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Zhong B, Sun H, Wang G, Junwen S, Tang S, Gao Y, Chen H, Lu T, Yan J. Physical activity on the mental health of children and adolescents during COVID-19 pandemic-induced school closures-A systematic review. PLoS One 2024; 19:e0299158. [PMID: 38917211 PMCID: PMC11198782 DOI: 10.1371/journal.pone.0299158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/06/2024] [Indexed: 06/27/2024] Open
Abstract
PROPOSE To review published Physical Activity (PA) on the Mental Health of Children and Adolescents aged 5 to 18 years during COVID-19 pandemic-induced school closures. METHODS From the database creation to April 2022, 10 databases are retrieved, with 4427 records filtered, 14 included in this research. The research takes Agency for Healthcare Research and Quality (AHRQ) evaluation standards. RESULTS The thesis selects 14 studies from 6 countries, involving 400009 children and adolescents. These studies happened during the lockdown of COVID-19 (from December 2019 to April 2021). During the lockdown of COVID-19, schools were closed, which was considered part of a more extensive lockdown. Schools were closed for 1 to 4 weeks. There were 10 high quality studies (71.4%) and 4 medium quality studies (28.6%). 4 studies report that the pandemic reduces the time of PA but increases the time of watching screen and sitting. 10 studies (71.4%) identify that PA is positive for the mental health, because it helps reduce mental symptoms to a certain extent, especially anxiety, depression, and emotional disorders. 5 studies show that PA may not improve the mental health of children and adolescents under 12 during the pandemic. 4 studies indicate that the influence of PA on mental health of children and adolescents is determined by the amount of activity, including the extent, intensity, frequency, and duration, etc. CONCLUSIONS In this narrative synthesis of reports from the class suspension period, reports that PA has a improve on the mental health of children and adolescents to a certain extent. it is found that PA may be helpful in reducing mental health symptoms of children and adolescents who are influenced by class suspension because of the COVID-19 pandemic. Therefore, stakeholders of the mental health of children and adolescents around the world should recommend PA because it is a practicable and beneficial way for long-term mental support.
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Affiliation(s)
- Bingbing Zhong
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - HaiChun Sun
- College of Education, University of South Florida, Tampa, FL, United States of America
| | - Guixiang Wang
- Department of Sports Work, Beijing University of Civil Engineering and Architecture, Beijing, China
| | - Shu Junwen
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Shaohua Tang
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Yuan Gao
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Hanwen Chen
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - TianCi Lu
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Jun Yan
- College of Physical Education, Yangzhou University, Yangzhou, China
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2
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Sundaram N, Abramsky T, Oswald WE, Cook S, Halliday KE, Nguipdop‐Djomo P, Sturgess J, Ireland G, Ladhani SN, Mangtani P, Langan SM, Hargreaves JR, Bonell C. Implementation of COVID-19 Preventive Measures and Staff Well-Being in a Sample of English Schools 2020-2021. THE JOURNAL OF SCHOOL HEALTH 2023; 93:266-278. [PMID: 36450450 PMCID: PMC9877738 DOI: 10.1111/josh.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/12/2022] [Accepted: 11/02/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND We examined fidelity and feasibility of implementation of COVID-19 preventive measures in schools, and explored associations between adherence to these measures and staff well-being, to inform policy on sustainable implementation and staff wellbeing. METHODS Surveys were conducted across 128 schools in England with 107 headteachers and 2698 staff-members with reference to autumn term 2020, examining school-level implementation of preventive measures, adherence, and teacher burnout (response rates for headteacher and staff surveys were 84% and 59%, respectively). RESULTS The median number of measures implemented in primary and secondary schools was 33 (range 23-41), and 32 (range 22-40), respectively; most measures presented challenges. No differences were found regarding number of measures implemented by school-level socio-economic disadvantage. High adherence was reported for staff wearing face-coverings, staff regularly washing their hands, (secondary only) desks facing forwards, and (primary only) increased cleaning of surfaces and student hand-washing. Adherence to most measures was reported as higher in primary than secondary schools. Over half of school leaders and 42% (517/1234) of other teaching staff suffered from high emotional exhaustion. Higher teacher-reported school-wide adherence with measures was consistently associated with lower burnout for leaders and other teaching staff. CONCLUSIONS Findings indicate a tremendous effort in implementing preventive measures and an urgent need to support investments in improving teacher wellbeing.
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Affiliation(s)
- Neisha Sundaram
- Department of Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineWC1H 9SHLondonUK
| | - Tanya Abramsky
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineWC1H 9SHLondonUK
| | - William E Oswald
- Department of Disease ControlLondon School of Hygiene & Tropical MedicineWC1E 7HTLondonUK
| | - Sarah Cook
- Department of Non‐communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT; National Heart and Lung Institute, Imperial College LondonLondonUK
| | - Katherine E Halliday
- Department of Disease ControlLondon School of Hygiene & Tropical MedicineWC1E 7HTLondonUK
| | - Patrick Nguipdop‐Djomo
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineWC1E 7HTLondonUK
| | - Joanna Sturgess
- Department of Medical StatisticsLondon School of Hygiene & Tropical MedicineWC1E 7HTLondonUK
| | | | - Shamez N Ladhani
- Public Health Programmes, UK Health Security Agency; Paediatric Infectious Diseases Research Group, St George's University of LondonLondonUK
| | - Punam Mangtani
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineWC1E 7HTLondonUK
| | - Sinéad M Langan
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineWC1E 7HTLondonUK
| | - James R Hargreaves
- Department of Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineWC1H 9SHLondonUK
| | - Chris Bonell
- Department of Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineWC1H 9SHLondonUK
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3
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Borges LP, Guimarães AG, Fonseca DLM, Freire PP, Barreto ÍD, Souza DR, Gurgel RQ, Lopes AS, Melquiades de Rezende Neto J, dos Santos KA, Matos IL, da Invenção GB, Oliveira BM, Santos AA, Soares DA, de Jesus PC, dos Santos CA, Goes MA, Plaça DR, Filgueiras IS, Marques AH, Baiocchi GC, Cabral-Miranda W, Cabral de Miranda G, Saraiva Camara NO, Garcia Calich VL, Ramos RN, Nakaya HI, Rocha V, Giil LM, Ochs HD, Schimke LF, de Souza MS, Cuevas LE, Martins AF, Cabral-Marques O. Cross-sectional analysis of students and school workers reveals a high number of asymptomatic SARS-CoV-2 infections during school reopening in Brazilian cities. Heliyon 2022; 8:e11368. [PMID: 36349284 PMCID: PMC9633633 DOI: 10.1016/j.heliyon.2022.e11368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/10/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Brazil experienced one of the most prolonged periods of school closures, and reopening could have exposed students to high rates of SARS-CoV-2 infection. However, the infection status of students and school workers at the time of the reopening of schools located in Brazilian cities is unknown. Here we evaluated viral carriage by RT-PCR and seroprevalence of anti-SARS-CoV-2 antibodies (IgM and IgG) by immunochromatography in 2259 individuals (1139 students and 1120 school workers) from 28 schools in 28 Brazilian cities. We collected the samples within 30 days after public schools reopened and before the start of vaccination campaigns. Most students (n = 421) and school workers (n = 446) had active (qRT-PCR + IgM- IgG- or qRT-PCR + IgM + IgG-/+) SARS-CoV-2 infection. Regression analysis indicated a strong association between the infection status of students and school workers. Furthermore, while 45% (n = 515) of the students and 37% (n = 415) of the school workers were neither antigen nor antibody positive in laboratory tests, 16% of the participants (169 students and 193 school workers) were oligosymptomatic, including those reinfected. These individuals presented mild symptoms such as headache, sore throat, and cough. Notably, most of the individuals were asymptomatic (83.9%). These results indicate that many SARS-CoV-2 infections in Brazilian cities during school reopening were asymptomatic. Thus, our study highlights the need to promote a coordinated public health effort to guarantee a safe educational environment while avoiding exacerbating pre-existent social inequalities in Brazil, reducing social, mental, and economic losses for students, school workers, and their families.
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Affiliation(s)
- Lysandro P. Borges
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Adriana G. Guimarães
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Dennyson Leandro M. Fonseca
- Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - Paula P. Freire
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Íkaro D.C. Barreto
- Nuclear and Energy Technology Graduate Program (UFPE), Recife, Pernambuco, Brazil
| | - Daniela R.V. Souza
- Department of Education in Health, Lagarto and Post-graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Ricardo Q. Gurgel
- Department of Medicine and Post-Graduate Programs in Parasitic Biology and Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Aline S.A. Lopes
- Department of Education in Health, Lagarto and Post-graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - José Melquiades de Rezende Neto
- Department of Education in Health, Lagarto and Post-graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Kezia A. dos Santos
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Igor L.S. Matos
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Brenda M. Oliveira
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Aryanne A. Santos
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Pamela C. de Jesus
- Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Marco A.O. Goes
- Department of Medicine and Post-Graduate Programs in Parasitic Biology and Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- State Health Department, Sergipe, Brazil
| | - Desirée Rodrigues Plaça
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Igor Salerno Filgueiras
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Alexandre H.C. Marques
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Gabriela Crispim Baiocchi
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | | | - Gustavo Cabral de Miranda
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Niels Olsen Saraiva Camara
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Vera Lúcia Garcia Calich
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Nalio Ramos
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology and Cell Therapy, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- Instituto D'Or de Ensino e Pesquisa, São Paulo, Brazil
| | - Helder I. Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
- Scientific Platform Pasteur, University of São Paulo, São Paulo 05508-020, Brazil
| | - Vanderson Rocha
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology and Cell Therapy, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- Instituto D'Or de Ensino e Pesquisa, São Paulo, Brazil
- Fundação Pró-Sangue-Hemocentro de São Paulo, São Paulo, Brazil
- Churchill Hospital, Department of Hematology, University of Oxford, Oxford, United Kingdom
| | - Lasse M. Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Hans D. Ochs
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Lena F. Schimke
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Mércia S.F. de Souza
- Department of Medicine and Post-Graduate Programs in Parasitic Biology and Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- State Health Department, Sergipe, Brazil
| | - Luis E. Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Aline F. Martins
- Department of Education in Health, Lagarto and Post-graduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Otavio Cabral-Marques
- Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of Sao Paulo (USP), Sao Paulo, SP, Brazil
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
- Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Sao Paulo, Brazil
- Department of Pharmacy and Postgraduate Program of Health and Science, Federal University of Rio Grande do Norte, Natal, Brazil
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4
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Charalampopoulou M, Choi EJ, Korczak DJ, Cost KT, Crosbie J, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiades S, Ayub M, Schachar RJ, Iaboni A, Anagnostou E. Les profils de santé mentale des enfants et adolescents autistes pendant la pandémie de COVID-19. Paediatr Child Health 2022; 27:S143-S150. [PMID: 36092298 PMCID: PMC9455656 DOI: 10.1093/pch/pxac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectifs Les confinements dans les provinces canadiennes ont malmené la santé mentale des enfants pendant la pandémie de COVID-19, et les enfants autistes y ont été particulièrement vulnérables. La présente étude visait à recenser les sous-groupes d’enfants autistes ayant des profils distincts de modification à leur santé mentale, afin de comprendre les facteurs propres aux enfants, aux parents et au système qui y sont associés et d’éclairer de futures interventions. Méthodologie Les chercheurs ont extrait les données d’une vaste cohorte ontarienne (n=1 570), dont faisaient partie 265 enfants autistes (âge moyen=10,9 ans, 76 % de sexe masculin). Ils ont utilisé l’analyse des nuées dynamiques pour répartir les profils de santé mentale distincts en six mesures (humeur, anxiété, symptômes de trouble obsessionnel-compulsif, irritabilité, inattention, hyperactivité) et ont examiné les différences entre les groupes. Ils ont également étudié les caractéristiques des enfants qui ont accédé à des services aigus en santé mentale. Résultats Le nombre optimal de grappes était fixé à deux. La première incluait ceux qui avaient éprouvé une détérioration de leur santé mentale dans les six mesures (61,3 %, intervalle de confiance à 95 %=54,9 à 67,4) et la seconde, les jeunes dont la santé mentale n’avait pas changé (38,7 %, intervalle de confiance à 95 %=32,6 à 45,1). Des facteurs étaient associés à la détérioration de la santé mentale des enfants : plus de symptômes internalisés préexistants et de forts taux de stress liés à la COVID-19. Les problèmes de santé mentale des parents et les facteurs propres aux systèmes, tels que la perte de soutien à l’apprentissage, l’accès aux médecins et les difficultés matérielles, étaient aussi liés à cette détérioration. L’accès à des services aigus en santé mentale découlait d’abord de l’insécurité financière et de la perte de services. Conclusions Plus de la moitié des enfants autistes ont éprouvé une détérioration de leur santé mentale, et les caractéristiques individuelles (troubles de santé mentale préexistants, stress lié à la COVID-19), parentales (santé mentale des parents) et systémiques (perte de services et difficultés matérielles) y étaient reliées, ce qui ouvrait la voie à des interventions cliniques et politiques multiniveaux.
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Affiliation(s)
| | - Eun Jung Choi
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
| | - Daphne J Korczak
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Katherine T Cost
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Jennifer Crosbie
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Catherine S Birken
- Département de pédiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
- Sciences évaluatives de la santé des enfants, The Hospital for Sick Children Research Institute, Toronto (Ontario)Canada
| | - Alice Charach
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
- Sciences évaluatives de la santé des enfants, The Hospital for Sick Children Research Institute, Toronto (Ontario)Canada
- Institut des politiques, de la gestion et de l’évaluation de la santé, faculté de médecine Temerty, Université de Toronto, Toronto (Ontario)Canada
| | - Suneeta Monga
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Elizabeth Kelley
- Département de psychologie, Université Queen’s, Kingston (Ontario)Canada
- Département de psychiatrie, Université Queen’s, Kingston (Ontario)Canada
| | - Rob Nicolson
- Département de psychiatrie, Université Western, London (Ontario)Canada
| | - Stelios Georgiades
- Département de psychiatrie et de neurosciences comportementales, Université McMaster, Hamilton (Ontario)Canada
| | - Muhammad Ayub
- Département de psychiatrie, Université Queen’s, Kingston (Ontario)Canada
| | - Russell J Schachar
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Alana Iaboni
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
| | - Evdokia Anagnostou
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
- Département de pédiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
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5
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Charalampopoulou M, Choi EJ, Korczak DJ, Cost KT, Crosbie J, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiades S, Ayub M, Schachar RJ, Iaboni A, Anagnostou E. Mental health profiles of autistic children and youth during the COVID-19 pandemic. Paediatr Child Health 2022; 27:S59-S65. [PMID: 35615409 PMCID: PMC9126276 DOI: 10.1093/pch/pxab111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/24/2022] [Indexed: 12/18/2022] Open
Abstract
Objectives Canadian province-wide lockdowns have challenged children's mental health (MH) during the COVID-19 pandemic, with autistic children being at particular risk. The purpose of our study was to identify sub-groups of autistic children with distinct mental health change profiles, to understand the child-, parent-, and system-specific factors associated with such profiles in order to ultimately inform future interventions. Methods Data were drawn from a large Canadian cohort (N=1,570) across Ontario, resulting in 265 autistic children (mean age=10.9 years, 76% male). K-means clustering analyses were employed to partition distinct MH profiles in six MH measures (mood, anxiety, OCD symptoms, irritability, inattention, hyperactivity) and group differences were examined with reference to the above factors. Additionally, we investigated the characteristics of children who accessed acute MH services. Results The optimal number of clusters was two; one included those experiencing MH deterioration across all six MH measures (61.3%, 95% confidence interval [CI]=54.9 to 67.4), and a second included youth that did not experience MH changes (38.7%, 95%CI=32.6 to 45.1). Child-specific factors associated with MH deterioration included higher pre-existing internalizing symptoms, high levels of COVID stress. Parental MH challenges and system-specific factors, such as the loss of learning supports, access to physicians and material deprivation, were also associated with MH deterioration. Access to acute MH services were primarily associated with financial insecurity and loss of services. Conclusions More than half of autistic children experienced MH deterioration, and person-specific (pre-existing MH, COVID related stress), parent-specific (Parent MH) and system-level (loss of services and material deprivation) characteristics were associated with such decline, providing clinical and policy opportunities for intervention at multiple levels.
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Affiliation(s)
| | - Eun Jung Choi
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katherine T Cost
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute Hospital for Sick Children, Canada
| | - Alice Charach
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute Hospital for Sick Children, Canada.,Institute for Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.,Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Ayub
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alana Iaboni
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- Holland Bloorview Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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6
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Waboso N, Donison L, Raby R, Harding E, Sheppard LC, Grossman K, Myatt H, Black S. 'We can play tag with a stick'. Children's knowledge, experiences, feelings and creative thinking during the COVID-19 pandemic. CHILDREN & SOCIETY 2022; 37:CHSO12579. [PMID: 35942025 PMCID: PMC9348108 DOI: 10.1111/chso.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/26/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
Using a relational approach, we draw on repeated interviews with a group of 30 diverse children from Ontario to share and reflect on their knowledge, experiences and feelings early in the COVID-19 pandemic. Prioritising relational interdependence and relational agency, this paper illustrates our participants' embedded engagements with the pandemic and their contribution to the co-production of knowledge. We emphasise their thoughtful responses to the pandemic; their creative, self-reflexive strategies for managing a difficult time; and their advice to others. We thus prioritise children's viewpoints and emphasise their relational interconnections with others during a time that was marked by social isolation.
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Affiliation(s)
| | | | | | | | | | | | | | - Sara Black
- Brock UniversitySt. CatharinesOntarioCanada
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7
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Krishnaratne S, Littlecott H, Sell K, Burns J, Rabe JE, Stratil JM, Litwin T, Kreutz C, Coenen M, Geffert K, Boger AH, Movsisyan A, Kratzer S, Klinger C, Wabnitz K, Strahwald B, Verboom B, Rehfuess E, Biallas RL, Jung-Sievers C, Voss S, Pfadenhauer LM. Measures implemented in the school setting to contain the COVID-19 pandemic. Cochrane Database Syst Rev 2022; 1:CD015029. [PMID: 35037252 PMCID: PMC8762709 DOI: 10.1002/14651858.cd015029] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In response to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the impact of coronavirus disease 2019 (COVID-19), governments have implemented a variety of measures to control the spread of the virus and the associated disease. Among these, have been measures to control the pandemic in primary and secondary school settings. OBJECTIVES To assess the effectiveness of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID-19 pandemic, with particular focus on the different types of measures implemented in school settings and the outcomes used to measure their impacts on transmission-related outcomes, healthcare utilisation outcomes, other health outcomes as well as societal, economic, and ecological outcomes. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and the Educational Resources Information Center, as well as COVID-19-specific databases, including the Cochrane COVID-19 Study Register and the WHO COVID-19 Global literature on coronavirus disease (indexing preprints) on 9 December 2020. We conducted backward-citation searches with existing reviews. SELECTION CRITERIA We considered experimental (i.e. randomised controlled trials; RCTs), quasi-experimental, observational and modelling studies assessing the effects of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID-19 pandemic. Outcome categories were (i) transmission-related outcomes (e.g. number or proportion of cases); (ii) healthcare utilisation outcomes (e.g. number or proportion of hospitalisations); (iii) other health outcomes (e.g. physical, social and mental health); and (iv) societal, economic and ecological outcomes (e.g. costs, human resources and education). We considered studies that included any population at risk of becoming infected with SARS-CoV-2 and/or developing COVID-19 disease including students, teachers, other school staff, or members of the wider community. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts and full texts. One review author extracted data and critically appraised each study. One additional review author validated the extracted data. To critically appraise included studies, we used the ROBINS-I tool for quasi-experimental and observational studies, the QUADAS-2 tool for observational screening studies, and a bespoke tool for modelling studies. We synthesised findings narratively. Three review authors made an initial assessment of the certainty of evidence with GRADE, and several review authors discussed and agreed on the ratings. MAIN RESULTS We included 38 unique studies in the analysis, comprising 33 modelling studies, three observational studies, one quasi-experimental and one experimental study with modelling components. Measures fell into four broad categories: (i) measures reducing the opportunity for contacts; (ii) measures making contacts safer; (iii) surveillance and response measures; and (iv) multicomponent measures. As comparators, we encountered the operation of schools with no measures in place, less intense measures in place, single versus multicomponent measures in place, or closure of schools. Across all intervention categories and all study designs, very low- to low-certainty evidence ratings limit our confidence in the findings. Concerns with the quality of modelling studies related to potentially inappropriate assumptions about the model structure and input parameters, and an inadequate assessment of model uncertainty. Concerns with risk of bias in observational studies related to deviations from intended interventions or missing data. Across all categories, few studies reported on implementation or described how measures were implemented. Where we describe effects as 'positive', the direction of the point estimate of the effect favours the intervention(s); 'negative' effects do not favour the intervention. We found 23 modelling studies assessing measures reducing the opportunity for contacts (i.e. alternating attendance, reduced class size). Most of these studies assessed transmission and healthcare utilisation outcomes, and all of these studies showed a reduction in transmission (e.g. a reduction in the number or proportion of cases, reproduction number) and healthcare utilisation (i.e. fewer hospitalisations) and mixed or negative effects on societal, economic and ecological outcomes (i.e. fewer number of days spent in school). We identified 11 modelling studies and two observational studies assessing measures making contacts safer (i.e. mask wearing, cleaning, handwashing, ventilation). Five studies assessed the impact of combined measures to make contacts safer. They assessed transmission-related, healthcare utilisation, other health, and societal, economic and ecological outcomes. Most of these studies showed a reduction in transmission, and a reduction in hospitalisations; however, studies showed mixed or negative effects on societal, economic and ecological outcomes (i.e. fewer number of days spent in school). We identified 13 modelling studies and one observational study assessing surveillance and response measures, including testing and isolation, and symptomatic screening and isolation. Twelve studies focused on mass testing and isolation measures, while two looked specifically at symptom-based screening and isolation. Outcomes included transmission, healthcare utilisation, other health, and societal, economic and ecological outcomes. Most of these studies showed effects in favour of the intervention in terms of reductions in transmission and hospitalisations, however some showed mixed or negative effects on societal, economic and ecological outcomes (e.g. fewer number of days spent in school). We found three studies that reported outcomes relating to multicomponent measures, where it was not possible to disaggregate the effects of each individual intervention, including one modelling, one observational and one quasi-experimental study. These studies employed interventions, such as physical distancing, modification of school activities, testing, and exemption of high-risk students, using measures such as hand hygiene and mask wearing. Most of these studies showed a reduction in transmission, however some showed mixed or no effects. As the majority of studies included in the review were modelling studies, there was a lack of empirical, real-world data, which meant that there were very little data on the actual implementation of interventions. AUTHORS' CONCLUSIONS Our review suggests that a broad range of measures implemented in the school setting can have positive impacts on the transmission of SARS-CoV-2, and on healthcare utilisation outcomes related to COVID-19. The certainty of the evidence for most intervention-outcome combinations is very low, and the true effects of these measures are likely to be substantially different from those reported here. Measures implemented in the school setting may limit the number or proportion of cases and deaths, and may delay the progression of the pandemic. However, they may also lead to negative unintended consequences, such as fewer days spent in school (beyond those intended by the intervention). Further, most studies assessed the effects of a combination of interventions, which could not be disentangled to estimate their specific effects. Studies assessing measures to reduce contacts and to make contacts safer consistently predicted positive effects on transmission and healthcare utilisation, but may reduce the number of days students spent at school. Studies assessing surveillance and response measures predicted reductions in hospitalisations and school days missed due to infection or quarantine, however, there was mixed evidence on resources needed for surveillance. Evidence on multicomponent measures was mixed, mostly due to comparators. The magnitude of effects depends on multiple factors. New studies published since the original search date might heavily influence the overall conclusions and interpretation of findings for this review.
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Affiliation(s)
- Shari Krishnaratne
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Julia E Rabe
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Litwin
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analytics and Modeling (FDM), Faculty of Medicine and Medical Center, Albert-Ludwig-University, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analytics and Modeling (FDM), Faculty of Medicine and Medical Center, Albert-Ludwig-University, Freiburg, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Anna Helen Boger
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analytics and Modeling (FDM), Faculty of Medicine and Medical Center, Albert-Ludwig-University, Freiburg, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Suzie Kratzer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Carmen Klinger
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke L Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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8
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Repairing boundaries along pathways to tuberculosis case detection: a qualitative synthesis of intervention designs. Health Res Policy Syst 2022; 20:7. [PMID: 35012561 PMCID: PMC8751340 DOI: 10.1186/s12961-021-00811-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tuberculosis case-finding interventions often involve several activities to enhance patient pathways, and it is unclear which activity defines the type of case-finding intervention. When conducting studies to identify the most effective case-finding intervention it is important to have a clear understanding of these interventions for meaningful comparisons. This review aimed to construct a systems-based logic model of all pathways to tuberculosis case detection through a synthesis of intervention designs. METHODS We identified an existing systematic review on the effectiveness of interventions to increase tuberculosis case detection and updated the search from December 2016 to October 2020. We included randomized controlled trials, as these designs encourage detailed description of interventions. Taking each study in turn, intervention descriptions were read in detail. The texts were analysed qualitatively by constantly comparing emerging codes to construct patient journeys, visualized as logical chains. Actions taken as part of interventions were positioned along patient journeys to theorize the sequence of outcomes. Patient journeys formed the basis of the model, which was refined through discussion. RESULTS Based on intervention descriptions from 17 randomized controlled trials, our model distinguishes two care-seeking pathways and four screening pathways. An open invitation to people with tuberculosis symptoms creates care-seeking pathways. On care-seeking pathways, systematic screening can be conducted at general health services, but not at specific TB care services. People invited to tuberculosis services regardless of symptoms follow tuberculosis screening pathways and may be identified with presumptive tuberculosis even if they do not seek care for tuberculosis symptoms. Tuberculosis screening pathways include screening offered to all people accessing care at general health services, screening at a mobile clinic or health facility with open invitation to a whole population or tuberculosis contacts, screening personally offered to a whole population or tuberculosis contacts at home, work or school, and screening offered to people receiving care for human immunodeficiency virus or other clinical risk-group care. CONCLUSION This systems-based logic model of tuberculosis case-finding pathways may support standardized terminology, consistency, transparency and improved communication among researchers, policy-makers, health workers and community members when implementing and evaluating interventions to improve tuberculosis case detection.
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9
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Loganathan T, Chan ZX, Hassan F, Kunpeuk W, Suphanchaimat R, Yi H, Majid HA. Education for non-citizen children in Malaysia during the COVID-19 pandemic: A qualitative study. PLoS One 2021; 16:e0259546. [PMID: 34855770 PMCID: PMC8638886 DOI: 10.1371/journal.pone.0259546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic disrupted schooling for children worldwide. Most vulnerable are non-citizen children without access to public education. This study aims to explore challenges faced in achieving education access for children of refugee and asylum-seekers, migrant workers, stateless and undocumented persons in Malaysia during the pandemic. In-depth interviews of 33 stakeholders were conducted from June 2020 to March 2021. Data were thematically analysed. Our findings suggest that lockdowns disproportionately impacted non-citizen households as employment, food and housing insecurity were compounded by xenophobia, exacerbating pre-existing inequities. School closures disrupted school meals and deprived children of social interaction needed for mental wellbeing. Many non-citizen children were unable to participate in online learning due to the scarcity of digital devices, and poor internet connectivity, parental support, and home learning environments. Teachers were forced to adapt to online learning and adopt alternative arrangements to ensure continuity of learning and prevent school dropouts. The lack of government oversight over learning centres meant that measures taken were not uniform. The COVID-19 pandemic presents an opportunity for the design of more inclusive national educational policies, by recognising and supporting informal learning centres, to ensure that no child is left behind.
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Affiliation(s)
- Tharani Loganathan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhie X. Chan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fikri Hassan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Watinee Kunpeuk
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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10
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Perra N. Non-pharmaceutical interventions during the COVID-19 pandemic: A review. PHYSICS REPORTS 2021; 913:1-52. [PMID: 33612922 PMCID: PMC7881715 DOI: 10.1016/j.physrep.2021.02.001] [Citation(s) in RCA: 224] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 05/06/2023]
Abstract
Infectious diseases and human behavior are intertwined. On one side, our movements and interactions are the engines of transmission. On the other, the unfolding of viruses might induce changes to our daily activities. While intuitive, our understanding of such feedback loop is still limited. Before COVID-19 the literature on the subject was mainly theoretical and largely missed validation. The main issue was the lack of empirical data capturing behavioral change induced by diseases. Things have dramatically changed in 2020. Non-pharmaceutical interventions (NPIs) have been the key weapon against the SARS-CoV-2 virus and affected virtually any societal process. Travel bans, events cancellation, social distancing, curfews, and lockdowns have become unfortunately very familiar. The scale of the emergency, the ease of survey as well as crowdsourcing deployment guaranteed by the latest technology, several Data for Good programs developed by tech giants, major mobile phone providers, and other companies have allowed unprecedented access to data describing behavioral changes induced by the pandemic. Here, I review some of the vast literature written on the subject of NPIs during the COVID-19 pandemic. In doing so, I analyze 348 articles written by more than 2518 authors in the first 12 months of the emergency. While the large majority of the sample was obtained by querying PubMed, it includes also a hand-curated list. Considering the focus, and methodology I have classified the sample into seven main categories: epidemic models, surveys, comments/perspectives, papers aiming to quantify the effects of NPIs, reviews, articles using data proxies to measure NPIs, and publicly available datasets describing NPIs. I summarize the methodology, data used, findings of the articles in each category and provide an outlook highlighting future challenges as well as opportunities.
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Affiliation(s)
- Nicola Perra
- Networks and Urban Systems Centre, University of Greenwich, London, UK
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11
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Krishnaratne S, Pfadenhauer LM, Coenen M, Geffert K, Jung-Sievers C, Klinger C, Kratzer S, Littlecott H, Movsisyan A, Rabe JE, Rehfuess E, Sell K, Strahwald B, Stratil JM, Voss S, Wabnitz K, Burns J. Measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review. Cochrane Database Syst Rev 2020; 12:CD013812. [PMID: 33331665 PMCID: PMC9206727 DOI: 10.1002/14651858.cd013812] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In response to the spread of SARS-CoV-2 and the impact of COVID-19, national and subnational governments implemented a variety of measures in order to control the spread of the virus and the associated disease. While these measures were imposed with the intention of controlling the pandemic, they were also associated with severe psychosocial, societal, and economic implications on a societal level. One setting affected heavily by these measures is the school setting. By mid-April 2020, 192 countries had closed schools, affecting more than 90% of the world's student population. In consideration of the adverse consequences of school closures, many countries around the world reopened their schools in the months after the initial closures. To safely reopen schools and keep them open, governments implemented a broad range of measures. The evidence with regards to these measures, however, is heterogeneous, with a multitude of study designs, populations, settings, interventions and outcomes being assessed. To make sense of this heterogeneity, we conducted a rapid scoping review (8 October to 5 November 2020). This rapid scoping review is intended to serve as a precursor to a systematic review of effectiveness, which will inform guidelines issued by the World Health Organization (WHO). This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and was registered with the Open Science Framework. OBJECTIVES To identify and comprehensively map the evidence assessing the impacts of measures implemented in the school setting to reopen schools, or keep schools open, or both, during the SARS-CoV-2/COVID-19 pandemic, with particular focus on the types of measures implemented in different school settings, the outcomes used to measure their impacts and the study types used to assess these. SEARCH METHODS We searched the Cochrane COVID-19 Study Register, MEDLINE, Embase, the CDC COVID-19 Research Articles Downloadable Database for preprints, and the WHO COVID-19 Global literature on coronavirus disease on 8 October 2020. SELECTION CRITERIA We included studies that assessed the impact of measures implemented in the school setting. Eligible populations were populations at risk of becoming infected with SARS-CoV-2, or developing COVID-19 disease, or both, and included people both directly and indirectly impacted by interventions, including students, teachers, other school staff, and contacts of these groups, as well as the broader community. We considered all types of empirical studies, which quantitatively assessed impact including epidemiological studies, modelling studies, mixed-methods studies, and diagnostic studies that assessed the impact of relevant interventions beyond diagnostic test accuracy. Broad outcome categories of interest included infectious disease transmission-related outcomes, other harmful or beneficial health-related outcomes, and societal, economic, and ecological implications. DATA COLLECTION AND ANALYSIS We extracted data from included studies in a standardized manner, and mapped them to categories within our a priori logic model where possible. Where not possible, we inductively developed new categories. In line with standard expectations for scoping reviews, the review provides an overview of the existing evidence regardless of methodological quality or risk of bias, and was not designed to synthesize effectiveness data, assess risk of bias, or characterize strength of evidence (GRADE). MAIN RESULTS We included 42 studies that assessed measures implemented in the school setting. The majority of studies used mathematical modelling designs (n = 31), while nine studies used observational designs, and two studies used experimental or quasi-experimental designs. Studies conducted in real-world contexts or using real data focused on the WHO European region (EUR; n = 20), the WHO region of the Americas (AMR; n = 13), the West Pacific region (WPR; n = 6), and the WHO Eastern Mediterranean Region (EMR; n = 1). One study conducted a global assessment and one did not report on data from, or that were applicable to, a specific country. Three broad intervention categories emerged from the included studies: organizational measures to reduce transmission of SARS-CoV-2 (n = 36), structural/environmental measures to reduce transmission of SARS-CoV-2 (n = 11), and surveillance and response measures to detect SARS-CoV-2 infections (n = 19). Most studies assessed SARS-CoV-2 transmission-related outcomes (n = 29), while others assessed healthcare utilization (n = 8), other health outcomes (n = 3), and societal, economic, and ecological outcomes (n = 5). Studies assessed both harmful and beneficial outcomes across all outcome categories. AUTHORS' CONCLUSIONS We identified a heterogeneous and complex evidence base of measures implemented in the school setting. This review is an important first step in understanding the available evidence and will inform the development of rapid reviews on this topic.
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Affiliation(s)
- Shari Krishnaratne
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Carmen Klinger
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Suzie Kratzer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Hannah Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Julia E Rabe
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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12
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Kneale D, O'Mara-Eves A, Rees R, Thomas J. School closure in response to epidemic outbreaks: Systems-based logic model of downstream impacts. F1000Res 2020; 9:352. [PMID: 32864104 PMCID: PMC7445561 DOI: 10.12688/f1000research.23631.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
Background: School closures have been a recommended non-pharmaceutical intervention in pandemic response owing to the potential to reduce transmission of infection between children, school staff and those that they contact. However, given the many roles that schools play in society, closure for any extended period is likely to have additional impacts. Literature reviews of research exploring school closure to date have focused upon epidemiological effects; there is an unmet need for research that considers the multiplicity of potential impacts of school closures. Methods: We used systematic searching, coding and synthesis techniques to develop a systems-based logic model. We included literature related to school closure planned in response to epidemics large and small, spanning the 1918-19 'flu pandemic through to the emerging literature on the 2019 novel coronavirus. We used over 170 research studies and a number of policy documents to inform our model. Results: The model organises the concepts used by authors into seven higher level domains: children's health and wellbeing, children's education, impacts on teachers and other school staff, the school organisation, considerations for parents and families, public health considerations, and broader economic impacts. The model also collates ideas about potential moderating factors and ethical considerations. While dependent upon the nature of epidemics experienced to date, we aim for the model to provide a starting point for theorising about school closures in general, and as part of a wider system that is influenced by contextual and population factors. Conclusions: The model highlights that the impacts of school closures are much broader than those related solely to health, and demonstrates that there is a need for further concerted work in this area. The publication of this logic model should help to frame future research in this area and aid decision-makers when considering future school closure policy and possible mitigation strategies.
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Affiliation(s)
- Dylan Kneale
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Alison O'Mara-Eves
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Rebecca Rees
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - James Thomas
- Department of Social Science, UCL Institute of Education, University College London, London, UK
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