Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. MethodsThe Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A posthoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5•9 months (IQR 4•9-6•5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity.Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments w...

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Substance use has become one of the growing major public health and socioeconomic issues worldwide; it has dramatically increased, particularly in developing countries. [1-3] The analysis of substance use is complex, due in part to its varieties, degree of secrecy, health challenges and different legal connotations surrounding its use globally. The use of khat (Catha edulis), cigarettes, heroine, alcohol and other substances is a worldwide threat which especially affects young people. The World Health Organization (WHO) estimates that there are about 2 billion people worldwide who consume alcoholic beverages, of whom 76.3 million are affected by alcohol-related disorders. [4-8] It is estimated that 9% of the global population aged ≥12 years are classified as dependent on psychoactive substances. [9] Studies have confirmed that there is a growing epidemic of tobacco, heroine and alcohol use among adolescents in the developing world, especially in southern Africa and in sub-Saharan Africa as a whole. [6,10-12] Khat has been used in African countries for centuries as a mild stimulant. For most youths, chewing khat is considered a method for increasing energy and elevating mood in order to improve work performance. [13] The WHO report on substance use in southern Africa showed that negative consequences are common traits of substance use. [3,14] These include sexual violence (e.g. rape), physical violence, criminal activity, neglect of social responsibilities, disease, injury and loss of life. Harmful effects occur with any psychoactive substance use and early initiation has been found to be associated with an increased risk of developing addiction and adulthood dependence. [3,15] In general, it has been shown that the use of cigarettes, alcohol and other substances is a worldwide threat that affects young people. [3,16] In some parts of Ethiopia, such as Bale and Harar, khat chewing in communities in which smoking is common is seen as a social custom that dates back thousands of years. Many students also consider khat chewing as a method of improving their reading ability. However, no activity has been seen in the reduction of substance use. [17,18] While substance use is not new in research parlance, [1] the high level of ingenuity among young people (especially adolescents) that has resulted in numerous complex mixtures, experimentation and discoveries of new materials and volatile solvents (or inhalants) that can be drunk or inhaled with immediate intoxicating effect or other diverse consequences, [11] could make continuous research on this menace relevant. The prevalence of substance use varies from country to country and time to time. Regular updates on substance use and its associated factors could therefore hold significant input regarding appropriate and dynamic interventions towards reduction or eradication of substance use among adolescents, not only in southern Africa but also worldwide. [19,20] The present study therefore aims to assess the prevalence of substance use among adolescent in sub-Saharan Afri...

Persistent ill health after acute COVID-19—referred to as long COVID, the post-acute COVID-19 syndrome, or the post-COVID-19 condition—has emerged as a major concern. We undertook an international consensus exercise to identify research priorities with the aim of understanding the long-term effects of acute COVID-19, with a focus on people with pre-existing airways disease and the occurrence of new-onset airways disease and associated symptoms. 202 international experts were invited to submit a minimum of three research ideas. After a two-phase internal review process, a final list of 98 research topics was scored by 48 experts. Patients with pre-existing or post-COVID-19 airways disease contributed to the exercise by weighting selected criteria. The highest-ranked research idea focused on investigation of the relationship between prognostic scores at hospital admission and morbidity at 3 months and 12 months after hospital discharge in patients with and without pre-existing airways disease. High priority was also assigned to comparisons of the prevalence and severity of post-COVID-19 fatigue, sarcopenia, anxiety, depression, and risk of future cardiovascular complications in patients with and without pre-existing airways disease. Our approach has enabled development of a set of priorities that could inform future research studies and funding decisions. This prioritisation process could also be adapted to other, non-respiratory aspects of long COVID.