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...
The coronavirus disease 2019 pandemic has disrupted life for all, causing school closures and changes in daily schedules. The pandemic has significantly altered normal sleep patterns for children and teenagers. While similar to summer vacation sleep laxity, children and families need to adjust sleep schedules to be well rested and arise appropriately to start their day. Sleep is a key component of healthy living when bodies and brains rest and recharge. If children and teenagers do not get enough sleep, they can be irritable and have behavior changes, attention difficulties, and memory problems. Inadequate sleep increases the risk of high blood pressure, obesity, depression, and diabetes. The American Academy of Sleep Medicine recommends children aged 3 to 5 years get 10 to 13 hours of sleep daily, those aged 6 to 12 years get 9 to 12 hours of sleep, and teenagers get 8 to 10 hours of sleep. Signs of too little sleep include difficulty getting up in the morning, falling asleep during the day (outside appropriate napping age), longer weekend sleep, yawning, or poor behavior. With relaxed schedules, children and teenagers may be going to bed later and sleeping later. With a return to more regular schedules, families may need guidance to reset sleep times. First, establish a daily routine for all family members with set times for waking up, meals, school or work, recreation, and bed. School-aged children and adolescents can help create their schedules, but parents must provide healthy boundaries. Second, stick to a consistent evening routine including a regular bedtime. Avoid caffeinated drinks, including soda, tea, and coffee drinks. Establish an electronics turn off time at least 1 hour before bedtime, and store them outside the child's room. This means no cell phone, TV, computer, tablet, or handheld gaming systems. Sleep disruption increases just by having electronic devices in the room, even if they are not being used. Electronics emit blue light that stimulates wakefulness, as do after-bedtime snacks and drinks. Finally, keep sleep spaces dark and cool, but a night-light is OK. If bedtime has been later than usual, it may take a few weeks to graduallymovebedtimesandrisetimesearlierbecauseitiseasiertostay up later than to go to sleep earlier. Set a wake-time goal, and gradually move bedtime earlier by 10 minutes every 3 to 4 days. Once a child can fallasleepwithin30minutesofbedtime,movebedtime10minutesearlier the next night. With each step, move up the wake time. It is important to avoid napping; the sleepiness that builds during the day helps children fall asleep at night. If a nap is inevitable, limit it to 20 minutes. Consider contacting your pediatrician if you are having trouble moving your child's sleep-wake schedule around or for other sleep behaviors such as snoring, gasping, kicking, or sleeping too much. These could be signs of a different health problem. Adjusting sleep schedules can be challenging at first and will take time to implement. Sleep is a critical part of health for children and adolescen...
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