Navigating stroke care during the COVID-19 pandemic: A scoping review (preprint)

Background: Previous viral outbreaks have highlighted implications for the management of complex health conditions. This study delves into the repercussions of the COVID-19 pandemic on stroke care, by examining evidence of shifts in healthcare utilization, the enduring effects on post-stroke recovery, and the overall quality of life experienced by stroke survivors. Methods: A scoping review was conducted following the Joanna Briggs Institute Methodology for Scoping Reviews. The search strategy encompassed electronic databases (APA PsycInfo, Embase, Medline, and CINAHL). English language articles published between December 2019 and January 2022 were included, focusing on individuals who experienced a stroke during the COVID-19 pandemic. Data extraction involved identifying study characteristics and significant findings, facilitating a qualitative and narrative synthesis of the gathered evidence. Results: Seven domain summaries were identified. They all described the aspects of systemic transformations in stroke care during the COVID-19 pandemic: (1) patient behavior and awareness; (2) telemedicine and remote care; (3) delays in treatment; (4) impact on healthcare resources; (5) quality of care; (6) changes in stroke severity; and (7) reduction in stroke admissions. Conclusions: This study underscored the critical need to encourage swift patient response to acute stroke symptoms, by finding new avenues for treatment, mitigating hospital-related infection fears, and advocating for the establishment of centralized stroke centers. These measures are integral to optimizing stroke care delivery and ensuring timely interventions, particularly in the challenging context of a pandemic.

Rising Through the Pandemic: A scoping review of quality improvement in public health during the COVID-19 pandemic (preprint)

Background: The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) has been identified as a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which it has been used in public health settings during the COVID-19 pandemic remains unclear. Methods: We conducted a scoping review of literature published January 2020 - February 2021 and focused on the topic of QI at public health agencies during the COVID-19 pandemic. The search was conducted on four bibliographic databases, in addition to a supplementary grey literature search using custom Google search engines and targeted website search methods. Of the 1,878 peer-reviewed articles assessed, 15 records met the inclusion criteria. An additional 11 relevant records were identified during the grey literature search, for a total of 26 records included in the scoping review. Results: Records were organized into five topics: 1) collaborative problem solving and analysis with stakeholders; 2) supporting learning and capacity building in QI; 3) learning from past emergencies; 4) implementing QI methods during COVID-19; and 5) evaluating performance using frameworks/indicators. Conclusions: The literature indicates that QI-oriented activities are occurring at the organizational and program levels to enhance COVID-19 response. To optimize the benefits that QI approaches and methodologies may offer, it is important for public health agencies to focus on both widespread integration of QI as part of an organization's management philosophy and culture, as well as project level activities at all stages of the emergency management cycle.

One Virus, Four Continents, Eight Countries: An Interdisciplinary and International Study on the Psychosocial Impacts of the COVID-19 Pandemic Among Adults (preprint)

Background: The COVID-19 pandemic brings several features that increase the sense of fear, not to mention confusion, quarantine, financial losses, etc., which may lead to adverse psychosocial outcomes. The influence of such stressors takes place within a broader sociocultural context that needs to be considered.Objective: To examine how the psychological response to the pandemic varies across countries and identify which risk/protective factors contribute to this response.Methods : An online survey was conducted from May 29-June 12, 2020, among a multinational sample of 8,806 adults from eight countries/regions (Canada, United States, England, Switzerland, Belgium, Hong Kong, Philippines, New Zealand). Probable generalized anxiety disorder (GAD) and major depression episode (MDE) were assessed. The independent role of a wide range of potential factors was examined using multilevel logistic regression.Findings: Probable GAD and MDE were indicated by 21.0% and 25.5% of the respondents, respectively, with an important variation according to countries/regions (GAD: 12.2%-31.0%; MDE: 16.7%-32.9%). When considered together, 30.2% of the participants indicated probable GAD or MDE. Several factors were positively associated with a probable GAD or MDE, including (in descending order of importance) weak sense of coherence (SOC), lower age, false beliefs, isolation, threat perceived for oneself/family, mistrust in authorities, stigma, threat perceived for country/world, financial losses, being a female, and having high level of information about COVID-19. Having a weak SOC yielded the highest adjusted odds ratio for probable GAD or MDE (3.23; 95% CI: 2.76-3.78).Interpretation: This pandemic is having an impact on psychological health. In some places and under certain circumstances, however, people seem to be better protected psychologically. This is a unique opportunity to evaluate the psychosocial impacts across various sociocultural backgrounds, providing important lessons that could inform all phases of disaster risk management.Funding: This study was funded by the Canadian Institutes of Health Research.Declaration of Interests: All authors declare no competing interest.Ethics Approval Statement: This study takes place within a broader research project funded by the Canadian Institutes of Health Research. It was reviewed and approved by the Research Ethics Board of the CIUSSS de l'Estrie – CHUS (HEC ref: 2020-3674).