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of non-communicable diseases will also be impaired, leading to increased complication and hospitalisation rates and adding to the rise of catastrophic health expenditures. Our research shows the remarkable capacity of UNRWA-through flexible staff deployment, innovation in models of service delivery, and introduction of e-health-to demonstrate resilient functioning in the face of threats to its operations. However, the current funding crisis could severely compromise its capacity to support the health and dignity of Palestinians. Our analysis reinforces the moral and technical rationale for the call to the international community to #FundUNRWA. This work is informed by ongoing research funded by Elrha's Research for Health in Humanitarian Crises (R2HC) Programme. The R2HC programme aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. The R2HC programme is funded equally by the Wellcome Trust and the UK Department for International Development, with Elrha overseeing the programme's execution and management. AA is Deputy Chief Scientific Adviser to the UK Department for International Development. We declare no other competing interests.

The early identification of patients suffering from SARS-CoV-2 infection in primary care is of outmost importance in the current pandemic. The objective of this study was to describe the clinical characteristics of primary care patients who tested positive for SARS-CoV-2. We conducted a cross-sectional study between March 24 and May 7, 2020, involving consecutive patients undergoing RT-PCR testing in two community-based laboratories in Lyon (France) for a suspicion of COVID-19. We examined the association between symptoms and a positive test using univariable and multivariable logistic regression, adjusted for clustering within laboratories, and calculated the diagnostic performance of these symptoms. Of the 1561 patients tested, 1543 patients (99%) agreed to participate. Among them, 253 were positive for SARS-CoV-2 (16%). The three most frequently reported ‘ear-nose-throat’ and non-‘ear-nose-throat’ symptoms in patients who tested positive were dry throat (42%), loss of smell (36%) and loss of taste (31%), respectively fever (58%), cough (52%) and headache (45%). In multivariable analyses, loss of taste (OR 3.8 [95% CI 3.3–4.4], p-value < 0.001), loss of smell (OR 3.0 [95% CI 1.9–4.8], p < 0.001), muscle pain (OR 1.6 [95% CI 1.2–2.0], p = 0.001) and dry nose (OR 1.3 [95% CI 1.1–1.6], p = 0.01) were significantly associated with a positive result. In contrast, sore throat (OR 0.6 [95% CI 0.4–0.8], p = 0.003), stuffy nose (OR 0.6 [95% CI 0.6–0.7], p < 0.001), diarrhea (OR 0.6 [95% CI 0.5–0.6], p < 0.001) and dyspnea (OR 0.5 [95% CI 0.3–0.7], p < 0.001) were inversely associated with a positive test. The combination of loss of taste or smell had the highest diagnostic performance (OR 6.7 [95% CI 5.9–7.5], sensitivity 44.7% [95% CI 38.4–51.0], specificity 90.8% [95% CI 89.1–92.3]). No other combination of symptoms had a higher performance. Our data could contribute to the triage and early identification of new clusters of cases.

Background: The early identification of patients suffering from SARS-CoV-2 infection in primary care is of outmost importance in the current pandemic.Aim: To gain a better understanding of the specific symptoms of SARS-CoV-2 infection in primary care.Design and setting: We conducted a cross-sectional study between March 24 and May 7, 2020, involving consecutive patients undergoing RT-PCR testing in two community-based laboratories in Lyon (France) for a suspicion of COVID-19.Methods: We examined the association between various symptoms and a positive test using univariate and multivariate logistic regression, adjusted for clustering within the laboratories.Results: Of the 1561 patients tested, 1543 agreed to participate (participation rate: 99%). Among them, 253 were positive for SARS-Cov-2 (16%). In multivariate analysis, loss of taste (OR 3.8 [95%CI 3.3-4.4], p-value<0.001), loss of smell (OR 3.0 [95%CI 1.9-4.8], p-value<0.001), muscle pain (OR 1.6 [95%CI 1.2-2.0], p-value 0.001) and dry nose (OR 1.3 [95%CI 1.1-1.6], p-value 0.01) were significantly associated with a positive result. The strength of association with taste and smell disorders was higher for symptom combinations (OR 6.5 [95%CI 3.9-10.8] for loss of taste and smell, OR 6.7 [95%CI 5.9-7.5] for loss of taste or smell). In contrast, sore throat (OR 0.6 [95%CI 0.4-0.8], p-value 0.003), stuffy nose (OR 0.7 [95%CI 0.6-0.7], p-value<0.001), diarrhea (OR 0.6 [95%CI 0.5-0.6], p-value<0.001) and dyspnea (OR 0.5 [95%CI 0.3-0.7], p-value<0.001) were inversely associated with a positive test.Conclusion: Our data could further facilitate targeted screening and contribute to the triage and early identification of new clusters of cases.

Background Video gaming is one of the main recreational activities of children and adolescents. The American Psychiatric Association and the World Health Organization recently proposed diagnostic criteria for a pathological use of video games. The objective is to explore the perceptions of adolescents concerning pathological video game use. Methods Qualitative study by semi structured individual interviews in the homes of adolescent gamers and non-gamers living in southwest France. The sampling was theoretical. The analysis was carried out using an inductive approach following the phases of thematic analysis. The researchers used triangulation. Collection was concluded when theoretical saturation had been reached. Results 17 adolescents aged 10-18 were interviewed between April 2018 and March 2019. The adolescents recognised that video games use can be pathological. Deleterious consequences to physical, mental, and social wellbeing associated with gaming were discussed. Mental health, family and social environments, and the type of game seemed to in uence the transition from recreational to pathological video-game use. The adolescents agreed on the need to regulate their gaming, particularly through parental control and self-control. Conclusions Risks and protective factors related to the types of video game, the adolescent, and the environment were identi ed. Parental support would help lower the risk of pathological gaming. Recruitment Sources of recruitment were family physicians, hospital-based doctors, and music teachers. The last source allowed a recruitment of adolescents not necessarily included in care plan and who had hobbies. An informational letter was given to each of these contacts, who forwarded an information sheet to the parents.

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