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.

In addition to its potential contribution to reaching climate targets, cycling may generate substantial population-level health benefits through the physical activity it requires. Due to the lack of nationally representative mobility data, the health impact of current levels of cycling is still unknown for France. Relying on a health impact assessment framework and using recent nationally-representative data on mobility, we assessed the health and related economic benefits of cycling in 2018-2019 in France. We show that such benefits remain moderated and fall short when compared to those estimated in other countries with high cycling levels. We argue that cycling in France did not receive the attention and investments it deserves over the past decade and thus represents a missed opportunity for climate action and public health.

Physical activity (PA) is a modifiable health behaviour that can support and improve mental health. The tendency for activity levels to track over time suggests that through continued participation, those most active in youth may experience better long-term mental health than less active peers. Exploring the extent to which mental health benefits of child/adolescent PA persevere over time helps advocates and policy-makers determine whether PA promotion in youth constitutes effective allocation of public health resources and a viable means of reducing the global burden of common mental disorders and suboptimal wellbeing across the lifespan. This systematic review synthesised evidence for childhood/adolescent PA as a predictor of future anxiety, depression and wellbeing indicators (PROSPERO: CRD42021242555). Systematic searches of CINAHL, Medline, PsycInfo, and Scopus (conducted 27th October 2022) returned 12,703 articles with 98 retained. Included: prospective, quantitative, longitudinal designs; PA measured ages 5-17 years; anxiety, depression, and/or wellbeing indicators measured at least 12 months later; generally healthy populations. Excluded: severe mental illnesses. Risk of bias and quality of evidence were assessed following the GRADE framework. Effect sizes from moderate- and high-quality studies are discussed narratively. Studies are grouped by mental health outcome, PA type, domain, and whether participants adhered to current World Health Organisation PA guidelines. PA was negatively associated with depression in 41/67 studies (61.2%); anxiety in 20/35 studies (57.1%); and positively associated with wellbeing in 25/39 studies (64.1%). Effect sizes for all outcomes were small and evidence quality low across all timeframes. Team sports were the most consistently predictive type of PA. Whether domain-specific activities or guideline (non)adherence have differential effects remains unclear. Heterogeneity was attributed to the vastness of associations tested and psychometric measures used. Current literature offers low-quality partial evidence that childhood/adolescent PA has small beneficial effects for prospective anxiety, depression and wellbeing at least 12 months later.

ObjectivesTo identify typologies of activity-related behaviours in childhood and adolescence and to explore transitions between the identified typologies. Additionally, we aimed to identify demographic indicators associated with the transitions and typology membership. DesignProspective cohort study SettingCzech Republic ParticipantsIndividuals involved in the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ) study, aged 11 to 18 years. The study involved more than 563 individuals of which 380 provided complete data the analysis. Primary outcome measuresTime spent outdoors, participation in organised physical activity (PA) and sport activities, time watching television and using personal computer, and total sleep duration. Latent variables defined by the Latent Transition Analysis. ResultsFour typologies of activity-related behaviours were identified and labelled to reflect their behavioural profiles: 1) Actives (high outdoor time and organised PA and sport participation, low screen time, optimal sleep duration), 2) Active screeners (median outdoor time, high organised PA and sport participation, high screen time, optimal sleep duration), 3) Poor sleepers (average outdoor time and organised PA and sport participation, low screen time, not meeting sleep guidelines), and 4) Averages (average duration of all behaviours and optimal sleep duration). A major shift in typology membership from 11 to 18 years was observed with a decreasing proportion of individuals in typologies characterised by a high proportion of outdoor time and participation in organised PA and sport activities (i.e. Actives; Active screeners). A high proportion of individuals also transitioned to the typology with poor sleeping habits (i.e. Poor sleepers). Sex and maternal education were associated with the typology membership and transition probabilities (p < 0.05). ConclusionsOur findings highlight the importance of implementing lifestyle interventions in childhood to prevent possible sleep disorders and low physical activity later in life. Strengths and limitations of this studyO_LIThe longitudinal design allows an investigation of unique activity-related behaviour patterns across the transition from childhood to adolescents. C_LIO_LIUtilising various activity-related behaviours (e.g. outdoor time or screen time) provide a comprehensive understanding of the lifestyle of children and adolescents. C_LIO_LIData were collected from a specific geographic region from the Central Europe, which may limit the generalisability to broader population. C_LI

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.

BackgroundExisting studies on contextual health effects struggle to account for selection bias, limiting causal interpretation. We use refugee dispersal in Germany as natural experiment to study the effect of small-area deprivation on mental and physical health, while considering the potential mediating role of housing and social context. MethodsRefugees subject to dispersal (n=1400) are selected from a nation-wide longitudinal refugee study (IAB-SOEP-BAMF Panel; 2016-2018). Multi-level linear regression models, adjusted for age, sex, education, region of origin, federal state, asylum status and length of residence in Germany, are fitted to the change in mental and physical health subscales of the SF-12 depending on quintiles (Q1 - Q5) of district-level socioeconomic deprivation (German Index of Socio-Economic Deprivation, GISD). This is followed by mediation analyses (for housing and social context) and sensitivity analyses. FindingsResidency in districts with moderate-high deprivation (Q4) has a negative impact on physical health (coef{middle dot}: -2{middle dot}2, 95%CI: -4{middle dot}1;-0{middle dot}2) compared to lowest deprivation (Q1). Moderate-high deprivation (Q4) also has a positive impact on mental health, but the effect is statistically insignificant following covariate adjustment (coef{middle dot}: 2{middle dot}5, 95%CI: -0{middle dot}7;5{middle dot}6). Comparisons with other deprivation quintiles are statistically insignificant. InterpretationThe results point to gaps in health and social service provision for refugees living in the most deprived regions. Further efforts should be made to support integration of refugees into health and social systems in resource-poor regions, including improved interpreting services, specifically trained social workers and diversity-sensitive information offerings. Further research using longer timeframes and larger sample sizes are required to confirm results. FundingGerman Science Foundation (FOR: 2928/ GZ: BO5233/1-1).

The Healthy Life in an Urban Setting (HELIUS) study is an ongoing prospective multi-ethnic cohort study, in Amsterdam, The Netherlands that started in 2011. The principle aim of the HELIUS study is to investigate the causes of (the unequal burden of) diseases across ethnic groups, with emphasis on mental disorders, cardiovascular disease and infectious disease, and their interrelationships. Stratified sampling by ethnic group was used to allow for an equal representation of the largest ethnic groups resulting in similar-sized samples of individuals of Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Turkish and Moroccan origin. A total of 24,780 individuals participated in the baseline examination that consisted of a questionnaire, physical examination and collection of biological material. Follow-up data have been collected through linkage with health care registries and a first follow-up data collection that took part between 2019 and 2022 and included 11,035 participants with an average follow-up time of 6.4 years. The data collection included information on demographics, medical history (including medication use and mental health status), anthropometrics, and fasting blood, urine and stool samples. Here we give an update on the HELIUS study and its methods regarding the first follow-up data collection, data linkage, and additional analyses using stored biomaterials. In addition, we provide a summary of key findings.

The COVID-19 pandemic has impacted population health on a global scale. Most of the studies on mortality impacts are at national level, while broad evidence exists on heterogeneous COVID-19 incidence across regions and within countries. Using Spanish data for 2020, we estimate life expectancy changes in 2020 compared with the 2017-19 period in 50 Spanish provinces. We visualize longer-term trends (1990-2020), and compare the robustness of our province-specific results with cumulative COVID-19 incidence using regional data from the Spanish ENECOVID seroprevalence study. In 2020 there was a 1.2 and 1.1 year drop in life expectancy for men and women in Spain, but this impact was heterogeneous across regions. For men these losses were highest in the province of Segovia (-3.5 years decline), while for women the highest drop was observed in Salamanca (-2.8 years decline). Life expectancy actually increased in Santa Cruz de Tenerife (+1.1 and +0.6 years for men and women, respectively). Declines in life expectancy in 2020 were also highly correlated with the cumulative seroprevalence through November 2020 ({rho}=0.80 and 0.77 in men and women, respectively). Monitoring regional life expectancy dynamics provide valuable and granular information on the heterogeneous impacts of the pandemic on health at the population level. Similar exercises in other European countries may reveal insightful geographic patterns in mortality impacts in COVID-19 pandemic years.

ObjectivesIn this retrospective cohort study, we aimed to investigate symptom severity change following COVID-19 vaccination among post COVID-19 condition (PCC) patients on Bonaire. MethodsSymptomatic cases who tested positive for SARS-CoV-2 between the start of the pandemic and 1 October 2021, were unrecovered on the interview day and unvaccinated prior to infection were identified from the national case registry. Patients were interviewed by telephone between 15 November and 4 December 2021 about sociodemographic factors, pre-pandemic health, COVID-19 symptoms and vaccination status. We compared symptom severity change between the acute and post-acute disease phase (>4 weeks after disease onset) of 14 symptoms on a five-point Likert scale for 36 PCC patients having received at least one dose of the BNT162 (BioNTech/Pfizer) vaccine and 11 patients who remained unvaccinated, using separate multiple linear regression models. ResultsMost common post-acute symptoms included fatigue (81%), reduced physical endurance (79%), and reduced muscle strength (64%). Post-infection vaccination was significantly associated with reduced severity of heart palpitations, after adjusting for acute phase severity and duration of illness ({beta} 0.60, 95% CI 0.18-1.02). We did not find a statistically significant association with symptom severity change for other, more prevalent symptoms. ConclusionsLarger prospective studies are needed to confirm our observation in a small study population that post-infection COVID-19 vaccination was associated with reduced severity of heart palpitations among those with this symptom self-attributed to SARS-CoV-2 infection.

Similarities between mental symptoms in Post-COVID syndrome (PCS) and those in Post-COVID-19 vaccination syndrome (PCVS) have been observed. Based on a representative survey of the population aged 18 to 69 years in Germany (n = 4,628), the epidemiologies of both PCS and PCVS were studied. Mental symptoms of PCS (fatigue/exhaustion/weakness, reduced performance, concentration and memory problems, sleep disorders and depressed mood) were reported by 12.1% and mental symptoms of PCVS were reported by 12.6% of all respondents. Concerning PCS, mental symptoms were reported more often by females compared to males (13.5% versus 10.7%), whereas no gender differences were found for PCVS. With the increasing number of booster vaccinations, mental PCVS decreased from 20.8% with one vaccination to 8.9% with four or more vaccinations. Overall, non-mRNA vaccines did not lead significantly to more mental symptoms than mRNA vaccines (12.9% versus 12.5%) but did differ concerning mental symptom patterns: concentration and memory problems (8.2% versus 3.3%), impaired performance (5.7% versus 4.2%) and sleep disorders (6.6% versus 3.2%) were reported more frequently in non-mRNA vaccines. The reported rate of mental PCVS being 12.6% is clearly higher than the 0.5% recorded by official documentation systems (Paul-Ehrlich-Institut (PEI)), suggesting a major underreporting. The data indicate that mental symptoms occurring in both PCS and PCVS are common, making the differential diagnosis between PCS and PCVS, as well as between both PCS and PCVS and independent mental disorders such as depressive disorders, an important but challenging task.

ObjectiveTo assess the impact of the COVID-19 pandemic on families with young children in two population-based childhood cohorts with a low and moderate COVID-19 prevalence, respectively. MethodsA cross-sectional study using online questionnaires in families from LIFE Child (n=306, Leipzig) and KUNO Kids (n=612, Regensburg) was performed at the end of the German lock-down period. Outcomes were parent-reported impact of the COVID-19 pandemic on family life, concerns and trust in political measures. ResultsMost families were concerned about the COVID-19 pandemic and lock-down measures, with major concerns directed towards the economic situation (>70%), the health of close-ones (37%), but less towards their own health (<10%). Many concerns, seeking information and approval of federal measures were more pronounced in the more affected region. Approval of lockdown measures and concerns about economic recession were related to regional differences and not significantly dependent on educational status or being personally affected by the disease. ConclusionRegional differences in approval of lockdown measures were observed and thus, measures to specifically support families according to the regional impact of the COVID-19 pandemic are needed.

AbstractThis study examines the changes in childhood self-reported health and wellbeing between 2014 and 2022. An annual survey delivered by HAPPEN-Wales, in collaboration with 500 primary schools, captured self-reported data on physical health, dietary habits, mental health, and overall wellbeing for children aged 8-11 years. The findings reveal a decline in physical health between 2014 and 2022, as evidenced by reduced abilities in swimming and cycling. For example, 68% of children (95%CI: 67%-69%) reported being able to swim 25m in 2022, compared to 85% (95% CI: 83%-87%) in 2018. Additionally, unhealthy eating habits, such as decreased fruit and vegetable consumption and increased consumption of sugary snacks, have become more prevalent. Mental health issues, including emotional and behavioural difficulties, have also increased, with emotional difficulties affecting 13%-15% of children in 2017-2018 and now impacting 29% of children in 2021-2022. Moreover, indicators of wellbeing, autonomy, and competence have declined. Importantly, this trend of declining health and wellbeing predates the onset of the Covid-19 pandemic, suggesting that it is not solely attributed to the pandemics effects. The health of primary school children has been on a declining trajectory since 2018/2019 and has continued to decline through the COVID recovery period. The study suggests that these trends are unlikely to improve without targeted intervention and policy focus.

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

We aimed to assess differences in the summer excess of mortality by COVID-19 history using data from the mortality and COVID-19 surveillances. We found 4% excess risk in 2022 summer, compared to 2015-2019. A mortality rate ratio of 1.59 (95%CI 1.39-1.82) for COVID-19 survivors compared to naive, was found. Both were higher in people aged [&ge;]75 years. During the July heat wave, the excess for COVID-19 survivors decreased and disappeared when excluding people living in nursing homes. Funding statementThis study was partially supported by the Italian Ministry of Health -CCM 2020 - "Sorveglianza epidemiologica e controllo del COVID-19 in aree urbane metropolitane e per il contenimento della circolazione del Sars-CoV-2 nella popolazione immigrata in Italia" and by the Ricerca Corrente 2023 HighlightsO_LIthe excess of mortality in COVID-19 survivors is not exacerbated by heatwaves C_LIO_LIan excess of mortality during the whole summer in COVID-19 survivors aged over 75 suggest that no harvesting effect is appreciable in the older population that survived COVID-19 C_LIO_LIFor COVID-19 survivors aged over 75, a lower mortality than the naive population was observed only during the July heat wave when we stratified by residency C_LI

Based on nationally representative panel data (N person-years=40,020; N persons=18,704; Panel Labour Market and Social Security; PASS) from 2018 to 2022, we investigate how mental health changed during and after the COVID-19 pandemic. We employ time-distributed fixed effects regressions to show that mental health (Mental Health Component Summary Score of the SF-12) decreased from the first COVID-19 wave in 2020 onward, leading to the most pronounced mental health decreases during the Delta wave, which began in August 2021. In the summer of 2022, mental health had not returned to baseline levels. An analysis of the subdomains of the mental health measure indicates that long-term negative mental health changes are mainly driven by declines in psychological well-being and calmness. Furthermore, our results indicate no clear patterns of heterogeneity between age groups, sex, income, education, migrant status, childcare responsibilities or pre-COVID-19 health status. Thus, the COVID-19 pandemic appears to have had a uniform effect on mental health in the German adult population and did not lead to a widening of health inequalities in the long run.

AimsAn important barrier for a nationwide implementation of a daily physical activity (PA) intervention at primary schools is the lack of spatial and human resources. Therefore, the aim was to develop an innovative PA intervention that can be implemented, without additional spatial and human resource requirements. The effects of this intervention on anthropometrics and health-related fitness of primary school children were investigated. MethodsIn twelve primary schools, 24 classes were randomly allocated to an intervention and control group. In the intervention group, children received mix physical education lessons, cognitive content using movement, and additional opportunities for extracurricular physical activities (home exercises) over a 9-month period. In the control group, children received the usual physical education classes. At baseline (Sept 2021) and at follow-up immediately after the intervention (June 2022), body weight, height, waist circumference and fitness parameters (cardiorespiratory fitness, muscle strength, flexibility) were measured. Intervention effects were assessed using multilevel regression models, adjusted for gender, urban/rural school, sports club membership, and for baseline values of the outcome parameter. Interactions between intervention and being a member of a sports club were assessed. ResultsOf 485 invited children, 412 (85%) were included in the analyses; 228 in the intervention and 184 in the control group. Children were 9.7 (SD 0.5) years old at baseline. In the total intervention group, a reduction in waist-to-height ratio and increase in all fitness parameters were found compared to the control group. Interactions with being a member of a sports club were found, and intervention effects were more pronounced in the group of children who were not a member of a sports club. ConclusionsOur daily physical activity intervention for primary schools showed positive effects on important health related parameters, especially for children who were not in a sports club and had most of their PA at school. Wider implementation of this intervention in primary schools is warranted, which should be feasible, since we made sure that no extra resources are needed. Trial registrationDRKS00025515.

We aimed to investigate the social inequalities in the fear of not having enough food for the household, a psychological domain of food insecurity, during the COVID-19 pandemic among mothers from the 2019 Rio Grande birth cohort. In 2019 we invited all mothers who gave birth to a singleton liveborn in the municipality of Rio Grande (southern Brazil) to respond to a standardized questionnaire. In 2020, we followed these mothers twice. In wave I we located 1,077 of all eligible mothers and 1,033 in wave II (follow-up rate of 52.1% and 50.4%). We estimated the absolute and relative inequalities of food insecurity according to the number of people living in the household, maternal education, family income, and income change during the pandemic using the slope index of inequalities (SII) and the concentration index (CIX), respectively. 1,021 mothers reported having food insecurity, and the prevalence was 42.8% and 44.7% for waves I and II, respectively. In wave I we observed inequities in the distribution of food insecurity, being higher among mothers living with [&ge;]3 people (SII:-17.3; 95%CI[-29.6;-5.0]), with a lower education (SII:-36.7; 95%CI[-47.0;-26.4]), lower income (SII-48.9; 95%CI[-58.0;-39.7]), and with an income that decreased during the pandemic (SII:-47.1; 95%CI[-57.3;-36.9]). These inequities widened from wave I to wave II. This study describes the impact of the COVID-19 pandemic on maternal and family food insecurity and the increased social disparities during the pandemic, especially among the most vulnerable populations.

BackgroundCountries confronting the COVID-19 pandemic are implementing different social distancing strategies. We evaluated the impact of small-area lockdowns in Chile, aimed to reduce viral transmission while minimizing the population disrupted. The effectiveness of this intervention on the outbreak control is unknown. MethodsA natural experiment assessing the impact of small-area lockdowns between February 15th and April 25th, 2020. We used mobility data and official governmental reports to compare regions with small-area lockdowns versus regions without. The primary outcome was the mean difference in the effective reproductive number (Re) of COVID-19. Secondary outcomes were changes in mobility indicators. We used quasi-experimental methods for the analysis and examined the impact of other concurrent public health interventions to disentangle their effects. ResultsSmall-area lockdown produced a sizable reduction in human mobility, equivalent to an 11.4% reduction (95%CI -14.4% to -8.38%) in public transport and similar effects in other mobility indicators. Ten days after implementation, the small-area lockdown produced a reduction of the effective reproductive number (Re) of 0.86 (95%CI -1.70 to -0.02). School and university closures, implemented earlier, led to a 40% reduction in urban mobility. Closure of educational institutions resulted in an even greater Re reduction compared with small-area lockdowns. ConclusionsSmall-area lockdowns produced a reduction in mobility and viral transmission, but the effects were smaller than the early closures of schools and universities. Small-area lockdowns may have a relevant supporting role in reducing SARS-CoV-2 transmission and could be useful for countries considering scaling-down stricter social distancing interventions.

The direct and indirect impact of the COVID-19 pandemic on population-level mortality is of concern to public health but challenging to quantify. We modelled excess mortality and the direct and indirect effects of the pandemic on mortality in Switzerland. We analyzed yearly population data and weekly all-cause deaths by age, sex, and canton 2010-2019 and all-cause and laboratory-confirmed COVID-19 deaths from February 2020 to April 2022 (study period). Bayesian models predicted the expected number of deaths. A total of 13,130 laboratory-confirmed COVID-19 deaths were reported. The model estimated that COVID-19-related mortality was underestimated by a factor of 0.72 [95% Credible Interval: 0.46-0.78] resulting in 18,140 [15,962-20,174] excess deaths. After accounting for COVID-19 deaths, the observed mortality was 3% [-1-7] lower than expected, corresponding to a deficit of 4,406 deaths, with a wide credibility interval [-1,776-10,700]. Underestimation of COVID-19 deaths was greatest for ages 70 years and older; the mortality deficit was most pronounced in age groups 40 to 69 years. We conclude that shortcomings in testing caused underestimation of COVID-19-related deaths in Switzerland, particularly in older people. Although COVID-19 control measures may have negative effects (e.g., delays in seeking care or mental health impairments), after subtracting COVID-19 deaths, there were fewer deaths in Switzerland during the pandemic than expected, suggesting that any negative effects of control measures on mortality were offset by the positive effects. These results have important implications for the ongoing debate about the appropriateness of COVID-19 control measures.

BackgroundExtensive research has established the intricate links between diverse social support sources and vital adolescent health indicators, such as mental wellbeing (MWB), problematic social media use (PSMU), and physical activity (PA). However, existing studies have not explored these interrelationships within a unified model or examined the moderating effects of gender and socio-economic status (SES). MethodsThis cross-sectional study employed a representative Danish sample of 2.034 adolescents, aged 13 and 15 years. A Multi-group Structural Equation Model (SEM) and covariance-based comparisons analysis utilized items from Multidimensional Scales of Perceived Social Support, The Warwick-Edinburgh Mental Well-being Scale, Social Media Disorder Scale, and measures of PA duration and frequency. ResultsThe associations between MWB-Teacher Support and MWB-Classmate Support were stronger in low SES adolescents than those with mid-high SES. Notably, the PSMU-Family Support negative association was more pronounced among girls, while PSMU-Friend Supports negative relationship was stronger among boys. The PA-Family Support positive relationship was more robust in boys, while the PA-Teacher Support positive association was stronger among low-mid SES adolescents than those in high SES. The positive correlation between PA and MWB was stronger among boys and mid-low SES adolescents. ConclusionsStrategies designed to enhance family and school support, considering gender and SES, could effectively promote MWB and deter behavioural issues like PSMU and sedentary behaviours in adolescents.