COSMO Wave 1 Initial Findings: Health Impacts and Behaviours

COVID infection and vaccination rates: Between October 2021 and March 2022, 48% of young people in the study reported having COVID-19. Of this group, 1 in 5 said they had long COVID (equating to 9% of the sample overall). 70% of these participants said that this limited their daily activities - 26% said activities were limited ‘severely’ (2% of the population overall). Those from the most deprived parts of the country (determined by IDACI quintile groups, an area-level measure for disadvantage) who had contracted the virus were more likely to report symptoms of long COVID, at 25% of those infected compared to 18% of those from the least deprived areas. 8% of participants said they were asked to shield at some point during the pandemic. Shielders were more likely to take part in catch-up activities like tutoring and weekend catch-up classes, compared to those not asked to shield. Controlling for background characteristics and prior attainment, suffering from long COVID that severely limits daily activities and being asked to shield were associated with lower teacher assessed GCSE grades. The experience of being seriously ill in hospital (not only due to COVID-19) is also negatively associated with teacher assessed GCSE attainment. // Health behaviours in the pandemic: Taking part in sports organised by school was considerably more common at independent schools (at 72% pre-pandemic) than in state comprehensives (26%) and grammars (32%). Provision by schools fell across all school types during the pandemic, although participation rates fell the least in independent schools, reducing by 9 percentage points, compared to 18pp in grammars and 14pp in state comprehensives. 23% of young people reported having smoked a cigarette, lower than the 33% who reported having used e-cigarettes. The use of e-cigarettes was more prevalent among young people from disadvantaged family backgrounds and state comprehensive schools compared to their more advantaged peers

Briefing No. 6 - Financial Inequalities and the Pandemic

Many households’ financial situation declined during the pandemic. 39% reported worse financial health, and just 16% better. Gaps have widened, with 52% of disadvantaged households reporting worse financial health, compared to 34% of others. 22% of professional households reported an improved financial situation, over twice that of working class households (10%). One in ten young people (10%) were living in households classed as food insecure, with many reporting running out of food, skipping meals, and 5% of parents reporting going a whole day without eating. Social renters were six times more likely to experience food insecurity than those who owned their home (26% vs 4%). Rates of food insecurity were highest in the North East and North West (15% and 12%), and lowest in the South East (9%) and East of England (7%). 8% of parents used a food bank during the pandemic period, three quarters of whom had also used food banks pre-pandemic. Food poverty is not restricted to Free School Meals eligible families. The majority (57%) of households where children went hungry were not FSM eligible during that time, and 36% of those using foodbanks were not FSM eligible. Pupils in families who reported using food banks during the pandemic received lower GCSE grades (almost half a grade per subject), even taking into account previous grades and other aspects of their household finances. However, long-term disadvantage played a bigger role than the pandemic. Pandemic financial experiences were more closely linked to mental health. Among families finding it very difficult to get by financially, rates of psychological distress were 82% among parents, and 53% among children. Among parents this is four times higher than those living comfortably. Rates of psychological distress were substantially higher in households who started using foodbanks in the pandemic (53% among young people and 63% among parents), compared to 41% and 33% for those not using foodbanks. They were also slightly higher than ‘long term’ users, potentially indicating the impacts of short-term financial shocks

COSMO Wave 1 Initial Findings: Mental Health and Wellbeing

Over 2 in 5 (44%) 16/17 year olds in England report elevated psychological distress, 9%pts higher than the 35% reporting distress at age 17-18 in the Our Future cohort study (2017) and 21%pts higher than the 23% at age 16-17 in the Next Steps cohort study (2007). Higher proportions of elevated psychological distress were seen among those who reported having long COVID, bad/’severe long COVID’, or who had to shield during the pandemic. For instance, 66% of those with severe long COVID, which largely affected ability to carry out daily activities, reported high psychological distress. Those who experienced major life events during the pandemic, such as being seriously ill and suffering from food affordability issues, were also more likely to report elevated psychological distress. There are stark patterns in signs of poor mental health by gender: Those who identify as female report elevated psychological distress (54%), self-harm (23%) and suicide attempts (11%), compared to those who identify as male (33% report distress, 11% report self-harm and 5% report attempting suicide). Those who identify as ‘non-binary+’ report high psychological distress (69%) and they are considerably more likely to have self- harmed (61%) or to have attempted suicide (35%) than their peers who identify as male or female. Over 2 in 5 (44%) young people with a parent who has high psychological distress also report high distress, compared to 30% of those with a parent who does not report high distress. Half of the pupils from comprehensive or grammar schools rated their school’s mental health support as ‘not very good’ or ‘not at all good’ compared to just a quarter of those attending independent schools. Half of young people said that they are now less motivated to study and learn as a result of the pandemic, with those who reported high psychological distress 31%pts more likely to say so (68% compared to 37% of other participants)

COSMO Wave 1 Initial Findings: Lockdown Learning

There were substantial gaps between state and private secondary schools in the intensity of remote learning during the first lockdown in 2020, with the private sector much better placed to adapt quickly. 96% of independent school pupils had live online lessons in the first lockdown, compared to 65% of state school pupils. While state sector provision improved in the second period of school closures in early 2021, inequalities opened up within the state sector. Grammar schools (96%) and comprehensive schools with more affluent intakes (95%) caught up the most, compared to 80% at schools with the most deprived intakes. Barriers to remote learning – such as lack of access to a suitable device for learning or sharing a device, lack of a quiet space in the home, lack of support from teachers or parents – were all more likely to be experienced by young people from lower socio-economic backgrounds, and those who experienced those barriers reported working fewer hours during lockdowns. Those without a device worked on average 8 hours per week in lockdown 1, those with just a mobile phone 10 hours, and those with a laptop or tablet 14 hours. While many pupils without suitable devices received support through school and government distribution programmes, over half (53%) of those who lacked a device at the beginning of the pandemic had still not received one by the end of the second period of school closures. Problems with internet access showed a different pattern, complicated by the fact that more intensive online learning was associated with more internet problems. Having internet issues was not associated with working fewer hours. Patterns by ethnicity and race were mixed. Overall there were few differences in the amount of time spent learning by ethnic background. While young people from Black and Asian backgrounds were more likely to receive tutoring and had parents more confident with support for learning, they were also more likely to need to share devices and less likely to have a quiet place to study

Briefing No. 7 - Attainment and Assessment

Pupils from independent schools were much more likely to report that their Teacher Assessed Grades (TAGs) were higher than they expected (43%) than those in state schools (34% for those in state grammars and 29% in state comprehensives). They were also much less likely to report that they were lower than they expected (at 7%, compared to 15% of those in state grammars and 23% in state comprehensives). A third of young people reported that they felt that teachers were biased against certain groups in their teacher assessment. This figure was higher among those from ethnic minority backgrounds and lower among those with more socio-economically advantaged backgrounds. Pupils who had particularly disrupted experiences during the COVID-19 pandemic received lower GCSE Teacher Assessed Grades (TAGs) than their peers whose disruption was more moderate. One-to-one or small group tutoring as catch-up provision was most likely to be offered to those from less advantaged backgrounds and those who had lower prior attainment. Boys were more likely to be offered tutoring but, as they were less likely to take it up, there was no gender difference in reported receipt of tutoring. Those who received one-to-one and small group tutoring appeared to perform slightly better in their GCSE TAGs than their peers who were offered this tutoring but did not take it up. However, only just over a quarter of the sample reported that they have received one-to-one or small group tutoring, meaning it is unlikely to have made a big difference to learning lost at the cohort level

A PM10 chemically characterised nation-wide dataset for Italy. Geographical influence on urban air pollution and source apportionment

: Urban textures of the Italian cities are peculiarly shaped by the local geography generating similarities among cities placed in different regions but comparable topographical districts. This suggested the following scientific question: can such different topographies generate significant differences on the PM10 chemical composition at Italian urban sites that share similar geography despite being in different regions? To investigate whether such communalities can be found and are applicable at Country-scale, we propose here a novel methodological approach. A dataset comprising season-averages of PM10 mass concentration and chemical composition data was built, covering the decade 2005-2016 and referring to urban sites only (21 cities). Statistical analyses, estimation of missing data, identification of latent clusters and source apportionment modelling by Positive Matrix Factorization (PMF) were performed on this unique dataset. The first original result is the demonstration that a dataset with atypical time resolution can be successfully exploited as an input matrix for PMF obtaining Country-scale representative chemical profiles, whose physical consistency has been assessed by different tests of modelling performance. Secondly, this dataset can be considered a reference repository of season averages of chemical species over the Italian territory and the chemical profiles obtained by PMF for urban Italian agglomerations could contribute to emission repositories. These findings indicate that our approach is powerful, and it could be further employed with datasets typically available in the air pollution monitoring networks

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Rheumatoid arthritis - clinical aspects: 134. Predictors of Joint Damage in South Africans with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) causes progressive joint damage and functional disability. Studies on factors affecting joint damage as clinical outcome are lacking in Africa. The aim of the present study was to identify predictors of joint damage in adult South Africans with established RA. Methods: A cross-sectional study of 100 black patients with RA of >5 years were assessed for joint damage using a validated clinical method, the RA articular damage (RAAD) score. Potential predictors of joint damage that were documented included socio-demographics, smoking, body mass index (BMI), disease duration, delay in disease modifying antirheumatic drug (DMARD) initiation, global disease activity as measured by the disease activity score (DAS28), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and autoantibody status. The predictive value of variables was assessed by univariate and stepwise multivariate regression analyses. A p value <0.05 was considered significant. Results: The mean (SD) age was 56 (9.8) years, disease duration 17.5 (8.5) years, educational level 7.5 (3.5) years and DMARD lag was 9 (8.8) years. Female to male ratio was 10:1. The mean (SD) DAS28 was 4.9 (1.5) and total RAAD score was 28.3 (12.8). The mean (SD) BMI was 27.2 kg/m2 (6.2) and 93% of patients were rheumatoid factor (RF) positive. More than 90% of patients received between 2 to 3 DMARDs. Significant univariate predictors of a poor RAAD score were increasing age (p = 0.001), lower education level (p = 0.019), longer disease duration (p < 0.001), longer DMARD lag (p = 0.014), lower BMI (p = 0.025), high RF titre (p < 0.001) and high ESR (p = 0.008). The multivariate regression analysis showed that the only independent significant predictors of a higher mean RAAD score were older age at disease onset (p = 0.04), disease duration (p < 0.001) and RF titre (p < 0.001). There was also a negative association between BMI and the mean total RAAD score (p = 0.049). Conclusions: Patients with longstanding established RA have more severe irreversible joint damage as measured by the clinical RAAD score, contrary to other studies in Africa. This is largely reflected by a delay in the initiation of early effective treatment. Independent of disease duration, older age at disease onset and a higher RF titre are strongly associated with more joint damage. The inverse association between BMI and articular damage in RA has been observed in several studies using radiographic damage scores. The mechanisms underlying this paradoxical association are still widely unknown but adipokines have recently been suggested to play a role. Disclosure statement: C.I. has received a research grant from the Connective Tissue Diseases Research Fund, University of the Witwatersrand. All other authors have declared no conflicts of interes

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis &lt; 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11&nbsp;years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982