Analyzing the Effect of Choice and Availability in Healthcare on Health Outcomes in Canada – A Pre-COVID-19 Environment

This research hypothesizes that greater availability of healthcare services, and greater choice in healthcare facilities results in better health when controlling for a variety of socio-economic factors within the Canadian context. This research will model access to healthcare services using density of general and specialist physicians relative to population size, and the geographic density of healthcare facilities. Choice in healthcare is modeled by the number of healthcare facilities in each health region, when normalized by the population in that health region. Various health outcomes will be used as benchmarks to test this hypothesis, including self-reported general health, self-reported mental health, influenza immunization rates, body mass index (BMI), and incidence of diabetes, cardiovascular disease and hypertension. From the empirical results, choice in the healthcare system does not have an impact on the selected health outcomes. Increased availability of healthcare generally improves health outcomes, but this is dependent on the health outcome in question, and the provincial region being analyzed. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Liquid biopsy testing in metastatic or advanced breast cancer patients during the COVID-19 pandemic

Objective: During the COVID-19 pandemic, cancer patients had restricted access to standard of care tissue biopsy. Liquid biopsy assays using next generation sequencing technology provides a less invasive method for determining circulating tumour mutations (ctDNA) associated with targeted treatments or prognosis. As part of deploying technology to help cancer patients obtain molecular testing, a clinical program was initiated to offer liquid biopsy testing for Canadian patients with advanced or metastatic breast cancer. Method(s): Blood was drawn in two 10 mL StreckTM DNA BCTs and sent to the CAP/CLIA/DAP accredited Imagia Canexia Health laboratory for testing using the clinically validated Follow ItTM liquid biopsy assay. Plasma was isolated using a double spin protocol and plasma cell-free DNA (cfDNA) extracted using an optimized Promega Maxwell RSC method. Extracted cfDNA was amplified using the multiplex amplicon-based hotspot 30 or 38 gene panel and sequenced. An inhouse developed bioinformatics pipeline and reporting platform were used to identify pathogenic single nucleotide variants (SNVs), indels (insertions and deletions), and gene amplification. Included in the panel are genes associated with metastatic breast cancer: AKT1, BRAF, ERBB2, ESR1, KRAS, PIK3CA, TP53. Result(s): To identify biomarkers, 1214 metastatic or advanced breast cancer patient cfDNA samples were tested. There were 15 cases sent for repeat testing. We reported 48% of samples harboring pathogenic ctDNA mutations in TP53 (22%), PIK3CA (19%), ESR1 (18%), AKT1 (2%), ERBB2 (1.5%). Co-occurring variants were identified in samples with ESR1/PIK3CA as well as TP53/PIK3CA (both p-values <0.001). Interestingly, 29% of samples with mutated ESR1 harbored >= 2 ESR1 ctDNA mutations. In 56% of cases, previous molecular testing indicated the cancer subtype as hormone receptor (ER, PR) positive with/without HER2 negative status. In this specific subgroup, 49% harbored ctDNA mutations with 63% of those being PIK3CA and/or ESR1 mutations. Conclusion(s): A population of Canadian women with metastatic breast cancer were tested using a liquid biopsy gene panel during the COVID-19 pandemic for identification of biomarkers for targeted therapeutic options. Over 50% of the samples were identified as hormone positive, with greater than 60% harboring PIK3CA and ESR1 ctDNA mutations. Studies have shown that metastatic PIK3CA mutated ER-positive/HER2-negative tumors are predictive to respond to alpelisib therapy and have FDA and Health Canada approval. Additionally, ESR1 mutations are associated with acquired resistance to antiestrogen therapies, and interestingly we identified 29% of ESR1 mutated samples with multiple mutations possibly indicating resistance subclones. In future studies, longitudinal monitoring for presence of multiple targetable and resistance mutations could be utilized to predict or improve clinical management.

Reducing anxiety levels during a pandemic with virtual art therapy: A quasi-experimental pilot study

The COVID-19 pandemic brought an increased need for mental health support. Art therapists, like other mental health providers, made rapid decisions to transition from in-person to virtual formats. The Canadian International Institute of Art Therapy (CiiAT) in Victoria, Canada, provides online diploma and certificate programs in art therapy with a requirement for practice in settings, such as hospitals and community organizations. Due to contact restrictions in early 2020, the non-profit Proulx Global Education and Community Foundation, which oversees CiiAT, set up a Virtual Art Therapy Clinic (VATC) to meet the needs of practicum students and serve clients dealing with anxiety and other challenges. Students could continue with their practicum while providing accessible and affordable art therapy services to clients at home. VATC uses the Jane Application as its video conferencing and scheduling platform, which is privacy compliant following Canadian regulations. Clients can virtually receive art therapy services from VATC anywhere globally by setting up appointments with supervised CiiAT student art therapists. This chapter describes a CiiAT student-initiated pilot quantitative research study in which student art therapists recorded their clients' anxiety levels before and after virtual art therapy sessions. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Self-Care for Rheumatoid Arthritis during the Covid-19 Pandemic: Transferability of Canadian and Uk Experiences

Background/Aims The COVID-19 pandemic posed unique challenges for people worldwide in self-caring for their rheumatoid arthritis (RA). COVID-19 also prompted global changes in public health (e.g., vaccination programs and mask wearing) and rheumatology services (e.g., integrating telehealth with in-person healthcare). To facilitate cross-country learning of how to support people with RA to self-care during and post-pandemic, better understanding of individuals' experiences of self-care in the context of changes in public health and 'integrated' healthcare is needed. Our study aimed to explore transferability in experiences of public health measures and telehealth during COVID- 19 among individuals with RA in Canada and the UK. Methods Between July and October 2022, online focus groups (90 mins) took place with participants living with RA in the UK. Participants were recruited via social media and professional networks (including Versus Arthritis). Each participant received a report >=7days before each focus group, with a request to review in advance. The report contained preliminary findings identified through reflexive thematic analysis of interviews (30-70 mins) with thirty-nine participants with RA in British Columbia, Canada (26-86 years;36 females) between December 2020 and 2021. Nine preliminary themes were identified across three topics: accessing telehealth and in-person healthcare;decision-making around COVID-19 vaccinations and public health measures;and renegotiating 'the self'. The themes guided the focus groups, wherein UK participants shared their perspectives on each theme arising in the Canadian context. Audio-visual recordings were transcribed verbatim, and transcripts were de-identified. Ongoing directed content analysis of focus group data involves a collaborative approach with patient partners. Results Four focus groups involving thirteen participants (44-81 years;11 females) living across the UK were conducted. Participants had lived with RA for between 3-36 years. Canadian experiences typically resonated with UK participants, with some feeling a sense of unity and sadness that challenges were also experienced by others living with RA beyond their national context. Many UK participants supported preferences expressed by Canadian participants for a 'hybrid' healthcare approach to maximise benefits and minimise downsides of telehealth, and in-person consultations post-pandemic. Benefits (e.g., avoiding risk of COVID-19 transmission with telehealth) and disadvantages (e.g., lacking sensitivity/accuracy of in-person assessments) described by Canadian participants also resonated with UKbased participants. Many described how their decision-making on adopting public health measures to maintain their self-care was supported and/or undermined in their local context/community. Conclusion Our findings offer novel insights into the challenges and opportunities experienced by people with RA in their decision-making around public health measures and telehealth during a global pandemic. They also demonstrate some transferability of experiences between the UK and Canada. Insights may serve to inform decision-making for policy and programmes to support self-care (e.g., by integrating telehealth into routine rheumatology practice) across countries during and postpandemic.

VARIABLE REDUCTIONS IN SARS-CoV-2 VARIANT IMPORTATIONS FOLLOWING TRAVEL RESTRICTIONS

Background: Retrospectively quantifying effectiveness of interventions such as travel restrictions to counter viral introduction and transmission is critical to inform public health policy. Phylogenetic analyses of SARS-CoV-2 variants were undertaken to quantify the effects Canadian COVID-19 travel restrictions had on variant importation and transmission dynamics. Method(s): Global and Canadian GISAID sequences available up to March 2022 were subsampled proportionally to variant-specific case counts and ten phylogenies were inferred for each variant. Trees, dates, and geographies were inferred using maximum likelihood. Result(s): In response to Alpha, Canada implemented a UK flight ban from December 20, 2020-January 6, 2021, resulting in a 1.5-fold reduction in UK sublineage importation rate, with subsequent rebound (Fig. 1). Enhanced screening measures were implemented on December 24, 2020 for South African arrivals to counter Beta. Although there was a 6.3-fold reduction of Beta sublineages per week from South Africa following enhanced screening, there is low confidence in rare events. For Gamma, enhanced screening for arrivals from Brazil was implemented March 31-April 13, 2021. Proportion of Gamma sublineages from Brazil was reduced 1.6-fold within 2 weeks of the intervention, but the weekly importation rate was not significantly changed from start to end of intervention. In response to Delta, Canada issued a suspension of flights from India from April 22-September 23, 202, coinciding with a 2.4-fold reduction in sublineage importation and 3.8-fold reduction in proportion of sublineages from India. Increased importations from the USA and Europe progressively negated the ban's effectiveness. Against Omicron, Canada banned entry of all foreign nationals who had travelled through southern Africa and implemented enhanced screening for Canadians from November 26- December 18, 2021. Subsequently, the BA.1 sublineage importation rate from South Africa was maintained at a low level amid rising cases, while importations from other sources increased, reducing the proportion of sublineages from South Africa and diluting the measure's effectiveness. Conclusion(s): Flight bans and enhanced screening against SARS-CoV-2 variants were most effective when implemented rapidly and for lengthier time;however, effectiveness declined as variants became globally widespread. Ongoing genomic surveillance programs incorporating phylodynamic analyses can inform travel restriction and non-pharmaceutical intervention policy. (Figure Presented).

COVID-19 effects on the Canadian term structure of interest rates

In Canada, COVID-19 pandemic triggered exceptional monetary policy interventions by the central bank, which in March 2020 made multiple unscheduled cuts to its target rate. In this paper we assess the extent to which Bank of Canada interventions affected the determinants of the yield curve. In particular, we apply Functional Principal Component Analysis to the term structure of interest rates. We find that, during the pandemic, the long-run dependence of level and slope components of the yield curve is unchanged with respect to previous months, although the shape of the mean yield curve completely changed after target rate cuts. Bank of Canada was effective in lowering the whole yield curve and correcting the inverted hump of previous months, but it was not able to reduce the exposure to already existing long-run risks.

Chronic sleep disturbance among adult Canadians: Associations and implications to the evaluation of noise impacts under Canada's Impact Assessment Act

The Canadian Perspectives on Environmental Noise Survey was completed online by 6647 randomly selected Canadians 18 years of age and older between April 12 and May 25, 2021. The survey objective was to explore attitudes, perceptions, and expectations toward environmental noise in rural and non-rural Canada. The questionnaire assessed self-reported high sleep disturbance (HSD) in the previous year, at home. The prevalence of HSD was 7.8% overall. A list of potential sources of sleep disturbance was provided to the full sample, where 6.1%, 5.2%, and 3.0% reported HSD by noisy neighbors, road traffic noise and indoor noise, respectively. Stress/anxiety or worrying about something was selected most frequently at 12.9%. Finally, 7.6% and 5.5% reported pain/illness and partner's sleep disturbance, respectively, as sources of HSD. Reported HSD was significantly higher among respondents below 55 years of age, females, lower income groups, unemployed respondents, those on paid leave (sick, maternity, disability), and living in an urban area. Expectations of quiet, perceiving nighttime noise to have increased over time, high noise sensitivity, hearing and being highly annoyed by road traffic noise was also associated with an increased prevalence of reporting HSD. In contrast to hearing impairment and heart disease (including high blood pressure);rated physical health, mental health, anxiety/depression, and reporting a sleep disorder, were associated with increased HSD. The perceived affects of the COVID-19 pandemic on health and annoyance toward environmental and indoor noise also influenced HSD. In the fully adjusted multivariate logistic regression model, the effect of age, gender, changes in nighttime noise, road traffic noise annoyance, noise sensitivity and sleep disorder remained statistically significant. The univariate and multivariate models showed a similar prevalence of HSD between Indigenous Peoples and non-Indigenous Canadians. Results are discussed in relation to the provision of advice on sleep and health under Canada's Impact Assessment Act. © 2023

Determinants of recreational screen time behavior following the COVID-19 pandemic among Canadian adults.

The objectives of our study were to examine recreational screen time behavior before and 2 years following the COVID-19 pandemic lockdown, and explore whether components of the capability-opportunity-motivation-behavior (COM-B) model would predict changes in this recreational screen time behavior profile over the 2-year period. This cross-sectional, retrospective study was conducted in March 2022. Canadian adults (n = 977) completed an online survey that collected demographic information, current screen time behavior, screen time behavior prior to the pandemic, and beliefs about capability, opportunities, and motivation for limiting screen time based on the COM-B model. We found that post-pandemic recreational screen time (3.91 ± 2.85 h/day) was significantly higher than pre-pandemic levels (3.47 ± 2.50 h/day, p < 0.01). Three recreational screen time behavior profiles were identified based on the Canadian 24-Hour Movement Guidelines: (1) always met screen time guidelines (≤3 h/day) (47.8%; n = 454); (2) increased screen time (10.1%; n = 96); and (3) never met screen time guidelines (42%; n = 399). The overall discriminant function was found to be significant among the groups (Wilks' λ = 0.90; canonical r = 0.31, χ2 = (14) = 95.81, p < 0.001). The group that always met screen time guidelines had the highest levels of automatic motivation, reflective motivation, social opportunity, and psychological capabilities to limit screen time compared to other screen time profile groups. In conclusion, recreational screen time remains elevated post-pandemic. Addressing motivation (automatic and reflective), psychological capabilities, and social opportunities may be critical for future interventions aiming to limit recreational screen time.

The Importance of Context: Describing the Who, Where, and How of Technology-Facilitated Sexual Harassment

Many of the pervasive problems that women historically faced in person, such as sexual harassment, can now follow them everywhere through technology. The purpose of this study was to address contextual gaps in the literature about women's experiences of technology-facilitated sexual harassment (TFSH). Specifically, information about perpetrator and platform types, location, percentage of time experienced, and COVID-19 experiences were captured. Canadian women (N = 481) were recruited through a course credit system and online advertisements. Results indicated the public, private, and chronic nature of TFSH. Furthermore, social media and dating applications were identified as commonly occurring places for TFSH, with strangers and acquaintances often being reported as perpetrators. This research may help to inform future research and prevention strategies for TFSH.Copyright © 2023 Taylor & Francis.

Validation of the French-Canadian version of the COVID-19 Peritraumatic Distress Index with parents of an infant

Parents of an infant may be particularly vulnerable to peritraumatic distress (e.g., psychological distress experienced during or immediately following a traumatic event) associated with events such as the COVID-19 pandemic. Since peritraumatic distress could affect both their psychological well-being and their couple relationship functioning, it is essential to measure and document these symptoms within parents. The COVID-19 Peritraumatic Distress Index (CPDI;Qiu et al., 2020) was the first validated instrument to measure COVID-19 peritraumatic distress, but it has not yet been validated in French. This study aimed to assess the psychometric properties of the French-Canadian version of the CPDI (F-CPDI) in a sample of 492 parents (58% of mothers) of an infant in Quebec Province (Canada). The factor structure, internal consistency, and convergent validity of the instrument were tested. Results indicate that the F-CPDI has good internal consistency and supports the four-factor structure proposed by the authors of the original instrument. Results of correlation analyses indicated that peritraumatic distress was related to increased psychological distress, postpartum depression, and lower life satisfaction. Results indicate satisfactory psychometric qualities for the F-CPDI, providing researchers and mental health professionals access to a COVID-19 peritraumatic distress measure. This questionnaire can be used to assess peritraumatic distress in parents of an infant during a pandemic period, which is a first step towards offering adapted intervention strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (French) Les parents d'un nouveau-ne peuvent etre particulierement vulnerables a la detresse peritraumatique (c'est-a-dire la detresse psychologique vecue pendant ou immediatement apres un evenement traumatique) associee a des evenements tels que la pandemie de COVID-19. Puisque la detresse peritraumatique pourrait affecter a la fois leur bien-etre psychologique et le fonctionnement de leur relation de couple, il est essentiel de mesurer et de documenter ces symptomes chez les parents. L'indice de detresse peritraumatique reliee a la COVID-19 (IDPC;Qiu et al., 2020) a ete le premier instrument valide pour mesurer la detresse peritraumatique reliee a la COVID-19, mais il n'a pas encore ete valide en francais. Cette etude visait a evaluer les proprietes psychometriques de la version franco-canadienne du CPDI (l'IDPC en francais) aupres d'un echantillon de 492 parents (58 % de meres) d'un nouveau-ne dans la province de Quebec (Canada). La structure factorielle, la coherence interne et la validite convergente de l'instrument ont ete testees. Les resultats indiquent que l'IDPC a une bonne coherence interne et soutient la structure a quatre facteurs proposee par les auteurs de l'instrument original. Les resultats des analyses de correlation indiquent que la detresse peritraumatique est liee a une detresse psychologique accrue, a la depression post-partum et a une satisfaction de vie moindre. Les resultats indiquent des qualites psychometriques satisfaisantes pour l'IDPC, permettant aux chercheurs et aux professionnels de la sante mentale d'avoir acces a un indice de detresse peritraumatique reliee a la COVID-19. Ce questionnaire peut etre utilise pour evaluer la detresse peritraumatique des parents d'un nouveau-ne en periode de pandemie, ce qui constitue une premiere etape pour proposer des strategies d'intervention adaptees. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement The COVID-19 pandemic is associated with an increase in mental health problems, including peritraumatic distress (Qiu et al., 2020). This study tested the validity of the French-Canadian COVID-19 Peritraumatic Distress Index (F-CPDI;Qiu et al., 2020), the first validated instrument to measure COVID-19 peritraumatic distress. Results revealed satisfactory psychometric qualities for the F-CPDI and prevalence rate of peritraumatic distress reaching 20.5% in Quebec parents of an infant. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact of the COVID-19 pandemic on Canadian Armed Forces Veterans who live with chronic pain

Introduction: Chronic pain is more prevalent in military Veterans than in the general population. The extent to which the COVID-19 pandemic has affected Canadian Armed Forces (CAF) Veterans living with chronic pain is unknown. This study compared the impact of the pandemic and public health measures on Canadian Veterans and non-Veterans. Methods: An online cross-sectional study was conducted across Canada. Participants (n = 3,159) were adults with chronic pain recruited from April to May 2020. Seventy-six participants reported having formerly served in the CAF and were pair-matched with non-Veterans. Results: CAF Veteran participants' mean age was 55.1 (standard deviation = 9.6) years;50.0% were female. Over 60% lived with chronic pain for > 10 years. Two thirds of Veterans (67.1%) reported worsened pain since pandemic onset, and 44.7% experienced moderate to severe psychological distress. This was comparable to the non-Veteran group (63.2%, p = 0.61;35.5%, p = 0.25), and no differences were found between female and male Veterans (p = 0.22, p = 0.36). Percentages of participants reporting changes in pharmacological pain treatments because of the pandemic were similar in CAF Veterans (14.9%) and non-Veterans (13.3%) (p = 0.68). Over 50% of Veterans modified their physical/psychological pain treatments due to the pandemic, compared with 45.3% of non-Veterans (p = 0.24). Discussion: Pain deterioration, psychological distress, and pain treatment changes were observed in CAF Veterans living with chronic pain during the COVID-19 pandemic, as was the case in non-Veterans. These results will help develop interventions to adequately face pandemic waves to come and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) Introduction : La prevalence de la douleur chronique est plus elevee chez les veterans que dans la population en general. La mesure dans laquelle la pandemie de COVID-19 a touche les veterans des Forces armees canadiennes (FAC) souffrant de douleur chronique n'est pas connue. La presente etude compare l'impact de la pandemie et des mesures de sante publique chez des veterans et des non-veterans canadiens. Methodologie : Une etude transversale en ligne a ete effectuee partout au Canada. Les participants (n = 3 159) etaient des adultes vivant avec de la douleur chronique, recrutes en avril et en mai 2020. Soizante-seize participants ont indique avoir servi dans les FAC et ont ete apparies avec des non-veterans. Resultats : L'age moyen des participants veterans FAC etait de 55,1 ans (ecart-type = 9,6);50 % etaient des femmes. Plus de 60 % d'entre eux vivaient avec de la douleur chronique depuis plus de 10 ans. Deux tiers des veterans (67,1 %) ont indique que leur douleur s'etait aggravee depuis le debut de la pandemie et 44,7 % ont ressenti de la detresse psychologique moderee a grave. Ces pourcentages sont comparables a ceux observes chez le groupe de non-veterans (63,2 %, p =0,61 ;35,5 %, p = 0,25) et aucune difference n'a ete notee entre les veterans masculins et feminins (p = 0,22, p = 0,36). Les pourcentages de participants rapportant des changements dans leurs traitements pharmacologiques pour la douleur, en raison de la pandemie, etaient semblables chez les veterans des FAC (14,9 %) et les non-veterans (13,3 %) (p = 0,68). Plus de 50 % des veterans ont modifie leurs traitements physiques/psychologiques pour la douleur en raison de la pandemie, comparativement a 45,3 % des non-veterans (p = 0,24). Discussion : Une intensification de la douleur, de la detresse psychologique et des modifications apportees aux traitements de la douleur ont ete observees pendant la pandemie de COVID-19 chez les veterans des FAC qui vivent avec la douleur chronique comme c'etait le cas chez les non-veterans. Ces resultats aideront a mettre au point des interventions qui permettront de faire face de facon adequate aux prochaines vagues de la pandemie et a de futures crises sanitaires. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement Chronic pain is more frequent in military Veterans than in the general population. The objective of this study was to assess whether the COVID-19 pandemic has had a greater impact on Canadian Armed Forces (CAF) Veterans who live with chronic pain compared to non-Veterans. An online survey of Canadian adults with chronic pain was conducted between April and May 2020;76 respondents reported having formerly served in the CAF and were compared with 76 similar non-Veterans. About two thirds of the Veterans had been living with chronic pain for longer than 10 years. Two thirds reported worsened pain since the pandemic began. Nearly half experienced moderate to severe psychological distress. These changes were similar to those in non-Veterans with chronic pain. A significant number of Veterans and non-Veterans changed their pain treatments due to the pandemic. In summary, the COVID-19 pandemic and associated restriction measures did not have a greater impact in CAF Veterans with chronic pain compared with non-Veterans. However, changes in chronic pain supports are needed to be better prepared for COVID-19 waves to come and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

PPE Supply Optimization Under Risks of Disruption from the COVID-19 Pandemic

The COVID-19 pandemic has struck health service providers around the world with dire shortages, inflated prices, and volatile demand of personal protective equipment (PPE). This paper discusses supply chain resilience in the context of a Canadian provincial healthcare provider during the COVID-19 pandemic. A multi-period multi-objective mixed-integer programming model is presented for PPE supply planning under disruption risk. The deterministic formulation is extended to consider both two-stage and multi-stage uncertainty in the supply, price, and demand of PPE using stochastic programming (SP) and chance-constrained programming (CCP). The first objective is to minimize a risk measure of the stochastic total cost, either its Expected Value (EV) or its Value-at-Risk (VaR), and the second objective is to minimize the maximum shortage of any product in any time period. The ϵ-constraint method is used to generate sets of Pareto-optimal solutions and analyze the trade-off between these two competing objectives. Numerical experiments are conducted to analyze the efficacy of emergency inventory and increased inventory levels as risk mitigation strategies. We consider uncertainty scenarios based on plausible and actual pandemic trajectories seen around the world during the COVID-19 pandemic including single-wave, two-wave, and exponential growth. © 2023, The Author(s), under exclusive licence to Springer Nature Switzerland AG.

"I Called us the Sacrificial Lambs": Experiences of Nurses Working in Border City Hospitals During the First Wave of the COVID-19 Pandemic.

BACKGROUND: The first wave of the COVID-19 pandemic had a significant impact on the personal and professional lives of frontline nurses. PURPOSE: The purpose of this descriptive phenomenological study was to explore the experiences of Canadian Registered Nurses (RNs) working in Ontario or United States hospitals during the first wave of the COVID-19 pandemic. METHODS: Semi-structured interviews were conducted with 36 RNs living in Ontario and employed either at an Ontario or United States hospital. Three main themes were identified across both healthcare contexts. RESULTS: 1) The Initial Response to the pandemic included a rapid onset of chaos and confusion, with significant changes in structure and patient care, often exacerbated by hospital management. Ethical concerns arose (e.g., redeployment, allocation of resources) and participants described negative emotional reactions. 2) Nurses described Managing the Pandemic by finding new ways to nurse and enhanced teamwork/camaraderie; they reported both struggle and resiliency while trying to maintain work and home life balance. Community responses were met with both appreciation and stigma. 3) Participants said they were Looking Forward to a "new normal", taking pride in patient improvements, accomplishments, and silver linings, with tempered optimism about the future. Many expressed a reaffirmation of their identities as nurses. Differences between participants working in the US and those working in Ontario were noted in several areas (e.g., initial levels of chaos, ethical concerns, community stigma). CONCLUSIONS: The COVID-19 pandemic has been very difficult for nursing as a profession. Close attention to post-pandemic issues is warranted.

Association between Area Level Material Deprivation and Incidence of Hospitalization among Children with Sars-Cov-2 in Montreal

BACKGROUND: Although sociodemographic factors have been linked with SARS-CoV-2 infection and hospitalizations in adults, there are little data on the association between sociodemographic characteristics and SARS-CoV-2-related hospitalization in children. OBJECTIVE(S): The objective of this study was to determine the association between area-level material deprivation and incidence of hospitalization with SARS-CoV-2 among children. DESIGN/METHODS: We conducted a retrospective cohort study of all children (0-17 years of age) with a PCR-confirmed SARS-CoV-2 infection between March 1, 2020, and May 31, 2021, at a tertiary care pediatric hospital. Data were collected through chart review and included age, sex, and postal code. Postal codes were then assigned a dissemination area-level material deprivation score, measured via the Pampalon Material Deprivation Index (PMDI) quintiles. The Pampalon Material Deprivation Index (PMDI) uses postal codes to describe factors related to material deprivation obtained from the Canadian census, which are proxies for individual data in a geographic area. Specifically, the PMDI integrates data regarding (i) the proportion of persons without a high school diploma;(ii) the employment-to-population ratio;(iii) average personal income which is aggregated at the dissemination area level. We examined the association between PMDI quintiles and hospitalization using Poisson regression. RESULT(S): During the study period, 964 children had a positive PCRconfirmed SARS-CoV-2 test and 124 were hospitalized due to SARSCoV- 2 infection. Children from the most deprived PMDI quintile represented 31.6% of positive cases and 40.7% of hospitalizations (Figure 1 and 2). Both in bivariate and multivariable regression analyses, there was evidence of greater proportion of positive test results in the most deprived PMDI quintile (Quintile 5) compared to the least deprived quintile (Quintile 1) (rate ratio 1.77, 95%CI: 1.36;2.62) (Table 1). The incidence of hospitalization due to SARS-CoV-2 infection was 2.42 times greater in the most deprived quintile compared to the least deprived quintile (95%CI: 1.33;4.41) (table 1). In a post-hoc analysis, the risk for severe disease appeared higher for children living in Q5 areas relative to other areas but the difference did not reach statistical significance. CONCLUSION(S): In conclusion, in this study we found evidence that Canadian children living in neighbourhoods with high material deprivation had a higher incidence of infection and hospitalizations related to SARS-Cov-2 compared to children living in neighbourhoods with less material deprivation. Public health authorities should take these disparities into account when devising public health policy and interventions especially at this crucial point in the pandemic. Special efforts should be deployed to protect children from these more disadvantaged areas, especially as vaccination is not yet available to a majority of children.

Ambulatory Care Visits and Admissions for Suicidal Ideation and Self-Harm in Canadian Adolescents during the Covid-19 Pandemic: A Population-Based Analysis

Database, and Hospital Morbidity Database. The primary outcome was ambulatory care visits for a composite of suicidal ideation, intentional self-poisoning, and intentional self-harm. Results were stratified by age and sex and expressed as a rate (proportion of encounters with an outcome per 100 encounters). We compared the differences (delta) in slopes (average increase in outcomes) between April 1, 2015, to March 31, 2020, and April 1, 2020 to March 31, 2021 to determine if the expected rate (pre-pandemic) differed significantly from the observed rate (pandemic). RESULT(S): From April 1, 2020, to March 31, 2021, compared to April 1, 2015, to March 31, 2020, the rate of ambulatory care visits and admissions for all conditions decreased. The average quarterly rate of ambulatory care visits for the composite among males 10-14 years, increased by 40.3%, from 0.57 to 0.8 (slope delta=0.1;95% CI: 0.02, 0.18;p=0.012). Among females 10-14 years, the rate increased by 85.1%, from 1.81 to 3.35 (slope delta=0.7;95% CI: 0.43, 0.97;p<0.001). Among males 15-18 years, the rate increased by 29.5%, from 1.56 to 2.02 (slope delta=0.13;95% CI: -0.02, 0.28;p=0.078). Among females 15-18 years, the rate increased by 33.6%, from 3.18 to 4.25 (slope delta=0.26;95% CI: -0.16, 0.68;p=0.192). The average quarterly rate of admissions was significant for females 10-14 years and increased by 27.7%, from 8.59 to 10.97 (slope delta=1.99;95% CI: 0.57, 3.41;p=0.017). CONCLUSION(S): The proportion of ambulatory care visits and admissions for emotional symptoms, suicidal ideation, and self-harm during the first year of the COVID-19 pandemic increased compared to pre-pandemic rates among adolescents 10-14 years in Canada. Our findings underscore the importance of promoting public health policies that mitigate the impact of pandemics on adolescent mental health.

editor's message

[...]as the authors in this issue who have contributed to our understanding of good teaching and learning practices gleaned amidst the COVID-19 pandemic would remind us, we need to continue the practices which make our music-learning spaces more inclusive. Reflecting on this teaching and learning experience, Hill discusses how this unit taught by John responded to some of the Truth and Reconciliation Commission of Canada: Calls to Action, namely to develop culturally appropriate curricula and build student capacity for intercultural understanding, empathy, and mutual respect. [...]guest columnist Laurel Forshaw details the Kodály Society of Canada's activities over the past year that have focused on helping their membership engage in reconciliation efforts, guided by the Truth and Reconciliation Commission of Canada: Calls to Action.

Frailty and the impacts of the COVID-19 pandemic on community-living middle-aged and older adults: an analysis of data from the Canadian Longitudinal Study on Aging (CLSA).

BACKGROUND: frailty imparts a higher risk for hospitalisation, mortality and morbidity due to COVID-19 infection, but the broader impacts of the pandemic and associated public health measures on community-living people with frailty are less known. METHODS: we used cross-sectional data from 23,974 Canadian Longitudinal Study on Aging participants who completed a COVID-19 interview (Sept-Dec 2020). Participants were included regardless of whether they had COVID-19 or not. They were asked about health, resource, relationship and health care access impacts experienced during the pandemic. Unadjusted and adjusted prevalence of impacts was estimated by frailty index quartile. We further examined if the relationship with frailty was modified by sex, age or household income. RESULTS: community-living adults (50-90 years) with greater pre-pandemic frailty reported more negative impacts during the first year of the pandemic. The frailty gradient was not explained by socio-demographic or health behaviour factors. The largest absolute difference in adjusted prevalence between the most and least frail quartiles was 15.1% (challenges accessing healthcare), 13.3% (being ill) and 7.4% (increased verbal/physical conflict). The association between frailty and healthcare access differed by age where the youngest age group tended to experience the most challenges, especially for those categorised as most frail. CONCLUSION: although frailty has been endorsed as a tool to inform estimates of COVID-19 risk, our data suggest it may have a broader role in primary care and public health by identifying people who may benefit from interventions to reduce health and social impacts of COVID-19 and future pandemics.

Abstracts of the 2022 Annual Conference of the Canadian Paediatric

The proceedings contain 98 papers. The topics discussed include: ambulatory care visits and admissions for suicidal ideation and self-harm in Canadian adolescents during the COVID-19 pandemic: a population-based analysis;estimating the impact of menstrual poverty on adolescents in Nova Scotia;self-care and coping behaviors among trans and gender-diverse adolescents in clinical care: a mixed methods study;the impact of the COVID-19 pandemic on number and severity of new diagnoses of restrictive eating disorders during prolonged lockdown in Ontario, Canada;clinical and demographic characteristics of a cohort of children and adolescents followed at a multidisciplinary gender diversity clinic for French-speaking youth;incidence of eating disorders during COVID-19: a retrospective review;does physical activity vary by virtual or in-person school models in school-aged children?;the effect of decreased physical activity on physical and mental health of school-aged children during the COVID-19 pandemic;congenital heart disease and autism spectrum disorders: is there a link?;the association between underweight and iron status in early childhood: cross-sectional and prospective study;and the association between underweight and iron status in early childhood: cross-sectional and prospective study.