Impact of COVID-19 inequalities on children: An intersectional analysis

Socioeconomic inequalities in the incidence of COVID-19 in Barcelona students

Objective

This study aimed to assess socioeconomic inequalities in schools regarding the COVID-19 incidence during different epidemic waves among Barcelona students, differentiating by sex and educational stage.

Study design

Cross-sectional ecological study.

Methods

We included in the study all students from childhood to secondary education in Barcelona city. The unit of analysis was the schools. The study covered the epidemic waves coinciding with the 2020-21 and 2021-22 school courses. The cumulative incidence (CI) per school and wave was calculated. Bivariate and multivariate analyses using Poisson regression were conducted to estimate relative risks. The population attributable risk, by sex and educational stage, was calculated as a measure of impact.

Results

In the second wave, higher CI in students was associated with greater school socioeconomic deprivation in all groups. In the younger girls, 24.5 % (5.2-41.4) of the CI was attributed to school socioeconomic vulnerability, increasing to 33.1 % (15.1-47.2) in older girls. During the sixth wave, the impact was lower in the most vulnerable schools in all strata.

Conclusions

Socioeconomic factors significantly impacted the incidence of COVID-19 in schools, reflecting social inequalities in Barcelona. There was an inversion of the pattern of inequalities in the sixth wave compared to the previous ones. The results emphasize the need for urgent action and targeted resources to address health inequalities in education and understand the impact of epidemic dynamics on socioeconomic context.

Health inequalities in childhood diseases: temporal trends in the inter-crisis period

BACKGROUND

Since 2008, children in Catalonia (Spain) have suffered a period of great economic deprivation. This situation has generated broad-ranging health inequalities in a variety of diseases. It is not known how these inequalities have changed over time. The aim of the present study is to determine trends in inequalities over this period in ten relevant diseases in children according to sex and age.

METHODS

A retrospective cross-sectional population-based study of all children under 15 years old resident in Catalonia during the 2014-2021 period (over 1.2 million children/year) and of their diagnoses registered by the Catalan Health System. Health inequalities were estimated by calculating the relative index of inequality and time trends using logistic regression models. Interaction terms were added to test for the effects of sex on time trends.

RESULTS

Increasing significant temporal trends in inequalities were shown for both sexes in almost all the diseases or adverse events studied (asthma, injuries, poisoning, congenital anomalies, overweight and obesity), in mood disorders in boys, and in adverse birth outcomes in girls. Adjustment and anxiety and mood disorders in girls showed a decreasing temporal trend in inequalities. More than half of the diseases and adverse events studied experienced significant annual increases in inequality. Poisoning stood out with an average annual increase of 8.65% [4.30, 13.00], p ≤ 0.001 in boys and 8.64% [5.76, 11.52], p ≤ 0.001) in girls, followed by obesity with increases of 5.52% [4.15, 6.90], p =  < 0.001 in boys and 4.89% [4.26, 5.51], p ≤ 0.001) in girls.

CONCLUSIONS

Our results suggest that inequalities persist and have increased since 2014. Policy makers should turn their attention to how interventions to reduce Health inequalities are designed, and who benefits from them.

The Urban-Rural Difference in Child Mental Health in Vietnam: The Continuing Impacts of the COVID-19 Pandemic on Health

OBJECTIVES

We aimed to explore the difference between rural and urban children's mental health and quality of life after the pandemic.

METHODS

A total of 200 parents and their 11- to 15-year-old children were interviewed face to face in October 2022. This study measures child mental health and quality of life using the Strengths and Difficulties Questionnaire and Child Health Utility 9 Dimensions tools. The unadjusted effect sizes on health outcomes among demographic groups are calculated using Cohen's d. The school-specific fixed effects linear regression model with bootstrapped standard errors is applied.

RESULTS

Rural children have significantly higher mean internalizing behavior scores than urban children (emotional problems, Cohen's d score = 0.38; peer difficulties, Cohen's d score = 0.39; P < .05). Although children living in urban areas who had COVID-19 had significantly higher peer problem scores (Cohen's d score = 0.82, P < .05), the result was not found in those residing in rural areas. After controlling all variables, the econometrics method confirms that infection status significantly affects children's peer problems, obviously in the urban sample.

CONCLUSIONS

Children may experience the consequences of the pandemic on their mental health related to peer difficulties, differently between urban and rural areas. Further research is required to investigate the different impacts of COVID-19 on health in urban and rural areas.

Overcoming language barriers in pediatric care: a multilingual, AI-driven curriculum for global healthcare education

Background

Online medical education often faces challenges related to communication and comprehension barriers, particularly when the instructional language differs from the healthcare providers' and caregivers' native languages. Our study addresses these challenges within pediatric healthcare by employing generative language models to produce a linguistically tailored, multilingual curriculum that covers the topics of team training, surgical procedures, perioperative care, patient journeys, and educational resources for healthcare providers and caregivers.

Methods

An interdisciplinary group formulated a video curriculum in English, addressing the nuanced challenges of pediatric healthcare. Subsequently, it was translated into Spanish, primarily emphasizing Latin American demographics, utilizing OpenAI's GPT-4. Videos were enriched with synthetic voice profiles of native speakers to uphold the consistency of the narrative.

Results

We created a collection of 45 multilingual video modules, each ranging from 3 to 8 min in length and covering essential topics such as teamwork, how to improve interpersonal communication, "How I Do It" surgical procedures, as well as focused topics in anesthesia, intensive care unit care, ward nursing, and transitions from hospital to home. Through AI-driven translation, this comprehensive collection ensures global accessibility and offers healthcare professionals and caregivers a linguistically inclusive resource for elevating standards of pediatric care worldwide.

Conclusion

This development of multilingual educational content marks a progressive step toward global standardization of pediatric care. By utilizing advanced language models for translation, we ensure that the curriculum is inclusive and accessible. This initiative aligns well with the World Health Organization's Digital Health Guidelines, advocating for digitally enabled healthcare education.

Risk of partial school closure for COVID-19 by socio-economic level in the period 2020-22

BACKGROUND

The objective was to analyse the risk of partial school closure by economic level in Barcelona city.

METHODS

In this ecological study, the risk of partial school closure for the academic years 2020-21 and 2021-22 was estimated by dividing the total number of days that each child was in quarantine or isolation by the total number of days that each child was at risk to be in quarantine or isolation in the academic year. The association between partial school closure risk and mean income by district was estimated with the Spearman rho.

RESULTS

The lower the mean income, the higher the risk of partial closure (Spearman rho = 0.83; P-value = 0.003) during the academic year 2020-21. Specifically, the children from the district with the lowest income had a six times greater risk of partial school closure compared with those from the highest-income district. This risk did not show a significant socioeconomic gradient in the academic year 2021-22.

CONCLUSIONS

The risk of partial school closure presented an inverse socioeconomic gradient in the city of Barcelona according to average income by district in the academic year 2020-21. This distribution was not observed in the academic year 2021-22.

Social determinants associated with psychological distress in children and adolescents during and after the first COVID-19-related lockdown in France: results from the CONFEADO study

BACKGROUND

This study aimed to analyze the parental socio-demographic characteristics of children and adolescents aged 9 to 18 years old, as well as the living and housing conditions associated with the psychological distress in these two sub-populations during and after France's first national COVID-19-related lockdown in spring 2020.

METHODS

We used data from the cross-sectional, observational, web-based study CONFEADO, which collected data on children and adolescents' living and housing conditions and socio-demographic characteristics as well as those of their parents. It also collected data on children's and adolescents' health behaviors and psychological distress. We assessed psychological distress using the 10-item Children and Adolescents Psychological Distress Scale (CAPDS-10), and performed a multinomial logistic regression.

RESULTS

A total of 2882 children and adolescents were included in the present study. Factors associated with moderate psychological distress included being a female, parental financial difficulties, a lack of a private living space at home for the child/adolescent, and the following child health behaviors: no leisure or recreational activities with adults in the household, doing less than one hour of school homework a day, and not going outside during the lockdown. Severe psychological distress was associated with the parent's occupation (especially essential frontline workers), a lack of a private living space at home for the child/adolescent, and the following child health behaviors: spending over 5 h a day on social media, doing less than one hour of school homework a day, and no leisure or recreational activities with adults in the household.

CONCLUSIONS

This study emphasizes the impact of housing and living conditions, as well as parents' socio-economic characteristics on children's health behaviors and psychological needs during the first COVID-19-related lockdown in France. Our results suggest that health policies implemented during future pandemics should consider these structural social determinants to prevent severe psychological distress in children and adolescents.

Child health and development in the course of the COVID-19 pandemic: are there social inequalities?

COVID-19 pandemic lockdowns and closures have influenced all children's health and development (HAD). We aimed to examine whether this differs by social circumstances. We hypothesised that socially disadvantaged children experienced more pronounced deterioration in their HAD compared with better-off children. In our trend study, we included five cohorts of school enrolment medical screening (school entrance 2018-2022) in the city of Dusseldorf, Germany. To compensate for selection bias due to the limited number of examinations in pandemic months, we chose the first 800 examinations of each cohort. We computed predicted prevalences of overweight, coordination and language problems as indicators of HAD. Neighbourhood deprivation, single-parent families and non-German nationality were used as indicators of social disadvantage. All groups of children experienced a deterioration in their HAD. Its magnitude is comparable between children with different social circumstances. For instance, between 2018 and 2021, prevalence of overweight increased from 19.2 to 24.2% in children from deprived neighbourhoods, and from 8.1 to 16.5% in children from well-off neighbourhoods. Prevalence of language problems (prepositions) increased from 49.9 to 72.1% among non-German children, and from 14.4 to 39.1% among German children.   Conclusion: Results only partly confirmed our hypothesis. However, since the pre-pandemic prevalences of HAD problems among disadvantaged children were already higher, further deterioration - regardless of its magnitude - has led to their particularly poor situation. For those children, overweight and language development should be priorities of prevention. Generally, important settings for child HAD such as kindergartens or leisure facilities should remain open in future pandemics. What is known: • The COVID-19 pandemic has had a negative impact on general child health and development. • Before the pandemic, social inequalities in child health and development were a common phenomenon. What is new: • Children in all social groups experienced a deterioration in their health and development over the course of the pandemic. • Over the course of the pandemic, children from deprived neighbourhoods have demonstrated a particularly high prevalence of overweight. Language problems are particularly prevalent among non-German children.