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Background: People with intellectual disabilities commonly experience multiple barriers to 'going out'. Aims: This paper explores what barriers prevented people from going out, and if the extent and nature of going out changed over time for people with intellectual disabilities as the COVID-19 pandemic progressed. Methods: Data are drawn from a wider study that explored, at four time points, the experiences of people with intellectual disabilities through the COVID-19 pandemic in the United Kingdom. Findings: The number of people leaving the house for almost all reasons increased over time through the pandemic, except for some outdoor participation and exercise. However, there was a significant decrease in outdoor exercise at the final time point of the study. Reliance on other people and a lack of availability of support were identified as barriers. Conclusion: A combination of factors restricted the extent to which people were going out even after COVID-19 protections were lifted.

Student-faculty interaction (SFI) is an important indicator of student engagement that positively associates with academic achievement and retention. Quantitative information regarding the impact of emergency remote teaching (ERT) during COVID-19 on SFI is limited. This retrospective, observational cohort study tests the hypothesis that COVID-19 ERT negatively affected SFI in a gender-dependent manner. Electronic records of office hour (OH) appointments, used to measure SFI, for first-year medical students across three time periods, before, during and after COVID, were obtained and analyzed. A concerning, marked decline in SFI during and after the COVID-19 pandemic is noted. Before COVID, significantly more women (75.20%) made at least one OH appointment compared with men (40.54%). During COVID, the proportion of women making an OH appointment (69.71%) was statistically indistinguishable from women before COVID-19. In contrast, significantly fewer men during COVID (10.34%) than before COVID made an OH appointment. On return to face-to-face teaching, no rebound effect was observed. Compared with before COVID gender-matched peers, fewer men and women after COVID made OH appointments. Discipline-based analyses show that for all three time periods physiology emerged as the content area in which students made most OH appointments. The reduction in SFI observed, combined with the consistency with which the participants in our study indicated a need for assistance with the physiology discipline, emphasizes the importance of active promotion of faculty support and deliberate efforts to reconnect with students in the post-COVID context.

BACKGROUND: The emergence of COVID-19 resulted in a substantial loss of education because of global school closures. Face masks are a potential measure to restrain the COVID-19 spread; therefore, this paper evaluated the effectiveness of face masks in reducing COVID-19 incidence in school settings. METHODS: A systematic review was conducted by searching the literature in the Cochrane COVID-19 Study Register and the World Health Organization COVID-19 global literature. Data were summarized in tabular forms, and the findings were presented as narrative synthesis. RESULTS: A total of 15,709 records were retrieved. The screening and selection led to the inclusion of 12 observational and 2 quasi-experimental studies. Nine studies were conducted in different states, counties, or districts of the United States, and the remaining 5 were reported from Germany, Finland, Spain, and the United Kingdom. The results of 10 out of 14 studies favored mask use in reducing school COVID-19 incidence. Three studies found no link between mask use and COVID-19 incidences, whereas 1 quasi-experimental study noted a higher COVID-19 incidence with mask use in students aged 6-11 years than no use of mask among preschool children aged 3-5 years. CONCLUSION: Mask mandates may lessen the incidence of respiratory infectious diseases in school settings during a pandemic; more well-designed studies are warranted to clarify further the evidence regarding mask use in school settings.

With the increase of special schools in UK and around the world, this study seeked to explore in-depth the reality of practitioners working with children with SEND in specialist settings throughout the COVID-19 pandemic. Utilising semi-structured interviews with 11 special school teachers and leaders, this study found that professionals working in specialist settings experienced parental conflict, challenges related to personal life and working arrangements during this time, and highlighted concerns and opportunities for the future and sustainability of the SEND system. The professionals highlighted some essential components needed to support the development of meaningful careers and the reduction of attrition in the sector such as an increase in pay and greater appreciation of the role. This study has implications for policy and practice in a time of uncertainty pre-election and during national crises such as high teacher turnover coupled with low teacher recruitment.

This qualitative study captured the reflections of 53 English language teachers from 40 different contexts including Bangladesh, Colombia, France, India, Scotland, Taiwan, Türkiye and the United Kingdom on teaching English during the times of COVID-19 and its post-effects on their practices. Data were collected through an online form consisting of three stems and the participants were asked to create similes about teaching English before, during and after the pandemic. By conducting thematic analysis, images created for each phase were categorized under occupational well-being, digital transformation, transactional distance, gap of communication and social isolation. Teachers pointed out work overload, lack of administrational support, instructions' not making sense, decreasing level of participation, dropouts, loss of student--teacher interaction and isolation as the drawbacks of the process along with the possibility of digital transformation ahead of their profession.

Long covid (persistent COVID-19) is a new disease with contested aetiology and variable prognosis. We report a 2-year ethnography of UK long covid clinics. Using a preformative lens, we show that multidisciplinary teams (MDTs) built working knowledge based on shared practices, mutual trust, distributed cognition (e.g. emails, record entries), relational knowledge of what was at stake for the patient, and harnessing uncertainty to open new discursive spaces. Most long covid MDTs performed the working knowledge of 'rehabilitation', a linked set of practices oriented to ensuring that the patient understood and strove to 'correct' maladaptive physiological responses (e.g. through breathing exercises) and pursued recovery goals, supported by physiotherapists, psychologists and generalist clinicians. Some MDTs with a higher proportion of doctors (e.g. cardiologists, neurologists, immunologists) enacted the working knowledge of 'microscopic damage', seeking to elucidate and rectify long covid's underlying molecular and cellular pathology. They justified non-standard investigations and medication in selected patients by co-constructing an evidentiary narrative based on biological mechanisms. Working knowledge was ontologically concordant within MDTs but sometimes discordant between MDTs. Overt ontological conflict occurred mostly when patients attending 'rehabilitation' clinics invoked the working knowledge of microscopic damage that had been generated and circulated in online support communities., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

The COVID-19 pandemic had a disproportionate impact on ethnically minoritised and other marginalised communities, yet little is known about the impacts of long COVID-19 (LC) on this group. Living with LC takes its toll both physically, emotionally and financially and even more so when a diagnosis is hard to come by. By using qualitative interviews centring the view of undiagnosed and marginalised communities already classed as 'underserved' in the medical literature, we show the range of barriers and impacts faced by these groups in the UK, and the strategies of resilience they use. Whether trapped on a 'diagnostic odyssey' at the level of primary care, struggling to maintain employment and businesses, or managing family commitments, we argue many minoritised communities are caught in a liminal space of misrecognition, invalidation and ambiguity. We show how these impacts are generated by tensions and challenges in the process and categorisation of diagnosis, and how this effects the daily lives of many individuals already on the receiving end of health inequity. We also offer some examples and suggestions for best practices., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Background: Following the COVID-19 pandemic, millions of people continue to experience ongoing physical and mental health sequelae after recovery from acute infection. There is currently no specific treatment for the diverse symptoms associated with post-COVID-19 condition. Physical and mental health rehabilitation may help improve quality of life in such patients. This study reports the cost-effectiveness of a programme of physical and mental health rehabilitation compared to best practice usual care in people with post-COVID-19 condition who were previously hospitalised., Methods: We conducted an economic evaluation within a randomised controlled trial from the perspective of the UK national health service (NHS) and personnel social services perspective (PSS). Resource used and health-related quality of life were collected using bespoke questionnaire and the EQ-5D-5 L questionnaire at three, six, and 12 months. Incremental costs and quality adjusted life years accrued over the follow-up period were estimated and reported as the incremental cost-effectiveness ratio. Estimate uncertainty was managed by multiple imputation and bootstrapping cost-effectiveness estimates; and displayed graphically on the cost-effectiveness plane., Results: Over a 12-month time horizon, incremental costs and QALYs were £305 (95% CI: -123 to 732) and 0.026 (95% CI: -0.005 to 0.052) respectively. The ICER was £11,941 per QALY indicating cost-effective care. Sensitivity analyses supported the base case findings. The probability of the intervention being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 84%., Conclusion: The within-trial economic evaluation suggested that people with post-COVID-19 condition after hospitalisation should be offered a programme of physical and mental health rehabilitation as it likely reflects a cost-effective use of NHS resources. Hospitalisation for COVID-19 has become less commonplace: further evaluation in non-hospitalised patients may be worthwhile., Trial Registration: ISRCTN registry ISRCTN11466448 23rd November 2020., (© 2024. The Author(s).)

Population-representative estimates of SARS-CoV-2 infection prevalence and antibody levels in specific geographic areas at different time points are needed to optimise policy responses. However, even population-wide surveys are potentially impacted by biases arising from differences in participation rates across key groups. Here, we used spatio-temporal regression and post-stratification models to UK's national COVID-19 Infection Survey (CIS) to obtain representative estimates of PCR positivity (6,496,052 tests) and antibody prevalence (1,941,333 tests) for different regions, ages and ethnicities (7-December-2020 to 4-May-2022). Not accounting for vaccination status through post-stratification led to small underestimation of PCR positivity, but more substantial overestimations of antibody levels in the population (up to 21 percentage points), particularly in groups with low vaccine uptake in the general population. There was marked variation in the relative contribution of different areas and age-groups to each wave. Future analyses of infectious disease surveys should take into account major drivers of outcomes of interest that may also influence participation, with vaccination being an important factor to consider., (© 2024. The Author(s).)

Objectives: To examine trajectories of functional limitations, fatigue, health-related quality of life (HRQL) and societal costs of patients referred to long COVID clinics., Design: A population-based longitudinal cohort study using real-time user data., Setting: 35 specialised long COVID clinics in the UK., Participants: 4087 adults diagnosed with long COVID in primary or secondary care deemed suitable for rehabilitation and registered in the Living With Covid Recovery (LWCR) programme between 4 August 2020 and 5 August 2022., Main Outcome Measures: Generalised linear mixed models were fitted to estimate trajectories of functional limitations, using the Work and Social Adjustment Scale (WSAS); scores of ≥20 indicate moderately severe limitations. Other outcomes included fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) reversed score (scores of ≥22 indicate impairment), HRQL using the EQ-5D-5L, and long COVID-related societal costs, encompassing healthcare costs and productivity losses., Results: The mean WSAS score at 6 months after registration in the LWCR was 19.1 (95% CI 18.6, 19.6), with 46% of the participants (95% CI 40.3%, 52.4%) reporting a WSAS score above 20 (moderately severe or worse impairment). The mean change in the WSAS score over the 6-month period was -0.86 (95% CI -1.32, -0.41). The mean reversed FACIT-F score at 6 months was 29.1 (95% CI 22.7, 35.5) compared with 32.0 (95% CI 31.7, 32.3) at baseline. The mean EQ-5D-5L score remained relatively constant between baseline (0.63, 95% CI 0.62, 0.64) and 6 months (0.64, 95% CI 0.59, 0.69). The monthly societal cost per patient related to long COVID at 6 months was £931, mostly driven by the costs associated with working days lost., Conclusions: Individuals referred to long COVID clinics in the UK reported small improvements in functional limitations, fatigue, HRQL and ability to work within 6 months of registering in the LWCR programme., Competing Interests: Competing interests: KB's research portfolio is partly funded by National Institute for Health & and Care Research (NIHR) Applied Research Collaboration Wessex. HG reports working as a clinical safety officer for Living With. JRH reports receiving personal fees and fees to institution for honorariums and consultancy payments from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Takeda, and also sponsorship for attending meetings from AstraZeneca and GlaxoSmithKline. PP reports grants from the Medical Research Council and NIHR outside the submitted work. All other authors declare no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The protracted form of COVID-19 known as 'long covid' was first described in 2020. Its symptoms, course and prognosis vary widely; some patients have a multi-system, disabling and prolonged illness. In 2021, ring-fenced funding was provided to establish 90 long covid clinics in England; some clinics were also established in Scotland and Wales. The NIHR-funded LOCOMOTION project implemented a UK-wide quality improvement collaborative involving ten of these clinics, which ran from 2021 to 2023. At regular online meetings held approximately 8-weekly, participants prioritised topics, discussed research evidence and guidelines, and presented exemplar case histories and clinic audits. A patient advisory group also held a priority-setting exercise, participated in quality meetings and undertook a service evaluation audit. The goal of successive quality improvement cycles aimed at changing practice to align with evidence was sometimes hard to achieve because definitive evidence did not yet exist in this new condition; many patients had comorbidities; and clinics were practically constrained in various ways. Nevertheless, much progress was made and a series of 'best practice' guides was produced, covering general assessment and management; breathing difficulties; orthostatic tachycardia and other autonomic symptoms; fatigue and cognitive impairment; and vocational rehabilitation. This paper summarises key findings with the frontline clinician in mind., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Trisha Greenhalgh reports financial support was provided by National Institute for Health and Care Research. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Previous research has not investigated the persistent cutaneous immune-related adverse events (cirAEs) related to long COVID to investigate the long-term sequelae. This multinational study, using a propensity-matched overlap weighting method, utilizes large national claims-based cohorts, using ICD-10 code diagnosis, focusing on patients aged ≥20 years from three countries: South Korean, Japanese, and the British cohorts. To estimate the risk of cirAEs in long COVID, the persistence or emergence of cirAEs occurring 4 weeks after the initial SARS-CoV-2 infection, we employed a Cox proportional hazard regression model. The Korean cohort (n = 5,937,373; mean age 49.2 years [SD: 13.2]), the Japanese cohort (n = 4,307,587; 42.5 years [13.6]), and the UK cohort (n = 395,435; 71.0 years [8.07]) were presented. An increased risk of cirAEs in long COVID was observed (HR, 1.10; 95% CI, 1.06-1.14) in Korean cohort, while a similar association was observed in Japanese and UK cohorts. The long-term risk of cirAEs in long COVID was higher in more severe COVID-19 cases (1.31; 1.22-1.39). Unlike the increased risk of cirAEs in long COVID, COVID-19 vaccination attenuated the risk, especially with two or more doses (1.03; 0.95-1.11) or heterologous regimens (0.98; 0.76-1.27). The time attenuation effect indicated a sustained risk for up to 6 months postinfection (<3 months: 1.13 [1.07-1.19]; 3-6 months: 1.14 [1.06-1.22]). SARS-CoV-2 infection is associated with an increased risk of cirAEs in the aspect of long COVID. Vaccination might reduce this risk, highlighting the need for preventive strategies in long COVID management., (© 2024 Wiley Periodicals LLC.)

Purpose: The present study investigated school absence among 1,076 5-15 year-old children with neurodevelopmental conditions (intellectual disability and/or autism) approximately one year following the start of COVID-19 in the UK. Methods: Parents completed an online survey indicating whether their child was absent from school during May 2021 and the reason for each absence. Multi-variable regression models investigated child, family and school variables associated with absenteeism and types of absenteeism. Qualitative data were collected on barriers and facilitators of school attendance. Results: During May 2021, 32% of children presented with persistent absence (missing = 10% of school). School refusal and absence due to ill-health were the most frequent types of absence, accounting for 37% and 22% of days missed, respectively. COVID-19 related absence accounted for just 11% of days missed. Child anxiety was associated with overall absenteeism and with days missed because of school refusal. Parent pandemic anxiety and child conduct problems were not associated with school absenteeism. Hyperactivity was associated with lower levels of absenteeism and school refusal but higher levels of school exclusion. A positive parent-teacher relationship was associated with lower levels of absenteeism, school refusal and exclusion. Child unmet need in school was the most frequently reported barrier to attendance while COVID-19 was one of the least frequently reported barriers. Conclusion: COVID-19 had a limited impact on school attendance problems during this period. Findings highlighted the role of child mental health in different types of absence and the likely protective role of a positive parent-teacher relationship.

Due to the increased financial pressure--exacerbated by the COVID-19 pandemic--that students in higher education need to endure, considerable attention is being drawn towards the determinants of student financial anxiety. A conflicting picture has been captured about financial literacy, which has been shown to either be associated with better financial well-being or to be unrelated to financial stress. While discerning between financial knowledge ('objective' financial literacy) and perceived ability to manage personal finances ('subjective' financial literacy), this study also explores the impact that students' attitudes towards debt may exert on their financial anxiety. In a sample of 174 university students from the UK, we measured students' financial anxiety, objective and subjective financial literacy, attitudes towards debt and perceived impact of COVID-19 on financial behaviour. Bayesian analyses revealed that only attitudes towards debt and perception of the impact of the pandemic predicted students' financial anxiety. While the evidence in regard to financial literacy was inconclusive, mediation analyses showed that objective financial literacy indirectly impacted financial anxiety by increasing fear of debt. The findings suggest that students' financial anxiety may be reduced by adopting strategies that focus on the subjective perception of debt and of economic circumstances.

Previous research indicates that discipline identification -- the level of integration of one's discipline of study into the self-concept -- is associated with deep approaches to learning and academic self-efficacy. However, it is not known whether these relationships would hold in the context of learning during the COVID-19 pandemic. The present study investigates this, as well as exploring whether belonging, identity incompatibility, and virtual and in-person time spent with fellow students and with faculty act as potential antecedents of discipline identification. A cross-sectional online survey with n = 385 students in the UK was conducted during the spring term (February-May) of the 2019-2020 academic year, when UK universities were under COVID-19 restrictions. Of those students, n = 109 completed a follow-up survey during the autumn term (September-December) of the 2020-2021 academic year. Due to pandemic-related changes, the two waves of data were analysed separately using path analysis. During the spring term, identity incompatibility and discipline identification were significantly associated with both deep approaches to learning and academic self-efficacy. There were also significant indirect effects of belonging on both deep approaches to learning and academic self-efficacy via discipline identification. During the autumn term, discipline identification was again significantly associated with both academic outcomes. Identity incompatibility was significantly associated with academic self-efficacy. There were also indirect effects of identity incompatibility and belonging on deep approaches to learning via discipline identification. These results add to the literature on the importance of discipline identification and associated social-psychological processes in predicting important higher education outcomes during the COVID-19 pandemic.

Background: During the COVID-19 pandemic in the United Kingdom, many health services were withdrawn from people with learning disabilities, with negative impacts on people's health. What has happened to people's health and healthcare as we move beyond the pandemic? Methods: Access to health services and health status were tracked for 550 UK adults with learning disabilities, using structured online interviews with people with learning disabilities and online surveys with family members or paid careers. Information was provided four times, from Wave 1 (in the winter 2020/2021 'lockdown') to Wave 4 (autumn 2022, over a year after public health protections stopped). Findings: By Wave 4, most people with learning disabilities had had COVID-19, although high vaccination rates limited the number of people hospitalised. There was little evidence that use of GP services, community nurses, other therapists or annual health checks had increased over time, and at Wave 4 more people were having difficulty getting their medicines. People's health did not substantially improve over time. People with profound and multiple learning disabilities had poorer health and were less likely to be accessing health services. Conclusions: Improvements in access to health services for people with learning disabilities after the pandemic have not yet happened.

Early childhood education and care (ECEC) settings faced significant disruption during the COVID-19 pandemic, compromising the continuity, stability and quality of provision. Three years on from the first UK lockdown as pandemic-era preschoolers enter formal schooling, stakeholders are concerned about the impact of the disruption on children's cognitive and socioemotional development, especially those from socioeconomically disadvantaged backgrounds. Using parent-report data from 171 children aged 5 to 23 months (M = 15 months) in March to June 2020 living in the UK, we investigate whether previously attested positive associations between ECEC attendance and the development of language and executive functions was maintained as early years settings navigated operational challenges over the first full year of the pandemic. In response to concerns about 'school readiness', we analyse the relationship between ECEC attendance and children's communication, problem-solving and personal-social development. ECEC was associated with greater growth in receptive vocabulary over the 12-month period. In children from less advantaged backgrounds, ECEC was also associated with greater growth in expressive vocabulary. Our data suggest a similarly positive association between ECEC attendance and the communication and problem-solving skills of children from less advantaged backgrounds and between ECEC and the personal-social development of all children. Overall, results suggest that ECEC had sustained learning benefits for children growing up during the pandemic despite ongoing disruption to settings, with specific benefits for children from less affluent home environments. As pandemic-era children progress to primary school, we discuss the importance of adapting their learning conditions and adjusting the expectations placed on them.

Background: Pregnant women and their unborn babies are at increased risk from serious complications, hospitalisation and death from infectious diseases. Vaccinations for influenza (flu), pertussis (whooping cough) and Covid-19 are available for free for pregnant women in the UK, but uptake of these repeatedly remains low. This qualitative study aimed to explore how pregnant women feel about these vaccinations, and what factors influence the uptake of vaccinations amongst pregnant women since the onset of the Covid-19 pandemic., Methods: Pregnant women were recruited via two participating hospitals in one geographic area of the UK, and via one community group offering support to pregnant women from ethnic minorities. Semi-structured interviews were conducted remotely using telephone, were anonymised and transcribed, and analysed using thematic analysis., Findings: Interviews were conducted remotely with 43 pregnant women. The following themes were identified as influencing uptake of vaccinations amongst pregnant women: internal factors and beliefs, vaccination related factors, external influences and Covid-19 and changing perceptions of the pandemic., Discussion: Findings of this study increase awareness of some of the factors influencing vaccination decisions of pregnant women. It informs practice regarding healthcare professionals' discussions with pregnant women about vaccinations, and future vaccination campaigns and interventions that are targeting an increase in vaccination uptake amongst this population., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Debra Bick is Editor in Chief of Midwifery, but all editorial decisions from submission to final decision have been undertaken by one of ‘Midwifery's’ associate editors. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Many people experience persistent symptoms for more than 12 weeks following SARS-CoV-2 infection, which is known as post-COVID-19 condition (PCS) or Long COVID (LC). PCS can impair people's quality of life and daily functioning. However, there is a lack of in-depth research exploring the PCS patient journey, as well as gendered aspects of patients' experiences., Methods: Nineteen semi-structured qualitative interviews were conducted with people living with PCS in the United Kingdom (13 women, 6 men). Interviews were transcribed verbatim and analysed inductively using reflexive thematic analysis., Results: Five main themes were identified: 'Symptom dismissal', 'Lack of information and support', 'Life before and after Long COVID', 'Psychological impact' and 'Acceptance'. A shift overtime to self-management of symptoms was evident. These themes represent different stages of patients' PCS journey. Narratives indicated that women highlighted dismissal by healthcare professionals (HCPs), which was not as prominent in men's narratives. In addition, women went into more detail about the psychological impact of PCS compared to men., Conclusion: Women with PCS reported symptom dismissal by HCPs, which may have delayed their diagnosis and negatively affected their well-being. We were not able to explore the experiences of people from non-conforming gender groups. Raising awareness of these issues among HCPs, particularly general practitioners, could improve patient care in PCS., Patient or Public Contribution: Patient and public involvement consisted of people who took part in the interviews and commented on the themes' interpretation and study conclusions., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Background/aims: The UK Medicines and Healthcare products Regulatory Agency (MHRA) has published suspected adverse drug reactions to vaccines against COVID-19. Ocular inflammatory events following COVID-19 vaccination have been reported worldwide., Methods: We analysed MHRA data on spontaneous reports of suspected ocular inflammatory events following COVID-19 vaccination between January 2021 and September 2022., Results: The MHRA received 300 UK spontaneous suspected reports of ocular inflammatory events following COVID-19 vaccination, with a calculated prevalence of 6.6 events per 1 000 000 vaccinated individuals. Anterior uveitis was the most common phenotype (58.3%), followed by optic neuritis in 39.3%. Median number of days between vaccination and onset was 8 days. Resolution of the event was seen in 52.3%., Conclusion: Ocular inflammatory events following COVID-19 vaccination have a very rare prevalence in the UK. There is no increase in the reporting rate of uveitis, optic neuritis and scleritis following COVID-19 vaccination when compared with the range of incidence in the UK population. The Yellow Card System represents a vital instrument within the domain of pharmacovigilance, empowering patients and healthcare professionals to contribute to the ongoing monitoring of medication safety., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations., Aim: To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months., Design and Setting: An economic evaluation of the PANORAMIC trial in the UK., Method: A cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement., Results: In the base-case analysis, molnupiravir had higher mean costs of £449 (95% confidence interval [CI] = 445 to 453) and higher mean QALYs of 0.0055 (95% CI = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of £81 190). Sensitivity and subgroup analyses showed similar results, except for those aged ≥75 years, with a 55% probability of being cost-effective at a £30 000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15 000 per QALY threshold., Conclusion: At the current cost of £513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged ≥75 years., (© The Authors.)

Background: Findings from studies assessing Long Covid in children and young people (CYP) need to be assessed in light of their methodological limitations. For example, if non-response and/or attrition over time systematically differ by sub-groups of CYP, findings could be biased and any generalisation limited. The present study aimed to (i) construct survey weights for the Children and young people with Long Covid (CLoCk) study, and (ii) apply them to published CLoCk findings showing the prevalence of shortness of breath and tiredness increased over time from baseline to 12-months post-baseline in both SARS-CoV-2 Positive and Negative CYP., Methods: Logistic regression models were fitted to compute the probability of (i) Responding given envisioned to take part, (ii) Responding timely given responded, and (iii) (Re)infection given timely response. Response, timely response and (re)infection weights were generated as the reciprocal of the corresponding probability, with an overall 'envisioned population' survey weight derived as the product of these weights. Survey weights were trimmed, and an interactive tool developed to re-calibrate target population survey weights to the general population using data from the 2021 UK Census., Results: Flexible survey weights for the CLoCk study were successfully developed. In the illustrative example, re-weighted results (when accounting for selection in response, attrition, and (re)infection) were consistent with published findings., Conclusions: Flexible survey weights to address potential bias and selection issues were created for and used in the CLoCk study. Previously reported prospective findings from CLoCk are generalisable to the wider population of CYP in England. This study highlights the importance of considering selection into a sample and attrition over time when considering generalisability of findings., (© 2024. The Author(s).)

Objectives: To identify the needs of people with long COVID (LC) in the UK., Design: Qualitative study using the Framework Analysis to analyse focus group discussions., Participants: 25 adults with LC aged 19-76 years including 17 men and 8 women. Average disease duration was 80.1 weeks., Setting: Eight focus groups were conducted in April 2023 online and in-person at the University of Leeds (UoL), UK. Recruitment routes included advertisement via Leeds Community Healthcare services, the English National Opera Breathe Programme and within the UoL., Results: Three key themes/needs were identified. (Theme 1) Support systems including community groups, disability benefits, clinical services and employment support should be accessible and tailored to the needs of people with LC. (Theme 2) Research should investigate the physiology of symptoms, new clinical tests and treatment interventions to improve clinical understanding of the condition and symptom management. (Theme 3) Societal awareness should be promoted via local and national initiatives to educate the public about the condition and reduce stigma., Conclusions: Participants experienced varied and individual challenges to daily life due to LC. There is a need for government acknowledgement of LC as a disability to ensure people with LC have access to disability support and legal protection. Policy development should be patient-driven and acknowledge the individual needs of people with LC in order to improve their quality of life., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Hospitalized COVID-19 patients with troponin elevation have a higher prevalence of cardiac abnormalities than control individuals. However, the progression and impact of myocardial injury on COVID-19 survivors remain unclear., Objectives: This study sought to evaluate myocardial injury in COVID-19 survivors with troponin elevation with baseline and follow-up imaging and to assess medium-term outcomes., Methods: This was a prospective, longitudinal cohort study in 25 United Kingdom centers (June 2020 to March 2021). Hospitalized COVID-19 patients with myocardial injury underwent cardiac magnetic resonance (CMR) scans within 28 days and 6 months postdischarge. Outcomes were tracked for 12 months, with quality of life surveys (EuroQol-5 Dimension and 36-Item Short Form surveys) taken at discharge and 6 months., Results: Of 342 participants (median age: 61.3 years; 71.1% male) with baseline CMR, 338 had a 12-month follow-up, 235 had a 6-month CMR, and 215 has baseline and follow-up quality of life surveys. Of 338 participants, within 12 months, 1.2% died; 1.8% had new myocardial infarction, acute coronary syndrome, or coronary revascularization; 0.8% had new myopericarditis; and 3.3% had other cardiovascular events requiring hospitalization. At 6 months, there was a minor improvement in left ventricular ejection fraction (1.8% ± 1.0%; P < 0.001), stable right ventricular ejection fraction (0.4% ± 0.8%; P = 0.50), no change in myocardial scar pattern or volume (P = 0.26), and no imaging evidence of continued myocardial inflammation. All pericardial effusions (26 of 26) resolved, and most pneumonitis resolved (95 of 101). EuroQol-5 Dimension scores indicated an overall improvement in quality of life (P < 0.001)., Conclusions: Myocardial injury in severe hospitalized COVID-19 survivors is nonprogressive. Medium-term outcomes show a low incidence of major adverse cardiovascular events and improved quality of life. (COVID-19 Effects on the Heart; ISRCTN58667920)., Competing Interests: Funding Support and Author Disclosures This work was supported by NIHR (National Institute for Health and Care Research) and UK Research and Innovation (COV0254). West Yorkshire and Humber Clinical Research Network (CV070) funded the patient information leaflet translation. Dr Berry has received British Heart Foundation support (RE/18/6134217). Dr Artico received funding from the European Association of Cardiovascular Imaging (EACVI Research Grant App000073878). Dr McCann is funded by a NIHR Research Professorship (RP-2017-08-ST2-007). Dr Manisty is funded by a NIHR Clinician Scientist Award (CS-2015-15-003). Drs Ferreira, Piechnik, and Neubauer acknowledge the NIHR Oxford BRC for support of this study. Dr Bucciarelli-Ducci is in part supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS (National Health Service) Foundation Trust and the University of Bristol. Additional support was provided by the NIHR Leicester Biomedical Research Centre and the NIHR Leeds Clinical Research Facility. Dr Dweck is supported by the British Heart Foundation (FS/SCRF/21/32010). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. Dr Moon has served on Advisory Boards for Sanofi and Genzyme. Dr Miller has served on Advisory Boards for Novartis, Boehringer Ingelheim and Lilly Alliance, and AstraZeneca; serves as an advisor for HAYA Therapeutics and PureTech Health; and has received research support from Amicus Therapeutics, Guerbet Laboratories Limited, Roche, and Univar Solutions B.V. Dr Bucciarelli-Ducci is the chief executive officer (part-time) of the Society for Magnetic Resonance. Dr Berry is employed by the University of Glasgow, which holds research and/or consultancy agreements with AstraZeneca, Abbott Vascular, Boehringer Ingelheim, GlaxoSmithKline, HeartFlow, Opsens, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning., Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2-3 years, and whether symptoms at 2-3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2-3 years were associated with occupation change. People with lived experience were involved in the study., Findings: 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2-3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16-1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2-3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2-3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0-48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0-17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2-3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6-31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04-2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21-1·98] for every point increase in CCI-20)., Interpretation: Psychiatric and cognitive symptoms appear to increase over the first 2-3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19., Funding: National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research., Competing Interests: Declaration of interests AHa is co-director and owner of H2CD, and owner and director of Future Cognition, which support online studies and develop custom cognitive assessment software, respectively. PJHe is director and CEO of H2CD. JDC declares grants from AstraZeneca, Boehringer Ingelheim, Insmed, Novartis, Gilead Sciences, and Genentech; and consulting fees from AstraZeneca, Boehringer Ingelheim, Insmed, Novartis, Gilead Sciences, Chiesi, Zambon, and Genentech. L-PH declares grants to their institution from UK Research and Innovation (UKRI), Regenerative Medicine Platform, Celgene, British Lung Foundation, and Oxford Boehringer Ingleheim; the author is on the advisory board for the CATALYST trial and acts as chair of the Respiratory Translational Research Collaboration. AHo declares a grant to their institution from UKRI and the UK National Institute for Health Research (NIHR) to complete this work, funding from NIHR Manchester Clinical Research Facility to support study delivery, and personal funding from NIHR Manchester Biomedical Research Centre (BRC). AHo declares institutional payments to support grant-funded research from NIHR, UK Medical Research Council (MRC), Cystic Fibrosis Trust, Cystic Fibrosis Foundation, North West Lung Centre Charity, and Moulton Trust; consulting fees from Mylan Pharmaceuticals for advisory board participation; and payment from Vertex Pharmaceuticals for educational presentation, participation on a clinical trials advisory board, and writing of a review article. AHo's non-paid roles include chair of the Cystic Fibrosis Clinical Trials Accelerator Program, deputy chair of the NIHR Respiratory Translational Research Collaboration, and director of a university spin-out company (Mi-trial). BR declares payments from the British Heart Foundation Oxford Centre of Research Excellence, NIHR Oxford BRC, and UKRI for grants and contracts; and consulting fees from Axcella Therapeutics. ASh, ASi, and MM declare a grant to their institution from UKRI and NIHR to complete this work. ASh declares unremunerated participation on the AstraZeneca Thrombotic Thrombocytopenic Taskforce and Scottish and UK Governments COVID-19 advisory groups. LH-W declares a grant from NIHR unrelated to the submitted work; acting as independent chair of the NIHR Health Technology Assessment Committee for Colour COPD trial; and membership of the American Thoracic Society Pulmonary Rehabilitation Assembly Web and Planning Committees. NIL declares acting as director of research at the Intensive Care Society UK. CEB declares a grant to their institution from UKRI and NIHR to complete this work; the author reports grants from GSK, AstraZeneca, Sanofi, Boehringer Ingelheim, Chiesi, Novartis, Roche, Genentech, Mologic, and 4DPharma; and consultancy fees paid to their institution from GSK, AstraZeneca, Sanofi, Boehringer Ingelheim, Chiesi, Novartis, Roche, Genentech, Mologic, 4DPharma, and Teva. LVW declares research funding unrelated to the submitted work from GSK and Orion; consulting fees unrelated to the submitted work from Galapagos; a Wellcome Conference speaker honorarium; travel support from Genentech; advisory board participation for Galapagos; and an associate editor role for the European Respiratory Journal. RAE declares a grant to their institution from UKRI and NIHR to complete this work; the author declares speaker fees from Boehringer Ingelheim and unpaid roles as European Respiratory Society Assembly 01·02 Pulmonary Rehabilitation secretary and with the American Thoracic Society Pulmonary Rehabilitation Assembly programme committee. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Since most schools and learners had no choice but to learn online during the pandemic, online learning became the mainstream learning mode rather than a substitute for traditional face-to-face learning. Given this enormous change in online learning, we conducted a systematic review of 191 of the most recent online learning studies published during the COVID-19 era. The systematic review results indicated that the themes regarding "courses and instructors" became popular during the pandemic, whereas most online learning research has focused on "learners" pre-COVID-19. Notably, the research topics "course and instructors" and "course technology" received more attention than prior to COVID-19. We found that "engagement" remained the most common research theme even after the pandemic. New research topics included parents, technology acceptance or adoption of online learning, and learners' and instructors' perceptions of online learning.

COVID-19 changed university life worldwide as campuses closed or offered restricted inperson teaching. Whilst early evidence suggests that educational experiences were satisfactory, concerns were raised about the impact of COVID-19 on social and psychological elements of university including student loneliness. We conducted a UK-wide cross-sectional cohort comparison study using an anonymous online survey measuring loneliness and the factors which may predict it: belonging (need to belong and achieved belonging), social support, and social identity. We found that students who began their studies at the height of the pandemic (2020/21) or after restrictions largely lifted (2021/22) had a reduced sense of belonging compared to those who started earlier (2019/20), suggesting some longlasting effects on students. Whilst there were no significant cohort differences in loneliness, need to belong, sense of belonging, and social support were significant predictors of loneliness, suggesting these factors could be targeted to reduce loneliness in students going forward.

Background: The COVID-19 pandemic resulted in rapid changes to head and neck cancer (HNC) services. Multidisciplinary team (MDT) face-to-face appointments were converted to telehealth appointments (telephone and video-call) to reduce the risk of COVID-19 transmission. The literature exploring HNC patient experience of these appointment types is limited. Aims: To explore patient experience of telehealth appointments at one UK centre during the COVID-19 pandemic, as well as the variables that may influence patient preference for virtual or face-to-face appointments. Methods & Procedures: A survey-based study design was used, with closed questions and open text options to capture the views of the participants. Quantitative data were analysed using descriptive statistics. Open text data was used to add depth to the findings. Outcomes & Results: A total of 23 participant surveys were returned. Six categories were identified: Usability; Information receiving & giving; Satisfaction; Emotions and comfort; Rapport; and Travel time and cost. Overall, participants gave positive responses to each category and indicated that telehealth appointments met their needs. Areas for clinical consideration are highlighted. Variables such as age, travel distance from hospital site, fear of COVID-19 and information technology (IT) access did not appear to influence patient preference for appointment type. Conclusions & Implications: Going forward, telehealth may be considered for use in combination with face-to-face appointments in the HNC pathway. Areas for further development include a 'telehealth screening tool' that may help to identify those patients most appropriate for these appointment types, or who require support to access them.

Background: Many hospitals introduced procalcitonin (PCT) testing to help diagnose bacterial coinfection in individuals with COVID-19, and guide antibiotic decision-making during the COVID-19 pandemic in the UK., Objectives: Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme., Methods: Retrospective individual-level data on patients hospitalized with COVID-19 were collected from 11 NHS acute hospital Trusts and Health Boards from England and Wales, which varied in their use of baseline PCT testing during the first COVID-19 pandemic wave. A matched analysis (part of a wider analysis reported elsewhere) created groups of patients whose PCT was/was not tested at baseline. A model was created with combined decision tree/Markov phases, parameterized with quality-of-life/unit cost estimates from the literature, and used to estimate costs and quality-adjusted life years (QALYs). Cost-effectiveness was judged at a £20 000/QALY threshold. Uncertainty was characterized using bootstrapping., Results: People who had baseline PCT testing had shorter general ward/ICU stays and spent less time on antibiotics, though with overlap between the groups' 95% CIs. Those with baseline PCT testing accrued more QALYs (8.76 versus 8.62) and lower costs (£9830 versus £10 700). The point estimate was baseline PCT testing being dominant over no baseline testing, though with uncertainty: the probability of cost-effectiveness was 0.579 with a 1 year horizon and 0.872 with a lifetime horizon., Conclusions: Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Background: Despite strong evidence supporting COVID-19 vaccine efficacy and safety, a proportion of the population remains hesitant to receive immunization. Discrete choice experiments (DCEs) can help assess preferences and decision-making drivers., Objective: We aim to (1) elicit preferences for COVID-19 vaccines in Canada, Germany, the United Kingdom, and the United States; (2) understand which vaccine attributes people there value; and (3) gain insight into the choices that different population subgroups make regarding COVID-19 vaccines., Methods: Participants in the 2019nCoV-408 study were aged ≥18 years; self-reported antivaccinationists were excluded. A DCE with a series of 2 hypothetical vaccine options was embedded into a survey to determine participant treatment preferences (primary objective). Survey questions covered vaccine preference, previous COVID-19 experiences, and demographics, which were summarized using descriptive statistics to understand the study participants' backgrounds. In the DCE, participants were provided choice pairs: 1 set with and 1 without an "opt-out" option. Each participant viewed 11 unique vaccine profiles. Vaccine attributes consisted of type (messenger RNA or protein), level of protection against any or severe COVID-19, risk of side effects (common and serious), and potential coadministration of COVID-19 and influenza vaccines. Attribute level selections were included for protection and safety (degree of effectiveness and side effect risk, respectively). Participants were stratified by vaccination status (unvaccinated, or partially or fully vaccinated) and disease risk group (high-risk or non-high-risk). A conditional logit model was used to analyze DCE data to estimate preferences of vaccine attributes, with the percentage relative importance calculated to allow for its ranking. Each model was run twice to account for sets with and without the opt-out options., Results: The mean age of participants (N=2000) was 48 (SD 18.8) years, and 51.25% (1025/2000) were male. The DCE revealed that the most important COVID-19 vaccine attributes were protection against severe COVID-19 or any severity of COVID-19 and common side effects. Protection against severe COVID-19 was the most important attribute for fully vaccinated participants, which significantly differed from the unvaccinated or partially vaccinated subgroup (relative importance 34.8% vs 30.6%; P=.049). Avoiding serious vaccine side effects was a significantly higher priority for the unvaccinated or partially versus fully vaccinated subgroup (relative importance 10.7% vs 8.2%; P=.044). Attributes with significant differences in the relative importance between the high-risk versus non-high-risk subgroups were protection against severe COVID-19 (38.2% vs 31.5%; P<.000), avoiding common vaccine side effects (12% vs 20.5%; P<.000), and avoiding serious vaccine side effects (9.7% vs 7.5%; P=.002)., Conclusions: This DCE identified COVID-19 vaccine attributes, such as protection against severe COVID-19, that may influence preference and drive choice and can inform vaccine strategies. The high ranking of common and serious vaccine side effects suggests that, when the efficacy of 2 vaccines is comparable, safety is a key decision-making factor., (©David Salisbury, Jeffrey V Lazarus, Nancy Waite, Clara Lehmann, Sumitra Sri Bhashyam, Marie de la Cruz, Beth Hahn, Matthew D Rousculp, Paolo Bonanni. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 16.10.2024.)

Understanding the genetic basis of COVID-19 vaccine seroconversion is crucial to study the role of genetics on vaccine effectiveness. In our study, we used UK Biobank data to find the genetic determinants of COVID-19 vaccine-induced seropositivity and breakthrough infections. We conducted four genome-wide association studies among vaccinated participants for COVID-19 vaccine seroconversion and breakthrough susceptibility and severity. Our findings confirmed a link between the HLA region and seroconversion after the first and second doses. Additionally, we identified 10 genomic regions associated with breakthrough infection (SLC6A20, ST6GAL1, MUC16, FUT6, MXI1, MUC4, HMGN2P18-KRTCAP2, NFKBIZ and APOC1), and one with breakthrough severity (APOE). No significant evidence of genetic colocalisation was found between those traits. Our study highlights the roles of individual genetic make-up in the varied antibody responses to COVID-19 vaccines and provides insights into the potential mechanisms behind breakthrough infections occurred even after the vaccination., (© 2024. The Author(s).)

Purpose: To determine whether (1) healthcare access at onset of the pandemic and (2) age, gender, socioeconomic status (SES), and pre-existing health status were associated with change in health-related quality-of-life (HRQoL) during the COVID-19 pandemic. The study includes a general population sample of five countries., Methods: An online questionnaire was administered to respondents from Greece, Italy, the Netherlands, the UK, and the US at the onset of the COVID-19 pandemic between April 22nd and May 5th of 2020, and 1 year later between May 23rd and June 29th of 2021. The questionnaire included questions on demographic background, health status, and HRQoL. The primary outcome was change in HRQoL as measured by the EQ-5D-5L instrument. Specifically, the EQ-5D-5L index and EQ VAS were used. Healthcare access was quantified with regard to the respondent's ease of getting an appointment, waiting time, and opportunity to contact the provider and during analysis dichotomized into "sufficient" versus "insufficient". Linear regression analysis was performed with change in HRQoL as dependent variable and background variables as independent variables., Results: In total, 6,765 respondents completed the second questionnaire. 19.8% of total respondents reported insufficient healthcare access. Respondents with insufficient healthcare had both more improved and deteriorated HRQoL compared to respondents with sufficient healthcare, whose HRQoL remained unchanged. We did not find significant interactions between age, gender, SES and/or chronic disease status with healthcare access at onset of the COVID-19 pandemic., Conclusion: Healthcare access was not associated with cumulative differences in change in HRQoL over a 1-year period in strata of age, gender, SES, and chronic disease status., (© 2024. The Author(s).)

Informal Student Carers (ISC) are students across the UK who provide unpaid care to a friend or family member needing support. We explored the lived experiences of ISCs and the challenges they faced throughout the COVID-19 pandemic. A scoping review, questionnaire-based survey and volunteer interviews were undertaken to identify the themes which predicate ISC's experience during the COVID-19 pandemic. Our research showed that a combination of financial concerns, time constraints, and the lack of visibility of student caregivers all contributed to this student group's poor mental health during the COVID-19 pandemic. Educational institutions have an obligation to be informed and support the unique and varied needs of ISCs.

From early in the coronavirus disease 2019 (COVID-19) pandemic, there was interest in using machine learning methods to predict COVID-19 infection status based on vocal audio signals, for example, cough recordings. However, early studies had limitations in terms of data collection and of how the performances of the proposed predictive models were assessed. This article describes how these limitations have been overcome in a study carried out by the Turing-RSS Health Data Laboratory and the UK Health Security Agency. As part of the study, the UK Health Security Agency collected a dataset of acoustic recordings, SARS-CoV-2 infection status and extensive study participant meta-data. This allowed us to rigorously assess state-of-the-art machine learning techniques to predict SARS-CoV-2 infection status based on vocal audio signals. The lessons learned from this project should inform future studies on statistical evaluation methods to assess the performance of machine learning techniques for public health tasks., (© 2024 The Author(s). Statistics in Medicine published by John Wiley & Sons Ltd.)

Over the past four years, the COVID-19 pandemic has caused significant uncertainty, suffering, and economic disruption on a global scale. In response, governments have been under pressure to ensure equitable vaccine access while meeting vaccination targets quickly. These challenging circumstances created opportunities for nepotism and bribery, increasing attention to corruption risks associated with the pandemic response. This study investigates the relationship between public attitudes towards corruptive behaviour and the efficiency and equity of the UK's COVID-19 vaccination programme. It integrates primary data on public tolerance towards corruptive behaviour with secondary data on the efficiency of the vaccination program at the local authority level in England and Scotland. Employing a survival analysis approach, we estimate Cox Proportional Hazards Models to examine the time required to reach vaccination targets. Our findings suggest moderate tolerance towards corruptive behaviour among the British public, with 28% of survey participants considering monetary bribery and 34% considering nepotism/favouritism as acceptable means to secure early vaccination access. Notably, while public tolerance towards corruptive behaviour generally had a negative impact on the efficiency of the local rollout of the vaccination programme, it appeared to have accelerated its rollout in politically aligned local authorities governed by the Conservative and Unionist Party. However, this increase in efficiency seems to have come at the cost of reduced equity in vaccine distribution. These findings suggest a trade-off between efficiency and equity in vaccine distribution during public health crises, emphasising the need for balanced health policies that ensure fair and effective distribution of vaccines in the future., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: People with intellectual disabilities commonly experience multiple barriers to 'going out'., Aims: This paper explores what barriers prevented people from going out, and if the extent and nature of going out changed over time for people with intellectual disabilities as the COVID-19 pandemic progressed., Methods: Data are drawn from a wider study that explored, at four time points, the experiences of people with intellectual disabilities through the COVID-19 pandemic in the United Kingdom., Findings: The number of people leaving the house for almost all reasons increased over time through the pandemic, except for some outdoor participation and exercise. However, there was a significant decrease in outdoor exercise at the final time point of the study. Reliance on other people and a lack of availability of support were identified as barriers., Conclusion: A combination of factors restricted the extent to which people were going out even after COVID-19 protections were lifted., (© 2024 The Author(s). Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: Vaccine hesitancy has gained heightened relevance amid the COVID-19 pandemic, underscoring the urgency of understanding its determinants. This study explores the association between Covid-19 vaccine hesitancy, mental health variables and inflexible thinking., Methods: A convenience sample of 252 UK adults was assessed online between June 2021-July 2022 (when Covid-19 lockdown restrictions had finally eased). We assessed participants using the Oxford Covid Vaccine Hesitancy Scale (OCVHS), various aspects of mental health, using: the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Depression, Anxiety, and Stress scale (DASS-21), and finally, performance on a computerized version of the Wisconsin Card Sort Task (WCST). This study was preregistered at the Open Science Framework (https://osf.io/xd5wz)., Results: Multiple regression analyses showed that only cognitive inflexibility, and specifically the WCST item of perseverative errors, significantly predicted vaccine hesitancy., Conclusion: Our exploratory analysis provides the first evidence that cognitive inflexibility, measured using an objective task, is an independent risk-factor for vaccine hesitancy. Public health strategies should consider the impact of an inflexible thinking style on the decision-making of those most at risk of vaccine hesitancy and adapt interventions accordingly., Competing Interests: Declaration of competing interest Prof. Naomi Fineberg reports in the past 3 years she has held research or networking grants from the UKNIHR, COST Action, Orchard; accepted travel and/or hospitality expenses from the BAP, ECNP, RCPsych, CINP, International Forum of Mood and Anxiety Disorders, World Psychiatric Association; received payment from Elsevier for editorial duties and the Mental Health Academy for lecturing. Previously, she has accepted paid speaking engagements in various industry supported symposia and recruited patients for various industry-sponsored studies in the field of OCD treatment. She leads an NHS treatment service for OCD. She holds Board membership for various registered charities linked to OCD. She gives expert advice on psychopharmacology to the UK MHRA. She has participated in a WHO working group focusing on diagnosis and classification of obsessive compulsive or related disorders for the ICD-11. Dr Luca Pellegrini reports a relationship with European Cooperation in Science and Technology, the University of Hertfordshire, Orchard, ECNP-OCRN International College of Obsessive-Compulsive Spectrum Disorders (ICOCS), that includes: funding grants. Professor Laws and Dr. Clarke report no interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This paper investigates the social support provided by domestic animals to humans during the COVID-19 pandemic. The study comprises interviews with 39 British and American pet owners during March 2021, the point at which the UK had recently emerged from the third national lockdown and US states were under various restrictions. A thematic network approach to data analysis revealed four global themes, illustrating how pets provided buffers to the stress of the pandemic, facilitated ontological security by maintaining a sense of routine and purpose, offered myriad types of emotional support and enhanced and enabled wider social support. Taken together, these results reinforce and extend knowledge pertaining to the importance of companion animals for social support., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

During the early years (2020-2021) of the COVID-19 pandemic, relatively little attention focused on experiences of people with long-lasting symptoms, particularly young adults who were commonly understood to be invulnerable to serious effects of the virus. Drawing on narrative interviews with 15 adults in their twenties and living in the UK when they became ill with long COVID, we explore contextual factors which made their long COVID illness experience, and the wholescale disruption to their lives, challenging. We propose that existing adaptations of the concept of biographical disruption are problematic for this group, and instead suggest that 'biographical retrogression' may more accurately reflect these young adults' experiences. For many of these young adults, their illness occurred at a crucial stage in forming or solidifying (presumed) adult trajectories. Secondly, the recency of long COVID did not allow for comparison with an existing 'grand narrative' of recovery, so the future course of their illness was not just unknown for them as individuals; there was no prognostic map against which to assess their symptoms. Thirdly, the lives of people with long COVID have been disrupted in the context of global societal disruption by the same virus, rendering their experiences both topical yet invisible., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Background: Previous research has highlighted links between occupation and risk of COVID-19 transmission and suggests that occupational risk is influenced by covariates including socio-economic status, and deprivation. This study examined the perspectives of local authority teams of how changes in policy and advice, as set out in the UK government report 'Living with COVID,' affected COVID-19 transmission risk, response and resilience in workplace settings in Greater Manchester, an area that was disproportionately affected by the pandemic., Methods: The project, which took place between August and November 2022, undertook a mixed methods approach to incorporate wide-ranging reflections of changes following the publication of 'Living with COVID'. Quantitative data was collected from local employers (n = 149) and employees (n = 397) using online surveys, and qualitative interview data was collected from Greater Manchester local authority teams (n = 19)., Results: The research highlighted the inequitable impact of the pandemic on those already experiencing health inequalities, including people on more precarious employment contracts or those who were unable to work from home during the pandemic. The study found that the facilitators that helped local authorities to support employers to manage transmission included clear, detailed and timely national and local guidance, good communication, partnership working, funding, and timely access to data. Barriers to supporting employers included contradictory or confusing national guidance, structural inequalities, lack of funding, and delayed access to data. Interview participants reported that they were now utilising lessons learnt during the pandemic, along with the that partnerships developed, in order to tackle wider health issues and to prepare for future pandemics or health crises., Conclusion: The findings of the study, which concur with previously published research conducted as part of the PROTECT project, highlight the importance of active reflection on the lessons learned during the course of the pandemic. The study draws on PH and EH teams' perspectives of managing COVID-19 transmission, in an area that was disproportionately affected by the pandemic, in order to add to our understanding of the best ways to ensure preparedness for future pandemics or health crises at a national level., (© 2024. The Author(s).)

Background/aims: Considering emerging evidence on long COVID, comprehensive analyses of the post-acute complications of SARS-CoV-2 infection in the gastrointestinal and hepatobiliary systems are needed. We aimed to investigate the impact of COVID-19 on the long-term risk of gastrointestinal and hepatobiliary diseases and other digestive abnormalities., Methods: We used three large-scale population-based cohorts: the Korean cohort (discovery cohort), the Japanese cohort (validation cohort-A), and the UK Biobank (validation cohort-B). A total of 10,027,506 Korean, 12,218,680 Japanese, and 468,617 UK patients aged ≥20 years who had SARS-CoV-2 infection between 2020 and 2021 were matched to non-infected controls. Seventeen gastrointestinal and eight hepatobiliary outcomes as well as nine other digestive abnormalities following SARS-CoV-2 infection were identified and compared with controls., Results: The discovery cohort revealed heightened risks of gastrointestinal diseases (HR 1.15; 95% CI 1.08-1.22), hepatobiliary diseases (HR 1.30; 95% CI 1.09-1.55), and other digestive abnormalities (HR 1.05; 95% CI 1.01-1.10) beyond the first 30 days of infection, after exposure-driven propensity score-matching. The risk was pronounced according to the COVID-19 severity. The SARS-CoV-2 vaccination was found to lower the risk of gastrointestinal diseases but did not affect hepatobiliary diseases and other digestive disorders. The results derived from validation cohorts were consistent. The risk profile was most pronounced during the initial 3 months; however, it persisted for >6 months in validation cohorts, but not in the discovery cohort., Conclusion: The incidence of gastrointestinal disease, hepatobiliary disease, and other digestive abnormalities increased in patients with SARS-CoV-2 infection during the post-acute phase.

Background: The COVID-19 pandemic put unprecedented pressure on weight management services. These services were required to adapt to continue to provide care for people living with obesity. This study sought to develop consensus recommendations on the best practice solutions adopted by weight management services in the United Kingdom during the COVID-19 pandemic., Methods: This study utilised a semi-structured interview and a modified Delphi methodology to develop a consensus of best practice recommendations identified by specialist weight management services during the pandemic., Results: Twenty-three healthcare professionals working in weight management service across the United Kingdom participated in the study. Analysis of interview transcripts identified four key thematic domains: outpatient, patient education and support, perioperative care and team working. Of the initial 43 unique recommendations, 30 reached consensus agreement. Outpatient recommendations focused on communication strategies, patient self-monitoring and remote patient tracking. Patient education and support recommendations addressed the development of online educational resources and support groups. Perioperative care recommendations emphasised case prioritisation, waiting list support and postoperative care. Team working recommendations targeted the use of digital collaboration tools and strategies for effective teamwork., Conclusion: Developing consensus recommendations on best practice is a critical step for weight management and outpatient services to achieve higher standards of care. These recommendations provide a springboard for departmental discussions, paving the way for improved experiences for individuals living with obesity as they progress along their weight management journey., (© 2024 British Dietetic Association Ltd.)

Introduction: Effective and safe vaccines against COVID-19 are essential to achieve global control of the coronavirus (SARS-CoV-2). Using faith centres may offer a promising route for promoting higher vaccine uptake from certain minority ethnic groups known to be more likely to be vaccine hesitant., Methods: This cross-sectional study explored attendees' perceptions, experiences of being offered, and receiving COVID-19 vaccination in a local mosque in Woking, Surrey, UK. About 199 attendees completed a brief questionnaire on experiences, views, motivations about attending the mosque and vaccination on site., Results: The most common ethnic groups reported were White British (39.2%) and Pakistani (22.6%); 36.2% identified as Christian, 23.6% as Muslim, 5.5% as Hindu, and 17.1% had no religion. Genders was relatively equal with 90 men (45.2%) and 98 women (49.2%), and 35-44-year-olds represented the most common age group (28.1%). Views and experiences around receiving vaccinations at the mosque were predominantly positive. Primary reasons for getting vaccinated at the mosque included convenience, accessibility, positive aspects of the venue's intercultural relations, and intentions to protect oneself against COVID-19, regardless of venue type. Negative views and experiences in regards to receiving the vaccination at the mosque were less common (7% expressed no intention of recommending the centre to others), and disliked aspects mostly referred to the travel distance and long waiting times., Conclusions: Offering COVID-19 vaccination in faith centres appears acceptable for different faith groups, ensuring convenient access for communities from all religions and ethnic backgrounds., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The global effort to combat the COVID-19 pandemic highlights the pivotal role of vaccination in public health, particularly considering emerging severe acute respiratory syndrome-coronavirus-2 variants. While priority has been given to immunising vulnerable populations, children remain a significant unvaccinated group, prompting NHS England to include them in their new vaccination strategy. The role parents play in child healthcare decisions, specifically regarding COVID-19 vaccination, is crucial, and the Health Belief Model (HBM) provides a framework for understanding parental vaccination behaviour., Methods: To investigate the predictors influencing parental decision-making for COVID-19 vaccination in children aged 5-11, an online cross-sectional survey was conducted amongst parents (n = 206) living in the UK aged > 18, with one or more children aged 5-11. The present study measured HBM constructs, demographic factors, vaccine hesitancy and vaccine decision-making self-efficacy. Binomial logistic regression was used to analyse the responses of 206 participants using the child vaccination status (vaccinated vs. unvaccinated) as the outcome variable., Findings: The regression model significantly predicted child vaccination status, identifying perceived barriers, cues to action and parent age as significant predictors. Higher cues to action and older parent age increased the likelihood of child vaccination, while greater perceived barriers decreased it. The model achieved 80.8 % overall accuracy by correctly identifying 87.6 % of vaccinated cases and 69.4 % of unvaccinated cases, demonstrating high accuracy in predicting parental vaccination decisions., Conclusion: The present study contributes to our understanding of the factors shaping parental decision-making regarding COVID-19 child vaccination, highlighting the impact of perceived barriers, cues to action and parent age. Future public health campaigns should address the specific barriers faced by parents, emphasise external cues to action and tailor messaging to acknowledge age-related differences in parental vaccine decision-making. By addressing the aforementioned factors influencing parental behaviour regarding child vaccination, future interventions can increase the number of children vaccinated against COVID-19, preventing transmission, protecting from severe illness and contributing to the NHS vaccination strategy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: This paper asks whether Dynamic Causal modelling (DCM) can predict the long-term clinical impact of the COVID-19 epidemic. DCMs are designed to continually assimilate data and modify model parameters, such as transmissibility of the virus, changes in social distancing and vaccine coverage-to accommodate changes in population dynamics and virus behavior. But as a novel way to model epidemics do they produce valid predictions? We presented DCM predictions 12 months ago, which suggested an increase in viral transmission was accompanied by a reduction in pathogenicity. These changes provided plausible reasons why the model underestimated deaths, hospital admissions and acute-post COVID-19 syndrome by 20%. A further 12-month validation exercise could help to assess how useful such predictions are., Methods: we compared DCM predictions-made in October 2022-with actual outcomes over the 12-months to October 2023. The model was then used to identify changes in COVID-19 transmissibility and the sociobehavioral responses that may explain discrepancies between predictions and outcomes over this period. The model was then used to predict future trends in infections, long-COVID, hospital admissions and deaths over 12-months to October 2024, as a prelude to future tests of predictive validity., Findings: Unlike the previous predictions-which were an underestimate-the predictions made in October 2022 overestimated incidence, death and admission rates. This overestimation appears to have been caused by reduced infectivity of new variants, less movement of people and a higher persistence of immunity following natural infection and vaccination., Interpretation: despite an expressive (generative) model, with time-dependent epidemiological and sociobehavioral parameters, the model overestimated morbidity and mortality. Effectively, the model failed to accommodate the "law of declining virulence" over a timescale of years. This speaks to a fundamental issue in long-term forecasting: how to model decreases in virulence over a timescale of years? A potential answer may be available in a year when the predictions for 2024-under a model with slowly accumulating T-cell like immunity-can be assessed against actual outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Bowie and Friston.)

During the COVID-19 pandemic media narratives of solidarity often cast nations like the UK as if at war, while acclaiming health-care workers as heroic and beloved. However, this solidarity was often fragile and fleeting, as concerns and criticism about workers, citizens and services also circulated. In this article we explore these dynamics of solidarity in more depth, analysing framings of cancer patient suffering, private and public provision of health care in news media during the early part of the COVID-19 pandemic. We explore how cancer patients were positioned as victims of failure and abandonment by the state and its health-care providers, and how the private health-care system was presented in a saviour role. We conclude by reflecting on the implications of new media's alignment of appeals to solidarity with highly individualised forms of care and the consequences for state-based services founded on principles of solidarity., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Purpose: Long COVID is a global health concern which has debilitating effects on the individual experiencing it. In the United Kingdom, psychological therapies are being offered to people with long COVID, although the evidence for these therapies is yet to be demonstrated. This research aimed to understand how therapists and clients define and understand recovery from long COVID, and use hope theory to interpret the results., Methods: An online Q-methodology was employed, where participants sorted a range of statements pertaining to long COVID recovery based on their level of agreement with them. These arranged statements (Q-sorts) were collated and factor analysed to explore and compare underlying perspectives., Results: Sixteen participants were recruited for the study, including eleven clients, four IAPT therapists and one therapist working in the broader long COVID pathway. A four-factor model is reported, including (1) Psychological Pathways to Recovery, (2) Social Context and Agency, (3) Physiological Goals of Recovery and (4) Personal Meaning Making. All IAPT therapists loaded onto the psychological pathways factor, whereas the remaining participants shared more diverse perspectives., Conclusions: The belief that long COVID recovery was possible, taken as an indicator of hopefulness, was rated highest for Factor 1, Psychological Pathways to Recovery, and Factor 3, Physiological Recovery Goals. This suggested that having a clear definition of recovery, or clear guidance on how to intervene, promoted hopefulness and, theoretically, well-being. However, clients reported experiences of being invalidated and disbelieved by health professionals, with psychological explanations sometimes being experienced as dismissive and invalidating. Clinical implications and future research directions are discussed., (© 2024 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)