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Gouin J, de la Torre‐Luque A, Sánchez‐Carro Y, Geoffroy M, Essau C. Heterogeneity in the trajectories of psychological distress among late adolescents during the COVID-19 pandemic. JCPP ADVANCES 2023; 3:e12195. [PMID: 38054054 PMCID: PMC10694544 DOI: 10.1002/jcv2.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/28/2023] [Indexed: 12/07/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has constrained opportunities in social, educational and professional domains, leading to developmental challenges for adolescents initiating their transition to adulthood. Meta-analysis indicated that there was a small increase in psychological distress during the first year of the COVID-19 pandemic. However, significant heterogeneity in the psychological response to the COVID-19 pandemic was noted. Developmental antecedents as well as social processes may account for such heterogeneity. The goal of this study was to characterize trajectories of psychological distress in late adolescence during the COVID-19 pandemic. Methods 5014 late adolescents born between 2000 and 2002 from the UK Millennium Cohort Study completed online self-reported assessments at three occasions during the first year of the COVID-19 pandemic (May 2020, September/October 2020 and February/March 2021). These surveys assessed psychological distress, loneliness, social support, family conflict, as well as other pandemic stressors. Information on developmental antecedents were obtained when cohort members were 17 years of age. Results Four distinct trajectories class were identified. Normative class (52.13%) experienced low and decreasing levels of psychological distress, while moderately increasing class (31.84%) experienced a small, but significant increase in distress over time and increasing class (8.75%) exhibited a larger increase in distress after the first wave of the pandemic. Inverted U-shaped class (7.29%) experienced elevated psychological distress during the first wave of the pandemic, followed by a decrease in distress in subsequent waves of the pandemic. Larger longitudinal increases in loneliness were noted among individuals in the elevated distress trajectory, compared to other trajectories. Pre-pandemic psychopathology was associated with elevated distress early in the pandemic. Conclusions The largest trajectory showed low and declining psychological distress, highlighting the resilience of the majority of late adolescents. However, a subgroup of adolescents experienced large increases in psychological distress, identifying a group of individuals more vulnerable to pandemic-related stress.
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Affiliation(s)
| | - Alejandro de la Torre‐Luque
- Department of Legal Medicine, Psychiatry and PathologyUniversidad Complutense de Madrid, CIBERSAM ISCIIIMadridSpain
| | - Yolanda Sánchez‐Carro
- Center for Biomedical Research in Mental Health (CIBERSAM)Carlos III Health InstituteMadridSpain
| | - Marie‐Claude Geoffroy
- Department of PsychiatryMcGill University and Douglas Mental Health University InstituteMontrealQuebecCanada
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2
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Andajany NN, Msallam R, Qutah KM, Alyamani DA. The Child-Parent Relationship During the COVID-19 in Saudi Arabia. Cureus 2023; 15:e50335. [PMID: 38205448 PMCID: PMC10780951 DOI: 10.7759/cureus.50335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
Background The COVID-19 pandemic psychologically affected children and their caregivers. On the other side, parents were adapting to new daily routines for work, education, and self-care in response to the current situation. Therefore, assessing the child-parent relationship during the quarantine period is a crucial issue. Objective This study aimed to measure the impact of quarantine during the COVID-19 period on the relationship between children and their parents in the western region of Saudi Arabia, mainly in Jeddah and other nearby cities. Methods A cross-sectional survey study was conducted from April to December 2020 in the western region of Saudi Arabia, primarily Jeddah and neighboring cities, during the COVID-19 quarantine and shortly after it was stopped. A validated survey (Child-Parent Relationship Scale (CPRS)) comprising socio-demographic characteristics, conflict, and closeness of the child-parent relationship was distributed to the respondents after being translated from English to Arabic. Statistical analysis was conducted using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY). P-values less than 0.05 were considered statistically significant. Results The study included 361 parents with a mean (SD) age of 37.30 (7.77) years old. Most parents were mothers (77.9%, N=279), married (91.3%, N=326), lived with their children (98.3%, N=354), and had three or a lesser number of children (80%, N=287). The average time spent with children was significantly higher after the quarantine (12.96 hours) compared to before the quarantine (8 hours) (p<0.001). The number of hours spent with children before the quarantine was significantly higher for mothers than fathers (8.44 vs. 6.01 hours, respectively, p<0.001). There was a significant association between the mean difference in conflict scores before and after the quarantine and the age of parents (p=0.002), the gender of parents (p<0.001), and marital status (p=0.026). There was a significant correlation between mean differences in closeness scores before and after the quarantine and the gender of parents (p=0.038). Conclusion Our findings highlight the complex and varied effects of the pandemic on parent-child relationships. The results emphasize the need for support and interventions to address increased conflict and promote positive relationships between parents and children during challenging times.
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Affiliation(s)
| | - Reem Msallam
- Psychiatry, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Karimah M Qutah
- Family Medicine, King Abdulaziz University, Jeddah, SAU
- Quality Patient Safety, Horizon Health Network, Fredericton, CAN
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3
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Chambers S, Smillie S, Watson N. Rethinking children's right to leisure during school holidays. ANNALS OF LEISURE RESEARCH 2023; 27:399-416. [PMID: 39006997 PMCID: PMC11244624 DOI: 10.1080/11745398.2023.2250473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 07/16/2024]
Abstract
Leisure and health are human rights that apply to both children and adults. Leisure can enhance health and enable people to participate fully in leisure activities. One of children's main opportunities for leisure is during school holidays. Little previous research has focused on this time in children's lives. This paper presents a review of the literature surrounding school holidays, providing a critique of educational and public health approaches that focus narrowly on children's future outcomes that may be associated with how they spend their time during these leisure periods. It argues that a more sociological understanding, rooted within child-centred approaches to leisure, provides the opportunity for children's agency, participation and citizenship to be investigated more fully.
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Affiliation(s)
- Stephanie Chambers
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Susie Smillie
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nicholas Watson
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
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4
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Li B, Ng K, Tong X, Zhou X, Ye J, Yu JJ. Physical activity and mental health in children and youth during COVID-19: a systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 2023; 17:92. [PMID: 37468975 DOI: 10.1186/s13034-023-00629-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) and universal mitigation strategies have fundamentally affected peoples' lives worldwide, particularly during the first two years of the pandemic. Reductions in physical activity (PA) and increased mental health (MH) problems among children and youth have been observed. This systematic review and meta-analysis investigated the relationship between physical activity (PA) and mental health (MH) among children and youth during the COVID-19 pandemic. METHODS Four electronic databases (EMBASE, PsycINFO, PubMed, and Web of Science) were systematically searched to identify studies that (1) examined the relationship between PA and MH among children and youth (aged 2-24 years old) and (2) were published in peer-reviewed journals in English between January 2020 and December 2021. Relationships between PA and two MH aspects (i.e., negative and positive psychological responses) among children and youth at different age ranges and those with disabilities or chronic conditions (DCC) were synthesized. Meta-analyses were also performed for eligible studies to determine the pooled effect size. RESULTS A total of 58 studies were eventually included for variable categorization, with 32 eligible for meta-analyses. Our synthesis results showed that greater PA participation was strongly related to lower negative psychological responses (i.e., anxiety, depression, stress, insomnia, fatigue, and mental health problems) and higher positive psychological responses (i.e., general well-being and vigor) in children and youth during COVID-19. The pattern and strength of relations between PA and MH outcomes varied across age ranges and health conditions, with preschoolers and those with DCC receiving less attention in the existing research. Meta-analysis results showed that the magnitude of associations of PA with negative (Fisher's z = - 0.198, p < 0.001) and positive (Fisher's z = 0.170, p < 0.001) psychological responses among children and youth was weak. These results were linked to age of participants, study quality, and reporting of PA-related information. CONCLUSIONS PA participation and MH among children and youth deteriorated during the COVID-19 pandemic and were closely associated with each other. For the post-COVID-19 era, additional research on age- and health condition-specific relationships between PA and MH outcomes from a comprehensive perspective is warranted. (Word count: 344 words).
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Affiliation(s)
- Bowen Li
- Department of Sport and Exercise Science, College of Education, Zhejiang University, Hangzhou, China
| | - Kwok Ng
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Faculty of Education, University of Turku, Rauma, Finland
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Xiuhong Tong
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Jiangchuan Ye
- Department of Sport and Exercise Science, College of Education, Zhejiang University, Hangzhou, China
| | - Jane Jie Yu
- Department of Sport and Exercise Science, College of Education, Zhejiang University, Hangzhou, China.
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5
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Morgül E. Caregiver Worry of Infection and Family Co-existence Difficulty and Association With Change in Children's Internalizing and Externalizing Symptoms During the Initial COVID-19 Lockdown in the UK and Turkey. Psychol Rep 2023:332941221149183. [PMID: 36705275 PMCID: PMC9895281 DOI: 10.1177/00332941221149183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The study examined whether caregiver worry of COVID-19 infection and co-existence difficulty differentially predicted child mental health and wellbeing during the lockdown in two culturally different countries that were severely affected by the pandemic: the UK and Turkey. Co-existence difficulty is the hardship experienced by family members living all together in the same house at the same time during the lockdown period. Participants were 1849 caregivers of children between 5- and 12-years old living in the UK (n = 995) and Turkey (n = 854), who completed an electronic survey distributed via social networks during the initial phase of the COVID-19 lockdown (July and August 2020). Caregivers completed a set of questionnaires on child and family wellbeing and on whether the child's internalizing and externalizing symptoms changed during the lockdown as compared to before. Worry of COVID-19 infection was higher amongst caregivers in the Turkish sample and was associated with higher levels of child internalizing symptoms during the lockdown in the Turkish sample, however there were no statistically significant differences in the size of the impact of worry of infection on the children's internalizing symptoms between the two countries. Co-existence difficulty independently predicted increase in children's internalizing and externalizing symptoms during the lockdown in both samples. Families in the UK experienced a higher level of difficulty with co-existence compared to the families living in Turkey but the magnitude of the impact of co-existence difficulty on children's outcomes between the two samples was not significantly different.The findings suggest that public health strategies should aim to reduce social anxiety and invest in the development of programs aimed at supporting families to overcome the challenges of co-existence during times of public health crisis.
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Affiliation(s)
- Evren Morgül
- Department of Psychology, University of
Roehampton, London, UK
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6
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Sandner M, Patzina A, Anger S, Bernhard S, Dietrich H. The COVID-19 pandemic, well-being, and transitions to post-secondary education. REVIEW OF ECONOMICS OF THE HOUSEHOLD 2022; 21:461-483. [PMID: 36187597 PMCID: PMC9510585 DOI: 10.1007/s11150-022-09623-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
This study examines the immediate and intermediate effects of the COVID-19 pandemic on the well-being of two high school graduation cohorts (2020 and 2021) and how changes in well-being affect students' educational plans and outcomes. Our unique panel data on 3697 students from 214 schools in 8 German federal states contain prospective survey information on three dimensions of well-being: mental health problems, self-rated health, and life satisfaction. Data is collected several months before (fall 2019), shortly before and soon after (spring 2020) as well as several months after (fall/winter 2020/21) the beginning of the COVID-19 pandemic. Applying difference-in-differences designs, random effect growth curve models, and linear regression models, we find that school closures had a positive immediate effect on students' well-being. Over the course of the pandemic, however, well-being strongly declined, mainly among the 2021 graduation cohort. We show that a strong decline in mental health is associated with changes in educational and career plans and transition outcomes. As adverse life experiences in adolescence are likely to accumulate over the life course, this study is the first to exhibit potential long-lasting negative effects of the COVID-19 pandemic on education and careers of young individuals.
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Affiliation(s)
- Malte Sandner
- Institute for Employment Research (IAB), Nuremberg, Germany
| | - Alexander Patzina
- Institute for Employment Research (IAB), Nuremberg, Germany
- University of Bamberg, Bamberg, Germany
| | - Silke Anger
- Institute for Employment Research (IAB), Nuremberg, Germany
- University of Bamberg, Bamberg, Germany
- Institute of Labor Economics (IZA), Bonn, Germany
| | - Sarah Bernhard
- Institute for Employment Research (IAB), Nuremberg, Germany
| | - Hans Dietrich
- Institute for Employment Research (IAB), Nuremberg, Germany
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7
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Chambers S, Clarke J, Kipping R, Langford R, Brophy R, Hannam K, Taylor H, Willis K, Simpson SA. Parents' perceptions of children's emotional well-being during spring 2020 COVID-19 restrictions: A qualitative study with parents of young children in England. Child Care Health Dev 2022; 48:1071-1080. [PMID: 35839296 PMCID: PMC9349486 DOI: 10.1111/cch.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 05/16/2022] [Accepted: 07/08/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND During COVID-19 restrictions in England in spring 2020, early years settings for young children were closed to all but a small percentage of families, social contact was limited and play areas in parks were closed. Concerns were raised about the impact of these restrictions on young children's emotional well-being. The aim of this study was to explore parents' perceptions of young children's emotional well-being during these COVID-19 restrictions. METHODS We interviewed 20 parents of children 3-4 years due to begin school in England in September 2020. Interviews were conducted via telephone (n = 18) and video call (n = 2), audio-recorded and transcribed verbatim. Interviews focused on childcare arrangements, children's behaviour and transition to school. A sample of transcripts were coded line by line to create a coding framework, which was subsequently applied to the remaining transcripts. Coded data were then analysed using a nurture lens to develop themes and further understanding. RESULTS Participants were predominantly mothers (n = 16), White British (n = 10) and educated to degree level (n = 13), with half the sample living in the highest deprivation quintile in England (n = 10). Five were single parents. Three themes developed from nurturing principles were identified: creating age-appropriate explanations, understanding children's behaviour and concerns about school transition. Parents reported that their children's emotional well-being was impacted and described attempts to support their young children while looking ahead to their transition to primary school. CONCLUSIONS This study is one of the first to examine in-depth perceptions of COVID-19 restrictions on young children's emotional well-being. The longer term impacts are not yet understood. Although young children may be unable to understand in detail what the virus is, they undoubtedly experience the disruption it brings to their lives. The well-being of families and children needs to be nurtured as they recover from the effects of the pandemic to allow them to thrive.
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8
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Wagener A, Stassart C, Etienne AM. At the Peak of the Second Wave of COVID-19, Did Millennials Show Different Emotional Responses from Older Adults? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105908. [PMID: 35627444 PMCID: PMC9140619 DOI: 10.3390/ijerph19105908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic disturbs mental health. Indeed, higher levels of negative emotions and anxiety, along with lower levels of positive emotions and well-being, have been highlighted. As a result, individuals need to regulate these psychological states in a context of uncertainty and daily restrictions (e.g., access to leisure activities, social contacts) or modifications of livelihood (e.g., working modalities). Overall, psychological reactions to the pandemic have been shown to differ based on one’s age. The purpose of this research is to compare psychological reactions to the pandemic between Millennials (born between 1981 and 1996) and Older Adults. The generation’s prism seems relevant as members of specific generations are shaped (e.g., views of the world, the future) by their similar experiences. Ninety-four Millennials and 129 Older Adults, recruited in the general population, participated to an online survey assessing emotions, emotion regulation strategies, environmental satisfaction, and intolerance of uncertainty. Results show that Millennials experience higher levels of negative emotions along with higher levels of worry and rumination than Older Adults. Millennials also report a higher level of joy. Nonetheless, more Older Adults engage themselves in novel activities. Overall, findings confirm previous ones and indicate the need to offer effective clinicals tool to prevent mental health worsening.
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9
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COVID-19 and Its Lockdown in Belgium: How Limited Access to Environmental Satisfaction Impacts Emotions? Psychol Belg 2022; 62:34-46. [PMID: 35087679 PMCID: PMC8782079 DOI: 10.5334/pb.1082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/23/2021] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic has been shown to induce several psychological consequences (e.g., increases in anxiety and stress). Accordingly, it seems relevant to investigate how individuals cope with their emotions. Indeed, when facing negative emotions, individuals need to rely on adaptive emotion regulation strategies to alleviate their negative impacts (e.g., decrease in quality of life, increase in sleep disturbances). Moreover, lockdown’s measures led to a restriction of the access to activities which, in turn, might have decreased the “environmental satisfaction”. Then, this research investigates the pandemic’s psychological impacts on emotions and regulation strategies, intolerance of uncertainty, and environmental satisfaction. Our approach’s originality relies on comparing one’s actual psychological functioning (i.e., since the pandemic) to one’s general psychological functioning (i.e., before the pandemic). This study also assesses the relationships between both negative and positive emotions and (1) emotion regulation strategies, (2) intolerance of uncertainty and, (3) environmental satisfaction since the pandemic and its lockdown. The total sample comprised 948 adults from the general population. Results show that, since the pandemic, individuals experience higher levels of negative emotions, lower levels of positive emotions and environmental satisfaction. They also tend to worry less and to resort to acceptance more often. Also, environmental satisfaction is the most important predictor of both negative emotions and positive ones. Overall, findings confirm previous ones and seem to indicate that environmental satisfaction should be addressed more thoroughly.
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10
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Champeaux H, Mangiavacchi L, Marchetta F, Piccoli L. Child development and distance learning in the age of COVID-19. REVIEW OF ECONOMICS OF THE HOUSEHOLD 2022; 20:659-685. [PMID: 35399873 PMCID: PMC8982654 DOI: 10.1007/s11150-022-09606-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/10/2022] [Indexed: 05/10/2023]
Abstract
School closures, forcibly brought about by the COVID-19 crisis in many countries, have impacted children's lives and their learning processes. The heterogeneous implementation of distance learning solutions is likely to bring a substantial increase in education inequality, with long term consequences. The present study uses data from a survey collected during Spring 2020 lockdown in France and Italy to analyze parents' evaluations of their children's home schooling process and emotional well-being at time of school closure, and the role played by different distance learning methods in shaping these perceptions. While Italian parents have a generally worse judgment of the effects of the lockdown on their children, the use of interactive distance learning methods appears to significantly attenuate their negative perception. This is particularly true for older pupils. French parents rather perceive that interactive methods are effective in mitigating learning losses and psychological distress only for their secondary school children. In both countries, further heterogeneity analysis reveal that parents perceive younger children and boys to suffer more during this period.
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Affiliation(s)
| | - Lucia Mangiavacchi
- Department of Political Sciences, University of Perugia, Perugia, Italy
- IZA, Institute of Labor Economics, Bonn, Germany
| | | | - Luca Piccoli
- IZA, Institute of Labor Economics, Bonn, Germany
- Department of Sociology and Social Research, University of Trento, Trento, Italy
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11
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Reali L, Nijman RG, Hadjipanayis A, Del Torso S, Calamita P, Rafele I, Katz M, Barak S, Grossman Z. Repercussions of the COVID-19 pandemic on child and adolescent mental health: A matter of concern-A joint statement from EAP and ECPCP. Front Pediatr 2022; 10:1006596. [PMID: 36518772 PMCID: PMC9742603 DOI: 10.3389/fped.2022.1006596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/24/2022] [Indexed: 11/29/2022] Open
Abstract
COVID-19 pandemic and the consequent rigid social distancing measures implemented, including school closures, have heavily impacted children's and adolescents' psychosocial wellbeing, and their mental health problems significantly increased. However, child and adolescent mental health were already a serious problem before the Pandemic all over the world. COVID-19 is not just a pandemic, it is a syndemic and mentally or socially disadvantaged children and adolescents are the most affected. Non-Communicable Diseases (NCDs) and previous mental health issues are an additional worsening condition. Even though many countries have responded with decisive efforts to scale-up mental health services, a more integrated and community-based approach to mental health is required. EAP and ECPCP makes recommendations to all the stakeholders to take action to promote, protect and care for the mental health of a generation.
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Affiliation(s)
- L Reali
- Primary Care Pediatrician, Italian National Health System (INHS), ASL Rm1, Rome, Italy.,Department of Pediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, United Kingdom.,Section of Pediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, United Kingdom.,Centre for Pediatrics and Child Health, Imperial College London, London, United Kingdom
| | - R G Nijman
- European Society of Emergency Paediatrics, European Society of Emergency Medicine, Brussels, Belgium.,European Academy of Paediatrics (EAP), Brussels, Belgium
| | - A Hadjipanayis
- Medical School, European University Cyprus, Nicosia, Cyprus.,Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
| | - S Del Torso
- Medical School, European University Cyprus, Nicosia, Cyprus.,ChildCare WorldWide-CCWWItalia OdV, Padova, Italy
| | - P Calamita
- Department of Pediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, United Kingdom.,Section of Pediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, United Kingdom.,Centre for Pediatrics and Child Health, Imperial College London, London, United Kingdom.,Medical School, European University Cyprus, Nicosia, Cyprus
| | - I Rafele
- Department of Pediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, United Kingdom.,Section of Pediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, United Kingdom.,Centre for Pediatrics and Child Health, Imperial College London, London, United Kingdom.,Primary Care Pediatrician, Italian National Health System (INHS), ASL Rm 6, Rome, Italy.,Primary Care Pediatrician, Italian National Health System (INHS), ASL Rm 3, Rome, Italy
| | - M Katz
- Department of Pediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, United Kingdom.,Section of Pediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, United Kingdom.,Centre for Pediatrics and Child Health, Imperial College London, London, United Kingdom.,Patient Safety Department, Meuhedet Health Services, Tel Aviv, Israel
| | - S Barak
- Department of Pediatric Emergency Medicine, Division of Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, United Kingdom.,Section of Pediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, United Kingdom.,Centre for Pediatrics and Child Health, Imperial College London, London, United Kingdom.,Dana Dwek Children's Hospital, Tamsc, Tel Aviv, Israel
| | - Z Grossman
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Pediatrics, Adelson School of Medicine, Ariel University Pediatrics, Ariel, Israel.,Department of Pediatrics, Maccabi Health Care Services Pediatrics, Tel Aviv, Israel
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