Protocol for a systematic review to understand the long-term mental-health effects of influenza pandemics in the pre-COVID-19 era.

AIMS: This protocol describes a forthcoming systematic review of the question: 'What are the long-term effects of historical influenza pandemics on mental health, resulting either from illness itself or the social or economic effects of pandemics and public health responses?' METHODS: We will review studies that investigate associations between influenza pandemics and long-term mental-health impacts. Following the PICO framework, populations (P) may include those with and without pre-existing mental-health symptoms or conditions. Intervention (I) is exposure to an influenza pandemic during the study period encompassing five pandemics (1889-2009). Comparators or controls (C) are not applicable. The review will address outcomes (O) of mental-health morbidity from direct infection and/or related circumstances, including, for example, receiving a disability pension, institutionalisation and/or death. RESULTS: Due to societal disruptions, illness and bereavement during pandemics, many people are likely to be affected in myriad ways. Therefore, investigation into mental-health consequences should not be restricted by risk group or diagnosis. To our knowledge, this protocol and forthcoming systematic review are the first to include studies for broad populations and multiple measures of mental-health morbidity. The historical perspective and comparison of pandemics with varying severity but assumed similar causative pathogens also enable insights into the consistency of long-term consequences across pandemics. CONCLUSIONS: Pandemics likely produce long-term mental-health impacts with relevance for social, health and economic planning. The systematic review based on this protocol will complement other evidence on pandemic impacts and help policymakers incorporate relevant interventions.

"We didn't get much schooling because we were fishing all the time": Potential impacts of irregular school attendance on the spread of epidemics.

OBJECTIVES: Especially in traditional, rural, and low-income areas, children attend school irregularly. School-based interventions are common mitigation strategies for infectious disease epidemics, but if daily attendance is not the norm, the impact of schools on disease spread might be overestimated. METHODS: We use an agent-based model of an early 20th century Newfoundland community to compare epidemic size and duration in three scenarios: (1) all school-aged children attend school each weekday, (2) students aged 10-15 have a chance of engaging in adult activities each day, and (3) students aged 10-15 have a chance of being reassigned to adult roles at the start of each simulation and thus never attend school. RESULTS: As the probability of not attending school increases, epidemics become smaller and peak earlier. The change in final size is larger with permanent reassignment (35% at baseline, 18% at maximum reassignment) than with daily nonattendance (35% vs. 22%). For both scenarios, the peak occurs 3 days earlier with maximum absence compared to the baseline. Benefits extend beyond the reassigned agents, as all school-aged agents are more likely to escape infection with increasing reassignment, and on average, 3-6 additional agents (2.6%-5.3%) escape infection compared to the baseline. CONCLUSIONS: This study demonstrates that absenteeism can have important impacts on epidemic outcomes. Thus, socioeconomic and other reasons for nonattendance of school, as well as how rates vary in different contexts, must be considered in models predicting epidemic outcomes or evaluating public health interventions in the face of major pandemics.

Disparities in the offer of COVID-19 vaccination to migrants and non-migrants in Norway: a cross sectional survey study.

BACKGROUND: Vaccination is key to reducing the spread and impacts of COVID-19 and other infectious diseases. Migrants, compared to majority populations, tend to have lower vaccination rates, as well as higher infection disease burdens. Previous studies have tried to understand these disparities based on factors such as misinformation, vaccine hesitancy or medical mistrust. However, the necessary precondition of receiving, or recognizing receipt, of an offer to get a vaccine must also be considered. METHODS: We conducted a web-based survey in six parishes in Oslo that have a high proportion of migrant residents and were hard-hit during the COVID-19 pandemic. Logistic regression analyses were conducted to investigate differences in reporting being offered the COVID-19 vaccine based on migrant status. Different models controlling for vaccination prioritization variables (age, underlying health conditions, and health-related jobs), socioeconomic and demographic variables, and variables specific to migrant status (language spoken at home and years lived in Norway) were conducted. RESULTS: Responses from 5,442 participants (response rate of 9.1%) were included in analyses. The sample included 1,284 (23.6%) migrants. Fewer migrants than non-migrants reported receiving a vaccine offer (68.1% vs. 81.1%), and this difference was significant after controlling for prioritization variables (OR 0.65, 95% CI: 0.52-0.82). Subsequent models showed higher odds ratios for reporting having been offered the vaccine for females, and lower odds ratios for those with university education. There were few to no significant differences based on language spoken at home, or among birth countries compared to each other. Duration of residence emerged as an important explanatory variable, as migrants who had lived in Norway for fewer than 15 years were less likely to report offer of a vaccine. CONCLUSION: Results were consistent with studies that show disparities between non-migrants and migrants in actual vaccine uptake. While differences in receiving an offer cannot fully explain disparities in vaccination rates, our analyses suggest that receiving, or recognizing and understanding, an offer does play a role. Issues related to duration of residence, such as inclusion in population and health registries and health and digital literacy, should be addressed by policymakers and health services organizers.

Not the great equalizers: Covid-19, 1918-20 influenza, and the need for a paradigm shift in pandemic preparedness.

Despite common perceptions to the contrary, pandemic diseases do not affect populations indiscriminately. In this paper, we review literature produced by demographers, historians, epidemiologists, and other researchers on disparities during the 1918-20 influenza pandemic and the Covid-19 pandemic. Evidence from these studies demonstrates that lower socio-economic status and minority/stigmatized race or ethnicity are associated with higher morbidity and mortality. However, such research often lacks theoretical frameworks or appropriate data to explain the mechanisms underlying these disparities fully. We suggest using a framework that considers proximal and distal factors contributing to differential exposure, susceptibility, and consequences as one way to move this research forward. Further, current pandemic preparedness plans emphasize medically defined risk groups and epidemiological approaches. Therefore, we conclude by arguing in favour of a transdisciplinary paradigm that recognizes socially defined risk groups, includes input from the social sciences and humanities and other diverse perspectives, and contributes to the reduction of health disparities before a pandemic hits.

COVID-19 vaccination and infection among people with self-reported chronic health conditions and disabilities vs. people without medical risk factors in a survey sample from Oslo.

People with disabilities and chronic health conditions are at higher risk of poor outcomes to COVID-19, yet may have lower rates of vaccination due to differences in prioritization strategies, accessibility issues, vaccine hesitancy, and other factors. Survey data from Oslo are used to investigate differences in self-reported vaccine offer, uptake, and hesitancy, as well as COVID-19 infection, for individuals with self-reported medical risk factors classified as chronic health conditions or disabilities according to likely societal perceptions. Compared to participants who reported no pre-existing medical conditions, people with chronic health conditions were more likely to have a confirmed diagnosis, be offered and take the vaccine, and have lower hesitancy, while people with disabilities generally had either no differences in or less optimal outcomes. Results suggest possible biases in vaccine recommendations and raise questions about accessibility and communication strategies, with important implications for pandemic preparedness and public health communication and practice.

Socioeconomic status and disparities in COVID-19 vaccine uptake in Eastern Oslo, Norway.

Objective: The objective of this study was to assess whether socioeconomic status still remain a barrier to COVID-19 vaccination in eastern Oslo, Norway. Study design: A cross-section study. Methods: We conducted a web-based survey among the residents of six eastern parishes in Oslo, Norway. Text (SMS) messages were sent to 59978 potential participants. 5447 surveys were completed for a response rate of 9.1%. After removing participants who had not been offered the COVID-19 vaccine, we ended up with a valid sample of 4000. Results: We find a significant association between education and the likelihood of taking the COVID-19 vaccine in bivariate logistic regression. Further, we find a significant higher likelihood of taking the vaccine in the above-low-income group compared to the low-income group. However, when we add control variables to the regression, the significant results concerning both income and education are eliminated. In further analysis, we found that age worked as a moderator between socioeconomic status and vaccine uptake: In the youngest age group (18-29), we found a significant higher likelihood of taking the vaccine in the above-low-income group compared to the low-income group, and in the higher education group compared to the primary education group. Conclusion: Socioeconomic status remains a barrier to COVID-19 vaccination in the eastern parishes of Oslo, Norway. Indicating that Norwegians of lower socioeconomic status still disproportionately face barriers such as transportation, language, flexible work hours, and paid sick time. However, our analysis shows that this association is only found in the age group 18-29.

Identifying obesity and COVID-19 overlapping risk-factors: Protocol for a systematic review and meta-analysis.

This systematic review main goal is to identify the common risk factors of obesity and COVID-19 overall, and highlight the ones related to urban settings specifically, using a syndemic framework. COVID-19 highlighted the interaction between infectious diseases and non-communicable diseases. We hypothesise that obesity and COVID-19 share determinants, thus our main goal is to identify the overlapping risk factors and their magnitude of association with both health outcomes. Literature search was conducted in Medline and Embase, Cochrane Library and Epistemonikos, Web of Science and Scopus, ASSIA and SocINDEX and, Google Scholar, in June 2021. Covidence will be used to conduct the title and abstract, and full-text screening, considering the following inclusion criteria: (a) study addresses both health outcomes, (b) full-length articles, (c) study focuses on humans and (d) studies in English. The exclusion criteria will be: (a) study addresses one of the outcomes in combination with other pathologies, (b) not full-length article, (c) study focuses on animals, (d) study not written in English, (e) study focuses on treatment (pharmacological or other), testing (prognostic) or specific patients with other pathologies and (f) study focussed in clinical and/or physiological mechanisms associated with obesity and/or COVID-19. The included studies will be assessed for quality using the Effective Public Health Practice Project for quantitative studies and the tool described by Hawker for qualitative studies. Qualitative results will be assessed using thematic analysis methods to synthesise findings and presented in summary tables. Quantitative results - meta-analysis - will be analysed and presented using Q test and Funnel Plot.

Tuberculosis as a Risk Factor for 1918 Influenza Pandemic Outcomes.

Tuberculosis (TB) mortality declined after the 1918 pandemic, suggesting that influenza killed those who would have died from TB. Few studies have analyzed TB as a direct risk factor for 1918 influenza morbidity and mortality by age and sex. We study the impacts of TB on influenza-like illness (% of population sick) and case fatality (% of cases dying) by age and sex through case-control comparisons of patients (N = 201) and employees (N = 97) from two Norwegian sanatoriums. Female patients, patients at Landeskogen sanatorium, and patients aged 10-39 years had significantly lower morbidity than the controls. None of the 62 sick employees died, while 15 of 84 sick patients did. The case-control difference in case fatality by sex was only significant for females at Lyster sanatorium and females at both sanatoriums combined. Non-significant case-control differences in case fatality for males were likely due to small samples. Patients 20-29 years for both sexes combined at Lyster sanatorium and at both sanatoriums combined, as well as females 20-29 years for both sanatoriums combined, had significantly higher case fatality. We conclude that TB was associated with higher case fatality, but morbidity was lower for patients than for employees. The results add to the study of interactions between bacterial and viral diseases and are relevant in preparing for pandemics in TB endemic areas.

Using cultural, historical, and epidemiological data to inform, calibrate, and verify model structures in agent-based simulations.

Agent-based simulation models are excellent tools for addressing questions about the spread of infectious diseases in human populations because realistic, complex behaviors as well as random factors can readily be incorporated. Agent-based models are flexible and allow for a wide variety of behaviors, time-related variables, and geographies, making the calibration process an extremely important step in model development. Such calibration procedures, including verification and validation, may be complicated, however, and usually require incorporation of substantial empirical data and theoretical knowledge of the populations and processes under study. This paper describes steps taken to build and calibrate an agent-based model of epidemic spread in an early 20th century fishing village in Newfoundland and Labrador, including a description of some of the detailed ethnographic and historical data available. We illustrate how these data were used to develop the structure of specific parts of the model. The resulting model, however, is designed to reflect a generic small community during the early 20th century and the spread of a directly transmitted disease within such a community, not the specific place that provided the data. Following the description of model development, we present the results of a replication study used to confirm the model behaves as intended. This study is also used to identify the number of simulations necessary for high confidence in average model output. We also present selected results from extensive sensitivity analyses to assess the effect that variation in parameter values has on model outcomes. After careful calibration and verification, the model can be used to address specific practical questions of interest. We provide an illustrative example of this process.

Clothing-related barriers experienced by people with mobility disabilities and impairments.

Clothing-related issues can create barriers to social participation and other desired activities for people living with disabilities and their families. The purpose of this study was to identify clothing-related barriers people living with disabilities and their families are facing. An online survey was administered to people living with disabilities and parents/caregivers, resulting in a sample of 113 participants indicating mobility impairments. Survey results indicated that the clothing needs of people living with disabilities and impairments are not being met, the lack of appropriate clothing prevented individuals from fully engaging in social activities and relationships, employment or everyday life events. The design fields and apparel industry could play a vital role in helping people with mobility disabilities navigate these barriers.

Defining epidemics in computer simulation models: How do definitions influence conclusions?

Computer models have proven to be useful tools in studying epidemic disease in human populations. Such models are being used by a broader base of researchers, and it has become more important to ensure that descriptions of model construction and data analyses are clear and communicate important features of model structure. Papers describing computer models of infectious disease often lack a clear description of how the data are aggregated and whether or not non-epidemic runs are excluded from analyses. Given that there is no concrete quantitative definition of what constitutes an epidemic within the public health literature, each modeler must decide on a strategy for identifying epidemics during simulation runs. Here, an SEIR model was used to test the effects of how varying the cutoff for considering a run an epidemic changes potential interpretations of simulation outcomes. Varying the cutoff from 0% to 15% of the model population ever infected with the illness generated significant differences in numbers of dead and timing variables. These results are important for those who use models to form public health policy, in which questions of timing or implementation of interventions might be answered using findings from computer simulation models.

Apparel-related participation barriers: ability, adaptation and engagement.

PURPOSE: To document apparel-related barriers faced by people with disabilities (PWD) and their families as they attempted to engage in various aspects of social participation, and explore the often invisible relationship between apparel-related barriers and disablement. METHOD: For this qualitative research, we used focus groups to interview PWD, their caregivers and/or parents and health providers to document the experience of apparel-related barriers to community or social participation. A constructivist grounded theory approach was used to analyse interview transcripts and noted. RESULTS: Participant's responses were grouped into categories of unmet need for adaptive apparel as well as a list of specific apparel-related barriers that participants struggled to navigate in daily life; including functional, cultural and sensory-based issues. CONCLUSIONS: The lack of adequate accessible apparel for PWD exacerbated barriers to community participation and disablement, and identified the need for innovation in design, production, distribution and sale, of adaptive clothing. Implications for Rehabilitation The lack of adaptive or appropriate clothing or apparel for people living with disabilities can become a barrier, preventing engagement in meaningful activities, yet these barriers are not often explicitly identified. Cultural issues regarding clothing and the process of dressing may become unspoken barriers to engagement in meaningful activities, impacting the way care services are assigned. Rehabilitation professionals may need to take clothing and apparel-related issues faced by their clients into account, so that opportunities for social participation can be maximised.