Resilience in adolescence during the COVID-19 crisis in Canada.

BACKGROUND: The COVID-19 pandemic constitutes a social crisis that will have long-term health consequences for much of the global population, especially for adolescents. Adolescents are triply affected as they: 1) are experiencing its immediate, direct effects, 2) will carry forward health habits they develop now into adulthood, and 3) as future parents, will shape the early life health of the next generation. It is therefore imperative to assess how the pandemic is influencing adolescent wellbeing, identify sources of resilience, and outline strategies for attenuating its negative impacts. METHODS: We report the results of longitudinal analyses of qualitative data from 28 focus group discussions (FGDs) with 39 Canadian adolescents and of cross-sectional analyses of survey data from 482 Canadian adolescents gathered between September 2020 and August 2021. FGD participants and survey respondents reported on their: socio-demographic characteristics; mental health and wellbeing before and during the pandemic; pre- and during-pandemic health behaviours; experiences living through a crisis; current perceptions of their school, work, social, media, and governmental environments; and ideas about pandemic coping and mutual aid. We plotted themes emerging from FGDs along a pandemic timeline, noting socio-demographic variations. Following assessment for internal reliability and dimension reduction, quantitative health/wellbeing indicators were analyzed as functions of composite socio-demographic, health-behavioural, and health-environmental indicators. RESULTS: Our mixed methods analyses indicate that adolescents faced considerable mental and physical health challenges due to the pandemic, and were generally in poorer health than expected in non-crisis times. Nevertheless, some participants showed significantly better outcomes than others, specifically those who: got more exercise; slept better; were food secure; had clearer routines; spent more time in nature, deep in-person social relationships, and leisure; and spent less time on social media. CONCLUSIONS: Support for youth during times of crisis is essential to future population health because adolescence is a period in the life course which shapes the health behaviours, socio-economic capacities, and neurophysiology of these future parents/carers and leaders. Efforts to promote resilience in adolescents should leverage the factors identified above: helping them find structure and senses of purpose through strong social connections, well-supported work and leisure environments, and opportunities to engage with nature.

Creating Flexibility for Adapted Physical Education Teachers in Supporting Children with Disabilities Using Google Sites and Google Forms

The COVID-19 pandemic has changed education in how learning occurs such as utilizing technological supports. Specific to adapted physical education (APE), the pandemic affected APE teachers' abilities to support their students' physical activity (PA) needs, which produced barriers but also successes in the form of collaboration among APE professionals and increased knowledge, confidence, and use of technology. However, a question remains on what lasting impacts the COVID-19 pandemic will have on education and APE. As such, APE teachers should be prepared to support students in any educational setting and utilize the available resources regarding technology. Additionally, they should have the opportunity to explore different technology approaches to develop competence and determine what aspects can support their students and themselves. Therefore, the purpose of this article is to provide information about two technology resources-Google Sites and Google Forms-that APE teachers can use to support their teaching responsibilities and students. Information about how to utilize both resources are provided as well as suggestions for future use.

Remote Provision and Self-Administration of Misoprostol as Cervical Preparation for Hospital-Based Uterine Evacuation Between 14-18 Weeks

Introduction Guidelines support use of misoprostol or osmotic dilators until 18 weeks' gestation for cervical preparation prior to uterine evacuation. Use of misoprostol in a hospital-based multispecialty operating room setting can be challenging if procedure times are unpredictable. Additionally, perioperative areas may have minimal tolerance for misoprostol side effects or pregnancy expulsion. At our institution, the SARS-CoV-2 pandemic caused reevaluation of in-person preoperative visits for uterine evacuation procedures, especially if ultrasound records were available and placement of osmotic dilators was not necessary. This study evaluates telemedicine for provision of misoprostol prior to hospital-based uterine evacuation procedures between 14-18 weeks' gestation. Method Retrospective health data was ed from the electronic medical record at a large tertiary medical center and managed using REDCap electronic data capture tools hosted at Cedars-Sinai Medical Center. We included all patients who attended a telemedicine preoperative visit between 14-18 weeks' gestation with a family planning subspecialist between March 1, 2020 – August 31, 2022. Patients were electronically prescribed misoprostol 400 mcg for cervical preparation and instructed to place the tablets buccally or vaginally before presenting to the hospital on the day of the procedure. Surgery appointment times varied weekly based on operating room availability. Descriptive statistics were used to evaluate success of obtaining and self-administering misoprostol, along with the operative procedure itself. We also analyzed procedural details such as maximum mechanical cervical dilation, instruments used to complete the procedure, and any unanticipated complications from the misoprostol or procedure. Data analysis was completed utilizing Excel. Results Sixty-seven patients met eligibility criteria. Mean patient age was 36 (range 20-44). Median gestational age was 15 weeks (range 14-18). Most patients were vaginally nulliparous;only 23 patients (34%) had a prior vaginal delivery. No patients experienced pregnancy expulsion. Only one patient forgot to pick up misoprostol prescription. Misoprostol was obtained from the hospital pharmacy and administered in the pre-operative unit, leading to the only misoprostol-related procedure delay. Sixty-six other patients (99%) self-administered misoprostol as instructed. All procedures were successfully completed. Preferred target dilation based on gestational age, defined as 43 French (Fr) for 14 weeks gestation and 45 French for 15-18 weeks gestation, was met in 42 cases (63%). Of the remaining cases, 21 (31%) reached 37 French allowing passage of ring forceps. Only 4 (6%) had restricted mechanical dilation to less than 37 French, but procedures were completed due to early gestation of 14-15 weeks. Of the 22 procedures from 16-18 weeks, ring or sopher forceps were passable in all cases. Only three procedures (4.5%) required uterotonics. All cases had known risk factors. Two were size-discordant fetal demises and one had four prior cesarean deliveries with intraoperative diagnosis of placenta accreta. There were no cervical lacerations. Conclusions Utilizing a telemedicine pre-operative visit with electronic prescription and self-administration of misoprostol prior to hospital-based uterine evacuation procedure between 14-18 weeks is effective and safe. Though multi-specialty operating rooms can pose challenges with procedural timing and thus predictability for pre-hospital misoprostol administration, procedures are still completed with rare misoprostol-related delay and no complications. Telemedicine preoperative visits benefit patients logistically and give hospital-based providers flexibility to rapidly accommodate early second-trimester referrals. Streamlining hospital-based abortion into a single-day, in-person procedure visit can align us with outpatient clinics and increase overall capacity, which is important given the changing landscape of abortion care.

Together: Navy Reserve's Response to COVID-19 Pandemic

Under the direction of U.S. Northern Command for COVID-19 pandemic response efforts, approximately 500 Navy Reserve medical professionals were deployed to the New York City area from April to June 2020. Some of these providers were asked to serve in 11 overburdened local hospitals to augment clinic staffs that were exhausted from the battle against coronavirus. Two maternal/fetal medicine physicians were granted emergency clinical providers to assist in these efforts.

I.M.P.A.C.T. of Interprofessional Student Teams at a Remote Area Medical Clinic in Rural Appalachia

Introduction: Remote Area Medical (RAM), a non-profit organization serving underserved populations, partnered with East Tennessee State University to provide a unique learning opportunity for student volunteers at a clinic in rural Appalachia. Interprofessional student teams were established with undergraduate and graduate students in multiple professions. Research Question or Hypothesis: This study examined the impact on attitudes of students who participated and the impact of student teams on the event, hypothesizing that a positive impact would be seen on both. COVID-19 adjustments made were also evaluated. Study Design: Surveys of student participants were conducted electronically utilizing REDCap before and after participation in the event. Surveys included demographic questions, validated surveys, and open-ended questions. Methods: Demographic questions gauged personal background, level of education, and history of interprofessional education or events. The previously validated surveys utilized were the Interprofessional Collaborative Competency Attainment Scale-Revised (ICAAS-R) and the Student Perceptions of Interprofessional Clinical Education-Revised Instrument Version 2 (SPICE-R2). Quantitative data was analyzed with SPSS version 25. Qualitative data was analyzed with deductive coding. Interventions were tallied by student teams during the event. Results: Eighty-nine students participated logging 1,213 interventions and 84 completed portions of the survey (94% response rate). ICAAS-R (n=79) displayed mean increases from 4.19 out of 5 in the pre-survey to 4.58 in the post-survey (p<0.05). Matched responses for SPICE-R2 (n=69) increased for teamwork (p<0.001), healthcare outcomes (p <0.001), and roles and responsibilities (p<0.001) from pre-survey to post-survey. Qualitative themes acknowledged development of interprofessional competencies, identified patient need, and noted COVID-19 adjustments Conclusion: Statistically significant quantitative findings and qualitative themes supported the hypothesis that working in interprofessional teams at a RAM event would positively impact student attitudes towards interprofessional practice, and that student teams would have a positive impact on the event. COVID-19 adjustments made were well perceived. Findings can be summarized with the I.M.P.A.C.T. neumonic.

Social Integration in Social Isolation: Newcomers' Integration during the COVID-19 Pandemic

Attending to immigrants' social integration is a complex challenge for adult educators in ordinary times, and the complexity has significantly increased with the COVID-19 pandemic. This exploratory paper begins by outlining four aspects of social integration: forming social networks, developing a sense of belonging, linking social integration to the workplace, and language learning. Working within an intersectionality framework that foregrounds migrants' experiences of discrimination, this paper reveals ways that migrants have experienced increased discrimination and inequality in their social integration since the COVID-19 pandemic began. Recommendations are made regarding tending to migrants' physical and psychosocial needs, countering discriminatory attitudes with empathy, addressing the digital divide, and using intersectionality to empirically examine migrant experiences.

Exploring the acceptability of controlled human infection with SARSCoV2-a public consultation.

Rapid development of an effective vaccine for SARSCoV2 is a global priority. A controlled human infection model (CHIM) would accelerate the efficacy assessment of candidate vaccines. This strategy would require deliberate exposure of volunteers to SARSCoV2 with no currently available treatment and a small but definite risk of serious illness or death. This raises complex questions about the social and ethical acceptability of risk to individuals, given the potential benefit to the wider population, and as such, a study cannot be done without public involvement. We conducted a structured public consultation with 57 individuals aged 20-40 years to understand public attitudes to a CHIM, and pre-requisites for enrolment. The overall response to this strategy was positive, and many would volunteer altruistically. Carefully controlled infection is viewed as safer than natural exposure to wild virus. The prolonged social isolation required for the proposed CHIM is considered an obstacle but not insurmountable, with reasonable compensation and supportive care. Given the significant level of public interest, a CHIM should be done as open science with regular, controlled dissemination of information into the public domain. Importantly, there was a strong view that the final decision whether to conduct a CHIM should be in the hands of qualified and experienced clinician-scientists and the authorities.