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Introduction: Emergency department (ED) attendances fell across the UK after the ‘lockdown’ introduced on 23rd March 2020 to limit the spread of coronavirus disease 2019 (COVID-19). We hypothesised that reductions would vary by patient age and disease type. We examined pre- and in-lockdown ED attendances for two COVID-19 unrelated diagnoses: one likely to be affected by lockdown measures (gastroenteritis), and one likely to be unaffected (appendicitis).Methods: We conducted a retrospective cross-sectional study across two EDs in one London hospital Trust. We compared all adult and paediatric ED attendances, before (January 2020) and during lockdown (March/April 2020). Key patient demographics, method of arrival, and discharge location were compared. We used Systemised Nomenclature of Medicine codes to define attendances for gastroenteritis and appendicitis.Results: ED attendances fell from 1129 per day before lockdown to 584 in lockdown, 51.7% of pre-lockdown rates. In-lockdown attendances were lowest for under-18s (16.0% of pre-lockdown). The proportion of patients admitted to hospital increased from 17.3% to 24.0%, and the proportion admitted to intensive care increased fourfold. Attendances for gastroenteritis fell from 511 to 103, 20.2% of pre-lockdown rates. Attendances for appendicitis also decreased, from 144 to 41, 28.5% of pre-lockdown rates.Conclusion: ED attendances fell substantially following lockdown implementation. The biggest reduction was for under-18s. We observed reductions in attendances for gastroenteritis and appendicitis. This may reflect lower rates of infectious disease transmission, although the fall in appendicitis-related attendances suggests that behavioural factors were also important. Larger studies are urgently needed to understand changing patterns of ED use and access to emergency care during the coronavirus 2019 pandemic.

This study emphasises different facets of peer exploitation awareness and experience identified in closed‐type institutions, including a couple of abusive behaviours that have not been previously identified in long‐term residential centres. ‘Emphasises different facets of peer exploitation awareness and experience identified in closed‐type institutions’ A national representative sample of 1391 children (743 boys and 648 girls) seven to 20 years of age living in 44 long‐term residential centres was analysed to identify the prevalence of awareness and experience of peer exploitation. Multilevel logistic regression models were used to identify the predictors of peer exploitation experience. In total, 40.1 per cent of children reported that they were aware of peer exploitation, and 28.5 per cent that they were victims of such exploitation. Additionally, it was shown that (a) children who reported past abuse by a staff member were more likely to be victims of exploitation than those who did not; and (b) an increased number of children in a dorm room predicted a decrease in the odds of peer exploitation experience. This study provides a picture of the developmental environment for children in Romanian orphanages in the late 1990s, prior to subsequent child protection reforms, and underlines the prevalence of exploitation and the risk factors for peer exploitation in closed institutional systems. Copyright © 2017 John Wiley & Sons, Ltd. Key Practitioner Messages: Four in ten (40%) institutionalised children reported that they were aware of at least one form of peer exploitation, and nearly three in ten (28.5%) reported experiencing at least some of these types of exploitation practices by their older peers. This study highlights the importance of understanding the complex milieu that comprised the daily lives of institutionalised children in Romania, including an environment that consisted of physical abuse by institution staff and awareness and experiences of exploitation. [ABSTRACT FROM AUTHOR]