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1.
Int J Environ Res Public Health ; 19(22)2022 Nov 09.
Article in English | MEDLINE | ID: covidwho-2110077

ABSTRACT

Studies suggest that persistent symptoms after COVID-19 (long COVID) influence functioning and activities of daily living (ADL). However, it is still uncertain how and to what extent. This study aimed to describe patient-reported mental fatigue, ADL problems, ADL ability, sick leave and functional status among patients with long COVID. In this cross-sectional study, 448 patients, ≥18 years old and referred to occupational therapy at a Danish Post-COVID-19 Clinic, were included. Mental fatigue was measured by the Mental Fatigue Scale, ADL problems and ability were measured by the Canadian Occupational Performance Measure, sick leave was self-reported and functional status was evaluated by the Post-COVID-19 Functional Status Scale. Mean age was 46.8 years, 73% of the patients were female, and 75% suffered from moderate to severe mental fatigue. The majority reported difficulties performing productive and leisure activities. The median performance and satisfaction scores were 4.8 and 3, respectively. In total, 56% of the patients were on sick leave, and 94% were referred to rehabilitation. A decrease in functional status was found between pre-COVID-19 and assessment. Conclusively, the patients were highly affected in their everyday life and had distinct rehabilitation needs. Future research is needed to address causalities and rehabilitation for this patient group.


Subject(s)
COVID-19 , Sick Leave , Humans , Female , Middle Aged , Adolescent , Male , Activities of Daily Living , Cross-Sectional Studies , COVID-19/epidemiology , Functional Status , Canada , Mental Fatigue/epidemiology
2.
Int J Environ Res Public Health ; 19(22)2022 Nov 08.
Article in English | MEDLINE | ID: covidwho-2110063

ABSTRACT

Evidence about how the pandemic affected household violence in Canada is mixed, but inarguably, the risk factors increased. This study used data from the 2020 Canadian Perspective Survey Series and the 2020 and 2021 Surveys of COVID-19 and Mental Health to examine the following: changes in the prevalence of concern about violence in individuals' own homes during the pandemic; the characteristics of those who expressed concern; and the prevalence of concerns for specific household members. Among Canadians, the prevalence of concern about violence in individuals' own homes decreased significantly between July and Fall 2020 (5.8% to 4.2%). Among women, the characteristics that were significantly associated with higher adjusted odds of concern about household violence included larger household size and lower household income. Lower education among women was associated with lower adjusted odds of concern. The associations with higher adjusted odds of concern among men included: being an immigrant, larger household size, and lower household income. From Fall 2020 to Spring 2021, the prevalence of concerns for oneself and for a child/children increased (1.7% to 2.5% and 1.0% to 2.5%, respectively), but concern for other adults in the household decreased (1.9% to 1.2%). Ongoing surveillance is needed to understand vulnerable populations' exposure to household violence and to inform policies and programs.


Subject(s)
COVID-19 , Male , Child , Adult , Humans , Female , COVID-19/epidemiology , Pandemics , Cross-Sectional Studies , Canada/epidemiology , Violence
3.
Int J Public Health ; 67: 1604685, 2022.
Article in English | MEDLINE | ID: covidwho-2109900

ABSTRACT

Objectives: Adverse mental health impacts of the COVID-19 pandemic are well documented; however, there remains limited data detailing trends in mental health at different points in time and across population sub-groups most impacted. This paper draws on data from three rounds of a nationally representative cross-sectional monitoring survey to characterize the mental health impacts of COVID-19 on adults living in Canada (N = 9,061). Methods: Descriptive statistics were used to examine the mental health impacts of the pandemic using a range of self-reported measures. Multivariate logistic regression models were then used to quantify the independent risks of experiencing adverse mental health outcomes for priority population sub-groups, adjusting for age, gender, and survey round. Results: Data illustrate significant disparities in the mental health consequences of the pandemic, with inequitable impacts for sub-groups who experience structural vulnerability related to pre-existing mental health conditions, disability, LGBTQ2+ identity, and Indigenous identity. Conclusion: There is immediate need for population-based approaches to support mental health in Canada and globally. Approaches should attend to the root causes of mental health inequities through promotion and prevention, in addition to treatment.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Canada/epidemiology , Cross-Sectional Studies , Health Inequities , Humans , Pandemics
4.
J Med Internet Res ; 24(11): e39728, 2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2109564

ABSTRACT

BACKGROUND: Virtual care (VC) visits (telephone or video) and email-based patient communication have been rapidly adopted to facilitate cancer care during the COVID-19 pandemic. Inequities in access and patient experience may arise as these digital health tools become prevalent. OBJECTIVE: We aimed to characterize inequities in access and patient-reported experience following adoption of digital health tools at a tertiary cancer center during the COVID-19 pandemic. METHODS: We designed a cross-sectional study of outpatients with visits from September to December 2020. Patient characteristics and responses to an email-based patient-experience survey were collated. Inequities in access were assessed across three pairs of comparison groups: (1) patients with VC and in-person visits, (2) patients with and without documented email addresses, and (3) responders and nonresponders to the survey. Inequities in patient-reported experience were assessed among survey responders. Demographics were mapped to area-level averages from national census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation. Covariate balance between comparison groups was assessed using standardized mean differences (SMDs), with SMD≥0.2 indicating differences between groups. Associations between patient experience satisfaction scores and covariates were assessed using multivariable analyses, with P<.05 indicating statistical significance. RESULTS: Among the 42,194 patients who had outpatient visits, 62.65% (n=26,435) had at least one VC visit and 31.15% (n=13,144) were emailable. Access to VC and email was similar across demographic and socioeconomic indices (SMD<0.2). Among emailable patients, 21.84% (2870/13,144) responded to the survey. Survey responsiveness was similar across indices, aside from a small difference by age (SMD=0.24). Among responders, 24.4% received VC and were similar to in-person responders across indices (SMD<0.2). VC and in-person responders had similar satisfaction levels with all care domains surveyed (all P>.05). Regardless of visit type, patients had variable satisfaction with care domains across demographic and socioeconomic indices. Patients with higher ethnocultural composition scores were less satisfied with the cultural appropriateness of their care (odds ratio [OR] 0.70, 95% CI 0.57-0.86). Patients with higher situational vulnerability scores were less satisfied with discussion of physical symptoms (OR 0.67, 95% CI 0.48-0.93). Patients with higher residential instability scores were less satisfied with discussion of both physical (OR 0.81, 95% CI 0.68-0.97) and emotional (OR 0.86, 95% CI 0.77-0.96) symptoms, and also with the duration of their visit (OR 0.85, 95% CI 0.74-0.98; P=.02). Male patients were more satisfied with how their health care provider had listened to them (OR 1.64, 95% CI 1.11-2.44; P=.01). CONCLUSIONS: Adoption of VC and email can equitably maintain access and patient-reported experience in cancer care across demographics and socioeconomic indices. Existing health inequities among structurally marginalized patients must continue to be addressed to improve their care experience.


Subject(s)
COVID-19 , Neoplasms , Telemedicine , Humans , Male , COVID-19/epidemiology , Pandemics , Cross-Sectional Studies , Patient Satisfaction , Canada , Communication , Electronics , Neoplasms/therapy
7.
Am J Speech Lang Pathol ; 31(6): 2825-2834, 2022 Nov 16.
Article in English | MEDLINE | ID: covidwho-2106540

ABSTRACT

PURPOSE: During the COVID-19 pandemic, clinicians and researchers have increasingly used remote online assessments to pursue their activities, but mostly with tests not validated for videoconference administration. This study aims to validate the remote online administration of picture description in Canadian French neurotypical speakers and to explore the thematic unit (TU) checklist recently developed. METHOD: Spoken discourse elicited through the picture description task of the Western Aphasia Battery-Revised (WAB-R) was collected from Canadian French neurotypical speakers from Québec aged between 50 and 79 years old. Forty-seven participants completed the task in person, and 49 participants completed the task by videoconference. Videos of each discourse sample were transcribed using CHAT conventions. Microstructural variables were extracted using the CLAN (Computerized Language ANalysis) program, whereas thematic informativeness was scored for each sample using TUs. Chi-square tests were conducted to compare both groups on each TU; t tests were also performed on the total score of TUs and microstructural variables. RESULTS: Groups were matched on sex, age, and education variables. The t tests revealed no intergroup difference for the total TU score and for the microstructural variables (e.g., mean length of utterances and number of words per minute). Chi-square tests showed no significant intergroup difference for all 16 TUs. CONCLUSIONS: These findings support remote online assessment of the picnic scene of the WAB-R picture description in Canadian French neurotypical speakers. These results also validate the 16 TUs most consistently produced. The use of videoconference could promote and improve the recruitment of participants who are usually less accessible, such as people using assistive mobility technologies. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21476961.


Subject(s)
Aphasia , COVID-19 , Humans , Middle Aged , Aged , Language , Pandemics , Canada , Videoconferencing
8.
Can Fam Physician ; 68(10): e279-e282, 2022 10.
Article in French | MEDLINE | ID: covidwho-2101049
9.
Health Res Policy Syst ; 20(1): 51, 2022 May 07.
Article in English | MEDLINE | ID: covidwho-1820823

ABSTRACT

BACKGROUND: Timely knowledge mobilization has become increasingly critical during the COVID-19 pandemic and complicated by the need to establish or maintain lines of communication between researchers and decision-makers virtually. Our recent pan-Canadian research study on the mental health and substance use health (MHSUH) workforce during the pandemic identified key policy barriers impacting this essential workforce. To bridge the evidence-policy gap in addressing these barriers, we held a facilitated virtual policy dialogue. This paper discusses the insights generated at this virtual policy dialogue and highlights how this integrated knowledge mobilization strategy can help drive evidence-based policy in an increasingly digital world. METHODS: We held a 3-hour virtual policy dialogue with 46 stakeholders and policy decision-makers as the final phase in our year-long mixed-methods research study. The event was part of our integrated knowledge mobilization strategy and was designed to generate stakeholder-driven policy implications and priority actions based on our research findings. The data collected from the virtual policy dialogue included transcripts from the small-group breakout rooms and main sessions, reflective field notes and the final report from the external facilitator. Coded data were thematically analysed to inform our understanding of the prioritization of the policy implications and action items. RESULTS: Facilitated virtual policy dialogues generate rich qualitative insights that guide community-informed knowledge mobilization strategies and promote evidence-informed policy. Our policy dialogue identified actionable policy recommendations with equity as a cross-cutting theme. Adapting policy dialogues to virtual formats and including technology-assisted facilitation can offer advantages for equitable stakeholder participation, allow for deeper analysis and help build consensus regarding evidence-based policy priorities. CONCLUSIONS: Our facilitated virtual policy dialogue was a key knowledge mobilization strategy for our research on the capacity of the Canadian MHSUH workforce to respond to the COVID-19 pandemic. Our policy dialogue allowed us to engage a diverse group of MHSUH workforce stakeholders in a meaningful action-oriented way, provided an avenue to get feedback on our research findings, and generated prioritized action items that incorporated the knowledge and experience of these MHSUH workforce stakeholders.


Subject(s)
COVID-19 , Substance-Related Disorders , Canada , Health Policy , Health Workforce , Humans , Mental Health , Pandemics
11.
PLoS One ; 17(11): e0277243, 2022.
Article in English | MEDLINE | ID: covidwho-2098778

ABSTRACT

INTRODUCTION: Household composition may be an important factor associated with anxiety during the COVID-19 pandemic as people spend more time at home due to physical distancing and lockdown restrictions. Adults living with children-especially women-may be particularly vulnerable to anxiety as they balance additional childcare responsibilities and homeschooling with work. The objective of this study was to examine the association between household composition and anxiety symptoms during the COVID-19 pandemic and explore gender as an effect modifier. METHODS: Data were derived from seven waves of a national online survey of Canadian adults aged 18+ years from May 2020 to March 2021, which used quota sampling by age, gender, and region proportional to the English-speaking Canadian population (n = 7,021). Multivariable logistic and modified least-squares regression models were used. RESULTS: Compared to those living alone, significantly greater odds of anxiety symptoms were observed among single parents/guardians (aOR = 2.00; 95%CI: 1.41-2.84), those living with adult(s) and child(ren) (aOR = 1.39; 95%CI: 1.10-1.76), and those living with adult(s) only (aOR = 1.22; 95%CI: 1.00-1.49). Gender was a significant effect modifier on the additive scale (p = 0.0487) such that the association between living with child(ren) and anxiety symptoms was stronger among men than women. CONCLUSION: Additional tailored supports are needed to address anxiety among adults living with children-especially men-during the COVID-19 pandemic and future infectious disease events.


Subject(s)
COVID-19 , Adult , Male , Child , Female , Humans , COVID-19/epidemiology , Pandemics , Canada/epidemiology , Communicable Disease Control , Anxiety/epidemiology , Anxiety/diagnosis , Depression/epidemiology
12.
BMC Public Health ; 22(1): 1987, 2022 10 31.
Article in English | MEDLINE | ID: covidwho-2098328

ABSTRACT

BACKGROUND: The COVID-19 pandemic has drastically changed various aspects of our lives, including how we work. Since the start of the pandemic, numerous organizations in Canada have mandated their employees to work from home (WFH) on a full-time basis. The rapid rise in the number of remote workers and the possibility for WFH continuing in the future signifies the importance of understanding the health and well-being of employees working from home over the course of the pandemic in Canada. We present the findings of two surveys (initial and 6-month follow-up) to examine the health and well-being of WFH employees during the COVID-19 pandemic in Canada. We analyzed the changes in mental and physical health and well-being of employees who were working from home between two time points during the pandemic. METHODS: Initial survey was completed between October 2020 and December 2020 (n = 1617); follow-up survey was completed between May 2021 and June 2021 (n = 382). We calculated the frequencies for survey questions involving demographics, WFH preferences, workstation setup training, employment situation, provision of hardware technologies, provision and usage of software technologies, and organization's return to work plan. We conducted Wilcoxon signed-rank tests to analyze the within-individual changes in mental and physical health and well-being of the 382 respondents who completed both the initial and follow-up surveys. RESULTS: Our analyses showed significant changes in various aspects of employee mental and physical health and well-being. Burnout, stress, general mental health, and job insecurity levels significantly decreased between the two time periods. Work-related sedentary behaviour reduced over time; however, the average proportion of time spent sitting during work hours was more than 80% in both surveys. Employees received more help and feedback from their colleagues and experienced a better sense of community with their co-workers over time. CONCLUSION: The findings can inform workers and organizations on the changes in mental and physical health and well-being of employees working from home during the pandemic. By understanding the changes in worker health and well-being, employers can develop effective strategies and implement policies that help protect employees' health and well-being.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Canada/epidemiology , Mental Health , Employment
13.
Health Rep ; 33(10): 3-13, 2022 10 19.
Article in English | MEDLINE | ID: covidwho-2091443

ABSTRACT

Background: The lack of consistent measures of the cycling environment across communities hampers cycling research and policy action. Our goal was to develop the first national dataset in Canada for metrics of the cycling environment at the dissemination area (DA) level - the Canadian Bikeway Comfort and Safety (Can-BICS) metrics. Data and methods: The Can-BICS metrics are area-level metrics based on the quantity of cycling infrastructure within a 1 km buffer of the population-weighted centroid of DAs. The base data are a national cycling network dataset derived from OpenStreetMap (OSM) (extracted January 25, 2022) and classified by high-, medium- and low-comfort facilities. A Can-BICS continuous metric (sum of cycling infrastructure per square kilometre weighted by comfort class) and Can-BICS categorical metric were derived and mapped for all 56,589 DAs in Canada. The Can-BICS metrics were correlated with other national datasets (2016 Canadian Active Living Environments [Can-ALE] and 2016 Census journey-to-work data) to test for associations between Can-BICS and related measures. Additionally, city staff were engaged to provide feedback on metrics during the development phase. Results: One-third (34%) of neighbourhoods in Canada have no cycling infrastructure. According to the categorical measure, 5% of all DAs were assigned as the highest category of Can-BICS (corresponding to 6% of the population) and were nearly all within metro areas. The Can-BICS continuous metric had low correlation with bike-to-work rates (R = 0.29) and was more strongly correlated with sustainable-transportation-to-work rates (R = 0.56) and the Can-ALE metrics (R=0.62). These correlations were variable across cities. Interpretation: The Can-BICS metrics provide national research- and practice-ready measures of cycling infrastructure. The metrics complement existing measures of walking and transit environments (Can-ALE), collectively providing a cohesive set of active living measures. The datasets and code are publicly available, facilitating updates as new infrastructure is built.


Subject(s)
Bicycling , Environment Design , Humans , Canada , Transportation , Walking , Policy , Residence Characteristics
14.
CMAJ Open ; 10(3): E807-E817, 2022.
Article in English | MEDLINE | ID: covidwho-2090865

ABSTRACT

BACKGROUND: The role of remdesivir in the treatment of hospitalized patients with COVID-19 remains ill-defined. We conducted a cost-effectiveness analysis alongside the Canadian Treatments for COVID-19 (CATCO) open-label, randomized clinical trial evaluating remdesivir. METHODS: Patients with COVID-19 in Canadian hospitals from Aug. 14, 2020, to Apr. 1, 2021, were randomly assigned to receive remdesivir plus usual care versus usual care alone. Taking a public health care payer's perspective, we collected in-hospital outcomes and health care resource utilization alongside estimated unit costs in 2020 Canadian dollars over a time horizon from randomization to hospital discharge or death. Data from 1281 adults admitted to 52 hospitals in 6 Canadian provinces were analyzed. RESULTS: The total mean cost per patient was $37 918 (standard deviation [SD] $42 413; 95% confidence interval [CI] $34 617 to $41 220) for patients randomly assigned to the remdesivir group and $38 026 (SD $46 021; 95% CI $34 480 to $41 573) for patients receiving usual care (incremental cost -$108 [95% CI -$4953 to $4737], p > 0.9). The difference in proportions of in-hospital deaths between remdesivir and usual care groups was -3.9% (18.7% v. 22.6%, 95% CI -8.3% to 1.0%, p = 0.09). The difference in proportions of incident invasive mechanical ventilation events between groups was -7.0% (8.0% v. 15.0%, 95% CI -10.6% to -3.4%, p = 0.006), whereas the difference in proportions of total mechanical ventilation events between groups was -5.7% (16.4% v. 22.1%, 95% CI -10.0% to -1.4%, p = 0.01). Remdesivir was the dominant intervention (but only marginally less costly, with mildly lower mortality) with an incalculable incremental cost effectiveness ratio; we report results of incremental costs and incremental effects separately. For willingness-to-pay thresholds of $0, $20 000, $50 000 and $100 000 per death averted, a strategy using remdesivir was cost-effective in 60%, 67%, 74% and 79% of simulations, respectively. The remdesivir costs were the fifth highest cost driver, offset by shorter lengths of stay and less mechanical ventilation. INTERPRETATION: From a health care payer perspective, treating patients hospitalized with COVID-19 with remdesivir and usual care appears to be preferrable to treating with usual care alone, albeit with marginal incremental cost and small clinical effects. The added cost of remdesivir was offset by shorter lengths of stay in the intensive care unit and less need for ventilation. STUDY REGISTRATION: ClinicalTrials. gov, no. NCT04330690.


Subject(s)
COVID-19 , Adenosine Monophosphate/analogs & derivatives , Adult , Alanine/analogs & derivatives , COVID-19/drug therapy , Canada , Cost-Benefit Analysis , Humans
15.
CMAJ Open ; 10(4): E922-E929, 2022.
Article in English | MEDLINE | ID: covidwho-2090864

ABSTRACT

BACKGROUND: Maximizing uptake of SARS-CoV-2 vaccines among people in prison is essential in mitigating future outbreaks. We aimed to determine factors associated with willingness to receive SARS-CoV-2 vaccination before vaccine availability. METHODS: We chose 3 Canadian federal prisons based on their low uptake of influenza vaccines in 2019-2020. Participants completed a self-administered questionnaire on knowledge, attitude and beliefs toward vaccines. The primary outcome was participant willingness to receive a SARS-CoV-2 vaccine, measured using a 5-point Likert scale to the question, "If a safe and effective COVID-19 vaccine becomes available in prison, how likely are you to get vaccinated?" We calculated the association of independent variables (age, ethnicity, chronic health conditions, 2019-2020 influenza vaccine uptake and prison security level), identified a priori, with vaccine willingness using logistic regression and crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: We recruited 240 participants from Mar. 31 to Apr. 19, 2021 (median age 46 years; 19.2% female, 25.8% Indigenous). Of these, 178 (74.2%) were very willing to receive a SARS-CoV-2 vaccine. Participants who received the 2019-2020 influenza vaccine (adjusted OR 5.20, 95% CI 2.43-12.00) had higher odds of vaccine willingness than those who did not; those who self-identified as Indigenous (adjusted OR 0.27, 95% CI 0.11-0.60) and in medium- or maximum-security prisons (adjusted OR 0.36, 95% CI 0.12-0.92) had lower odds of vaccine willingness than those who identified as white or those in minimum-security prisons, respectively. INTERPRETATION: Most participants were very willing to receive vaccination against SARS-CoV-2 before vaccine roll-out. Vaccine promotion campaigns should target groups with low vaccine willingness (i.e., those who have declined influenza vaccine, identify as Indigenous or reside in high-security prisons).


Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , Prisoners , Humans , Female , Middle Aged , Male , COVID-19 Vaccines/therapeutic use , Influenza Vaccines/therapeutic use , Prisons , Cross-Sectional Studies , Influenza, Human/epidemiology , Influenza, Human/prevention & control , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/prevention & control , Canada/epidemiology
16.
Int J Environ Res Public Health ; 19(21)2022 Oct 27.
Article in English | MEDLINE | ID: covidwho-2090143

ABSTRACT

Few studies have examined social media and technology use during the COVID-19 pandemic in Canada. Therefore, the main research question and objective of this study was to examine similarities and differences in the influences of mobile technology and social media use on Canadians among different age groups and across gender during the COVID-19 pandemic. From June through October 2021, 204 persons completed a 72-item online survey. Survey questions encompassed COVID-19 pandemic experiences and technology use. Standardized measures including the Psychological Wellbeing measure, eHeals, and the UCLA V3 Loneliness scale were collected to examine the psychological influences of the COVID-19 pandemic. Findings showed that males under 50 years were most likely to self-isolate compared to the other demographic results of the study. Males reported using technology less than females but were more likely to report using technology to share information regarding COVID-19. Respondents under 50 years were also more likely to use smartphones/mobile phones as their most used mobile technology device, whereas respondents over 50 were more split between smartphones/mobile phones and computers/tablets as their most used device. Males scored higher on the UCLA loneliness scale and lower on the Psychological Wellbeing sub-scores compared to females. Further research should explore additional demographics in relation to broader aspects of digital skills across different age groups.


Subject(s)
COVID-19 , Social Media , Male , Female , Humans , COVID-19/epidemiology , Pandemics , Canada/epidemiology , Loneliness/psychology , Technology
17.
Int J Environ Res Public Health ; 19(21)2022 Oct 25.
Article in English | MEDLINE | ID: covidwho-2090125

ABSTRACT

The context of the COVID-19 pandemic imposed unprecedented restrictions. Within Canada, which is among the most stringent countries in terms of sanitary rules, Québec was among the provinces that imposed the strictest sanitary measures. The impacts of some measures were felt the most among athletes since they made it difficult, if not impossible, to practice their sports. This article therefore aimed to (1) evaluate the impact of the pandemic on the athletes' overall level of physical activity, (2) look at the relationship between overall level of physical activity and the level of psychological well-being and (3) analyze post-pandemic physical activity intentions. For this purpose, an online survey was conducted among 1456 athletes aged 3 to 61 years old. The results of this study show that the limitations imposed during the pandemic led to half of athletes decreasing their overall level of physical activity, leading to a deterioration in their psychological well-being (F(2.1438) = 54.707, p < 0.001). The current research provided further evidence that it is essential to implement strategies that favor practicing physical activities in a pandemic context. Furthermore, since almost all individuals who increased their practice of wheeled sports during the pandemic intend to continue after the pandemic, this is a great opportunity to promote active transportation among athletes by ensuring that the perception of the benefits associated with it does not decrease with time.


Subject(s)
COVID-19 , Humans , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , COVID-19/epidemiology , Pandemics/prevention & control , Quebec/epidemiology , Athletes/psychology , Canada , Exercise
18.
CMAJ ; 194(14): E513-E523, 2022 04 11.
Article in English | MEDLINE | ID: covidwho-2089467

ABSTRACT

BACKGROUND: SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS: We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement. RESULTS: Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13-17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6-12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 µg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI -0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%). INTERPRETATION: We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.


Subject(s)
COVID-19 , Connective Tissue Diseases , COVID-19/complications , COVID-19/epidemiology , Canada/epidemiology , Child , Child, Preschool , Cohort Studies , Ferritins , Humans , Male , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
19.
PLoS One ; 17(10): e0275774, 2022.
Article in English | MEDLINE | ID: covidwho-2089416

ABSTRACT

BACKGROUND: Post-traumatic stress disorder (PTSD) remains a significant treatment challenge among Canadian veterans. Currently accessible pharmacological and non-pharmacological interventions for PTSD often do not lead to resolution of PTSD as a categorical diagnosis and have significant non-response rates. Sudarshan Kriya Yoga (SKY), a complementary and integrative health (CIH) intervention, can improve symptoms of PTSD. In response to the COVID-19 pandemic, this intervention has pivoted to virtual delivery and may be reaching new sets of participants who face multiple barriers to care. OBJECTIVE: To evaluate the implementation and effectiveness of virtually delivered Sudarshan Kriya Yoga (SKY) on decreasing PTSD symptom severity, symptoms of depression, anxiety, and pain, and improving quality of life in Canadian veterans affected by PTSD. METHODS AND ANALYSIS: Using a mixed-methods approach guided by the RE-AIM framework, we will conduct a hybrid type II effectiveness and implementation study of virtually delivered Sudarshan Kriya Yoga (SKY) for Canadian veterans. Effectiveness will be evaluated by comparing virtually delivered SKY to a waitlist control in a single-blinded (investigator and data analyst) randomized controlled trial (RCT). Change in PTSD symptoms (PCL-5) is the primary outcome and quality of life (SF-36), symptoms of depression (PHQ-9), anxiety (GAD-7), and pain (BPI) are secondary outcomes. The SKY intervention will be conducted over a 6-week period with assessments at baseline, 6-weeks, 12-weeks, and 30 weeks. The reach, effectiveness, adoption, implementation, and maintenance of the intervention will be evaluated through one-on-one semi-structured interviews with RCT participants, SKY instructors, health professionals, and administrators that work with veterans. DISCUSSION: This is the first investigation of the virtual delivery of SKY for PTSD in veterans and aims to determine if the intervention is effective and implementable at scale.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Veterans , Yoga , Humans , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/therapy , COVID-19/epidemiology , Canada/epidemiology , Pain , Randomized Controlled Trials as Topic
20.
Sci Rep ; 12(1): 17817, 2022 Oct 24.
Article in English | MEDLINE | ID: covidwho-2087284

ABSTRACT

The purposes of our study are to map high-risk areas in Canada as well as quantifying the effects of vaccination intervention and socio-demographic factors on the transmission rates of infection, recovery, and death related to COVID-19. The data of this research included weekly number of COVID­19 cases, recovered, and dead individuals from 2020 through 2021 in Canada at health region and provincial levels. These data were associated with cumulative rates of partial and full vaccination and socio-demographic factors. We applied the spatio-temporal Susceptible-Exposed-Infected-Removed (SEIR), and Susceptible-Exposed-Infected-Removed-Vaccinated (SEIRV) models. The results indicated the partial vaccination rate has a greater effect compared with full vaccination rate on decreasing the rate of infectious cases (risk ratio (RR) = 0.18; 95%CrI: 0.16-0.2; RR = 0.60; 95%CrI: 0.55-0.65, respectively) and increasing the rate of recovered cases (RR = 1.39; 95%CrI: 1.28-1.51; RR = 1.21; 95%CrI: 1.23-1.29, respectively). However, for mortality risk reduction, only increasing full vaccination rate was significantly associated (RR = 0.09; 95%CrI: 0.05-0.14). In addition, our results showed that regions with higher rates of elderly and aboriginal individuals, higher population density, and lower socioeconomic status (SES) contribute more to the risk of infection transmission. Rates of elderly and aboriginal individuals and SES of regions were significantly associated with recovery rate. However, elderly individuals rate of regions was only a significant predictor of mortality risk. Based on the results, protection against mild and severe COVID-19 infection after the primary vaccination series decreased.


Subject(s)
COVID-19 , Aged , Humans , Canada/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Vaccination , Vaccination Coverage , Spatio-Temporal Analysis
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