Persistent symptoms among children and adolescents with and without anti-SARS-CoV-2 antibodies: a population-based serological study in Geneva, Switzerland

Background: It 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. Methods: We 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. Findings: Among 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 (ΔaPrev)=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% (ΔaPrev, 95%CI:-3.8-13.6). Interpretation: A 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.

1217The prevalence of post-traumatic stress disorder in Syrian refugees increased after long-distance migration

Background Refugees are forced migrants but there is a large variation in the distance that refugees cover. Previous studies suggest an inverse association between long-distance migration and self-reported health in the general population but there is a knowledge gap in the health effects of migration in refugee populations. Here, we estimate the association between long-distance migration and post-traumatic stress disorder (PTSD), a severe mental health disorder associated with deteriorating mental and somatic health. Methods Included were 712 adult Syrian refugees and asylum seekers newly arrived in Lebanon and Denmark. PTSD was assessed using the Harvard Trauma Questionnaire, confounding was handled by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience, and WHO-5-score after multiply imputing missing data, and the 95-percentile confidence interval (CI) was computed by bootstrapping. Results The prevalence of PTSD was high in both Lebanon (55%) and Denmark (60%). After adjusting for biases the prevalence difference increased to 9 percentage point (95-percentile CI: [-1; 19] percentage point). All sensitivity analysis produced estimates of the same magnitude and direction, except when grossly violating the assumption of multiple imputation which halved the magnitude of the association. Conclusions Long-distance migration was associated with an estimated 87 additional cases of PTSD for every 1000 Syrian refugees. This is a first step in examining the effects of migration in refugee health. Key messages Long-distance migration was positively associated with prevalence of post-traumatic stress disorder in Syrian refugees.

Anxiety and Depression Symptom Level and Psychotherapy Use Among Music and Art Students Compared to the General Student Population

Purpose: Previous epidemiological studies have shown higher levels of anxiety and depressive symptoms among professional musicians, compared to the general workforce. Similar findings have been observed for psychotherapy use among musicians. To date, large-scale investigations of prevalence rates among music and arts students are lacking.Methods: Eight hundred and eighty students from music and arts institutions and faculties were derived from a national health student survey for higher education in Norway (the SHoT study). They were compared to a sample of the general student population (n = 48,729). We used logistic regression analysis, adjusting for age, sex, and semesters of study.Results: Music and arts students reported higher rates of anxiety [OR 1.60 (1.38–1.85), Prevalence difference (PD) 9.6 (6.3–12.8)] and depression symptoms [OR 1.41 (1.22–1.62), PD 7.9 (4.5–11.2)] compared to the general student force. Similar patterns were observed for self-reported mental disorders [OR 1.71 (1.46–2.01), PD 8.1 (5.3–11.0)], as well as psychotherapy use [OR 1.91 (1.60–2.29), PD 7.4 (4.9–9.9)] in music and arts students.Conclusions: Our findings are consistent with studies comparing musicians to the general workforce, and indicate that challenges also exist at student level, and not only after becoming a professional in the performing arts, which is important when planning health-related measures. These findings have the potential to inform on health promotion and services in the educational system.

Trends in inequalities in disability in Europe between 2002 and 2017

BackgroundMonitoring socioeconomic inequalities in population health is important in order to reduce them. We aim to determine if educational inequalities in Global Activity Limitation Indicator (GALI) disability have changed between 2002 and 2017 in Europe (26 countries).MethodsWe used logistic regression to quantify the annual change in disability prevalence by education, as well as the annual change in prevalence difference and ratio, both for the pooled sample and each country, as reported in the European Union Statistics on Income and Living Conditions (EU-SILC) and the European Social Survey (ESS) for individuals aged 30–79 years.ResultsIn EU-SILC, disability prevalence tended to decrease among the high educated. As a result, both the prevalence difference and the prevalence ratio between the low and high educated increased over time. There were no discernible trends in the ESS. However, there was substantial heterogeneity between countries in the magnitude and direction of these changes, but without clear geographical patterns and without consistency between surveys.ConclusionsSocioeconomic inequalities in disability appear to have increased over time in Europe between 2002 and 2017 as per EU-SILC, and have persisted as measured by the ESS. Efforts to further harmonise disability instruments in international surveys are important, and so are studies to better understand international differences in disability trends and inequalities.

Characteristics and patterns of older adult homicides in the United States

Background Nearly 1800 homicides were reported in 2018 among individuals aged 60 years or older in the US. The characteristics and circumstances of these homicides are understudied. We investigated the trends of homicides over time and compared victim, perpetrator, and incident characteristics by mechanism (firearm vs. non-firearm) among adults aged 60 years or older. Methods We examined cross-sectional restricted-access data from the National Violent Death Reporting System from 2003 to 2017. Fatal Injury Data by CDC provided age-adjusted homicide rates. We quantitatively summarized victim, perpetrator, and incident characteristics for firearm and non-firearm homicides. We also reviewed 150 qualitative narratives to better understand the context of older adult homicides perpetrated by firearms. All data were analyzed in February 2020. Results Overall and firearm-specific older adult homicide rates increased between 2014 and 2017. Of the 6188 victims, 62% were male. The majority of victims (68%) were killed at home. Firearms (44%), sharp (19%) and blunt weapons (15%) were common mechanisms used in older adult homicides. The perpetrator was an intimate partner in 39% of firearm homicides and 12% of non-firearm homicides (prevalence difference = 27%; 95% CI: 25, 30%). Similarly, homicide-suicides (prevalence difference = 21%; 95% CI: 19, 22%) and multiple-victim incidents (prevalence difference = 7%; 95% CI: 5, 8%) were more common in firearm (23 and 13%, respectively) than in non-firearm (2 and 6%, respectively) homicides. Common contexts of firearm homicides were familial/intimate partner problems, robbery/burglary, argument, and illness. Conclusions A substantial number of older adults were killed with firearms and by their intimate partners. Further research to identify violence victimization prevention strategies in this group, especially those that limit access to firearms by potential perpetrators, is warranted.

Excess Risk of Tuberculosis Infection Among Extra-household Contacts of Tuberculosis Cases in an African City

Background Although households of tuberculosis (TB) cases represent a setting for intense transmission of Mycobacterium tuberculosis, household exposure accounts for <20% of transmission within a community. The aim of this study was to estimate excess risk of M. tuberculosis infection among household and extra-household contacts of index cases. Methods We performed a cross-sectional study in Kampala, Uganda, to delineate social networks of TB cases and matched controls without TB. We estimated the age-stratified prevalence difference of TB infection between case and control networks, partitioned as household and extra-household contacts. Results We enrolled 123 index cases, 124 index controls, and 2415 first-degree network contacts. The prevalence of infection was highest among household contacts of cases (61.5%), lowest among household contacts of controls (25.2%), and intermediary among extra-household TB contacts (44.9%) and extra-household control contacts (41.2%). The age-adjusted prevalence difference between extra-household contacts of cases and their controls was 5.4%. The prevalence of infection was similar among the majority of extra-household case contacts and corresponding controls (47%). Conclusions Most first-degree social network members of TB cases do not have adequate contact with the index case to experience additional risk for infection, but appear instead to acquire infection through unrecognized exposures with infectious cases in the community.

Duration of Postdiarrheal Enteric Pathogen Carriage in Young Children in Low-resource Settings

Background Prolonged enteropathogen shedding after diarrhea complicates the identification of etiology in subsequent episodes and is an important driver of pathogen transmission. A standardized approach has not been applied to estimate the duration of shedding for a wide range of pathogens. Methods We used a multisite birth cohort of children 0–24 months of age from whom diarrheal and monthly nondiarrheal stools were previously tested by quantitative polymerase chain reaction for 29 enteropathogens. We modeled the probability of detection of the etiologic pathogen before and after diarrhea using a log-normal accelerated failure time survival model and estimated the median duration of pathogen carriage as well as differences in subclinical pathogen carriage 60 days after diarrhea onset in comparison to a prediarrhea baseline. Results We analyzed 3247 etiologic episodes of diarrhea for the 9 pathogens with the highest attributable burdens of diarrhea. The median duration of postdiarrheal carriage varied widely by pathogen, from about 1 week for rotavirus (median, 8.1 days [95% confidence interval {CI}, 6.2–9.6]) to >1 month for Cryptosporidium (39.5 days [95% CI, 30.6–49.0]). The largest increases in subclinical pathogen carriage before and after diarrhea were seen for Cryptosporidium (prevalence difference between 30 days prior and 60 days after diarrhea onset, 0.30 [95% CI, .23–.39]) and Shigella (prevalence difference, 0.21 [95% CI, .16–.27]). Conclusions Postdiarrheal shedding was widely variable between pathogens, with strikingly prolonged shedding seen for Cryptosporidium and Shigella. Targeted antimicrobial therapy and vaccination for these pathogens may have a relatively large impact on transmission.

Caries and fluoridated water in two Brazilian cities in the first decade of the 21st century

Background Despite health policies must be shaped by scientific evidence, there is no data to prove that water fluoridation increases preventive benefit to dental caries in addition to that provided by the widespread use of fluoride toothpaste. Methods A double census population survey was conducted in two Brazilian small cities, differentiated only by exposure or not, for at least 5 years, to fluoridated water, in 2014. The magnitude and experience of caries were assessed using the dmft (at 5-6-year-old; N = 233), DMFT (at 11-12-year-old; N = 312) and SiC (at 11-12-year-old; N = 105) indexes. Associations were tested by Pearson's chi-square statistics and prevalence ratio (PR) between unexposed (NE) and exposed (E) to fluoridated water. Results Deciduous dentition: Although caries experience (dmft≥1) was not associated with exposure to fluoridated water (chi-square=2.77, p = 0.96, α = 5%), there was a significant difference in the magnitude which the disease reached the population: the mean dmft were 2.74 in those exposed and 4.17 in unexposed. PR (NE/E) was 1.21 indicating that exposure to fluoridated water corresponded to a 21% lower prevalence rate, compared to those unexposed. Permanent dentition: Although caries experience (DMFT≥1) was not associated with exposure to fluoridated water (chi-square=1.78; p = 0.18; α = 5%), a significant difference was observed in the magnitude with which the disease reached the population: the means of DMFT were 1.76 in those exposed and 2.60 in unexposed and the means of SiC were 4.04 and 6.16, respectively. PR (NE/E) was 1.13 indicating little expressiveness in prevalence difference. Conclusions Exposure to fluoridated water implied a lower mean value of the dmft, DMFT and SiC indexes at a level of 50%, although in the presence of concomitant universal exposure to fluoridated dentifrice. The maintenance of water fluoridated in Brazil and other countries as an effective public health measure is strongly supported by this research results. Key messages This research is in the interest of all countries to decide whether, even with access to fluoridated toothpastes, it is worth adding fluoride to the waters that supply their populations. The study's approach is unprecedented and describes innovative possibilities of using cross-sectional studies to evaluate the results and impacts of public oral health policies.

Changes in Cytomegalovirus Seroprevalence Among U.S. Children Aged 1–5 Years: The National Health and Nutrition Examination Surveys

Data from the cross-sectional National Health and Nutrition Examination Surveys (NHANES) indicate that the seroprevalence of cytomegalovirus immunoglobulin G (IgG) antibodies among US children aged 1–5 years was 20.7% (95% confidence interval [CI]: 14.0, 29.0) in 2011–2012 and 28.2% (95% CI: 23.1–34.0) in 2017–2018 (adjusted prevalence difference, +7.6% [95% CI: −.4, +15.6]).

Revisiting the continuum of resistance theory in the digital age: A comparison of early and delayed respondents to the Norwegian Counties Public Health Survey

BackgroundThe continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has not been assessed in a large online population health survey.MethodsRespondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n =4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension.ResultsThe overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%).ConclusionsThere appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.