Development of a User-Informed Decision Aid for Contraceptive Decision-Making Among Adolescents and Young Adults: Qualitative Study.

The short-term and long-term effects of COVID-19 continue to have a significant impact globally. The term post-acute sequelae of SARS-CoV-2 (PASC) refers to ongoing, relapsing, or new symptoms or other health effects occurring after the acute phase of SARS-CoV-2 infection, that are present for four or more weeks. PASC is also referred to as long COVID. Although limited, the literature on functional outcomes following COVID-19 infection reports poor quality of life; persistent symptoms affecting daily function; and impaired attention, executive functioning or occupational performance, with up to 40% of patients reporting psychiatric symptoms. The symptom trajectory is yet to be defined, with some studies signaling a lack of resolution or improvement. While data are accruing on long COVID manifestations in children, there are few published studies exploring the impact persistent symptoms on everyday function and quality of life in children and adolescents. One retrospective cohort study focused on children with multisystem inflammatory syndrome in children (MIS-C) and found little organ-specific sequelae at a six-month follow-up, but persistent physical mobility and mental health support needs. In another study regarding children with long COVID, nearly all participants (96.6%) reported persistent exertional dyspnea, cough, an impaired six-minute walk test, and exercise intolerance despite having normal pulmonary function testing, suggesting ongoing functional limitations. Additionally, a retrospective study of children in a multidisciplinary clinic for long COVID found overall elevated cognitive disengagement syndrome, with anxiety emerging as the primary predictor of functional impairment after accounting for mood and anxiety symptoms. Emerging evidence suggests that a subset of youth experience ongoing cognitive, emotional, and behavioral difficulties that may interfere with academic performance, emotional regulation, and daily functioning. To fully explore the impact of long COVID, it is essential to assess functional outcomes with shorter-term domains of mental status, communication, motor and sensory functioning, feeding, and respiratory status. Longer-term domains of cognition, school performance, the ability to perform daily routines, relationships, and sleep or mood status are also important. Therefore, the objectives of this study were to describe functional outcomes in children with long COVID in a large electronic health record (EHR)-based cohort, including the ability to participate in school and after-school activities, need for therapies, initiation or changes to existing education plans, or new or worsening behavioral or mental health diagnoses.