed for all workers unable to return to full-time employment. Due to the nature of the studies included, there was little reported evidence of effectiveness of getting individuals back into their normal activities. Funding statementThe Bangor Institute for Health and Medical Research was funded for this work by the Wales COVID-19 Evidence Centre, itself funded by Health & Care Research Wales on behalf of Welsh Government. Rapid Review DetailsO_ST_ABSReview conducted byC_ST_ABSBangor Institute for Health and Medical Research (BIHMR), Bangor University. Review Team{blacksquare} Dr Llinos Haf Spencer, l.spencer@bangor.ac.uk {blacksquare}Dr Annie Hendry, a.hendry@bangor.ac.uk {blacksquare}Mr Abraham Makanjuola, a.makanjuola@bangor.ac.uk {blacksquare}Ms Bethany Fern Anthony, b.anthony@bangor.ac.uk {blacksquare}Mr Jacob Davies, jacob.davies@bangor.ac.uk {blacksquare}Ms Kalpa Pisavadia, kalpa.pisavadia@bangor.ac.uk {blacksquare}Professor Dyfrig Hughes, d.a.hughes@bangor.ac.uk {blacksquare}Professor Deb Fitzsimmons, d.fitzsimmons@bangor.ac.uk {blacksquare}Professor Clare Wilkinson, c.wilkinson@bangor.ac.uk {blacksquare}Professor Rhiannon Tudor Edwards, r.t.edwards@bangor.ac.uk Review submitted to the WCEC on11 January 2023 Stakeholder consultation meeting8th November 2022 Rapid Review report issued by the WCEC inJanuary 2022 WCEC TeamAdrian Edwards, Ruth Lewis, Alison Cooper and Micaela Gal involved in drafting the Topline Summary and editing. This review should be cited asRR00042_ Wales COVID-19 Evidence Centre DisclaimerThe views expressed in this publication are those of the authors, not necessarily Health and Care Research Wales. The WCEC and authors of this work declare that they have no conflict of interest. TOPLINE SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur rapid reviews (RR) use a variation of the systematic review (SR) approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting RR, including a structured protocol, systematic search, screening, data extraction, critical appraisal, and evidence synthesis to answer a specific question and identify key research gaps. They take 1 to 2 months, depending on the breadth and complexity of the research topic/question(s), extent of the evidence base, and type of analysis required for synthesis. Who is this summary for?Policymakers in Welsh Government to plan and deliver services for individuals with Long COVID as they re-enter training, education, employment, and informal caring responsibilities. Background / Aim of Rapid ReviewPrevious research has categorised symptoms of COVID-19/Long COVID into 12 thematic areas including: fever, myalgia, fatigue, impaired cognitive function, and that COVID-19 survivors had reduced levels of physical function, activities of daily living, and health-related quality of life (Amdal et al., 2021; de Oliveira Almeida et al., 2022). NICE guidelines highlight the impact of the condition on quality of life and the challenge of determining best practice based on the current evidence (National Institute for Health and Care Excellence et al., 2022). Treatments for other post-viral syndromes may also apply to people living with Long COVID (Wong and Weitzer, 2021). Our aim was to review the evidence for interventions or best practice to support people with Long COVID, or similar post-viral conditions characterised by fatigue, to return to normal activities (including return to the workforce, education, childcare, or housework). Key FindingsEvidence was included from guidelines (n=3), systematic reviews (SRs) (n=3), and primary studies (n=4). Extent of the evidence base{blacksquare} Two SRs included non-pharmacological interventions for Long COVID or post-viral syndromes, including Long COVID (Chandan et al., 2022; Fowler-Davis et al., 2021). The remaining SR focused on interventions for Chronic Fatigue Syndrome (CFS). {blacksquare}The four primary studies were conducted in the UK, USA, Norway, and Turkey. The SRs included studies from across Europe, Asia, Africa, and Australasia. {blacksquare}Included SRs and primary studies evaluated non-pharmaceutical interventions, including fatigue management, exercise therapy, Cognitive Behavioural Therapy (CBT), workplace support, self-management, sleep therapy, music therapy, and counselling. {blacksquare}Two relevant guidelines were identified for Long COVID and one for ME/CFS. The Long COVID guideline was aimed at employers, and the ME/CFS guideline was aimed at service providers and users. Recency of the evidence base{blacksquare} Included papers were from 2014 to 2022. Evidence of effectiveness{blacksquare} The primary studies focussed on Long COVID indicated that there should be a needs-based focus to care for those with Long COVID (Lunt et al., 2022; Skilbeck, 2022; Wong et al., 2022). Consideration should be given to individuals living with Long COVID in the same way as people with disabilities are accommodated in terms of workplace adjustment (e.g. part-time hours, working from home, or hybrid working). {blacksquare}Two SRs indicated that non-pharmaceutical interventions for patients with Long COVID or CFS could help improve function for activities of daily life (Fowler-Davis et al., 2021; Larun et al., 2019). However, the third and most recent SR concluded that there is a lack of robust evidence for non-pharmaceutical interventions (Chandan et al., 2022). {blacksquare}Long COVID fatigue management by exercise therapy, electrical nerve stimulation, sleep and touch therapy, and behavioural self-management may be beneficial when: physical and psychological support is delivered in groups, people can plan their functional response to fatigue, strengthening rather than endurance is used to prevent deconditioning, fatigue is regarded in the context of an individuals lifestyle and home-based activities are used (Fowler-Davis et al 2021). {blacksquare}One SR (Chandan et al 2022) reported work capability as an outcome however they did not find any studies which evaluated the impact of interventions on return to work/ normal life. {blacksquare}One primary study concentrated on individuals with CFS (Nyland et al., 2014). Nyland et al. (2014) described a written self-management programme featuring active coping (with CFS) strategies for daily life. Following this intervention, there was an 18% increase in the number of patients in employment (from baseline to follow-up) (Nyland et al., 2014). Best quality evidence{blacksquare} The three SRs (Chandan et al., 2022; Fowler-Davis et al., 2021; Larun et al., 2019) were of high quality, as was one of the cohort studies (Lunt et al., 2022). Policy Implications{blacksquare} Long COVID is still being established as a post-viral condition with many symptoms. The Welsh Government may seek to consider patient-centred treatment options such as occupational therapy, self-management therapy and talking therapy (such as Cognitive Behavioural Therapy) in the same way as for other debilitating conditions including ME/CFS. {blacksquare}Return-to-work accommodations are needed for all workers unable to return to full-time employment. {blacksquare}Due to the nature of the studies included, there was little reported evidence of effectiveness of getting individuals back into their normal activities. Strength of EvidenceConfidence in the findings is low. Only four primary studies reported outcomes relating to work capacity and return to normal activities such as childcare and housework.

BackgroundThe COVID-19 pandemic had heterogeneous effects on the mental health of children and adolescents according to individual experiences, with some consequences persisting beyond the lifting of restrictions. We aimed to examine whether the perceived impact of the COVID-19 pandemic was associated with 2022-2025 trajectories of mental health difficulties in children and adolescents, and to identify associated risk and protective factors. MethodsData was drawn from the population-based SEROCoV-KIDS cohort study conducted in Geneva, Switzerland. The multidimensional perceived impact of the pandemic, as well as potential socio-demographic, health, family, social, and behavioral risk and protective factors were parent-reported at baseline, in 2022. Mental health difficulties were collected annually between 2022 and 2025. Generalized mixed effects models were used to estimate mental health trajectories by pandemic impact, and to assess risk and protective factors. ResultsOf 1907 children aged 2-17 years, 9.3% and 7.9% had experienced a negative and positive pandemic impact, respectively. Compared to their unaffected peers, negatively impacted children had more mental health difficulties in 2022 (incidence rate ratio [IRR]: 1.51; 95% confidence interval [CI]: 1.34-1.70) and improving trends between 2022 and 2025 (IRR: 0.97; 95% CI: 0.95-1.01). An average-to-poor financial situation was related to a milder mental health response to a negative impact in 2022 (IRR: 0.64; 95% CI: 0.46-0.89). A positive pandemic impact tended to be associated with higher difficulties in 7-12 years old children only (IRR: 1.36; 95% CI: 0.98-1.89) in 2022, with stable trends over time. ConclusionAbout five years after the onset of COVID-19, the lasting mental health difficulties presented by negatively impacted children had largely improved. Although globally reassuring, these findings call for proactive measures to prevent such long-term consequences on youth mental health in the event of future crises.

BackgroundSport participation is an important component of a healthy lifestyle and is known to be more common among privileged individuals. However, few studies have examined socio-demographic patterns of participation by type of activity. This study aims at quantifying socio-economic inequalities in sport participation by sport type, and to analyse their trend over 15 years. MethodsWe used 2005-2019 data from the Bus Sante study, a yearly population-based cross-sectional survey of Geneva adults. Sport participation was defined as reporting at least one sporting activity over the previous week; educational level, household income and occupational position were used as indicators of socio-economic position. Socio-economic inequalities in sport participation, and their trend over time, were examined using the relative and slope indexes of inequality (RII/SII). ResultsOut of 7769 participants (50.1% women, mean age 46 years old), 60% participated in a sporting activity. Results showed that the higher the socioeconomic circumstances, the higher the sport participation (RII=1.78; 95% Confidence Interval (CI): 1.64-1.92; SII=0.33; 95%CI: 0.29-0.37 for education). Relative inequalities varied per sport e.g., 0.68 (95%CI: 0.44-1.07) in football participation and 4.25 (95%CI: 2.68-6.75) in tennis/badminton participation for education. Yearly absolute inequalities in sport participation tended to increase between 2005 and 2019 for household income ({beta}=0.01; P-value=0.024). ConclusionWe observed strong socio-economic inequalities in sport participation in Geneva, with different magnitude depending on the type of sport. These inequalities seemed to increase over the 2005-2019 period. Our results call for tailored measures to promote the participation of socially disadvantaged populations in sporting activities. KEY MESSAGESO_LISport participation is associated with higher socioeconomic conditions. Research on the patterning of inequalities per sport type and on their trend over time remains scarce. C_LIO_LIThere are high growing socioeconomic inequalities in sport participation in Geneva. Inequalities in sport participation are heterogeneous and lower in sports practised in group. C_LIO_LITailored sport promotion measures are needed for disadvantaged populations. C_LI

BackgroundThe mental health impacts of COVID-19, particularly regarding anxiety and depression, are well-documented and more prevalent among women. This study aimed to assess the longitudinal effects of COVID-19 on anxiety, depression, and sleep conditions in a sample of Spanish adults. MethodsA total of 608 individuals completed biweekly anxiety, depression, and sleep questionnaires for over a year (July 2021-March 2023). Data on SARS-CoV-2 infection prior to questionnaire administration were also available. Respondents were classified into three groups based on prior SARS-CoV-2 infection and symptoms during a period preceding the administration of the questionnaire (no infection, infected asymptomatic, symptomatic). Means and variability scores for anxiety, depression, and sleep scores were tracked over time for each individual. Differences between the three groups were analysed, using generalized linear models to assess the impact of COVID-19 symptoms. ResultsNo significant differences in mean anxiety, depression, or sleep quality scores were observed among participants with no COVID-19 diagnosis, symptomatic infection, or asymptomatic infection. Women reported significantly higher anxiety and depression scores and poorer sleep quality than men (p < 0.001). Greater variability in anxiety and depression scores was found among symptomatic COVID-19 cases compared to non-infected individuals, while time since infection did not significantly influence mean scores or variability in any outcome. ConclusionsIndividuals with COVID-19 symptoms exhibited greater variability in anxiety and depression scores, indicating increased psychological instability. Sleep quality was not significantly affected by COVID-19 symptoms. These findings underscore the importance of targeted interventions to address post-pandemic mental health challenges.

BackgroundStudies on long COVID differ in the selection of symptoms used to define the condition. We aimed to assess to what extent symptom selection impacts prevalence estimates of long COVID. MethodsIn a prospective cohort of patients who experienced mild to critical coronavirus disease 2019 (COVID-19), we used longitudinal data on the presence of 20 different symptoms to evaluate changes in the prevalence of long COVID over time when altering symptom selection. ResultsChanging symptom selection resulted in wide variation in long COVID prevalence, even within the same study population. Long COVID prevalence at 12 months since illness onset ranged from 39.6% (95%CI=33.4-46.2) when using a limited selection of symptoms to 80.6% (95%CI=74.8-85.4) when considering any reported symptom to be relevant. ConclusionsComparing the occurrence of long COVID is already complex due to heterogeneity in study design and population. Disparate symptom selection may further hamper comparison of long COVID estimates between populations. Harmonised data collection tools could be one means to achieve greater reproducibility and comparability of results.

BackgroundDespite the high number of post-COVID-19 condition (PCC) cases worldwide, little is known about recovery and its associated factors yet. This study aimed to estimate the proportion of PCC patients that recover, and identity environment and individual factors. MethodsLongitudinal data of the PRIME cohort were analysed in patients with past infection who felt unrecovered at baseline (November 2021), grouped based on capacity of daily functioning (i.e., moderate to severe problems (PCC-impairedDA) or no or slight problems (PCC-affectedDA)). Proportions of recovery or deterioration at follow-up (after 9 months) were calculated. A range of individual, interpersonal, social network, and social and physical environment factors were assessed for lower likelihood for recovery, using multivariable logistic regression. Findings879 patients were analysed. Of patients with PCC-affectedDA (n=602), 222 (36.9%) recovered and 59 (9.8%) deteriorated to PCC-impairedDA. Of patients with PCC-impairedDA (n=277), 30 (10.8%) recovered and 88 (31.8%) improved in daily functioning; recovery was 2.1% when acute illness was >12 months before baseline, and was 12.5% and 13.6% when acute illness was 6-12 and 3-6 months before baseline, respectively. In both PCC groups, individual and environment factors that lowered recovery likelihood included worse physical health (mild/severe fatigue, severe dyspnea, severe symptoms of amnesia, concentration difficulties, muscle pain or -weakness, loss/change of smell/taste), worse mobility (hours spend lying down, problems with walking), worse mental health (depression), worse acute illness (more symptoms, hospitalization/oxygen use), former smoking, living in a rural area, having a relationship, and having more practical social network supporters (in patients with chronic co-morbidities). InterpretationOnly 11%-37% of PCC patients recovered after 9 months, leaving significant room for improvement. Future research should identify modifiable factors and treatments to help assist the recovery of PCC patients. FundingThis study was funded by the Dutch National Institute for Health and Environment, Ministry of Health, Welfare and Sport (Grant numbers: 3910090442/3910105642/3910121041).

BackgroundLongitudinal evidence on the association between temperature fluctuations and psychological wellbeing remains limited, particularly in ageing populations of Southeast Asia. This study examines how heat exposure affects multiple wellbeing outcomes among older adults in Thailand. MethodsWe linked longitudinal data from 16,002 observations in the Health, Aging, and Retirement in Thailand (HART) study (2015-2023) with province-level meteorological data. Using a multilevel mixed-effects model, we decomposed heat indicators into within-province (monthly fluctuation) and between-province (long-term average) components to assess their independent associations with psychological distress, self-rated mental/physical health, and life quality. We additionally use negative controls to address causation. ResultsA 1{degrees}C within-province increase in apparent temperature was associated with higher psychological distress ({beta}=0.10, 95%CI: 0.05, 0.14). Similar detrimental within-effects were observed for self-reported mental health ({beta}=0.06, 95%CI: 0.03, 0.09). Between-province differences in average heat showed minimal or non-significant associations. The negative within-province effect of heat was significantly stronger for individuals with limitations in activities of daily living (ADL) ({beta}=0.12, 95%CI: 0.08, 0.16 for physical health) and those in employment and with low socio-economic status. Results were consistent across all four heat metrics. ConclusionsThe wellbeing of Thai older adults is sensitive to within-province fluctuations in heat, but not to the long-term average heat of a province except for the physically frail and socioeconomically disadvantaged, who are vulnerable to both. The identified vulnerabilities highlight the need for targeted public health interventions, such as heat warnings and workplace protections, to build resilience in this ageing population.