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Objective: To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks. Design: Prospective national population‐based EPIPAGE‐2 cohort study. Setting: 268 neonatology departments in France, March to December 2011. Population: Mothers who delivered between 22 and 34 weeks and whose self‐reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES‐D) and anxiety (State‐Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge. Methods: The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES‐D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design‐based log‐linear regression model. Main outcome measures: Severe symptoms of depression and anxiety in mothers of preterm infants. Results: Among the 2270 women completing CES‐D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12–1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety. Conclusions: Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care. Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression. Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression. [ABSTRACT FROM AUTHOR]

Objective: To compare the short- and mid-term outcomes of preterm twins by chorionicity of pregnancy.Design: Prospective nationwide population-based EPIPAGE-2 cohort study.Setting: 546 maternity units in France, between March and December 2011.Population: A total of 1700 twin neonates born between 24 and 34 weeks of gestation.Methods: The association of chorionicity with outcomes was analysed using multivariate regression models.Main Outcome Measures: First, survival at 2-year corrected age with or without neurosensory impairment, and second, perinatal, short-, and mid-term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity.Results: In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2-year follow-up neurodevelopmental results were not significantly different between DC and MC twins.Conclusions: This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity.Tweetable Abstract: Monochorionicity is associated with adverse perinatal outcomes, but outcomes for preterm twins are comparable irrespective of their chorionicity. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between absent or reversed end-diastolic flow (ARED) on umbilical artery Doppler ultrasound and poor neurological outcome at 2 years of age after very preterm birth associated with suspected fetal growth restriction (FGR) or maternal hypertensive disorders.Methods: The study population comprised all very preterm (22-31 completed weeks) singleton pregnancies delivered because of suspected FGR and/or maternal hypertensive disorders that had umbilical artery Doppler and 2-year follow-up available included in EPIPAGE-2, a prospective, nationwide, population-based cohort of preterm births in France in 2011. Univariate and two-level multivariable logistic regression analyses were used to assess the association of ARED in the umbilical artery, as compared with normal or reduced end-diastolic flow, with severe or moderate neuromotor and/or sensory disability and with an Ages and Stages Questionnaire (ASQ) score below a threshold. This was defined as a score more than 2 SD below the mean in any of the five domains, at age 2, adjusting for gestational age at delivery. ASQ is used to identify children at risk of developmental delay requiring reinforced follow-up and further evaluation. Descriptive statistics and bivariate tests were weighted according to the duration of the inclusion periods.Results: The analysis included 484 children followed up at 2 years of age, for whom prenatal umbilical artery Doppler ultrasound was available. Among them, 8/484 (1.6%) had severe or moderate neuromotor and/or sensory disability, and 156/342 (45.4%) had an ASQ score below the threshold. Compared with normal or reduced end-diastolic flow in the umbilical artery (n = 305), ARED (n = 179) was associated with severe or moderate neuromotor and/or sensory disability (adjusted odds ratio (OR), 11.3; 95% CI, 1.4-93.2) but not with an ASQ score below the threshold (adjusted OR, 1.2; 95% CI, 0.8-1.9).Conclusion: Among children delivered before 32 weeks of gestation due to suspected FGR and/or maternal hypertensive disorder who survived until 2 years of age, prenatal ARED in the umbilical artery was associated with a higher incidence of severe or moderate neuromotor and/or sensory disability. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To assess whether planned route of delivery is associated with perinatal and 2-year outcomes for preterm breech singletons.Design: Prospective nationwide population-based EPIPAGE-2 cohort study.Setting: France, 2011.Sample: Three hundred and ninety women with breech singletons born at 26-34 weeks of gestation after preterm labour or preterm prelabour rupture of membranes.Methods: Propensity-score analysis.Main Outcome Measures: Survival at discharge, survival at discharge without severe morbidity, and survival at 2 years of corrected age without neurosensory impairment.Results: Vaginal and caesarean deliveries were planned in 143 and 247 women, respectively. Neonates with planned vaginal delivery and planned caesarean delivery did not differ in survival (93.0 versus 95.7%, P = 0.14), survival at discharge without severe morbidity (90.4 versus 89.9%, P = 0.85), or survival at 2 years without neurosensory impairment (86.6 versus 91.6%, P = 0.11). After applying propensity scores and assigning inverse probability of treatment weighting, as compared with planned vaginal delivery, planned caesarean delivery was not associated with improved survival (odds ratio, OR 1.31; 95% confidence interval, 95% CI 0.67-2.59), survival without severe morbidity (OR 0.75, 95% CI 0.45-1.27), or survival at 2 years without neurosensory impairment (OR 1.04, 95% CI 0.60-1.80). Results were similar after matching on propensity score.Conclusions: No association between planned caesarean delivery and improved outcomes for preterm breech singletons born at 26-34 weeks of gestation after preterm labour or preterm prelabour rupture of membranes was found. The route of delivery should be discussed with women, balancing neonatal outcomes with the higher risks of maternal morbidity associated with caesarean section performed at low gestational age. [ABSTRACT FROM AUTHOR]

Background: The present analysis aimed to assess the mediating role of psychosocial and behavioural factors in socio-economic inequalities in health-related quality of life (HRQoL) among children and adolescents., Methods: Cross-sectional data was drawn from the randomly selected SEROCoV-KIDS cohort study in Geneva, Switzerland. Associations of socio-economic conditions (parents' highest education, household financial situation) with HRQoL, psychosocial (parent-child relationship, school difficulties, friends, extracurricular activities) and behavioural factors (screen time, physical activity, green spaces time, sleep duration), along with associations of psychosocial and behavioural factors with HRQoL, were evaluated with generalized estimating equations. Counterfactual mediation analyses were conducted to test pathways linking socio-economic conditions to HRQoL., Results: Of 965 children and 816 adolescents, those with disadvantaged financial circumstances were more likely to have a poor HRQoL (adjusted Odds Ratio [aOR]: 3.80; 95% confidence interval [CI]: 1.96-7.36 and aOR: 3.66; 95%CI: 2.06-6.52, respectively). Psychosocial characteristics mediated 25% (95%CI: 5-70%) and 40% (95%CI: 18-63%) of financial disparities in HRQoL among children and adolescents, respectively. Health behaviours were weakly patterned by socio-economic conditions and did not contribute to financial differences in HRQoL., Conclusions: These findings provide empirical evidence for mechanisms explaining socio-economic disparities in child HRQoL and could inform interventions aimed to tackle health inequalities., (© 2024. The Author(s).)

Backgrounds: Acne vulgaris is one of the most common skin conditions worldwide among adolescents. Beyond its physical manifestations, acne can leave invisible psychological scars., Objectives: We aimed to examine the protective and risk factors of acne-related quality of life, and its association with mental health outcomes., Methods: The analysis included data collected in 2023 from adolescents enrolled in the SEROCoV-KIDS population-based cohort. By combining the Acne Severity and Acne-Quality of Life (Acne-QoL) scales, three groups were established: Acne-LowAQoL (adolescents with acne and low Acne-related Quality of Life), Acne-HighAQoL, and NoAcne-HighAQoL. We used multinomial and logistic regression to assess the association between health behaviours, these groups, and mental health outcomes., Results: Among 335 adolescents (mean age 16.1 years [SD 1.8], 56% female), 65 (19.4%) reported experiencing acne while maintaining a high Acne-QoL, 26 (7.7%) reported having acne and a low Acne-QoL and 244 (72.9%) reported having nearly no acne. Low engagement in physical activity (aOR: 0.30, 95% CI: 0.12-0.77), addictive use of social media (aOR: 3.78, 95%CI: 1.60-8.96), and prolonged screen time (aOR: 2.99, 95%CI: 1.26-7.08) were independently associated with Acne-LowAQoL. Conversely, those from the group Acne-HighAQoL reported higher social support (aOR: 1.95, 95%CI: 1.07-3.54). Adolescents with Acne-LowAQoL showed lower levels of self-esteem, resilience, and increased psychological distress., Conclusions: Among adolescents with acne, physical activity and social support were positively associated with good acne-related quality of life, which translated into better mental health. In contrast, screen time and social media use notably reduced it. Dermatologists should incorporate these considerations into clinical practice to ensure effective patient care., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Background: Maternal exposure to unfavourable social conditions is associated with a higher rate of perinatal complications, such as placental vascular pathologies. A higher risk of preterm birth (PTB) has also been reported, and variations across studies and settings suggest that different patterns may be involved in this association., Objective: To assess the association between maternal social deprivation and PTB (overall and by phenotype)., Methods: We analysed 9365 patients included in the PreCARE cohort study. Four dimensions (social isolation, insecure housing, no income from work and absence of standard health insurance) defined maternal social deprivation (exposure). They were considered separately and combined into a social deprivation index (SDI). The associations between social deprivation and PTB <37 weeks (primary outcome) were analysed with univariable and multivariable log-binomial models (adjusted for maternal age, parity, education level and birthplace). Then we used multinomial analysis to examine the association with preterm birth phenotypes (secondary outcome): spontaneous labour, preterm prelabour rupture of membranes (PPROM) and placental vascular pathologies., Results: In all, 66.3%, 17.8%, 8.9% and 7.0% of patients had an SDI of 0, 1, 2 and 3, respectively. Social isolation affected 4.5% of the patients, insecure housing 15.5%, no income from work 15.6% and no standard health insurance 22.4%. Preterm birth complicated 7.0% of pregnancies (39.8% spontaneous labour, 28.3% PPROM, 21.8% placental vascular pathologies and 10.1% other phenotypes). Neither the univariable nor multivariable analyses found any association between social deprivation and the risk of preterm birth overall (SDI 1 versus 0: aRR 1.02, 95% confidence interval [CI] 0.83, 1.26; 2 versus 0: aRR 1.05, 95% CI 0.80, 1.38; 3 versus 0: aRR 0.92, 95% CI 0.66, 1.29) or its different phenotypes., Conclusions: In the French PreCARE cohort, we observed no association between markers of social deprivation and the risk of preterm birth, regardless of phenotype., (© 2024 The Author(s). Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.)

Objective: To further examine the relationship between bedtime media use and sleep in adults by taking relevant covariates into account and testing hypothesised mediating and moderating pathways., Methods: Bedtime media use and sleep outcomes were examined by questionnaire in 4188 adults (59 % women, aged 19-94 years) from the Specchio cohort based in Geneva, Switzerland. We tested associations between bedtime media use and sleep (bedtimes, rise times, sleep latency, sleep duration, sleep quality, insomnia, and daytime sleepiness), adjusting for prior sleep, mental health, and health behaviours; whether bedtime media use mediates associations between individual susceptibility factors (age, chronotype, and mental health) and sleep; and whether individual susceptibility factors moderate associations between bedtime media use and sleep., Results: Often using a screen in the 30 minutes before going to sleep at night was associated with a late bedtime (≥midnight; OR [95 % CI] = 1.90 [1.44,2.51], p < 0.001), a short sleep duration (<7 h; 1.21 [1.01,1.46], p < 0.05), and excessive daytime sleepiness (Epworth score >9; 1.47 [1.25,1.74], p < 0.001), adjusting for all covariates. Bedtime media use partly mediated the association between younger age and an evening chronotype and these sleep outcomes. Mental health moderated the association between bedtime media use and sleep quality/insomnia, such that the former was only associated with poorer sleep quality/insomnia among individuals with better mental health., Conclusions: Frequent bedtime media use was associated with various sleep outcomes, independently of relevant covariates. Limiting the use of screens at bedtime is important to promote sleep among adults. Individuals with poorer mental health likely require additional support to improve their sleep quality., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Mental health deteriorated in the early stages of the COVID-19 pandemic, but improved relatively quickly as restrictions were eased, suggesting overall resilience. However, longer-term follow-up of mental health in the general population is scarce., Methods: We examined mental health trajectories in 5624 adults (58 % women; aged 18-97 years) from the Specchio-COVID19 cohort, using the Generalized Anxiety Disorder scale-2 and the Patient Health Questionnaire-2, administered each month from February to June 2021, and in Spring 2022 and 2023., Results: Depressive and anxiety symptoms declined during a pandemic wave from February to May 2021 (β = -0.06 [-0.07, -0.06]; -0.06 [-0.07, -0.05]), and remained lower at longer-term follow-up than at the start of the wave. Loneliness also declined over time, with the greatest decline during the pandemic wave (β = -0.25 [-0.26, -0.24]). Many higher-risk groups, including socioeconomically disadvantaged individuals, those with a chronic condition, and those living alone had poorer mental health levels throughout the study period. Women and younger individuals had a faster improvement in mental health during the pandemic wave. Loneliness trajectories were associated with mental health trajectories throughout the study period., Limitations: We cannot definitively conclude that the observed changes in mental health were due to experiences of the pandemic., Conclusions: While there was a need for additional mental health support during stricter policy responses to COVID-19, overall, mental health improved relatively soon after measures were eased. Nevertheless, the persistence of mental health disparities highlights the need for further efforts from the government and healthcare practitioners to support vulnerable groups beyond the pandemic., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: To assess the association between socioeconomic status (SES) and self-reported adherence to preventive measures in Switzerland during the COVID-19 pandemic., Methods: 4,299 participants from a digital cohort were followed between September 2020 and November 2021. Baseline equivalised disposable income and education were used as SES proxies. Adherence was assessed over time. We investigated the association between SES and adherence using multivariable mixed logistic regression, stratifying by age (below/above 65 years) and two periods (before/after June 2021, to account for changes in vaccine coverage and epidemiological situation)., Results: Adherence was high across all SES strata before June 2021. After, participants with higher equivalised disposable income were less likely to adhere to preventive measures compared to participants in the first (low) quartile [second (Adj.OR, 95% CI) (0.56, 0.37-0.85), third (0.38, 0.23-0.64), fourth (0.60, 0.36-0.98)]. We observed similar results for education., Conclusion: No differences by SES were found during the period with high SARS-CoV-2 incidence rates and stringent measures. Following the broad availability of vaccines, lower incidence, and eased measures, differences by SES started to emerge. Our study highlights the need for contextual interpretation when assessing SES impact on adherence to preventive measures., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Tancredi, van der Linden, Chiolero, Cullati, Imboden, Probst-Hensch, Keidel, Witzig, Dratva, Michel, Harju, Frank, Lorthe, Baysson, Stringhini, Kahlert, Bardoczi, Haller, Chocano-Bedoya, Rodondi, Amati, Albanese, Corna, Crivelli, Kaufmann, Frei and von Wyl.)

Background: The administration of tocolytics after preterm prelabor rupture of membranes remains a controversial practice. In theory, reducing uterine contractility should delay delivery and allow for optimal antenatal management, thereby reducing the risks for prematurity and adverse consequences over the life course. However, tocolysis may be associated with neonatal death or long-term adverse neurodevelopmental outcomes, mainly related to prolonged fetal exposure to intrauterine infection or inflammation. In a previous study, we showed that tocolysis administration was not associated with short-term benefits. There are currently no data available to evaluate the impact of tocolysis on neurodevelopmental outcomes in school-aged children born prematurely in this clinical setting., Objective: This study aimed to investigate whether tocolysis administered after preterm prelabor rupture of membranes is associated with neurodevelopmental outcomes at 5.5 years of age., Study Design: We used data from a prospective, population-based cohort study of preterm births recruited in 2011 (referred to as the EPIPAGE-2 study) and for whom the results of a comprehensive medical and neurodevelopmental assessment of the infant at age 5.5 years were available. We included pregnant individuals with preterm prelabor rupture of membranes at 24 to 32 weeks' gestation in singleton pregnancies with a live fetus at the time of rupture, birth at 24 to 34 weeks' gestation, and participation of the infant in an assessment at 5.5 years of age. Exposure was the administration of any tocolytic treatment after preterm prelabor rupture of membranes. The main outcome was survival without moderate to severe neurodevelopmental disabilities at 5.5 years of age. Secondary outcomes included survival without any neurodevelopmental disabilities, cerebral palsy, full-scale intelligence quotient, developmental coordination disorders, and behavioral difficulties. A propensity-score analysis was used to minimize the indication bias in the estimation of the treatment effect on outcomes., Results: Overall, 596 of 803 pregnant individuals (73.4%) received tocolytics after preterm prelabor rupture of membranes. At the 5.5-year follow-up, 82.7% and 82.5% of the children in the tocolysis and no tocolysis groups, respectively, were alive without moderate to severe neurodevelopmental disabilities; 52.7% and 51.1%, respectively, were alive without any neurodevelopmental disabilities. After applying multiple imputations and inverse probability of treatment weighting, we found no association between the exposure to tocolytics and survival without moderate to severe neurodevelopmental disabilities (odds ratio, 0.93; 95% confidence interval, 0.55-1.60), survival without any neurodevelopmental disabilities (odds ratio, 1.02; 95% confidence interval, 0.65-1.61), or any of the other outcomes., Conclusion: There was no difference in the neurodevelopmental outcomes at age 5.5 years among children with and without antenatal exposure to tocolysis after preterm prelabor rupture of membranes. To date, the health benefits of tocolytics remain unproven, both in the short- and long-term., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Pandemic-related life changes may have had a deleterious impact on suicidal behaviours. Early detection of suicidal ideation and identification of subgroups at increased risk could help prevent suicide, one of the leading causes of death among adolescents worldwide. Here, we aimed to investigate the prevalence of and risk factors for suicidal ideation in adolescents using a population-based sample from Switzerland, two years into the pandemic., Methods: Between December 2021 and June 2022, adolescents aged 14 to 17 years already enrolled in a population-based cohort study (State of Geneva, Switzerland) were asked about suicidal ideation over the previous year. In addition to a regression model, we conducted a network analysis of exposures which identified direct and indirect risk factors for suicidal ideation (i.e. those connected through intermediate risk factors) using mixed graphical models., Results: Among 492 adolescents, 14.4% (95% CI: 11.5-17.8) declared having experienced suicidal ideation over the previous year. Using network analysis, we found that high psychological distress, low self-esteem, identifying as lesbian, gay or bisexual, suffering from bullying, extensive screen time and a severe COVID-19 pandemic impact were major risk factors for suicidal ideation, with parent-adolescent relationship having the highest centrality strength in the network., Conclusion: Our results show that a significant proportion of adolescents experience suicidal ideation, yet these rates are comparable with pre-pandemic results. Providing psychological support is fundamental, with a focus on improving parent-adolescent relationships.

Objective: To assess the association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born preterm., Study Design: EPIPAGE 2 is a national, population-based cohort study of children born before 35 weeks of gestation in France in 2011. We included infants born alive between 24 0/7 and 34 6/7  weeks after preterm labor or preterm premature rupture of membranes. Clinical chorioamnionitis was defined as maternal fever before labor (>37.8°C) with ≥2 of the following criteria: maternal tachycardia, hyperleukocytosis, uterine contractions, purulent amniotic fluid, or fetal tachycardia. The primary outcome was a composite, including cerebral palsy, coordination disorders, cognitive disorders, sensory disorders, or behavioral disorders. We also analyzed each of these disorders separately as secondary outcomes. We performed a multivariable analysis using logistic regression models. We accounted for the nonindependence of twins and missing data by generalized estimating equation models and multiple imputations, respectively., Results: Among 2927 children alive at 5 years of age, 124 (3%) were born in a context of clinical chorioamnionitis. Overall, 8.2% and 9.6% of children exposed and unexposed, respectively, to clinical chorioamnionitis had moderate-to-severe neurodevelopmental disorders. After multiple imputations and multivariable analysis, clinical chorioamnionitis was not associated with the occurrence of moderate-to-severe neurodevelopmental disorders (aOR, 0.9; 95% CI, 0.5-1.8)., Conclusions: We did not find any association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born at <35 weeks of gestation after preterm labor or preterm premature rupture of membrane., Competing Interests: Declaration of Competing Interest The EPIPAGE 2 study was funded with support from the French Institute of Public Health Research/Institute of Public Health, and its partners. Partners include the French Health Ministry, National Institute of Health and Medical Research (INSERM), National Institute of Cancer, and National Solidarity Fund for Autonomy (CNSA); National Research Agency through the French EQUIPEX programme of investments in the future (reference ANR-11-EQPX-0038, ANR-19-COHO-001); PREMUP Foundation; Foundation of France (reference 11779); Foundation for Medical Research (SPF20160936356); and hospital clinical research programme Epinutri (DGOS13-040). Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation (G13129KK); Apicil Foundation (R20065KK). The funding source had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval the manuscript; and the decision to submit the manuscript for publication. The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Lorthe, Severo, Hamwi, Rodrigues, Teixeira and Barros.)

Background: Neuraxial analgesia (NA) is the most effective modality in managing labor pain with widespread availability in high-income countries. Previous research has reported a differential obstetric NA use among migrant and native women, but the contribution of language barriers is not well understood. We aimed to investigate whether host-country language proficiency among migrant women influences NA use and satisfaction with pain management during labor, when compared to natives., Methods: We conducted a secondary analysis of data collected from 1024 native and 1111 migrant women who had singleton vaginal deliveries between 2017 and 2019 and were enrolled in the nationwide Portuguese baMBINO prospective cohort study. Obstetric NA use, satisfaction with labor pain management, and migrants' Portuguese language proficiency were self-reported. Data were analyzed using robust multilevel Poisson regression, adjusted for maternal region of birth (characterized by the Human Development Index), age, and education., Results: Overall, 84.4% of native women gave birth with NA, compared to 81.6%, 71.3%, and 56.9% of migrant women with full, intermediate, and limited language proficiency, respectively. Compared to native women, migrants with intermediate (adjusted risk ratio [aRR] = 0.91 [95% confidence interval {CI}, 0.82-0.99]) and limited (aRR = 0.73 [95% CI, 0.56-0.94]) proficiency were less likely to receive NA. However, no significant differences were observed in pain management satisfaction by language proficiency level., Conclusions: Compared to native women, we observed a differential obstetric NA use across migrant women with different host-country language proficiency levels in Portugal, without affecting satisfaction with labor pain management. Although defining the mechanisms underlying NA use discrepancies requires further research, our findings support systematically evaluating pregnant migrant women's linguistic skills and ensuring their access to adequate obstetric analgesia-related information and interpretation services., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 International Anesthesia Research Society.)

Purpose: We aimed to assess the seroprevalence trends of SARS-CoV-2 antibodies in several Swiss cantons between May 2020 and September 2021 and investigate risk factors for seropositivity and their changes over time., Methods: We conducted repeated population-based serological studies in different Swiss regions using a common methodology. We defined three study periods: May-October 2020 (period 1, prior to vaccination), November 2020-mid-May 2021 (period 2, first months of the vaccination campaign), and mid-May-September 2021 (period 3, a large share of the population vaccinated). We measured anti-spike IgG. Participants provided information on sociodemographic and socioeconomic characteristics, health status, and adherence to preventive measures. We estimated seroprevalence with a Bayesian logistic regression model and the association between risk factors and seropositivity with Poisson models., Results: We included 13,291 participants aged 20 and older from 11 Swiss cantons. Seroprevalence was 3.7% (95% CI 2.1-4.9) in period 1, 16.2% (95% CI 14.4-17.5) in period 2, and 72.0% (95% CI 70.3-73.8) in period 3, with regional variations. In period 1, younger age (20-64) was the only factor associated with higher seropositivity. In period 3, being aged ≥ 65 years, with a high income, retired, overweight or obese or with other comorbidities, was associated with higher seropositivity. These associations disappeared after adjusting for vaccination status. Seropositivity was lower in participants with lower adherence to preventive measures, due to a lower vaccination uptake., Conclusions: Seroprevalence sharply increased over time, also thanks to vaccination, with some regional variations. After the vaccination campaign, no differences between subgroups were observed., (© 2023. The Author(s).)

Aim: To describe the circumstances, causes and timing of death in extremely preterm infants., Methods: We included from the EPIPAGE-2 study infants born at 24-26 weeks in 2011 admitted to neonatal intensive care units (NICU). Vital status and circumstances of death were used to define three groups of infants: alive at discharge, death with or without withholding or withdrawing life-sustaining treatment (WWLST). The main cause of death was classified as respiratory disease, necrotizing enterocolitis, infection, central nervous system (CNS) injury, other or unknown., Results: Among 768 infants admitted to NICU, 224 died among which 89 died without WWLST and 135 with WWLST. The main causes of death were respiratory disease (38%), CNS injury (30%) and infection (12%). Among the infants who died with WWLST, CNS injury was the main cause of death (47%), whereas respiratory disease (56%) and infection (20%) were the main causes in case of death without WWLST. Half (51%) of all deaths occurred within the first 7 days of life, and 35% occurred within 8 and 28 days., Conclusion: The death of extremely preterm infants in NICU is a complex phenomenon in which the circumstances and causes of death are intertwined., (© 2023 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: To compare the neurodevelopmental outcomes of preterm twins at 5½ years by chorionicity of pregnancy., Design: Prospective nationwide population-based EPIPAGE2 (Etude Epidémiologique sur les Petits Âges Gestationnels) cohort study., Setting: A total of 546 maternity units in France, between March and December 2011., Population: A total of 1126 twins eligible for follow-up at 5½ years., Methods: The association of chorionicity with outcomes was analysed using multivariate regression models., Main Outcome Measures: Survival at 5½ years with or without neurodevelopmental disabilities (comprising cerebral palsy, visual, hearing, cognitive deficiency, behavioural difficulties or developmental coordination disorders) were described and compared by chorionicity., Results: Among the 1126 twins eligible for follow-up at 5½ years, 926 (82.2%) could be evaluated: 228 monochorionic (MC) and 698 dichorionic (DC). Based on chronicity and gestational age of birth, we found no significant differences for severe neonatal morbidity. The rates of moderate/severe neurobehavioral disabilities were similar in infants from DC pregnancies versus infants from MC pregnancies (OR 1.22, 95% CI 0.65-2.28). By gestational age and without twin-twin transfusion syndrome (TTTS), no difference according to chorionicity was found for all neurodevelopmental outcome measures., Conclusions: The neurodevelopmental outcomes among preterm twins at 5½ years is similar, irrespective of chorionicity., (© 2023 John Wiley & Sons Ltd.)

Background: Children and adolescents are highly vulnerable to the impact of sustained stressors during developmentally sensitive times. We investigated how demographic characteristics intersect with socioeconomic dimensions to shape the social patterning of quality of life and mental health in children and adolescents, two years into the COVID-19 pandemic., Methods: We used data from the prospective SEROCoV-KIDS cohort study of children and adolescents living in Geneva (Switzerland, 2022). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 48 social strata defined by intersecting sex, age, immigrant background, parental education and financial hardship in Bayesian multilevel logistic models for poor health-related quality of life (HRQoL, measured with PedsQL) and mental health difficulties (measured with the Strengths and Difficulties Questionnaire)., Results: Among participants aged 2-17 years, 240/2096 (11.5%, 95%CI 10.1-12.9) had poor HRQoL and 105/2135 (4.9%, 95%CI 4.0-5.9) had mental health difficulties. The predicted proportion of poor HRQoL ranged from 3.4% for 6-11 years old Swiss girls with highly educated parents and no financial hardship to 34.6% for 12-17 years old non-Swiss girls with highly educated parents and financial hardship. Intersectional strata involving adolescents and financial hardship showed substantially worse HRQoL than their counterparts. Between-stratum variations in the predicted frequency of mental health difficulties were limited (range 4.4%-6.5%)., Conclusions: We found considerable differences in adverse outcomes across social strata. Our results suggest that, post-pandemic, interventions to address social inequities in HRQoL should focus on specific intersectional strata involving adolescents and families experiencing financial hardship, while those aiming to improve mental health should target all children and adolescents., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: KMPB is a member of the Advisory Boards for pneumococcal vaccine and varicella vaccine at MSD. All other authors declare that they have no competing interests., (© 2023 The Authors.)

Objectives: We compared socio-demographic characteristics, health-related variables, vaccination-related beliefs and attitudes, vaccination acceptance, and personality traits of individuals who vaccinated against COVID-19 and who did not vaccinate by December 2021. Methods: This cross-sectional study used data of 10,642 adult participants from the Corona Immunitas eCohort, an age-stratified random sample of the population of several cantons in Switzerland. We used multivariable logistic regression models to explore associations of vaccination status with socio-demographic, health, and behavioral factors. Results: Non-vaccinated individuals represented 12.4% of the sample. Compared to vaccinated individuals, non-vaccinated individuals were more likely to be younger, healthier, employed, have lower income, not worried about their health, have previously tested positive for SARS-CoV-2 infection, express lower vaccination acceptance, and/or report higher conscientiousness. Among non-vaccinated individuals, 19.9% and 21.3% had low confidence in the safety and effectiveness of SARS-CoV-2 vaccine, respectively. However, 29.1% and 26.7% of individuals with concerns about vaccine effectiveness and side effects at baseline, respectively vaccinated during the study period. Conclusion: In addition to known socio-demographic and health-related factors, non-vaccination was associated with concerns regarding vaccine safety and effectiveness., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2023 Sabatini, Kaufmann, Fadda, Tancredi, Noor, Van Der Linden, Cullati, Frank, Michel, Harju, Luedi, Frei, Ballouz, Menges, Fehr, Kohler, Kahlert, Scheu, Ortega, Chocano-Bedoya, Rodondi, Stringhini, Baysson, Lorthe, Zufferey, Suggs, Albanese, Vincentini, Bochud, D’Acremont, Nusslé, Imboden, Keidel, Witzig, Probst-Hensch and von Wyl.)

Background: Preterm birth is a global health concern. Its adverse consequences may persist throughout the life course, exerting a potentially heavy burden on families, health systems, and societies. In high-income countries, the first children who benefited from improved care are now adults entering middle age. However, there is a clear gap in the knowledge regarding the long-term outcomes of individuals born preterm., Objective: This study aimed to assess the feasibility of recruiting and following up an e-cohort of adults born preterm worldwide and provide estimations of participation, characteristics of participants, the acceptability of questions, and the quality of data collected., Methods: We implemented a prospective, open, observational, and international e-cohort pilot study (Health of Adult People Born Preterm-an e-Cohort Pilot Study [HAPP-e]). Inclusion criteria were being an adult (aged ≥18 years), born preterm (<37 weeks of gestation), having internet access and an email address, and understanding at least 1 of the available languages. A large, multifaceted, and multilingual communication strategy was established. Between December 2019 and June 2021, inclusion and repeated data collection were performed using a secured web platform. We provided descriptive statistics regarding participation in the e-cohort, namely, the number of persons who registered on the platform, signed the consent form, initiated and completed the baseline questionnaire, and initiated and completed the follow-up questionnaire. We also described the main characteristics of the HAPP-e participants and provided an assessment of the quality of the data and the acceptability of sensitive questions., Results: As of December 31, 2020, a total of 1004 persons had registered on the platform, leading to 527 accounts with a confirmed email and 333 signed consent forms. A total of 333 participants initiated the baseline questionnaire. All participants were invited to follow-up, and 35.7% (119/333) consented to participate, of whom 97.5% (116/119) initiated the follow-up questionnaire. Completion rates were very high both at baseline (296/333, 88.9%) and at follow-up (112/116, 96.6%). This sample of adults born preterm in 34 countries covered a wide range of sociodemographic and health characteristics. The gestational age at birth ranged from 23+6 to 36+6 weeks (median 32, IQR 29-35 weeks). Only 2.1% (7/333) of the participants had previously participated in a cohort of individuals born preterm. Women (252/333, 75.7%) and highly educated participants (235/327, 71.9%) were also overrepresented. Good quality data were collected thanks to validation controls implemented on the web platform. The acceptability of potentially sensitive questions was excellent, as very few participants chose the "I prefer not to say" option when available., Conclusions: Although we identified room for improvement in specific procedures, this pilot study confirmed the great potential for recruiting a large and diverse sample of adults born preterm worldwide, thereby advancing research on adults born preterm., (©Elsa Lorthe, Carolina Santos, José Pedro Ornelas, Julia Nadine Doetsch, Sandra C S Marques, Raquel Teixeira, Ana Cristina Santos, Carina Rodrigues, Gonçalo Gonçalves, Pedro Ferreira Sousa, João Correia Lopes, Artur Rocha, Henrique Barros. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.05.2023.)

Introduction: The global sequence of the pathogenesis of preterm labor remains unclear. This study aimed to compare amniotic fluid concentrations of extracellular matrix-related proteins (procollagen, osteopontin and IL-33), and of cytokines (IL-19, IL-6, IL-20, TNFα, TGFβ, and IL-1β) in asymptomatic women with and without subsequent spontaneous preterm delivery., Material and Methods: We used amniotic fluid samples of singleton pregnancy, collected by amniocentesis between 16 and 20 weeks' gestation, without stigmata of infection (i.e., all amniotic fluid samples were tested with broad-range 16 S rDNA PCR to distinguish samples with evidence of past bacterial infection from sterile ones), during a randomized, double-blind, placebo-controlled trial to perform a nested case-control laboratory study. Cases were women with a spontaneous delivery before 37 weeks of gestation (preterm group). Controls were women who gave birth at or after 39 weeks (full term group). Amniotic fluid concentrations of the extracellular matrix-related proteins and cytokines measured by immunoassays were compared for two study groups., Clinicaltrials: gov: NCT00718705., Results: Between July 2008 and July 2011, in 12 maternal-fetal medicine centers in France, 166 women with available PCR-negative amniotic fluid samples were retained for the analysis. Concentrations of procollagen, osteopontin, IL-19, IL-6, IL-20, IL-33, TNFα, TGFβ, and IL-1β were compared between the 37 who gave birth preterm and the 129 women with full-term delivery. Amniotic fluid levels of procollagen, osteopontin, IL-19, IL-33, and TNFα were significantly higher in the preterm than the full-term group. IL-6, IL-20, TGFβ, and IL-1β levels did not differ between the groups., Conclusions: In amniotic fluid 16 S rDNA PCR negative samples obtained during second-trimester amniocentesis, extracellular matrix-related protein concentrations (procollagen, osteopontin and IL-33), together with IL-19 and TNFα, were observed higher at this time in cases of later spontaneous preterm birth., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Background: Sport participation is an important component of a healthy lifestyle and is known to be more common among privileged individuals. However, few studies examined socio-demographic patterns of participation by type of activity. This study aims at quantifying socio-economic inequalities in sport participation by sport type, and to analyse their trend over 15 years., Methods: We used 2005-2019 data from the Bus Santé study, a yearly population-based cross-sectional survey of Geneva adults. Sport participation was defined as reporting at least one sporting activity over the previous week; educational level, household income and occupational position were used as indicators of socio-economic position. Socio-economic inequalities in sport participation, and their trend over time, were examined using the relative and slope indexes of inequality (RII/SII)., Results: Out of 7769 participants (50.8% women, mean age 46 years old), 60% participated in a sporting activity. Results showed that the higher the socioeconomic circumstances, the higher the sport participation (RII = 1.78; 95% Confidence Interval (CI): 1.64-1.92; SII = 0.33; 95%CI: 0.29-0.37 for education). Relative inequalities varied per sport e.g., 0.68 (95%CI: 0.44-1.07) for football and 4.25 (95%CI: 2.68-6.75) for tennis/badminton for education. Yearly absolute inequalities in sport participation tended to increase between 2005 and 2019 for household income, especially among women and older adults., Conclusions: We observed strong socio-economic inequalities in sport participation in Geneva, with different magnitude depending on the sport type. These inequalities seemed to increase over the 2005-2019 period. Our results call for tailored measures to promote the participation of socially disadvantaged populations in sporting activities., (© 2023. The Author(s).)

Objective: We aimed to examine factors associated with parental willingness to vaccinate their children against COVID-19., Methods: We surveyed adults included in a digital longitudinal cohort study composed of participants in previous SARS-CoV-2 serosurveys conducted in Geneva, Switzerland. In February 2022, an online questionnaire collected information on COVID-19 vaccination acceptance, parental willingness to vaccinate their children aged ≥5 years and reasons for vaccination preference. We used multivariable logistic regression to assess the demographic, socioeconomic and health-related factors associated with being vaccinated and with parental intention to vaccinate their children., Results: We included 1,383 participants (56.8% women; 69.3% aged 35-49 years). Parental willingness to vaccinate their children increased markedly with the child's age: 84.0%, 60.9% and 21.2%, respectively, for parents of adolescents aged 16-17 years, 12-15 years and 5-12 years. For all child age groups, unvaccinated parents more frequently indicated not intending to vaccinate their children than vaccinated parents. Refusal to vaccine children was associated with having a secondary education (1.73; 1.18-2.47) relative to a tertiary education and with middle (1.75; 1.18-2.60) and low (1.96; 1.20-3.22) household income relative to high income. Refusal to vaccine their children was also associated with only having children aged 12-15 years (3.08; 1.61-5.91), aged 5-11 years (19.77; 10.27-38.05), or in multiple age groups (6.05; 3.22-11.37), relative to only having children aged 16-17 years., Conclusion: Willingness to vaccinate children was high for parents of adolescents aged 16-17 years but decreased significantly with decreasing child age. Unvaccinated, socioeconomically disadvantaged parents and those with younger children were less likely to be willing to vaccinate their children. These results are important for vaccination programs and developing communication strategies to reach vaccine-hesitant groups, both in the context of COVID-19 and in the prevention of other diseases and future pandemics.

Background: During the 2020/2021 winter, the labour market was under the impact of the COVID-19 pandemic. Changes in socioeconomic resources during this period could have influenced individual mental health. This association may have been mitigated or exacerbated by subjective risk perceptions, such as perceived risk of getting infected with SARS-CoV-2 or perception of the national economic situation. Therefore, we aimed to determine if changes in financial resources and employment situation during and after the second COVID-19 wave were prospectively associated with depression, anxiety and stress, and whether perceptions of the national economic situation and of the risk of getting infected modified this association., Methods: One thousand seven hundred fifty nine participants from a nation-wide population-based eCohort in Switzerland were followed between November 2020 and September 2021. Financial resources and employment status were assessed twice (Nov2020-Mar2021, May-Jul 2021). Mental health was assessed after the second measurement of financial resources and employment status, using the Depression, Anxiety and Stress Scale (DASS-21). We modelled DASS-21 scores with linear regression, adjusting for demographics, health status, social relationships and changes in workload, and tested interactions with subjective risk perceptions., Results: We observed scores above thresholds for normal levels for 16% (95%CI = 15-18) of participants for depression, 8% (95%CI = 7-10) for anxiety, and 10% (95%CI = 9-12) for stress. Compared to continuously comfortable or sufficient financial resources, continuously precarious or insufficient resources were associated with worse scores for all outcomes. Increased financial resources were associated with higher anxiety. In the working-age group, shifting from full to part-time employment was associated with higher stress and anxiety. Perceiving the Swiss economic situation as worrisome was associated with higher anxiety in participants who lost financial resources or had continuously precarious or insufficient resources., Conclusion: This study confirms the association of economic stressors and mental health during the COVID-19 pandemic and highlights the exacerbating role of subjective risk perception on this association., (© 2023. The Author(s).)

Background: Despite an improvement in preventive care and perinatal health in previous decades, social inequalities persist, particularly to the disadvantage of isolated or unemployed women. The objective was to analyse the evolution between 1998 and 2016 of the association between women's occupational status and perinatal outcomes., Methods: Data came from four national surveys performed in 1998, 2003, 2010 and 2016. Occupational status was defined by maternal employment status and type of occupation during pregnancy. Preventive behaviours (initiation of antenatal care, antenatal classes, breast feeding) and health outcomes (hospitalization, preterm birth, birth weight below the 10th percentile) were analysed by occupational status adjusted for other maternal characteristics, for each study year., Results: The studied sample included 12,497 women in 1998, 13,290 in 2003, 13,209 in 2010 and 11,179 in 2016. The proportion of employed women increased from 66% to 75% between 1998 and 2016, and that of housewives decreased from 22% to 12%. The proportion of preterm births globally increased between 1998 and 2016, especially for housewives. The proportion of low birthweight for gestational age (LBWGA) remained similar over the years. From 1998 to 2016, the differences between occupational groups persisted for preterm births and LBWGA., Conclusions: Occupational groups exhibited strong social differences in preventive care over the entire study period and persisted in the recent data. As a major social indicator, women's occupational status during pregnancy has to be considered as a risk factor of poor preventive behaviour and unfavourable perinatal outcomes., Competing Interests: Declaration of competing interests None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Despite the potentially significant impact of women-prenatal care provider communication quality (WPCQ) on women's perinatal health, evidence on the determinants of those perceptions is still lacking, particularly among migrant women., Methods: We aimed to examine the effect of women's host-country language proficiency on their perceived WPCQ. We analyzed the data of 1210 migrant and 1400 native women who gave birth at Portuguese public hospitals between 2017 and 2019 and participated in the baMBINO cohort study. Migrants' language proficiency was self-rated. Perceived WPCQ was measured as a composite score of 9 different aspects of self-reported communication quality and ranged from 0 (optimal) to 27., Results: A high percentage of women (29%) rated communication quality as "optimal". Zero-inflated regression models were fitted to estimate the association between language proficiency and perceived WPCQ. Women with full (aIRR 1.35; 95% CI 1.22,1.50), intermediate (aIRR 1.41; 95% CI 1.23,1.61), and limited (aIRR 1.72; 95% CI 1.45,2.05) language proficiencies were increasingly more likely to have lower WPCQ when compared to natives., Conclusions: Facilitating communication with migrant women experiencing language barriers in prenatal care could provide an important contribution to improving prenatal care quality and addressing potential subsequent disparities in perinatal health outcomes., (© 2023. The Author(s).)

Background: The medium-term impact of the COVID-19 pandemic on the wellbeing of children and adolescents remains unclear. More than 2 years into the pandemic, we aimed to quantify the frequency and determinants of having been severely impacted by the COVID-19 pandemic and estimate its impact on health-related quality of life (HRQoL) and mental health., Methods: Data was drawn from a population-based cohort of children and adolescents, recruited between December 2021 and June 2022, in Geneva, Switzerland. The Coronavirus impact scale was used to assess the multidimensional impact of the pandemic on children through parent's report. A score higher than one standard deviation above the mean was deemed a severe impact. Parents additionally reported about their offspring HRQoL and mental health with validated scales. Determinants of having been severely impacted were assessed with logistic models, as were the associations between having experienced a severe impact and poor HRQoL or mental health., Results: Out of 2101 participants aged 2-17, 12.7% had experienced a severe pandemic impact. Having a lasting health condition, a pandemic-related worsening of lifestyle habits or an unfavorable family environment were associated with having been severely impacted by the pandemic, while a previous anti-SARS-CoV-2 infection was not. Participants who had experienced a severe pandemic impact were more likely to present poor HRQoL (aOR = 3.1; 95% CI 2.3-4.4) and poor mental health (aOR = 3.9; 95% CI 2.5-6.2)., Conclusion: The COVID-19 pandemic may have persistent consequences on the wellbeing of children and adolescents, especially among those with health and family vulnerabilities., (© 2023. The Author(s).)

Background: More than two years into the COVID-19 pandemic, most of the population has developed anti-SARS-CoV-2 antibodies from infection and/or vaccination. However, public health decision-making is hindered by the lack of up-to-date and precise characterization of the immune landscape in the population. Here, we estimated anti-SARS-CoV-2 antibodies seroprevalence and cross-variant neutralization capacity after Omicron became dominant in Geneva, Switzerland., Methods: We conducted a population-based serosurvey between April 29 and June 9, 2022, recruiting children and adults of all ages from age-stratified random samples of the general population of Geneva, Switzerland. We tested for anti-SARS-CoV-2 antibodies using commercial immunoassays targeting either the spike (S) or nucleocapsid (N) protein, and for antibody neutralization capacity against different SARS-CoV-2 variants using a cell-free Spike trimer-ACE2 binding-based surrogate neutralization assay. We estimated seroprevalence and neutralization capacity using a Bayesian modeling framework accounting for the demographics, vaccination, and infection statuses of the Geneva population., Findings: Among the 2521 individuals included in the analysis, the estimated total antibodies seroprevalence was 93.8% (95% CrI 93.1-94.5), including 72.4% (70.0-74.7) for infection-induced antibodies. Estimates of neutralizing antibodies in a representative subsample (N = 1160) ranged from 79.5% (77.1-81.8) against the Alpha variant to 46.7% (43.0-50.4) against the Omicron BA.4/BA.5 subvariants. Despite having high seroprevalence of infection-induced antibodies (76.7% [69.7-83.0] for ages 0-5 years, 90.5% [86.5-94.1] for ages 6-11 years), children aged <12 years had substantially lower neutralizing activity than older participants, particularly against Omicron subvariants. Overall, vaccination was associated with higher neutralizing activity against pre-Omicron variants. Vaccine booster alongside recent infection was associated with higher neutralizing activity against Omicron subvariants., Interpretation: While most of the Geneva population has developed anti-SARS-CoV-2 antibodies through vaccination and/or infection, less than half has neutralizing activity against the currently circulating Omicron BA.5 subvariant. Hybrid immunity obtained through booster vaccination and infection confers the greatest neutralization capacity, including against Omicron., Funding: General Directorate of Health in Geneva canton, Private Foundation of the Geneva University Hospitals, European Commission ("CoVICIS" grant), and a private foundation advised by CARIGEST SA., Competing Interests: DT is a founder and co-chair of the Scientific Advisory Board of Aerium Therapeutics, holds stock in that company, and has two patents pending for monoclonal antibodies against SARS-CoV-2. KMPB is a member of the Advisory Boards for pneumococcal vaccine and varicella vaccine at MSD. All other authors declare that they have no competing interests., (© 2022 The Authors.)

Introduction: Rates of episiotomy and severe perineal tears (SPT) are indicators of the quality of obstetric care. Time-trends in the reported occurrence of episiotomy and SPT can contribute to understand both, changes in care and in the frequency of risk factors. Therefore, we aimed to estimate time trends in the frequency of SPT in Portugal and its relationship with episiotomy., Methods: We conducted a nationwide register-based study using data from the national inpatient database of all Portuguese public hospitals between 2000 and 2015. Time-trend analysis using joinpoint regression models was performed to identify trends (joinpoints) and compare time changes in the prevalence of SPT and risk factors expressed as annual percentage changes (APC) with 95% Confidence Intervals (95% CI). Poisson regression models were fitted to estimate whether time-trends in SPT rates were explained by changes in risk factors and to assess the association between episiotomy and SPT. Adjusted relative risk (aRR) and their respective 95% CI were obtained., Results: From 908,999 singleton vaginal deliveries, 20.6% were instrumental deliveries, 76.7% with episiotomy and 0.56% were complicated by SPT. Among women with non-instrumental deliveries and no episiotomy SPT decreased from 2009 onwards (1.3% to 0.7%), whereas SPT kept increasing in women with episiotomy for both non-instrumental (0.1% in 2000 to 0.4% in 2015) and instrumental deliveries (0.7% in 2005 to 2.3% in 2015). Time-trends in potential risk factors did not explain the observed increase in SPT. Episiotomy was associated with a decrease in SPT with adjusted RR varying between 2000 and 2015 from 0.18 (95%CI:0.13-0.25) to 0.59 (95%CI:0.44-0.79) for non-instrumental deliveries and from 0.45 (95%CI:0.25-0.81) to 0.50 (95%CI:0.40-0.72) for instrumental deliveries., Conclusions: Our findings suggest that episiotomy rate could safely further decrease as the main factor driving SPT rates seems to be an increase in awareness and reporting of SPT particularly among women who underwent an episiotomy., (© 2022. The Author(s).)

Post-COVID syndrome remains poorly studied in children and adolescents. Here, we aimed to investigate the prevalence and risk factors of pediatric post-COVID in a population-based sample, stratifying by serological status. Children from the SEROCoV-KIDS cohort study (State of Geneva, Switzerland), aged 6 months to 17 years, were tested for anti-SARS-CoV-2 N antibodies (December 2021-February 2022) and parents filled in a questionnaire on persistent symptoms in their children (lasting over 12 weeks) compatible with post-COVID. Of 1034 children tested, 570 (55.1%) were seropositive. The sex- and age-adjusted prevalence of persistent symptoms among seropositive children was 9.1% (95%CI: 6.7;11.8) and 5.0% (95%CI: 3.0;7.1) among seronegatives, with an adjusted prevalence difference (ΔaPrev) of 4.1% (95%CI: 1.1;7.3). Stratifying per age group, only adolescents displayed a substantial risk of having post-COVID symptoms (ΔaPrev = 8.3%, 95%CI: 3.5;13.5). Identified risk factors for post-COVID syndrome were older age, having a lower socioeconomic status and suffering from chronic health conditions, especially asthma. Our findings show that a significant proportion of seropositive children, particularly adolescents, experienced persistent COVID symptoms. While there is a need for further investigations, growing evidence of pediatric post-COVID urges early screening and primary care management., (© 2022. The Author(s).)

Objectives: To estimate the prevalence of children and adolescents reporting persistent symptoms after SARS-CoV-2 infection., Design: A random sample of children and adolescents participated with their family members to a serological survey including a blood drawing for detecting antibodies targeting the SARS-CoV-2 nucleocapsid (N) protein and a questionnaire on COVID-19-related symptoms experienced since the beginning of the pandemic., Setting: The study took place in the canton of Geneva, Switzerland, between June and July 2021., Participant: 660 children aged between 2 and 17 years old., Primary and Secondary Outcome: The primary outcome was the persistence of symptoms beyond 4 weeks comparing seropositive and seronegative participants. The type of declared symptoms were also studied as well as associated risk factors., Results: Among seropositive children, the sex-adjusted and age-adjusted prevalence of symptoms lasting longer than 2 weeks was 18.3%, compared with 11.1% among seronegatives (adjusted prevalence difference (ΔaPrev)=7.2%, 95% CI: 1.5% to 13.0%). Among adolescents aged 12-17 years, we estimated the prevalence of experiencing symptoms lasting over 4 weeks to be 4.4% (ΔaPrev,95% CI: -3.8% to 13.6%), whereas no seropositive child aged 2-11 reported symptoms of this duration. The most frequently declared symptoms were fatigue, headache and loss of smell., Conclusions: We estimated the prevalence of experiencing persistent symptoms lasting over 4 weeks to be around 4% among adolescents, which represents a large absolute number, and should raise awareness and concern. We did not observe meaningful differences of persistent symptoms between seropositive and seronegative younger children, suggesting that they may be less affected than their older counterparts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The objective of this study was to determine the relationship between maternal pre-pregnancy body mass index (BMI) and child hyperactivity-inattention symptoms (HIS) at 5 years, including preterm and term-born children, and to determine whether this association varied with gestational age. Maternal pre-pregnancy BMI and offspring HIS were assessed in 10,898 participants born ≥ 33 weeks of gestation from the ELFE cohort and 2646 children born between 23 and 34 weeks from the EPIPAGE 2 cohort. Reported pre-pregnancy weight (kg) and measured height (m) were collected from mothers at inclusion and used to classify BMI (kg/m 2 ). Child HIS were evaluated using the Strengths and Difficulties Questionnaire around 5 years of age. Logistic regression estimated odds ratios (OR) of a high HIS score (≥ 90th percentile) in the ELFE cohort and generalized estimated equations were used in EPIPAGE 2 to account for non-independence of multiple births. As a negative control, paternal BMI was also considered as an exposure of interest in sensitivity analyses. Maternal pre-pregnancy obesity and overweight were associated with child HIS at 5 years in ELFE (adjusted OR [aOR] for obesity 1.27 [1.06, 1.53]; overweight aOR 1.16 [1.00, 1.36]) and pre-pregnancy obesity was associated with high HIS scores in preterm infants of EPIPAGE 2 (aOR 1.48 [1.06, 2.08]). In ELFE, the magnitude of the association increased with decreasing gestational age (interaction p = 0.02). High maternal pre-pregnancy BMI is associated with greater likelihood of high HIS scores in both at-term and preterm children at 5 years of age., (© 2022. The Author(s).)

Background: SARS-CoV-2 infection and its health consequences have disproportionally affected disadvantaged socio-economic groups globally. This study aimed to analyze the association between socio-economic conditions and having developed antibodies for-SARS-CoV-2 in a population-based sample in the canton of Geneva, Switzerland., Methods: Data was obtained from a population-based serosurvey of adults in Geneva and their household members, between November and December, 2020, toward the end of the second pandemic wave in the canton. Participants were tested for antibodies for-SARS-CoV-2. Socio-economic conditions representing different dimensions were self-reported. Mixed effects logistic regressions were conducted for each predictor to test its association with seropositive status as the main outcome., Results: Two thousand eight hundred and eighty-nine adults completed the study questionnaire and were included in the final analysis. Retired participants and those living in suburban areas had lower odds of a seropositive result when compared to employed participants (OR: 0.42, 95% CI: 0.20-0.87) and those living in urban areas (OR: 0.67, 95% CI: 0.46-0.97), respectively. People facing financial hardship for less than a year had higher odds of a seropositive result compared to those who had never faced them (OR: 2.23, 95% CI: 1.01-4.95). Educational level, occupational position, and household income were not associated with being seropositive, nor were ethnicity or country of birth., Discussion: While conventional measures of socio-economic position did not seem to be related to the risk of being infected in this sample, this study sheds lights on the importance of examining the broader social determinants of health when evaluating the differential impact of the pandemic within the population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Santa-Ramírez, Wisniak, Pullen, Zaballa, Pennacchio, Lorthe, Dumont, Baysson, Guessous and Stringhini.)

Objectives: To describe changes in adherence to recommendations for physical activity (PA), screen time (ST), and sleep duration over the first two waves of the pandemic in Switzerland, and to assess the associations of these lifestyle behaviours with life satisfaction and overall health as well-being indicators. Methods: In this observational study, we included 2,534 participants (5-16 years) from four Swiss cantons. Participants, or their parents, completed repeated questionnaires and reported on their (child's) lifestyle and well-being, between June 2020 and April 2021. We used linear and logistic regression models to assess the associations between lifestyle and well-being. Results: The percentage of children meeting the recommendations for PA and ST decreased from the pre-pandemic period to the first wave, with a slight recovery during the second wave. Participants meeting all three recommendations during the second wave were more likely to report excellent health (OR: 1.65 [95% CI: 1.00-2.76]) and higher life satisfaction ( β : 0.46 [0.16-0.77]) in early 2021 than participants not meeting any recommendation. Conclusion: We showed a substantial impact of the COVID-19 pandemic on children's and adolescents' lifestyle, and a positive association between meeting lifestyle recommendations and well-being., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Peralta, Camerini, Haile, Kahlert, Lorthe, Marciano, Nussbaumer, Radtke, Ulyte, Puhan and Kriemler.)