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Angarita-Fonseca A, Roy M, Lacasse A, Léonard G, Rainville P, Marin MF, Tufa I, Gentile EL, Pagé MG. Trajectories of pain and depressive symptoms among people living with low back pain during the COVID-19 pandemic: a 24-month longitudinal study. Pain Rep 2024; 9:e1165. [PMID: 38835744 PMCID: PMC11146579 DOI: 10.1097/pr9.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction: We explored trajectories of pain intensity and depressive symptoms over the first 24 months of the pandemic in people with low back pain. Methods: This longitudinal study was conducted alongside the Quebec Low Back Pain Study. Starting in April 2020 and every 3 months until July 2022, 291 participants completed an online survey. Group-based trajectory modeling was used to identify patterns of pain intensity and depressive symptoms. Onset outbreak characteristics were then put in relation with trajectory groups using multivariate logistic regression. Results: The analysis revealed 5 trajectories of pain intensity and depressive symptoms, respectively. The pain trajectories were stable mild (n = 17, 5.8%); stable moderate (n = 103, 35.4%); stable severe (n = 81, 27.8%); U-shape (n = 24, 8.3%), and inverted U-shape (n = 66, 22.7%). The trajectories of depressive symptoms were stable none (n = 58, 19.9%); stable very mild (n = 61, 21.0%); stable mild (n = 85, 29.2%); stable moderate (n = 59, 21.7%); and severe slightly improving (n = 24, 8.3%). Pre-COVID everyday/nearly everyday pain, average pain intensity, and widespread bodily pain were predictive of pain trajectory groups. Higher pre-COVID depression, acute stress disorder, and lockdown measures-related stress were associated with moderate/severe depressive trajectories. Discussion: Our findings indicated relative stability of pain and depressive symptoms among participants during the COVID-19 pandemic but also highlighted subgroups of people who experienced temporary deterioration or improvement over the first months of the pandemic that then reverted back to baseline levels. Modifiable risk factors were identified before the onset of the pandemic, which could give preventive measures in targeted populations.
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Affiliation(s)
- Adriana Angarita-Fonseca
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
- Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Guillaume Léonard
- Research Center on Aging, CIUSSS de l'Estrie-CHUS; School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pierre Rainville
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada
| | - Marie-France Marin
- Department of Psychology, Université de Québec à Montréal, Montreal, QC, Canada
| | - Iulia Tufa
- McGill University Health Center, Montreal, QC, Canada
- Quebec Pain Research Network, QC, Canada
| | - Erika L Gentile
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - M Gabrielle Pagé
- Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
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Aryal K, Mowbray FI, Miroshnychenko A, Strum RP, Dash D, Hillmer MP, Malikov K, Costa AP, Jones A. Evaluating methods for risk prediction of Covid-19 mortality in nursing home residents before and after vaccine availability: a retrospective cohort study. BMC Med Res Methodol 2024; 24:77. [PMID: 38539074 PMCID: PMC10976701 DOI: 10.1186/s12874-024-02189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/22/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND SARS-CoV-2 vaccines are effective in reducing hospitalization, COVID-19 symptoms, and COVID-19 mortality for nursing home (NH) residents. We sought to compare the accuracy of various machine learning models, examine changes to model performance, and identify resident characteristics that have the strongest associations with 30-day COVID-19 mortality, before and after vaccine availability. METHODS We conducted a population-based retrospective cohort study analyzing data from all NH facilities across Ontario, Canada. We included all residents diagnosed with SARS-CoV-2 and living in NHs between March 2020 and July 2021. We employed five machine learning algorithms to predict COVID-19 mortality, including logistic regression, LASSO regression, classification and regression trees (CART), random forests, and gradient boosted trees. The discriminative performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) for each model using 10-fold cross-validation. Model calibration was determined through evaluation of calibration slopes. Variable importance was calculated by repeatedly and randomly permutating the values of each predictor in the dataset and re-evaluating the model's performance. RESULTS A total of 14,977 NH residents and 20 resident characteristics were included in the model. The cross-validated AUCs were similar across algorithms and ranged from 0.64 to 0.67. Gradient boosted trees and logistic regression had an AUC of 0.67 pre- and post-vaccine availability. CART had the lowest discrimination ability with an AUC of 0.64 pre-vaccine availability, and 0.65 post-vaccine availability. The most influential resident characteristics, irrespective of vaccine availability, included advanced age (≥ 75 years), health instability, functional and cognitive status, sex (male), and polypharmacy. CONCLUSIONS The predictive accuracy and discrimination exhibited by all five examined machine learning algorithms were similar. Both logistic regression and gradient boosted trees exhibit comparable performance and display slight superiority over other machine learning algorithms. We observed consistent model performance both before and after vaccine availability. The influence of resident characteristics on COVID-19 mortality remained consistent across time periods, suggesting that changes to pre-vaccination screening practices for high-risk individuals are effective in the post-vaccination era.
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Affiliation(s)
- Komal Aryal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
- ICES, Hamilton, ON, Canada.
| | - Fabrice I Mowbray
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Ryan P Strum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Michael P Hillmer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Capacity Planning and Analytics, Ontario Ministry of Health, Toronto, Canada
| | - Kamil Malikov
- Capacity Planning and Analytics, Ontario Ministry of Health, Toronto, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- ICES, Hamilton, ON, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- ICES, Hamilton, ON, Canada
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Dai X, Acosta N, Lu X, Hubert CRJ, Lee J, Frankowski K, Bautista MA, Waddell BJ, Du K, McCalder J, Meddings J, Ruecker N, Williamson T, Southern DA, Hollman J, Achari G, Ryan MC, Hrudey SE, Lee BE, Pang X, Clark RG, Parkins MD, Chekouo T. A Bayesian framework for modeling COVID-19 case numbers through longitudinal monitoring of SARS-CoV-2 RNA in wastewater. Stat Med 2024; 43:1153-1169. [PMID: 38221776 DOI: 10.1002/sim.10009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
Wastewater-based surveillance has become an important tool for research groups and public health agencies investigating and monitoring the COVID-19 pandemic and other public health emergencies including other pathogens and drug abuse. While there is an emerging body of evidence exploring the possibility of predicting COVID-19 infections from wastewater signals, there remain significant challenges for statistical modeling. Longitudinal observations of viral copies in municipal wastewater can be influenced by noisy datasets and missing values with irregular and sparse samplings. We propose an integrative Bayesian framework to predict daily positive cases from weekly wastewater observations with missing values via functional data analysis techniques. In a unified procedure, the proposed analysis models severe acute respiratory syndrome coronavirus-2 RNA wastewater signals as a realization of a smooth process with error and combines the smooth process with COVID-19 cases to evaluate the prediction of positive cases. We demonstrate that the proposed framework can achieve these objectives with high predictive accuracies through simulated and observed real data.
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Affiliation(s)
- Xiaotian Dai
- Department of Mathematics, Illinois State University, Normal, Illinois, USA
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Acosta
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Xuewen Lu
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Casey R J Hubert
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Jangwoo Lee
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Frankowski
- Advancing Canadian Water Assets, University of Calgary, Calgary, Alberta, Canada
| | - Maria A Bautista
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Barbara J Waddell
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Kristine Du
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Janine McCalder
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Jon Meddings
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Norma Ruecker
- Water Services, City of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A Southern
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jordan Hollman
- Department of Geosciences, University of Calgary, Calgary, Alberta, Canada
| | - Gopal Achari
- Department of Civil Engineering, University of Calgary, Calgary, Alberta, Canada
| | - M Cathryn Ryan
- Department of Geosciences, University of Calgary, Calgary, Alberta, Canada
| | - Steve E Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda G Clark
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Parkins
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Thierry Chekouo
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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O'Connor S, Bélanger-Gravel A. Social determinants of long-term reported changes in physical activity and healthy eating during the COVID-19 pandemic in Canada: multiple cross-sectional surveys analysis from the iCARE study. Appl Physiol Nutr Metab 2024; 49:179-189. [PMID: 37820379 DOI: 10.1139/apnm-2023-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The long-term consequences of COVID-19 on healthy behaviours (physical activity practice and healthy eating) among Canadians remain largely unexplored. The objectives were (i) to describe the proportion of Canadians who reported a change in healthy behaviours, 9 and 20 months since the beginning of COVID-19; and (ii) to identify the social determinants associated with healthy behaviour changes. Using two representative Canadian surveys from the International COVID-19 Awareness and Responses Evaluation study (January 2021, n = 3000; November 2021, n = 3002), reported changes in healthy behaviours were assessed as follows: "In general, how have the following behaviours changed since the start of COVID-19?": (1) Increase; (2) No change; and (3) Decrease. The association between individual determinants and changes in healthy behaviours was analyzed using weighted univariate polytomous logistic regression models. In January 2021, 41% and 22% of respondents reported a decline in physical activity and healthy eating, respectively, while in November 2021, 34% and 20% of respondents reported a decline in physical activity and healthy eating, respectively. The main determinants associated with changes in healthy behaviours were younger age (18-25 years), area of residency, student status, changes in bodyweight, financial concerns/insecurity, anxiety/depression, and ethnicity. Changes in healthy behaviours were also associated with household composition, presence of chronic diseases, and occupation. In sum, this study depicted long-term changes in healthy behaviours during COVID-19, with differential changes according to social determinants of health. This study highlighted the presence of health inequalities in Canada during COVID-19 and supports the implementation of personalized programs in prevention of healthy behaviour degradation.
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Affiliation(s)
- Sarah O'Connor
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada
- Research Centre, Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Quebec City, QC, Canada
| | - Ariane Bélanger-Gravel
- Research Centre, Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Quebec City, QC, Canada
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Quebec City, QC, Canada
- Department of Information and Communication, Université Laval, Quebec City, QC, Canada
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Zhao QJ, Rozenberg D, Nourouzpour S, Orchanian-Cheff A, Flannery J, Kaul R, Agbeyaka S, Barber M, dePeiza P, Maria Doumouras A, Draper H, Gebara N, Lau J, Liberman D, Luther RA, Sanh M, Furlan AD. Positive impact of a telemedicine education program on practicing health care workers during the COVID-19 pandemic in Ontario, Canada: A mixed methods study of an Extension for Community Healthcare Outcomes (ECHO) program. J Telemed Telecare 2024; 30:365-380. [PMID: 34962167 DOI: 10.1177/1357633x211059688] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In addition to shifting and expanding clinical responsibilities, rapidly evolving information and guidelines during the COVID-19 pandemic has made it difficult for health care workers (HCW) to synthesise and translate COVID-19 information into practice. This study evaluated whether a COVID-19-specific telemedicine education program (ECHO COVID) would impact health care workers' self-efficacy and satisfaction in the management of patients with COVID-19. METHODS A prospective mixed methods parallel-design study was conducted among ECHO COVID participants using pre-post questionnaires and a focus group discussion. Questionnaire results were examined for changes in health care workers' self-efficacy and satisfaction. Focus group discussion data were analysed to explore health care workers' experience in ECHO COVID and the context of their practice during the COVID-19 pandemic. RESULTS 239 health care workers registered in ECHO COVID and 114 (47.7%) completed questionnaires and attended at least one ECHO COVID session. Median self-efficacy scores increased from 5 (IQR 4-6) to 6 (IQR 6-6) (p < 0.0001), independent of profession, years in practice, age group, or practice environment. Participants were highly satisfied with ECHO COVID sessions with a median score of 4 (IQR 4-5). Focus group discussion data indicated that health care workers gained knowledge through ECHO COVID and revealed facilitators for ECHO COVID program success, including the transition to virtual care, the practicability of knowledge provided, and a 'perspective from the trenches.' DISCUSSION This study demonstrated that a telemedicine education program aimed to support health care workers in managing patients with COVID-19 had a positive impact on health care workers' self-efficacy and satisfaction. This impact was specifically mediated by the ECHO COVID program.
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Affiliation(s)
- Q Jane Zhao
- ECHO at UHN, University Health Network, Toronto, Canada
| | - Dmitry Rozenberg
- ECHO at UHN, University Health Network, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
| | | | - Ani Orchanian-Cheff
- ECHO at UHN, University Health Network, Toronto, Canada
- Library and Information Services, University Health Network, Toronto, Canada
| | - John Flannery
- ECHO at UHN, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
| | - Rupert Kaul
- ECHO at UHN, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
| | | | - Mary Barber
- ECHO at UHN, University Health Network, Toronto, Canada
| | | | | | - Haley Draper
- ECHO at UHN, University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Nadine Gebara
- ECHO at UHN, University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Jenny Lau
- ECHO at UHN, University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Dan Liberman
- Department of Medicine, McGill University
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Ryan A Luther
- ECHO at UHN, University Health Network, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
| | - Monica Sanh
- ECHO at UHN, University Health Network, Toronto, Canada
- Library and Information Services, University Health Network, Toronto, Canada
| | - Andrea D Furlan
- ECHO at UHN, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
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Zwerwer LR, Kloka J, van der Pol S, Postma MJ, Zacharowski K, van Asselt ADI, Friedrichson B. Mechanical ventilation as a major driver of COVID-19 hospitalization costs: a costing study in a German setting. HEALTH ECONOMICS REVIEW 2024; 14:4. [PMID: 38227207 PMCID: PMC10790444 DOI: 10.1186/s13561-023-00476-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/21/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND While COVID-19 hospitalization costs are essential for policymakers to make informed health care resource decisions, little is known about these costs in western Europe. The aim of the current study is to analyze these costs for a German setting, track the development of these costs over time and analyze the daily costs. METHODS Administrative costing data was analyzed for 598 non-Intensive Care Unit (ICU) patients and 510 ICU patients diagnosed with COVID-19 at the Frankfurt University hospital. Descriptive statistics of total per patient hospitalization costs were obtained and assessed over time. Propensity scores were estimated for length of stay (LOS) at the general ward and mechanical ventilation (MV) duration, using covariate balancing propensity score for continuous treatment. Costs for each additional day in the general ward and each additional day in the ICU with and without MV were estimated by regressing the total hospitalization costs on the LOS and the presence or absence of several treatments using generalized linear models, while controlling for patient characteristics, comorbidities, and complications. RESULTS Median total per patient hospitalization costs were €3,010 (Q1 - Q3: €2,224-€5,273), €5,887 (Q1 - Q3: €3,054-€10,879) and €21,536 (Q1 - Q3: €7,504-€43,480), respectively, for non-ICU patients, non-MV and MV ICU patients. Total per patient hospitalization costs for non-ICU patients showed a slight increase over time, while total per patient hospitalization costs for ICU patients decreased over time. Each additional day in the general ward for non-ICU COVID-19 patients costed €463.66 (SE: 15.89). Costs for each additional day in the general ward and ICU without and with mechanical ventilation for ICU patients were estimated at €414.20 (SE: 22.17), €927.45 (SE: 45.52) and €2,224.84 (SE: 70.24). CONCLUSIONS This is, to our knowledge, the first study examining the costs of COVID-19 hospitalizations in Germany. Estimated costs were overall in agreement with costs found in literature for non-COVID-19 patients, except for higher estimated costs for mechanical ventilation. These estimated costs can potentially improve the precision of COVID-19 cost effectiveness studies in Germany and will thereby allow health care policymakers to provide better informed health care resource decisions in the future.
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Affiliation(s)
- Leslie R Zwerwer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Center for Information Technology, University of Groningen, Groningen, The Netherlands.
| | - Jan Kloka
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Simon van der Pol
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Health-Ecore, Zeist, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Health-Ecore, Zeist, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Antoinette D I van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Benjamin Friedrichson
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Soklaridis S, Chowdhury M, Turco MG, Tremblay M, Mazmanian P, Williams B, Besa R, Sockalingam S. Pivoting Continuing Professional Development During the COVID-19 Pandemic: A Narrative Scoping Review of Adaptations and Innovations. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2024:00005141-990000000-00104. [PMID: 38205969 DOI: 10.1097/ceh.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic. METHODS The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period. RESULTS Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives. DISCUSSION This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.
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Affiliation(s)
- Sophie Soklaridis
- Dr. Soklaridis: Senior Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and The Wilson Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada. Ms. Chowdhury: PhD (cand.), Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Turco: Associate Professor of Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Centre/Geisel School of Medicine at Dartmouth, Lebanon, NH. Dr. Tremblay: Senior Research and Innovation Advisor, Fédération des médecins spécialistes du Québec, Montréal, Québec, Canada. Dr. Mazmanian: Professor Emeritus, Department of Preventive Medicine and Community Health, Virginia Commonwealth University, Richmond, VA. Dr. Williams: Clinical Program Director, Professional Renewal Centre, Lawrence, KS, and Department of Psychiatry, School of Medicine, University of Kansas, Kansas City, KS. Ms. Besa: Information Specialist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Sockalingam: Vice-President Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and The Wilson Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada
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Young S, Gomes T, Kolla G, McCormack D, Dodd Z, Raboud J, Bayoumi AM. Initiations of safer supply hydromorphone increased during the COVID-19 pandemic in Ontario: An interrupted time series analysis. PLoS One 2023; 18:e0295145. [PMID: 38113220 PMCID: PMC10729949 DOI: 10.1371/journal.pone.0295145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023] Open
Abstract
AIMS Calls to prescribe safer supply hydromorphone (SSHM) as an alternative to the toxic drug supply increased during the COVID-19 pandemic but it is unknown whether prescribing behaviour was altered. We aimed to evaluate how the number of new SSHM dispensations changed during the pandemic in Ontario. METHODS We conducted a retrospective interrupted time-series analysis using provincial administrative databases. We counted new SSHM dispensations in successive 28-day periods from March 22, 2016 to August 30, 2021. We used segmented Poisson regression methods to test for both a change in level and trend of new dispensations before and after March 17, 2020, the date Ontario's pandemic-related emergency was declared. We adjusted the models to account for seasonality and assessed for over-dispersion and residual autocorrelation. We used counterfactual analysis methods to estimate the number of new dispensations attributable to the pandemic. RESULTS We identified 1489 new SSHM dispensations during the study period (434 [mean of 8 per 28-day period] before and 1055 [mean of 56 per 28-day period] during the pandemic). Median age of individuals initiating SSHM was 40 (interquartile interval 33-48) with 61.7% (N = 919) male sex. Before the pandemic, there was a small trend of increased prescribing (incidence rate ratio [IRR] per period 1.002; 95% confidence interval [95CI] 1.001-1.002; p<0.001), with a change in level (immediate increase) at the pandemic date (relative increase in IRR 1.674; 95CI 1.206-2.322; p = 0.002). The trend during the pandemic was not statistically significant (relative increase in IRR 1.000; 95CI 1.000-1.001; p = 0.251). We estimated 511 (95CI 327-695) new dispensations would not have occurred without the pandemic. CONCLUSION The pandemic led to an abrupt increase in SSHM prescribing in Ontario, although the rate of increase was similar before and during the pandemic. The absolute number of individuals who accessed SSHM remained low throughout the pandemic.
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Affiliation(s)
- Samantha Young
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Addiction Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Tara Gomes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | - Zoë Dodd
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
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9
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Staibano P, Khattak S, Amin F, Engels PT, Sommer DD. Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience. Ann Otol Rhinol Laryngol 2023; 132:1520-1527. [PMID: 37032528 PMCID: PMC10086820 DOI: 10.1177/00034894231166648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVES Novel coronavirus-19 (COVID-19) has led to over 6 million fatalities globally. An estimated 75% of COVID-19 patients who require critical care admission develop acute respiratory distress syndrome (ARDS) needing invasive mechanical ventilation (IMV) and/or extracorporeal membrane oxygenation (ECMO). Due to prolonged ventilation requirements, these patients often also require tracheostomy. We performed a review of clinical outcomes in COVID-19 patients on ECMO at a high-volume tertiary care center in Hamilton, Ontario, Canada. METHODOLOGY We performed a retrospective case series, including 24 adult patients diagnosed with COVID-19 who required IMV, veno-venous (ECMO), and tracheostomy. All patients were included from April to December 2021. We extracted demographic and clinical variables pertaining to the tracheostomy procedure and ECMO therapy. We performed descriptive statistical analyses. This study was approved by the Hamilton Integrated Research Ethics Board (14217-C). RESULTS We included 24 consecutive patients with COVID-19 who required tracheostomy while undergoing ECMO therapy. The mean age was 49.4 years [standard deviation (SD): 7.33], the majority of patients were male (75%), with mean body mass index of 32 (SD: 8.81). Overall mortality rate was 33.3%. Percutaneous tracheostomy was performed most frequently (83.3%) and, similar to open tracheostomy, was associated with a low rate of perioperative bleeding complications. Within surviving patients, the mean time to IMV weaning and decannulation was 60.2 (SD: 24.6) and 49.4 days (SD: 21.8), respectively. CONCLUSION Percutaneous tracheostomy appears to be safe in COVID-19 patients on ECMO and holding anticoagulation 24 hours prior to and after tracheostomy may limit bleeding events in these patients.
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Affiliation(s)
- Phillip Staibano
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Shahzaib Khattak
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Faizan Amin
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Paul T Engels
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Doron D Sommer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
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10
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Shaw-Churchill S, Phillips KP. The pandemic experiences of Ontario perinatal providers: a qualitative study. BMC Health Serv Res 2023; 23:1057. [PMID: 37794422 PMCID: PMC10552313 DOI: 10.1186/s12913-023-10079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has produced widespread disruptions for healthcare systems across Canada. Perinatal care in Ontario, Canada was subject to province-wide public health restrictions, reallocation of hospital beds and human health resources. To better understand the impacts of the pandemic on Ontario perinatal care, this study explored the perspectives of perinatal care providers about their clinical COVID-19 pandemic experiences. METHODS Semi-structured key informant virtual interviews were conducted between August 2021 and January 2022 with 15 Ontario-based perinatal care providers. Recorded interviews were transcribed, and thematic content analysis used to identify major themes and subthemes. RESULTS Participants were mainly women, practicing in Eastern and Central Ontario as health providers (obstetricians, nurses, midwives), allied regulated health professionals (social worker, massage therapist), and perinatal support workers (doula, lactation consultant). Major themes and subthemes were identified inductively as follows: (1) Impacts of COVID-19 on providers (psychosocial stress, healthcare system barriers, healthcare system opportunities); (2) Perceived impacts of COVID-19 on pregnant people (psychosocial stress, amplification of existing healthcare barriers, influences on reproductive decision making; minor theme- social and emotional support roles); (3) Vaccine discourse (provider empathy, vaccines and patient family dynamics, minor themes- patient vaccine hesitancy, COVID-19 misinformation); and (4) Virtual pregnancy care (benefits, disadvantages, adaptation of standard care practices). CONCLUSIONS Perinatal care providers reported significant stress and uncertainty caused by the COVID-19 pandemic and evolving hospital protocols. Providers perceived that their patients were distressed by both the pandemic and related reductions in pregnancy healthcare services including hospital limits to support companion(s). Although virtual pregnancy care impaired patient-provider rapport, most providers believed that the workflow efficiencies and patient convenience of virtual care is beneficial to perinatal healthcare.
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Affiliation(s)
- Sigourney Shaw-Churchill
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 6N5, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 6N5, Canada.
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11
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Simpson R, Szigeti Z, Sheppard CL, Minezes J, Hitzig SL, Mayo AL, Robinson L, Lung M, Wasilewski MB. The experiences of patients, family caregivers, healthcare providers, and health service leaders with compassionate care following hospitalization with COVID-19: a qualitative study. Disabil Rehabil 2023; 45:2896-2905. [PMID: 36354063 DOI: 10.1080/09638288.2022.2113564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE This study explored the experiences of patients, caregivers, healthcare providers, and health service leaders of compassion in the care of people hospitalized with COVID-19. MATERIALS AND METHODS This study is a secondary analysis of qualitative data deriving from primary research data on recommendations for healthcare organizations providing care to people hospitalized with COVID-19. Participants comprised patients with COVID-19 (n = 10), family caregivers (n = 5) and HCPs in COVID-19 units (n = 12). Primary research data were analyzed deductively under the "lens" of compassion, as defined by Goetz. RESULTS Four interacting themes were found: (1) COVID-19 - to care or not to care? The importance of feeling safe, (2) A lonely illness - suffering in isolation with COVID-19, (3) Compassionate care for people with COVID-19 across the hospital continuum, and (4) Sustaining compassionate care for people hospitalized with COVID-19 - healthcare provider compassion fatigue and burnout. CONCLUSIONS Compassionate care is not a given for people hospitalized with COVID-19. Healthcare providers must feel safe to provide care before responding compassionately. People hospitalized with COVID-19 experience additional suffering through isolation. Compassionate care for people hospitalized with COVID-19 is more readily identifiable in the rehabilitation setting. However, compassion fatigue and burnout in this context threaten healthcare sustainability.IMPLICATIONS FOR REHABILITATIONHealthcare providers need to feel physically and psychologically safe to provide compassionate care for people hospitalized with COVID-19.People hospitalized with COVID-19 infection experience added suffering through the socially isolating effects of physical distancing.Compassion and virtuous behaviours displayed by healthcare providers are expected and valued by patients and caregivers, including during the COVID-19 pandemic.High levels of compassion fatigue and burnout threaten the sustainability of hospital-based care for people with COVID-19.
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Affiliation(s)
- Robert Simpson
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Christine L Sheppard
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Sander L Hitzig
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Amanda L Mayo
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Lawrence Robinson
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Maria Lung
- Sunnybrook Research Institute, Toronto, Canada
| | - Marina B Wasilewski
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
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12
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Stoklosa K, Elfaki LA, Ding C, Sachal SS, Escuadro RJG, Tu K. Vaccine-incentivized blood donation: A survey of public perceptions in Canada. Vox Sang 2023; 118:624-636. [PMID: 37381906 DOI: 10.1111/vox.13484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Canadian blood donations declined during the start of the COVID-19 pandemic. Conversely, vaccine demand outpaced supply during the initial stages of the COVID-19 vaccine rollout in Canada. This study investigates public perceptions regarding vaccine-incentivized blood donation, among COVID-19 and future pandemics, in Canada. MATERIALS AND METHODS A 19-question survey was developed and distributed in person and online to Canadians during the third wave of the COVID-19 pandemic. Participants were asked questions about demographics, blood donation eligibility, previous donations and sentiments towards vaccine-incentivized blood donation. Data were analysed using descriptive statistics. RESULTS In total, 787 respondents completed the survey with representation from all sexes, ages, races, locations of residence and work employment. Overall, 176 (22%) participants self-identified as working or living in healthcare settings, 511 (65%) were currently able to donate blood products, 247 (31%) previously donated blood and 48 (6%) donated blood during the COVID-19 pandemic. With the exception of ineligible blood donors, many Canadians, particularly previous blood donors, were agreeable with this incentivization proposal. Many participants claimed they would donate blood products for vaccines during COVID-19 and future pandemics but raised concerns about the equitableness of such approach. CONCLUSION Vaccine-incentivized blood donation was viewed positively by many Canadians in our study. Future research must investigate the equity and feasibility of this strategy. In the interim, further strategies should be explored to encourage blood donation in Canada.
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Affiliation(s)
- Klaudiusz Stoklosa
- Division of Rural Family Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Lina A Elfaki
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christina Ding
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Sukhmeet S Sachal
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Karen Tu
- Department of Family and Community Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto-Dalla Lana School of Public Health, North York General Hospital, Toronto Western Family Health Team-University Health Network, Toronto, Ontario, Canada
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13
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Ara T, Ferdous Z, Mahi M, Amin E, Chowdhury SB, Shafiur Rahman M, Rahman L, Rahman MM. Assessment of COVID-19 management and its consequences on healthcare professionals: a cross-sectional study from Bangladesh. BMJ Open 2023; 13:e068633. [PMID: 37524557 PMCID: PMC10391835 DOI: 10.1136/bmjopen-2022-068633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE This explorative study aims to identify the gaps in COVID-19 management and their consequences on physicians in terms of contracting infection and psychological well-being during the early phase of the pandemic. DESIGN, SETTINGS AND PARTICIPANTS We conducted a nationwide cross-sectional online study to collect information from 420 intern doctors who were at their internship in government medical colleges from February to August 2020. METHODS We performed univariate and bivariate analyses to assess COVID-19 management. We investigated the consequences of COVID-19 management on infection risk, experiencing stress, developing anxiety, depression and sleep disturbance using five sets of multivariable logistic regression analyses. RESULTS Findings indicate a delay in first-case detection and identify people's tendency to hide COVID-19 symptoms as one of the possible causes of that delay. About 56% of the intern doctors experienced that patients were trying to hide COVID-19 symptoms in the earlier phase of the pandemic. More than half of the respondents did not get any training on COVID-19 from their working institutions. About 30% and 20% of the respondents did not use personal protective equipment (PPE) and masks while treating patients. Respondents who treated patients without PPE, masks, face shields and gloves were almost two times as likely to be infected by COVID-19. The odds of experiencing COVID-19-related stress was almost twofold among respondents who treated patients without wearing PPE and masks. Experiencing COVID-19-related stress was further associated with an increased risk of developing anxiety and depression that led to sleep disturbance. CONCLUSION Ensuring the maximum utilization of limited resources during any public health crisis such as COVID-19 needs developing coping mechanisms by projecting future demand. Ensuring proper training and safety measures can reduce physical and psychological hazards among physicians.
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Affiliation(s)
- Tasnim Ara
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Zannatul Ferdous
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
| | - Mahfuza Mahi
- Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Emama Amin
- Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | | | - Md Shafiur Rahman
- National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - Lutfor Rahman
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Md Mahabubur Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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14
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Jacob RA, Zhang A, Ajoge HO, D'Agostino MR, Nirmalarajah K, Shigayeva A, Demian WL, Baker SJC, Derakhshani H, Rossi L, Nasir JA, Panousis EM, Draia AN, Vermeiren C, Gilchrist J, Smieja N, Bulir D, Smieja M, Surette MG, McArthur AG, McGeer AJ, Mubareka S, Banerjee A, Miller MS, Mossman K. Sensitivity to Neutralizing Antibodies and Resistance to Type I Interferons in SARS-CoV-2 R.1 Lineage Variants, Canada. Emerg Infect Dis 2023; 29:1386-1396. [PMID: 37308158 PMCID: PMC10310370 DOI: 10.3201/eid2907.230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Isolating and characterizing emerging SARS-CoV-2 variants is key to understanding virus pathogenesis. In this study, we isolated samples of the SARS-CoV-2 R.1 lineage, categorized as a variant under monitoring by the World Health Organization, and evaluated their sensitivity to neutralizing antibodies and type I interferons. We used convalescent serum samples from persons in Canada infected either with ancestral virus (wave 1) or the B.1.1.7 (Alpha) variant of concern (wave 3) for testing neutralization sensitivity. The R.1 isolates were potently neutralized by both the wave 1 and wave 3 convalescent serum samples, unlike the B.1.351 (Beta) variant of concern. Of note, the R.1 variant was significantly more resistant to type I interferons (IFN-α/β) than was the ancestral isolate. Our study demonstrates that the R.1 variant retained sensitivity to neutralizing antibodies but evolved resistance to type I interferons. This critical driving force will influence the trajectory of the pandemic.
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15
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Rehmani AI, Abdi K, Mabrouk EB, Zhao T, Salami BO, Jones A, Tong H, Salma J. Impact of the COVID-19 pandemic on Muslim older immigrants in Edmonton, Alberta: A community-based participatory research project with a local mosque. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:378-388. [PMID: 36995615 PMCID: PMC10062246 DOI: 10.17269/s41997-023-00764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/02/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Older Muslim immigrants experience multiple vulnerabilities living in Canada. This study explores the experiences of Muslim older adults during the COVID-19 pandemic to identify ways to build community resilience as part of a community-based participatory research partnership with a mosque in Edmonton, Alberta. METHODS Using a mixed-methods approach, check-in surveys (n = 88) followed by semi-structured interviews (n = 16) were conducted to assess the impact of COVID-19 on older adults from the mosque congregation. Quantitative findings were reported through descriptive statistics, and thematic analysis guided the identification of key findings from the interviews using the socio-ecological model. RESULTS Three major themes were identified in consultation with a Muslim community advisory committee: (a) triple jeopardy leading to loneliness, (b) decreased access to resources for connectivity, and (c) organizational struggles to provide support during the pandemic. The findings from the survey and interviews highlight various supports that were missing during the pandemic for this population. CONCLUSION The COVID-19 pandemic exacerbated the challenges associated with aging in the Muslim population and contributed to further marginalization, with mosques being sites of support during times of crises. Policymakers and service providers must explore ways of engaging mosque-based support systems in meeting the needs of older Muslim adults during pandemics.
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Affiliation(s)
| | - Khadija Abdi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Tianqi Zhao
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Bukola O Salami
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Allyson Jones
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Hongmei Tong
- Robbins Health Learning Centre, MacEwan University, Edmonton, AB, Canada
| | - Jordana Salma
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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16
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Norton A, Rakowska S, Galloway T, Wilson K, Rosella L, Adams M. Are at-risk sociodemographic attributes stable across COVID-19 transmission waves? Spat Spatiotemporal Epidemiol 2023; 45:100586. [PMID: 37301601 DOI: 10.1016/j.sste.2023.100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/03/2023] [Accepted: 04/07/2023] [Indexed: 06/12/2023]
Abstract
COVID-19 health impacts and risks have been disproportionate across social, economic, and racial gradients (Chen et al., 2021; Thompson et al., 2021; Mamuji et al., 2021; COVID-19 and Ethnicity, 2020). By examining the first five waves of the pandemic in Ontario, we identify if Forward Sortation Area (FSAs)based measures of sociodemographic status and their relationship to COVID-19 cases are stable or vary by time. COVID-19 waves were defined using a time-series graph of COVID-19 case counts by epi-week. Percent Black visible minority, percent Southeast Asian visible minority and percent Chinese visible minority at the FSA level were then integrated into spatial error models with other established vulnerability characteristics. The models indicate that area-based sociodemographic patterns associated with COVID-19 infection change over time. If sociodemographic characteristics are identified as high risk (increased COVID-19 case rates) increased testing, public health messaging, and other preventative care may be implemented to protect populations from the inequitable burden of disease.
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Affiliation(s)
- Amanda Norton
- Department of Geography, Geomatics & Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Scarlett Rakowska
- Department of Geography, Geomatics & Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Tracey Galloway
- Department of Anthropology, University of Toronto Mississauga, HSC354, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Kathleen Wilson
- Department of Geography, Geomatics & Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Laura Rosella
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College St, Health Sciences Bldg., 6th floor, Toronto, ON M5T 3M7, Canada
| | - Matthew Adams
- Department of Geography, Geomatics & Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada.
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17
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Demchenko I, Tassone VK, Dunnett S, Balachandar A, Li S, Anderson M, Daskalakis ZJ, Foley K, Karkouti K, Kennedy SH, Ladha KS, Robertson J, Vaisman A, Koczerginski D, Parikh SV, Blumberger DM, Flint AJ, Bhat V. Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic. BMC Psychiatry 2023; 23:327. [PMID: 37165333 PMCID: PMC10170445 DOI: 10.1186/s12888-023-04832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020). METHODS A multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada). RESULTS Clinical operations of ECT programs were disrupted across all four regions - however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases. CONCLUSIONS The results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians' activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.
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Affiliation(s)
- Ilya Demchenko
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Sarah Dunnett
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Arpana Balachandar
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Sophie Li
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Melanie Anderson
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Karen Foley
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
| | - Jamie Robertson
- Centre for Clinical Ethics, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alon Vaisman
- Department of Infection Prevention and Control, University Health Network, Toronto, ON, Canada
| | - David Koczerginski
- Department of Psychiatry, North York General Hospital, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Daniel M Blumberger
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alastair J Flint
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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18
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Zhu Y, Holden M. Housing and psychosocial well-being during the COVID-19 pandemic. HABITAT INTERNATIONAL 2023; 135:102812. [PMID: 36992843 PMCID: PMC10033258 DOI: 10.1016/j.habitatint.2023.102812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
The loss of psychosocial well-being is an overlooked but monumental consequence of the COVID-19 pandemic. These effects result not only from the pandemic itself but, in a secondary way, from the Non-Pharmaceutical Interventions (NPIs) made to curb the spread of disease. The unprecedented physical distancing and stay-at-home requirements and recommendations provide a unique window for housing researchers to better understand the mechanisms by which housing affects psychosocial well-being. This study draws on a survey conducted with over 2,000 residents of the neighbouring Canadian provinces of British Columbia and Alberta in 2021. We propose a new multi-dimensional model to examine the relationships between the Material, Economic, Affordances, Neighbourhood, and Stability (MEANS) aspects of housing and psychosocial well-being. Our analysis reveals the direct and indirect pathways by which deficiencies in each of these areas had negative effects on psychosocial well-being. Residential stability, housing affordances, and neighbourhood accessibility exert stronger direct impacts on psychosocial well-being than material and economic housing indicators (e.g. size of living space and tenure). Notably, we find no significant well-being differences between different homeowners and renters when we account for other housing MEANS. These findings have important implications for housing policy across pandemic and post-pandemic contexts, suggesting a need for research and policy focus on understanding housing and well-being in terms of non-material aspects, such as residential stability and affordances that housing provides.
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Affiliation(s)
- Yushu Zhu
- Simon Fraser University, 515 W Hastings St, Vancouver, BC, V6B 5K3, Canada
| | - Meg Holden
- Simon Fraser University, 515 W Hastings St, Vancouver, BC, V6B 5K3, Canada
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Theivendrampillai S, Cooper J, Lee T, Lau MWK, Marquez C, Straus SE, Fahim C. Canadian public perceptions and experiences with information during the COVID-19 pandemic: strategies to optimize future risk communications. BMC Public Health 2023; 23:796. [PMID: 37118761 PMCID: PMC10141811 DOI: 10.1186/s12889-023-15659-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the spread of misinformation worldwide. The purpose of this study was to explore perceptions of misinformation and preferred sources of obtaining COVID-19 information from those living in Canada. In particular, we sought to explore the perceptions of East Asian individuals in Canada, who experienced stigma related to COVID-19 messaging. METHODS We conducted a qualitative thematic analysis study. Interviews were offered in English, Mandarin and Cantonese. Interviewers probed for domains related to knowledge about COVID-19, preferred sources of information, perceived barriers and facilitators of misinformation, and preferences for communication during a health emergency. Interviews were recorded, translated, transcribed verbatim and analyzed using a framework approach. Transcripts were independently double-coded until > 60% agreement was reached. This study received research ethics approval. RESULTS Fifty-five interviews were conducted. The majority of participants were women (67%); median age was 52 years. 55% of participants were of East-Asian descent. Participants obtained information about COVID-19 from diverse English and non-English sources including news media, government agencies or representatives, social media, and personal networks. Challenges to seeking and understanding information included: encountering misinformation, making sense of evolving or conflicting public health guidance, and limited information on topics of interest. 65% of participants reported encountering COVID-19 misinformation. East Asian participants called on government officials to champion messaging to reduce stigmatizing and racist rhetoric and highlighted the importance of having accessible, non-English language information sources. Participants provided recommendations for future public health communications guidance during health emergencies, including preferences for message content, information messengers, dissemination platforms and format of messages. Almost all participants preferred receiving information from the Canadian government and found it helpful to utilize various mediums and platforms such as social media and news media for future risk communication, urging for consistency across all platforms. CONCLUSIONS We provide insights on Canadian experiences navigating COVID-19 information, where more than half perceived encountering misinformation on platforms when seeking COVID-19 information . We provide recommendations to inform public health communications during future health emergencies.
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Affiliation(s)
| | - Jeanette Cooper
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada
| | - Taehoon Lee
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada
| | | | - Christine Marquez
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada
| | - Christine Fahim
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada.
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20
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Stacey D, Ludwig C, Archambault P, Smith M, Taljaard M, Carley M, Plourde K, Boland L, Gogovor A, Graham I, Kobewka D, McLean RKD, Nelson MLA, Vanderspank-Wright B, Légaré F. Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys. JMIR Public Health Surveill 2023; 9:e43652. [PMID: 36688986 PMCID: PMC10131685 DOI: 10.2196/43652] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/21/2022] [Accepted: 01/20/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced. OBJECTIVE We sought to identify the health-related decisions and decisional needs of Canadians. METHODS Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (≥18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100. RESULTS From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5% (2236/14,459) and 28.3% (1850/6542); participation rate, 69.3% (1549/2236) and 28.7% (531/1850); and completion rate, 97.3% (1507/1549) and 95.1% (505/531), respectively. The survey was completed by 1454 (97.3%) adults and 438 (95.1%) parents/caregivers in English (1598/1892, 84.5%) or French (294/1892, 15.5%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7%, vs 87/438, 19.9%), managing a health condition (253/1454, 17.4%, vs 47/438, 10.7%), other COVID-19 decisions (158/1454, 10.9%, vs 85/438, 19.4%), mental health care (128/1454, 8.8%, vs 27/438, 6.2%), and medication treatments (115/1454, 7.9%, vs 23/438, 5.3%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0%). Adults (323/1454, 22.2%) and parents/caregivers (95/438, 21.7%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3%, vs 184/438, 42.0%), worrying about getting COVID-19 (506/1454, 34.8%, vs 173/438, 39.5%), public health restrictions (427/1454, 29.4%, vs 158/438, 36.1%), information overload (300/1454, 20.6%, vs 77/438, 17.6%), difficulty separating misinformation from scientific evidence (297/1454, 20.4%, vs 77/438, 17.6%), and difficulty discussing decisions with clinicians (224/1454, 15.4%, vs 51/438, 11.6%). For 1318 (90.6%) adults and 366 (83.6%) parents/caregivers who had decided, 353 (26.8%) and 125 (34.2%) had significant decision regret, respectively. In addition, 1028 (50%) respondents made their decision alone without considering the opinions of clinicians. CONCLUSIONS During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Université Laval, Lévis, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Maureen Smith
- Patient Partner, Ottawa, ON, Canada
- Cochrane Consumer Network Executive, Ottawa, ON, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Karine Plourde
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Laura Boland
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Ian Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Kobewka
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- General Internal Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Michelle L A Nelson
- Sinai Health System, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brandi Vanderspank-Wright
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
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21
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Melnyk A, Kozarov L, Wachsmann-Hogiu S. A deconvolution approach to modelling surges in COVID-19 cases and deaths. Sci Rep 2023; 13:2361. [PMID: 36759700 PMCID: PMC9910232 DOI: 10.1038/s41598-023-29198-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
The COVID-19 pandemic continues to emphasize the importance of epidemiological modelling in guiding timely and systematic responses to public health threats. Nonetheless, the predictive qualities of these models remain limited by their underlying assumptions of the factors and determinants shaping national and regional disease landscapes. Here, we introduce epidemiological feature detection, a novel latent variable mixture modelling approach to extracting and parameterizing distinct and localized features of real-world trends in daily COVID-19 cases and deaths. In this approach, we combine methods of peak deconvolution that are commonly used in spectroscopy with the susceptible-infected-recovered-deceased model of disease transmission. We analyze the second wave of the COVID-19 pandemic in Israel, Canada, and Germany and find that the lag time between reported cases and deaths, which we term case-death latency, is closely correlated with adjusted case fatality rates across these countries. Our findings illustrate the spatiotemporal variability of both these disease metrics within and between different disease landscapes. They also highlight the complex relationship between case-death latency, adjusted case fatality rate, and COVID-19 management across various degrees of decentralized governments and administrative structures, which provides a retrospective framework for responding to future pandemics and disease outbreaks.
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Affiliation(s)
- Adam Melnyk
- Department of Bioengineering, McGill University, 3480 Rue University, Montreal, QC, H3A 0E9, Canada.
| | - Lena Kozarov
- Department of Bioengineering, McGill University, 3480 Rue University, Montreal, QC, H3A 0E9, Canada
| | - Sebastian Wachsmann-Hogiu
- Department of Bioengineering, McGill University, 3480 Rue University, Montreal, QC, H3A 0E9, Canada.
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22
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Silverstein WK, Zipursky JS, Amaral AC, Leis JA, Strong L, Nardi J, Weinerman AS, Wong BM, Stroud L. Effect of Ward-Based High-Flow Nasal Cannula (HFNC) Oxygen Therapy on Critical Care Utilization During the COVID-19 Pandemic: A Retrospective Cohort Analysis. J Gen Intern Med 2023; 38:1160-1166. [PMID: 36662403 PMCID: PMC9854405 DOI: 10.1007/s11606-022-07949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/15/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hospitals expanded critical care capacity during the COVID-19 pandemic by treating COVID-19 patients with high-flow nasal cannula oxygen therapy (HFNC) in non-traditional settings, including general internal medicine (GIM) wards. The impact of this practice on intensive care unit (ICU) capacity is unknown. OBJECTIVE To describe how our hospital operationalized the use of HFNC on GIM wards, assess its impact on ICU capacity, and examine the characteristics and outcomes of treated patients. DESIGN Retrospective cohort study of all patients treated with HFNC on GIM wards at a Canadian tertiary care hospital. PARTICIPANTS All patients admitted with COVID-19 and treated with HFNC on GIM wards from December 28, 2020, to June 13, 2021, were included. MAIN MEASURES We combined administrative data on critical care occupancy daily with chart-abstracted data for included patients to establish the total number of patients receiving ICU-level care at our hospital per day. We also collected data on demographics, medical comorbidities, illness severity, COVID-19 treatments, HFNC care processes, and patient outcomes. KEY RESULTS We treated 124 patients with HFNC on the GIM wards (median age 66 years; 48% female). Patients were treated with HFNC for a median of 5 days (IQR 3 to 8); collectively, they received HFNC for a total of 740 hospital days, 71% of which were on GIM wards. At peak ICU capacity strain (144%), delivering HFNC on GIM wards added 20% to overall ICU capacity by managing up to 14 patients per day. Patients required a median maximal fraction of inspired oxygen of 80% (IQR 60 to 95). There were 18 deaths (15%) and 85 patients (69%) required critical care admission; of those, 40 (47%) required mechanical ventilation. CONCLUSIONS With appropriate training and resources, treatment of COVID-19 patients with HFNC on GIM wards appears to be a feasible strategy to increase critical care capacity.
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Affiliation(s)
| | - Jonathan S Zipursky
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Clinical Pharmacology & Toxicology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andre C Amaral
- Department of Medicine, University of Toronto, Toronto, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jerome A Leis
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Laura Strong
- Integrated Community Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Julie Nardi
- Department of Respiratory Therapy, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adina S Weinerman
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian M Wong
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lynfa Stroud
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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23
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Fahim C, Cooper J, Theivendrampillai S, Pham B, Straus SE. Exploring Canadian perceptions and experiences of stigma during the COVID-19 pandemic. Front Public Health 2023; 11:1068268. [PMID: 36960376 PMCID: PMC10027913 DOI: 10.3389/fpubh.2023.1068268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background The COVID-19 pandemic has led to stigmatization of individuals based on race/ethnicity, age, gender, and occupation, among other factors. We canvassed Canadian residents to explore perceptions of and experiences with stigma during the COVID-19 pandemic. Methods We conducted an online survey between June 10 and December 31 2020. The survey was rooted in the Health Stigma and Discrimination Framework and included multiple choice, Likert and open-ended questions related to perceived and experienced stigma. Residents of Ontario, Canada were eligible to participate and we aimed to recruit a sample that was diverse by race/ethnicity and age. Results A total of 1,823 individuals participated in the survey (54% women, 39% men; 54% 18-40 years old, 28% 41-60 years old, 12% 61+ years old; 33% White, 26% East/SouthEast Asian, 14% Black, 12% South Asian). Fifty-one percent of participants agreed/strongly agreed that racist views had increased toward certain racial/ethnic groups in Canada during the pandemic. Participants perceived that people in Canada were stigmatized during the pandemic because of race/ethnicity (37%), political beliefs (26%), older age (24%), being a healthcare worker (23%), younger age (22%), being an essential worker (21%), and gender (11%). Thirty-nine percent of respondents feared experiencing and 37% experienced stigmatization during the pandemic. Men, individuals aged 18-40, and racialized participants were more likely to fear or experience stigma. With respect to health behaviors, 74, 68, and 59% of respondents were comfortable masking in public, seeking medical care if they became ill, and getting tested for COVID-19, respectively. Men were less likely to indicate comfort with mask wearing or seeking medical care. Participants aged 18-40 and Black participants were less likely to indicate comfort with all three behaviors compared to those over age 41 and White participants, respectively. South Asian participants were less likely to be comfortable seeking medical care compared to White Participants. Discussion Participants feared or experienced stigmatization towards various demographic characteristics during the COVID-19 pandemic. It is critical that the factors driving stigma during health emergencies in Canada be better understood in order to develop effective public health messaging and interventions.
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24
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Lin S(L. The "loneliness epidemic", intersecting risk factors and relations to mental health help-seeking: A population-based study during COVID-19 lockdown in Canada. J Affect Disord 2023; 320:7-17. [PMID: 36058359 PMCID: PMC9436782 DOI: 10.1016/j.jad.2022.08.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/22/2022] [Accepted: 08/29/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pandemic-induced social distancing and stay-at-home orders, while successful in decreasing the transmission of COVID-19, could exacerbate loneliness. Few studies have examined how pandemic-related social determinants intersect to shape pandemic loneliness and its relations to mental health care in Canada. METHODS A population-representative sample of 3772 adults from the Canadian Perspective Survey Series (CPSS-6; January 25 to 31, 2021) was analyzed. Gender-specific logistic regression was employed to investigate the association between three-item loneliness scale (UCLA-3) with socio-demographics, job precarity, health behaviours, social isolation indicators, and mental health help-seeking. Classification and Regression Tree (CART) modelling was used to identify intersecting risk factors and the most important predictor of severe loneliness (UCLA-3 score ≥ 7). RESULTS The estimated prevalence of severe loneliness was 34.7 % in Canada, with women significantly higher than men (38.1 % vs 31.3 %, p < 0.001). Pandemic loneliness were more prevalent in female (OR = 1.53, 99 % CI: 1.26-1.85), those who were younger (OR's range 1.42-3.00), women without college degree (OR = 1.44, 99 % CI: 1.01-2.04), those living alone (OR = 1.56, 99 % CI: 1.09-2.23), immigrant men (OR = 1.79, 99 % CI: 1.23-2.60), those with small network (OR's range: 1.73-3.26), those who were absent from work due to COVID-19 related reasons (OR = 2.11, 99 % CI: 1.04-4.28), past-month binge drinkers (OR's range: 1.39-1.70) and cannabis user (OR = 1.47, 99 % CI: 1.12-1.93). The CART algorithm identifies that immigrants who experienced pandemic-triggered job insecurity were the most-at-risk group of severely loneliness. Pandemic loneliness was positively associated with formal help-seeking from mental health professionals (OR = 1.71, 99 % CI: 1.21-2.41), informal help-seeking from social circle (OR = 1.51, 99 % CI: 1.17-1.95), and unmet mental health needs (OR = 1.78, 99 % CI: 1.29-2.49). LIMITATIONS Cross-sectional data prohibits causal inferences. CONCLUSION The COVID-19 pandemic converges with loneliness epidemic in Canada. Prevention and intervention programs should target upstream social determinants of mental health, especially the intersection of migration status and COVID-19-related job precarity, to eliminate loneliness during the pandemic.
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25
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Chen D, Randhawa GS, Soltysiak MP, de Souza CP, Kari L, Singh SM, Hill KA. Mutational Patterns Observed in SARS-CoV-2 Genomes Sampled From Successive Epochs Delimited by Major Public Health Events in Ontario, Canada: Genomic Surveillance Study. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e42243. [PMID: 38935965 PMCID: PMC11135226 DOI: 10.2196/42243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND The emergence of SARS-CoV-2 variants with mutations associated with increased transmissibility and virulence is a public health concern in Ontario, Canada. Characterizing how the mutational patterns of the SARS-CoV-2 genome have changed over time can shed light on the driving factors, including selection for increased fitness and host immune response, that may contribute to the emergence of novel variants. Moreover, the study of SARS-CoV-2 in the microcosm of Ontario, Canada can reveal how different province-specific public health policies over time may be associated with observed mutational patterns as a model system. OBJECTIVE This study aimed to perform a comprehensive analysis of single base substitution (SBS) types, counts, and genomic locations observed in SARS-CoV-2 genomic sequences sampled in Ontario, Canada. Comparisons of mutational patterns were conducted between sequences sampled during 4 different epochs delimited by major public health events to track the evolution of the SARS-CoV-2 mutational landscape over 2 years. METHODS In total, 24,244 SARS-CoV-2 genomic sequences and associated metadata sampled in Ontario, Canada from January 1, 2020, to December 31, 2021, were retrieved from the Global Initiative on Sharing All Influenza Data database. Sequences were assigned to 4 epochs delimited by major public health events based on the sampling date. SBSs from each SARS-CoV-2 sequence were identified relative to the MN996528.1 reference genome. Catalogues of SBS types and counts were generated to estimate the impact of selection in each open reading frame, and identify mutation clusters. The estimation of mutational fitness over time was performed using the Augur pipeline. RESULTS The biases in SBS types and proportions observed support previous reports of host antiviral defense activity involving the SARS-CoV-2 genome. There was an increase in U>C substitutions associated with adenosine deaminase acting on RNA (ADAR) activity uniquely observed during Epoch 4. The burden of novel SBSs observed in SARS-CoV-2 genomic sequences was the greatest in Epoch 2 (median 5), followed by Epoch 3 (median 4). Clusters of SBSs were observed in the spike protein open reading frame, ORF1a, and ORF3a. The high proportion of nonsynonymous SBSs and increasing dN/dS metric (ratio of nonsynonymous to synonymous mutations in a given open reading frame) to above 1 in Epoch 4 indicate positive selection of the spike protein open reading frame. CONCLUSIONS Quantitative analysis of the mutational patterns of the SARS-CoV-2 genome in the microcosm of Ontario, Canada within early consecutive epochs of the pandemic tracked the mutational dynamics in the context of public health events that instigate significant shifts in selection and mutagenesis. Continued genomic surveillance of emergent variants will be useful for the design of public health policies in response to the evolving COVID-19 pandemic.
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Affiliation(s)
- David Chen
- Department of Biology, Western University, London, ON, Canada
| | - Gurjit S Randhawa
- School of Mathematical and Computational Sciences, University of Prince Edward Island, Charlottetown, PE, Canada
| | | | - Camila Pe de Souza
- Department of Statistical and Actuarial Sciences, Western University, London, ON, Canada
| | - Lila Kari
- School of Computer Science, University of Waterloo, Waterloo, ON, Canada
| | - Shiva M Singh
- Department of Biology, Western University, London, ON, Canada
| | - Kathleen A Hill
- Department of Biology, Western University, London, ON, Canada
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26
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"They're trying to bribe you and taking away your freedoms": COVID-19 vaccine hesitancy in communities with traditionally low vaccination rates. Vaccine 2022; 40:7280-7287. [PMID: 36334965 PMCID: PMC9618440 DOI: 10.1016/j.vaccine.2022.10.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
Vaccination is an essential public health intervention to control the COVID-19 pandemic. A minority of Canadians, however, remain hesitant about COVID-19 vaccines, while others outright refuse them. We conducted focus groups to gauge perceptions and attitudes towards COVID-19 vaccines in people who live in a region with historically low rates of childhood vaccination. Participants discussed their perception of COVID-19 vaccines and their intention to get vaccinated, and the low rate of COVID-19 vaccine uptake in Manitoba's Southern Health Region compared to other regions in Canada. We identified three drivers of vaccine hesitancy: (1) risk perceptions about COVID-19 and the vaccines developed to protect against it, (2) religious and conservative views; and (3) distrust in government and science. Participant proposed recommendations for improving communication and uptake of the COVID-19 vaccines included: public health messages emphasising the benefits of vaccination; addressing the community's specific concerns and dispelling misinformation; highlighting vaccine safety; and emphasising vaccination as a desirable behaviour from a religious perspective. Understanding the specific anxieties elicited by COVID-19 vaccines in areas with low childhood immunization rates can inform risk communication strategies tailored to increase vaccination in these specific regions. This study adds important information on potential reasons for vaccine hesitancy in areas with historically low rates of childhood vaccination, and provides important lessons learned for future emergencies in terms of vaccine hesitancy drivers and effective risk communication to increase vaccine uptake.
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27
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Ugas MA, Avery L, Wang Y, Berlin A, Giuliani ME, Krzyzanowska M, Papadakos TJ, Quartey NK(L, Samoil D, Papadakos JK. COVID-19 and Cancer Patients in the Second Year of the Pandemic: Investigating Treatment Impact, Information Sources, and COVID-19-Related Knowledge, Attitudes and Practices. Curr Oncol 2022; 29:8917-8936. [PMID: 36421354 PMCID: PMC9689213 DOI: 10.3390/curroncol29110701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The novel coronavirus that has triggered the present COVID-19 pandemic continues to spread globally, resulting in widespread morbidity and mortality. Patients with cancer remain one of the most vulnerable subsets of the population to the disease. This study examined the effects of the pandemic on cancer patients' treatment, psychology, knowledge, attitudes, and practices. METHODS A survey was emailed to 9861 patients at a cancer centre in Toronto, Canada. Descriptive results were summarized. Qualitative feedback was coded and summarized. Regression modelling was used to explore factors associated with patient psychological well-being, knowledge, attitudes, and practices. RESULTS A total of 1760 surveys were completed, with a response rate of 17.8%. Most participants did not experience any pandemic-related treatment delays, and vaccination rates were high. Participants who identified themselves as non-white (OR 3.30, CI: 1.30-5.30; p ≤ 0.001), and those who referred to journal articles for information (p = 0.002) reported higher psychological impact scores. There were no significant predictors of whether participants would use personal protective equipment when leaving their homes or whether they would go to crowded places. DISCUSSION This study provides another snapshot of cancer patients perceptions and needs during the COVID-19 pandemic.
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Affiliation(s)
- Mohamed A. Ugas
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
| | - Lisa Avery
- Biostatistics Department, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Yanning Wang
- Biostatistics Department, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- Techna Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Meredith E. Giuliani
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, ON M5T 1V4, Canada
| | - Monika Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- Division of Medical Oncology, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Tina J. Papadakos
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, ON M5T 1V4, Canada
| | - Naa Kwarley (Linda) Quartey
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
| | - Diana Samoil
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
| | - Janet K. Papadakos
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, ON M5T 1V4, Canada
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MacDonald SE, Paudel YR, Du C. COVID-19 vaccine coverage among immigrants and refugees in Alberta: A population-based cross-sectional study. J Glob Health 2022; 12:05053. [PMID: 36472928 PMCID: PMC9725104 DOI: 10.7189/jogh.12.05053] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Studies have shown that immigrants have lower vaccination rates than the Canadian-born population. We sought to assess COVID-19 vaccine coverage and factors associated with uptake among foreign-born immigrants relative to the non-immigrant population in Alberta, Canada. Methods In this cross-sectional study, we analysed population-based linked administrative health data from Alberta to examine vaccine coverage for 3 931 698 Albertans, of which 731 217 were immigrants. We calculated COVID-19 vaccination coverage as the proportion of eligible Albertans with a record of receiving at least one dose of a COVID-19 vaccine as of November 29, 2021. We used multivariable logistic regression to examine the association of vaccine coverage with migration status (immigrants: four categories based on time since migration and non-immigrants) adjusting for socio-demographic variables. Results Overall, COVID-19 vaccination coverage was 78.2% (95% confidence interval (CI) = 78.1%-78.3%) among immigrants and 76.0% (95% CI = 75.9%-76.0%) among non-immigrants. Coverage among immigrants differed by continent of origin, with North America, Oceania, and Europe having the lowest coverage. Although vaccine coverage was relatively uniform across neighbourhood income quintiles for immigrants, immigrants living in rural areas had lower vaccine coverage compared to non-immigrants living in rural areas. Multivariable logistic regression analysis showed a significant interaction between age category and migration status. While immigrants below 50 years of age generally had significantly higher vaccine coverage compared to non-immigrants, there was some variation based on time since migration. Immigrants above 50 years of age showed significantly lower coverage compared to non-immigrants of the same age. Conclusions Public health interventions should focus on older immigrants, immigrants living in rural areas, and immigrants from specific continental backgrounds in order to improve COVID-19 vaccination coverage.
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Affiliation(s)
- Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Crystal Du
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Detsky AS, Bogoch II. COVID-19 in Canada-The Fourth Through Seventh Waves. JAMA HEALTH FORUM 2022; 3:e224160. [PMID: 36399350 DOI: 10.1001/jamahealthforum.2022.4160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This Viewpoint discusses Canada’s experience and response to COVID-19 pandemic–related events during the fourth through seventh waves.
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Affiliation(s)
- Allan S Detsky
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Zhang T, Gunderson M. The Differential Impact of COVID-19 on Labour Market Outcomes of Immigrants in Canada. CANADIAN PUBLIC POLICY. ANALYSE DE POLITIQUES 2022; 48:473-490. [PMID: 37275473 PMCID: PMC10231670 DOI: 10.3138/cpp.2021-043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Based on Canadian Labour Force Survey data, we estimate the differential effect of the COVID-19 pandemic on seven labour market outcomes, and separate between recent and established immigrants relative to domestic-born Canadians. We also use Recentered Influence Function (RIF) unconditional quantile regressions to estimate the differential effects across the distribution of outcomes. We find that the pandemic had an adverse effect on the labour market outcomes for all workers, and that the adverse effects were generally larger for immigrants and especially recent immigrants as well as for immigrants at the bottom of the outcome distributions. The adverse effects were generally larger at the earliest waves of the pandemic, and for recent immigrants who were female, less educated, and those with child responsibilities, and for jobs at greater risk of contact with the pandemic.
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Affiliation(s)
- Tingting Zhang
- School of Labor and Employment Relations, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States
| | - Morley Gunderson
- Centre for Industrial Relations and Human Resources and Department of Economics, University of Toronto, Toronto, Ontario, Canada
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31
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Statistical framework to support the epidemiological interpretation of SARS-CoV-2 concentration in municipal wastewater. Sci Rep 2022; 12:13490. [PMID: 35931713 PMCID: PMC9355971 DOI: 10.1038/s41598-022-17543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
The ribonucleic acid (RNA) of the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is detectable in municipal wastewater as infected individuals can shed the virus in their feces. Viral concentration in wastewater can inform the severity of the COVID-19 pandemic but observations can be noisy and sparse and hence hamper the epidemiological interpretation. Motivated by a Canadian nationwide wastewater surveillance data set, unlike previous studies, we propose a novel Bayesian statistical framework based on the theories of functional data analysis to tackle the challenges embedded in the longitudinal wastewater monitoring data. By employing this framework to analyze the large-scale data set from the nationwide wastewater surveillance program covering 15 sampling sites across Canada, we successfully detect the true trends of viral concentration out of noisy and sparsely observed viral concentrations, and accurately forecast the future trajectory of viral concentrations in wastewater. Along with the excellent performance assessment using simulated data, this study shows that the proposed novel framework is a useful statistical tool and has a significant potential in supporting the epidemiological interpretation of noisy viral concentration measurements from wastewater samples in a real-life setting.
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Cheung DC, Bremner KE, Tsui TCO, Croxford R, Lapointe-Shaw L, Giudice LD, Mendlowitz A, Perlis N, Pataky RE, Teckle P, Zeitouny S, Wong WWL, Sander B, Peacock S, Krahn MD, Kulkarni GS, Mulder C. "Bring the Hoses to Where the Fire Is!": Differential Impacts of Marginalization and Socioeconomic Status on COVID-19 Case Counts and Healthcare Costs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1307-1316. [PMID: 35527165 PMCID: PMC9072854 DOI: 10.1016/j.jval.2022.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/01/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Local health leaders and the Director General of the World Health Organization alike have observed that COVID-19 "does not discriminate." Nevertheless, the disproportionate representation of people of low socioeconomic status among those infected resembles discrimination. This population-based retrospective cohort study examined COVID-19 case counts and publicly funded healthcare costs in Ontario, Canada, with a focus on marginalization. METHODS Individuals with their first positive severe acute respiratory syndrome coronavirus 2 test from January 1, 2020 to June 30, 2020, were linked to administrative databases and matched to negative/untested controls. Mean net (COVID-19-attributable) costs were estimated for 30 days before and after diagnosis, and differences among strata of age, sex, comorbidity, and measures of marginalization were assessed using analysis of variance tests. RESULTS We included 28 893 COVID-19 cases (mean age 54 years, 56% female). Most cases remained in the community (20 545, 71.1%) or in long-term care facilities (4478, 15.5%), whereas 944 (3.3%) and 2926 (10.1%) were hospitalized, with and without intensive care unit, respectively. Case counts were skewed across marginalization strata with 2 to 7 times more cases in neighborhoods with low income, high material deprivation, and highest ethnic concentration. Mean net costs after diagnosis were higher for males ($4752 vs $2520 for females) and for cases with higher comorbidity ($1394-$7751) (both P < .001) but were similar across levels of most marginalization dimensions (range $3232-$3737, all P ≥ .19). CONCLUSIONS This study suggests that allocating resources unequally to marginalized individuals may improve equality in outcomes. It highlights the importance of reducing risk of COVID-19 infection among marginalized individuals to reduce overall costs and increase system capacity.
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Affiliation(s)
- Douglas C Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | - Lauren Lapointe-Shaw
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lisa Del Giudice
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Reka E Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paulos Teckle
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - William W L Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada; Queen's University, Kingston, Ontario, Canada.
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Mucaki EJ, Shirley BC, Rogan PK. Likely community transmission of COVID-19 infections between neighboring, persistent hotspots in Ontario, Canada. F1000Res 2022; 10:1312. [PMID: 35646330 PMCID: PMC9130760 DOI: 10.12688/f1000research.75891.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: This study aimed to produce community-level geo-spatial mapping of confirmed COVID-19 cases in Ontario Canada in near real-time to support decision-making. This was accomplished by area-to-area geostatistical analysis, space-time integration, and spatial interpolation of COVID-19 positive individuals. Methods: COVID-19 cases and locations were curated for geostatistical analyses from March 2020 through June 2021, corresponding to the first, second, and third waves of infections. Daily cases were aggregated according to designated forward sortation area (FSA), and postal codes (PC) in municipal regions Hamilton, Kitchener/Waterloo, London, Ottawa, Toronto, and Windsor/Essex county. Hotspots were identified with area-to-area tests including Getis-Ord Gi*, Global Moran’s I spatial autocorrelation, and Local Moran’s I asymmetric clustering and outlier analyses. Case counts were also interpolated across geographic regions by Empirical Bayesian Kriging, which localizes high concentrations of COVID-19 positive tests, independent of FSA or PC boundaries. The
Geostatistical Disease Epidemiology Toolbox, which is freely-available software, automates the identification of these regions and produces digital maps for public health professionals to assist in pandemic management of contact tracing and distribution of other resources. Results: This study provided indicators in real-time of likely, community-level disease transmission through innovative geospatial analyses of COVID-19 incidence data. Municipal and provincial results were validated by comparisons with known outbreaks at long-term care and other high density residences and on farms. PC-level analyses revealed hotspots at higher geospatial resolution than public reports of FSAs, and often sooner. Results of different tests and kriging were compared to determine consistency among hotspot assignments. Concurrent or consecutive hotspots in close proximity suggested potential community transmission of COVID-19 from cluster and outlier analysis of neighboring PCs and by kriging. Results were also stratified by population based-categories (sex, age, and presence/absence of comorbidities). Conclusions: Earlier recognition of hotspots could reduce public health burdens of COVID-19 and expedite contact tracing.
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Affiliation(s)
- Eliseos J. Mucaki
- Department of Biochemistry, University of Western Ontario, London, Ontario, N6A 5C1, Canada
- CytoGnomix Inc, London, Ontario, N5X 3X5, Canada
| | | | - Peter K. Rogan
- Department of Biochemistry, University of Western Ontario, London, Ontario, N6A 5C1, Canada
- CytoGnomix Inc, London, Ontario, N5X 3X5, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, N6A 5C1, Canada
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Descary MH, Froda S. Estimating the basic reproduction number from noisy daily data. J Theor Biol 2022; 549:111210. [PMID: 35788342 PMCID: PMC9250830 DOI: 10.1016/j.jtbi.2022.111210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/20/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
In this paper, we propose an easy to implement generalized linear models (GLM) methodology for estimating the basic reproduction number, R0, a major epidemic parameter for assessing the transmissibility of an infection. Our approach rests on well known qualitative properties of the classical SIR and SEIR systems for large populations. Moreover, we assume that information at the individual network level is not available. In inference we consider non homogeneous Poisson observation processes and mainly concentrate on epidemics that spread through a completely susceptible population. Further, we examine the performance of the estimator under various scenarios of relevance in practice, like partially observed data. We perform a detailed simulation study and illustrate our approach on Covid-19 Canadian data sets. Finally, we present extensions of our methodology and discuss its merits and practical limitations, in particular the challenges in estimating R0 when mitigation measures are applied.
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Affiliation(s)
- Marie-Hélène Descary
- Université du Québec à Montréal, Département de mathématiques, Montréal H2X 3Y7, Québec, Canada.
| | - Sorana Froda
- Université du Québec à Montréal, Département de mathématiques, Montréal H2X 3Y7, Québec, Canada
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Liu CW, Jeyakumar N, McArthur E, Sontrop JM, Myran DT, Schwartz KL, Sood MM, Tanuseputro P, Garg AX. SARS-CoV-2 testing, infection and outcomes among Ontario physicians: a descriptive population-based cohort study. CMAJ Open 2022; 10:E657-E665. [PMID: 35853660 PMCID: PMC9313000 DOI: 10.9778/cmajo.20210263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Health care workers have a higher risk of acquiring SARS-CoV-2 infection than the general population. Our study reports on SARS-CoV-2 testing, infection and associated outcomes in Ontario physicians before SARS-CoV-2 vaccination became available on Dec. 14, 2020. METHODS We conducted a descriptive, population-based cohort study of physicians in Ontario, Canada, from Jan. 25 to Dec. 31, 2020. We included physicians and postgraduate medical trainees who were residents of Ontario and registrants with the College of Physicians and Surgeons of Ontario during the study period. We examined the proportion of physicians tested for SARS-CoV-2 infection, the proportion who tested positive, and how testing and infections varied by certain physician characteristics. We reported on clinical outcomes associated with infection, including hospital admission and death. RESULTS Of 41 208 physicians (mean age 47 yr; 56.1% male), 19 116 (46.4%) were tested at least once for SARS-CoV-2 infection; 358 tested positive (0.9%). No physicians died within 30 days of testing positive; however, 20/358 (5.6%) were admitted to hospital. By specialty, the proportion tested was highest among postgraduate medical trainees (2531/4125 [61.4%]), emergency physicians (281/478 [58.8%]), infectious disease physicians (33/67 [49.3%]) and family physicians (8857/18 553 [47.7%]). The proportion who tested positive was highest among internal medicine physicians (44/3499 [1.3%]), postgraduate medical trainees (47/4125 [1.1%]) and family physicians (171/18 553 [0.9%]). Of 2290 physicians who worked in long-term care, 1636 (71.4%) were tested and 25 (1.1%) tested positive. INTERPRETATION During the prevaccination period of the COVID-19 pandemic in Ontario, nearly half of all physicians in the province were tested at least once for SARS-CoV-2 infection, 0.9% tested positive and none died. These findings may reflect the public health measures that were implemented in the province during this period.
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Affiliation(s)
- Cheng-Wei Liu
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont
| | - Nivethika Jeyakumar
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont
| | - Eric McArthur
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont
| | - Jessica M Sontrop
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont
| | - Daniel T Myran
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont
| | - Kevin L Schwartz
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont
| | - Manish M Sood
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont
| | - Amit X Garg
- ICES Jeyakumar, McArthur, Garg, Myran, Sood, Tanuseputro, Schwartz, Ont.; Department of Medicine (Liu, Garg), Western University, London, Ont.; Department of Epidemiology & Biostatistics (Sontrop, Garg), Western University, London, Ont.; Clinical Epidemiology Program (Myran, Sood, Tanuseputro), Ottawa Hospital Research Institute, Ottawa, Ont.; Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Sood, Tanuseputro) and Department of Family Medicine (Myran), University of Ottawa, Ottawa, Ont.
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Impact of the COVID-19 Pandemic on Biomass Supply Chains: The Case of the Canadian Wood Pellet Industry. ENERGIES 2022. [DOI: 10.3390/en15093179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The ongoing COVID-19 pandemic has disrupted global economic activity in all sectors, including forest industries. Changes in demand for forest products in North America over the course of the pandemic have affected both primary processors and downstream industries reliant on residues, including wood pellet producers. Wood pellets have become an internationally traded good, mostly as a substitute for coal in electricity generation, with a significant proportion of the global supply coming from Canadian producers. To determine the effect of the COVID-19 pandemic on the Canadian wood pellet industry, economic and market data were evaluated, in parallel with a survey of Canadian manufacturers on their experiences during the first three waves of the pandemic (March 2020 to September 2021). Overall, the impact of the pandemic on the Canadian wood pellet industry was relatively small, as prices, exports, and production remained stable. Survey respondents noted some negative impacts, mostly in the first months of the pandemic, but the quick recovery of lumber production helped to reduce the impact on wood pellet producers and ensured a stable feedstock supply. The pandemic did exacerbate certain pre-existing issues, such as access to transportation services and labour availability, which were still a concern for the industry at the end of the third wave in Canada. These results suggest that the Canadian wood pellet industry was resilient to disruptions caused by the pandemic and was able to manage the negative effects it faced. This is likely because of the integrated nature of the forest sector, the industry’s reliance on long-term supply contracts, and feedstock flexibility, in addition to producers and end-users both being providers of essential services.
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Leigh JP, Brundin-Mather R, Soo A, FitzGerald E, Mizen S, Dodds A, Ahmed S, Burns KEA, Plotnikoff KM, Rochwerg B, Perry JJ, Benham JL, Honarmand K, Hu J, Lang R, Stelfox HT, Fiest K. Public perceptions during the first wave of the COVID-19 pandemic in Canada: a demographic analysis of self-reported beliefs, behaviors, and information acquisition. BMC Public Health 2022; 22:699. [PMID: 35397530 PMCID: PMC8994420 DOI: 10.1186/s12889-022-13058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
We explored associations between sociodemographic factors and public beliefs, behaviors, and information acquisition related to the coronavirus disease 2019 (COVID-19) to identify how the experiences of subpopulations in Canada may vary.
Methods
We administered a national online survey through Ipsos Incorporated to adults residing in Canada. Sampling was stratified by population age, sex, and regional distributions. We used descriptive statistics to summarize responses and test for differences based on gender, age, educational attainment, and household income using chi-squared tests, followed by weighted logistic regression.
Results
We collected 1996 eligible questionnaires between April 26th and May 1st, 2020. Respondents mean age was 50 years, 51% were women, 56% had a post-secondary degree, and 72% had a household income <$100,000. Our analysis found differences within the four demographic groups, with age effects most acutely evidenced. Respondents 65 years and older were more likely to perceive the pandemic as very serious, less likely to report declines in overall health, and more likely to intend to get vaccinated, compared to 18–29 year olds. Women overall were more likely to report negative outcomes than men, including stress due to the pandemic, and worsening social, mental/emotional, and spiritual health. Respondents 45 and older were more likely to seek and trust information from traditional Canadian news sources, while 18-29 year olds were more likely to seek and trust information on social media; overall, women and respondents with a post-secondary degree were more likely to access and trust online information from public health sites.
Conclusion
This study found important demographic differences in how adults living in Canada perceived the COVID-19 pandemic, the impacts on their health, and their preferences for information acquisition. Our results highlight the need to consider demographic characteristics in tailoring the format and information medium to improve large scale acceptance and uptake of mitigation and containment measures.
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Beauchamp MK, Joshi D, McMillan J, Erbas Oz U, Griffith LE, Basta NE, Kirkland S, Wolfson C, Raina P. Assessment of Functional Mobility After COVID-19 in Adults Aged 50 Years or Older in the Canadian Longitudinal Study on Aging. JAMA Netw Open 2022; 5:e2146168. [PMID: 35019980 PMCID: PMC8756318 DOI: 10.1001/jamanetworkopen.2021.46168] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The association of COVID-19 not requiring hospitalization with functional mobility in community-dwelling adults above and beyond the impact of the pandemic control measures implemented in 2020 remains to be elucidated. OBJECTIVE To evaluate the association between a COVID-19 diagnosis and change in mobility and physical function of adults in Canada aged 50 years or older during the initial pandemic lockdown. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 study. This study was launched on April 15, 2020, and the exit questionnaires were completed between September and December 2020. Prepandemic data from the first CLSA follow-up (2015-2018) were also used. Respondents included middle-aged and older community-dwelling participants residing in Canadian provinces. Data were analyzed from February to May 2021. EXPOSURES The assessment for self-reported COVID-19 status was adapted from the Public Health Agency of Canada and the Centers for Disease Control and Prevention case definition available at the time of data collection; cases were classified as confirmed or probable, suspected, or non-COVID-19. MAIN OUTCOMES AND MEASURES Changes in mobility since the start of the COVID-19 pandemic were assessed using global rating of change in mobility scales at the COVID-19 exit questionnaire. Participant-reported new onset of difficulty in 3 physical function tasks was also examined. RESULTS Among 51 338 participants at baseline, 21 491 participants (41.9%) were 65 years or older and 26 155 participants (51.0%) were women and 25 183 (49.1%) were men. Of 2748 individuals with confirmed or probable or suspected COVID-19, 113 (94.2%) were not hospitalized. Individuals with confirmed or probable COVID-19 had higher odds of worsening mobility in terms of ability to engage in household activity (odds ratio [OR], 1.89; 95% CI, 1.11-3.22), physical activity (OR, 1.91; 95% CI, 1.32-2.76), and standing up after sitting in a chair (OR, 2.33; 95% CI, 1.06-5.11) compared with adults without COVID-19 during the same pandemic time period. Similar results were found for suspected COVID-19 status (eg, household activity: OR, 2.09; 95% CI, 1.82-2.41). CONCLUSIONS AND RELEVANCE This cohort study among older adults in Canada found that receiving a COVID-19 diagnosis was significantly associated with worse mobility and functioning outcomes even in the absence of hospitalization. These findings suggest that interventions may be needed for individuals with mild to moderate COVID-19 who do not require hospitalization.
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Affiliation(s)
- Marla K. Beauchamp
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Canada
| | - Divya Joshi
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jacqueline McMillan
- Department of Medicine, Section of Geriatric Medicine, University of Calgary, Calgary, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Urun Erbas Oz
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lauren E. Griffith
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nicole E. Basta
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Susan Kirkland
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Parminder Raina
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada
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Gibney RN, Blackman C, Gauthier M, Fan E, Fowler R, Johnston C, Jeremy Katulka R, Marcushamer S, Menon K, Miller T, Paunovic B, Tanguay T. COVID-19 pandemic: the impact on Canada’s intensive care units. Facets (Ott) 2022. [DOI: 10.1139/facets-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.
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Affiliation(s)
- R.T. Noel Gibney
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Cynthia Blackman
- Dr. Cynthia Blackman and Associates, Edmonton, AB M5R 3R8, Canada
| | - Melanie Gauthier
- Faculty of Nursing, McGill University, Montréal, QC Canada
- President, Canadian Association of Critical Care Nurses, Quebec, QC, Canada
| | - Eddy Fan
- Interdisciplinary Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert Fowler
- Interdisciplinary Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, Sunnybrook Hospital, Toronto, ON M5S 1A1, Canada
| | - Curtis Johnston
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
| | - R. Jeremy Katulka
- Department of Medicine, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Samuel Marcushamer
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
| | - Kusum Menon
- Paediatric Intensive Care Unit, Children’s Hospital of Eastern Ontario, Ottawa, ON K1N 6N5, Canada
- Paediatric Intensive Care Unit, Department of Pediatrics, University of Ottawa, Ottawa, ON T6G 2R3, Canada
| | - Tracey Miller
- Intensive Care Unit, Royal Columbian Hospital, New Westminster, BC V3L 3W7, Canada
| | - Bojan Paunovic
- Department of Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- President, Canadian Critical Care Society, Winnipeg, MB R3T 2N2, Canada
| | - Teddie Tanguay
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
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