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To investigate New South Wales adults' perceived adequacy of their fruit and vegetable consumption and to identify the barriers to consumption.An online cross-sectional survey of a sample of adults in New South Wales (n = 1603) in February 2019 measured self-reported fruit and vegetable intakes, perception of consumption adequacy and barriers to consumption. Proportions of participants whose reported consumption met the daily recommended serves of fruit and vegetables per day were calculated. Chi-square and Fisher's exact tests were used to explore differences between demographic characteristics and meeting fruit and vegetable recommendations. For those not meeting recommendations, Chi-square and Fisher's exact tests were used to explore perceived adequacy of intake as a potential barrier to consumption.The sample included 52.7% women, 40.0% aged under 40 years and 28.6% over 59 years, 68.2% lived in a major city, and 32.6% were university educated. Overall, 64.8% of participants reported consuming adequate fruit and 12.4% reported consuming adequate vegetables. Of those consuming less than the guidelines, 21.3% perceived that they were eating enough fruit and 53.7% perceived they were eating enough vegetables. The most common barriers to eating more fruit were preference for other foods (29.6%), fruit spoiling too quickly (28.3%), and habit (27.0%). The most common barriers to eating more vegetables were the perception that they eat enough (26.8%), preference for other foods (21.9%), and habit (19.7%).Greater efforts are needed to support the public to eat adequate fruit and vegetables, consistent with dietary guidelines. Public education campaigns specifically targeting increasing vegetable consumption are required to address knowledge gaps, given a large proportion of our study population consumed inadequate levels of vegetables yet perceived their intake to be adequate.

ObjectivesTo assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection.DesignWe analysed data from the UK Office of National Statistics COVID-19 Infection Survey linked to vaccination data from the National Immunisation Management System in England from December 1st2020 to 11thMay 2022. We analysed vaccination uptake and SARS-CoV-2 infection risk by occupational group and assessed whether adjustment for vaccination reduced the variation in risk between occupational groups.SettingResultsEstimated rates of triple-vaccination were high across all occupational groups (80% or above), but were lowest for food processing (80%), personal care (82%), hospitality (83%), manual occupations (84%), and retail (85%). High rates were observed for individuals working in health (95% for office-based, 92% for those in patient-facing roles) and education (91%) and office-based workers not included in other categories (90%). The impact of adjusting for vaccination when estimating relative risks of infection was generally modest (ratio of hazard ratios reduced from 1.38 to 1.32), but was consistent with the hypothesis that low vaccination rates contribute to elevated risk in some groups. Conversely, estimated relative risk for some occupational groups, such as people working in education, remained high despite high vaccine coverage.ConclusionsVariation in vaccination coverage might account for a modest proportion of occupational differences in infection risk. Vaccination rates were uniformly very high in this cohort, which may suggest that the participants are not representative of the general population. Accordingly, these results should be considered tentative pending the accumulation of additional evidence.

ObjectivesTo establish whether prevalence and severity of long-COVID symptoms vary by industry and occupation.MethodsWe utilised ONS Coronavirus Infection Survey (CIS) data (February 2021-April 2022) of working-age participants (16-65 years). Exposures were industrial sector, occupation and major Standard Occupational Classification (SOC) group. Outcomes were self-reported: (1) long-COVID symptoms; and (2) reduced function due to long-COVID. Binary (outcome 1) and ordered (outcome 2) logistic regression were used to estimate odds ratios (OR) and prevalence (marginal means) for all exposures.ResultsPublic facing industries, including teaching and education, social care, healthcare, civil service, retail and transport industries and occupations had highest odds ratios for long-COVID. By major SOC group, those in caring, leisure and other services (OR 1.44, CIs: 1.38-1.52) had substantially elevated odds than average. For almost all exposures, the pattern of odds ratios for long-COVID symptoms followed that for SARS-CoV-2 infections, except for professional occupations (OR1 for long-COVID). The probability of reporting long-COVID for industry ranged from 7.7% (financial services) to 11.6% (teaching and education); whereas the prevalence of reduced function by ‘a lot’ ranged from 17.1% (arts, entertainment and recreation) to 22-23% (teaching and education and armed forces) and to 27% (those not working).ConclusionsThe risk and prevalence of long-COVID differs across industries and occupations. Generally, it appears that likelihood of developing long-COVID symptoms follows likelihood of SARS-CoV-2 infection, except for professional occupations. These findings highlight sectors and occupations where further research is needed to understand the occupational factors resulting in long-COVID.Key messagesWhat is already known on this topicSARS-CoV-2 infection and COVID-19 mortality in the UK varied by occupational group; yet it is not known if any occupational groups are more susceptible to long-COVID than others.What this study addsThis is the first study to examine how prevalence of long-COVID and its impacts on functional capacity differ by industrial sector and occupational groups.Prevalence of self-reported long-COVID increased with time across all exposure groups and mostly followed SARS-CoV-2 infection trends; with the exception of Professional occupations that demonstrated notable differences in the direction of odds of long-covid when compared to odds of SARS-CoV-2 infection.Those working in Teaching and education, and social care industries showed the highest likelihood of having long-COVID symptoms. The exact same pattern was observed when analysis was performed using occupational groups. When we used SOC groups the likelihood was higher in Caring, leisure and other services.How this study might affect research, practice or policyThe findings contribute to the evidence base that long-COVID differences occur across industries and occupations, provides insights for employees, employers, occupational and healthcare for the industries and occupations that may need additional support for return- to-work policies and highlights sectors and occupations where further research is needed to understand the mechanisms resulting in long-COVID and how occupational factors influence the risk of developing long-COVID or interact with long-COVID to increase the impact on activities.

ObjectiveTo explore impacts of the COVID-19 pandemic on patterns of sickness absence among staff employed by the National Health Service (NHS) in England.MethodsWe analysed prospectively collected, pseudonymised data on 959,356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020, comparing the frequency of new sickness absence in 2020 with that at corresponding times in 2019.ResultsAfter exclusion of episodes directly related to COVID-19, the overall incidence of sickness absence during the initial 10 weeks of the pandemic (March-May 2020) was more than 20% lower than in corresponding weeks of 2019, but trends for specific categories of illness varied. Marked increases were observed for asthma (122%), infectious diseases (283%) and mental illness (42.3%), while reductions were apparent for gastrointestinal problems (48.4%), genitourinary/gynaecological disorders (33.8%), eye problems (42.7%), injury and fracture (27.7%), back problems (19.6%), other musculoskeletal disorders (29.3%), disorders of ear, nose and throat (32.7%), cough/flu (24.5%) and cancer (24.1%). A doubling of new absences for pregnancy-related disorders during 18 May to 19 July of 2020 was limited to women with earlier COVID-19 sickness absence.ConclusionsVarious factors will have contributed to the large and divergent changes that were observed. The findings add to concerns regarding delays in diagnosis and treatment of cancers, and support a need to plan for a large backlog of treatment for many other diseases. Further research should explore the rise in absence for pregnancy-related disorders among women with earlier COVID-19 sickness absence.1. What is already known about this subject?Historically, rates of sickness absence among the NHS workforce in England have been relatively high but stable. Reports of a marked increase during the first wave of the COVID-19 pandemic have not distinguished between different categories of underlying illness.2. What are the new findings?During the first wave of COVID-19, incidence of sickness-absence changed markedly when compared to the previous year, with major increases for some categories of illness, and large declines for many others, including cancer.3. How might this impact on policy or clinical practice in the foreseeable future?The findings support a need to plan for effects from delayed diagnosis and treatment of cancer, and to manage a large backlog of treatment for many other diseases.

ObjectiveThe objective was to see if it was feasible and acceptable to deliver a brief public health intervention as part of an attendance at the paediatric emergency department (PED).DesignA feasibility and acceptability pilot design was used as there is no previous work done in this clinical area, population or using this approach in children and young people (CYP). Quantitative and qualitative data were collected. Follow-up was at 1 week and 1, 3 and 6 months.SettingThis pilot took place in a single PED in Greater Manchester, England.ParticipantsParticipants were CYP (under 16 years old) and their parents/carers, attending the PED during a 2-week recruitment period in September 2019.InterventionsThe intervention was a brief conversation with a Consultant in Paediatric Public Health Medicine, using Screening, Brief Intervention and Referral to Treatment. The intervention focused on vaccination, dental health, household smoking and frequent attendance.Primary and secondary outcome measuresThe primary outcome measure was information to support the effective development of a larger-scale study. Secondary outcomes were measures of health, again intended to provide additional information prior to a larger study.ResultsThirty CYP were recruited from 29 households. Sixty per cent of CYP triggered at least one screening question, most commonly household smoking and dental health. It was not possible to accurately assess frequent attendance and 97% of parents/carers stated that they thought their child or young person was fully vaccinated for their age, which is likely to be an over-estimate.ConclusionsIt is feasible to deliver a brief public health intervention in the PED and such an approach is acceptable to a variety of stakeholders including CYP, parents/carers and nursing staff. The pilot revealed issues around data quality and access. Future work will focus on vaccination and dental health.

BackgroundMonitoring differences in COVID-19 vaccination uptake in different groups is crucial to help inform the policy response to the pandemic. A key gap is the absence of data on uptake by occupation.MethodsUsing nationwide population-level data, we calculated the proportion of people who had received two doses of a COVID-19 vaccine (assessed on 31 August 2021) by detailed occupational categories in adults aged 40-64 and estimated adjusted odds ratios to examine whether these differences were driven by occupation or other factors, such as education. We also examined whether vaccination rates differed by ability to work from home.ResultsOur study population included 14,298,147 adults 40-64. Vaccination rates differed markedly by occupation, being higher in administrative and secretarial occupations (90.8%); professional occupations (90.7%); and managers, directors and senior officials (90.6%); and lowest (83.1%) in people working in elementary occupations. We found substantial differences in vaccination rates looking at finer occupational groups even after adjusting for confounding factors, such as education. Vaccination rates were higher in occupations which can be done from home and lower in those which cannot. Many occupations with low vaccination rates also involved contact with the public or with vulnerable peopleConclusionsIncreasing vaccination coverage in occupations with low vaccination rates is crucial to help protecting the public and control infection, especially in occupations that cannot be done from home and involve contacts with the public. Policies such as ‘work from home if you can’ may only have limited future impact on hospitalisations and deathsWhat is already known on this subject?Whilst several studies highlight differences in vaccination coverage by ethnicity, religion, socio-demographic factors and certain underlying health conditions, there is very little evidence on how vaccination coverage varies by occupation, in the UK and elsewhere. The few study looking at occupational differences in vaccine hesitancy focus on healthcare workers or only examined broad occupational groups. There is currently no large-scale study on occupational differences in COVID-19 vaccination coverage in the UK.What this study adds?Using population-level linked data combining the 2011 Census, primary care records, mortality and vaccination data, we found that the vaccination rates of adults aged 40 to 64 years in England differed markedly by occupation. Vaccination rates were high in administrative and secretarial occupations, professional occupations and managers, directors and senior officials and low in people working in elementary occupations. Adjusting for other factors likely to be linked to occupation and vaccination, such as education, did not substantially alter the results. Vaccination rates were also associated with the ability to work from home, with the vaccination rate being higher in occupations which can be done performed from home. Policies aiming to increase vaccination rates in occupations that cannot be done from home and involve contacts with the public should be priorities

Background This study quantifies the risk of Covid-19 among ethnic groups of healthcare staff during the first pandemic wave in England. Methods We analysed data on 959 356 employees employed by 191 National Health Service trusts during 1 January 2019 to 31 July 2020, comparing rates of Covid-19 sickness absence in different ethnic groups. Results In comparison with White ethnic groups, the risk of short-duration Covid-19 sickness absence was modestly elevated in South Asian but not Black groups. However, all Black and ethnic minority groups were at higher risk of prolonged Covid-19 sickness absence. Odds ratios (ORs) relative to White ethnicity were more than doubled in South Asian groups (Indian OR 2.49, 95% confidence interval (CI) 2.36–2.63; Pakistani OR 2.38, 2.15–2.64; Bangladeshi OR 2.38, 1.98–2.86), while that for Black African ethnicity was 1.82 (1.71–1.93). In nursing/midwifery staff, the association of ethnicity with prolonged Covid-19 sickness absence was strong; the odds of South Asian nurses/midwives having a prolonged episode of Covid-19 sickness absence were increased 3-fold (OR 3.05, 2.82–3.30). Conclusions Residual differences in risk of short term Covid-19 sickness absences among ethnic groups may reflect differences in non-occupational exposure to SARS-CoV-2. Our results indicate ethnic differences in vulnerability to Covid-19, which may be only partly explained by medical comorbidities.

The COVID-19 pandemic has dramatically impacted cancer care worldwide. Disruptions have been seen across all facets of care. While the long-term impact of COVID-19 remains unclear, the immediate impacts on patients, their carers and the healthcare workforce are increasingly evident. This study describes disruptions and reorganisation of cancer services in Australia since the onset of COVID-19, from the perspectives of people affected by cancer and healthcare workers. Two separate online cross-sectional surveys were completed by: a) cancer patients, survivors, carers, family members or friends (n = 852) and b) healthcare workers (n = 150). Descriptive analyses of quantitative survey data were conducted, followed by inductive thematic content analyses of qualitative survey responses relating to cancer care disruption and perceptions of telehealth. Overall, 42% of cancer patients and survivors reported experiencing some level of care disruption. A further 43% of healthcare workers reported atypical delays in delivering cancer care, and 50% agreed that patient access to research and clinical trials had been reduced. Almost three quarters (73%) of patients and carers reported using telehealth following the onset of COVID-19, with high overall satisfaction. However, gaps were identified in provision of psychological support and 20% of participants reported that they were unlikely to use telehealth again. The reorganisation of cancer care increased the psychological and practical burden on carers, with hospital visitation restrictions and appointment changes reducing their ability to provide essential support. COVID-19 has exacerbated a stressful and uncertain time for people affected by cancer and healthcare workers. Service reconfiguration and the adoption of telehealth have been essential adaptations for the pandemic response, offering long-term value. However, our findings highlight the need to better integrate psychosocial support and the important role of carers into evolving pandemic response measures. Learnings from this study could inform service improvements that would benefit patients and carers longer-term.

Introduction The importance of elucidating the relationships between pain, mood and quality of life (QoL) amongst people with amyotrophic lateral sclerosis/motor neuron disease is evident to clinicians, yet the literature is limited and inconsistent. We explored the relationships between pain, depression, anxiety and QoL to reconcile the previous contrasting findings and inform future research and clinical practice. Methods Patient-reported outcomes were obtained as part of the Trajectories of Outcomes in Neurological Conditions study. Mood and QoL scales underwent Rasch analysis. Correlation coefficients examined the strength of association between variables of interest. A bivariate regression model was developed to examine the effects of pain, depression and anxiety on joint psychological and physical QoL domains. Results Of 636 people with ALS, 69% reported pain, of these most had mild pain. Seven percent (7%) of participants exceeded published cutoffs for probable depression and 14% had probable anxiety. Pain, depression and anxiety all influence quality of life; depression has a significant effect on both physical and psychological domains of QoL, whereas pain affects physical QoL and anxiety psychological QoL. Conclusions These results show the importance of expressing quality of life in a conceptually appropriate way, as failing to take account of the multidimensional nature of QoL can result in important nuances being overlooked. Clinicians must be aware that pain, depression and anxiety all worsen QoL across their ranges, and not just when pain is severe or when anxiety or depression reach case level.

ObjectiveTo quantify occupational risks of COVID-19 among healthcare staff during the first wave (9 March 2020–31 July 2020) of the pandemic in England.MethodsWe used pseudonymised data on 902 813 individuals employed by 191 National Health Service trusts to explore demographic and occupational risk factors for sickness absence ascribed to COVID-19 (n=92 880). We estimated ORs by multivariable logistic regression.ResultsWith adjustment for employing trust, demographic characteristics and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in ‘additional clinical services’ (care assistants and other occupations directly supporting those in clinical roles) (OR 2.31 (2.25 to 2.37)), registered nursing and midwifery professionals (OR 2.28 (2.23 to 2.34)) and allied health professionals (OR 1.94 (1.88 to 2.01)) and intermediate in doctors and dentists (OR 1.55 (1.50 to 1.61)). Differences in risk were higher after the employing trust had started to care for documented patients with COVID-19, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged COVID-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater.ConclusionsAfter allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for COVID-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. COVID-19 may meet criteria for compensation as an occupational disease in some healthcare occupations.Trial registration numberISRCTN36352994.

ObjectiveTo explore the patterns of sickness absence in National Health Service (NHS) staff attributable to mental ill health during the first wave of the Covid-19 epidemic in March – July 2020DesignCase-referent analysis of a secondary data setSettingNHS Trusts in EnglandParticipantsPseudonymised data on 959,356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020Main Outcome MeasuresTrends in the burden of sickness absence due to mental ill health from 2019 to 2020 according to demographic, regional and occupational characteristics.ResultsOver the study period, 164,202 new sickness absence episodes for mental ill health were recorded in 12.5% (119,525) of the study sample. There was a spike of sickness absence for mental ill health in March-April 2020 (899,730 days lost) compared with 519,807 days in March-April 2019; the surge was driven by an increase in new episodes of long-term absence and had diminished by May/June 2020. The increase was greatest in those aged >60 years (227%) and among employees of Asian and Black ethnic origin (109%-136%). Among doctors and dentists the number of days absent declined by 12.7%. The biggest increase was in London (122%) and the smallest in the East Midlands (43.7%); the variation between regions reflected the rates of Covid-19 sickness absence during the same period.ConclusionAlthough the Covid-19 epidemic led to an increase in sickness absence attributed to mental ill health in NHS staff, this had substantially declined by May/June 2020, corresponding with the decrease in pressures at work as the first wave of the epidemic subsided.Article SummaryStrengths and limitations of this studyLarge study populationStudy population were not self-selectedJob exposure matrix allowed adjustment for occupational exposureData did not extend to the start of the second wave in September 2020

ObjectiveTo quantify occupational risks of Covid-19 among healthcare staff during the first wave of the pandemic in EnglandMethodsUsing pseudonymised data on 902,813 individuals continuously employed by 191 National Health Service trusts during 1.1.19 to 31.7.20, we explored demographic and occupational risk factors for sickness absence ascribed to Covid-19 during 9.3.20 to 31.7.20 (n = 92,880). We estimated odds ratios (ORs) by multivariable logistic regression.ResultsWith adjustment for employing trust, demographic characteristics, and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in additional clinical services (including care assistants) (OR 2.31 [2.25-2.37]), registered nursing and midwifery professionals (OR 2.28 [2.23-2.34]) and allied health professionals (OR 1.94 [1.88-2.01]), and intermediate in doctors and dentists (OR 1.55 [1.50-1.61]). Differences in risk were higher after the employing trust had started to care for documented Covid-19 patients, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged Covid-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater.ConclusionsAfter allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for Covid-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. Covid-19 may meet criteria for compensation as an occupational disease in some healthcare occupations.Key messagesWhat is already known about this subject?Healthcare workers and other keyworkers (workers whose job was considered essential to societal functioning) had a higher likelihood of testing positive for COVID-19 than other workers during the first lockdown in England. Amongst healthcare workers, those working in inpatient settings had the highest rate of infection.What are the new findings?Between March and July 2000, the overall risk of COVID-19 sickness absence in National Health Service staff in England was lower at older ages, higher in non-white staff, and (in comparison with administrative and clerical staff) more than doubled in registered nurses and among workers such as healthcare assistants providing support to health professionals. Risk in health care scientists was little different from that in administrative and clerical occupationsHow might this impact on policy or clinical practice in the foreseeable future?Our results suggest that the risk reduction strategies that were in place for healthcare scientists were effective. However, the protection for nursing and supporting health professionals was insufficient. In the event of a further ‘wave’ of infections resulting in high hospital admissions, attention should be paid to ensuring that risk reduction strategies for nurses and supporting health professionals are improved.

Purpose This study aimed to explore the psychosocial impacts of the coronavirus disease (COVID-19) pandemic on cancer patients, survivors, and carers in Australia. Methods Using real-time insights from two Cancer Council NSW services—131120 Information and Support Line and Online Community (CCOC) forums—we assessed service demand trends, distress levels (using the distress thermometer), and content from 131120 calls and online posts between 01 December 2019 and 31 May 2020. Emergent themes were identified through an inductive conventional content analysis with 131120 call notes, followed by a deductive directed content analysis on CCOC posts. Results In total, 688 COVID-19-related 131120 calls (n = 496) and online posts (n = 192) were analysed. Service demand peaked in March 2020 and self-reported distress peaked in May 2020 at an average of 8/10 [Mean = 7.5; SD = 0.9]. Five themes emerged from the qualitative analysis: psychological distress and fear of virus susceptibility, practical issues, cancer service disruptions, information needs, and carer Issues. Conclusions The psychosocial impacts of COVID-19 on people affected by cancer are multifaceted and likely to have long-lasting consequences. Our findings drove the development of six recommendations across three domains of support, information, and access. Cancer patients, survivors, and carers already face stressful challenges dealing with a cancer diagnosis or survivorship. The added complexity of restrictions and uncertainty associated with the pandemic may compound this. It is important that healthcare providers are equipped to provide patient-centred care during and after this crisis. Our recommendations provide points of consideration to ensure care is tailored and patient oriented.

Aim Paediatric Emergency Departments (PEDs) are well-placed to deliver public health interventions. Whilst numerous studies describe the effectiveness of a range of ED-based interventions for adults, less has been done to assess interventions for Children and Young People (CYP). Every year in England, millions of CYP attend hospital, often with relatively minor illnesses/injuries, which sometimes result in long waits – time that could be used to improve wider health and wellbeing. This pilot study assessed the feasibility and acceptability of delivering a public health intervention in the PED of a busy district general hospital. Methods Full prospective ethical approval was obtained. Participants were CYP and their carers attending a PED in England. An opportunistic sampling strategy was used, with a focus on recruiting those who had a wait whilst in the department. The intervention was a consultation delivered by a public health specialist, based around the ‘Screening, Brief Intervention, and Referral for Treatment’ (SBIRT) model and focussed on: household smoking, vaccination status, dental health, and frequent attendance. Quantitative outcome data (e.g. registering with dentist) were collected by phone at one week and then one, three, and six months post-enrolment (where indicated). Qualitative data came from engaging with participants and completion of a field diary by the public health specialist (primary researcher). Results Thirty participants were recruited over the two-week pilot, with 50% of CYP participating in the consent process. Twenty participants (67%) triggered at least one screening question, with dental health and (household) smoking being the most common triggers. Four participants were lost to phone follow-up at one week and a further five were ‘thanked and discharged’ as they had not triggered any of the categories during screening. Of the remaining participants, five had taken action as a result of the study and others had plans, all relating to dental appointments. Follow-up is ongoing and due for completion in March 2020. Conclusion The PED offers an underutilised opportunity to deliver public health interventions. Findings from this study will be used to refine the intervention before an assessment of its effectiveness is made, using an appropriate study design. Acknowledgements This study was funded by a grant from the Sir Halley Stewart Trust.

INTRODUCTION: This cross-sectional study looked at the impact of the SARS-CoV-2/COVID-19 pandemic on pediatric emergency department (PED) attendances and admissions (as a proxy for severity of illness) in the United States and United Kingdom. METHODS: Data were extracted for children and adolescents, younger than 16 years, attending Royal Manchester Children's Hospital (RMCH, United Kingdom), and Yale New Haven Children's Hospital (YNHCH, United States). Attendances for weeks 1 to 20 of 2020 and 2019 were compared, and likelihood of admission was assessed via calculation of odds ratios, using week 13 (lockdown) as a cutoff. RESULTS: Attendance numbers for each PED decreased in 2020 compared with 2019 (RMCH, 29.2%; YNHCH, 24.8%). Odds of admission were significantly higher after lockdown than in 2019-RMCH (odds ratio, 1.26; 95% confidence interval, 1.08-1.46) and YNHCH (odds ratio, 1.60; 95% confidence interval, 1.31-1.98). CONCLUSIONS: Although the absolute numbers of children and adolescents attending the PED and being admitted decreased after lockdown, the acuity of illness of those attending appears to be higher.

Objective: The objective of this review is to identify and collate the available evidence, and to produce an overview of interventions delivered in secondary and tertiary healthcare settings with the aim of improving vaccination uptake in children and young people. Introduction: Vaccine hesitancy appears in the World Health Organization's Ten Threats to Global Health in 2019.1 Time spent in secondary or tertiary healthcare settings with a child or young person may present an opportunity to deliver vaccination-focused interventions. National Institute for Health and Care Excellence guidance highlights a gap in the evidence of the effectiveness of different interventions aimed at increasing immunization uptake among children and young people.2 Inclusion criteria: Quantitative studies that describe interventions delivered in secondary and tertiary care settings will be included. Participants will include children and young people aged less than 16 years and/or their parents/carers (potentially interventions could be delivered to the child-parent/carer dyad) present in a secondary or tertiary care setting as either a patient or relative. Methods: This scoping review will be conducted using MEDLINE, CINAHL, Cochrane Library, Embase, Web of Science, as well as gray literature. The scoping review will exclude publications not available in English and any publication older than 30 years. Two reviewers will independently select articles using the inclusion criteria, based on their title and abstract. Data will be extracted from selected full text articles using a data extraction tool based on JBI recommendations. Study findings will be presented in tabular form detailing the interventions identified in the literature.

On Wednesday, 11 March 2020, the WHO declared a global pandemic of COVID-191—the disease caused by SARS-CoV-2, a novel coronavirus first reported in Wuhan, China, in December 2019.2 While the body of knowledge around the virus and the disease it causes grows on a daily basis, relatively little is known about the course of COVID-19 in children and young people (CYP; defined here as those under the age of 16 years).3 If the epidemiology of the pandemic in the UK follows that of countries with similar demographics and healthcare provision, it is likely that the burden of disease will fall predominantly on older age groups.4 Although CYP can become infected with SARS-CoV-2, it appears that they are mainly asymptomatic or experience mild symptoms,3 resulting in a much smaller number …

The Chief Medical Officer recommends that all health care workers receive an influenza vaccination annually. High vaccination coverage is believed to be the best protection against the spread of influenza within a hospital, although uptake by health care workers remains low. We conducted semistructured interviews with seven medical students and nine early career doctors, to explore the factors informing their influenza vaccination decision making. Data collection and analysis took place iteratively, until theoretical saturation was achieved, and a thematic analysis was performed. Socialization was important although its effects were attenuated by participants’ previous experiences and a lack of clarity around the risks and benefits of vaccination. Many participants did not have strong intentions regarding vaccination. There was considerable disparity between an individual’s opinion of the vaccine, their intentions, and their vaccination status. The indifference demonstrated here suggests few are strongly opposed to the vaccination—there is potential to increase vaccination coverage.

Introduction The Chief Medical Officer for England recommends that healthcare workers have a seasonal influenza vaccination in an attempt to protect both patients and NHS staff. Despite this, many healthcare workers do not have a seasonal influenza vaccination. Social network analysis is a well-established research approach that looks at individuals in the context of their social connections. We examine the effects of social networks on influenza vaccination decision and disease dynamics. Methods We used a social network analysis approach to look at vaccination distribution within the network of the Lancaster Medical School students and combined these data with the students’ beliefs about vaccination behaviours. We then developed a model which simulated influenza outbreaks to study the effects of preferentially vaccinating individuals within this network. Results Of the 253 eligible students, 217 (86%) provided relational data, and 65% of responders had received a seasonal influenza vaccination. Students who were vaccinated were more likely to think other medical students were vaccinated. However, there was no clustering of vaccinated individuals within the medical student social network. The influenza simulation model demonstrated that vaccination of well-connected individuals may have a disproportional effect on disease dynamics. Conclusions This medical student population exhibited vaccination coverage levels similar to those seen in other healthcare groups but below recommendations. However, in this population, a lack of vaccination clustering might provide natural protection from influenza outbreaks. An individual student’s perception of the vaccination coverage amongst their peers appears to correlate with their own decision to vaccinate, but the directionality of this relationship is not clear. When looking at the spread of disease within a population it is important to include social structures alongside vaccination data. Social networks influence disease epidemiology and vaccination campaigns designed with information from social networks could be a future target for policy makers.

Background The Chief Medical Officer for England recommends that all health-care workers receive an influenza vaccination annually. Medical students are also encouraged to get vaccinated. High vaccination coverage is believed to be the best form of protection against the spread of influenza within hospital settings, protecting both staff and patients, and reducing virus transmission. However, uptake of seasonal influenza vaccination by health-care workers remains substantially lower than the target level of 75%. Our study aimed to provide a deeper insight into the influenza vaccination practices of health-care workers. Methods An opportunistic sampling strategy was used and participants recruited via compulsory teaching sessions. We conducted a series of semi-structured interviews with seven medical students and nine foundation doctors, to explore the factors informing their vaccination decisions. Interviews were transcribed and the data analysed thematically. Data collection and analysis took place as an iterative process, until theoretical saturation was achieved. Findings Of the 16 participants, ten had been vaccinated during the 2015–16 season. A number of key themes emerged, and there were inconsistencies between an individual's opinion of the vaccine, their intentions, and their vaccination status. For example, someone reporting negative opinions of the vaccine could have been vaccinated. Moreover, individuals did not necessarily vaccinate year on year. Participants were influenced by senior staff as role models, demonstrating both positive and negative attitudes towards the vaccine. Participants often presented this observation in the context of their own conflicting ideals of medical professionalism. The decision making processes around influenza vaccination seem to be finely balanced, take place within a culture of relative ambivalence, and can easily be tipped one way or the other by factors such as convenience. Interpretation The findings are drawn from a diverse sample, and are supported by the literature. This study suggests that senior staff have an important role in the vaccination practices of juniors. The influential role of consultants could be used as part of a future strategy to increase vaccination, since positive role models can facilitate a cultural shift in favour of vaccination uptake. Future research involving senior staff is necessary to understand the complexities behind their own vaccination practices. Funding Colt Foundation.

Background There is increasing interest in the effects of social networks on disease dynamics. We simulated the spread of influenza through a population of medical students where transmission was related to the social network structure and vaccination status of individuals. Methods All students at Lancaster Medical School, Lancaster, UK (n=253) were asked to rate the strength of their relationship with all other students from the medical school. Students also self-reported their influenza vaccination status. An individual-based outbreak model was developed using R statistical software. Using these data, combined with appropriate transmission parameters, we simulated an influenza outbreak and assessed the effects of preferentially vaccinating according to the social network analysis data. We ran the simulation 1500 times. Each simulation selected a random student to introduce the virus into the population. For each vaccination strategy, the likelihood of each individual being infected was calculated as a percentage of the number of times they were infected in the 1500 possible outbreaks. Findings 215 students (85%) responded. Non-responders were assumed to have reciprocal relationships with responders; therefore it was possible to construct the entire medical student network. We found that the outcomes of vaccination strategies based on between-ness (the extent to which an individual lies between others in the network) and degree (the number of connections an individual has), which are both measures of connectedness, quickly converged. As more individuals were vaccinated, the likelihood of individuals contracting the infection tended to be similar, irrespective of vaccination based on between-ness or degree. After vaccination of an additional 8% of the population (20 students) the outcome of the experimental influenza outbreak was similar for both strategies. Interpretation Our results add to a small pool of evidence supporting targeting vaccination of individuals according to between-ness in an attempt to reduce the spread of influenza. However, in small, densely connected populations, vaccination according to degree might be preferential because of the rapid convergence and the relative ease of locating individuals with a high degree versus those with high between-ness. This study suggests that vaccination strategies that target highly connected individuals within a network might limit spread of infectious disease. Future work could include evaluating current vaccination approaches using social network analysis. Funding University Hospitals of Morecambe Bay NHS Foundation Trust funded data collection.