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

The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of Kathmandu

Enteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi A (S. Typhi and S. Paratyphi A) remains a major public health problem in many settings. The disease is limited to locations with poor sanitation which facilitates the transmission of the infecting organisms. Efficacious and inexpensive vaccines are available for S. Typhi, yet are not commonly deployed to control the disease. Lack of vaccination is due partly to uncertainty of the disease burden arising from a paucity of epidemiological information in key locations. We have collected and analyzed data from 3,898 cases of blood culture-confirmed enteric fever from Patan Hospital in Lalitpur Sub-Metropolitan City (LSMC), between June 2005 and May 2009. Demographic data was available for a subset of these patients (n = 527) that were resident in LSMC and who were enrolled in trials. We show a considerable burden of enteric fever caused by S. Typhi (2,672; 68.5%) and S. Paratyphi A (1,226; 31.5%) at this Hospital over a four year period, which correlate with seasonal fluctuations in rainfall. We found that local population density was not related to incidence and we identified a focus of infections in the east of LSMC. With data from patients resident in LSMC we found that the median age of those with S. Typhi (16 years) was significantly less than S. Paratyphi A (20 years) and that males aged 15 to 25 were disproportionately infected. Our findings provide a snapshot into the epidemiological patterns of enteric fever in Kathmandu. The uneven distribution of enteric fever patients within the population suggests local variation in risk factors, such as contaminated drinking water. These findings are important for initiating a vaccination scheme and improvements in sanitation. We suggest any such intervention should be implemented throughout the LSMC area.This work was supported by The Wellcome Trust, Euston Road, London, United Kingdom. MFB is supported by the Medical Research Council (grant G0600718). SB is supported by an OAK foundation fellowship through Oxford University

Gait function improvements, using Cardiff Classifier, are related to patient-reported function and pain following hip arthroplasty

Summarizing results of three-dimensional (3D) gait analysis into a comprehensive measure of overall gait function is valuable to discern to what extent gait function is affected, and later recovered after surgery and rehabilitation. This study aimed to investigate whether preoperative gait function, quantified and summarized using the Cardiff Classifier, can predict improvements in postoperative patient-reported activities of daily living, and overall gait function 1 year after total hip arthroplasty (THA). Secondly, to explore relationships between pre-to-post surgical change in gait function versus changes in patient-reported and performance-based function. Thirty-two patients scheduled for THA and 25 nonpathological individuals were included in this prospective cohort study. Patients were evaluated before THA and 1 year postoperatively using 3D gait analysis, patient-reported outcomes, and performance-based tests. Kinematic and kinetic gait parameters, derived from 3D gait analysis, were quantified using the Cardiff Classifier. Linear regressions investigated the predictive value of preoperative gait function on postoperative outcomes of function, and univariate correlations explored relationships between pre-to-post surgical changes in outcome measures. Preoperative gait function, by means of Cardiff Classifier, explained 35% and 30% of the total variance in change in patient-reported activities of daily living, and in gait function, respectively. Moderate-to-strong correlations were found between change in gait function and change in patient-reported function and pain, while no correlations were found between change in gait function and performance-based function. Clinical significance: Preoperative gait function predicts postsurgical function to a moderate degree, while improvements in gait function after surgery are more closely related to how patients perceive function than their maximal performance of functional tests

La composition corporelle des adolescentes. La mode et quelques répercussions cliniques

Les changements biologiques et psychologiques qui surviennent au moment de la croissance fragilisent l’enfant et peuvent favoriser des facteurs de risque durant cette période de maturation et dans sa future vie d’adulte. L’influence de la publicité et la pression sociale font naître, essentiellement chez les filles, un nouveau prototype corporel où l’extrême maigreur n’est plus l’exception comme c’était le cas dans les périodes précédentes. Pour détecter les possibles risques ou maladies causés par de telles modifications, 134 adolescentes de la ville de Madrid et de sa banlieue, âgées de 15 à 17 ans, ont été échantillonnées. Les participantes connaissaient les objectifs de l’étude et y ont participé volontairement avec le consentement parental. Deux sous-échantillons contrastés ont été comparés, en fonction de l’indice de masse corporelle (groupes au-dessous et au-dessus de la limite du dixième percentile somatique, soit IMC = 17). On constate une très basse ingestion de calories (900 Kcal/jours) pour les filles avec un IMC < 17, et une diminution de la proportion recommandée d’hydrates de carbone. On remarque également une prise alimentaire irrégulière et des comportements alimentaires à risque. La composition corporelle est modifiée par rapport aux normes habituelles chez la femme, ce qui pourrait être la cause de 77.7 % des aménorrhées et de l’androgénicité dans la distribution des graisses.The biological and psychological changes which occur during growth stages render children fragile, which can favour risk factors during the period of maturation as well as later on in adult life. The influence of advertising and social pressure is particularly strong in the case of girls, and a new prototype of body proportion has emerged in which extreme thinness is no longer the exception as it has been in previous periods. In order to detect the possible risks and diseases caused by such modifications, 134 adolescent girls in the city of Madrid and its outskirts, aged 15 to 17 years of age, were sampled. The participants understood the objectives of the study and participated voluntarily with parental consent. Two contrasting sub-samples were compared, according to the index of body mass (groups below and above the limit of the somatic tenth percentile, that is BMI = 17). A very low nutritional intake was observed (900 Kcal/day) for the girls with a BMI < 17, as well as a decrease in the recommended proportion of carbohydrates. Irregularity of food intake and risky food-related behaviours were noted. The body composition was modified in comparison to female body norms, which could be the cause of 77% of amenorrhoeas and of androgenicity in fat distribution