Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C

OBJECTIVES: To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C). METHODS: Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS: Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8%) with acute COVID-19 and 160 of 203 (78.8%) with MIS-C. Thirteen (11%) patients with acute COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95% CI, 1.04-1.59]) and activity impairment (aRR, 1.37 [95% CI, 1.06-1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95% CI, 1.55-6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95% CI, 1.35-4.69]). New morbidities were infrequent (9% COVID-19, 1% MIS-C). CONCLUSIONS: Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery

Pre-funding Expenditure on Health and Long-term Care under Demographic Uncertainty

Public health and long-term care services are predominantly used by old people and financed by taxes paid by working-age people. Fluctuating sizes of generations create variations in tax rates, similar to what occurs in pension contribution rates. Pre-funding is a commonly suggested cure for this variation in pension systems: could and should expenditure on health and long-term care also be pre-funded, and if so to what degree? To address this question, we examine several pre-funding rules using Finland as an example. If the focus is on tax smoothing during the next few decades, an effective rule is a buffer fund whose construction is based on the current population forecast. But if we lengthen the time horizon, the benefits of using rules conditional on new demographic information become evident, even though they may result in higher tax-rate variation during the first few decades. The Geneva Papers on Risk and Insurance (2004) 29, 620–639. doi:10.1111/j.1468-0440.2004.00306.x

Warm Arctic—cold continents: climate impacts of the newly open Arctic Sea

Recent Arctic changes are likely due to coupled Arctic amplification mechanisms with increased linkage between Arctic climate and sub-Arctic weather. Historically, sea ice grew rapidly in autumn, a strong negative radiative feedback. But increased sea-ice mobility, loss of multi-year sea ice, enhanced heat storage in newly sea ice-free ocean areas, and modified wind fields form connected positive feedback processes. One-way shifts in the Arctic system are sensitive to the combination of episodic intrinsic atmospheric and ocean variability and persistent increasing greenhouse gases. Winter 2009/10 and December 2010 showed a unique connectivity between the Arctic and more southern weather patterns when the typical polar vortex was replaced by high geopotential heights over the central Arctic and low heights over mid-latitudes that resulted in record snow and low temperatures, a warm Arctic&#x2014;cold continents pattern. The negative value of the winter (DJF 2009/10) North Atlantic Oscillation (NAO) index associated with enhanced meridional winds was the lowest observed value since the beginning of the record in 1865. Wind patterns in December 2007 and 2008 also show an impact of warmer Arctic temperatures. A tendency for higher geopotential heights over the Arctic and enhanced meridional winds are physically consistent with continued loss of sea ice over the next 40 years. A major challenge is to understand the interaction of Arctic changes with climate patterns such as the NAO, Pacific North American and El Ni&#x00F1;o&#x2013;Southern Oscillation