Temporal examination of adult food insecurity amongst Canadian families managing food allergy.

BACKGROUND: Pediatric food allergy is associated with excess familial food costs compared to families without allergy. Since the start of the COVID-19 pandemic, food prices have increased substantially. OBJECTIVE: To understand the temporal pattern of food insecurity amongst Canadian families with food allergy from the year prior to the pandemic, through May 2022. METHODS: Using data collected electronically from families reporting food allergy using a validated food security questionnaire, we estimated food insecurity, including categories of food insecurity (marginal, moderate, secure) in the year prior to the pandemic (2019; Wave 1), and the first (2020; Wave 2) and second years of the pandemic (2022; Wave 3). RESULTS: Participants in all waves were commonly in 2 + adult, 2 child households. Less than half of participants (Waves 1-3: 45.7%, 31.0%, and 22.9%, respectively) reported household incomes below the median Canadian. Common allergies were milk, eggs, peanuts and tree nuts. In Wave 1, 22.9% of families reported food insecurity; corresponding numbers at Waves 2 and 3 were 30.6% and 74.4%, respectively, representing an overall increase of 225.6%, including notable increases in severe food insecurity. CONCLUSION: Canadian families with pediatric food allergy report higher rates of food insecurity compared to the general Canadian population, especially during the pandemic.

Vaccine confidence among those living with allergy during the COVID pandemic (ACCORD): A scoping review.

Background: Reports of allergic reactions to coronavirus disease 2019 (COVID-19) vaccines, coupled with an "infodemic" of misinformation, carry the potential to undermine confidence in the COVID-19 vaccines. However, no attempts have been made to comprehensively synthesize the literature on how allergic disease and fear of allergic reactions to the vaccines contribute to hesitancy. Objectives: Our aim was to review the academic and gray literature on COVID-19 vaccine hesitancy and allergic reactions. Methods: We searched 4 databases (CINAHL, PsycINFO, MEDLINE, and Embase) using a search strategy developed by content and methodologic experts. No restrictions were applied regarding COVID-19 vaccine type, country of study, or patient age. Eligible articles were restricted to 10 languages. Results: Of the 1385 unique records retrieved from our search, 60 articles (4.3%) were included. Allergic reactions to the COVID-19 vaccine were rare but slightly more common in individuals with a history of allergic disease. A fifth of the studies (13 of 60 [22%]) discussed vaccine hesitancy due to possibility of an allergic reaction. Additionally, the present review identified research on details of vaccine-related anaphylaxis (eg, a mean and median [excluding clinical trial data] of 12.4 and 5 cases per million doses, respectively) and allergic reactions (eg, a mean and median [excluding clinical trial data] of 489 and 528 cases per million doses, respectively). Conclusion: COVID-19 vaccine acceptance among individuals living with allergy and among those with no history of allergic disease may be affected by fear of an allergic reaction. Despite the low incidence of allergic reactions to the COVID-19 vaccine, fear of such reactions is one of the most commonly cited concerns reported in the literature.

Paediatric asthma hospitalisations continue to decrease in Finland and Sweden between 2015 and 2020.

We previously reported a decreasing incidence of paediatric asthma hospitalisations in Finland, but a rather stable trend in Sweden, between 2005 and 2014. We now aimed to investigate the incidence of paediatric asthma hospitalisations in these countries between 2015 and 2020, using Finland's National Hospital Discharge Register and Sweden's National Patient Register, which cover all hospitalisations in the respective countries. From 2015 to 2019, the incidence of paediatric asthma hospitalisations decreased by 36.7% in Finland and by 39.9% in Sweden and are increasingly approaching parity. In 2020, despite differences in COVID-19-related restrictions, asthma hospitalisations decreased by over 40%, thus warranting future research on the subject.

vACcine COnfidence amongst those living with alleRgy during the COVID pandemic (ACCORD): a scoping review protocol.

BACKGROUND: Reports of allergic reactions to the COVID-19 vaccines have been documented, which may also contribute to hesitancy. Despite the low likelihood that the COVID-19 vaccine will trigger an allergic reaction, we and others have reported that families with allergy remain vaccine hesitant due to concerns of COVID-19-vaccine-triggered anaphylaxis. OBJECTIVE: To present our scoping review protocol, that will inform a forthcoming living scoping review in which we will investigate the peer-reviewed and grey literature on COVID-19 vaccine hesitancy and allergic disease and/or allergic reactions following a COVID-19 vaccine. METHODS: Informed by Arksey and O'Malley framework for methodological review, we have developed a search strategy with content and methodological experts, and which has undergone Peer Review of Electronic Search Strategies review. A search of four scientific databases, as well as gray literature, will be performed without restriction to articles by type of COVID-19 vaccine, or country of study, and will include publications in the ten languages our team can handle. Bi-monthly search alerts based on the search strategy will be generated. RESULTS: The first search will result in a stand alone peer reviewed scoping review. Bi-monthly updates will be posted on a pre-print server. Depending on the volume of literature, these updates will be synthesized and submitted for peer-review at 6 and/or 12 months. CONCLUSION: COVID-19 vaccine hesitancy amongst individuals with allergy persists, despite very low risk of serious adverse reactions. Our living scoping review, which includes multiple forms of knowledge translation, will be a rigorous way to address hesitancy.

Building Emotional Awareness and Mental Health (BEAM): study protocol for a phase III randomized controlled trial of the BEAM app-based program for mothers of children 18-36 months.

BACKGROUND: The prevalence of maternal depression and anxiety has increased during the COVID-19 pandemic, and pregnant individuals are experiencing concerningly elevated levels of mental health symptoms worldwide. Many individuals may now be at heightened risk of postpartum mental health disorders. There are significant concerns that a cohort of children may be at-risk for impaired self-regulation and mental illness due to elevated exposure to perinatal mental illness. With both an increased prevalence of depression and limited availability of services due to the pandemic, there is an urgent need for accessible eHealth interventions for mothers of young children. The aims of this trial are to evaluate the efficacy of the Building Emotion Awareness and Mental Health (BEAM) app-based program for reducing maternal depression symptoms (primary outcome) and improve anxiety symptoms, parenting stress, family relationships, and mother and child functioning (secondary outcomes) compared to treatment as usual (TAU). METHODS: A two-arm randomized controlled trial (RCT) with repeated measures will be used to evaluate the efficacy of the BEAM intervention compared to TAU among a sample of 140 mothers with children aged 18 to 36 months, who self-report moderate-to-severe symptoms of depression and/or anxiety. Individuals will be recruited online, and those randomized to the treatment group will participate in 10 weeks of psychoeducation modules, an online social support forum, and weekly group teletherapy sessions. Assessments will occur at 18-36 months postpartum (pre-test, T1), immediately after the last week of the BEAM intervention (post-test, T2), and at 3 months after the intervention (follow-up, T3). DISCUSSION: eHealth interventions have the potential to address elevated maternal mental health symptoms, parenting stress, and child functioning concerns during and after the COVID-19 pandemic and to provide accessible programming to mothers who are in need of support. This RCT will build on an open pilot trial of the BEAM program and provide further evaluation of this evidence-based intervention. Findings will increase our understanding of depression in mothers with young children and reveal the potential for long-term improvements in maternal and child health and family well-being. TRIAL REGISTRATION: ClinicalTrials.gov NCT05306626 . Registered on April 1, 2022.

Changes in food-related costs during the COVID-19 pandemic among families managing food allergy.

Background: The COVID-19 pandemic has affected the supply, cost, and demand for certain foods, but it is not clear how these changes have affected food-allergic households. Objective: To describe the changes in food-related costs that have followed COVID-19, as reported by higher- and lower-income households with a food-allergic member. Methods: Between May 1-June 30, 2020, Canadian households, with at least one food-allergic member, completed an online survey on food shopping and preparation habits before and during the COVID-19 pandemic. The sample was divided into binary groups, either higher or lower than the sample median income. Data were analyzed using descriptive statistics and multiple regression. Results: The sample was comprised of 102 participants (i.e., 51/ income group). The three most common food allergies amongst both groups were peanuts, tree nuts and milk. Since the start of the pandemic, both groups reported greater monthly direct grocery costs, although costs amongst the higher-income group were twice as high as the lower-income group ($212.86 vs. $98.89, respectively). Indirect food preparation costs were similarly elevated. Higher-income households with food procurement difficulties reported increased indirect shopping costs following the outbreak of COVID-19, whereas those without such difficulties reported decreased costs. Lower-income households with allergies to milk, wheat, or eggs (i.e., staple allergy) experienced a larger change in indirect food preparation costs following the outbreak of COVID-19 relative to those with other food allergies ($244.58 vs. -$20.28, respectively; p = 0.03). Conclusion: Both higher and lower income households with food allergy reported greater direct food costs and indirect food preparation costs following the COVID-19. Households with staple allergy and those with difficulties finding their typical food items were particularly affected.

Building Emotional Awareness and Mental Health (BEAM): A Pilot Randomized Controlled Trial of an App-Based Program for Mothers of Toddlers.

Background: Families have faced unprecedented challenges during the COVID-19 pandemic, leading to increased maternal mental health problems and barriers to accessing care. Innovative programs are needed to support both maternal mental health and parenting, and to buffer the long-term impacts of stress on young children. Using a patient-oriented approach, our research team aimed to co-develop and pilot test an App-based psychoeducation and social-connection platform: Building Emotional Awareness and Mental Health (BEAM). Methods: The co-development process involved a parent advisory board from conceptualization and design, through to direct participation in the program delivery. The BEAM program includes weekly videos and activities based on Unified Protocol therapy modules and emotion-focused parenting strategies, a weekly telehealth group review session, and access to a private online forum for support from other mothers and clinical coaches. A parallel randomized control trial was conducted across two provinces in Canada. Mothers of preschool children (aged 18-36 months old), with moderate-to-severe depression (Patient Health Questionaire-9 ≥ 10), were recruited online and randomized to either the 10-week BEAM intervention or treatment as usual (TAU) control group. Online surveys (ensuring researcher blinding) included questions about feasibility and acceptability of the program and pre/post self-report measures of mental health, parenting, positive coping and child behavior outcomes. The primary outcome measures were symptoms of depression and parenting stress. Data were analyzed using mixed models and an intention-to-treat approach. Results: 65 participants were randomized, by an online allocation tool, to the BEAM (n = 33) and TAU (n = 32) groups. Engagement was relatively high at the beginning of the program, with 78.8% starting the BEAM App and 70.6% attending ≥1 telehealth session. Most respondents felt socially supported, satisfied with the App, and found it easy to use. Pre-post results indicated interaction effects with greater reductions in overall mental health problems, and specifically anxiety and sleep symptoms, among BEAM vs. control participants. There were also time effects with reductions in depression symptoms across both groups. No significant treatment effects emerged for the other mental health symptoms, parenting problems, positive coping, or child behavior outcomes. Descriptive data are included to highlight possible areas of promise for future large efficacy trials. Technological difficulties and other challenges that may have led to attrition and impacted outcomes are discussed. There were no adverse events related to study participation. Conclusions: The BEAM program has promise as a novel, feasible and acceptable intervention for improving mental health among mothers of young children. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04772677].

The need for a food allergy educator program for allied healthcare professionals in Canada.

Owing to a collaborative approach to patient care, and a paucity of allergists in Canada, there is a need to develop a food allergy educational program for allied health care professionals in Canada. Such programs already exist in the United States and Britain. Herein, we describe the outcomes of recent conference proceedings to inform the educational needs for such a program. As part of the 76th Annual Meeting of the Canadian Society of Allergy and Clinical Immunology (CSACI), held virtually due to the COVID-19 pandemic, we hosted a virtual workshop on the need for a food allergy educator program for Canadian allied health professionals. This workshop was co-developed with the CSACI and an industry partner, and featured allergy specialist dietitians. Attendance was open to all conference delegates, and to allied health professionals. As part of the registration process, registrants posed diverse food allergy-related questions, ranging from how to use an epinephrine autoinjector, to daily management and, how to cure food allergy. A national food allergy educator program will empower both allergy and non-allergy specialist healthcare professionals to appropriately counsel patients. This virtually-delivered program will begin to close a gap in healthcare access resulting from the geographic size of Canada, as it will enhance allied healthcare providers' confidence to provide evidence-based food allergy care appropriately for those with food allergy.

Elementary School Teachers' Perceptions of COVID-19-Related Restrictions on Food Allergy Management.

(1) Background: Approximately 7% of Canadian children live with a food allergy (FA). Pre-COVID-19, ~20% of anaphylactic reactions occurred in schools. Yet, teachers reported poor FA-related knowledge, and experiences during the COVID-19 pandemic are not well-studied. Additionally, teachers' management approaches vary widely. We aimed to describe elementary school teachers' perceptions about FA management during the COVID-19 pandemic; (2) Methods: Using a semi-structured interview guide, English-speaking elementary school teachers in Winnipeg, Canada were interviewed virtually. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically; (3) Results: Most teachers were female and taught in public schools. Two themes were identified. Theme 1, COVID-19 restrictions made mealtimes more manageable, capturing the positive impacts of pandemic restrictions such as seating arrangements and enhanced cleaning. Limited lunchtime supervision prompted some teachers to assume this role. Theme 2, Food allergy management was indirectly adapted to fit changing COVID-19 restrictions, describing how changing restrictions influenced FA-related practices. FA training was offered virtually with less nursing support. Class cohorts and remote learning decreased teachers' perceived risk and FA-related management responsibility; (4) Conclusions: COVID-19-related practices were perceived as positively influencing in-school FA management, although unintended consequences, such as increased supervisory roles for teachers and reduced nursing support, were described.

Changes in Maternal Substance Use During the COVID-19 Pandemic.

OBJECTIVE: Maternal stress and mental health challenges have increased since the coronavirus disease 2019 (COVID-19) pandemic began. Experts are concerned about elevated substance use given its well-known association with negative emotions, but existing research has not examined substance use among mothers during the COVID-19 pandemic. This is a crucial next step to inform policy and service supports given links between maternal substance use and adverse family experiences. METHOD: Data were collected online between April 14 and 28, 2020. A total of 508 mothers (mean age = 34.8 years, SD = 5.1) with children 0-8 years old participated via the Parenting During the Pandemic study. Mothers self-reported substance use change and motivations for using substances, as well as mental health symptoms. RESULTS: Of participating mothers, 54.9% did not change, 39.2% increased, and 5.9% decreased their substance use. Findings indicated that mothers with an anxiety disorder or elevated anxiety symptoms were more likely to report increased substance use during the pandemic. Using substances to cope with anxiety, depression, and boredom was elevated among mothers self-reporting increased substance use during the pandemic versus those reporting no change or a decrease in usage. Using substances to cope with anxiety was a risk factor for increased substance use. CONCLUSIONS: Many mothers have increased their substance use since the onset of the COVID-19 pandemic. Results highlight the need to treat maternal anxiety and the importance of teaching mothers coping strategies, other than using substances, to reduce the incidence of increased substance use among mothers and its negative sequelae.

Paying the price? Academic work and parenting during COVID-19 Payer le prix? Conciliation travail universitaire et famille pendant la pandémie de la COVID-19

Introduction The shift to remote working/learning to slow transmission of the SARS-CoV-2 virus has had widespread mental health impacts. We aimed to describe how the COVID-19 pandemic impacted the mental health of students and faculty within a health sciences faculty at a central Canadian university. Methods Via an online survey, we queried mental health in the first four months of the COVID-19 pandemic quantitatively (scale: 1 (most negative)-100 (most positive)) and qualitatively. Results The sample (n = 110) was predominantly women (faculty 39/59;[66.1%];students 46/50;[92.0%]). Most faculty were married/common law (50/60;[84.8%]) and had children at home (36/60;[60.0%]);the opposite was true for most students. Faculty and students self-reported comparable mental health (40.47±24.26 and 37.62±26.13;respectively). Amongst women, those with vs. without children at home, reported significantly worse mental health impacts (31.78±23.68 vs. 44.29±27.98;respectively, p = 0.032). Qualitative themes included: “Sharing resources,” “spending money,” “few changes,” for those without children at home;“working at home can be isolating,” including the subtheme, “balancing act”: “working in isolation,” “working more,” for those with children at home. Discussion Amongst women in academia, including both students and faculty, those with children at home have disproportionately worse mental health than those without children at home.

"Another Tool in Your Toolkit": Pediatric Occupational and Physical Therapists' Perspectives of Initiating Telehealth during the COVID-19 Pandemic.

AIMS: Pediatric occupational and physical therapy service delivery via telehealth increased during the COVID-19 pandemic. Real-world experience can guide service improvement. This study explored experiences, barriers, and facilitators of initial telehealth implementation from the therapist's perspective. METHODS: Qualitative descriptive approach. Semi-structured interviews were conducted with occupational therapists (n = 4) and physical therapists (n = 4) between May-June 2020. Interviews were recorded, and transcribed verbatim. Data were coded inductively to generate themes, then re-coded deductively to classify barriers and facilitators to telehealth acceptance and use using the Unified Technology Acceptance Theory. RESULTS: Participants had 16.5 [(2-35); median (range)] years of experience (3 months with telehealth) and predominantly worked with preschool children. Three themes about telehealth were identified: a practical option; requires skill development and refinement; beneficial in perpetuity. Most frequently cited barriers were the lack of opportunity for 'hands-on' assessment/intervention and the learning curve required. Most frequently cited facilitators included seeing a child in their own environment, attendance may be easier for some families, and families' perception that telehealth was useful. CONCLUSION: Despite rapid implementation, therapists largely described telehealth as a positive experience. Telehealth facilitated continued service provision and was perceived as relevant post-pandemic. Additional training and ensuring equitable access to services are priorities as telehealth delivery evolves.

Supporting families to protect child health: Parenting quality and household needs during the COVID-19 pandemic.

BACKGROUND: Supportive parenting is critical for promoting healthy child development in the face of stressors, such as those occurring during COVID-19. Here, we address a knowledge gap regarding specific household risk factors associated with parenting quality during the pandemic and incorporate first-person accounts of family challenges and needs. METHODS: Mixed methods were applied to data collected between April 14th - 28th, 2020 from the "Parenting During the Pandemic" survey. Participants included 656 primary caregivers (e.g., mothers, fathers, foster parents) of least one child age 1.5-8 years of which 555 (84.6%) responded to at least one parenting questionnaire. Parenting quality was assessed across stressful, negative, and positive parenting dimensions. Household risk was examined across pandemic- linked (e.g., caregiver depression, unmet childcare needs) and stable factors (i.e., annual income, mental illness history). Significant correlates were examined with regressions in Mplus. Thematic analysis identified caregiver challenges and unmet needs from open-ended questions. FINDINGS: Caregiver depression, higher child parity, unmet childcare needs, and relationship distress predicted lower-quality parenting. Caregiver depression was the most significant predictor across every parenting dimension, with analyses indicating medium effect sizes, ds = .39 - .73. Qualitative findings highlighted severe strains on parent capacities including managing psychological distress, limited social supports, and too much unstructured time. INTERPRETATIONS: Lower quality parenting during COVID-19 is associated with multiple household and pandemic risk factors, with caregiver depression consistently linked to parent- child relationship disruptions. Focused efforts are needed to address caregiver mental health to protect child health as part of the pandemic response.

High anxiety and health-related quality of life in families with children with food allergy during coronavirus disease 2019.

BACKGROUND: Food allergy has a known effect on quality of life (QoL), but this has not been extensively studied during the coronavirus disease 2019 pandemic. OBJECTIVE: To characterize the levels of anxiety of mothers of children aged 0 to 8 years with food allergy compared with families of children without a food allergy and the health-related QoL among children with food allergy during the coronavirus disease 2019 pandemic. METHODS: In a mixed-methods study, Canadian mothers of children aged 0 to 8 years with (cases) and without (controls) food allergy provided demographic data and completed age-appropriate anxiety questionnaires between April 14, 2020, and April 28, 2020. The cases also provided food allergy-related data and completed the Food Allergy Quality of Life Questionnaire. In-depth interviews were subsequently conducted with purposefully selected cases. RESULTS: In a total of 580 participants, 5.5% were cases and 94.5% were controls. For mothers of children aged 0 to 1.5 years, anxiety levels did not differ between cases and controls. For mothers of children aged 1.5 to 8 years, anxiety levels were higher in cases vs controls (P < .05). Among the cases, neither overall nor domain-specific Food Allergy Quality of Life Questionnaire scores differed between age groups (0-3 vs 4-7 years), even after adjustment for confounding variables, including childcare during the pandemic. Qualitatively, the following 3 themes were identified: unexpected challenges of food shopping; less food-related food anxiety during the pandemic; and differences and delays in food allergy testing and therapy. CONCLUSION: Mothers of children with food allergy reported high anxiety and poor health-related QoL. Yet, qualitatively, day-to-day food allergy management was better during the pandemic.

Maternal psychological distress & mental health service use during the COVID-19 pandemic.

BACKGROUND: Mental health problems are increasingly recognized as a significant and concerning secondary effect of the COVID-19 pandemic. Research on previous epidemics/pandemics suggest that families, particularly mothers, may be at increased risk, but this population has yet to be examined. The current study (1) described prevalence rates of maternal depressive and anxiety symptoms from an online convenience sample during the COVID-19 pandemic, (2) identified risk and protective factors for elevated symptoms, and (3) described current mental health service use and barriers. METHODS: Participants (N = 641) were mothers of children age 0-8 years, including expectant mothers. Mothers completed an online survey assessing mental health, sociodemographic information, and COVID-19-related variables. RESULTS: Clinically-relevant depression was indicated in 33.16%, 42.55%, and 43.37% of mothers of children age 0-18 months, 18 months to 4 years, and 5 to 8 years, respectively. Prevalence of anxiety was 36.27%, 32.62%, and 29.59% for mothers across age groups, respectively. Binary logistic regressions indicated significant associations between risk factors and depression/anxiety across child age groups. LIMITATIONS: Cross-sectional data was used to describe maternal mental health problems during COVID-19 limiting the ability to make inferences about the long-term impact of maternal depression and anxiety on family well-being. CONCLUSIONS: Maternal depression and anxiety appear to be elevated in the context of COVID-19 compared to previously reported population norms. Identified risk factors for depression and anxiety across different child age ranges can inform targeted early intervention strategies to prevent long-term impacts of the COVID-19 pandemic on family well-being and child development.